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What's an excess...and how does it work?

We get it. Sometimes, private health insurance can be confusing.

But at RT Health, we don’t want it to be that way. We want you to have the information you need to make informed decisions about your health cover and your care – when you need it!

That’s why we use our Stay Well blog to provide more insight for our members.

Useful, easy-to-read-and easy-to-understand information that’s always on our website if you need to come back to it.

So, what’s an excess?

An excess is the amount you’ll pay upfront (out of your own pocket) before you’re admitted to hospital for planned treatment.

Generally, the higher your excess, the lower your premiums will be (and vice versa).

Just like with your car or home insurance, an excess is the amount you contribute to the expense of your hospital treatment.

Choosing a Hospital cover with an excess is a way to reduce the cost of your cover, without reducing the level of cover you have.

You’d have chosen your excess level when you first joined RT Health (on a hospital cover). Or, you can change it to suit your needs at any time throughout your membership (but subject to waiting periods if you lower your excess).

You don’t have to pay any excess on benefits and services covered by Extras and Ambulance Only covers.

When do I pay an excess? How often?

You’ll pay an excess if you (or someone on your policy), go to hospital. This is paid directly to the hospital (they’ll let you know when you need to pay it).

You’ll only need to pay one hospital excess amount per person per calendar year.  Also, you won’t pay hospital excess for dependent children (under the age of 22).

Depending on your level of cover, you won’t pay an excess (or you’ll only pay a reduced excess) on same-day hospital admissions (when you don’t stay overnight at hospital).

If your Hospital cover does have a same-day admission excess, and you have multiple day admissions in a calendar year, you’ll only pay up to the maximum of your full hospital excess amount, no matter how many admissions you have.

If you have our Gold Optimum Hospital or Gold Ultimate Hospital cover, there’s no excess (for anyone on your membership) for day surgery admissions. For those on RT Health’s Silver Plus Advantage Hospital, Silver Plus Assure Hospital, Bronze Plus Classic Hospital and Bronze Plus Everyday Hospital covers, your excess for day surgery is $100 per admission (capped at your full excess amount).

To find out more about your excess, take a look at your Cover Guides, or give us a call.

How do you pay your excess? 

If you’re going to hospital either overnight or for a same-day admission, hospital staff will ask you for your Hospital cover details and then contact us to confirm: 

- that you’re covered for the procedure you’re booked in for

- that your cover is paid up to date 

- the amount of excess on your cover. 

If you have an excess to pay, we’ll confirm the amount and they’ll let you know when you need to pay it. You’ll pay your excess directly to the hospital.

Your excess is an out-of-pocket expense and can’t be claimed back from the fund.

It’s your choice. Changing your excess.

You can change your excess amount at any time you like. Choosing a higher level of excess may make your membership premiums cheaper.

But, it pays to know that lowering your excess (for example, from a $700 excess to a $350 excess) counts as an upgrade to your cover. That means you may have to pay your previous higher excess until you’ve served the waiting period for the new, lower level excess.

No excess for the kids!

Good news for families!

No matter which of our RT Health hospital covers you have, you'll never pay any excess for dependents on your membership under the age of 22.

Check your excess before you go to hospital

If you have a hospital stay coming up, we’re here to help! Just give us a call and we can answer any questions you may have, including confirming the amount of your excess and that you’re covered for the procedure you need.

We're here to help

Our Member Care team is here to help you every step of the way.

Just give them a call on 1300 886 123 or send them an email to help@rthealthfund.com.au