Hernia and Appendix

What is covered under Hernia and Appendix?

Hospital Cover for Hernia and Appendix includes hospital treatment to investigate and treat appendicitis or a hernia.

Examples include:

• hiatus hernia
• congenital hernia of the diaphragm (the major muscle over your lungs)
• removing the appendix.

This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS).

Some treatments you might expect to be in the Hernia and Appendix clinical category are in other clinical categories. For example, treatments for digestive conditions like gallstones are under Digestive System.

Which Hospital Cover tiers include Hernia and Appendix?

What does it mean if cover is ‘optional’?

‘Optional’ means that the Australian Government allows insurers to choose whether or not to cover the clinical category under that Hospital Cover tier.

What does ‘restricted cover’ mean? 

Restricted cover means the insurer pays only limited benefits. 

If insurers offer cover for Hernia and Appendix under Basic Hospital Cover, they can do so on a ‘restricted’ basis. If you are admitted as a private patient in a private hospital for treatments under this clinical category, you will face considerable out-of-pocket costs.

Always check with your insurer before agreeing to be treated as a private patient in a private hospital if you have restricted cover for Hernia and Appendix. 

Does Medicare cover Hernia and Appendix?

Yes. Medicare includes all treatments under the Hernia and Appendix clinical category.

If there is an MBS item number for the treatment, Medicare covers it. 

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