What Does OSHC Cover in Australia 2026: GP, Hospital, Pharmacy and Ambulance

Overseas Student Health Cover (OSHC) is a mandatory health insurance policy that every international student on a Subclass 500 visa must hold. It is a visa condition — if your OSHC lapses, you are in breach of your visa. But while OSHC is non-negotiable, many students arrive in Australia without a clear understanding of what their policy actually covers, what it does not cover, and how much they will need to pay out of their own pocket when they need medical care.

This guide explains exactly what OSHC covers under the Australian Government’s OSHC Deed, the limits and exclusions you need to know about, and how the gap between the Medicare Benefits Schedule (MBS) fee and what doctors actually charge can leave you with unexpected bills. Understanding OSHC before you need to use it helps you avoid financial surprises and make informed decisions about your health care.

The OSHC Deed: Minimum Coverage Standards

OSHC is not a free-market insurance product — it is governed by a Deed between the Australian Government and each registered OSHC provider. The Deed sets out the minimum benefits every OSHC policy must provide. All six registered OSHC providers (ahm OSHC, Allianz Care Australia, Bupa, CBHS International Health, Medibank, and nib) must meet these minimum standards, though they may offer additional benefits, extras cover, or enhanced services to differentiate themselves.

The minimum coverage under the OSHC Deed includes four core areas: out-of-hospital medical services (GP and specialist consultations), in-hospital medical services (public and private hospital treatment), Pharmaceutical Benefits Scheme (PBS) prescription medications, and ambulance services. Let’s examine each in detail.

GP Visits: What OSHC Covers Outside Hospital

General Practitioner (GP) visits are the most common medical service international students use. OSHC covers 100% of the Medicare Benefits Schedule (MBS) fee for a standard GP consultation. For a standard Level B consultation (the most common type, lasting less than 20 minutes), the MBS fee is approximately $42.85 as of 2026. This means OSHC will pay $42.85 toward your GP visit.

However, many GP clinics in Australia charge above the MBS fee, a practice known as “private billing” or “mixed billing.” A GP in a major city might charge $80 to $100 for a standard consultation. If OSHC covers $42.85, you pay the remaining $37.15 to $57.15 as an out-of-pocket “gap” payment. The gap is not covered by OSHC.

Some GP clinics “bulk bill,” which means they accept the MBS fee as full payment and charge you nothing out of pocket. Bulk-billing clinics are more common in lower-income areas, university health services, and some suburban practices, though they have become less common in recent years as practice costs have risen. University health services on campus typically bulk bill for currently enrolled students, making them the most affordable option for routine GP visits.

Before booking an appointment, ask the receptionist whether the clinic bulk bills and whether there is a gap for your consultation type. For more information on choosing a provider with good network access, see our guide on how to compare OSHC providers.

Specialist Referrals

OSHC covers specialist consultations (dermatologists, cardiologists, orthopaedic surgeons, and other specialists) at 100% of the MBS fee, but only when you are referred by a GP. You cannot book a specialist directly and claim on OSHC without a referral. The MBS fee for an initial specialist consultation varies by specialty but typically ranges from $85 to $150, while the actual specialist charge often ranges from $180 to $350. Gaps of $100 to $200 are common.

Hospital Treatment: Public and Private

In-hospital coverage is the most important and expensive component of your OSHC policy. If you need to be admitted to hospital for surgery, a medical procedure, or an overnight stay, OSHC provides the following as a minimum.

For treatment in a public hospital as a shared-ward patient, OSHC covers the full cost of your accommodation in a shared ward and 100% of the MBS fees for the doctors who treat you (surgeons, anaesthetists, and other specialists). You will not receive a bill for the hospital bed. However, if the doctors charge above the MBS fee, you will have a gap to pay. In the public system, patients are treated by the doctors assigned to them; you do not choose your surgeon. Waiting times for non-urgent procedures (elective surgery) in public hospitals can be long — months, in some cases.

For treatment in a private hospital, OSHC covers the cost of accommodation but only up to the rate set in the provider’s agreement with that hospital. If your OSHC provider has a negotiated agreement with the hospital (a “hospital purchaser-provider agreement”), the hospital bed cost is usually fully covered. If there is no agreement, you may face a gap for the hospital accommodation. OSHC also covers 25% of the MBS fee for doctors’ services in a private hospital — this is a key difference from public hospital coverage, where 100% of the MBS fee is covered. The remaining 75% of the MBS fee, plus any amount the doctor charges above the MBS fee, is your out-of-pocket cost.

This is a complex area and the source of many unexpected bills for international students. Before any planned hospital admission — even for a minor day procedure — ask the hospital and your doctor for a written cost estimate that itemises the hospital accommodation fee, the surgeon’s fee, the anaesthetist’s fee, the MBS rebate for each, and your estimated out-of-pocket gap. Your OSHC provider can help you understand what will and will not be covered under your specific policy. Do not rely on verbal assurances alone.

PBS Pharmaceuticals

OSHC covers prescription medications that are listed on the Pharmaceutical Benefits Scheme (PBS). For each PBS-listed item, OSHC pays the cost above the PBS patient contribution (approximately $31.60 for general patients as of 2026), up to a maximum of $50 per item. The annual limit on OSHC pharmaceutical benefits is typically $300 per person per year for singles policies, or $600 per year for couples or family policies.

What this means in practice: if you are prescribed a PBS-listed antibiotic that costs $45, you pay the PBS contribution of $31.60, and OSHC covers the remaining $13.40. If you are prescribed a PBS-listed medication costing $90, you pay $31.60, and OSHC covers $50 (the maximum per item), leaving a gap of $8.40. If your total OSHC pharmaceutical claims in a calendar year reach $300 (for singles), you pay the full cost of any further prescriptions for the rest of the year.

Medications that are not listed on the PBS — including most over-the-counter medicines (paracetamol, antihistamines, cold and flu remedies), vitamins and supplements, some brand-name drugs, and medications not approved for PBS subsidy — are not covered by OSHC at all. You pay the full retail price.

Ambulance Services

OSHC covers emergency ambulance services that are medically necessary. This includes ambulance transport by road or air when you need emergency treatment and transport to a hospital. The coverage is typically unlimited for emergency ambulance — there is no annual cap.

However, the ambulance coverage has important limitations that vary by provider and by state. In most OSHC policies, ambulance cover applies only when the service is clinically necessary and you are transported for emergency treatment. Non-emergency patient transport (for example, being transferred between hospitals for a scheduled appointment) may not be covered.

Additionally, state ambulance services in Australia are not free — they charge for callouts. In Queensland and Tasmania, state government ambulance services are free to all residents, including international students. In all other states and territories (New South Wales, Victoria, South Australia, Western Australia, ACT, Northern Territory), ambulance services charge fees that can range from $400 for a standard road ambulance callout to several thousand dollars for an air ambulance or long-distance transport. OSHC covers these fees in an emergency.

It is important to note that OSHC covers emergency ambulance — not membership to the state ambulance service. If you call an ambulance for a non-emergency reason (for example, because you cannot get to a GP appointment by other means), your claim may be reviewed and potentially denied. Always call an ambulance in a genuine emergency; do not hesitate because of cost concerns.

What OSHC Does NOT Cover

Understanding OSHC’s exclusions is as important as understanding what it covers. The following services and treatments are generally excluded from OSHC unless you purchase an extras add-on policy.

Dental care — including check-ups, fillings, extractions, root canals, and orthodontics — is not covered by standard OSHC. Optometry and optical — eye tests, glasses, and contact lenses are not covered. Physiotherapy, chiropractic, and allied health services such as podiatry, dietetics, and psychology beyond the Medicare-funded sessions are not covered. Many OSHC providers offer an “extras” or “ancillary” cover package that you can purchase in addition to your standard OSHC policy to cover these services. Extras cover adds approximately $10 to $25 per month to your premium.

There are also medical exclusions that apply regardless of whether you have extras cover. Pre-existing conditions (a condition you had signs or symptoms of during the six months before you joined the OSHC policy) are subject to a 12-month waiting period. You must hold OSHC continuously for 12 months before you can claim for treatment related to a pre-existing condition. After 12 months, the condition is covered as normal.

Pregnancy and childbirth are subject to a 12-month waiting period. If you are already pregnant when you join OSHC, or if you become pregnant within the first three months of your policy, the pregnancy and birth will not be covered. After 12 months of continuous OSHC, pregnancy-related services are covered under the standard in-hospital benefits described above.

Assisted reproductive services (IVF) and cosmetic surgery that is not medically necessary are not covered by OSHC. Treatments that are not clinically necessary or that are experimental are also excluded.

Gap Payments: How to Avoid Surprises

The “gap” — the difference between what the doctor charges and what OSHC (through the MBS) pays — is the single biggest source of unexpected medical bills for international students. Gaps are most common with specialist consultations, private hospital admissions, and diagnostic tests (pathology and imaging).

You can minimise or avoid gap payments by using bulk-billing GPs whenever possible, asking about costs before any specialist appointment or hospital admission, using public hospitals as a public patient (no hospital accommodation gap), and choosing doctors who participate in your OSHC provider’s gap cover or direct-billing network. Some OSHC providers, notably Bupa and Medibank, have established networks of “Members First” or “GapCover” doctors who agree to charge no gap or a known gap for services. Before booking a specialist, ask the receptionist if the doctor participates in your provider’s gap arrangement.

University health services are almost always the most affordable entry point for medical care. They typically bulk bill, understand the international student context, and can refer you to specialists who are price-transparent.

Waiting Periods

OSHC policies apply waiting periods for certain benefits, designed to prevent people from joining, claiming for an expensive treatment, and then cancelling. The standard waiting periods are:

• General treatment (GP visits, specialist consultations, pharmacy): no waiting period — covered from the day your policy starts.
• Pre-existing conditions: 12-month waiting period.
• Pregnancy and childbirth: 12-month waiting period.
• Psychiatric care and rehabilitation: 2-month waiting period for some policies.

If you switch OSHC providers, the waiting periods you have already served with your previous provider are generally recognised by the new provider, provided you transfer directly with no gap in cover. Contact both providers to arrange a transfer and request a clearance certificate that shows your join date and waiting periods served.

For an overview of how OSHC compares to health cover for other visa types, read our guide on the difference between OSHC and OVHC. To find the best-value policy for your circumstances, use the OSHC Cost calculator to compare premiums across all registered providers.

Disclaimer: This is general information only and does not constitute insurance advice, medical advice, or visa advice. Policy terms, coverage, and premiums vary by provider and change over time. Always check the current Product Disclosure Statement (PDS) from your OSHC provider and consult official Home Affairs requirements for your visa.