Gold cover: The highest tier for hospital insurance policies.
As part of the range of reforms announced by the government at the end of 2017, Australia is getting a new system for categorising hospital treatment products to make comparing products easier for consumers.
Hospital products will now fall into one of four tiers: Gold, Silver, Bronze or Basic.
What is Gold hospital cover?
Gold tier hospital cover is the top level of hospital insurance and provides you with access to a range of services not covered by the other tiers. As part of the reforms, for a policy to carry the Gold tier classification, it must cover treatments in all 38 clinical categories, giving you unrestricted access to treatments in these categories.
A Gold policy gives unrestricted access for treatments as a private patient in a private facility, a private patient in a public hospital or as a private patient in a private day facility. These policies cover your accommodation and theatre costs up to the Medicare Benefits Schedule (MBS) limit.
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What is covered by Gold hospital policies?
As previously mentioned, Gold hospital policies will provide you with access to treatments that are grouped into 38 clinical categories. These categories are:
- Assisted reproductive services
- Back, neck and spine
- Blood
- Bone, joint and muscle
- Brain and nervous system
- Breast surgery (medically necessary)
- Cataracts
- Chemotherapy, radiotherapy and immunotherapy for cancer
- Dental surgery
- Diabetes management (excluding insulin pumps)
- Dialysis for chronic kidney failure
- Digestive system
- Ear, nose and throat
- Eye (not cataracts)
- Gastrointestinal endoscopy
- Gynaecology
- Heart and vascular system
- Hernia and appendix
- Hospital psychiatric services
- Implantation of hearing devices
- Insulin pumps
- Joint reconstructions
- Joint replacements
- Kidney and bladder
- Lung and chest
- Male reproductive system
- Miscarriage and termination of pregnancy
- Pain management
- Pain management with device
- Palliative care
- Plastic and reconstructive surgery (medically necessary)
- Podiatric surgery (provided by a registered podiatric surgeon)
- Pregnancy and birth
- Rehabilitation
- Skin
- Sleep studies
- Tonsils, adenoids and grommets
- Weight loss surgery
Policies that are in this tier offer cover for all treatments in the 38 clinical categories above and are not permitted to have any restrictions. However, co-payments may still be applicable depending on your policy.
Who needs Gold hospital insurance?
If you've had top hospital in the past then the Gold tier of hospital is the new equivalent. Those who benefit most from taking out a Gold tier policy are those who need access to any of the following treatments as they are not covered under any of the other tiers:
People starting a family
If you're starting a family and want to have access to a private room for your pregnancy you're going to want cover on the Gold tier. Gold tier covers both the pregnancy and birth but can also provide you with cover for assisted reproductive services (ART) such as in-vitro fertilisation (IVF). Benefits only available on Gold tier hospital include:
- Pregnancy and birth
- Assisted reproductive services
Older Australians
Unfortunately, getting older means you're more susceptible to certain conditions. Two common benefits that are especially helpful for seniors is cover for joint replacement and cover for cataracts surgery. Benefits only available on Gold tier hospital include:
- Cataracts
- Joint replacements
Other Gold tier coverage
Gold hospital cover also provides a range of services not covered by other tiers of hospital insurance. If you're looking into weight reduction procedures or have diabetes, then a Gold policy might be suitable. Benefits only available on Gold tier hospital include:
- Dialysis for chronic kidney failure
- Weight loss surgery
- Insulin pumps
- Pain management with device
- Sleep studies
When are these changes happening?
Depending on your insurer, they may have already happened. The product tiers will officially be introduced on 1 April 2019, with insurers having until 1 April 2020 to make sure all their products fall into these tiers.
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