Health insurance tiers: Gold, Silver, Bronze & Basic

New health insurance tiers aim to make health insurance simpler.

The new classification system aims to provide consumers with a simplified tier structure for policies: Gold, Silver, Bronze and Basic.

The four-tiered system has already gone begun to roll out and will be fully in force by April 2020. It will eventually affect all of the existing 70,000 private health insurance policies in Australia.

You can now switch to or buy a basic, bronze, silver or gold policy from a number of insurers. However, health funds have until 2020 to roll out the new products - so for some providers, you may have to wait a little longer.

Compare Bronze, Silver and Gold Health Insurance

Use our free tool to compare quotes from over 20 Australian health funds - you can use the filters to select Basic, Bronze, Silver or Gold on your results page.

Health insurance tiers and other updates in 3 minutes

Which tier is right for you?

It can be tricky to know whether you're going for the right option, and you don't always know what treatments you're going to use in the future. We've taken a look at some of the main inclusions to get a general guide for what could be right, when. You can expect the tiers to cover the following procedures:

Picture not described: Basic-min.png Image: Getty

What does the Basic tier health insurance cover?

The Basic tier of cover only entitles consumers to three treatments as a minimum requirement. These three must be offered on a restricted basis:

  • Rehabilitation
  • Hospital psychiatric services
  • Palliative care

Basic tier hospital is great for those:

  • Trying to avoid the medicare levy surcharge and reduce your tax
  • Who live in an area without private hospitals

If this doesn't sound like you then you might want to consider a higher tiered policy.

Picture not described: Copy-of-Bronze-min.png Image: Getty

What does the Bronze tier health insurance cover?

On the Bronze tier, consumers can expect the same minimum requirements as the Basic tier. Insurers are required to offer rehabilitation, hospital psychiatric services and palliative care on a restricted basis. In addition to what is covered by Basic policies, Bronze policies include cover for the following:

  • Brain
  • Eye
  • Ear, nose and throat
  • Tonsils, adenoids and grommets
  • Bone, joint and muscle
  • Joint reconstructions
  • Kidney and bladder
  • Male reproductive system
  • Digestive system
  • Hernia and appendix
  • Gastrointestinal endoscopy
  • Miscarriage and termination of pregnancy
  • Chemotherapy, radiotherapy and immunotherapy for cancer
  • Skin
  • Breast surgery (medically necessary)
  • Diabetes

Who is it for?

Bronze health insurance policies provide cover for services in 18 clinical categories. The reforms mean that two groups of people really benefit from the new tiered system and especially for bronze cover and that is: women and young people.

As part of the reforms, a range of services for women will be available on the bronze tier including:

  • Breast and ovarian cancer treatment
  • Breast reconstruction
  • Gynaecological services

If you're young and in the market for a hospital insurance policy that provides you with more than just protection from tax, you might look at a bronze policy. It provides you with cover for common treatments categories such as:

  • Ear, nose and throat
  • Tonsils, adenoids and grommets
  • Pain management

One of the major benefits to come with the health insurance reforms is that people under 30 can get discounts on their hospital policies of up to 10% per year.

See more on Bronze health insurance

Picture not described: Silver-min.png Image: Getty

What does the Silver tier health insurance cover?

On the Silver tier, consumers can expect the same minimum requirements as the Bronze tier. The Silver tier must also offer rehabilitation, hospital psychiatric services and palliative care on a restricted basis just like the Basic and Bronze tiers. In addition to the services that the Basic and Bronze policies cover, Silver policies also include cover for the following:

  • Heart, lung and vascular system
  • Blood
  • Back, neck and spine
  • Plastic and reconstructive surgery (medically necessary)
  • Dental surgery
  • Podiatric surgery (provided by an accredited podiatric surgeon)
  • Implantation of hearing devices

Who is it for?

Silver hospital policies are great for those looking for good but not "the best" health insurance. Silver policies are particularly good for those who don't intend on starting a family and older Aussies.

If you're not planning on having children in the next 12 months, then a silver policy might be right for you, as it provides cover for a range of services without the added expenses that come with cover for assisted reproductive procedures, pregnancy and birth.

If you're getting older and want the peace of mind knowing that you're covered for a range of benefits that become more important the older you get, including:

  • Back, neck and spine
  • Blood
  • Heart and vascular system
  • Implantation of hearing device
  • Lung and chest
  • Podiatric surgery (provided by a registered podiatric surgeon)

See more on Silver health insurance

Picture not described: Gold-min.png Image: Getty

What does the Gold tier health insurance cover?

The Gold tier is the only tier that must offer full cover for rehabilitation, hospital psychiatric services and palliative care without restrictions. In addition to the services that the three previous tiers cover, the Gold tier provides coverage for the following:

  • Cataracts
  • Joint replacement and spinal fusion
  • Dialysis for kidney disease
  • Pregnancy, birth and neonates
  • Assisted reproductive services
  • Weight loss surgery
  • Insulin pumps
  • Chronic pain
  • Sleep studies

Who is it for?

There are three main groups of people that can benefit from gold hospital cover and that is those starting a family, people with chronic illnesses and older Australians.

If you and your partner are planning on starting a family in the near future you might want to consider a gold hospital policy. The gold tier provides cover for pregnancy related benefits such as:

  • Birth and pregnancy
  • Assisted reproductive services such as in-vitro fertilisation (IVF)

But before you run out and buy a gold policy you should know that there is a 12-month waiting period on these services. So if there's already a bun in the oven, you won't be covered.

It's also worth pointing out that only the person who is going to have the child needs cover for pregnancy, which means unless the dads out there can benefit from other features on a gold policy, you might be better off looking at a lower tier of hospital cover for dad rather than getting a couples policy at the same tier.

Gold hospital provides benefits for the treatment for a range of chronic conditions including:

  • Dialysis for chronic kidney failure
  • Insulin pumps
  • Pain management with device
  • Sleep studies
  • Weight loss surgery

If you're getting a little long in the tooth and are in the market for top tier hospital cover, then gold might be for you. Gold hospital provides cover for the treatment of a range of degenerative conditions, many of which are associated with aging. This not only includes the chronic conditions listed above but also benefits for:

  • Cataracts
  • Joint replacements

This is not to say that gold is right for all older Australians, as silver hospital also provides a range of helpful benefits.

What are Plus [+] policies?

For a policy to fall into one of these tiers, they must meet the minimum standards of that tier. However, health funds can offer policies that provide cover above those minimum standards and as such will be referred to as plus [+] policies. For example, pregnancy is only required of gold tier policies but if a fund wants to offer that type of cover on its silver tier policy, the policy would be referred to as silver plus [+].

See more on Gold health insurance

What else is changing with these reforms?

The major beneficiaries of these reforms will be Australian women, who for the first time will benefit from gynaecological services, ovarian and breast cancer treatment and breast reconstruction under the Silver and Bronze categories. These reforms aim to amend the "disparity in the past between coverage of men and women for different types of cancers."

Why is Australia getting a tiered health insurance?

The government made these changes so that consumers have a "no surprise" experience with their health insurance, meaning that consumers know exactly what they are in for at each tier of cover.

This will mean you can go down a list, check off items you do and don't want cover for and make a decision. Additionally, standardising the terms for the treatments will cut out the guesswork consumers have to do when comparing policies, making it easier to compare apples with apples. All the info will be provided on a single document.

While the government is mandating that policies be split into tiers, there will be some wiggle room for health insurers who choose to offer coverage beyond the minimum mandated standards set out by the legislation. This means that in the lower tiers of cover, the Silver, Bronze and Basic tiers, insurers will be able to offer a premium form of that cover with a Plus (+).

What can I expect to pay?

We checked the averages across 10 funds here in Australia. The prices below are based on a single policy, in Sydney NSW for Hospital Cover at each tier level.

Hospital Tier Average
Basic $79.86
Bronze $90.87
Silver $126.81
Gold $170.90

Overview of hospital treatments in Basic, Bronze, Silver and Gold

Hospital treatments by clinical category Basic Bronze Silver Gold
Rehabilitation
R
R
R
Hospital psychiatric services
R
R
R
Palliative care
R
R
R
Brain and nervous system RCP
Eye (not cataracts) RCP
Ear, nose and throat RCP
Tonsils, adenoids and grommets RCP
Bone, joint and muscle RCP
Joint reconstructions RCP
Kidney and bladder RCP
Male reproductive system RCP
Digestive system RCP
Hernia and appendix RCP
Gastrointestinal endoscopy RCP
Gynaecology RCP
Miscarriage and termination of pregnancy RCP
Chemotherapy, radiotherapy and immunotherapy for cancer RCP
Pain management RCP
Skin RCP
Breast surgery (medically necessary) RCP
Diabetes management (excluding insulin pumps) RCP
Heart and vascular system RCP
Lung and chest RCP
Blood RCP
Back, neck and spine RCP
Plastic and reconstructive surgery (medically necessary) RCP
Dental surgery RCP
Podiatric surgery (provided by a registered podiatric surgeon) RCP
Implantation of hearing devices RCP
Cataracts RCP
Joint replacements RCP
Dialysis for chronic kidney failure RCP
Pregnancy and birth RCP
Assisted reproductive services RCP
Weight loss surgery RCP
Insulin pumps RCP
Pain management with device RCP
Sleep studies RCP

Source: http://www.health.gov.au/

Latest health headlines

Picture: Shutterstock

Was this content helpful to you? No  Yes

Related Posts

You might like these...

Ask an Expert

You are about to post a question on finder.com.au:

  • Do not enter personal information (eg. surname, phone number, bank details) as your question will be made public
  • finder.com.au is a financial comparison and information service, not a bank or product provider
  • We cannot provide you with personal advice or recommendations
  • Your answer might already be waiting – check previous questions below to see if yours has already been asked

Finder only provides general advice and factual information, so consider your own circumstances, or seek advice before you decide to act on our content. By submitting a question, you're accepting our Terms of Use, Disclaimer & Privacy Policy and Privacy & Cookies Policy.
Ask a question
Go to site