In Australia, private hospital insurance is categorised using a 4-tier system. Every single hospital policy will either be classed as basic, bronze, silver or gold. The policies become more comprehensive as they go up through the tiers. You're covered for more private hospital treatments, but you'll also pay more money.
Gold-tier hospital insurance covers all 38 treatments outline by the Australian government. This includes joint replacements, pregnancy, insulin pumps and other treatments, as well as all services covered by silver-tier policies.
Average premium:
$219.35
a month for a single policy.*
Lowest premium:
$162.44
a month for a single policy.*
Silver-tier hospital insurance covers at least 26 treatments outlined by the Australian government. This includes treatments such as dental, lung and chest and podiatric surgeries, as well as all services covered by bronze-tier policies.
Average cost:
$148.21
a month for a single policy.*
Lowest premium:
$102.5
a month for a single policy.*
Bronze-tier hospital insurance covers at least 18 treatments outlined by the Australian government. This includes joint reconstructions, ear, nose and throat as well as gynaecology treatments, plus all services covered by basic-tier policies.
Average cost:
$98.73
a month for a single policy.*
Lowest premium:
$86.34
a month for a single policy.*
Basic-tier hospital insurance isn't required to fully cover any treatments outlined by the Australian government, but it needs to have restricted cover for rehabilitation, hospital psychiatric services and palliative care. Basic cover is primarily used to avoid the Medicare levy surcharge (MLS) and lifetime health cover (LHC) loading.
Average cost:
$84.13
a month for a single policy.*
Lowest premium:
$76.9
a month for a single policy.*
*Average prices are updated monthly, in line with Finder's database of health insurance policies. Prices are based on a single individual with less than $93,000 income and living in Sydney with a $750 excess.
A policy must meet some minimum requirements to fall into a specific tier. If it doesn't meet those requirements, it'll be categorised in a lower tier. Those requirements are the same across the entire industry so every insurer is working from the same system.
That means every silver policy will cover the same clinical categories regardless of which insurer you go with. The same goes for basic, bronze and gold. The table below lays out the minimum requirements for each tier. "R" means insurers are allowed to offer cover for this clinical category on a restricted basis or with limited benefits.
| 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 | ||||
| Eye (not cataracts) | ||||
| 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 | ||||
| Gynaecology | ||||
| Miscarriage and termination of pregnancy | ||||
| Chemotherapy, radiotherapy and immunotherapy for cancer | ||||
| Pain management | ||||
| Skin | ||||
| Breast surgery (medically necessary) | ||||
| Diabetes management (excluding insulin pumps) | ||||
| Heart and vascular system | ||||
| Lung and chest | ||||
| Blood | ||||
| Back, neck and spine | ||||
| Plastic and reconstructive surgery (medically necessary) | ||||
| Dental surgery | ||||
| Podiatric surgery (provided by a registered podiatric surgeon) | ||||
| Implantation of hearing devices | ||||
| Cataracts | ||||
| Joint replacements | ||||
| Dialysis for chronic kidney failure | ||||
| Pregnancy and birth | ||||
| Assisted reproductive services | ||||
| Weight loss surgery | ||||
| Insulin pumps | ||||
| Pain management with a device | ||||
| Sleep studies |
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A "plus" policy falls in between categories in that it has exceeded the minimum requirements of a tier but hasn't quite met the requirements of the tier above it. An example of a "silver plus" policy would be one that covers every silver treatment, but also covers pregnancy. The same goes for the other tiers.
No, most "plus" policies are different from one another. A "plus" tier means that a policy has met the minimum requirements of the core tier, but has offered some extra benefits too. While those minimum requirements will be the same, 2 plus policies could have different extras.
For example, a silver plus policy will have all the same core benefits available in a silver policy, plus cover for sleep studies and insulin pumps. On the other hand, a different silver plus policy will have all the same core benefits, plus cover for cataracts and joint replacements.
Always check the extras in a plus policy. They may be exactly what you're looking for, or something you know you'll never need.
| Response | 75+ yrs | 65-74 yrs | 55-64 yrs | 45-54 yrs | 35-44 yrs | 25-34 yrs | 18-24 yrs |
|---|---|---|---|---|---|---|---|
| Yes | 47.73% | 33.14% | 32.3% | 26.63% | 40.54% | 40.53% | 27.06% |
| No | 15.91% | 16.28% | 19.88% | 22.49% | 20% | 13.16% | 20% |
While the tier system wasn't made to match a particular policy to a particular type of person, some groups of people will likely benefit more from one tier than another. We've outlined some of those associations below.
Basic-tier hospital policies don't cover much. In fact, they are only required to offer restricted cover for 3 treatments. However, there are some other benefits to a basic hospital policy, including some tax implications. Here are a few groups of people who may benefit from basic coverage:
Bronze hospital insurance is more comprehensive than basic cover, but is still quite affordable. Bronze hospital policies cover a range of common treatment types, including joint reconstructions, bone, joint and muscle issues and hernia and appendix treatment. Here are a few groups of people who may benefit from bronze coverage:
Silver coverage is comprehensive, covering more complex treatments than bronze-tier policies. These include lung and chest, back, neck and spine and dental surgery, although dental surgery is often found on "bronze plus" policies. Here are a few groups of people who may benefit from silver coverage:
Gold hospital polices are the most comprehensive policies available in Australia, with coverage for all 38 clinical categories. Here are a few groups of people who may benefit from gold coverage:
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