Silver tier hospital insurance

Silver cover: What is covered by the second-highest tier of hospital insurance policies?

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As part of new government legislation designed to help make health insurance easier to understand and compare, hospital insurance policies will now be sorted into four tiers: Gold, Silver, Bronze and Basic.

What is Silver tier hospital cover?

Silver is the second-highest tier available for those wanting hospital cover and provides members with unrestricted access to 26 clinical categories, along with providing cover on a restricted basis for a further 3 treatments.

Health funds can also offer a Silver Plus [+] tier, which indicates the policy provides above the minimum requirements for the Silver tier.

Fund Policy Name Cost per month Apply
ahm logo Starter Silver $105.65 Go to Site
nib helath insurance logo Silver Hospital $109.24 Go to Site
Medibank logo Silver Everyday $116.10 Go to Site
Silver Everyday Hospital Plus $116.61 Go to Site
Silver Plus Hospital $145.64

Quotes are based on a single individual with less than $90,000 income, $500 excess and living in Sydney.

Compare hospital cover in Australia

Use this free tool to see more options and quotes from Australian health funds. You can also filter by tier level (Bronze, Silver or Gold) on the results screen.

What does the Silver hospital tier cover?

Silver health insurance covers about 68% of the clinical treatment categories that are offered by a Gold tier hospital policy. Silver tier hospital cover includes:

  • 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

As previously mentioned, Silver tier cover also offers cover for certain benefits on a restricted basis. These clinical categories are:

What is silver plus (+)?

With the roll out of the health insurance reforms, health funds have the option of offering a "Plus [+]" option for any policy outside of the gold tier, in this case a Silver Plus [+] policy. All this means is a policy with Plus [+] provides cover that is above the minimum requirements of the silver tier. For example, CUA offer a Silver Plus policy that in addition to the minimum benefits required for a Silver tier policy, Premium Hospital Non-Obstetrics (Silver Plus) offers benefits for:

  • Cataracts
  • Dialysis for chronic kidney failure
  • Insulin pumps
  • Joint replacements
  • Pain management with device
  • Sleep studies

Who needs Silver hospital insurance?

If you had a relatively comprehensive policy before the changes, you may find yourself with a Silver tier policy following the reforms. Those who'll see the most benefit from a Silver policy include:

Those not looking to start a family

If you're not planning to start a family in the near future but still want reasonable coverage, then a Silver policy might be a good choice for you. It provides you with a range of benefits but doesn't provide cover for clinical categories you're not going to use such as pregnancy and birth and assisted reproductive services.

Older Australians

Silver tier cover provides a range of benefits that are suitable for older Australians including:

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

Other additional cover options

If you're looking for a step up in cover from Bronze, Silver offers cover for an additional eight clinical categories. In addition to those benefits listed above, you'll also have cover for:

  • Plastic and reconstructive surgery (medically necessary)
  • Dental surgery

When are these changes happening?

Depending on who you have your private health insurance with, it may have already happened. The four tiers for hospital insurance came into effect on 1 April 2019. The aim is to have all health funds adopting these categories by 1 April 2020, but some have already started issuing Gold, Silver, Bronze and Basic policies.

Read more:

Picture: Unsplash

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