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Silver tier hospital insurance

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

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 will provide members with unrestricted access to 26 clinical categories, along with providing cover on a restricted basis for a further 3 treatments.

However, health funds will be able to offer a Silver Plus [+], which indicates the policy provides above the minimum requirements for the tier.

Compare hospital cover in Australia

What does the Silver hospital tier cover?

Silver health insurance will cover about 68% of the procedures that are offered by a Gold tier hospital policy. Silver tier hospital cover will include:

  • 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 may offer cover for certain benefits on a restricted basis. These clinical categories are:

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 come into effect on 1 April 2019 with the aim of all health funds adopting these categories by 1 April 2020.

Picture: Unsplash

Richard Laycock

Richard is the Insurance Editor at Finder, wrangling insurance product disclosure statements for the better part of five years. His musings on insurance can be found the web including on Yahoo Finance, Travel Weekly and Dynamic Business. When he’s not helping Aussies make sense of insurance fine print, he is testing the quality of cocktails in his new found home of New York. Richard studied Media at Macquarie University and The Missouri School of Journalism and has a Tier 1 certification in General Advice for Life Insurance.

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