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4 Health Insurance Product Tiers Explained: Gold, Silver, Bronze Health Insurance

Megan Fraser Updated: 10 June 2022
Types of Health Insurance

Thinking about taking out private health insurance? You’re not alone. Many Australians are concerned about what would happen if they had to go to the hospital and don’t have hospital cover. However, the world of health insurance can be complicated to understand. We’re here to explain the four different health product tiers offered through private health insurance.

Private health insurance companies generally offer bronze, silver, and gold policies that give you comprehensive coverage in a private hospital. With one of these policies, you’ll be able to relax knowing that you’re fully covered in case of an unexpected illness or injury. Remember to compare and review various policies before making your final choice to ensure you’re getting the best value for yourself and your family.

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What are Health insurance product tiers?

Private hospital insurance in Australia is generally categorised using a 4-tier system.
Every policy will be classed as basic, bronze, silver or gold, and the coverage becomes more comprehensive with each increasing tier you go up. However, the higher your level of private health insurance cover, the more costly the premium prices are in order to pay for this privilege.

What does Basic health insurance cover?

A Basic tier under hospital cover is the lowest level policy one can purchase. This private health insurance product tier only offers restricted cover for three clinical treatments, including rehabilitation, palliative care, and hospital psychiatric services. This level generally costs around $75.00 a month for a single policy.

Restricted cover

  • Rehabilitation
  • Hospital psychiatric services
  • Palliative care

Unrestricted cover

  • None

What does Bronze health insurance cover?

The hospital cover bronze plan is a great option for those who need some coverage but don’t want to break the bank. This type of policy will cover common treatments such as joint replacements, bone issues and hernia procedures. Other treatments include but are not limited to the list below.

Restricted cover

  • Rehabilitation
  • Hospital psychiatric services
  • Palliative care

Unrestricted cover

  • 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

What does Silver health insurance cover?

A Silver tiered healthcare policy is a much more comprehensive form of coverage. It covers all treatments included in the Bronze tier, with a range of additional treatments. While this level of hospital cover certainly costs more per month, it provides members with fewer limits and more coverage.

Restricted cover

  • Rehabilitation
  • Hospital psychiatric services
  • Palliative care

Unrestricted cover

  • Heart and vascular system
  • Blood
  • Podiatric surgery
  • Implantation of hearing devices
  • Dental surgery
  • Lung and chest
  • Back, neck, and spine
  • Plastic and reconstructive surgery

What does Gold health insurance cover?

The Gold tier in health insurance is the most comprehensive level of coverage that can be purchased. It usually covers every treatment offered with few or no restrictions at all.

Restricted cover

  • None

Unrestricted cover

  • Dialysis for chronic kidney failure
  • Cataracts
  • Pregnancy and birth
  • Joint replacement
  • Insulin pumps
  • Sleep studies
  • Assisted reproductive services
  • Weight loss surgery
  • Pain management with device

What is a “plus” policy?

Health insurance policies come with a set of minimum requirements for each category tier; these are then appended by an additional + or word ‘plus’. Your health fund isn’t required to offer you any coverage beyond what’s included in the basic plan. Still, if you want extensive coverage or unrestricted cover for certain treatments, you can take out a policy with plus.

This level of cover will cost more, as you are purchasing extra protection, but will provide you with the funds required for specific treatments that were not on the original policy tier.

Are all “plus” health insurance policies the same?

No. Most “plus” tier policies are different from one another. A policy can meet the minimum requirements of their core tier but offer some extra benefits too! And while these two sets may have similar necessities in them – like what’s required for both levels– there could still be differences between how they’re delivered and marketed to customers who want that particular coverage.

health family doctor 03 400

Compare benefits across all 4 private health insurance product tiers

The requirements for a policy to be categorised into different tiers are universal across the entire industry, so every insurer is working from this same system.

Below is a table outlining the hospital treatments included in each policy tier:

Compare the four private health insurance tiers

Treatment Category Basic Bronze Silver Gold
Rehabilitation(R)(R)(R)
Hospital psychiatric services(R)(R)(R)
Palliative care(R)(R)(R)
Brain and nervous systemO (R)
Eye (not cataracts)O (R)
Ear, nose and throatO (R)
Tonsils, adenoids and grommetsO (R)
Bones, joints, and musclesO (R)
Joint reconstructionsO (R)
Kidney and bladderO (R)
Male reproductive systemO (R)
Digestive systemO (R)
Hernia and appendixO (R)
Gastrointestinal endoscopyO (R)
GynaecologyO (R)
Miscarriage and termination of pregnancyO (R)
Chemotherapy, radiotherapy and immunotherapy for cancerO (R)
Pain managementO (R)
SkinO (R)
Breast surgery (medically necessary)O (R)
Diabetes management (excluding insulin pumps)O (R)
Lung and chestO (R)O
BloodO (R)O
Back, neck and spineO (R)O
Plastic and reconstructive surgery (medically necessary)O (R)O
Dental surgeryO (R)O
Podiatric surgery (provided by an accredited podiatric surgeon)O (R)O
Implantation of hearing devicesO (R)O
CataractsO (R)OO
Joint replacementsO (R)OO
Dialysis for chronic kidney failureO (R)OO
Pregnancy and birthO (R)OO
Assisted reproductive servicesO (R)OO
Weight loss surgeryO (R)OO
Insulin pumpsO (R)OO
Pain management with deviceO (R)OO
Sleep studiesO (R)OO

Source: privatehealth.gov.au

(R) Restricted
O Optional for private health insurers to include
Covered

Are there tiers for Extras policies?

No, there are no official tiers when it comes to Extra’s policies. Each health fund has its own set of rules for treating extras. Luckily, this type of policy tends to be easier than hospital plans because there are fewer details that need clarification or consideration when it comes time to make a claim.

Frequently asked questions and answers

  • What is an appropriate level of private patient hospital cover?

    The appropriate policy is the level of coverage that works best for you and your unique healthcare needs. Since there is a wide range of policies on offer, it depends entirely on your lifestyle and budget, as well as if you are going to include dependents on your policy. For example, if you are a single on a budget and lead a relatively healthy lifestyle where you do not go to the hospital often, you may want to purchase a Basic tiered policy to receive restricted coverage on certain treatments but also to avoid paying government costs such as the lifetime loading fee. However, if you are well-off and want medical protection for both you and your family, you may consider taking out a Silver policy that provides extensive coverage.
  • Which product tier will help you avoid paying MLS and LHC loading?

    The cheapest and least comprehensive coverage will still help you avoid paying both the medicare levy surcharge and the Lifetime Loading Cover Fee. The Basic tier policy from any private health insurance company is enough to protect you from paying these fees.
  • Do waiting periods differ between categories?

    Health insurance wait times vary by provider and condition. While some insurers offer a waiver in extracurricular circumstances, all Australian health plans will have some form of the waiting period as a general rule – don’t forget to check with your own company before making an appointment!
  • Which health insurance category is the best?

    Some people believe that the only way to be safe is by having a high-level policy, but this could lead you into expensive trouble if something were ever fallen out of pocket. It all depends on what kind of lifestyle one has in mind when purchasing their own health coverage – whether it’s just oneself plus parents who live at home with them; two married adults aged 25 years old+ living separately from each other.
  • What does it mean when there’s a plus (+) in the policy?

    Health insurance policies come with a set of minimum requirements for each category tier; these are then appended by an additional + or word ‘plus’. Your health fund isn’t required to offer you any coverage beyond what’s included in the basic plan, but if you want extensive coverage and unrestricted treatment options, there is always plus option available.

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