In April 2019, the Australian Government introduced standardised hospital product tiers to help make private health insurance easier to understand and compare.
The 4 product tiers are Basic, Bronze, Silver and Gold, and are based on the types of services included in the product.
Tiers set minimum coverage requirements, however products within the same tier can still differ between funds. This is why you see products described as Basic Plus, Bronze Plus or Silver Plus, as the fund has added additional services above the minimum tier requirements.
Key Points
- Hospital cover is grouped into four tiers: Basic, Bronze, Silver and Gold
- Each tier has minimum service requirements set by the Australian Government
- Products within the same tier can still differ between health funds
- Higher tiers include a broader range of hospital services
What are Hospital Product Tiers?
Hospital product tiers are categories used to classify private hospital cover based on the services included in the policy.
The tier system was introduced to create greater consistency across private health insurance products and make it easier for people to compare different levels of hospital cover.
Each tier has minimum clinical category requirements set by the Australian Government. These categories determine the types of hospital treatments and services a product must include to qualify for a particular tier.
You can view the full list of clinical categories and tier requirements on the PrivateHealth.gov.au website.
Why do Hospital Product Tiers exist?
Before hospital product tiers were introduced, there was less consistency between health funds and less certainty about what services a hospital product was likely to cover.
The tier system was designed to create a clearer framework for hospital cover by setting minimum hospital treatment requirements for each level of cover.
This makes it easier to understand the general level of cover a product provides and compare products across different health funds.
Do hospital tiers affect the quality of treatment you receive?
No. Hospital product tiers don’t determine the quality of treatment you receive or the experience and qualifications of your doctor or surgeon.
The tier system is designed to show which hospital treatments are included under your cover. The Gold tier includes a broader range of hospital treatments, but it doesn’t change the quality of care you receive.
What are the four Hospital Product Tiers?
The four hospital product tiers are Basic, Bronze, Silver and Gold.
As you move through the tiers, products include a broader range of hospital treatments. Basic products include a more limited range of treatments, while Gold products include the most comprehensive range of hospital treatments.
Basic Hospital Cover
Basic hospital cover is the lowest hospital product tier available.
Under a Basic product, hospital treatments are included on a restricted basis only. This means you are only covered as a private patient in a public hospital for certain treatments.
You are likely to have significant out-of-pocket expenses if you choose to be treated in a private hospital.
Bronze Hospital Cover
Bronze hospital cover includes a broader range of hospital treatments than Basic cover, while still excluding some treatments that are only included in higher tiers.
Bronze products include treatment for things like broken bones, tonsils, hernias and appendix removal.
Bronze cover is often chosen by people looking for a balance between cost and cover, while still wanting access to a broader range of hospital treatments than Basic products provide.
Silver Hospital Cover
Silver hospital cover includes all treatments covered under Bronze hospital cover, plus a broader range of additional hospital treatments.
Silver products include treatment for things like heart conditions, lung conditions and back and spinal procedures.
Silver cover is often chosen by people wanting access to a wider range of hospital treatments, without paying for the most comprehensive level of hospital cover.
Gold Hospital Cover
Gold hospital cover includes all clinical categories that health funds can pay benefits towards.
Gold products include treatment for things like pregnancy, cataracts, joint replacements and weight-loss surgery.
Gold cover is often chosen by people wanting the highest level of hospital cover available and access to the widest range of hospital treatments.
What does the Plus at the end of a tier mean?
Products described as Basic Plus, Bronze Plus or Silver Plus include hospital treatments above the minimum requirements for that tier.
For example, a Bronze Plus product may include additional hospital treatments from either the Silver or Gold tiers that are not required under a standard Bronze product.
Plus products are common across the private health insurance industry and allow funds to offer a wider range of hospital treatments within a tier.
What’s the difference between included, restricted and excluded services?
If a hospital treatment is included, your health fund pays benefits towards treatment in a private hospital, subject to any excesses, waiting periods or out-of-pocket expenses.
If a hospital treatment is restricted, you’re only covered as a private patient in a public hospital for that treatment. This can result in significant out-of-pocket expenses if you choose to be treated in a private hospital.
If a hospital treatment is excluded, your health fund won’t pay benefits towards treatment for that service. If you’re treated privately, you will need to pay the full cost of the private hospital admission, minus any benefits Medicare may pay.
Understanding the difference between included, restricted and excluded services is important when comparing hospital cover.
How do you choose the right hospital tier?
The right hospital tier will depend on your health needs, budget and the types of hospital treatments you want access to.
Some people choose lower tiers to reduce the cost of cover, while others prefer a higher tier for access to a wider range of hospital treatments.
When choosing a hospital cover, it’s important to look beyond the tier itself and understand what treatments are included, restricted or excluded under the product.
If you’re comparing your options, you can learn more about our hospital cover options or get a quick quote.
