As part of the 2019 reforms to private health insurance, the government introduced a new tiered
system for naming and categorising hospital insurance products: the Gold, Silver, Bronze and Basic system.
Each tier has a minimum list of hospital treatment categories that they must include—these are requirements
set by the Australian Government.
In terms of minimum coverage requirements, Basic covers the least and Gold covers the most.
Each tier has the same minimum requirements as the tier below, plus more.
Health funds don’t need to stick to the minimum — they can offer more coverage than is required in the Basic,
Bronze and Silver tiers. This is what HBF has chosen to do.
This article will help you understand the Australian Government’s minimum requirements for what’s included on
each tier of Hospital cover, as well as how HBF’s coverage stacks up.
But before we get into the tiers, here’s a little info on ‘plus’ products that will help you
compare with confidence.
Not all ‘plus’ products are made equal
If a Hospital insurance product includes more than the minimum, its name may include a “plus” or
“+”, e.g. “Bronze Hospital Plus”.
Where one health fund might cover seven more categories than the minimum, another might only cover an additional
three—because both cover more than the minimum, they’ll probably both have a ‘plus’ in
This means a lot of variation can occur between funds when it comes to what’s covered on a
‘plus’ product, so keep this in mind when shopping around.
Also note that a health fund doesn’t have to add a ‘plus’ to the name of a product which covers more than the minimum requirements. This means you can’t always assume a product with no ‘plus’ only covers the bare minimum. Now, onto the tiers…
Basic Hospital is the minimum coverage tier a health fund can offer.
At a minimum, Basic Hospital must include restricted cover for Hospital psychiatric services, Palliative care
It’s designed for people that are young and healthy or are looking for affordable cover.
If you’re keen on Basic Hospital cover, just be aware that on ‘restricted’ treatments, you’ll only receive the
minimum default benefit as set by the Australian Government. If you get treatment for a restricted service as a
private patient, you’ll probably have large out-of-pocket costs.
On the up side, Basic Hospital will help you avoid the Medicare Levy
HBF offers two levels of Basic Hospital cover, both of which include more than the Australian Government’s
For example, they both include accident cover which means you’ll be covered for hospital treatment as a result of
an accident. (1) This can be really valuable because – in the case of an accident – you could be covered for
treatments that would usually only be included on higher levels of cover. HBF includes accident cover only on
these two Basic Hospital cover options.
HBF Basic Hospital Plus: In addition to restricted cover for the three mandatory categories,
we’ve included full cover for five treatment categories that young people commonly need. That’s
things like Dental surgery and Joint reconstructions.
Find out what’s covered on HBF
Basic Hospital Plus here.
HBF Basic Hospital Plus Elevate:
In order to bridge the gap between Basic and Bronze, we’ve added family-friendly treatment categories such as
Ear, nose and throat, and cover for important things like Bone, joint and muscle and Digestive system.
Find out what’s covered on HBF Basic Hospital
Plus Elevate here.
At a minimum, Bronze Hospital must include cover for 18 specific treatment categories, and restricted cover for Hospital psychiatric services, Palliative care and Rehabilitation.
In addition to the minimum coverage requirements on Basic Hospital, Bronze Hospital must also include
Chemotherapy, radiotherapy and immunotherapy for cancer, Joint reconstructions, Ear, nose and throat and many
other treatment categories.
HBF offer one level of Bronze Hospital cover, which includes more than the Australian Government’s minimum
HBF Bronze Hospital Plus: In addition to the minimum requirements, we’ve included full cover for Palliative care and an additional eight treatment categories. These additional categories include Blood, and Back, neck and spine.
Want to learn more? Find out what’s covered on HBF Bronze Hospital Plus here.
Silver Hospital is the second highest tier of cover.
At a minimum, Silver Hospital must include cover for 26 specific treatment categories, and restricted cover for Hospital psychiatric services, Palliative care and Rehabilitation.
As well as the minimum requirements on Bronze Hospital, Silver Hospital must also include Heart and vascular system, Lung and chest, Podiatric surgery (provided by a registered podiatric surgeon) and a large range of other treatment categories.
It’s designed for people that are looking for more cover than Bronze Hospital, but who don’t need cover for all treatment categories (which are found in Gold Hospital cover).
HBF offer two levels of Silver Hospital cover. Both include more than the government’s minimum
HBF Silver Hospital: In addition to the minimum requirements, we’ve included full cover for Palliative care and three additional treatment categories: Pain management with device, Sleep studies and Insulin pumps.
HBF Silver Hospital Plus: In addition to the minimum requirements, we’ve included full cover for Palliative care and for five additional treatment categories. Additional categories include Cataracts and Joint replacements.
Want to learn more? Find out what’s covered on HBF Silver Hospital and Silver Hospital Plus here.
Gold Hospital is the highest level of cover.
It must include cover for all 38 categories of treatment and services.
It’s designed for people who are looking for the fullest cover.
Gold Hospital is the only tier of cover where the treatment category Pregnancy and birth is a mandatory
inclusion, so if you’re shopping for pregnancy cover, you can be sure all health funds will have pregnancy cover
on their Gold Hospital option. Some funds include Pregnancy and birth on lower tiers of cover, but Gold is the
only tier guaranteed to have it.
HBF Gold Hospital: Gold Hospital already includes cover for all 38 treatment categories, so we
can’t add anything more! With HBF Gold Hospital you’ll have peace of mind you’ve got the top
level of cover with HBF.
The only treatments not covered by Gold Hospital are things that aren’t covered by private health cover. This includes treatments that aren’t on the Medicare benefits schedule such as cosmetic surgery.
Want to learn more? Find out what’s covered on HBF Gold Hospital here.
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So which level of cover is the best fit for you?
If you are looking for health insurance, the best thing you can do is check the product sheet (a summary of what’s covered) before you commit to a product. This will help you make sure everything you need is included.
And if you’re still not sure, don’t worry. We’re here to help. Contact us and we’ll help you understand which of our health cover options is best for your needs.