Gold, silver, bronze and basic hospital cover tiers explained

By Ysabel Tang

5 minutes

18 April 2019

Young boy playing at beach with family as sun sets

Heard about the Australian Government’s new Gold, Silver, Bronze and Basic Hospital cover tiers? We explain what they cover and how HBF’s products stack up.

As part of the recent 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.

On a sliding scale of Basic to Gold, Basic covers the least and Gold covers the most.

Each tier includes cover for everything in the tier below it, plus more (sometimes, a lot more).

Health funds don’t need to stick to the minimum—they can offer more coverage than is required in each tier. This is what HBF has chosen to do.

This article will help you understand the 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 their name.

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.

Now, onto the tiers…

Basic Hospital

Basic Hospital is the lowest level of cover a health fund can now offer.

At a minimum, Basic Hospital must include restricted cover for in-hospital psychiatric services, palliative care and rehabilitation.

It’s designed for people that are young and healthy, and unlikely to go to hospital.

If you’re keen on Basic Hospital cover, just be aware that ‘restricted’ cover doesn’t cover a lot. If you try to claim on a restricted service, you’ll probably have a large out-of-pocket.

On the up side, Basic Hospital will help you avoid the Medicare Levy Surcharge and Lifetime Health Cover loading.

If you’re young and healthy and just want a basic option to help you avoid the government’s ‘please buy health insurance’ incentives, Basic Hospital is a solid choice.

HBF offer one level of Basic Hospital cover, which includes more than the government’s minimum requirements.

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 Aussies commonly need. That’s things like dental surgery and joint reconstructions.

Want to learn more? Find out what’s covered on HBF Basic Hospital Plus here.

Bronze Hospital

Bronze Hospital is a significant step up in cover compared to Basic Hospital.

At a minimum, Bronze Hospital must include cover for 21 categories of treatment and services.

In addition to everything covered on Basic Hospital, Bronze Hospital includes chemotherapy, joint reconstructions, ear, nose and throat procedures and many other treatment categories.

It’s designed for people that are healthy but want more than the basic level of cover, just in case.

HBF offer one level of Bronze Hospital cover, which includes more than the government’s minimum requirements.

HBF Bronze Hospital Plus: In addition to cover for the required 21 treatment categories, we’ve included full cover for six categories that represent common areas of concern. 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

Silver Hospital is the second highest tier of cover.

At a minimum, Silver Hospital must include cover for 29 categories of treatment and services.

As well as everything covered on Bronze Hospital, Silver Hospital includes heart and vascular system, lung and chest, podiatric surgery 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 top coverage.

HBF offer two levels of Silver Hospital cover. Both include more than the government’s minimum requirements.

HBF Silver Hospital: In addition to cover for the required 29 treatment categories, we’ve included full cover for three categories: pain management with device, sleep studies and insulin pumps.

HBF Silver Hospital Plus: In addition to cover for the required 29 treatment categories, we’ve included full cover for five 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

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 that they can obtain for peace of mind.

Gold Hospital is the only tier of cover where pregnancy and birth related services are a mandatory inclusion, so if you’re shopping for maternity cover, you can be sure all health funds will have maternity cover on their Gold Hospital option.

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.

Want to learn more? Find out what’s covered on HBF Gold Hospital here.

It will be a while before everything aligns

All health funds will need to organize their products into the new Gold, Silver, Bronze and Basic system by 1 April 2020. You might see some funds begin to use the new system this year.

What does this mean for you?

Basically, until next year, comparing health funds will still be tricky.

Some health funds may not have aligned to the new system just yet, so be aware of this when you’re shopping around.

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 health cover option is best for your needs.

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