Blog article
Hospital cover 101: Understanding Gold, Silver, Bronze and Basic tiers
But what exactly are they, and why does every health insurance provider use the same tiers? Introduced by the Australian Government as part of the 2019 reforms to private health insurance, the tiered system was designed to provide Australians with greater clarity when comparing health insurance products.
Each tier represents a different level of coverage and includes a minimum set of hospital treatment categories mandated by the government. This standardised approach ensures that you can more easily compare "apples with apples" and clearly understand the benefits and coverage options offered by various health insurance providers.
What about plus (+) tiers?
If a hospital insurance product includes more than the minimum set of treatment categories mandated by the government, its name may include a “plus” or “+”, e.g. “Bronze Hospital Plus”.
When comparing plus products, it’s important to remember that not all are made equal. Where one health fund might cover seven more categories than the minimum, another might only cover an additional three. But, because both cover more than the minimum, they can 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.
It's also worth noting 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.
A couple of good to knows
Before we get into the tiers, it’s worth giving yourself a quick refresh on the following:
Medicare Levy Surcharge: The Medicare Levy Surcharge (MLS) is a surcharge applied to people who don’t have an appropriate level of hospital cover and:
- earn over $97,000 as a single
- earn over $194,000 as a couple/family1
The surcharge is designed to encourage Australians to get hospital cover and use private hospitals to reduce demand on the public health system. Income thresholds for the private health insurance rebate update on July 1 every year and can be viewed on the Australian Government website.
All of HBF's hospital cover options qualify as an appropriate level of hospital cover. When you do get hospital cover, you’ll still pay the MLS for the part of the year you weren’t covered. You’ll only avoid the MLS completely if you’ve held hospital cover for the full financial year.
Lifetime Health Cover: Lifetime Health Cover loading (LHC loading) is an extra cost applied to the price of hospital cover. Each year you wait to get hospital cover after the age of 31, you’ll pay an extra 2% for your cover, up to a maximum of 70%. This extra cost is applied by the government to encourage Australians to get hospital cover earlier in life. So, if you get hospital cover before you’re 31, you’ll avoid higher premiums.
Urgent ambulance: All HBF hospital cover products include unlimited urgent or emergency ambulance transport or onsite treatment by an approved HBF provider, by road only (excludes air transport).
Basic Hospital tier
Basic Hospital is the minimum coverage tier a health fund can offer. An entry-level product, it’s designed for people that are young and healthy or are looking for the most affordable cover available.
As per government guidelines, it must include restricted cover for Hospital psychiatric services, Palliative care and Rehabilitation. While restricted cover means you’ll receive the minimum default benefit as set by the Australian Government, you’ll avoid the Medicare Levy Surcharge and LHC loading, plus enjoy the benefits of being able to choose your hospital, choose your doctor, and avoid public waiting lists when you need hospital treatment.
HBF offers three levels of Basic Hospital cover, with HBF Basic Hospital Plus and HBF Basic Hospital Plus Elevate including more than the Australian Government’s minimum requirements.
HBF Basic Hospital Accident Only: This is our lowest cost hospital cover. It includes Accident cover (which means you’ll be covered for hospital treatment as a result of an accident2) and restricted cover for Hospital psychiatric services, Palliative care and Rehabilitation.
HBF Basic Hospital Plus: In addition to the cover provided under Basic Hospital Accident Only, HBF Basic Hospital Plus includes cover for Dental surgery; Joint reconstructions; Gynaecology; Tonsils, adenoids and grommets; and Hernia and appendix.
HBF Basic Hospital Plus Elevate: We created this cover in order to bridge the gap between Basic and Bronze tiers. In addition to everything covered under HBF Basic Hospital Plus, we’ve added Gastrointestinal endoscopy; Skin; Kidney and bladder; Bone, joint and muscle; Digestive system; Ear, nose and throat; Male reproductive system; Chemotherapy, radiotherapy and immunotherapy for cancer; Miscarriage and termination of pregnancy; and Blood.
Bronze Hospital tier
The second lowest cover tier, Bronze Hospital must include cover for 18 specific treatment categories, and restricted cover for Hospital psychiatric services, Palliative care and Rehabilitation, as per government guidelines.
This includes: 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); and Diabetes management (excluding insulin pumps).
HBF offers two levels of Bronze Hospital cover, HBF Lite Bronze Hospital Plus and HBF Bronze Hospital Plus.
HBF Lite Bronze Hospital Plus: In addition to the minimum requirements listed above, we’ve included cover for four additional treatment categories: Dental surgery; Blood, Lung and chest; and Sleep studies.
HBF Bronze Hospital Plus: In addition to everything covered under HBF Lite Bronze Hospital Plus, we’ve included cover for Palliative care and an additional three treatment categories: Plastic and reconstructive surgery (medically necessary); Pain management with device; and Back, neck and spine.
In the Finder Health Insurance Awards 2024, HBF’s Bronze Hospital Plus was highly commended.
Silver Hospital tier
Silver Hospital is the second highest tier of cover available. 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 the following as per government guidelines: 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); and Implantation of hearing devices.
Silver Hospital tier is designed for people 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: HBF Silver Hospital and HBF Silver Hospital Plus.
HBF Silver Hospital: In addition to the minimum requirements listed above, we’ve included 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 listed above, we’ve included cover for Palliative care and for five additional treatment categories: Pain management with device; Sleep studies; Insulin pumps; Cataracts; and Joint replacements.
Gold Hospital tier
Gold Hospital is the highest level of cover available. As per government guidelines, it must include cover for all 38 categories of treatment and services.
This means included cover for Rehabilitation; Hospital psychiatric services; and Palliative care; all minimum requirements on Basic Hospital; Bronze Hospital and Silver Hospital; Cataracts; Joint replacements; Dialysis for chronic kidney failure; Pregnancy and birth; Assisted reproductive services; Weight loss surgery; Insulin pumps; Pain management with device; and Sleep studies.
HBF offers one level of Gold Hospital cover, HBF Gold Hospital Elevate.
HBF Gold Hospital Elevate: This is the highest level of cover currently available for sale. It provides cover for all 38 clinical categories, giving you ultimate peace of mind.
The only treatments not covered by Gold Hospital Elevate 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.
In the Finder Health Insurance Awards 2024, HBF’s Gold Hospital Elevate was highly commended.
