A Simple Guide To The New Private Health Insurance Tiers

As of April 1 2019 under the new system, insurers will be required classify their policies to a minimum standard set by the government. All policies will have in the product name one of the following – Gold, Silver, Bronze or Basic, for example Premium Gold Hospital.

Any policy that has either Gold, Silver, Bronze of Basic in the title will be required to meet a minimum standard. This will prevent a lot of confusion as members will have a clear understanding of what is included in their policy.

There are a further 2 categories to consider:

1. Unrestricted cover – access to a private hospital that has an agreement with your health fund providing your choice of treating doctor
2. Restricted Cover – public hospital admission only as a private patient. This provides you with the ability to choose your treating doctor

These products will sometimes feature the name of the policy, along with a ‘plus’ sign, ie: Silver plus [+], Bronze plus [+], and Basic plus [+].

What does a Basic health insurance policy cover?

A Basic policy will allow you to access the following treatments as a minimum requirement, however, restrictions may apply:

• Rehabilitation
• Hospital psychiatric services
• Palliative care

If you take out Basic cover, your insurer may offer additional clinical categories on a restricted or unrestricted basis. These policies will be known as Basic plus [+] policies.

What does a Bronze health insurance policy cover?

A Bronze policy will offer you the same restricted cover for rehabilitation, hospital psychiatric services, and palliative care, but it will also provide unrestricted cover for the following treatments:

• 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)
• Diabetes management (excluding insulin pumps)

If you take out a Bronze policy, your insurer may include benefits towards other clinical categories, which are found in higher levels of cover. These policies will be referred to as Bronze plus [+] policies.

What does a Silver health insurance policy cover?

A Silver policy will cover you for the same hospital treatments found in the basic and bronze policies, but it will also cover you for the following treatments on an unrestricted basis:

• Heart and vascular system
• Lung and chest
• Blood
• Back, neck, and spine
• Plastic and reconstructive surgery (medically necessary)
• Dental surgery
• Podiatric surgery (provided by an accredited podiatric surgeon)
• Implantation of hearing devices

If you opt for Silver cover, your insurer may offer additional cover for some of the clinical categories found in Gold cover. These policies will be referred to as Silver plus [+] policies.

What does a Gold health insurance policy cover?

A Gold policy will offer unrestricted cover for all of the treatments and services covered in the Basic, Bronze, and Silver tiers. It will also offer you unrestricted cover for the following clinical treatments:

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

A Gold policy is the ultimate level of cover. It offers unrestricted cover for the full range benefits included in each of the clinical categories.

What will happen during the transition period?

During the transition to a four-tiered system, the Private Health Insurance Ombudsman will be given extra power and have access to a greater pool of resources. This will ensure that your rights and best interests are taken care of while the changes are implemented, and that the process runs as smoothly as possible.

Although the Private Health Insurance Ombudsman is currently able to conduct inspections and audits at insurers’ premises, the additional powers will ensure that your rights are protected, and increase consumer confidence that the information they provide is accurate.

Who will benefit from the health insurance reforms?

The new private health insurance reforms will provide health fund members with clear information on what is included or excluded on your health insurance policy, allowing you to better understand your rights and work out exactly what you’re covered for.

It will also make it easier to compare health insurance products, which you can do with iSelect – and if you find a better deal and decide to switch, we’ll also handle the admin of switching for you.

The new system will also offer younger Australians a more affordable level of cover, and make it easier for all policyholders to access mental health services if required. Women will also come out on top once the new reforms are implemented, with gynaecology and all medically required breast surgery included in all Bronze tier hospital treatment products and above.

If you live in regional and rural areas, you’ll also benefit from the changes, with private health insurers being able to offer travel and accommodation benefits under hospital cover from 2019.

Find a health insurance policy with iSelect

Private health insurance is an important issue, and it’s hoped that the new reforms will make the private health insurance system simpler, and more affordable for all Australians.

If you’re concerned about the changes to private health insurance or need advice, call 13 19 20 to speak to one of our expert health advisors.

Sources:
1. http://www.health.gov.au/internet/main/publishing.nsf/Content/private-health-insurance-reforms-fact-sheet-gold-gilver-bronze-basic-product-categories