This new tiered system is part of a series of reforms designed to make private health insurance easier to understand, particularly when it comes to what policies do and do not cover. Each tier of hospital insurance will carry minimum coverage requirements for medical treatments and services. Insurers can also offer Plus policies for the Basic, Bronze and Silver tiers, which can include additional coverage on top of the minimum requirements.
Below we take a look at what the minimum hospital inclusions are for Bronze policies.
What is the Bronze tier of cover?
The new Bronze tier of hospital cover will be the third-highest level of cover out of the four main tiers, sitting above Basic but below Silver and Gold. It will offer the same minimum coverage requirements as a Basic policy, but include cover for an additional 18 hospital treatment categories, including joint reconstructions, ear, nose and throat treatments and gastrointestinal endoscopies.
What hospital cover does the Bronze tier include?
Bronze policies will provide cover for a minimum total of 21 hospital treatment categories as a private patient. Of these, the government has indicated that rehabilitation, hospital psychiatric services and palliative care may be offered on a restricted basis (whereby insurers pay a limited amount towards these treatment categories and there may be out-of-pocket expenses), while the remaining 18 treatment categories are unrestricted (meaning patients won’t have to pay out-of-pocket hospital costs apart from their excess).
The categories covered under a Bronze policy are:
- Rehabilitation (Restricted cover permitted)
- Hospital psychiatric services (Restricted cover permitted)
- Palliative care (Restricted cover permitted)
- Miscarriage and termination of pregnancy
- Chemotherapy, radiotherapy and immunotherapy for cancer
- Pain management
- Brain and nervous system
- Eye (not cataracts)
- Breast surgery (medically necessary)
- Ear, nose and throat
- Diabetes management (excluding insulin pumps)
- Tonsils, adenoids and grommets
- Male reproductive system
- Bone, joint and muscle
- Digestive system
- Joint reconstructions
- Hernia and appendix
- Kidney and bladder
- Gastrointestinal endoscopy
Indicates the clinical category is a minimum requirement of the Bronze tier.
What is not included?
There are 17 hospital treatment categories that are not included as a minimum requirement of the Bronze tier. These are:
- Heart and vascular system
- Lung and chest
- Back, neck and spine
- Plastic and reconstructive surgery (medically necessary)
- Dental surgery
- Podiatric surgery (provided by a registered podiatric surgeon)
- Implantation of hearing devices
- Joint replacements
- Dialysis for chronic kidney failure
- Pregnancy and birth
- Assisted reproductive services
- Weight loss surgery
- Insulin pumps
- Pain management with device
- Sleep studies
As these treatments are not a minimum requirement, your insurer does not need to provide cover for them under a Bronze policy. If you want cover for one or several of the above treatments as a minimum requirement, you may want need to consider the Silver or Gold tiers of hospital cover.
For a rundown of what sorts of hospital treatments these categories are expected to include, click here.
What is Bronze Plus (+)?
Under the new health insurance reforms, insurers may choose to offer additional cover under the Basic, Bronze and Silver categories in addition to the minimum prescribed categories. These upgraded categories can feature the name of the policy along with the word Plus or a plus sign, such as Bronze Plus or Bronze +. For example, you could have a Bronze Plus policy that includes cover for dental surgery, which would normally only be available under a Silver or Gold policy.
This is not a required category and it is up to insurers to determine if they wish to include a Bronze Plus policy in their product offerings. If they do, it is also up to them to determine what additional benefits they will offer under such a policy and what restrictions and exclusions apply.
Who may suit Bronze cover?
Based on its lower level of cover, Bronze tier policies may be particularly suited to those who are generally fit and healthy, with no serious history of illness and who are not planning to have a family (as there will be no pregnancy, birth or reproductive cover under standard Bronze policies).
As the Bronze tier provides treatment for joint reconstructions and bone, joint and muscle treatments, it may also be suited for those who live an active lifestyle or who have a physically demanding job where these treatments may be needed. On the other hand, if you expect you may require cover for your back and neck or joint replacement surgery, then you may want to consider a policy from a higher tier, as these treatments will not generally be offered under Bronze policies.
Deciding whether the Bronze tier of cover is right for you will ultimately depend on your personal circumstances and needs. When researching your options, it is important to read the policy inclusions and exclusions carefully and consider contacting your chosen fund to understand the restrictions which may apply.
If you currently have private health insurance, keep a look out for further details from your health fund on how these reforms may affect your existing policy. You may notice your insurer renames your product or adds or removes services to fit your policy into a higher or lower tier of cover come 1 April. If you need further details on what you will and will not be covered for and whether there will be any changes to your existing policy, contact your insurer directly.
For more information on the health insurance reforms, read this article or contact the Department of Health. A breakdown of the minimum coverage requirements for the other tiers can be found under the following – Basic, Silver and Gold.
To find out more about the reform changes, click here.