Compare Gold health insurance

What is Gold health insurance?

Gold private health cover policies offer the highest level of hospital cover available, covering policyholders for all 38 of the clinical categories set out by the Australian Federal Government.

Private health insurance hospital policies are grouped into four main tiers: Gold, Silver, Bronze and Basic. Each tier covers different categories of medical treatments and services that must be included in policies as a minimum. This makes it easier for consumers to compare products and see which ones suit their specific needs.

Given that Gold health insurance provides cover for the widest range of services and treatments, it’s likely to be more expensive, coming with higher premiums attached when compared to policies of lower tiers. That’s why it’s worth comparing Gold health insurance policies to help you find the best value across the different health funds for your needs and budget. You can use the table above to compare Gold tier hospital & extras policies from our Online Partners and can also change the table’s filters to better suit your requirements.

It’s also worth noting that health insurers can choose to offer ‘Plus’ policies (Basic Plus, Bronze Plus and Silver Plus) which include extra coverage on top of the minimum required by law. For example, you could have a Silver Plus policy that includes pregnancy and birth cover, which would normally only be available under a Gold policy. However, as Gold is already the top tier of coverage available, you won’t find Gold Plus policies.

What is covered by Gold private health cover?

On top of providing the same level of cover as Basic, Bronze and Silver policies, Gold policies include mandatory cover for an extra nine clinical categories such as cataracts, pregnancy and birth, and joint replacements.

Gold tier policies must also provide unrestricted cover for each category, which differs from Basic, Bronze and Silver tier policies. This includes rehabilitation, hospital psychiatric services and palliative care, which insurers are only required to cover on a restricted basis under their policies in other tiers.

As set out by the Federal Government, the categories covered under a Gold tier policy are:

• Rehabilitation
• Breast surgery (medically necessary)
• Hospital psychiatric services
• Diabetes management (excluding insulin pumps)
• Palliative care
• Heart and vascular system
• Brain and nervous system
• Lung and chest
• Eye (not cataracts)
• Blood
• Ear, nose and throat
• Back, neck and spine
• Tonsils, adenoids and grommets
• Plastic and reconstructive surgery (medically necessary)
• Bone, joint and muscle
• Dental surgery
• Joint reconstructions
• Podiatric surgery (provided by registered podiatric surgeon)
• Kidney and bladder
• Implantation of hearing device
• 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

In addition, Gold private health cover includes the following nine clinical categories, which are not covered by other tiers of health insurance:

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

How does Gold health insurance work?

To understand how Gold health insurance works, it can help to think of the different tiers in terms of the level of cover they provide. For example, Bronze offers low cover, Silver offers a medium level of cover, and Gold provides the highest level of cover.

As noted, Gold private health cover offers benefits not available with other tiers. This does not, however, mean that these benefits are associated with rare or unusual conditions. As a guide, Gold cover includes cataract surgery, which Bupa says is one of the most common operations in Australia. Likewise, if you’re planning to start a family, only Gold private health cover includes benefits for pregnancy and assisted reproductive services as a standard inclusion.

As with all levels of hospital cover, if you take out Gold private health cover for the first time or increase your level of cover from Silver, Bronze or Basic, you will normally have to complete waiting periods before you can claim any benefits. A waiting period is the period of time that you’ll need to hold a policy before being able to claim for certain medical treatments and services. An exception may be if you need hospital or medical treatment because of an accident that happens after you start your policy.

More generally though, the maximum waiting periods that insurers can impose for hospital treatment are 12 months for pre-existing conditions or pregnancy and birth benefits, and two months for other treatments.

How much is Gold health insurance?

The cost of premiums for Gold private health insurance can vary widely. It’s not just about the provider you choose, the policy you select, or even if you want cover for just yourself or the whole family. The cost of Gold hospital cover can also be impacted by where you live. Since the population and health systems of each state and territory are different, your insurance premiums may vary depending on which state or territory you reside in, according to the health fund nib.

Gold cover premiums can be further impacted by the Federal Government’s Private Health Insurance Rebate. That’s the amount the Government contributes towards the cost of your private health insurance premiums, and it’s means tested, so your eligibility can depend on your annual income.

In addition, the cost of Gold private health cover can change depending on when you take out health insurance for the first time. A lifetime health cover (LHC) loading can apply if you haven’t had private hospital cover in place from the year you turned 31. The LHC loading of 2% is added to premiums for every year you’re aged over 30 and don’t have private hospital cover.

All these factors mean that the cost of Gold health insurance can change depending on your individual situation as well as the policy and provider you choose. That’s why comparing different policies and their premiums is the best way to know how much you’re likely to pay in monthly premiums. The table above shows the approximate monthly premium for Gold tier hospital & extras policies from our Online Partners. You can also change the filters on the table to better suit your requirements.

Is Gold health insurance worth it?

Whether Gold health insurance is worth it for you will depend on your healthcare needs and financial situation. It may be worth considering if you’re planning to start a family. If you want to give birth as a private patient, Gold is the only tier that is required to cover you for pregnancy and birth services, although some Silver Plus policies may include pregnancy and birth cover.  Also, Gold policies will provide coverage if you need assisted reproductive services such as IVF.

Gold policies may also be worth looking into for older Australians or people with chronic illnesses. Notably, the Gold tier is the only one required to cover cataracts, joint replacements and dialysis for chronic kidney failure, which policies from other tiers will not necessarily cover. Gold private health cover could also be of interest if you have diabetes and need an insulin pump.

Canstar Star Ratings and Awards

Looking for an award-winning product or to switch providers or brands? Canstar rates products based on price and features in our Star Ratings and Awards. Our expert Research team shares insights about which products offer 5-Star value and which providers offer outstanding value overall. We also reveal which providers have the most satisfied customers in our dedicated Customer Satisfaction Awards.

Health Insurance Awards