Compare gold health insurance

On top of providing the same level of cover as Basic, Bronze and Silver policies, Gold policies include 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.

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 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

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 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. 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.

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 cover can also be impacted by where you live. The Commonwealth Ombudsman says the premiums you pay and the benefits you’re entitled to can differ from state to state.

Gold cover premiums can be further impacted by the Government’s Private Health Insurance Rebate. That’s the amount the Federal 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 hinge around when you take out health insurance for the first time. A lifetime health cover (LHC) loading can apply if you haven’t had hospital cover in place from the year you turned 31. The LHC loading of 2% is added to premiums for every year you are aged over 30.

All these factors mean that the cost of Gold private health cover hinges on your individual situation as well as the policy and provider you choose. That’s why comparing premiums is the best way to know how much you’re likely to pay in monthly premiums.

Gold private health cover may be worth considering if you are pregnant or trying to get pregnant. 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, 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.