Silver Private Health Cover: How Does It Work?


The new tiered system of private hospital insurance will begin rolling out from 1 April, 2019, with every insurer required to implement the reforms by 1 April, 2020. This system classifies hospital policies into four tiers – Gold, Silver, Bronze and Basic. Here is a breakdown of what the Silver tier covers.

The tiered health insurance system is part of a raft of Federal Government reforms aimed at simplifying health insurance policies for Australians. According to the Federal Government, many consumers find hospital insurance complex and difficult to understand. The Government hopes the reforms will make it easier for consumers to see what each product does and doesn’t cover.

Each tier must include certain categories of medical treatment and services as a minimum. While this is designed to make it easier to compare policies, insurers can also offer Plus policies if they so choose – that is, Basic Plus, Bronze Plus and Silver Plus – which include additional coverage on top of the minimum requirements.

To start with, let’s take a look at what hospital inclusions Silver policies must cover as a minimum.

What is the Silver tier of cover?

Silver is the second highest level of coverage available out of the four main tiers. In addition to providing the same minimum levels of cover as Basic and Bronze policies, Silver policies must also include cover for eight more medical categories such as heart, back, neck and spine and dental surgery.

Silver tier health insurance dental surgery
Source: Oscar Carrascosa Martinez (Shutterstock)

What hospital cover does the Silver tier include?

Silver policies will cover 29 of the 38 clinical categories as a minimum. Of these, three categories – rehabilitation, hospital psychiatric services and palliative care – may be offered on a restricted basis. According to the Federal Government, this could mean that you end up facing some out-of-pocket expenses for these treatments. For the remaining 26 categories, your insurer must cover all treatments available in that category.

The categories covered under a Silver policy are:

Tick Rehabilitation (Restricted cover permitted) Tick Miscarriage and termination of pregnancy
Tick Hospital psychiatric services (Restricted cover permitted) Tick Chemotherapy, radiotherapy and immunotherapy for cancer
Tick Palliative care (Restricted cover permitted) Tick Pain management
Tick Brain and nervous system Tick Skin
Tick Eye (not cataracts) Tick Breast surgery (medically necessary)
Tick Ear, nose and throat Tick Diabetes management (excluding insulin pumps)
Tick Tonsils, adenoids and grommets Silver tier Heart and vascular system
Tick Bone, joint and muscle Silver tier Lung and chest
Tick Joint reconstructions Silver tier Blood
Tick Kidney and bladder Silver tier Back, neck and spine
Tick Male reproductive system Silver tier Plastic and reconstructive surgery (medically necessary)
Tick Digestive system Silver tier Dental surgery
Tick Hernia and appendix Silver tier Podiatric surgery (provided by registered podiatric surgeon)
Tick Gastrointestinal endoscopy Silver tier Implantation of hearing device
Tick Gynaecology

Silver tier Indicates the clinical category is a minimum requirement of the Silver tier.

What is not included under Silver cover?

Silver policies typically will not offer the same level of protection as Gold tier policies. Unlike Gold policies, Silver policies will not necessarily cover the following nine categories as standard:

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

For a rundown of what sorts of hospital treatments these 38 categories are expected to include, click here.

What is Silver Plus (+)?

A Silver Plus policy is one that includes coverage in addition to the minimum prescribed categories. 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. It is up to your insurer whether or not it will offer Plus policies and what clinical categories will be included in them.

Who may suit Silver cover?

A Silver policy may be worth considering if you want to be covered for a variety of hospital treatments and services. For example, as it covers back, neck and spine treatment, it could be helpful if your job is physically intensive. A Silver policy could also be worth looking into if you need dental surgery or if you have heart and vascular problems or need to have a hearing device implanted.

A Silver policy may not be appropriate for you if you are planning on having children and need private pregnancy, birth and assisted reproductive services, although it is possible that some insurers may decide to create Silver Plus policies with these services included. If you are considering a Silver Plus policy, be sure to check with your insurer for a full list of what is and isn’t covered.

If you’re interested in taking out a Silver hospital insurance policy, bear in mind that insurers will have until 1 April, 2020 to implement the tiered system. If you already have private health insurance, you may start to notice your insurer renames your product or adds or removes services so that your product will fit into a tier of cover. If you’re unsure how the reforms will impact you, check in with your health fund.

To find out more about the reform changes, click here.

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