Hospital insurance can help you cover the cost of treatment as a private hospital patient. What you are covered for will depend on your policy, including what tier of cover you have. Each tier must include cover for certain categories of medical treatment and services as a minimum. This is designed to make it easier to compare products.
Insurers can also offer ‘Plus’ policies if they so choose – Basic Plus, Bronze Plus and Silver Plus – which include extra coverage on top of the minimum requirements.
Let’s take a look at what Silver health insurance policies must cover as a minimum.
What is Silver health insurance?
A Silver tier hospital policy provides the second-highest level of coverage available out of the four main tiers. As well as providing the same minimum levels of cover as Basic and Bronze policies, Silver policies must also include cover for eight extra medical categories, including heart and vascular system, lung and chest, blood, back, neck and spine, dental surgery and implantation of hearing devices.
What is covered by Silver health insurance policies?
Silver policies 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:
- Rehabilitation (Restricted cover permitted)
- Hospital psychiatric services (Restricted cover permitted)
- Palliative care (Restricted cover permitted)
- 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
- Miscarriage and termination of pregnancy
- Chemotherapy, radiotherapy and immunotherapy for cancer
- Pain management
- Breast surgery (medically necessary)
- Diabetes management (excluding insulin pumps)
- Heart and vascular system
- Lung and chest
- Back, neck and spine
- Plastic and reconstructive surgery (medically necessary)
- Dental surgery
- Podiatric surgery (provided by registered podiatric surgeon)
- Implantation of hearing device
Indicates the clinical category is a minimum requirement of the Silver tier.
What don’t Silver health insurance policies cover?
Silver health insurance policies are not required to cover the following hospital treatments. However, you may be able to receive coverage for some of these treatments with a Silver Plus policy.
- Joint replacements
- Dialysis for chronic kidney failure
- Pregnancy and birth
- Assisted reproductive services
- Weight loss surgery
- Insulin pumps
- Pain management with device
- Sleep studies
Read more about each clinical category and the types of hospital treatments that they cover.
What is Silver Plus health insurance?
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 tier policy. It is up to your insurer whether or not it offers Plus policies and what clinical categories are included in them. It could be a wise idea to check with your health insurance provider what is covered, and check the Product Disclosure Statement (PDS).
How much is Silver health insurance?
The cost of Silver health insurance can range from $1,265 to $1,517 per year, according to Canstar’s research. The average annual premium is $1,388. This is based on a Silver hospital policy for a single in NSW with an excess of $750. It also takes into account the Government’s Private Health Insurance Rebate base tier of 24.608%.
Silver Plus policies are typically more expensive. Canstar found that they can range from $1,299 to $2,261 per year, with an average annual premium of $1,766.
Average hospital insurance premiums
Source: www.canstar.com.au – 14/09/2021. The Australian Government Private Health Insurance Rebate Base Tier for under 65s, of 24.608% has been applied to premiums. Discounts (e.g. direct debit) not taken into account.
Who may suit Silver health insurance?
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.
You can compare Silver health insurance policies with Canstar. Our expert researchers have assessed a range of policies from different insurers on our database.
Cover image source: Canstar.
Sub edited by Milan Cuk.