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 hard to understand. The Government hopes the reforms will make it easier for consumers to compare products and see what each product does and doesn’t offer.
Each tier has different categories of medical treatments and services which products in that particular group must include as a minimum. For example, Silver and Gold policies have to cover dental surgery, while Basic and Bronze policies do not.
Insurers can also choose to offer Plus policies within each tier which include additional coverage on top of the minimum standards required. For example, you could have a Bronze Plus policy that includes dental surgery, which would normally only be available under a Silver policy. As Gold is the top tier of coverage, Gold Plus is not an option.
What is the Gold tier of cover?
Gold policies offer the highest level of hospital cover available, covering you for all 38 of the clinical categories. Because they will cover you for the widest range of services and treatments, Gold policies are likely to be the most expensive policies you can take out.
What hospital cover does the Gold tier include?
On top of providing the same level of cover as Silver policies, Gold policies include an additional nine clinical categories such as cataracts, pregnancy and birth, and joint replacements.
Furthermore, in comparison to the Basic, Bronze and Silver tiers, Gold tier policies must provide unrestricted cover for each category. 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 |
 Cataracts |
| Digestive system |
Joint replacements |
| Hemia and appendix |
Dialysis for chronic kidney failure |
| Gastrointestinal endoscopy |
Pregnancy and birth |
| Gynaecology |
Assisted reproductive services |
| Miscarriage and termination of pregnancy |
Weight loss surgery |
| Chemotherapy, radiotherapy and immunotherapy for cancer |
Insulin pumps |
| Pain management |
Pain management with device |
| Skin |
Sleep studies |
Indicates the clinical category is a minimum requirement of the Gold tier only.
For a rundown of what sorts of hospital treatments these 38 categories are expected to include, click here.
Who may suit Gold cover?
A Gold tier policy 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 it’s possible that some insurers may ultimately decide to create Silver Plus policies with these services included. Additionally, 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. According to the Australian Commission on Safety and Quality in Health Care, cataract surgery is the most common elective procedure in Australia. Gold tier policies could also be of interest if you have diabetes and need an insulin pump.
If you’re interested in taking out a Gold 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, it is worth being aware that your insurer may rename your product or add or remove services to fit your product into a different tier of cover. If you’re unsure, it could be worth asking your health fund if, how and when the reforms may impact you.
To find out more about the reform changes, click here.
A breakdown of the minimum coverage requirements for the other tiers can be found under the following – Basic, Bronze and Silver.
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