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Tiers and categories

As part of the private health insurance reforms, from 1 April 2019 Hospital covers will be assigned to one of four tiers - Basic, Bronze, Silver and Gold. To be categorised in a certain tier, each hospital product must cover a minimum set of services as defined by the Government.

These hospital services have been standardised across the whole industry and are referred to as ‘clinical categories’. These changes will make it easier for you to identify, compare and choose a health cover that’s right for you.

What’s included in each tier and what does ‘Plus’ mean?

Each tier has a minimum set of hospital services that must be included, but health insurers can choose to include additional services on top of the minimum required to create ‘Plus’ products.

A ‘Basic Plus’ for example, must include all the minimum required services as set out by a Basic tier, and additional services not required in that tier.

It’s important to remember that these tiers only apply to the Hospital component of your cover.

Basic

All Basic covers must cover Hospital Rehabilitation, Hospital Psychiatric Services and Palliative Care on a restricted basis as a minimum requirement.

Any ‘Basic Plus’ covers include additional hospital services on top of the minimum requirement. These extra services may be included, offered with restricted benefits or with minimum benefits payable (MBP).

Bronze

Bronze covers have the same required inclusions as Basic. In addition, Bronze covers include 18 further hospital services, such as brain and nervous system, joint reconstructions and ear, nose and throat.

Silver

Silver covers have the same required inclusions as Bronze, and include an additional 8 groupings of hospital services, such as heart and vascular system, dental surgery and lung and chest.

Gold

All Gold covers must not exclude or restrict any Medicare recognised hospital services, making Gold our most comprehensive cover.

You can get a quote to see the full list of hospital services included on each level of cover, or login to Online Services if you’re already a member.

We’ll let you know if your cover is changing

To make sure all of our Hospital covers are compliant with the new tiers, we may need to make some changes to our current Hospital covers. If you’re an existing member, we’ll be in contact soon to explain what tier your current cover fits into. You can also login to Online Services to review how your cover is changing, or contact us.

Want to know more about the private health insurance reforms?

For more information about the private health insurance reforms being introduced from 1 April, check out our reform page.

Frequently Asked Questions

Q: Are all health funds introducing the new tiers from 1 April 2019?

A: While we’re introducing the new product tiers from 1 April 2019, other health funds may choose to transition their products any time from 1 April 2019 until 31 March 2020.

Q: Some of my inclusions don’t have the same name anymore - what’s the deal?

A: As part of the reforms, a standardised list of hospital services set by the Government will be introduced from 1 April 2019. This will help you easily understand and compare what each Hospital cover includes.

For example, the two hospital services ‘Joint reconstruction’ and ‘Joint investigations’ will be combined into the one category ‘Joint reconstruction’ from 1 April.

Q: Do I have to change health covers?

A: You don’t need to do anything as we introduce the new tiers and categories, but some of our current health covers will require changes to align with the new tiers. If your cover has changed at all, we’ll communicate this with you soon. If you decide it’s time to review your cover, you can login and use our new compare tool from 1 April or contact us to discuss your options.

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