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Tiers and categories

As part of the private health insurance reforms, Hospital covers are now 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 tiers 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 any 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 log in to Online Services if you’re already a member.

While we introduced 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.

Want to know more about the private health insurance reforms?

For more information about the private health insurance reforms, check out our reform page.

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