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Cover

How to understand the difference between Basic, Bronze, Silver and Gold Hospital Cover

Reviewed and updated 5 June 2023

How the Hospital Cover tiers work

The difference between Basic, Bronze, Silver and Gold Hospital Cover lies in the number of clinical categories each product tier offers:

Clinical CategoryBasicBronzeSilverGold
Rehabilitation✓ (R)✓ (R) ✓ (R)✓ 
Hospital Psychiatric Services✓ (R)✓ (R)✓ (R)✓ 
Palliative Care✓ (R)✓ (R)✓ (R)✓ 
Brain and Nervous System(O) (R)✓ ✓ ✓ 
Eye (not cataracts)(O) (R)✓ ✓ ✓ 
Ear, Nose and Throat(O) (R)✓ ✓ ✓ 
Tonsils, Adenoids and Grommets(O) (R)✓ ✓ ✓ 
Bone, Joint and Muscle(O) (R)✓ ✓ ✓ 
Joint Reconstructions(O) (R)✓ ✓ ✓ 
Kidney and Bladder(O) (R)✓ ✓ ✓ 
Male Reproductive System(O) (R)✓ ✓ ✓ 
Digestive System(O) (R)✓ ✓ ✓ 
Hernia and Appendix(O) (R)✓ ✓ ✓ 
Gastrointestinal Endoscopy(O) (R)✓ ✓ ✓ 
Gynaecology(O) (R)✓ ✓ ✓ 
Miscarriage and Termination of Pregnancy(O) (R)✓ ✓ ✓ 
Chemotherapy, Radiotherapy and Immunotherapy for Cancer(O) (R)✓ ✓ ✓ 
Pain Management(O) (R)✓ ✓ ✓ 
Skin(O) (R)✓ ✓ ✓ 
Breast Surgery (medically necessary)(O) (R)✓ ✓ ✓ 
Diabetes Management (excluding insulin pumps)(O) (R)✓ ✓ ✓ 
Heart and Vascular System(O) (R)(O)✓ ✓ 
Lung and Chest(O) (R)(O)✓ ✓ 
Blood(O) (R)(O)✓ ✓ 
Back, Neck and Spine(O) (R)(O)✓ ✓ 
Plastic and Reconstructive Surgery (medically necessary)(O) (R)(O)✓ ✓ 
Dental Surgery(O) (R)(O)✓ ✓ 
Podiatric Surgery (provided by a registered Podiatric Surgeon)(O) (R)(O)✓ ✓ 
Implantation of Hearing Devices(O) (R)(O)✓ ✓ 
Cataracts(O) (R)(O)(O)✓ 
Joint Replacement(O) (R)(O)(O)✓ 
Dialysis for Chronic Kidney Failure(O) (R)(O)(O)✓ 
Pregnancy and Birth(O) (R)(O)(O)✓ 
Assisted Reproductive Services(O) (R)(O)(O)✓ 
Weight Loss Surgery(O) (R)(O)(O)✓ 
Insulin Pumps(O) (R)(O)(O)✓ 
Pain Management with Device(O) (R)(O)(O)✓ 
Sleep studies.(O) (R)(O)(O)

The product tier must include this clinical category.

(R)

The insurer is allowed to offer this clinical category on a restricted basis/with limited benefits

(O)

It is optional for the insurer to include the clinical category within the product tier.


What does ‘restricted’ on Basic, Bronze and Silver Hospital Cover mean?

Before you buy Basic, Bronze or Silver Hospital Cover, be aware health insurers are allowed to offer these clinical categories on a ‘restricted basis’:

  • rehabilitation
  • hospital psychiatric services
  • palliative care. 

For Basic Cover, if an insurer covers any of the optional clinical categories, it may do so on a restricted basis.

If a clinical category is covered on a restricted basis, your coverage for treatment in that category is very limited.

Restricted cover means:

  • If you enter a public hospital as a private patient, you are covered.
  • If you enter a private hospital as a private patient, your insurer does not cover costs such as theatre fees and accommodation and your out-of-pocket costs will be high.

If you have restricted cover for a clinical category, always check with your insurer before agreeing to be treated as a private patient in a private hospital.

Here are some examples of how restricted cover works in practice:

Jan has Bronze Hospital Cover, with restricted cover for Rehabilitation

Jan broke her hip and needed a hip replacement. As she did not have Gold Hospital Cover for Joint Replacements, she decided to be treated as a public patient in a public hospital. She now needs Rehabilitation but her Bronze Hospital Cover offers only restricted cover for this clinical category. She speaks to her insurer and discovers that, if she is admitted as a private patient into a private hospital, it will pay only a small amount towards her accommodation fee. She will face considerable out-of-pocket costs.

Fred has Basic Plus Hospital Cover, with restricted cover for Joint Replacements and unrestricted cover for Rehabilitation

Fred needed a knee replacement after a sports injury. As he had restricted cover for Joint Replacements, he decided to be treated as a private patient in a public hospital rather than a private patient in a private hospital. He wanted to avoid the considerable out-of-pocket costs for theatre fees and accommodation if he was admitted as a private patient in a private hospital. As he had unrestricted cover for Rehabilitation, he decided to be admitted as a private patient in a private hospital. The insurer covered most of his costs.


Why should I take out Basic Hospital Cover when the cover is so limited?

You may want to take out Basic Hospital Cover, not because the cover is limited, but because you are classified as a high-income earner. This means you can avoid paying the Medicare Levy Surcharge.

Here is an example of how you might decide to take out Basic Hospital Cover:

Michaela decides to take out Basic Hospital Cover

Michaela is a single woman who has just received a promotion and is now earning $250,000 per year. She does not have Hospital Cover. Her accountant advises her she will have to pay the Medicare Levy Surcharge. He advises her to take out Basic Hospital Cover because, even if it provides very limited coverage, it will be cheaper than paying the Medicare Levy Surcharge. 


Why should I take out Gold Hospital Cover over Basic, Bronze and Silver Hospital Cover?

One of the benefits of Gold Hospital Cover is you are not paying for treatments under any of the clinical categories on a ‘restricted’ basis. 

Unlike most Basic, Bronze or Silver Hospital Cover, if you take a private room or have treatment at a private hospital, you do not pay additional expenses for Rehabilitation, Hospital Psychiatric Services and Palliative Care.

Of course, Gold Hospital Cover is usually much more expensive than the lower tiers.

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