Private Health Insurance Tiers

Compare different tiers of private hospital insurance and find out what each of them covers with Savvy today.

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, updated on July 10th, 2023       

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Health Insurance Banner - Nurse sitting at the front desk at a hospital taking a patient's card

The Australian Government made it easier to compare private hospital insurance policies when it introduced compulsory tiers of cover in April 2019. The tiers became mandatory from 1 April 2020, allowing Aussies to easily compare hospital cover policies. 

Savvy can help you choose the appropriate tier for your private health insurance by enabling you to compare between different health funds. Just by answering a few simple questions about your health insurance needs, you can have a range of quotes from our trusted panel of Australian insurers. Get your health insurance needs sorted out here through Savvy today!

What are the private health insurance tiers?

The new health insurance laws introduced by the Australian Government in 2019 stipulate that hospital cover must be provided with each of four levels or ‘tiers’ of cover: basic, bronze, silver and gold.

Therefore, all policies at a certain level must include cover for a set number of clinical categories, making it easier to compare. 

Basic Tier

A basic tier hospital policy only offers cover for three clinical categories, and even these areas can be offered on a restricted cover basis.

What is restricted cover?

Restricted cover means you may be covered for hospital costs as a private patient in a public hospital. However, there may still be significant costs if you wish to be treated as a private patient in a private hospital. The cover offered at a basic tier level includes:

  • Rehabilitation
  • Hospital psychiatric services
  • Palliative care

Bronze Tier

The cover offered at a bronze tier level includes those offered by basic cover (with restricted limits) plus the following additional categories when admitted to a private hospital: 

  • 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 
  • Gynaecology 
  • Miscarriage and termination of pregnancy 
  • Chemotherapy, radiotherapy and immunotherapy for cancer 
  • Pain management 
  • Skin 
  • Breast surgery (medically necessary) 
  • Diabetes management (excluding insulin pumps) 

Silver Tier 

The cover offered at a silver tier level includes all those offered by basic and bronze cover (including restricted limits) plus the following additional categories:

  • Heart and vascular system 
  • Lung and chest 
  • Blood 
  • Back, neck and spine 
  • Plastic and reconstructive surgery (medically necessary) 
  • Dental surgery 
  • Podiatric surgery (provided by a registered podiatric surgeon) 
  • Implantation of hearing devices

Gold Tier 

Gold tier is the top level of cover available, and includes cover for all clinical categories available in Australia. It includes all treatments offered at a basic, bronze and silver tier level with no restricted limitations, plus the following additional categories:

  • Cataracts 
  • Joint replacements 
  • Dialysis for chronic kidney failure 
  • Pregnancy and birth 
  • Assisted reproductive services 
  • Weight loss surgery 
  • Insulin pumps 
  • Pain management with a device 
  • Sleep studies

What are ‘plus’ policies? 

These four mandated tiers tell insurers what they must offer as a minimum with a certain level of hospital cover, which makes policy comparisons easy. However, offering additional clinical categories at any level is optional. What this means is that a provider can offer a tier policy ‘plus’, which refers to categories it offers on an optional basis.  

For example, a silver tier policy does not have to offer pregnancy and birth cover, but some health funds may offer a ‘silver plus’ policy with pregnancy and birth services offered on top of the required minimum coverage.   

Each fund can choose if it offers ‘plus’ policies and what those additional categories are. In this way, health funds can offer a variety of policies geared towards different demographics of customers. 

How do I compare private health insurance policies to find the right tier?

These are some aspects of health insurance policies to consider when deciding which tier may be the right one for your needs: 

What areas of health treatment do you need cover for?

Think about your existing medical needs and pre-existing conditions and use these as a guide to the areas of cover you may require in the future. For example: 

  • if you are an keen netballer or footballer, you may consider bone, joint and muscle cover (plus joint reconstruction) important, in case you require a knee reconstruction. If this is the case, either a bronze, silver or gold policy could provide the cover you’re looking for  
  • if you injured your back playing sport as a youngster, you may be aware that surgery could be required in the future. If so, only silver and gold policies offer cover for the back, neck and spine 
  • if you’ve been trying to get pregnant for some time, you may wish to look at cover which includes assisted reproductive services, such as IVF. This cover may only be offered with a gold tier policy 

What you can afford

Now that you’ve identified what your priorities are for health cover, think about your budget. The cost of any policy increases with the level of coverage offered, so a bronze policy will be cheaper than a gold policy. Consider the additional areas of cover offered by bronze, silver and gold tiers and think which of these additional areas of cover may be worth you upgrading for.  It's also crucial to compare like policies side-by-side, as this can help you determine which is the most affordable while offering the cover you're looking for.

Excess and co-payments

These are payments which you may have to make up-front if you need to be admitted to hospital and wish to make a claim on your policy. Excess payments range from zero to $750 for a single person and $1,500 for couples and families. The higher the excess you’re prepared to pay, the lower your ongoing premiums may be. The same applies to co-payments. These are contributions you may be required to pay to assist with the cost of a hospital stay. Compare these out-of-pocket expenses and consider whether you could afford to pay them if you have to make a claim.  

Other areas for consideration when comparing policies: 

  • Waiting periods – you may have to serve additional waiting periods if you upgrade your policy to the next level 
  • Bonus and special offers – special offers can include free weeks of cover or waived waiting periods, although these are more common with extras policies than with hospital cover policies 
  • Combined policies – some funds offer a combined hospital and extras policy with both types of insurance bundled together. These may be cheaper than paying for two separate policies 
  • Ambulance cover – this is often offered along with hospital cover, so check if you need ambulance cover in your state or territory 

What are the private health insurance rebate income tiers?

The Australian Government assists with the cost of paying for your private health insurance. This is in the form of a private health insurance rebate. However, this rebate is income-tested, so the amount of rebate you may be entitled to will depend on your taxable income that financial year. These are the income tiers which will determine how much private health insurance rebate you can claim: 

Private Health Insurance Rebate Income Tiers for those aged under 65* 

Taxable Income Rebate
Single
Up to $90,000
24.608%
Family
Up to $180,000
24.608%
Single
$90,001 to $105,000
16.405%
Family
$180,001 to $210,000
16.405%
Single
$105,001 to $140,000
8.202%
Family
$210,001 to $280,000
8.202%

For singles earning over $140,000, or couples or families earning over $280,000, no private health insurance rebate is available. The family threshold increasesby $1500 for each child after the first.

*Correct as of May 2023, but subject to change. Check with the ATO if you're unsure.

Frequently asked questions about private health insurance tiers

Will I have to re-serve waiting periods if I increase my tier of hospital cover?

You may have to serve waiting periods for those areas of cover that you haven’t previously had if you upgrade your hospital cover to a higher tier. However, once you’ve served a waiting period for an area of clinical cover, you may not have to re-serve it if you increase the level of your cover.  

What medical treatments aren’t included under any tier of hospital cover?

There are certain treatments that aren’t covered by any level of hospital cover health insurance. These include: 

  • Medical treatments which are not considered medically necessary 
  • Tattoo removal 
  • Breast reduction or augmentation (for cosmetic reasons)  
  • Face lifts 
  • Tummy tucks
  • Most other cosmetic surgery 
  • X-rays, MRI and CT scans performed when you're an outpatient 
  • GP visits (for which part of the cost is covered by Medicare) 
Do ‘plus’ policies always include coverage for pregnancy?

No – the ‘plus’ in a policy doesn’t always refer to additional cover for pregnancy and birth, particularly if you’re looking at lower-level policies. It simply indicates it offers more than the government-regulated minimum coverage for that specified level or tier.

Which tier of hospital cover do I need to avoid the Medicare Levy Surcharge?

Any hospital cover policy offered in Australia with an excess of $750 or less for a single, or $1,500 for a couple or family, will be sufficient health cover to mean you don’t have to pay the Medicare Levy Surcharge for the period you hold that private cover. This means for singles who earn a high income, you may consider a private health insurance policy worth having just to avoid the surcharge. 

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