Private health insurance reforms: Gold/Silver/Bronze/Basic product tiers

A new system for categorising hospital products will be introduced from 2019.

Page last updated: 11 October 2018

Private health insurance reforms: Gold/Silver/Bronze/Basic product tiers (PDF 272 KB)

  • Hospital products will be simplified for consumers by creating easily understood tiers of cover.
  • There will be four tiers of hospital products – Gold, Silver, Bronze and Basic (see attached product tiers table).
  • These product tiers will be introduced from 1 April 2019 and insurers have until 1 April 2020 to adopt the tiers for all products. The requirements for each product tier are minimum standards. Insurers will be able to offer additional coverage in Basic, Bronze and Silver tiers. If insurers already provide additional coverage in low and mid-level products, the new categories do not require insurers to reduce that coverage.
  • Minimum requirements for each tier of cover are outlined in the Private Health Insurance (Reforms) Amendment Rules 2018.

Why is this important?

  • Private health insurance is an important issue to many Australians, with 55 per cent of the population covered by some form of private health insurance.
  • The Government’s consultations revealed that consumers find hospital insurance products complex and difficult to understand.
  • Consumers face difficulty in trying to compare private hospital insurance products. They also find it difficult to understand what services different products do, and do not, cover.

Who will benefit?

  • The new product tiers will give consumers greater certainty about the services covered by each type of hospital treatment product.
  • The changes will make it easier to shop around and compare different hospital treatment products to find one that meets individual needs.
  • The changes will particularly benefit women with breast cancer, as all medically necessary breast surgery will be included in all Bronze tier hospital treatment products and above. Women will also have access to gynaecology in these products.

What impact will this change have on private health insurance?

This change is designed to help consumers compare different hospital treatment products more easily and shop around for a better deal.

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