Private health insurance reforms: Transition to the new Gold/Silver/Bronze/Basic hospital product tiers

From 1 April 2019 hospital insurance products will be categorised into Gold, Silver, Bronze or Basic product tiers.

Page last updated: 11 October 2018

Private health insurance reforms: Transition to the new Gold/Silver/Bronze/Basic hospital product tiers (PDF 237 KB)

  • The new tiers will help consumers understand their private health insurance and make it easier for them to shop around for a better deal.
  • For the first time the new gold, silver, bronze and basic classifications will set minimum standards for the hospital services to be covered under each tier.
  • The new silver plus [+], bronze plus [+] and basic plus [+] categories will mandate that insurers are able to offer products with cover above the minimum requirements. This will allow insurers to effect minor upgrades to policies that include restrictions or exclusions to ensure that consumers continue to enjoy the same level of cover.
  • These product tiers will be introduced from 1 April 2019 and insurers have until 1 April 2020 to adopt the tiers for all products.

For consumers

  • The Government’s consultations on private health insurance reforms revealed that consumers find hospital insurance products complex and difficult to understand and compare.
  • Importantly the reforms will deliver consumers much clearer information. Insurers can provide a one page statement to consumers on their cover, so that they are able to understand what they are and what they are not covered for.
  • The new product tiers are specifically designed so that the majority of existing policies are able to migrate into the new product tiers.
  • The Government has mandated that insurers are able to offer basic plus [+], bronze plus [+] and silver plus [+] policies. This will allow insurers to migrate the majority of existing policies to the new categories and minimise changes for consumers

New consumer protections

  • To ensure that consumer’s rights are protected through the transition, the reforms strengthen the powers and resources of the Private Health Insurance Ombudsman to protect consumers’ interests.
  • The Private Health Insurance Ombudsman is able to conduct inspections or audits at insurers’ premises to verify accuracy of information. Private health insurers have consistently and actively provided access to the Ombudsman investigating officers to verify the accuracy of information and this is expected to continue. The additional powers will give consumers further confidence that the Ombudsman has access to all relevant information.

For medical professionals

  • The changes will ensure that private health insurers are able to maintain existing cover of products for policy holders through introducing basic plus [+], bronze plus [+] and silver plus [+] categories.
  • The product tiers will be reviewed after two years to ensure that they are operating as planned.
  • Following significant consultation and detailed analysis the Private Health Ministerial Advisory Committee (which includes representatives of the AMA, College of Surgeons, Consumer Health Forum, and private health insurers and hospitals) has recommended a gold, silver, bronze and basic classification and plus categories as an important measure to improve consumer knowledge of private health insurance.

For private health insurers

  • The introduction of a new Private Health Insurance Statement will replace the current Standard Information Statement insurers are required to provide, and offer more flexibility for insurers to provide information that is relevant and personalised for their consumers.
  • While the new gold, silver, bronze and basic classification sets minimum standards, the rules mandate that private health insurers are able to offer additional coverage under each category to meet the needs of their consumers, consistent with the way they do currently.
  • If insurers already provide additional coverage in low and mid-level products, the new categories do not require insurers to reduce that coverage and ensure that current policies with restrictions, part cover or exclusions are able to be upgraded to higher cover.