How do hospital cover levels work in Australia?
In shortPrivate hospital cover in Australia is standardised into 4 tiers (levels) that all health funds have to follow, and where gold level gives you the most cover. |
On this page
- Private hospital cover levels explained
- What do clinical categories mean?
- How to choose the right level of cover
Australia has 4 tiers of private hospital cover; Basic, Bronze, Silver, and Gold.
Each level must cover a minimum number of clinical categories (treatments and services like surgery/chemotherapy) to use one of the 4 names listed above.
Those 4 levels and the clinical categories covered in each are set by the Federal Government to make it easier for people to know what they're covered for.
What are the private hospital cover levels?
If you're still unsure what each level covers you for, here's a quick summary of each.
Basic hospital cover
The lowest level hospital cover you can purchase is called ‘Basic’ and it covers these categories on a restricted basis;
- Rehabilitation
- Hospital psychiatric services
- Palliative care
Key point – Restricted basis means you're partially covered for hospital costs as a private patient in a public hospital.
You may incur significant expenses in a private room or private hospital.
Bronze hospital cover
Bronze is a lower-level hospital cover with limited clinical inclusions, and includes the same restricted benefits as the Basic tier.
It includes unrestricted hospital cover for 18 clinical categories.
Unrestricted cover refers to being covered for your theatre and accommodation fees as a private patient in a private hospital or a private day hospital facility,
It also refers to being covered up to the Medicare Benefit Schedule (MBS) for clinical categories included as unrestricted on your policy.
It allows you to choose the available doctor who treats you, provided your doctor has an arrangement with the hospital you want to be treated at, and the hospital you have chosen has beds available.
Silver hospital cover
Silver hospital cover has a wider range of clinical inclusions than Basic and Bronze.
It includes the same clinical categories as Bronze policies, as well as 8 additional on an unrestricted basis.
Gold hospital cover
Gold is the highest level of hospital cover. Gold hospital cover must include unrestricted cover for all clinical categories (38 clinical categories in total).
This top-level cover is what Police Health specialises in. Our Gold Hospital cover also has no excess and no co-payments*.
Clinical categories explained
Clinical categories are groups of hospital treatments set by the Australian Government to standardise what health insurance covers.
What a clinical category means
Each category represents a type of treatment, such as pregnancy and birth or joint replacements.
How categories determine what’s covered
If a category is included in your cover, you’re covered for treatments in that category. If it’s not, you may want to consider upgrading your cover.
How to choose the right level of cover
This always depends on your health needs, future treatments and balancing that against cost.
Gold hospital cover includes all clinical categories without exclusions, so it can reduce the chance of needing to upgrade later.
It also provides the greatest certainty that you will be covered for any future healthcare needs, even if your circumstances change.
For some people, that added peace of mind makes gold cover the right choice.
*All benefits may be subject to Waiting Periods, Limits and other conditions. Providers must be recognised by us. Review the cover tables on the Combined, Hospital and Extras pages, and your State Premium and Benefit Guide or contact us for more information.