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Top 5 things to know about basic hospital over

1

There are different tiers of hospital cover

Hospital cover policies are available in four tiers, with each one offering different levels of cover

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2

Basic hospital cover is the lowest tier

Basic is the lowest level of hospital cover and is only required to include three restricted clinical categories.

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3

Benefit from taking out hospital insurance before your 31st birthday

Waiting to take out private hospital health insurance for the first time could end up costing you more.

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4

Avoid paying the Medicare Levy Surcharge

Taking out an eligible health insurance policy could help you avoid paying the Medicare Levy Surcharge (MLS).

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5

You could get more than the minimum cover

You may be able to get more clinical categories through a Basic Plus policy, which goes beyond the standard Basic inclusions.

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Written by Joshua Wildie
Reviewed by Tiana Templeman
Expert reviewed by Steven Spicer
Updated 17 June 2025

Expert tips on basic health insurance cover

Our health insurance expert, Steven Spicer, has some tips on basic health insurance and how to choose a hospital insurance tier that works for you.

Steven Spicer
Executive General Manager – Health, Life & Energy

Consider you and your family’s medical history

Whether a basic policy will be enough depends on your needs and what medical services you want to be covered for. To avoid finding yourself underinsured, consider any previous hospital admissions along with your family’s medical history when looking at different levels of cover. Thinking about factors such as your age and lifestyle can help you decide whether you’ll need a higher level of cover.

Pay attention to your waiting periods

There could be waiting periods when you take out health insurance for the first time or are upgrading your policy. Choose the level of cover that suits your needs so you can start serving any waiting periods immediately. Waiting periods for hospital treatment that relates to pre-existing conditions are usually longer, so remember to take this into account as well.

The cheapest basic health insurance option isn’t always best

While it might be tempting to save costs by choosing the cheapest basic hospital cover, this approach may not be the best health insurance choice in the long run. While it will help you avoid paying the Medicare Levy Surcharge at tax time (provided you held eligible hospital cover for the full financial year), even the best basic health insurance won’t provide much cover. Bronze cover doesn’t cost much more, yet it pays benefits towards a lot more procedures than basic cover.

Why do health insurance tiers exist?

To make health insurance easier to understand, the Australian Government introduced private health insurance reforms in 2019, which required health funds to categorise their hospital products into four different tiers: Basic, BronzeSilver and Gold.

The tiers are classified by how many clinical categories they cover (each clinical category includes certain hospital treatments), with higher tiers including more clinical categories than the lower ones. In order to meet the classification, the product must include all of the clinical categories required for that tier (e.g. if a policy does not include ‘brain and nervous system’ or ‘joint reconstructions’ as a minimum category inclusion it can’t be classified as bronze).

Insurers can also offer ‘plus’ or ‘+’ tiered policies, which include some of the categories of a higher-level tier but not enough to enter that tier (e.g. a Basic plus policy might include ‘brain and nervous system’ and ‘joint reconstructions’ but none of the other categories that are a minimum requirement for a bronze policy).

What is Basic private health insurance

Basic health insurance is the lowest level of hospital cover a fund can offer. These policies will have limited features and the most exclusions. Basic hospital cover is only required to include restricted cover^, for hospital psychiatric services, rehabilitation and palliative care as a private patient in a public hospital.

This means you are only covered to a very limited extent. To give you an idea of how limited the cover is, a Bronze policy has a minimum requirement of 18 unrestricted clinical categories. If you want a policy that includes a broader range of services without breaking the bank on premiums, consider comparing Basic Plus and Bronze tiered policies using our free health insurance comparison tool.

Inclusions and exclusions

What does Basic hospital cover include?

What is a Basic Plus policy and what does it cover?

What is not included on a Basic health insurance policy?

Choosing your tier

Who might suit Basic tier cover?

Is Basic health insurance worth it?

What does Basic health insurance cost?

Can I get a Basic level of extras-only health insurance?

Meet our health insurance expert, Steven Spicer

Steven Spicer
Executive General Manager – Health, Life & Energy

As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.

^ Restricted cover – this means you’re covered as a private patient in a public hospital. It also means that if you go to a private hospital as a private patient, you’ll only receive a small benefit towards your accommodation fee, and you won’t receive any benefits at all towards your theatre fees. As a result, you will have to pay substantial out-of-pocket costs.

* Unrestricted cover – this means you’re covered for your theatre and accommodation fees as a private inpatient in a private hospital or a private day hospital facility. It also means you’re covered up to the Medicare Schedule of Fees (MBS) for clinical categories included as unrestricted on your policy. This level of cover 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 available beds.