Trying to decide if Basic hospital insurance is enough, or if you should opt for Bronze, Silver or Gold tiers? We’ll take you through everything you need to know about Basic health insurance in Australia.
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, Bronze, Silver and Gold.
The tiers are classified by how many clinical categories they cover (each clinical category includes certain hospital treatments), with higher tiers covering 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).
Basic health insurance is the lowest level of hospital cover a fund can offer. These policies will have limited features and the most exclusions, but offer basic hospital cover, known as restricted cover ^, for hospital psychiatric services, rehabilitation and palliative care as a private patient in a public hospital.
This means that you are only covered to a very limited extent. If you want to be fully covered for a broader range of services with breaking the bank on premiums, consider comparing some Basic plus and Bronze tiered policies through our free comparison tool.
Basic health insurance policies will include (at a minimum) restricted^ hospital cover for the following three clinical categories:
In some states, Basic level hospital policies may also come with ambulance cover, which can pay towards emergency ambulance services if your state government does not already cover you.
Compared to higher tiers, Basic health cover in Australia covers the fewest hospital treatments.
A standard Basic policy is only required to include restricted^ private hospital cover for three clinical categories out of 38 total. This is 18 fewer clinical categories than the Bronze tier and 26 fewer than the Silver tier. Meanwhile, Gold tier policies cover you for all 38 clinical categories.
If you want to be covered for more hospital treatments but don’t want a higher tier policy, you may be able to find a health fund that offers the treatments you want on their Basic Plus policy.
If a health fund chooses, they can offer Basic Plus or + policies, which cover more than a standard Basic health cover policy. Basic Plus policies can include additional restricted^ or unrestricted* Basic hospital cover for one or more of the 35 clinical categories that are usually only found in higher-tiered policies.
However, this means a Basic Plus policy may cost more than a standard Basic policy. Depending on your health insurance needs it may be better to consider a Bronze tier policy which could be better value for money than a basic plus policy in some circumstances.
| Clinical categories | Is it covered? |
| Rehabilitation (restricted^) | ✔ |
| Hospital psychiatric services (restricted^) | ✔ |
| Palliative care (restricted^) | ✔ |
| Brain and nervous system | X |
| Bone, joint and muscle | X |
| Breast surgery | X |
| Chemotherapy, radiotherapy and immunotherapy for cancer | X |
| Diabetes management (excluding insulin pumps) | X |
| Digestive system | X |
| Ear, nose and throat | X |
| Eye (not cataracts) | X |
| Gastrointestinal endoscopy | X |
| Gynaecology | X |
| Hernia and appendix | X |
| Joint reconstructions | X |
| Kidney and bladder | X |
| Male reproductive system | X |
| Miscarriage and termination of pregnancy | X |
| Pain management | X |
| Skin | X |
| Tonsils, adenoids and grommets | X |
| Back, neck and spine | X |
| Blood | X |
| Dental surgery | X |
| Heart and vascular system | X |
| Implantation of hearing devices | X |
| Lung and chest | X |
| Medically necessary plastic and reconstructive surgery | X |
| Podiatric surgery provided by a registered podiatric surgeon | X |
| Assisted reproductive services | X |
| Cataracts | X |
| Dialysis for chronic kidney failure | X |
| Insulin pumps | X |
| Joint replacements | X |
| Pain management devices | X |
| Pregnancy and birth | X |
| Sleep studies | X |
| Weight loss surgery | X |
A Basic tier policy would suit those who are taking out hospital cover purely to avoid the Medicare Levy Surcharge (MLS) or Lifetime Health Cover loading (LHC). For example, it may suit higher income earners, who are happy to rely on Medicare (Australia’s universal health care system) for their hospital care.
Basic level health insurance policies are the lowest level of hospital cover a fund can offer, which means Basic health insurance in Australia may be worth it if:
However, as it has limited benefits, Basic hospital cover may not be worth it if you require cover for additional hospital treatments. If this is the case, a Basic Plus, Bronze or even a higher tier may be more worthwhile.
The government reforms regarding the classification of health insurance only apply to hospital products. However, there continues to be a full range of extras cover options available, including entry-level products. Lower-level extras policies usually come with lower annual limits and higher out-of-pocket expenses. Because of this, you might actually save more on a higher level of extras cover, depending on how often you take advantage of the services offered to you.
Although, it’s worth noting that extras-only policies can’t include the name of any metal, gemstone or semi-precious stone in their product name (e.g. Diamond or Platinum extras are no longer allowed). However, some combined policies (hospital and extras) may be named Basic hospital cover and extras.
The base premium of a Basic health insurance plan will depend on your state, which health fund you’re with and what’s included in your policy. Basic health insurance policies will generally cost less than higher tiers (e.g. Bronze, Silver or Gold health insurance), as it typically covers fewer hospital treatments.
However, if you have a Basic Plus hospital policy, it may cost more than higher tiers. A simple way to find out how much a Basic health insurance plan might cost is to compare policies online.
If you use our health insurance comparison service, you can easily compare a variety of health insurance policies side-by-side in minutes. Our comparison service will also allow you to filter limited hospital cover, helping you find Basic hospital cover more easily.
Think you’ll need more than a Basic policy? Check out the other health insurance tiers.
^ 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 patient 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 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.
