A standard Basic private health insurance policy isn’t required cover any of the additional 35 clinical categories (and corresponding hospital treatments) that are included under Bronze, Silver or Gold tiers. However, basic hospital coverage for one or more of these clinical categories can be included in a Basic Plus policy, if a health fund chooses to offer it.
|Clinical categories||Basic tier||Bronze tier||Silver tier||Gold tier|
|Brain and nervous system||X||✔||✔||✔|
|Bone, joint and muscle||X||✔||✔||✔|
|Chemotherapy, radiotherapy and immunotherapy for cancer||X||✔||✔||✔|
|Diabetes management (excl. insulin pumps)||X||✔||✔||✔|
|Ear, nose & throat||X||✔||✔||✔|
|Eye (not cataracts)||X||✔||✔||✔|
|Hernia and appendix||X||✔||✔||✔|
|Kidney and bladder||X||✔||✔||✔|
|Male reproductive system||X||✔||✔||✔|
|Miscarriage and termination of pregnancy||X||✔||✔||✔|
|Tonsils, adenoids and grommets||X||✔||✔||✔|
|Back, neck and spine||X||✔||✔|
|Heart and vascular system||X||✔||✔|
|Implantation of hearing devices||X||✔||✔|
|Lung and chest||X||✔||✔|
|Plastic and reconstructive surgery (medically necessary)||X||✔||✔|
|Assisted reproductive services||X||✔|
|Dialysis for chronic kidney failure||X||✔|
|Pain management with device||X||✔|
|Pregnancy and birth||X||✔|
|Weight loss surgery||X||✔|
If you use our health insurance comparison service, you can easily compare a variety of health insurance policies side-by-side in seconds. Our comparison service will also allow you to filter limited hospital cover, helping you more easily find Basic hospital cover.
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. Having 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 beds available.