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Trying to get your head around the new health insurance tiers? Wondering if you should opt for a Bronze tier hospital policy instead of Silver or Basic?

Read on to discover everything you need to know about Bronze health insurance.

But first, why do these new tiers exist?

Due to the government reforms, hospital policies must now be categorised into four distinctive tiers: Gold, Silver, Bronze and Basic health insurance, as well as three subset tiers (Basic+, Bronze + and Silver+) from 1 April 2019. However, insurers have until 1 April 2020 to put these changes into place.

Each tier includes cover for a certain number of clinical categories (hospital treatments); higher tiers will cover more hospital treatments.

So, why might you consider opting for Bronze health insurance? Here’s a look at what Bronze policies should include and how they differ to other tiers.

What is Bronze health insurance?

Bronze health insurance is a tier of hospital cover introduced on 1 April 2019 under the new private health insurance reforms. Bronze policies sit between Basic and Silver tiers.

A Bronze tier policy will cover 21 clinical categories (out of 38), which include common hospital treatments such as brain surgery, joint reconstructions, gynaecology services and more. A Bronze policy will pay a benefit towards your hospital treatment as a private patient for the categories included under the cover.

How does Bronze health insurance compare to Silver and Basic?

Bronze level health insurance is the second-lowest level of cover you can choose from out of the four tiers. This means standard Bronze cover will include more benefits for more hospital treatments than a standard Basic policy does, but not as much as a Silver policy. It also means that Bronze policies may cost somewhere in between the price of Basic and Silver policies.

Although it doesn’t cover as many hospital treatments as Silver (which has eight more clinical categories), Bronze still covers a substantial range. As a minimum requirement, a standard Bronze policy will cover what’s included in a Basic policy and also cover hospital treatments under an additional 18 clinical categories (within the scope of cover). Twenty-one categories in total are covered under the Bronze tier.

What does Bronze health insurance cover?

A standard Bronze policy will cover 21 clinical categories (and all the corresponding hospital treatments, within the scope outlined by the Department of Health), as shown below.

Which hospital procedures are covered by Bronze health insurance?

Your Bronze tier policy includes cover for:         
RehabilitationHospital treatment for physical rehabilitation for a patient related to surgery or illness. For example: inpatient and admitted day patient rehabilitation, stroke recovery, cardiac rehabilitation.✔R
Hospital psychiatric servicesHospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders. For example: psychoses such as schizophrenia, mood disorders such as depression, eating disorders and addiction therapy.✔R
Palliative careHospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain.✔R
Brain and nervous systemHospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system. For example: stroke, brain or spinal cord tumours, head injuries, epilepsy and Parkinson’s disease.✔✩
Eye (not cataracts)Hospital treatment for the investigation and treatment of the eye and the contents of the eye socket. For example: retinal detachment, tear duct conditions, eye infections and medically managed trauma to the eye. Cataract procedures are listed separately under ‘Cataracts’, which is only covered in the Gold tier.✔✩
Ear, nose & throatHospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck. For example: damaged ear drum, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer.✔✩
Tonsils, adenoids and grommetsHospital treatment of the tonsils, adenoids and insertion or removal of grommets.✔✩
Bone, joint and muscleHospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system. For example: carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis and bone cancer.✔✩
Joint reconstructionsHospital treatment for surgery for joint reconstructions. For example: torn tendons, rotator cuff tears and damaged ligaments. Joint replacement surgery is listed separately under ‘Joint Replacements’ which is only covered in the Gold tier.✔✩
Kidney and bladderHospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder. For example: kidney stones, adrenal gland tumour and incontinence. Dialysis is listed separately under ‘Dialysis for chronic kidney failure’ which is only covered in the Gold tier.✔✩
Male reproductive systemHospital treatment for the investigation and treatment of the male reproductive system including the prostate.✔✩
Digestive systemHospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel. For example: oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids.✔✩
Hernia and appendixHospital treatment for the investigation and treatment of a hernia or appendicitis. Digestive conditions are listed separately under ‘Digestive system’ above.✔✩
Gastrointestinal endoscopyHospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope. For example: colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP). Non-endoscopic procedures for the digestive system are listed separately under Digestive system above.✔✩
GynaecologyHospital treatment for the investigation and treatment of the female reproductive system. For example: endometriosis, polycystic ovaries, female sterilisation and cervical cancer.✔✩
Miscarriage and termination of pregnancyHospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy.✔✩
Chemotherapy, radiotherapy and immunotherapy for cancerHospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours. Surgical treatment of cancer is listed separately under each body system.✔✩
Pain managementHospital treatment for pain management that does not require the insertion or surgical management of a device. For example: treatment of nerve pain and chest pain due to cancer by injection of a nerve block. Pain management using a device (for example an infusion pump or neurostimulator) is listed separately under Pain management with device.✔✩
SkinHospital treatment for the investigation and treatment of skin, skin-related conditions and nails. For example: melanoma, minor wound repair and abscesses. The removal of foreign bodies is also included. Plastic surgery that is medically necessary and relating to the treatment of a skin-related condition is also included. Removal of excess skin due to weight loss is listed separately under ‘Weight loss surgery’ which is only covered in the Gold tier.✔✩
Breast surgery (medically necessary)Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy. For example: breast lesions, breast tumours, asymmetry due to breast cancer surgery, and gynecomastia. This clinical category does not require benefits to be paid for cosmetic breast surgery that is not medically necessary.✔✩
Diabetes management (excluding insulin pumps)Hospital treatment for the investigation and management of diabetes. For example: stabilisation of hypo- or hyper- glycaemia, contour problems due to insulin injections. Treatment for diabetes-related conditions is listed separately under each body system affected. For example, treatment for diabetes-related eye conditions is listed separately under ‘Eye’.✔✩
✔ = This clinical category is covered.
R = Services and treatments under these clinical categories may be offered on a restricted^ basis.
✩ = These clinical categories are a minimum requirement of the Bronze tier only; they’re not required to be covered under the Basic tier.

Source: Department of Health – Clinical and Product Categories Tables for Hospital Treatment Product Tiers (Accurate as of July 2019)

What isn’t covered under Bronze health insurance plans?

If you purchase a standard Bronze health insurance policy, it won’t include cover for any of the hospital treatments that are included in the Silver or Gold tier; this means you won’t be covered for 17 clinical categories, such as:

  • back, neck and spine (Silver and Gold tiers)
  • blood (Silver and Gold tiers)
  • dental surgery (Silver and Gold tiers)
  • heart and vascular system (Silver and Gold tiers)
  • implantation of hearing devices (Silver and Gold tiers)
  • lung and chest (Silver and Gold tiers)
  • plastic and reconstructive surgery; medically necessary (Silver and Gold tiers)
  • podiatric surgery provided by a registered podiatric surgeon (Silver and Gold tiers)
  • assisted reproductive services (Gold tier)
  • cataracts (Gold tier)
  • dialysis for chronic kidney failure (Gold tier)
  • insulin pumps (Gold tier)
  • joint replacements (Gold tier)
  • pain management with device (Gold tier)
  • pregnancy and birth (Gold tier)
  • sleep studies (Gold tier)
  • weight loss surgery (Gold tier).

Although, you may be able to get cover for one or more of these clinical categories (and respective hospital treatments) through a Bronze Plus policy.

What’s a Bronze Plus policy (and what does it cover)?

In addition to standard Bronze cover, a Bronze Plus policy may offer either a clinical categories or a specific additional procedure that would normally be found in Silver and/or Gold tiers. Bronze Plus health insurance policies typically cost more than standard Bronze policies, and health insurers can choose whether or not they offer this type of policy to their customers. If a fund does offer additional cover, it must be on an unrestricted* basis.

two older women dressed in workout clothes and smiling while exercising outdoors

Who might suit Bronze tier cover?

The Bronze tier is a great base-level cover for Aussies of all ages, as it covers a broad range of hospital treatments. However, its suitability will depend on your circumstances. For example, Bronze health insurance might suit you in the following situations:

  • your health and private hospital cover are important to you, and Bronze health insurance sits within your budget;
  • you’re relatively healthy and don’t have any serious history of illnesses or injuries (if you do, Silver or Gold may be more suitable);
  • you aren’t planning on having children soon and don’t wish to be covered for private birth services;
  • you play sports, have a physical job or live an active lifestyle and may potentially need a joint reconstruction in the future; although, if you require a completely new knee (or other joint), then joint replacements are only found under Gold cover;
  • you’re an Aussie man who wants to be privately covered for prostate cancer, circumcision, or to ‘get the snip’ (vasectomy);
  • you’re an Aussie woman who wants to be privately covered for gynaecology, medically necessary breast surgery, and treatment for breast and cervical cancer;
  • you have diabetes (which affects around 1.7 million Aussies1). Bronze policies can cover you for diabetes management in hospital. That said, if you want cover for your insulin pumps, you may need to upgrade to Gold cover;
  • you require chemotherapy or other therapies for cancer. Keep in mind that Bronze policies will not cover cancer removal surgeries, as these are only minimum requirements for Silver hospital policies and above, and are covered under clinical categories for their respective body parts (heart, lung, blood, back, neck, spinal cancer, etc.).

Is Bronze health insurance worth it?

A Bronze health insurance policy could be worth it if it’s within your budget and you’ll gain comfort from knowing the range of treatments it covers, just in case you need it.

However, if you don’t think you’ll actually need it and are only looking to get hospital cover to avoid the Medicare Levy Surcharge (MLS) or Lifetime Health Cover loading (LHC), then a Basic policy may be more worth it for you.

Also, Bronze health insurance coverage may not be worth it if you need cover for any premium hospital treatments that are only covered under Silver or Gold tiers – unless you can get a Bronze Plus policy that includes this cover.

Can I get a Bronze ‘extras-only’ health insurance policy?

The classification of products in relation to the government reforms only applies to hospital products. This also means extras-only policies can no longer include the name of any metal, gemstone or semi-precious stone in their product name (i.e. Diamond or Platinum extras is no longer allowed).

However, there continues to be a full range of extras policies available, including entry- and mid-level products. Also, some combined policies (hospital and extras) may be named Bronze hospital and extras.

How much does bronze health insurance cost?

The cost of a Bronze health insurance plan will range in price depending on the health fund and what your policy includes. Bronze health insurance generally costs less than Silver or Gold health insurance, but more than Basic health insurance.

However, a Bronze plus policy may cost more than a standard Silver or Gold policy. An easy way to find out how much a Bronze health insurance plan may cost you is to compare policies.


Ready to compare Bronze health insurance? You can easily compare a number of health insurance policies side-by-side in seconds through our health insurance comparison service. Our comparison service will also allow you to select the hospital policies that are important to you and figure out whether Bronze or Silver health insurance (or another tier) could suit you.

Wondering what the other tiers include? Find out more about Gold, Silver and Basic policies.

Glossary

^Restricted cover –this means your insurer will pay part of any private hospital costs against that category. You might have to pay large out of pocket costs.2

*Unrestricted cover – this means your insurer is likely to have an agreement with a hospital. You might not have to pay any out of pocket costs other than any agreed excess or co-payments.3

Sources
  1. Diabetes Australia, About Diabetes
  2. Department of Health – Hospital cover product tiers and clinical categories: How product tiers work. (last updated 23 December 2019)
  3. Ibid.

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