Bronze health insurance policies
Why do health insurance tiers exist?
In 2019, the government introduced private health insurance reforms that required all hospital policies in Australia to be categorised into four distinct tiers: Basic, Bronze, Silver and Gold, as well as three subset tiers (Basic+, Bronze+ and Silver+).
Each tier includes a certain number of clinical categories. A higher level of cover will include more clinical categories and a broader range of hospital treatments.
What is Bronze hospital cover?
A Bronze tier policy includes 18 of the 38 clinical categories, which include common inpatient hospital treatments such as brain and nervous system, joint reconstructions, gynaecology services and more. In addition, Bronze hospital policies must include restricted cover^ for in-hospital psychiatric services, in-hospital rehabilitation and palliative care.
Bronze hospital cover will pay a benefit towards your hospital treatment as a private inpatient in a private or public hospital for the categories included on your policy, as well as other hospital costs like your accommodation, theatre fees and any approved prostheses.
When you’re treated in a private hospital as a private patient, you’ll have access to a private room (subject to availability) and your choice of an available doctor. Between Medicare and your health fund, you’ll be covered for 100% of the Medicare Benefits Schedule (MBS) fee; however, if your doctor sets their fees above the MBS, you could have out-of-pocket expenses. This difference is called ‘the gap’ and can potentially be avoided or reduced if you’re treated in an agreement hospital by a doctor that participates in your fund’s no-gap or known-gap scheme.
Expert tips on Bronze health insurance
Our health insurance expert, Steven Spicer, knows how important it is to get hospital insurance that works for you and your family, which is why he’s put together these tips on how to choose your hospital policy tier.
Steven Spicer
Executive General Manager – Health, Life & Energy
Keep your waiting periods in mind
If you’re new to health insurance or upgrading your level of cover, you’ll be required to serve waiting periods before you can make any claims on your hospital cover. Therefore, it might be a good idea to take out cover before you think you’ll need it.
Consider your medical needs
When comparing hospital cover, it can be difficult to know which policy or fund is most suitable for you. It can be helpful to consider factors such as your current needs, what you may need in the near future, lifestyle factors (e.g. risk of sporting injuries), family history or your preferred hospital.
Cheaper isn’t necessarily better
While it may be tempting to take out a lower level of cover to save money on premiums, it’s important to consider what you may be missing out on as a result. It’s also helpful to remember that you can change your level of cover at any time, so you can upgrade or downgrade as your needs change (you may just need to serve waiting periods on any upgrades).
Inclusions and exclusions
What does Bronze health insurance cover?
A standard Bronze policy will include 18 clinical categories (and all the corresponding hospital treatments within the scope outlined by the Department of Health), as shown below. Bronze hospital policies must include restricted cover^ for in-hospital psychiatric services, in-hospital rehabilitation and palliative care.
You may also be able to claim a benefit on emergency ambulance services if your policy includes ambulance cover and you live in a state where ambulance services aren’t covered by your state government (e.g. NSW, VIC and SA).
| Minimum requirements for a Bronze tier policy: | |
|---|---|
| Rehabilitation (✔R) | Hospital treatment for physical rehabilitation related to surgery or illness. For example, inpatient and admitted day patient rehabilitation, stroke and cardiac recovery. |
| Hospital psychiatric services (✔R) | Hospital treatment for patients with psychiatric disorders. For example, psychoses such as schizophrenia, mood disorders such as depression, eating disorders and addiction therapy. |
| Palliative care (✔R) | Hospital treatment to provide quality of life improvements for a patient with a terminal illness by alleviating or managing pain. |
| Brain and nervous system (✔✩) | Hospital treatment for the investigation and treatment of brain-related conditions and the spinal cord and peripheral nervous system. For example, Parkinson’s disease, strokes, head injuries, epilepsy and brain or spinal cord tumours. |
| Eye (not cataracts) (✔✩) | Hospital treatment for the investigation and treatment of the eye and the contents of the eye socket. For example, tear duct conditions, eye infections and retinal detachment. Cataract procedures are listed separately under ‘Cataracts’, which is only covered by Gold hospital policies. |
| Ear, nose and throat (✔✩) | Hospital treatment for the investigation and treatment of the ear, nose, throat, thyroid, larynx, middle ear, parathyroid, lymph nodes and related areas of the head and neck. For example, damaged eardrums, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer. |
| Tonsils, adenoids and grommets (✔✩) | Hospital treatment for the tonsils and adenoids, including the insertion or removal of grommets. |
| Bone, joint and muscle (✔✩) | Hospital treatment for the investigation and treatment of disorders, diseases and injuries to the musculoskeletal system. For example, hand surgery, joint fusion, carpal tunnel, fractures, bone spurs, osteomyelitis and bone cancer. |
| Joint reconstructions (✔✩) | Hospital treatment for surgery for joint reconstructions. For example, torn tendons, rotator cuff and ligament damage. Joint replacement surgery is a separate clinical category, which is only required to be included in Gold tier policies. |
| Kidney and bladder (✔✩) | Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder. For example, adrenal gland tumours, kidney stones and incontinence. Dialysis is listed separately under ‘Dialysis for chronic kidney failure’, which is only required to be included in the Gold tier. |
| Male reproductive system (✔✩) | Hospital treatment for the investigation and treatment of the male reproductive system, including the prostate. |
| Digestive system (✔✩) | Hospital treatment for the investigation and treatment of the digestive system, including the stomach, oesophagus, gall bladder, spleen, pancreas, liver and bowel. For example, irritable bowel syndrome, oesophageal cancer, gall stones and haemorrhoids. |
| Hernia and appendix (✔✩) | Hospital treatment for the investigation and treatment of a hernia or appendicitis. |
| Gastrointestinal endoscopy (✔✩) | Hospital treatment for the diagnosis, investigation and treatment of the gastrointestinal system using an endoscope. For example, colonoscopy, gastroscopy and endoscopic retrograde cholangiopancreatography (ERCP). Non-endoscopic procedures for the digestive system are listed separately under ‘Digestive system’. |
| Gynaecology (✔✩) | Hospital treatment for the investigation and treatment of the female reproductive system. For example, polycystic ovaries, endometriosis, female sterilisation and cervical cancer. |
| Miscarriage and termination of pregnancy (✔✩) | Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy. |
| Chemotherapy, radiotherapy and immunotherapy for cancer (✔✩) | Hospital treatment for chemotherapy, immunotherapy and radiotherapy for the treatment of cancer or benign tumours. Surgical treatment of cancer is listed separately under each body system. |
| Pain management (without a device) (✔✩) | Hospital treatment for pain management that doesn’t require a medical device; for example, treatment of nerve and chest pain by injection of a nerve block. Pain management using a device (e.g. an infusion pump or neurostimulator) is listed separately under ‘Pain management with device’, which is only required to be included in the Gold tier. |
| Skin (✔✩) | Hospital treatment for the investigation and treatment of skin and nail-related conditions like melanoma, minor wound repair and abscesses. The removal of foreign bodies and medically necessary plastic surgery related to 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 required to be covered by the Gold tier. |
| Breast surgery (medically necessary) (✔✩) | Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes. and. For example, breast lesions, breast tumours, asymmetry due to breast cancer surgery and gynecomastia. This also includes reconstruction/reduction following breast surgery or a preventative mastectomy. |
| Diabetes management (excluding insulin pumps) (✔✩) | Hospital treatment for the investigation and management of diabetes. For example, stabilisation of hypo- or hyper-glycaemia. Treatment for diabetes-related conditions is listed separately under each body system affected (e.g. treatment for diabetes-related eye conditions is listed separately under ‘Eye’). Insulin pumps are also listed as a separate clinical category, which is only required to be covered by the Gold tier. |
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✔ = This clinical category is included as a minimum requirement. R = You may only be covered for restricted services^ and treatments under these clinical categories. Source: Privatehealth.gov – Clinical categories. Accessed May 2024 |
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What’s not included on Bronze health insurance?
If you purchase a standard Bronze health insurance policy, you won’t have access to the hospital treatments from the higher tiers. This means you won’t be covered for these clinical categories:
- 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)
- Medically necessary plastic and reconstructive surgery (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 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 cover for additional clinical categories that would normally only be found on Silver and 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 inclusions, it must be on an unrestricted* basis.
Choosing your health insurance tier
How does Bronze hospital cover compare to the other tiers?
Bronze hospital insurance is the second lowest level of cover you can choose out of the four hospital tiers. This means standard Bronze hospital cover will include benefits for more hospital treatments than a standard Basic policy, but not as many as a standard Silver or Gold policy. It also means that Bronze policies will likely cost somewhere between a Basic and Silver policy.
Although Bronze doesn’t include as many hospital treatments as Silver (which includes eight more clinical categories), Bronze still includes a substantial range. A Bronze hospital policy can therefore provide many customers with a suitable and affordable level of cover.
Who might suit Bronze tier cover?
The Bronze tier is a great base-level cover for Australians of all ages, as it includes 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:
- You’re relatively healthy and don’t have any pre-existing conditions that would require a Silver or Gold policy.
- You aren’t planning on having children within the next 12-18 months and don’t need to include private birth services on your policy.
- You play sports, have a physical job or live an active lifestyle and may potentially need a joint reconstruction in the future. If you require a completely new joint, joint replacements are classified as a Gold tier clinical category, but may be available on some Silver+ policies.
- You’re a man who wants inpatient treatment for prostate cancer, circumcision or a vasectomy included on their policy.
- You’re a woman who wants inpatient gynaecology, medically necessary breast surgery and treatment for breast and cervical cancer included on their policy.
- You have diabetes and want to include diabetes management in hospital on your policy. However, if you want to include insulin pumps, you may need to upgrade to Gold or Silver+ cover.
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 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), a Basic policy may be better value for you.
Also, Bronze health insurance coverage may not be worth it if you would like to include clinical categories for hospital treatments that are only mandatory under Silver or Gold tiers – unless you can get a Bronze Plus policy that includes this cover.
How much does Bronze health insurance cost?
The cost of a Bronze health insurance plan will vary 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.
Your premiums could also be lower if you qualify for the Australian Government rebate, which you can claim as a reduced premium or through your yearly tax return. The price of your policy can also be impacted by an age-based discount or Lifetime Health Cover loading, depending on your age when you took out the policy.
Can I get a Bronze extras health insurance policy?
The classification of products in relation to the government reforms only applies to hospital products. This also means extras cover don’t include the name of any metal, gemstone or semi-precious stone in their product name (e.g. ‘diamond’ or ‘platinum’ extras aren’t allowed).
However, there’s still a full range of extras policies available, including entry, mid and high-level products. Also, some combined policies (hospital and extras) may be named Bronze hospital and extras.
Meet our health insurance expert, Steven Spicer
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.
Want to know more about health insurance?
^Restricted cover –this means your insurer will only pay part of any private hospital costs against that category. You might have to pay large out-of-pocket costs.
*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.