Trying to get your head around the 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 tiers exist?
In 2019, the government introduced private health insurance reforms that required all hospital policies in Australia to be categorised into four distinctive tiers: Basic, Bronze, Silver and Gold, as well as three subset tiers (Basic+, Bronze + and Silver+).
Each tier includes cover for a certain number of clinical categories. A higher level of cover will include more clinical categories and, therefore, a broader range of hospital services.
So, why might you consider opting for Bronze health insurance? Here’s a look at what Bronze policies should include and how they differ from other tiers.
What is Bronze hospital cover?
Bronze health insurance is the second tier of hospital cover and sits between the Basic and Silver tiers.
A Bronze tier policy covers 18 of the 38 clinical categories, which includes common hospital treatments such as brain surgery, 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 patient 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 and your choice of doctor (subject to availability). Between Medicare and your health fund, you’ll be covered for 100% of the Medicare Benefits Schedule (MBS) fee, although you may still have some out-of-pocket expenses if your doctors or the hospital charge above the MBS fee. This difference is called ‘the gap’ and can potentially be avoided if you’re treated in an agreement hospital that participates in your fund’s no-gap scheme.
How does Bronze hospital cover compare to the other tiers?
Bronze hospital insurance is the second lowest level of cover you can choose from 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 cover as many hospital treatments as Silver (which includes eight more clinical categories), Bronze still covers a substantial range. A Bronze hospital policy can therefore provide many customers with a suitable and affordable level of cover.
What does Bronze health insurance cover?
A standard Bronze policy will cover 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 covered for emergency ambulance services if your policy includes ambulance cover and you live in a state where ambulance services aren’t fully covered by your state government (e.g. NSW, VIC and SA).
|Your Bronze tier policy includes cover for:|
|Rehabilitation||Hospital treatment for physical rehabilitation related to surgery or illness. For example, inpatient and admitted day patient rehabilitation, stroke recovery and cardiac rehabilitation.||✔R|
|Hospital psychiatric services||Hospital treatment for the treatment and care of psychiatric, mental, addiction or behavioural disorders. For example, psychoses such as schizophrenia, mood disorders such as depression, eating disorders and addiction therapy.||✔R|
|Palliative care||Hospital treatment for care where the intent is primarily to provide quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain.||✔R|
|Brain and nervous system||Hospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system. For example, strokes, 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 & throat||Hospital 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 eardrums, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer.||✔✩|
|Tonsils, adenoids and grommets||Hospital treatment of the tonsils, adenoids and insertion or removal of grommets.||✔✩|
|Bone, joint and muscle||Hospital 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 reconstructions||Hospital 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 bladder||Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder. For example, kidney stones, adrenal gland tumours and incontinence. Dialysis is listed separately under ‘Dialysis for chronic kidney failure’, which is only covered 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 oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel. For example, oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids.||✔✩|
|Hernia and appendix||Hospital treatment for the investigation and treatment of a hernia or appendicitis. Digestive conditions are listed separately under ‘Digestive system’.||✔✩|
|Gastrointestinal endoscopy||Hospital treatment for the diagnosis, investigation and treatment of the internal parts 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, endometriosis, polycystic ovaries, 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, radiotherapy and immunotherapy for the treatment of cancer or benign tumours. Surgical treatment of cancer is listed separately under each body system.||✔✩|
|Pain management||Hospital treatment for pain management that doesn’t 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 (e.g. infusion pump or neurostimulator) is listed separately under ‘Pain management with device’, which is only covered in the Gold tier.
|Skin||Hospital 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 and plastic surgery that is medically necessary for 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/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 doesn’t pay benefits for cosmetic breast surgery that isn’t medically necessary.||✔✩|
|Diabetes management (excluding insulin pumps)||Hospital treatment for the investigation and management of diabetes. For example, stabilisation of hypo- or hyper-glycaemia and 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 = You may only be covered for restricted services^ and treatments under these clinical categories.
✩ = These clinical categories are a minimum requirement of the Bronze tier.
Source: Department of Health – Hospital cover product tiers and clinical categories. Accessed September 2022
What isn’t covered under Bronze health insurance plans?
If you purchase a standard Bronze health insurance policy, you’ll have exclusions for all 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 cover, it must be on an unrestricted* basis.
Who might suit Bronze tier cover?
The Bronze tier is a great base-level cover for Australians 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 within the next 12-18 months and don’t need 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. 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 to be privately covered for prostate cancer, circumcision or a vasectomy.
- You’re a woman who wants to be privately covered for gynaecology, medically necessary breast surgery and treatment for breast and cervical cancer.
- You have diabetes and want cover for diabetes management in hospital. However, if you want cover for insulin pumps, you may need to upgrade to Gold or Silver+ cover.