Gold health insurance policies
Considering Gold health insurance? Find out more about what Gold cover includes compared to other private health insurance tiers.
- Australian owned and operated call centre
- Speak to an expert right away
- A quick call could save weeks of research
Why are there health insurance tiers?
In 2019, the Australian Government introduced Private Health Insurance Reforms to simplify health insurance. Because of these government reforms, all hospital policies are categorised into four distinctive tiers: Basic, Bronze, Silver and Gold.
For a policy to be classified in a specific tier, it needs to include a certain number of clinical categories (groupings of hospital treatments and services). For example, to be classified as Gold tier, a policy must include all 38 clinical categories without restrictions or exclusions. The following are the minimum clinical categories for each tier:
- Basic hospital cover: 3 restricted clinical categories
- Bronze hospital cover: 21 clinical categories including (3 restricted)
- Silver hospital cover: 29 clinical categories including (3 restricted)
- Gold: 38 clinical categories.
What is Gold health insurance?
The Gold tier offers the highest level of cover available on the Australian health insurance market. This means that you’ll be covered for all in-hospital procedures listed on the Medicare Benefits Schedule (MBS) as a private patient in either a private or public hospital.
When you go in for treatment, your health fund may pay 25% of the MBS fee for your treatment, as well as hospital charges such as accommodation, theatre fees, medicines and dressings. The other 75% of the MBS fee is paid by Medicare. If your treating doctors choose to charge above the MBS fee, you could be responsible for paying the gap, so you may have some out-of-pocket expenses.
Depending on your state of residence, your Gold hospital insurance will often also include cover for ambulance services.
Expert tips on Gold 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
Health cover gives you more choice
Private health insurance gives you the ability to improve the quality of your healthcare options. Having cover allows for more choice and control of when and where you’re treated, and by whom.
Increase your excess for cheaper premiums
While having lower premiums is tempting, cheaper doesn’t necessarily mean better. Instead of sacrificing inclusions on your cover, consider increasing your excess to lower costs.
Know your options
There are many options out there when it comes to private health insurance. This is why speaking to a health insurance comparison expert can be so important. With the right cover, you can have peace of mind knowing you have access to high-quality health care.
Gold tier hospital cover inclusions and exclusions
Gold tier hospital cover offers comprehensive coverage for all 38 clinical categories with no restrictions or exclusions. This includes clinical categories not standard on lower tiers, such as joint replacements, cataracts, assisted reproductive services and pregnancy and birth.
What does Gold health insurance cover?
Gold health insurance policies include unrestricted cover for all medically necessary inpatient hospital treatments (within the scope of cover outlined by the Department of Health) listed under the 38 clinical categories set by the Australian Government. This means comprehensive cover for all standardised hospital treatments without exclusions. Hospital insurance won’t cover out-patient treatments like dental, physiotherapy or optical which fall under extras cover.
Clinical categories included in Gold cover
| Clinical category | Description |
|---|---|
| Rehabilitation | Hospital treatment for physical rehabilitation for a patient related to surgery or illness. For example: inpatient and admitted day patient rehabilitation, stroke recovery and cardiac rehabilitation. |
| Hospital psychiatric services | Hospital 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. |
| Palliative care | Hospital treatment for care that provides quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain. |
| 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: 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 eye trauma. |
| 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. |
| 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. |
| 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. |
| 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). |
| 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. The surgical treatment of cancer is included under each body system category (e.g. skin cancer surgery is included under the ‘Skin’ clinical category). |
| 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. |
| 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 is also included. Plastic surgery that is medically necessary and related to the treatment of a skin-related condition is also included. |
| Breast surgery (medically necessary) | Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction 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 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 (e.g. treatment for diabetes-related eye conditions is included under ‘Eye’). |
| Heart and vascular system | Hospital treatment for the investigation and treatment of the heart, heart-related conditions and vascular system. For example: heart failure and heart attack, monitoring of heart conditions, varicose veins and removal of plaque from arterial walls. |
| Lung and chest | Hospital treatment for the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest. For example: lung cancer, respiratory disorders such as asthma, pneumonia and treatment of trauma to the chest. |
| Blood | Hospital treatment for the investigation and treatment of blood and blood-related conditions. For example: blood clotting disorders and bone marrow transplants. |
| Back, neck and spine | Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion. For example: sciatica, prolapsed or herniated disc, spinal disc replacement and spine curvature disorders such as scoliosis, kyphosis and lordosis. |
| Plastic and reconstructive surgery (medically necessary) | Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity, whether congenital or caused by illness or accident. For example: burns requiring a graft, cleft palate, club foot and angioma. |
| Dental surgery | Hospital treatment for surgery on the teeth and gums. For example: surgery to remove wisdom teeth and dental implant surgery. |
| Podiatric surgery (provided by a registered podiatric surgeon) | Hospital treatment for the investigation and treatment of conditions affecting the foot and or ankle, provided by a registered podiatric surgeon. This benefit is limited to cover for accommodation and the cost of a prosthesis as listed in the Private Health Insurance (Prostheses) Rules. Note: Insurers are not required to pay for any other benefits for hospital treatment for this clinical category but may choose to do so. |
| Implantation of hearing devices | Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device. |
| Cataracts | Hospital treatment for surgery to remove a cataract and replace it with an artificial lens. |
| Joint replacements | Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses. For example: replacement of the shoulder, wrist, finger, hip, knee, ankle or toe joint. |
| Dialysis for chronic kidney failure | Hospital treatment for dialysis treatment for chronic kidney failure. For example: peritoneal dialysis and haemodialysis. |
| Pregnancy and birth | Hospital treatment for investigation and treatment of conditions associated with pregnancy and childbirth. |
| Assisted reproductive services | Hospital treatment for fertility treatments or procedures. For example: retrieval of eggs or sperm, in vitro fertilisation (IVF) and Gamete Intra-fallopian Transfer (GIFT). |
| Weight loss surgery | Hospital treatment for surgery to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure. For example: gastric banding, gastric bypass and sleeve gastrectomy. |
| Insulin pumps | Hospital treatment for the provision and replacement of insulin pumps for the treatment of diabetes. |
| Pain management with device | Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain. For example: treatment of nerve pain, back pain and pain caused by coronary heart disease with a device (e.g. an infusion pump or neurostimulator). |
| Sleep studies | Hospital treatment for the investigation of sleep patterns and anomalies. For example: sleep apnoea and snoring. |
What is the difference between restricted and unrestricted cover?
Restricted cover will only pay a limited benefit towards being a private patient in a public hospital, whereas unrestricted cover pays full benefits towards accommodation and theatre fees as a private patient in either a public or private hospital. Both restricted and unrestricted cover allow you to choose your doctor (depending on availability).
Gold hospital policies must include all 38 clinical categories with unrestricted cover. Even with unrestricted cover, you may still have out-of-pocket costs.
Are there waiting periods on Gold tier policies?
Yes, there are waiting periods on Gold tier policies. The length of a waiting period will depend on the specific service and whether the treatment is for a condition classified as pre-existing.
Waiting periods work the same for Gold tier policies as they do for all hospital insurance policies, as these are regulated by the government.
Waiting periods for hospital treatments
| Service | Waiting period |
|---|---|
| Treatments for pre-existing health conditions | 12 months |
| Birth-related services and pregnancy | 12 months |
| Rehabilitation, palliative care and psychiatric care (even for a pre-existing condition) | 2 months |
| All other conditions | 2 months |
A pre-existing condition is any ailment, illness or condition that, in the opinion of a medical practitioner assigned by your health fund, you showed signs or symptoms of 6 months prior to taking out cover.
When you upgrade to a Gold tier hospital insurance policy, you’ll only need to serve a waiting period for the upgrades to your policy, so you won’t need to re-serve any waiting periods you’ve already completed with your current health fund.
“We all know that the pre- and post-natal process can be incredibly stressful. A Gold hospital policy can help cover you for pregnancy and birthing related services when you are admitted to hospital as an inpatient.
‘It’s important to note that cover for pregnancy and birth related services has a 12-month waiting period, so it’s recommended to serve the waits before becoming pregnant.” – Steven Spicer.
Choosing your health insurance tier
To choose your health insurance tier, consider factors such as your health needs, lifestyle, and health history and then check which health tier best suits your circumstances.
Who might suit Gold tier cover?
Gold tier hospital cover best suits those who want comprehensive cover or require a specific treatment, elective surgery or service only covered by a Gold policy. For example, if you’re planning on starting a family, Gold tier is the only level of cover where pregnancy cover is standard. Whether or not a Gold plan is suitable for you will depend on your situation.
As a guide, you might want to consider upgrading to this level of cover if one or more of the following apply to you:
- You want peace of mind, as Gold health insurance includes all 38 clinical categories.
- Gold health insurance is within your budget as it’s typically the most expensive, and you will benefit from its extensive coverage.
- You’re planning on becoming pregnant and want to be able to claim a benefit for having your baby as a private patient in a private hospital, with the option to potentially choose your available obstetrician and have a private room (if one’s available).
- You’re considering in-hospital IVF treatment (provided your IVF treatment is deemed medically necessary).
- You may require joint replacement surgery in the future if, for example, you have a family history of bad knees or joints, have a physically hard job, play sport at a high level or you’ve previously had a physical accident.
- You have chronic pain and need devices to keep your pain under control or have chronic kidney failure and require dialysis.
- You struggle with your weight or sleeping patterns and require medically necessary treatment.
- You have diabetes and require an insulin pump.
- You need in-hospital treatment for cataracts.
How much is Gold health insurance?
For a single person in Queensland, Gold hospital policies cost between $248 and $583 a month,1 according to the Private Health Insurance Ombudsman. These figures do not include any rebates, discounts or loading. Premiums will be influenced by your specific circumstances and, therefore, your total costs may be higher or lower than this price range.
The cost of Gold health insurance will generally be more expensive than Silver or Bronze health insurance, but will still vary in price. The cost of your Gold health cover will depend on what your policy includes and which health fund you take out your insurance policy through.
You’ll also want to consider the effect of the Australian Government Private Health Insurance Rebate, Lifetime Health Cover loading, and age-based discounts on your total premiums before taking out a policy.
How does Gold health insurance compare to Silver and Bronze cover?
Gold health insurance includes all 38 clinical categories for hospital services and treatment, which is 9 more than what’s covered by Silver health insurance policies and 17 more than Bronze health insurance policies. Gold level health insurance policies must include unrestricted cover for all categories (within the outlined scope of cover).
Gold policies also include unrestricted cover for rehabilitation, hospital psychiatric services and palliative care, all of which may either be offered on a restricted or unrestricted basis under lower-level Silver, Bronze or Basic tiers.
Due to the Gold tier’s extensive coverage of hospital treatments and services, this top-level cover will generally be more expensive than Silver, Bronze or Basic health insurance policies.
Is Gold cover the top health insurance available?
Gold provides the most comprehensive health insurance for hospital cover, including more clinical categories than any other tier. However, this doesn’t necessarily mean it’s the right option for you. If a Gold policy is too expensive, health funds 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. This could be an option for you if you can find a Plus policy which includes the clinical category you need. Keep in mind, the health fund will usually choose which additional clinical category is included in a Plus policy, not you. It is therefore important to compare the different options available and which policies will suit your needs.
There is a lot to consider, such as inclusions, restrictions, exclusions and premiums. The right cover for you will depend on your budget and healthcare needs, so we recommend shopping around to find a policy that works for you.
What Gold health insurance options are available?
Gold health insurance is the highest tier of hospital cover available in singles, couples and family policies. Gold tier policies offer comprehensive cover of all 38 clinical categories as defined by the Department of Health, including major treatments like pregnancy, IVF and joint replacements.
Can I get a Gold Plus policy?
No, you cannot purchase Gold Plus health insurance. Gold is the highest tier, which means it already includes all clinical categories.
You can only get ‘plus’ policies in Silver, Bronze or Basic tiers. These ‘plus’ policies may offer cover for treatments that are usually only available in higher-level tiers, although this will likely cost extra in premiums.
Can I get a Gold extras health insurance policy?
No, you can only get Gold hospital insurance policies. Under the 2019 government reforms, these classifications only apply to hospital products. Extras tiers are named by the health funds themselves. full range of extras policies are still available, including top-level extras products.
Also, some combined cover policies (hospital and extras) may be named Gold hospital and extras.
Some common outpatient treatments and services covered by extras cover (also known as ancillary or general treatment cover) include:
- dental (including general dental, major dental, orthodontics and endodontics)
- physiotherapy
- optical
- hearing aids.
Is Gold tier health insurance worth it?
Gold health insurance is a worthwhile means of getting comprehensive cover for private hospital treatment. However, if a Gold plan is outside your budget and you don’t need to include certain clinical categories on your policy (e.g. if you’re an older Australian and no longer require cover for pregnancy), a Gold tier policy may not be the best health insurance for you.
In this case, a Silver Plus or Bronze Plus policy could be worth it, as you may still be able to get the coverage that’s important to you, and it may be more affordable than Gold.
For example, if you want cover for a knee replacement in the future, you may be able to find a Silver Plus policy which includes ‘joint replacements’.
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?
1 Prices obtained using the ‘Compare policies option’ available on privatehealth.gov.au on 17/08/2026 for a single person living in Qld. Prices compared using ‘hospital only’ options, looking for ‘private hospital cover for most services’. The search included all available health funds including all restricted insurers, and ‘I have current health insurance’ selected. Prices quoted do not include Australian Government Rebate, Lifetime Health Cover Loading or Age Based Discount. Prices vary between funds and products. Waiting periods apply.
Talk to an expert
At a time that suits you
Call now