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Not sure what the new hospital tiers are all about? Trying to understand how a Silver health insurance plan compares to Gold and Bronze?

Here’s a breakdown of everything you need to know about Silver health insurance.

But first, why do these new tiers exist?

To make health insurance simpler, the Australian Government introduced Private Health Insurance Reforms in 2019.

These reforms aimed to categorise all private hospital policies into four different tiers: Gold (considered the new comprehensive policy), Silver, Bronze and Basic health insurance, as well as three subset tiers: Basic+, Silver+ and Gold+.

Each tier covers a certain number of clinical categories; this means the higher the tier (e.g. Gold), the wider range of hospital treatments and services it covers.

These new product tiers for hospital cover were introduced from 1 April 2019 (some health funds introduced them before this date), and all health funds will have until 1 April 2020 to categorise and assign tiers to their products.

So, what exactly will Silver-tier policies cover? And, why should you consider a Silver policy rather than Gold or Bronze? Let’s find out more about the Silver health insurance tier.

What is Silver health insurance?

Silver level health insurance is a mid-level tier of hospital cover offered under the new private health insurance reforms; it sits between Gold and Bronze.

A Silver tier policy covers 29 clinical categories (out of a total 38), including benefits toward diabetes, breast surgery, heart disease and more.

How does Silver health insurance compare to Gold and Bronze?

Silver level health insurance is the second-highest level of hospital cover available out of the four tiers, which means it has more benefits than Bronze, but isn’t as comprehensive as Gold; this means the pricing will fall somewhere between Gold and Bronze.

While it doesn’t provide cover for all clinical categories like Gold policies, Silver still covers a wide range of hospital treatments.

Silver tier policies will, at a minimum, cover eight additional clinical categories than the Bronze tier covers, totalling 29 clinical categories.

Although, standard Silver tier policies cover nine less clinical categories than Gold, which means you may not be covered for premium treatments like pregnancy and birth-related services or joint replacements. However, you may still be able to get cover for one of these treatments through a Silver plus policy, which could be a more cost-effective option than getting Gold health insurance.

What’s more, Silver health insurance policies will also include restricted^ or unrestricted* hospital cover for rehabilitation, hospital psychiatric services and palliative care, unlike the Gold tier, which must offer these services on an unrestricted* basis.

What does Silver health insurance cover?

Silver tier policies include cover for 29 clinical categories and their respective hospital treatment (within the scope that’s outlined by the Department of Health), as shown below.

Which hospital procedures are covered by Silver health insurance?
Your Silver tier policy provides 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’.
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’.
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’, which is only covered in the Gold tier.
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’.
Heart and vascular systemHospital 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 chestHospital 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.✔✩
BloodHospital treatment for the investigation and treatment of blood and blood-related conditions. For example: blood clotting disorders and bone marrow transplants.✔✩
Back, neck and spineHospital 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 acquired as a result of illness or accident, or congenital. For example: burns requiring a graft, cleft palate, club foot and angioma. Plastic surgery that is medically necessary relating to the treatment of a skin-related condition is listed separately under Skin.✔✩
Dental surgeryHospital treatment for surgery to 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, but limited to cover for accommodation and the cost of a prosthesis as listed in the prostheses list set out in the Private Health Insurance (Prostheses) Rules, as in force from time to time. 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 devicesHospital treatment to correct hearing loss, including implantation of a prosthetic hearing device. Stapedectomy is listed separately under ‘Ear, nose and throat’.✔✩
✔ = 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 Silver tier only; they’re not required to be covered under the Bronze 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 Silver health insurance?

A standard Silver health insurance policy doesn’t cover any of the hospital treatments included in the Gold tier; this means your standard Silver tier policy won’t cover:

  • pregnancy and birth
  • pain management with device
  • cataracts
  • joint replacements
  • assisted reproductive services
  • sleep studies
  • dialysis for chronic kidney failure
  • weight loss surgery
  • insulin pumps.

Although not required, health funds may still include additional cover for one or more of these clinical categories (and their respective hospital services) under a Silver+ or Silver Plus health insurance policy.

What is a Silver Plus health insurance policy (and what does it cover)?

A Silver plus health insurance policy includes everything under the Silver tier, as well as one or more hospital treatments from the Gold tier.

If an insurer offers a Silver plus policy, it may include cover for one or more of the nine clinical categories usually only covered under the Gold tier (see above). If a health fund offers a Silver plus policy, they must provide unrestricted* cover for the additional treatments or categories. Because of its additional coverage, a Silver plus policy may cost more than a standard Silver policy.

Older couple embracing in kitchen

Who might suit Silver tier cover?

Silver health insurance will cover you for a range of hospital treatments, but the tier that suits you most will depend on your situation. To put this into perspective, a standard Silver hospital policy might suit you in the following circumstances:

  • your health is a priority, and you would like cover for a wide range of hospital treatments;
  • you aren’t planning on having joint replacement surgery, weight loss surgery, or children any time soon, and won’t be needing cover for premium hospital services included under Gold cover;
  • you have a family history of heart problems, or you’re worried about heart disease being the number one killer in Australia.1 The Silver tier will include benefits for treating heart-related conditions, such as heart failure, heart attacks and monitoring heart conditions;
  • you have any concerns around your lungs and chest or blood;
  • you need a hearing device implanted;
  • you have foot issues and could potentially require surgery by a podiatric surgeon;
  • you have an active lifestyle or physical job and run the risk of hurting your back, neck or spine; and
  • you need (often expensive) medically necessary plastic or reconstructive surgery after being physically injured.

Is Silver health insurance worth it?

A Silver health insurance plan may be worth it if it’s within your budget and you’ll make use out of the treatments covered under this tier.

However, if you are comfortable only being covered for treatments found under the Bronze tier, then this lower-level policy might be better suited to your needs.

Also, if you’re planning on having a baby or getting a joint replacement in the near future and want health insurance, Silver vs Gold is a valid argument. A Silver Plus health insurance policy that includes cover for ‘pregnancy and birth’ or ‘joint replacements’ might be more worth it than purchasing a Gold policy.

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

Extras products won’t need to be classified under the different tiers, as these classifications only apply 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, a full range of extras policies are still available, including mid-level and higher-level extras products. Also, some combined policies (hospital and extras) may be named Silver hospital and extras.

How much is Silver health insurance?

Silver health insurance may typically cost more than Bronze health insurance and less than Gold health insurance, but will range in price. How much Silver health insurance costs may depend on which health fund provides the policy, what’s included in the policy, and other factors that affect your premiums.

For example, a Silver plus health insurance policy will generally cost more than a regular Silver health insurance, as it will include cover for more hospital treatments. However, a simple way to find out how much Silver health insurance may cost you is to compare health insurance policies online.


Ready to compare Silver health insurance? In seconds, you can compare a range of health insurance policies through our health insurance comparison service.

Our comparison service will allow you to see Silver health insurance policies we currently offer. It will also allow you to figure out whether Silver level health insurance could suit you or if you may be better off with Bronze or Gold health insurance.

Wondering what the other tiers include? If you want to compare Silver health insurance to other tiers, read our overview of the health insurance tiers.

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. Australian Bureau of Statistics, Causes of Death Report 2016
  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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