Silver health insurance policies

Average customer rating: 4.3/5
Written by Joshua Malin
Reviewed by Steven Spicer
Updated 26 March, 2024

Why do health insurance tiers exist?

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

These reforms categorised all private hospital policies into four different tiers (BasicBronze, Silver and Gold) and three subset tiers (Basic+, Bronze+ and Silver+).

Each tier includes a certain number of clinical categories and their associated hospital treatments and services. As you go up through the tiers, each includes more clinical categories and a broader range of hospital treatments.

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

What is Silver hospital insurance?

Silver hospital cover sits between Gold and Bronze and includes 26 of 38 clinical categories which must be unrestricted. With a Silver tier hospital insurance policy, you’ll be able to claim a benefit as a private patient in a private or public hospital for the hospital treatments listed under the included clinical categories. In addition to this, Silver hospital policies must include restricted cover for in-hospital psychiatric services, in-hospital rehabilitation and palliative care.

When you’re treated in a private hospital with private hospital cover, you’ll have access to your choice of available doctor and a private room (subject to availability). Your health fund will also pay towards other expenses associated with your hospital admission, such as accommodation and theatre fees. However, this doesn’t always mean you’ll have no out-of-pocket expenses. While Medicare and your health fund will together pay 100% of the Medicare Benefits Schedule (MBS) fee for your treatment, you may have out-of-pocket expenses if your doctor charges above the MBS; this is known as ‘the gap’. However, you may be able to avoid this additional cost if you’re treated in an agreement hospital that participates in your fund’s no-gap scheme.

Expert tips on Silver health insurance

Our health insurance expert, Steven Spicer, knows how hard it can be to pick the right hospital insurance for you. Which is why he’s put together these tips on how to choose your tier.

Steven Spicer
Executive General Manager – Health, Life & Energy

You can switch at any time

There are no lock-in contracts when it comes to health insurance, so you can upgrade or downgrade your policy at any time as your needs change. However, you will be required to serve a waiting period for any upgrades to your hospital insurance policy.

Compare your options

The cost of a standard Silver policy can vary from fund to fund, so it’s a good idea to compare your options prior to purchasing health insurance to ensure you have found the best option for your needs.

Consider your waiting periods

If you’re transferring from another fund, you won’t be required to re-serve any waiting periods. Any waiting periods that you have already served will carry across to the new fund, meaning that you’ll only need to serve a waiting period for any upgrades to your hospital insurance policy. If you haven’t yet completed a waiting period, the time you’ve already served will be applied to your new policy.

Inclusions and exclusions

What does Silver health insurance cover?

What’s a Silver Plus policy and what does it cover?

What’s not covered by Silver health insurance?

Choosing your tier

How does Silver hospital cover compare to the other tiers?

Who might suit Silver tier cover?

Is Silver health insurance worth it?

How much does Silver health insurance cost?

Can I get a Silver extras health insurance policy?

Meet our health insurance expert, Steven Spicer

Steven Spicer
Executive General Manager – Health, Life & Energy

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.

^Restricted cover – this means your insurer will only pay part of any private hospital costs in 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.

1 Privatehealth.gov.au – Clinical categories and product tiers. Updated January 2024.