The health insurance reforms introduced a ‘tiered’ policy system back in April last year, to help make choosing the most suitable cover for consumer’s needs more straightforward. Now, new health insurance sales data reveals consumers want more than just basic cover – in fact, more than three-quarters (79%) have purchased policies at a Bronze Plus or higher level.
The new tiers of hospital cover were designed to simplify consumer’s understanding of health insurance and clearly outline the clinical categories offered within each policy. Aussies are now provided with options to purchase private hospital insurance – Basic, Bronze, Silver or Gold – with ‘Plus’ tiers also available.
‘Plus’ refers to insurers offering additional coverage and benefits above the minimum requirements of each tier. This includes Basic Plus, Bronze Plus and Silver Plus.
Surprisingly, comparethemarket.com.au’s customer data reveals that most customers choose policies with ‘Plus’ features over and above the minimum cover required for the standard tiers, with three quarters of customers (74%) opting for this type of cover. Policies with ‘Plus’ features were particularly popular for singles cover, with two fifths (40%) choosing this option.
This behaviour represents the desire of customers to select cover for services they need, rather than jumping up an entire category for one aspect of their policy.
Delving deeper into the differences between tiers: a Silver-tier policy covers 29 clinical categories, including benefits toward cancer treatments, diabetes, breast surgery, heart disease and more. All Silver tier policies will, at a minimum, cover eight more clinical categories than the Bronze tier covers and nine less clinical categories than Gold tier polices.
What this means for customers is that you will not be covered for treatments like birth-related services or joint replacements on a standard Silver-tier policy, however you may still be able to get cover for one of these treatments through a Silver Plus policy without taking on all of the additional, remaining clinical categories that make up Gold-tier cover.
Similarly, with Bronze policies: a Bronze-tier policy will cover 21 clinical categories, which include common hospital treatments such as brain surgery, joint reconstructions, gynaecology services and more.
Once again, standard Bronze cover will include more categories for hospital treatments than a standard Basic-tier policy does, but not as much as a Silver-tier policy. Whilst a Bronze Plus policy may offer either a clinical category or an additional procedure that would normally be found in Silver or even Gold tiers.
The comparethemarket.com.au data revealed that policies with ‘Plus’ features were purchased by more under-40s compared to any other age group.
Private health cover provides consumers with peace of mind, with some out-of-pocket expenses reduced depending on the level of coverage taken out. Industry data reveals that nearly half (47%) of hospital payments made by health funds were for medical treatments costing more than $10,000. On top of this, in 2019 the average benefits paid by health funds for hospital claims increased to $1,408 per person.
Health expert at comparethemarket.com.au Anthony Fleming says: ‘What was interesting within the results was that the lowest-tier policy – Basic – was the least popular among Compare the Market customers. After completing a needs analysis, just two per cent of consumers purchased a Basic policy over a six-month period.
‘The new categorisation system can still sometimes prove tricky to navigate when deciding what health services you’ll need. What we’re finding is that many Australians are doing their research and due diligence to consider what works for their lifestyle and circumstances, our data shows that more consumers are finding value within the Plus categories.
‘The government recently introduced a Medical Costs Finder tool to help consumers find out more about the possible expense of certain hospital procedures within each tier. We encourage consumers to check out what they could be shelling out for particular health services as well as what policy tier will cover them if they need to head to hospital.
‘It’s also a good idea to use comparison services such as comparethemarket.com.au and look at policies side-by-side, to find cover that suits your needs and budget,’ explains Fleming.
Pricing breakdown of some of the top causes for hospitalisation
|Clinical category||Some of the top causes for hospitalisation||Typical doctors’ treatment fees in a private hospital||Typical gap private patients pay for doctors’ fees||Typical amount insurers pay for your private hospital stay||Category of cover (policy tier) that includes treatment|
|Dialysis for chronic kidney failure||Dialysis||$80-330||$0-70||$440||Gold|
|Digestive system||Gall bladder||$2100-3800||$60-1500||$4600||Bronze, Silver, Gold|
|Heart and vascular system||Pacemaker||$1400-4100||$10-310||$18,000||Silver and Gold|
|Heart valve replacement||$11,000-19,000||$10-1,400||$39,000|
|Pregnancy and birth||Caesarean section (minor/ intermediate complexity)||$3,100-4,700||$130-940||$7,800||Gold|
|Vaginal delivery (minor /intermediate complexity)||$2,100-3,300||$90-610||$5,900|
|Hip replacement||Single hip replacement||$3,700-7,200||$50-3,700||$21,000||Gold|
**The figures in the above table and graph will vary depending on your specific treatment, doctors, hospital and insurer. Figures do not include the excess or co-payments you may need to pay when you claim on your policy. As such, this table should be taken as a guide only.
For interviews and more information, please contact:
Macrina Lim | +61 2 9279 3330 | +61 430 547 751 | [email protected]
 Customer data compiled from 1 July 2019 to 20 January 2020
 Private Healthcare Australia, 2019, https://www.privatehealthcareaustralia.org.au/wp-content/uploads/PHA-Annual-Hospital-High-Claims-2019-Report.pdf
 Figures are taken from the Department of Health’s Medical Costs Finder tool. Results from this tool are based on ‘the most recent publicly available government data about what people have paid for procedures’. This information is general only. It cannot determine how much you will pay for treatment as gap fees vary. Patients with private health cover should check with their insurer and healthcare professional to find out how much they might pay for treatment.
 The amount your insurer pays for your stay cover costs for accommodation, theatre fees and medical device fees
 Some of the treatments in the table may fall under some other Plus policies (e.g. Bronze Plus). This will depend on, and vary between, insurers. When choosing your tier, it’s important you consider all your healthcare needs.
 Some insurers may charge a co-payment, which is payable every day you’re admitted into hospital as an inpatient.