Gold, Silver, Bronze or Basic health insurance: What’s right for you?

We’re rolling out all the Government’s health insurance reforms to make it easier to compare and choose health insurance that’s right for you.

Written by Medibank

As part of government reforms to health insurance, Medibank will categorise covers as ‘Gold’, ‘Silver’, ‘Bronze’ or ‘Basic’. This change aims to make it easier to compare covers and choose health insurance that is right for you.

Read on to find out how the new categories work, and what to think about when choosing or reviewing your cover.

What are the new product classifications?

Under the new system, hospital insurance will be categorised as Gold, Silver, Bronze or Basic.

Each product classification will include the same minimum set of hospital services (called standard clinical definitions or clinical categories) and health insurers across the industry will talk about them in the same way. For example, no matter which health fund you are with, Bronze covers will include joint reconstructions, while all Gold covers will include pregnancy and birth services.

Silver Plus, Bronze Plus and Basic Plus cover

‘Plus’ covers include some additional services. For example, ‘Bronze Plus’ covers must include all of the Bronze services, along with some additional services from the Silver and/or Gold classifications. Each health insurer decides which extra services to include in their ‘plus’ covers, meaning there is likely to be variation in ‘plus’ covers across the industry.

Want to talk to someone about it? Chat to one of our expert staff by getting in touch over the phone, online or in-store.

When should you consider Gold health insurance?

If you want the confidence of knowing you’ll be looked after, Gold cover could be the right cover for you. It’s the only category of cover that includes all 38 of the clinical categories that have been set out by the Government.

Some services that are included in Gold health insurance (and not Silver) are joint replacements, sleep studies and cataracts. Therefore, it may be right for you if you suffer from conditions like sleep apnoea, cataracts or advanced osteoarthritis, and you’re likely to need a related procedure or hospital treatment. Keep in mind if you have a pre-existing condition, there is a 12 month waiting period, which means you need to have cover that includes these services at least a year before you can claim for them.

If you’re looking to expand or start a family, you should also consider Gold cover, with the option to give birth as a private patient in a private hospital and choose your own obstetrician. Gold also includes assisted reproductive services, if you should need them. A 12 month waiting period also applies for pregnancy and birth services and if you’re experiencing fertility issues, you may have to wait 12 months after taking out Gold cover to claim for assisted reproductive services.

If you want the peace of mind of comprehensive cover, but you know you won’t need pregnancy and birth services, it may be worth considering Silver Plus cover.

When should you consider Silver health insurance?

Silver health insurance may be suitable for you if you want a wide range of services included in your cover, or if you have certain pre-existing conditions.

Silver cover includes, among other things, heart and vascular services, reconstructive surgery (when medically necessary) and lung and chest services. It may meet your needs if you have a history of heart or lung issues, or if you need reconstructive surgery following a bout of breast or skin cancer in the future. Keep in mind if you have a pre-existing condition, there is a 12 month waiting period, which means you need to have cover that includes these services at least a year before you can claim for them.

And remember, it’s good to check through the list of services included in Gold cover to make sure there isn’t anything else you might need included in your cover.

When should you should consider Bronze health insurance?

Bronze health insurance may be suitable for you if you want a lower cost option that covers a wide range of common services, including gastrointestinal endoscopy (like colonoscopies) and cancer treatments (like chemotherapy). It may also be suitable for young families looking for cover that includes common procedures for kids, like tonsil or grommet procedures. Keep in mind that a 12 month waiting period applies for any pre-existing health conditions.

If you’re looking for a lower cost option but want a few more services included, Bronze Plus cover options may be right for you.

And while Bronze and Bronze Plus covers offer a broad set of services, it’s still a good idea to compare them with Gold and Silver covers to ensure there are no other services you might need, like pregnancy and birth, or heart and vascular services.

When should you consider Basic health insurance?

If you’re young and healthy, Basic health insurance could be right for you. However, you should carefully consider which services are included, and familiarise yourself with any Restricted Services before making a decision. Restricted Services mean that if you choose to be treated in a private hospital, the benefits paid will not cover all hospital costs and are likely to result in significant out-of-pocket expenses.

Basic cover may be suitable for you if you are earning over $90,000 as a single (or $180,000 as a couple*) a year and you want a lower cost cover to help you avoid paying the Medicare Levy Surcharge.

It might also be suitable if you want cover that is designed to look after you if you have an accident. Medibank Basic Accident and Ambulance cover gives you the benefits of our Gold hospital cover if you have an Accident**.

When considering Basic cover, it is worth having a read through the list of services included under Bronze, Silver and Gold covers to make sure you’re not missing out on something you might need, such as joint reconstructions or dental surgery.

If you’re looking for cover with a few more services included, but don’t want the expense of a Bronze cover, a Basic Plus cover might be right for you. These include products Medibank has designed especially for young, healthy people, like Medibank Basic Plus Healthy Start, which includes joint reconstructions, dental surgery and appendix removal.

Other things to consider when choosing or reviewing your health insurance

Once you’ve decided on which cover is right for you, it’s worth considering the extra things your health insurer provides that can make a difference, from helping you with your health goals, to value on your extras insurance, or support when going to hospital.

For example, Medibank members with hospital cover can call our 24/7 Medibank Nurse phone service to discuss their health concerns at any time of the day or night. We're also providing Medibank at Home programs that allow eligible members, with their doctor’s support, to receive rehabilitation care from the comfort of their own home, and trialing, chemo, dialysis and palliative care~.

I’m an existing Medibank member. How do the new classifications affect my cover?

Existing Medibank members’ products will be categorised into Gold, Silver, Bronze or Basic health insurance, progressively up until April 2020.

If you’re a Medibank member, your policy name will change. The services included in your cover may also change so that it fits into one of the new classifications. If your cover is changing, we’ll be in touch well beforehand to let you know which services are being added or removed.

During this time, we’ll be encouraging members to review their cover, to ensure they’re still on the right cover for their health needs. And while these changes may deliver some short term challenges, we believe it will help to make health insurance easier to understand and compare for all Australians.

Gold, Silver, Bronze and Basic health insurance is just one of the reforms Medibank is rolling out to make health insurance easier to understand. And we’re giving our customers even more -- find out about the changes we’re making to give members better value, personalised support and more choice.

* Single parents and couples (including de facto couples) are subject to family tiers. For families with children, the thresholds are increased by $1,500 for each child after the first. The MLS applies proportionately for the period during the tax year when you and any dependants did not hold an appropriate level of private hospital cover.

** For Accidents that occur after your cover starts and for which treatment is sought within 7 days. Excludes claims covered by third parties such as WorkCover and our Private Room Promise. Out of pockets may apply.

~ Not available in all areas. Must have eligible hospital cover, all relevant waiting periods must have been served and treating doctor must consider it appropriate. Out of pocket expenses may apply.

Written by Medibank

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