How to understand the difference between Basic, Bronze, Silver and Gold Hospital Cover

How the Hospital Cover tiers work

The difference between Basic, Bronze, Silver and Gold Hospital Cover lies in the number of clinical categories each product tier offers:

Restricted cover pays part of the costs of hospital cover.

Unrestricted cover pays all costs of hospital cover, other than any agreed excess or co-payments.

What does ‘restricted’ on Basic, Bronze and Silver Hospital Cover mean?

Before you buy Basic, Bronze or Silver Hospital Cover, be aware health insurers are allowed to offer these clinical categories on a ‘restricted basis’:

• rehabilitation
• hospital psychiatric services
• palliative care. 

For Basic Cover, if an insurer covers any of the optional clinical categories, it may do so on a restricted basis.

If a clinical category is covered on a restricted basis, your coverage for treatment in that category is very limited.

Restricted cover means:

• If you enter a public hospital as a private patient, you are covered.
• If you enter a private hospital as a private patient, your insurer does not cover costs such as theatre fees and accommodation and your out-of-pocket costs will be high.

If you have restricted cover for a clinical category, always check with your insurer before agreeing to be treated as a private patient in a private hospital.

Here are some examples of how restricted cover works in practice:

Why should I take out Basic Hospital Cover when the cover is so limited?

You may want to take out Basic Hospital Cover, not because the cover is limited, but because you are classified as a high-income earner. This means you can avoid paying the Medicare Levy Surcharge.

Here is an example of how you might decide to take out Basic Hospital Cover:

Why should I take out Gold Hospital Cover over Basic, Bronze and Silver Hospital Cover?

One of the benefits of Gold Hospital Cover is you are not paying for treatments under any of the clinical categories on a ‘restricted’ basis. 

Unlike most Basic, Bronze or Silver Hospital Cover, if you take a private room or have treatment at a private hospital, you do not pay additional expenses for Rehabilitation, Hospital Psychiatric Services and Palliative Care.

Of course, Gold Hospital Cover is usually much more expensive than the lower tiers.