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Last Updated on 15 November 2019

2019 Health Reforms: Gold Health Insurance Policies


Gold product tier health insurance
Key Points
  • Health insurance reforms set to go into effect on 1 April 2019 will change the way health funds present their hospital policies, placing them into the tier system.
  • These tiers are Gold, Silver, Bronze, and Basic – Gold being the highest level of cover.
  • Gold health insurance offers benefits that aren’t required for any other tiers, in categories including pregnancy and birth, joint replacement, and insulin pumps.

Australian health insurance becomes more expensive every year, but that doesn’t mean the benefits are going up. There are thousands of different hospital policies out there, and each one is different from the next.

This makes it challenging to compare like with like, leaving many Australians wondering whether or not they’re getting a good deal. Without minimum basic requirements for different levels of cover, it’s hard to know which policy offers the most value.

That’s set to change when new legislation goes into effect on 1 April 2019. It will introduce a tiered product system to make shopping and comparing hospital cover much easier.

All existing hospital policies will be categorised into one of the four product tiers, starting from 1 April 2019. Health funds must transition all policies to the tier system by 1 April 2020. You will receive notification about which category your policy falls under, which is a good time to review your cover.

Ahead, we’ll take a look at the tier system and tell you more about the top level of coverage: Gold health insurance.

What is the new health insurance tier system?

As we’ve covered, health insurance in Australia can be complicated. It’s difficult to compare policies when every health fund has a different name for each level of coverage and different benefits than their competitors.

When the product tier system is introduced, Australians will be better equipped to evaluate different health funds. Note that the tier system only applies to hospital policies, not extras cover.

The new system breaks hospital policies into four tiers: Basic, Bronze, Silver, and Gold. Every policy will have a minimum coverage standard they must meet to fall into one of the tiers.

After the change goes through, it will be easier to compare funds and find the best deal. Some health insurance policies may offer additional features to attract customers, bumping them into value-added product tiers: Basic Plus, Bronze Plus, and Silver Plus.

You might find a Silver Plus health insurance policy, for instance, that covers a procedure or service that is usually reserved for the Gold tier. Apart from these cases, the products from different funds will become more standardised.

 

What is Gold tier health insurance?

As you can probably guess by the name, Gold health insurance is the highest tier of health insurance available. These policies offer the widest range of unrestricted procedures and have minimum requirements that other policies do not.

Take a look at the infographic below to learn the minimum requirements that are exclusive to Gold hospital policies.

 

On top of these benefits, you’ll also be covered for the categories included in Silver, Bronze, and Basic product tiers.

As we stated earlier, you will likely see some health funds offering Gold features under a Silver policy. This can act as an incentive to choose their Silver health policy over a competitor’s.

Who is gold tier health insurance suited to?

Gold-level health insurance is the most comprehensive tier, but it’s also the most expensive. Young, healthy, single Australians probably don’t need to purchase Gold hospital cover, and can instead opt for a lower tier.

There are a few groups who Gold health insurance will benefit, though. Here are a few people who might want to consider purchasing a Gold health insurance policy.

Aging Australians

It’s an unfortunate reality that getting older comes with health complications. Those who are aging need comprehensive coverage to make sure they can get timely and affordable treatment for their ailments.

Procedures like cataract surgery, joint replacement, and dialysis are only required with Gold insurance policies. These problems—especially those regarding eyes and joints—disproportionately affect older Australians.

Those who are getting a bit older and want to make sure they have the most comprehensive cover might want to take a look at upgrading to the Gold tier.

Those who want to start a family

Australians who plan on starting a family might also want to consider Gold hospital cover. Gold health insurance is the only tier guaranteed to include pregnancy and birth-related services, as well as assisted reproductive services.

While Basic, Bronze, and Silver policies are not required to include cover for pregnancy, birth, or assisted reproductive services, health funds can choose to include these categories in Plus levels of cover.

Keep in mind that these procedures will come with a 12-month waiting period after you sign up, so it’s important to act sooner rather than later if you and your partner are considering having kids.

Those who struggle with their weight

Gold health insurance is also an attractive option for people struggling with obesity. This level of health insurance is the only one that requires coverage for weight loss surgery, which can be an essential tool for some who can’t lose the weight on their own.

When diet and exercise aren’t effective, weight loss surgery can make a difference and possibly prolong your life.

This level of health insurance also includes the categories of insulin pumps and sleep studies. Those who are obese have a greater risk of developing diabetes and conditions like sleep apnea. Gold tier health insurance provides benefits for accompanying procedures and services.

Should you consider gold tier health insurance?

Gold health insurance isn’t for everyone, so young and healthy Australians may not need to spend the extra money. If you fall into one of the categories above, you might want to consider upgrading to a Gold policy.

Want to get started comparing health insurance for the upcoming changes? Take a look at our comparison tool below.

Disclaimer: The above information is correct and current at the time of publication


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