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Gold, Silver, Bronze and Basic product tiers - what are the new product tiers and what is covered?

19 December, 2018
PHI Reforms

Comparing hospital cover can be like comparing apples – one sunset red, another sunrise red.

But that’s about to change.

The Government’s Private Health Insurance Reforms are going to make it easier – and less daunting – for consumers to compare insurance products across health funds.

They’re hoping to achieve this by introducing standardised hospital products categorised into four tiers of cover:

  • Gold
  • Silver
  • Bronze
  • Basic

From 1 April 2019, each tier will have minimum standards for services to be covered.

Plus products

Insurers will be able to provide cover for additional services on Silver, Bronze and Basic products.  These will be referred to as “Plus” products.  For example – Bronze Plus will cover all minimum required services for the Bronze tier, plus additional services selected by the insurer.

Gold products are the highest level of cover available.  To be categorised as Gold, a product must offer all services on an unrestricted basis.

Clinical categories

As part of these Reforms, the Government has also created a new list of clinical categories.  These categories make it simple to understand what you are covered for.

Health insurers must now use the Government’s defined categories across all products when displaying what’s covered or not covered under each hospital product.

The Clinical Definitions Working Group, established by the Private Health Ministerial Advisory Committee, has developed a list of standard clinical categories which is consumer-friendly and easy to understand.

How this might affect your cover

Each CBHS product will be categorised into Gold, Silver, Bronze or Basic.  Most CBHS products will move seamlessly into the new tiers and will cover more services than the Government’s minimum standards.  In some cases, there may be products that will have some changes to the services covered.  In early 2019, members will receive individual communications outlining any changes to their cover.

You can visit the Department of Health website for more information.

More information on what is covered in each product tier

Comprehensive list of the categories

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