Last Updated on 23 December 2020

Silver Tier – Health Insurance Cover & Reforms Guide

Key Points
  • On 1 April 2019, a new system of four main product tiers will be introduced for hospital cover policies.
  • There are four tiers in total: Gold, silver, bronze and basic. Silver health insurance will offer benefits for categories including heart, vascular system and dental surgery.
  • Silver health insurance provides a middle ground between the top coverage of Gold and the partial coverage of Bronze.

If you’re tired of comparing apples with oranges when it comes to your health insurance, the government is looking to make some changes this year on April 1st that should make your life a little easier!

Hospital policies will be categorised into four tiers (gold, silver, bronze and basic), making it easier to compare the benefits offered by each policy.

Ahead, we’ll look into what’s covered within the silver tier, but first, let’s get an understanding on how the new tier system works overall:

What is the health insurance tier system?

It can be hard to choose a policy under the current system, where each fund has its own policy names and offers a different combination of benefits.

One fund might have three levels of coverage when the next one has six. There is plenty of confusion here, and it can be tough to tell whether or not you’re getting a good deal.

The tier system that goes into effect on April 1st will clear things up a bit. Health funds now have to place each of their hospital policies into one of the four tiers: Basic, Bronze, Silver, or Gold.

Each tier has minimum requirements that the policy must meet in order to fall into a category. Funds also have the option of offering ‘Plus’ tiers: Basic Plus, Bronze Plus, and Silver Plus.

You may see a health fund offering a benefit that’s a minimum for the Silver tier in a Bronze Plus policy. Strategies like this can help attract new customers to their health fund.

The result of these changes is that it will be easier to compare health funds going forward. The competition will be more transparent, and what is and isn’t covered will be a lot clearer.

Be aware that these product tiers will only apply to hospital cover, not extras cover.

What is Silver Tier health insurance?

Silver health insurance, as the name suggests, is the second highest tier of hospital cover you can purchase. These policies rank second to gold but offer a wide range of coverage that will serve the needs of many Australians.

Here’s an infographic that outlines the benefits Silver insurance policies offer that Bronze and Basic do not. In addition to these, you’ll also receive all of the coverage from Basic and Bronze policies.

Like Bronze and Basic health insurance, Silver policies are also required to offer rehabilitation, hospital psychiatric services, and palliative care in some form. These three categories can be restricted, which means that a fund can set its own benefit level. It’s important to check what your policy offers.

You may also see some health funds offering services like joint replacements or cataracts—benefits that are only required with Gold products—on their Silver policy, which likely makes it a Silver Plus policy.

This is not required, but it’s a way for some health funds to attract new customers. You might be more inclined to choose a Silver Plus policy with a few added Gold benefits for a slightly higher price than the minimum Silver policy from another provider.

As we stated above, you might also see a Bronze policy with Silver benefits. For example, if you’re looking for dental surgery or heart and vascular system benefits, it may be possible to find these under a Bronze Plus policy from some health funds.

Who is Silver Tier Health Insurance For?

Silver health insurance is the second-highest level of insurance you can buy next to gold. This also means that it’s usually going to be the second most expensive policy as well.

Not everyone is going to need such a high level of coverage, however. Young, healthy Australians who don’t put themselves in harm’s way can probably get away with a Bronze or Basic policy if they don’t have the funds.

In this section, we’ll take a look at a few key demographics that could benefit from Silver hospital cover.

Family History of Heart Trouble

Those who have a family history of heart problems could benefit from Silver health insurance. Apart from Gold, Silver is the only tier where you’re guaranteed to receive heart and vascular system benefits.

Heart monitoring and coverage for heart failure and heart attacks are crucial for those with a family history of heart disease.

Heart disease is the leading killer in Australia and most of the developed world. Those who are already predisposed to heart problems can get value from adequate coverage, and Silver health insurance can offer that.

Those Who Risk Injury

Does your job or hobby put you at risk of getting hurt? If so, you’ll might want to opt for Silver health insurance.

Silver is the lowest tier of health insurance that covers back, neck, and spine surgeries. It also includes dental surgery and reconstructive surgery when medically necessary.

Risky jobs and hobbies are common, and private health cover can be invaluable if you’re constantly putting your body in harm’s way. An injury might be even more of a hit to your pocket if you aren’t covered for the treatments you need.

Those Not Interested in Starting a Family Right Now

Silver health insurance usually doesn’t include benefits for pregnancy or reproductive services. You might be able to find a Silver Plus policy with these inclusions, but they are only required to be offered with Gold policies.

Silver health insurance is comprehensive to a degree, but it’s a good idea to buy Gold health insurance if you plan to start a family in the next year. Pregnancy, birth-related services, and assisted reproductive services usually have a 12-month waiting period attached, so you need to upgrade as soon as possible if you want pregnancy and reproductive benefits.

Want to get started comparing and shopping for health insurance under the new system? Take a look at our comparison tool below.


Still have questions? Let's talk!

Confused? Not sure if this applies to your situation? Phone us on 1300 163 402 for some free, no obligation advice.


Or want to compare policies now?