Gold Tier - Health Insurance Cover & Reforms Guide
Find out more about Gold tier health insurance, which offers benefits that aren't required for any other tiers, such as pregnancy and birth, joint replacement and more.
by Gary Andrews
Last update 15 Apr 2021
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.
New tiers introduced by the federal government in 2019 was meant to change this – in theory it should have been easier to make comparing policies easier, although the system can still be confusing.
Ahead, we'll take a look at the tier system and tell you more about the top level of coverage: Gold health insurance.
Health insurance in Australia can be complicated.
The tier system was designed to allow Australians to easily compare different health funds.
Note this 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.
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.
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.
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.
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.
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.
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.
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.
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This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.