Find the Right Cover of Private Health Insurance for Your Needs with Silver Hospital Cover
If you're feeling a bit overwhelmed and unsure about which level of health insurance is right for you, you've come to the right place. We understand that navigating through the tiers of health insurance can be confusing, especially when it comes to comparing Silver, Gold, and Bronze plans.
To make things simpler, the Australian Government introduced Private Health Insurance Reforms in 2019, categorising all private hospital policies into four tiers: Basic, Bronze, Silver, and Gold.
In this guide, we'll focus on Silver health insurance and give you a comprehensive breakdown of what it offers. So, let's dive in and explore the world of Silver health insurance together.
Find the Right Cover of Private Health Insurance for Your Needs with Silver Hospital Cover
What is Silver Hospital Cover?
Positioned between Gold and Bronze, it offers a wide range of benefits. With a Silver tier policy, you'll receive unrestricted cover for 26 out of 38 clinical categories, ensuring you're well taken care of in a private or public hospital. Plus, Silver policies also include restricted cover for important services like in-hospital psychiatric care, rehabilitation, and palliative care.
You can be treated as a private patient in a private hospital with all the comforts you deserve - your choice of doctor and, when available, a private room.
Your health fund will even help with other expenses related to your hospital stay, such as accommodation and theatre fees.
It's important to note that while Medicare and your health fund together cover the Medicare Benefits Schedule (MBS) fee, there may still be out-of-pocket expenses if your doctor or hospital charges above the MBS.
What’s Covered Under Silver Hospital Cover?
Silver tier policies offer unrestricted cover for 26 clinical categories and their respective hospital treatments. The coverage is in accordance with the guidelines set by the Department of Health.
Here are some of the categories covered:
- Rehabilitation
- Hospital psychiatric services
- Palliative care
- Brain and nervous system
- Eye (excluding cataracts)
- Ear, nose, and throat
- Tonsils, adenoids, and grommets
- Bone, joint, and muscle
- Joint reconstructions
- Kidney and bladder
- Male reproductive system
- Digestive system
- Hernia and appendix
- Gastrointestinal endoscopy
- Gynaecology
- Miscarriage and termination of pregnancy
- Chemotherapy, radiotherapy, and immunotherapy for cancer
- Pain management (without a device)
- Skin
- Breast surgery (medically necessary)
- Diabetes management (excluding insulin pumps)
- Heart and vascular system
- Lung and chest
- Blood
- Back, neck, and spine
- Plastic and reconstructive surgery (medically necessary)
- Dental surgery
- Podiatric surgery (provided by a registered podiatric surgeon)
- Implantation of hearing devices
If you reside in a state where emergency ambulance services are not covered by the government (e.g., NSW, VIC, and SA), your Silver tiered policy may also include ambulance cover.
What Isn’t Covered Under Silver Hospital Insurance?
While Silver health insurance offers comprehensive coverage, it's important to note the exclusions. A standard Silver policy does not cover the following hospital treatments, which are included in the Gold tier:
- Pregnancy and birth
- Pain management with devices
- Cataracts
- Joint replacements
- Assisted reproductive services
- Sleep studies
- Dialysis for chronic kidney failure
- Weight loss surgery
- Insulin pumps
What is a Silver Plus Health Insurance Policy?
However, it's worth mentioning that some health funds may offer additional cover for one or more of these clinical categories under a Silver+ or Plus health insurance policy. This means you might still have the opportunity to receive coverage for specific treatments or services not included in the standard Silver policy.
It's always a good idea to review the details of your specific policy and discuss any specific needs or concerns with your health fund provider
Silver Plus health insurance takes the coverage of the Silver tier to the next level by including selected hospital treatments from the Gold tier. If you opt for a Silver Plus policy, you'll not only receive all the benefits of the Silver tier but also enjoy coverage for additional treatments or categories from the higher Gold tier.
It's important to note that health funds offering Silver Plus policies must provide unrestricted cover for these additional treatments or categories, ensuring you have comprehensive coverage. Keep in mind that due to the enhanced coverage, a Silver Plus policy may come with a slightly higher cost compared to a standard Silver policy. However, the added coverage can provide you with greater peace of mind and more extensive protection for your healthcare needs.
Who Might Benefit from Silver Cover?
Those not planning to start a family
If you're not currently planning to have children but still want comprehensive coverage, a Silver policy could be a great fit. It offers a range of benefits while excluding clinical categories like pregnancy, birth, and assisted reproductive services. This may be suitable for various people, including:
- Established singles seeking good coverage
- Couples or partners without children
- Families with children who don't plan on expanding their family further
Older Australians
Silver-tier cover provides a range of benefits that cater to the needs of older Australians. However, it's important to note that not all Silver policies include treatments that may be important for some older individuals. Here are some examples:
Mandatory in Silver cover:
- Heart and vascular system
- Lung and chest
- Blood
- Back, neck, and spine
Not mandatory in Silver cover:
- Cataracts
- Joint replacements
- Weight loss surgery
- Insulin pumps
People with specific needs
Silver-tier cover offers more specialised treatments compared to Bronze, making it beneficial for individuals with specific medical needs requiring coverage. Additionally, many providers offer "Silver plus" policies that include a selection of Gold-tier treatments. These policies provide flexibility for those who want coverage for specific Gold-tier treatments without needing the highest level of cover.
Pros & Cons of Silver Health Insurance
PROS
- Good coverage for private hospital treatment.
- Includes treatments for the heart and vascular system.
- Silver Plus policies offer flexibility in choosing Gold treatments.
CONS
- Still relatively expensive, costing around $115+ per month.
- Covers some uncommon treatments not everyone may need.
- Does not include coverage for outpatient services without additional extras cover.
How Much Does Silver Hospital Cover Cost?
Silver health insurance typically falls in between Bronze and Gold in terms of cost. The exact price can vary and depends on factors such as the health fund offering the policy, the coverage included, and individual circumstances like Lifetime Health Cover loading, Aged Based Discount, and the Australian Government Rebate.
If you opt for a Silver Plus health insurance policy, it will generally be more expensive than regular Silver coverage because it provides additional coverage for a wider range of hospital treatments.
To get an idea of how much Silver health insurance might cost you, a quick and easy way is to compare different health insurance policies online. This allows you to explore different options and find a plan that fits your budget and coverage needs.
How Does Silver Cover Compare to Gold and Bronze?
Silver health insurance falls in the middle when it comes to coverage levels among the four tiers available. It offers more benefits than Basic and Bronze, but it's not as comprehensive as Gold. The cost of a Silver policy usually falls between the prices of Bronze and Gold, although it may vary.
Although Silver policies don't provide coverage for all clinical categories like Gold policies do, they still cover a wide range of hospital treatments. A Silver tier policy typically includes coverage for 26 clinical categories, which is eight more than what Bronze covers. Additionally, Silver policies must include restricted cover for in-hospital psychiatric services, rehabilitation, and palliative care.
Compared to Gold, standard Silver tier policies cover 12 fewer clinical categories. This means treatments like insulin pumps or joint replacements may not be fully covered. However, you may have the option to choose a Silver Plus policy that offers cover for these treatments. Going for a Silver Plus policy can be a cost-effective alternative to opting for Gold health insurance.
Silver health insurance policies can also provide either restricted or unrestricted hospital cover for rehabilitation, psychiatric services, and palliative care. This flexibility is not offered by the Gold tier, which requires these services to be provided on an unrestricted basis.
FAQs
Can I get a Silver extras health insurance policy?
Unlike hospital products, extras cover products do not fall under different tiers. This means that in Australia, extras-only policies can no longer use the names of metals, gemstones, or semi-precious stones in their product names. For example, you won't find policies named Diamond or Platinum extras anymore.
However, there is still a wide range of extras policies available, including mid- and higher-level options. Additionally, some combined policies that offer both hospital and extras cover may use names like Silver hospital and extras to indicate the level of coverage provided. This ensures that you have access to a variety of extras cover options to suit your specific needs.
Are there waiting periods with Silver hospital cover?
Yes, there are waiting periods associated with Silver hospital cover, just like with any other health insurance policy. Waiting periods are the specific periods of time that you must wait after taking out a policy before you can make a claim for certain treatments or services. The length of waiting periods can vary depending on the health fund and the specific treatment or service. It's important to check with your health fund to understand the waiting periods that apply to your Silver hospital cover.
What are restricted services?
Restricted services refer to specific treatments or services that are covered under your health insurance policy but have certain limitations or conditions attached to them. These limitations can include restrictions on the number of treatments covered, the providers you can choose from, or the specific circumstances under which the treatment is covered. For Silver hospital cover, some examples of restricted services can include in-hospital psychiatric services, in-hospital rehabilitation, and palliative care. It's important to review the policy details provided by your health fund to understand the specific restrictions that may apply to your Silver hospital cover.
I have a pre-existing condition, can I still be covered?
Yes, you can still be covered for a pre-existing condition under Silver hospital cover. Health funds in Australia are generally required to offer coverage for pre-existing conditions, although waiting periods may apply. A pre-existing condition is a health condition that you had before taking out the health insurance policy. The waiting period for pre-existing conditions can vary depending on the health fund and the specific condition. It's recommended to contact your health fund directly and disclose your pre-existing condition to understand how it may affect your coverage and any waiting periods that may apply.
Am I covered for a colonoscopy under silver hospital insurance?
Yes, colonoscopies are generally covered under Silver hospital insurance. They fall under the treatment category of "gastrointestinal endoscopy," which is a minimum requirement in the Bronze tier and above. However, it's important to note that specific policy details and coverage may vary between health funds.
