Private Health Insurance Reforms

The Australian Government introduced Reforms to private health insurance in April 2019, to make it easier for people to compare policies.

All private health funds must now classify their Hospital covers into one of four tiers: Gold, Silver, Bronze or Basic. You can find out more information on the Reforms on the Department of Health website.

If you have questions about your cover, please call us on 1300 586 462.

Private Health Insurance Reforms

Four product tiers

The Basic tier must cover a minimum of three categories: 

  • Rehabilitation 
  • Psychiatric care 
  • Palliative care 

The Bronze tier must also include the above, plus the following categories: 

  • Joint reconstruction 
  • Ear, nose, and throat 
  • Gynaecology 
  • Male reproductive system 
You can find all the mandatory Bronze tier categories at the Department of Health.        

The Silver tier must also include the above, plus the following categories: 

  • Heart and vascular 
  • Back, neck and spine 
You can find all the mandatory Silver tier categories at the Department of Health. 
The Gold tier must also include the above, plus following categories: 

  • Cataracts 
  • Joint replacement 
  • Pregnancy and birth 
You can find all the mandatory Gold tier categories at the Department of Health. 

Health funds have the discretion to provide cover for additional services on Silver, Bronze and Basic products.  These are known as ‘Plus’ products.  For example – Bronze Plus covers all minimum services for the Bronze tier, plus additional services selected by the fund.

Why isn’t there a Gold Plus tier? Gold products are the highest level of cover available.  Gold products must offer all services on an unrestricted basis. 

As part of the Reforms, the Government created a new list of clinical categories. Health funds must all use the same clinical definitions when they refer to these categories, to make it easier for you to understand what you’re covered for.

The list of standard clinical categories is consumer-friendly and easy to understand.

Each CBHS Corporate Health product is now categorised as Gold, Silver, Bronze or Basic. Most CBHS Corporate Health products moved seamlessly into the new tiers and they cover more services than the Government’s minimum standards. In some cases, there were products that required some changes to the services covered. We notified any impacted members about this.

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