What is Silver Health Insurance?
Hospital health insurance policies in Australia are split into four main tiers—Gold, Silver, Bronze and Basic. Each tier includes cover for certain categories of medical treatment and services as a minimum, as set out by the Federal Government.
Silver health insurance is the second highest tier of hospital cover, behind Gold. As well as providing the same minimum levels of cover as Basic and Bronze policies, Silver policies must also include cover for eight additional categories:
- Heart and vascular system
- Lungs and chest
- Blood
- Back, neck and spine
- Plastic and reconstructive surgery (medically necessary)
- Dental surgery
- Podiatric surgery
- Implantation of hearing devices
What is covered by Silver health insurance?
As a minimum, Silver health insurance policies cover 29 clinical categories out of the total 38. Of these, three categories—rehabilitation, hospital psychiatric services and palliative care—may be offered on a restricted basis.
If a certain clinical category is offered on a restricted basis, it means the insurer pays only a limited amount of the private hospital costs. According to the Commonwealth Ombudsman, this means people are more likely to face significant out-of-pocket expenses for treatments with restricted benefits.
Including from the categories above, Silver policies also cover:
- Rehabilitation (restricted)
- Hospital psychiatric services (restricted)
- Palliative care (restricted cover)
- Brain and nervous system
- Eye (not 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 & immunotherapy for cancer
- Pain management
- Skin
- Breast surgery (medically necessary)
- Diabetes management (excluding insulin pumps)
What does Silver health insurance policies not cover?
Silver health insurance policies are not required to cover the following nine categories:
- Cataracts
- Joint replacements
- Dialysis for chronic kidney failure
- Pregnancy and birth
- Assisted reproductive services (i.e. IVF)
- Weight loss surgery
- Insulin pumps
- Pain management with device
- Sleep studies
However, providers may offer these treatments and services as an optional addition to their policies in the form of ‘Silver Plus’ health insurance.
‘General’ treatment and services, such as dental or podiatric care, may not be covered unless you’ve taken out an ‘extras’ policy along with your Silver hospital cover.
What is ‘Silver Plus’ health insurance?
A Silver Plus health insurance policy is one that includes coverage for clinical categories outside of the ones that are minimum requirements. For example, you could have a Silver Plus policy that includes pregnancy and birth cover, joint replacements or cataracts, which would normally only be available under a Gold tier policy.
It’s up to your chosen provider whether or not it offers ‘Plus’ policies and what clinical categories are included in them. Check with your health insurance provider directly about what is and isn’t covered or read the policy’s Private Health Information Statement (PHIS).
How much does Silver health insurance cost?
The cost of Silver health insurance can vary depending on several factors, such as the provider you choose, the policy you select, the excess you’re willing to pay and where you live. The price of your health insurance premiums will also depend on whether you’re covering just yourself or the whole family.
In addition, if you’re taking out hospital cover for the first time and you’re over 31, you may pay higher premium costs under Lifetime Health Cover (LHC). This is a 2% loading that’s added to your premiums for every year you’re aged over 31, based on your age on the 1 July prior to joining, and don’t have an eligible private hospital policy.
You may be able to use the Private Health Insurance Rebate to lower the cost of your premiums. The Private Health Insurance Rebate is an amount the Federal Government contributes towards your private health insurance costs. But the rebate is income tested, meaning your eligibility will depend on your annual income, as well as your age.
With all these factors in mind, the cost of your Silver health insurance heavily depends on your own individual circumstances. That’s why comparing policies can be one way to determine how much you’ll likely pay in monthly premiums. Click the ‘compare health insurance’ button to get a personalised health insurance quote.
Is Silver health insurance worth it?
You may find that a Silver health insurance policy is worth it for you if it’s within your budget and if it gives you some peace of mind knowing that you’ll be covered for certain hospital procedures.
If you don’t think you’ll need coverage for any of the treatments or services that a Silver policy provides and are looking to avoid the Medicare Levy Surcharge (MLS) or LHC, you may find that a Basic or Basic Plus policy offers better value for you. A Silver health insurance policy may also not be worth it for you if you wish to be covered for a comprehensive range of hospital procedures, which you may find in a Gold policy.
