The most wide-ranging reforms to health insurance in the last two decades have been introduced by the federal government, with most changes due to come into effect from April 2019.
Gold, Silver, Bronze and Basic product tiers are being sold as a solution that will make health insurance simpler, but the reality is far from that.
Will the reforms reduce confusion?
Gold, Silver, Bronze and Basic should, in theory, make choosing a policy simpler, however the proposed product tiers are not four options. Insurers can label their products as 'Plus', creating seven categories, and then there are literally billions of versions of potential policies.
The set-up of these categories plays into the hands of insurers who now have the means to better market their products, while consumer confusion remains unaddressed.
Previously there were around 12 categories of often-excluded treatments, now there are 38 categories. And the definitions of these treatments aren't always easy to understand. For example:
- Chemotherapy is covered in Bronze policies, but cancer surgery cover depends on which clinical category it falls under. For example, lung cancer surgery would only be covered by Silver and Gold policies.
- Eye is covered in Bronze policies – but that includes only part of the services needed for your eye. If you need an eyelid procedure, that's plastic and reconstructive surgery covered under Silver policies and if you have a cataract you'll need a Gold policy to be covered.
- Podiatric surgery is listed as covered for a Silver policy, but this cover only relates to the hospital accommodation and any necessary prostheses, while the surgery itself still isn't covered
But wait, there's more
Insurers can also offer Basic Plus, Bronze Plus and Silver Plus policies.
These policies cover additional treatments available in a higher category, so for example:
- Silver Plus could contain cover for all Silver treatments and pregnancy.
- Bronze Plus could contain all Bronze treatments plus heart surgery.
The federal government has created a factsheet to explain what treatments are included in Gold, Silver, Bronze and Basic policies.
But it doesn't address the confusion surrounding categories, or explain what's included in any 'Plus' policies.
Image source: Hospital Treatment Product Tiers; Gold, Silver, Bronze and Basic, health.gov.au.