Do you need Gold health insurance?

What does the top cover option give you under the new system.

Cover for pregnancy, chronic disease and surgery

New government changes to health insurance came into effect on 1 April. 

We are currently reviewing the new policies and will bring you our recommendations toward the middle of this year. Sign up now if you want to be first to know.

What's Gold, Silver, Bronze?

The new product tiers of Gold, Silver, Bronze and Basic can be confusing. In short, they are:

  • Basic – very little if any cover in private hospital
  • Bronze – low cover
  • Silver – medium cover
  • Gold – full or top cover
  • Basic Plus, Bronze Plus and Silver Plus policies will cover at least one service more than normal Basic, Bronze or Silver policies.

Read more about what Gold, Silver, Bronze and Basic policies cover.

What the new Gold policies cover

If you want health insurance that gives peace of mind, we suggest you look for a Gold policy.

Gold policies cover everything covered by Medicare including: 

  • Heart attack, stroke, cancer surgery and plastic surgery (after a burn or accident)
  • IVF, pregnancy and birth
  • Cataract eye surgery
  • Hip or knee replacement
  • Rehabilitation, palliative and in hospital psychiatric care
  • Thousands of other procedures in private hospital

When it makes sense to pay an excess

Policies usually offer excess options of $250, $500 and $750. The higher the excess, the lower the premium.

A policy with an excess might be better value for money but it depends on how soon you think you'll use your hospital cover.

  • If you're healthy or not planning on going to hospital soon: consider an excess. Usually the discount on the premium for policies with excess is so significant that you'd get a better deal even if you had to go to hospital unexpectedly and pay the excess. 
  • If you have a chronic or specific health condition that means you're likely to end up in hospital: you're better off with a policy without excess.

What to expect from your fund, when to switch and how to save: More advice on health insurance.

The best value excess options for Gold

Gold cover with an excess is the best value option. These policies give you peace of mind. Premiums are discounted, but you'll pay an excess or co-payment if you require treatment. You're covered for everything covered under Medicare.

Gold cover with no excess means you're covered for everything covered by Medicare. There are no excesses or co-payments. Use one of these policies if you have a chronic illness or expect to need treatment in hospital soon.

Make sure you upgrade early enough

  • If you have a pre-existing condition that's not covered in your current policy, upgrading to a new one with cover will still mean you need to wait 12 months before you can claim on that condition. 
  • If you upgrade from a policy with excess to one without excess you'll still have to pay the excess if you go to hospital during the first 12 months.
  • Palliative care and rehabilitation are exceptions, they have a two-month waiting period. For psychiatric care you can upgrade once in your life without any waiting period. After that a two-month waiting period applies.

Do you need health insurance? Try our quiz to find out if health insurance will save you money at tax time.

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