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The government also decides which treatments must be included under each clinical category. Insurers are not allowed to vary or exclude those treatments from their cover.
When you get a quote for Hospital Cover, you cannot choose the clinical categories you want cover for.
Instead, since 1 April 2020, you choose a policy from 4 product tiers:
Basic
Bronze
Silver
Gold.
The government decides which clinical categories fall into each tier. When you buy a Hospital Cover policy, you know exactly what clinical categories and treatments are included:
Level
Categories Included
Basic Hospital Cover
3 of 38
Bronze Hospital Cover
21 of 38
Silver Hospital Cover
29 of 38
Gold Hospital Cover
38 of 38
The government uses this system of Hospital Cover tiers to make it easier for you to compare policies from different insurers.
One limitation is you have to pay for treatments in clinical categories you will never use:
Bert takes out Gold Hospital Cover but this includes some treatments he is unlikely to need.
Bert is 25. He decides to purchase Gold Hospital Cover because, after reviewing the list of 38 clinical categories, he wants cover for joint replacements. He discovers only Gold Hospital Cover includes this clinical category. However, if he takes out Gold Cover, he will also be paying for treatments in clinical categories he is unlikely to need, including: – assisted reproductive services – pregnancy and birth – weight loss surgery – sleep studies – insulin pumps.