As part of various private health insurance changes, four new tiers of hospital cover began rolling out from 1 April 2019 and became mandatory from 1 April 2020. All hospital insurance policies are classified as Gold, Silver, Bronze or Basic.

In order to be classified in a tier, the policy has to meet the minimum requirements of that tier as set out in the table below. All treatments in the table below refer to treatment received as part of a hospital admission.

Each of the clinical categories listed below are groups of what hospital treatments are, and are not, covered under each policy. Each standard category—for example, ‘bone, joint and muscle’ category or ‘heart and vascular system’ category—sets out the hospital treatments that must be covered by your private health insurer. If a policy covers a certain category, then it must cover everything listed in it—not only some things.

If a policy meets the minimum requirements of a tier, but also includes additional coverage, then it can be called a 'Plus' policy – for example, Bronze Plus or Silver Plus.

Clinical Category	Basic	Bronze	Silver	Gold
Rehabilitation
Hospital psychiatric services
Palliative care
Brain and nervous system	O (R)
Eye (not cataracts)	O (R)
Ear, nose and throat	O (R)
Tonsils, adenoids and grommets	O (R)
Bone, joint and muscle	O (R)
Joint reconstructions	O (R)
Kidney and bladder	O (R)
Male reproductive system	O (R)
Digestive system	O (R)
Hernia and appendix	O (R)
Gastrointestinal endoscopy	O (R)
Gynaecology	O (R)
Miscarriage and termination of pregnancy	O (R)
Chemotherapy, radiotherapy and immunotherapy for cancer	O (R)
Pain management	O (R)
Skin	O (R)
Breast surgery (medically necessary)	O (R)
Diabetes management (excluding insulin pumps)	O (R)
Heart and vascular system	O (R)	O
Lung and chest	O (R)	O
Blood	O (R)	O
Back, neck and spine	O (R)	O
Plastic and reconstructive surgery (medically necessary)	O (R)	O
Dental surgery	O (R)	O
Podiatric surgery (provided by a registered podiatric surgeon)	O (R)	O
Implantation of hearing devices	O (R)	O
Cataracts	O (R)	O	O
Joint replacements	O (R)	O	O
Dialysis for chronic kidney failure	O (R)	O	O
Pregnancy and birth	O (R)	O	O
Assisted reproductive services	O (R)	O	O
Weight loss surgery	O (R)	O	O
Insulin pumps	O (R)	O	O
Pain management with device	O (R)	O	O
Sleep studies	O (R)	O	O

Legend

	Indicates the clinical category is a minimum requirement of the product tier.
(R)	Restricted cover permitted: insurers are allowed to offer cover for this clinical category on a restricted basis. A restricted benefit means you are partially covered for hospital costs as a private patient in a public hospital.  ou may incur significant expenses in a private room or private hospital so you should check with your insurer and hospital for details.
O	Optional for the insurer to include: insurers may choose to offer these as additional clinical categories.
	Included, with restricted cover permitted.
O (R)	Optional, with restricted cover permitted.