Are you ready for the biggest change to Private Health Insurance for decades?

For years now, the health insurance industry and its regulators have heard the growing concerns from Australia’s population covered by some form of Private Health Insurance, ranging from policies not being easy to compare, and how difficult it is to understand what is actually covered when they join.

In one of the health insurance industry’s biggest efforts to address this, The Private Health Insurance Reform will be introduced as of 1st April 2019.

This reform will introduce a more easily understood 4-tiered system, comprised of Gold, Silver, Bronze and Basic packages that will affect each of the 70,000 plus policies within Australia. It will also simplify the entire process of comparing products, understanding how they work and striking a better deal.

However, many questions still remain. What level of cover is best suited to me?  What is the difference between the different tiers? And how will these changes affect me?

Let’s break-down the 4-tiered system in order to understand what Basic, Bronze, Silver and Gold really mean:

Minimum Package Requirements How Are You Covered? Appropriate For:
  • In Hospital Rehabilitation
  • In Hospital Psychiatric
  • Palliative Care
These services will be restricted, meaning you will be covered as a private patient in a public hospital only, with your choice of doctor and a shared room. You will still be subject to public waiting periods. Ben who is turning 31 and requires an entry level of cover to avoid age-based penalties.

Sarah who received a bonus which took her over the annual threshold so she could avoid paying further taxes.

  • Brain
  • Eye
  • 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
  • Miscarriage and termination of pregnancy
  • Chemotherapy and radiotherapy for cancer
  • Skin
  • Breast surgery (medically necessary)
  • Diabetes
A step up from Basic, however, the same restricted services apply. This level will now cover most procedures and operations up to 100% of the Medicare schedule fee as a private patient in a private participating hospital with your choice of doctor and private room on availability. You are not subject to the public waiting lists Thomas who has just come off his parent’s policy and wanted a basic level of cover for all the what ifs.

Todd and Sean don’t have any overwhelming bodily concerns and regularly attend the gym. At this stage of their lives they are more so worried about the unknown and know that they can upgrade their cover at any moment’s notice.

  • Heart, lung and vascular system
  • Blood
  • Back, neck and spine
  • Plastic and reconstructive surgery (medically necessary)
  • Dental surgery
  • Implantation of hearing devices
  • Podiatric surgery (provided by an accredited podiatric surgeon)
This level will include the previous two tiers’ procedures and remains to cover you up to 100% of the Medicare schedule fee as a private patient in a private participating hospital with your choice of doctor and private room on availability. You are not subject to the public waiting lists Dale, 38, knows that heart issues run in his family so wanted to make sure that heart related surgeries are covered. Also because his wife Rebecca told him to cover it.

Hannah is a professional motocross rider and wanted to make sure that should she fall off her bike in a race and injure her back, she was covered straight away.

  • Cataracts
  • Joint replacements and spinal fusion
  • Dialysis for kidney disease
  • Pregnancy, birth and IVF
  • Weight loss surgery
  • Insulin Pumps
  • Chronic Pain
  • Sleep studies
This is the highest level of the hospital that will be available. This is also the only level of cover that will cover in hospital rehabilitation, psychiatric care and palliative care as a private patient in a private participating hospital with your choice of doctor and private room on availability, covered up to 100% of the Medicare schedule fee.

Joey and Margaret want to add to their family so want to take out a Gold Cover to cover pregnancy for their baby boy.

Phyllis was told by her doctor that she would need to have cataract surgery. This would be the best level of cover for her and her surgery.


Health funds will also be able to provide a Basic Plus, Bronze Plus and Silver Plus which allows them to cover minor upgrades to policies that include restrictions and/or exclusions to ensure that consumers continue to enjoy the same level of cover.

Some other big changes that may affect you:

  • For the first time in Australia, women will benefit from gynaecological services as well as ovarian and breast cancer treatment under the Silver and Bronze levels. This has been introduced to modernise the differences between coverage of men and women for different types of cancer.
  • Younger people may be offered a discount to their premium by signing up for health cover early.This scales to a larger discount for every year under 30, with 29-year olds getting a 2% discount, 28-year olds a 4%, up to a maximum of 10% for anyone 18-25 years old. These young people will be able to then retain the same discount until the age of 40, provided they stay with the same provider in this time.
  • Extras cover will no longer include naturopathy and other alternative therapies that are not supported by professional medical evidence.

Health Insurers will have between April 1st, 2019 and April 1st, 2020 to adopt the changes. However, you now have the information to understand where you stand and what options are available to you, as every policy with every health fund within Australia both closed or open will be affected.

As always, if you need more information about your own personal circumstances, or if you still aren’t clear on how these changes may affect your fund, you can get in touch with the Its My Health Insurance team on 1300 73 96 92, chat with us live on the site, or leave us a message so we can come back to you.

How it works: first choose which best fits you