What is Silver tier health insurance?

On April 1, the Australian Government introduced a simplified tier system which requires all heath insurers to include the same clinical categories (groups of hospital and medical services) under four simplified tiers - Basic, Bronze, Silver and Gold. Its aim is to make it easier for to identify, compare, research and take out private health insurance. Silver tier is the second highest level of Hospital cover available.

With HIF, our Silver Hospital cover includes 26 of the 38 clinical categories available, and our new Silver Plus Hospital option includes 32 categories (plus access to our exclusive HIF Second Opinion service as a bonus inclusion!). To view and compare all HIF Hospital cover options, check out our handy comparison table.

Is Silver Plus Hospital the right policy for you?

Our new Silver Plus Hospital option is a great choice for singles, couples and families who would like comprehensive cover, but don't require maternity or IVF services. It includes all the clinical categories covered on our standard Silver Hospital option, plus joint replacements, cataract treatment, sleep studies and pain management devices.

Also included on this policy:

  • Exclusive access to our popular HIF Second Opinion, enabling you to get a second opinion on any diagnosis, condition or treatment from over 50,000 medical specialists worldwide.
  • At-home hospital services such as chemotherapy, rehabilitation, complex wound management (home nursing) and chronic health disease management. 

How do I switch to Silver Plus Hospital from another insurer?

It's easy! To authorise us to arrange the transfer on your behalf, simply check the box during the online application process and enter the name of your current health fund and your member number. Then we'll do the rest. Alternatively, if you're joining over the phone, you can instruct your Sales Consultant to complete the authorisation details for you.

Once we have your authorisation, we'll then contact your previous fund and request that they send us what's known as a 'Clearance Certificate'. The certificate provides HIF with all the details we need in order to finalise your new policy with us, including any waiting periods that may still be outstanding, plus any Lifetime Health Cover loading that may apply. 

What’s not included on Silver Plus Hospital?

Silver Plus Hospital does not include the following clinical categories:

  • Dialysis for chronic kidney failure
  • Pregnancy and birth
  • Assisted reproductive services (e.g. IVF)
  • Weight loss surgery
  • Insulin pumps

What's restricted on Silver Plus Hospital?

Only Hospital Psychiatric Services are restricted on Silver Plus Hospital. If you would like to be covered for this category too, please take out our Gold Star Hospital option instead.

What’s the difference between Gold, Silver and Bronze tiers?

As part of the 2019 Private Health Insurance Reforms, each Hospital cover tier now defines the minimum requirements for the services ('clinical categories') that must be included. Each tier incrementally includes  everything in the previous tier, plus more. 

Gold is the highest tier of cover available and must include all 38 clinical categories. It's also the only tier of cover which includes pregnancy and birth related services as a mandatory inclusion. 

Silver is the second highest tier of cover and must include a minimum of 26 clinical categories (not including restricted services). It includes heart and vascular systems, lung and chest plus many other services. 

Bronze is a basic tier of cover and includes 18 clinical categories. It's a great entry-level tier to provide peace of mind.

Basic is the minimum hospital tier health funds can offer. It must include cover for tonsils, adenoids and grommets, joint reconstructions, hernia repairs and appendix treatment, plus restricted cover for in-hospital psychiatric services, palliative care and rehabilitation, and it's a popular option if you'd like to avoid the Medicare Levy Surcharge

What is hospital cover?

Hospital cover is private health insurance that helps to cover the costs of inpatient hospital admissions, including accommodation, theatre fees and charges raised by your doctor.  All medical services listed under the Medicare Benefits Schedule (MBS) are also covered by private hospital insurance, and benefits will be payable when you hold the appropriate level of cover for the service(s) you wish to claim. It includes the option to:

  • Choose your own hospital, doctor and specialist
  • Stay in a private room (if available and included on your cover)
  • Plus - the peace of mind knowing that you can avoid lengthy public hospital waiting lists

Are there any hospital waiting periods?

Whether we’re answering your call, or helping you switch from another health fund, we don’t like to keep people waiting. But unfortunately waiting periods (the time you have to wait before you can claim for treatment) are a universal necessity. All health funds have them. We wouldn't be able to offer our affordable premiums and generous rebates without them.

Waiting periods protect us and our Members against people who simply join us, claim large amounts and then leave. We always try to keep waiting periods to an absolute minimum though.

That’s why, if you join us from another health fund, we’ll take your previous membership into account so you don’t have to re-serve waiting periods on an equivalent level or higher level of cover.

For HIF Hospital Cover, the waiting periods are as follows:

  • 2 months: General hospitalisation
  • 2 months: Psychiatric care*, rehabilitation & palliative care (regardless of whether it's pre-existing or not)
  • 12 months: All pregnancy related services (only applicable to HIF Gold Star Hospital cover)
  • 12 months: Pre-existing conditions or ailments

* New Members transferring to HIF who previously had limited psychiatric cover can now upgrade their policy without serving a two month waiting period for the higher or additional benefits. The waiting period exemption for psychiatric care benefits can only be accessed once in a lifetime, and is only available after a person has served their initial two month waiting period for any psychiatric treatment.

When will I have to pay an excess?

If you choose Hospital Cover with an excess, you'll only have to pay it upon admission to hospital, and only once per calendar year (even if you have multiple admissions in the same year). Use the table below to see which excess rules apply to your cover.

Hospital coverSame-day admissionsOvernight admissionsDependants under 18Per-person excess options
Basic PlusN/A$500
$750
Bronze$200
$500
$750
Bronze Plus$200
$500
$750
Silver$500
$750
Silver Plus $200
$500
$750
Gold Starxx$0
$200
$500
$750

Frequently Asked Questions

 Will I have any out-of-pocket medical expenses? 

The Medicare Benefits Schedule (MBS) is the schedule of fees set by the government for standard medical services. In a nutshell, it determines the amounts that Medicare defines to be a fair charge by a doctor or specialist. If a doctor charges within the MBS, Medicare will pay 75% of the doctor's fee up to the pre-defined limit, and your hospital insurance policy will cover the remaining 25%. If your provider’s fee is the same or less than the MBS fee, you’ll be covered by Medicare and HIF. However, different providers can charge different prices for the same procedure, and if your provider’s fee is higher than the MBS fee, you’re likely to have an out-of-pocket (gap) expense. If you’re planning a procedure, ask your medical provider and any associated health provider (e.g. anaesthetist or assistant surgeon) if they will participate in HIF's AccessGap scheme (see below) to help minimise or eliminate your out-of-pocket expenses. If they don’t confirm your out-of-pocket expenses, contact us with your provider’s details, item numbers and charges and we’ll provide you with a benefit estimate.

What is HIF AccessGap Cover?

AccessGap Cover is HIF's medical gap cover arrangement, designed to minimise or eliminate any out-of-pocket expenses for inpatient medical services. Australian Medical providers can nominate to opt in or out of AccessGap, which may mean that if you choose an AccessGap Doctor you can have lower out-of-pocket costs. HIF Members now have access to over 30,000 doctors and specialists practising in over 111,000 locations around Australia who have agreed to participate in AccessGap

Should I notify HIF before I go into hospital? 

Before undergoing any hospital treatment, we strongly recommend that you get in touch so you know exactly what your gap, if any, might be. To request a benefit estimate in advance, please ask your doctor or specialist for a detailed medical estimate (this will include a list of the items you’ll be billed for including fees for each item and your doctor’s provider number), then complete our online Medical Estimate Form. Alternatively, you’re always welcome to call us on 1300 13 40 60 and we can provide a benefit estimate over the phone.

What's a pre-existing condition? 

A pre-existing condition is defined as: ‘Any ailment, illness, or condition where, in the opinion of a medical adviser appointed by the health insurer, the signs or symptoms of that illness, ailment or condition existed at any time in the period of six months ending on the day on which the person became insured under the policy.’ A pre-existing condition can be identified by the presence of signs or symptoms of the illness, ailment or condition (i.e. it’s not necessary for the member or their doctor to know what their condition is, or for it to be diagnosed). In assessing whether a condition is a pre-existing condition or not, an HIF-appointed medical practitioner will take into account information provided by your treating doctor.

What if I want to add maternity cover in the future?

No problem! You can upgrade to our Gold Star Hospital policy at any time. The waiting period for all obstetric related services (including assistant reproductive technology) is 12 months though, so if you're planning a family in the future you’ll need to hold maternity cover for 12 months prior to your due date.