Key takeaways
- Compare clinical categories, not just tier names — Silver Plus can beat plain Silver.
- Match excess, rebate tier, and gap arrangements across funds.
- Check extras annual limits for services you actually use.
Comparing health funds means more than sorting by price. Here is a practical checklist to line up policies fairly before you switch.
On this page
Start with clinical categories
Download the clinical categories list for each policy — not just the metal tier name. Insurers can add Plus categories beyond the tier minimum, so two Silver policies may cover different services.
| Tier | Minimum categories | Examples of covered services |
|---|---|---|
| Gold | All 38 clinical categories | Pregnancy, joint replacements, cataracts, psychiatry |
| Silver | 26 categories | Heart surgery, lung cancer, dental surgery in hospital |
| Bronze | 18 categories | Broken bones, hernias, joint reconstructions (limited) |
| Basic | 3 categories + accident cover | Accidents, ambulance, palliative care (varies) |
Insurers may offer "Plus" products with extra categories beyond the tier minimum. Always read the clinical category list in the PDS.
Four financial variables to compare
Compare annual premium after rebate, hospital excess (per admission vs per year), co-payments for hospital stays, and gap risk for non-participating specialists. A cheap premium with high excess and weak gap cover can cost more overall.
Extras limits that matter
For extras, compare annual limits for dental (general and major), optical, physio, and psychology. Check whether preferred providers near you offer higher benefits.
Switching checklist
Step-by-step
- 1Compare same tier and similar excess across 3–4 funds
- 2Request a quote with your applicable rebate tier applied
- 3Confirm waiting periods will transfer (same or lower tier)
- 4Get new policy confirmed before cancelling the old fund
- 5Provide certificate of membership from previous fund if requested
General information only — not personal financial advice. Consider your own circumstances and read the Product Disclosure Statement (PDS) before purchasing any policy. Moneyhero may earn referral fees from some providers when you switch through us; this does not change how results are ordered. How we compare
Frequently asked questions
Comparing health funds — tier categories, premiums, excess, and waiting periods explained.
Does my waiting period carry over when I switch health funds?
If you switch to the same or lower tier of cover, waiting periods already served at your previous fund transfer to the new fund. Moving to a higher tier triggers new waiting periods only for the additional clinical categories. Provide your previous insurer's certificate of membership when joining the new fund.
How do I find out if my specialist is covered by no-gap arrangements?
Contact your fund before booking an elective procedure and ask whether the treating specialist participates in their gap cover scheme. Alternatively, ask the specialist's billing staff directly. Knowing in advance prevents unexpected out-of-pocket bills.
Why are premiums different between people on the same policy?
Premiums vary by age band (older members pay more to cross-subsidise younger members), the applicable government rebate percentage (which reduces with income), and whether LHC loading applies. The headline premium is before these adjustments.
Can I change my excess to reduce my premium?
Yes. Many funds allow you to increase your hospital excess to lower the annual premium — useful if you are unlikely to claim. The maximum excess for singles is capped by the Australian Government's rebate rules; confirm the eligible excess with your fund.