optometry treatment

Health insurance and eye care

How to get optometry and eye care covered by your health fund

Eyes are complicated, so a lot of things can go wrong with them. That’s why it helps to have optical private health insurance to cover optometrist visits and other eye care. Lifetime eye care includes regular check ups and, depending on your needs, might also include glasses or contact lenses, vision therapy, laser eye procedures or cataract and other eye surgery.

What optometry costs will your health fund cover?

While cover will vary depending on your policy, you can receive cover for:

  • Check ups and examinations
  • Glasses and contact lenses
  • Eye disease
  • Eye surgery for medical issues
  • Vision therapy
  • Laser eye surgery
Medicare provides cover for some of these benefits, but for full cover you’ll need private health insurance.

Optometry serviceDoes Medicare cover it?Can private health insurance cover it?
Check ups and examinationsYesYes
Eye surgery for medical issuesYesYes
Eye diseaseYesYes
Glasses and contact lensesNoYes
Vision therapyNoYes, as an extra
Laser eye surgeryNoYes, as an extra

Compare your health insurance options

How do I know if something is covered by Medicare?

If something is medically necessary, such as regular eye examinations or treatment for a disease, then it is most likely covered by Medicare. If something is not medically necessary, such as cosmetic or laser eye surgery, or if it involves providing equipment or aids, such as contact lenses or glasses, then it’s not covered by Medicare but generally can be covered by your private health insurance.


Should you get optical cover with private health insurance?

When deciding whether you are at risk of optical issues and whether you should get health insurance to cover them you should consider age as a factor. Eye disease and serious issues are relatively uncommon in younger age groups, but very common in older demographics.

  • 31% of older Australians (over the age of 55) have cataract presence, compared to less than 5% under that age.
  • More than 40% of older Australians are visually impaired, in contrast to less than 5% of younger Australians.
  • Almost 20% of Australians aged 90+ are blind, but less than 1% of younger Australians are.

What should I look for in a health insurance policy?

There are some terms and conditions you should look out for when finding an insurance policy.

Exclusions

Exclusions are the things that aren’t covered by your private health fund. Some frequently encountered exclusions are:

  • Treatment outside of Australia. If you want to head abroad for cheaper laser eye surgery, for example, most health funds won’t cover that. You might consider medical tourism insurance instead.
  • No cover unless there is a specific, named health issue involved.
  • No cover for additional costs like administration fees.

Limits

These are the maximum amounts your policy will pay in benefits, or how much you can claim before your benefits cap out. Your policy may have yearly or lifetime limits for a number of treatment sessions or an amount of money paid out.

  • If the cost of a treatment is more than the limit of your policy, you will only be covered up to that limit and must pay the rest yourself.
  • In the case of family or couple policies there may be limits for individuals as well as limits for the group as a whole.

Excess

This is an additional amount you must pay when making a claim and you may encounter one or more of these. If more than one excess applies, you must pay the total sum of all applicable excesses.

  • Age related excess. The older you are the higher your risk levels. Certain age groups have this additional excess.
  • Hospital excess. If someone on your policy goes to hospital this excess will apply to cover the additional costs involved.
  • Special excess. Pre-existing conditions, ongoing health issues or a history of making many claims will drive up your special excess.

How do I make an optical cover health insurance claim?

Depending on the procedure and your insurer, there are a few ways to make a claim. Some claims may require more than one of these. For example, you might be able to claim a procedure online, but you may be required to fill out a claims form and mail it in to claim the related ambulance ride.

  • Use an app. Some health funds offer a mobile app you can use to make a claim. This is an easy way to do it but might not always be an option.
  • Claim online. Visit your insurer’s website to make a claim online. Login with your details and go to the claims section. From there you can follow the steps, provide the information required and have the benefit paid sent directly to your bank account or mailed as a cheque.
  • Send in a claims form. Download a claims form from your insurer’s website, fill it in and mail it off to the address provided. Your claim will be processed and handled accordingly.

Compare policies for optometry and eye care

Details Features
Active Life Extras
Active Life Extras
Straightforward extras that covers you for vital out of hospital services while keeping premiums low. Treatments include general dental and optical, as well as healthy lifestyle benefits.
  • $500 general and major dental combined limit
  • $400 chiro and osteo annual limit
  • $400 physio annual limit
  • $400 alternate therapies annual limit
Get Quote More info
Extras 50
Extras 50
With the Extras 50 policy health.com.au will pay 50% of the provider's fee.
  • From $10.58 weekly
  • 50% back on extras
  • Unlimited emergency ambulance transport cover
  • $500 general dental limit
Enquire Now More info
Super
Super
Super Extras is the highest level of extras cover available from AHM and provides cover for services ranging from major dental to diet and nutrition to health improvement benefits.
  • No family limits
  • Orthodontics
  • Outpatient care
  • Pre and postnatal
Enquire Now More info
Premium Options
Premium Options
Premium extras cover for all everyday healthcare services. Save 4% when you pay for 12 months of your cover upfront.
  • Dental and chiropractic cover
  • Osteopathy and optical
  • Occupational therapy
  • Orthoptic
Get Quote More info
Platinum 80%
Platinum 80%
Platinum 80% provides you with 80% back on all included extras.
  • Claim up to $8500 on extras
  • General, complex and major dental and orthodontics
  • Pharmacy
  • Travel vaccinations
Enquire Now More info
Top Extras
Top Extras
Comprehensive extras cover that includes a wide range of non-hospital related treatments and services. Restricted fund: Only current and former employees of the Commonwealth Bank of Australia Group and their eligible families can join.
  • Generous overall limits on services
  • Major dental including orthodontics
  • Unlimited preventative dental
  • Hearing aids
Enquire Now More info
Gold Extras Set Benefits
Gold Extras Set Benefits
Top level extras cover including cover for a wide range of popular services including orthodontics, physiotherapy and optical.
  • Podiatry
  • Nursing
  • Pressure garments
  • Weight loss program
Enquire Now More info
Platinum Extras Cover
Platinum Extras Cover
Top level extras cover with highes range of cover for therapies and serivces.
  • 100% back on up to 2 dental visits per year
  • 100% back on initial chiro, physio, osteo
  • General therapies cover
  • Vaccinations and immunisations cover
Enquire Now More info
Top Extras
Top Extras
NIB's premier extras cover with up to $1,000 in General dental covered annually and cover for a range of therapies including Chiro & Osteo.
  • $1,000 general dental cover annual limit
  • $600 physiotherapy annual limit
  • Unlimited ambulance cover
  • $350 optical annual limit
Enquire Now More info
Top Extras
Top Extras
Top level extras cover with highest percentage back.
  • 60 - 100% back
  • $800 dental annual limit per person
  • $850 physiotherapy annual limit per person
  • $300 optical annual limit per person
Enquire Now More info

Picture: Shutterstock

Andrew Munro

Andrew writes for finder.com.au, comparing products, writing guides, sniffing out deals and looking for new ways to help people get the most out of their money.

Was this content helpful to you? No  Yes

Related Posts

Ask a Question

You are about to post a question on finder.com.au

  • Do not enter personal information (eg. surname, phone number, bank details) as your question will be made public
  • finder.com.au is a financial comparison and information service, not a bank or product provider
  • We cannot provide you with personal advice or recommendations
  • Your answer might already be waiting – check previous questions below to see if yours has already been asked

Disclaimer: At finder.com.au we provide factual information and general advice. Before you make any decision about a product read the Product Disclosure Statement and consider your own circumstances to decide whether it is appropriate for you.
Rates and fees mentioned in comments are correct at the time of publication.
By submitting this question you agree to the finder.com.au privacy policy, receive follow up emails related to finder.com.au and to create a user account where further replies to your questions will be sent.

Ask a question
feedback