Corrective Laser Eye Surgery

Health insurance for major eye surgery

Seeking health insurance that covers major eye surgery? Compare policies from Australian health funds.

Recent advances in surgical techniques, particularly laser surgery, means that eye surgery is becoming increasingly accessible and effective. Two of the most common optical procedures carried out in Australia are:

  • Corrective laser eye surgery. As an optional procedure it isn’t covered by Medicare, but it is often covered by private health insurance extras policies.
  • Cataract surgery. This is essential major eye surgery, and as such it is covered by Medicare, to a certain extent, as well as private health insurance.

The majority of other eye surgeries, with the notable exception of corrective surgery, will be medically necessary and covered by both Medicare and private health insurance to various extents.

What if you have multiple major eye surgery options?

In the case of major eye surgery, you will sometimes be faced with a choice as to how you would like the procedure to be carried out, and your decision will have health insurance implications. For example, you may be given the choice of:

  • Femtosecond laser cataract surgery, which is quicker and safer although may require a high level of extras cover.
  • Manual cataract surgery. Which is cheaper and therefore may be your only option if you have basic extras cover.

Should this happen, it’s a good idea to check with your health fund and your doctor before agreeing to any procedure to ensure that you understand all the insurance implications of your decision.

Which policies from the finder.com.au panel cover major eye surgery?

Health fundPolicies that include cover for non-cosmetic eye surgeryFind out more
HIF Logo
  • Hospital only policies
    • GoldStar Hospital
    • Gold Hospital
More info
health.com.aulogo
  • Hospital only policy
    • High Hospital
  • Combined hospital + extras policy
    • High
More info
ahm
  • Hospital only policies
    • Top
    • Deluxe
  • Combined hospital + extras policy
    • Black + White Deluxe Flexi
More info
Australian Unity
  • Hospital only policy
    • Gold Hospital
  • Combined hospital + extras policies
    • Smart Combination
    • Smart Start (restricted benefit*)
More info
GMHBA
  • Hospital only policies
    • Gold Hospital
    • Bronze Hospital (restricted benefit*)
More info
HCF
  • Hospital only policies
    • Premium Hospital
    • Mid Plus Hospital
More info
nib
  • Hospital only policies
    • Top Hospital
    • Advantage Hospital
More info
Transport Health Logo
  • Hospital only policies
    • Top Hospital
    • Top Hospital with Excess
    • Top Hospital with Co-Payment
    • Basic Hospital (restricted benefit*)
More info

*Benefit only applies if you are treated as a private patient in a public hospital. If you attend a private hospital you will incur significant out-of-pocket expenses for your treatment.

How does the public and private health systems handle major eye surgery?

Medicare, Australia’s public health system, only covers essential procedures like cataract removal surgery. It does not cover optionals like corrective laser eye surgery.

What does Medicare cover you for?What isn't covered?
  • Costs of treatment as a public patient in a public hospital.
  • Partial costs of being treated as a private patient in a public hospital.
  • Essential eye procedures required for the patient to maintain their sight.
  • Corrective surgery.
  • Unessential elective or optional procedures done for cosmetic purposes.
  • Procedures carried out to prevent a patient from needing to wear glasses or contact lenses.
Private health insurance, by contrast, can cover all major eye surgeries to a certain extent, even corrective laser surgery. Most private health funds offer combined hospital and extras policies, as well as hospital only and extras only policies. The level of cover you have depends on the comprehensiveness of your health insurance.

Health insurance policy typeWhat can it cover?
  • Hospital Cover
  • Treatments undertaken as a private patient in a private hospital.
  • Treatments undertaken at private ophthalmology (eye-related) surgery centres.
  • Ancillary costs associated with eye surgery such as anaesthesia and operating theatre fees.
  • Extras Cover
  • Corrective laser eye surgery.
  • Additional treatments such as eye therapy.
  • Subsidies for glasses and contact lenses.

What should I look for when comparing insurance policies?

When comparing health insurance policies for major eye surgery, or for that matter any type of medical service, you should be aware of the terms and conditions, as well as the fine print stating exactly which procedures are covered.

  • Exclusions. These are what the insurer will not pay a benefit for. Exclusions might be for specific procedures, such as corrective surgery, or under specific conditions, such as if you get treatment outside of Australia.
  • Restrictions. These are services that are covered to a limited extent, meaning greater out-of-pocket expenses for you. Restrictions are relatively common in major eye surgery, and you may see certain policies with eye surgery restrictions at the basic level and none at the comprehensive level.
  • Waiting periods. This is the minimum amount of time you must wait between taking out a policy and claiming benefits with it. For in-hospital major eye surgery this is typically 2 months, while for extras corrective eye surgery it is usually about 12 months.
  • Excess. This is a fee you must pay when claiming benefits. Not all health insurance policies include excesses, but some do. You may be able to opt for a higher excess and lower premiums, or a lower excess and higher premiums. It’s good to make sure that your excess is not so high as to prevent you from making any claims.
  • Limits. All private health funds have annual limits, which are the maximum amount you can claim in benefits per year. There might be more than one applicable limit. For example, you might have a policy that lets you claim a maximum of $1,000 per year for all hospital surgery, or $1,000 for all eye surgeries. Limits will always apply so make sure to read your policy’s product disclosure statement closely.

When determining which eye surgeries are covered by your private health insurance policy, you should look for terminology including:

  • Corrective surgery, refractive surgery or laser eye surgery. These are all different ways of reshaping the lens to correct vision and remove  the need to wear glasses. Depending on the nature of your impaired vision, a different corrective procedure might be undertaken. These procedures vary in cost, and it is possible that only some will be covered by either your hospital or extras policy.
  • Major eye surgery. This encompasses a wide variety of surgical procedures undertaken for the purpose of fixing medical issues, such as glaucoma, rather than simply correcting vision. Each insurer may have their own definition of major eye surgery. Some will pay for any major eye procedure recommended by an ophthalmologist, others will only cover specific treatments or parts of the eye.

Seeking health insurance for major eye surgery? Get in touch with an adviser for a quote

Complete list of providers who offer cover for major eye surgery

Health fundPolicies that include cover for non-cosmetic eye surgeryFind out more
ahm
  • Hospital only policies
    • Top
    • Deluxe
  • Combined hospital + extras policy
    • Black + White Deluxe Flexi
More info
Australian Unity
  • Hospital only policy
    • Gold Hospital
  • Combined hospital + extras policies
    • Smart Combination
    • Smart Start (restricted benefit*)
More info
Bupa
  • Hospital only policies
    • Top Hospital
    • Standard Hospital (restricted benefit*)
    • Budget Hospital (restricted benefit*)
  • Combined hospital + extras policies
    • Ultimate Health Cover
    • Prime Plus
    • All other Bupa combined policies have restricted benefits*
More info
cdhlogo
  • Hospital only policies
    • Gold Hospital
    • Silver Hospital (restricted benefit*)
    • Thrifty Hospital (restricted benefit*)
  • Combined hospital + extras policy
    • Smart Cover (restricted benefit*)
More info
cua
  • Hospital only policies
    • 100% Private Hospital Cover
    • 90% Private Hospital Cover
    • 75% Private Hospital Cover
    • Public Hospital Cover (restricted benefit*)
More info
GMHBA
  • Hospital only policies
    • Gold Hospital
    • Bronze Hospital (restricted benefit*)
More info
Frank
  • Hospital only policies
    • Best Hospital
    • Basic Hospital + some private (restricted benefit*)
    • Basic Hospital (restricted benefit*)
More info
gmflogo
  • Hospital only policy
    • Complete Hospital Cover
More info
HBF
  • Hospital only policy
    • Top Hospital
More info
HCF
  • Hospital only policies
    • Premium Hospital
    • Mid Plus Hospital
More info
health.com.aulogo
  • Hospital only policy
    • High Hospital
  • Combined hospital + extras policy
    • High
More info
hcilogo
  • Hospital only policy
    • Hospital Cover
More info
logo health partners
  • Hospital only policies
    • Gold Hospital
    • Silver Hospital
    • Bronze Hospital
  • Combined hospital + extras policy
    • Prime Living
More info
HIF Logo
  • Hospital only policies
    • GoldStar Hospital
    • Gold Hospital
More info
latrobehealthlogo
  • Hospital only policies
    • Top Hospital
    • MemberShare
    • CoverWise
    • Loyal Members
    • Family Care
More info
 medibank
  • Hospital only policies
    • Top Hospital
    • Top Hospital Essentials
More info
onemedifundlogo
  • Hospital only policy
    • Private Plus Hospital
More info
nib
  • Hospital only policies
    • Top Hospital
    • Advantage Hospital
More info
peoplecare provider page link
  • Hospital only policies
    • Premium Hospital
    • Mid Hospital (restricted benefit*)
More info
phoenix health fund provider link
  • Hospital only policy
    • Top Hospital
  • Combined hospital + extras policies
    • Top Cover
    • Value 500
More info
queensland country health fund provider link
  • Hospital only policies
    • Top Hospital Cover
    • Intermediate Hospital Cover (restricted benefit*)
    • Public Hospital (restricted benefit*)
  • Combined hospital + extras policies
    • Singles and Couples Combined Cover (restricted benefit*)
More info
St. Lukes Health Logo
  • Hospital only policies
    • Hospital Platinum
    • Hospital
    • Budget 500 (restricted benefit*)
  • Combined hospital + extras policies
    • Platinum Plus
    • Platinum
    • Gold
    • Silver
    • Packaged Bronze Plus
    • Packaged Budget 500 (restricted benefit*)
More info
Transport Health Logo
  • Hospital only policies
    • Top Hospital
    • Top Hospital with Excess
    • Top Hospital with Co-Payment
    • Basic Hospital (restricted benefit*)
More info
westfund provider link
  • Hospital only policy
    • Gold Hospital
  • Combined hospital + extras policies
    • Platinum Plus
    • Platinum Extended
    • Platinum
    • Gold
    • Gold Extended
    • Gold Classic
    • Gold Public (restricted benefit*)
    • Platinum Public (restricted benefit*)
More info
CBHS Health Fund LogoRestricted fund**
  • Hospital only policies
    • Comprehensive Hospital
    • Active Hospital
    • Limited Hospital (restricted benefit*)
    • Basic Hospital (restricted benefit*)
  • Combined hospital + extras policies
    • Prestige
    • StepUp (restricted benefit*)
    • KickStart (restricted benefit*)
More info
defencehealthlogoRestricted fund**
  • Hospital only policies
    • Premier Hospital
  • Combined hospital + extras policy
    • ADF Total Package
More info
navyhealthlogoRestricted fund**
  • Hospital only policies
    • Premium Hospital
    • Healthy Hospital
    • NT Hospital (Northern Territory only)
    • NT Hospital 300 (Northern Territory only)
More info
doctorshealthfundlogoRestricted fund**
  • Hospital only policies
    • Top Cover
    • Prime Choice
More info
policehealthlogoRestricted fund**
  • Combined hospital + extras policies
    • Platinum Plus
    • Platinum Health
More info
rthealthlogoRestricted fund**
  • Hospital only policies
    • Premium Hospital
    • Smart Hospital
More info
teachersRestricted fund**
  • Hospital only policies
    • Top Hospital
    • Mid Hospital (restricted benefit*)
    • Basic Hospital (restricted benefit*)
  • Combined hospital + extras policy
    • StarterPak (restricted benefit*)
More info
tuhRestricted fund**
  • Hospital only policies
    • Total Care Hospital
  • Combined hospital + extras policy
    • Ultimate Choice
    • Easy Choice
More info

*Benefit only applies if you are treated as a private patient in a public hospital. If you attend a private hospital you will incur significant out-of-pocket expenses for your treatment.
**Restricted funds only provide cover to members of specific industries, groups and organisations. In some cases family members may also be eligible to join.

Seeking health insurance for major eye surgery? Get in touch with an adviser for a quote

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