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.
Compare policies with cover for major eye surgery
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 fund | Policies that include cover for non-cosmetic eye surgery | Find out more |
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| Australian Unity |
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*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.
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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.
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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 fund | Policies that include cover for non-cosmetic eye surgery | Find out more |
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| Australian Unity |
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 Restricted fund** |
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 Restricted fund** |
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 Restricted fund** |
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 Restricted fund** |
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 Restricted fund** |
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 Restricted fund** |
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 Restricted fund** |
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 Restricted fund** |
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*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
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