What costs do health funds cover for orthotics?
If you require treatment from an orthotist or you need orthotics to improve your mobility, the cost of treatment can be quite expensive. However, if you have private health insurance, your health fund may cover some or all of the costs.
Cover for orthotics is typically included in an extras or general treatment policy, so let’s take a look at what sort of benefits are available and how to find a policy that suits your needs.
Which Australian health funds cover orthotics?
| Health fund | Extras policies and annual benefit limits* | Waiting periods |
|---|---|---|
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| Australian Unity |
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*The policies listed in this table are extras only. However, in most cases these can be combined with hospital cover.
| Health fund | Extras policies and annual benefit limits* | Waiting periods |
|---|---|---|
| ahm |
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| Australian Unity |
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| Bupa |
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| CUA Health |
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| GMF |
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| GMHBA |
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| HBF |
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| HCF |
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| Health Care Insurance |
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| hif |
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| Latrobe Health Services |
| |
| Medibank |
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| Mildura Health Fund |
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| nib |
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| onemedifund |
| |
| Peoplecare |
| |
| Queensland Country Health Fund |
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| St. Lukes Health |
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| Transport Health |
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| ACA Health |
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| Defence Health |
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| Navy Health |
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| RT Health |
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| Teachers Health Fund |
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| TUH |
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*The policies listed in this table are extras only. However, in most cases these can be combined with hospital cover.
What's in this guide?
- Which Australian health funds cover Orthotics?
- What are orthotists and orthotics?
- Are orthotists the same as podiatrists?
- Are orthotic services covered by health insurance?
- What should I be aware of when claiming for orthotics?
- Final things you might want to know about orthotics
- Compare comprehensive extras policies and get a quote from an adviser
Compare health insurance for orthotics
What are orthotists and orthotics?
An orthotist is an allied health professional who can, according to the Australian Orthotic Prosthetic Association, “Assess and treat the physical and functional limitations of people resulting from illnesses and disabilities, including limb amputations.” Orthotists can prescribe, design, fit and monitor the performance of orthotic and prosthetic devices.
Orthotics, which are also called orthoses, are specially designed braces, appliances and inserts that can be fitted to the body. There are orthoses available for knees, ankles and feet – for example, shoe inserts – plus orthoses to protect fractures and spinal orthoses. These appliances are used to:
- Assist in rehabilitation
- Control biomechanical alignment
- Correct deformities
- Reduce pain
- Increase mobility and independence
- Prevent injury or protect an injury while it heals
Are orthotists the same as podiatrists?
Although there are some similarities between the work they do, orthotists and podiatrists are two very different types of health professionals.
- Orthotists. Work exclusively with orthoses, which are devices fitted externally to the body to treat a wide variety of physical limitations resulting from illnesses, disabilities and deformities. In some cases this involves using orthotics to treat abnormalities, prevent injuries and improve normal functions of the lower limbs and feet.
- Podiatrists. Concentrate solely on the disorders of the lower limbs. Treatment from a podiatrist may sometimes involve the fitting of orthotic devices, but it can also involve more palliative treatment such as the removal of calluses, warts, corns and ingrown toenails.
Are orthotic services covered by health insurance?
The good news is that many Australian private health funds include cover for orthotics as part of some extras policies. However, you will usually need to take out a comprehensive extras cover in order to receive benefits for orthotics, as it is commonly excluded from basic extras policies.
It is also important to be aware that health funds classify orthotics differently. Some funds will list orthotics in its own section with a single annual benefit limit you can claim for orthoses and treatment by an orthotist. Other health funds will combine orthotics with other appliances under a health aids with a shared annual benefit limit.
Examples of orthoses you may be able to claim for
What should I be aware of when claiming for orthotics?
- Certified supplier. Before you lodge a claim for orthotic appliances, be aware that the items will need to be provided by a registered orthotist, orthotic supplier or podiatrist. Make sure your health fund will cover your orthotics purchase from your chosen supplier before you pay for your appliance.
- Waiting periods. Familiarise yourself with the different waiting periods that apply to orthotics under your policy. Some health funds will impose a blanket waiting period on all orthotics claims, such as 12 months. However, some health funds will impose separate waiting periods on the repair, maintenance, hire and replacement of orthotic equipment, so be sure to check the fine print before taking out cover.
- Annual benefit limits. Check the limits that apply to your cover. In addition to an annual benefit limit for orthotics, your health fund may impose limits on the amount it will pay for specific orthotic devices, or it may agree to cover a certain percentage of your bill for specific orthotic appliances. Remember that any annual limit listed may also include any benefits you receive for other health aids and appliances.
Final things you might want to know about orthotics
Compare comprehensive extras policies and get a quote from an adviser
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