Health insurance 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?

Here's a snapshot from Finder partners that cover orthodontics in an extras policy. Below are prices and example products that offer a limit towards the cost of treatment.

Provider	Policy name	Cost per month	Limit per person	Waiting period	Apply
	Family Extras	$55.15	$150	12 months	Go to Site
	Vital Extras	$56.35	$200	12 months	Go to Site
	Top Extras	$116.09	$400	2 months	Go to Site

^{Quotes are based on a single living in Sydney earning less than $90,000.}

• finder.com.au health funds
• Complete list of health funds

Health fund	Extras policies and annual benefit limits*	Waiting periods
	Premium Options. $240 per person Super Options. $200 per person	12 months
	Premier Extras. $200 per person	2 months
	Restricted health fund Top Extras. $60 per person	2 months
	Family Extras. $150 per person Super Extras. $200 per person	12 months
Australian Unity	Gold Extras. $350 per person Platinum 80% Extras. $600 per person	12 months
	Gold Extras. $250 per person Silver Extras. $200 per person	12 months
	Gold Extras. $200 per person Platinum Extra. $250 per person	12 months
	Top Extras. $400 per person Core Family Extras. $200 per person Core Young at Heart Extras. $200 per person	2 months
	Top Extras. $200 per person	12 months

_{*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	Family Extras. $150 per person Super Extras. $200 per person	12 months
Australian Unity	Gold Extras. $350 per person Platinum 80% Extras. $600 per person	12 months
Bupa	Platinum Extras. $1,200 per person Gold Extras. $1,000 per person Silver Extras. $800 per person	12 months
CUA Health	Total Extras. $400 per person Classic Extras. $210 per person	12 months
GMHBA	Gold Extras. $250 per person Silver Extras. $200 per person	12 months
HBF	Flexi Extras Plus. $500 per person Flexi Extras Mid. $400 per person Flexi Extras. $300 per person Saver Flexi Extras Plus. $250 per person Saver Flexi Extras Mid. $200 per person Saver Flexi Extras. $150 per person	12 months
HCF	Gold Extras. $200 per person Platinum Extras. $250 per person	12 months
Health Care Insurance	Premier Extras. $200 per person	2 months
hif	Premium Options. $240 per person Super Options. $200 per person	12 months
Latrobe Health Services	Premier Gold, Family Care Gold. $600 per person Premier Silver, Family Care. $300 per person Premier, Premier Plus. $300 per person
Medibank	Growing Family Extras Only. $300 per person Top Extras. $200 per person	2 months
Mildura Health Fund	Five Star Extras. $650 per person Ancillary Plus. $540 per person Basic Ancillary. $390 per person	12 months
nib	Top Extras. $200 per person Family Extras. $200 per person Young at Heart Extra. $200 per person	2 months
onemedifund	Extras Plus. $250 per person
Peoplecare	Premium Extras. $700 per person High Extra. $500 per person
Queensland Country Health Fund	Premium Extras. $600 per person. Essential Extras. $400 per person. Young Extras. $500 per person.	2 months
St. Lukes Health	Super Extras. $200 per person	12 months
Transport Health	Top Extras. $200 per person	12 months
ACA Health	Restricted health fund Complete Ancillary. $400 per person	12 months
Defence Health	Restricted health fund Premier Extras. $300 per person Value Extras. $250 per person	12 months
Navy Health	Restricted health fund Premium Extras. $300 per person Healthy Living Extras. $200 per person	2 month
RT Health	Restricted health fund Premium Extra. $175 per person Smart Extras. $140 per person	12 months
Teachers Health Fund	Restricted health fund Top Extras. $60 per person	2 months
TUH	Restricted health fund Comprehensive Extras. $360 per membership year	2 months

_{*The policies listed in this table are extras only. However, in most cases these can be combined with hospital cover.}

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:

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

• Are there any other limits I should be aware of?

  Yes. Some health funds may place a limit on the number of orthotic repairs they will cover, such as limits claims to one repair per person per calendar year.

• Are orthotic treatments covered by Medicare?

  No. Medicare does not subsidise orthotic treatments.

• Can I lodge a claim on the spot by swiping my membership card?

  No. Unfortunately, the HICAPS electronic claiming system is not yet available for use by orthotists in Australia. You will instead need to forward your receipt onto your health fund to ensure that your claim is processed.

• Do I need a referral to see an orthotist?

  While you do not need a referral to see an orthotist, your health fund will usually only process your claim if you have a referral.

• How long will I have to wait before I can make a claim?

  Although waiting periods differ between health funds, you will usually have to serve a waiting period of 12 months before you can make a claim for orthotics.

• What other benefits are included in a comprehensive extras policy?

  A comprehensive extras policy will also include cover for general and major dental, endodontic, orthodontic, optical, non-PBS pharmaceuticals, physiotherapy, podiatry and many other benefits.

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