Get cover for non-hospital treatment with extras only health insurance. Comprehensive cover for dental, optical, physio and more
Private health cover is designed to provide cover for a wide range of medical procedures and treatments, help you avoid public hospital waiting lists, give you the freedom to choose your own doctor and in some cases receive treatment in your own private room. In short, it’s all about ensuring ultimate peace of mind when it comes to your health. There are two types of health insurance available: hospital cover and extras cover. While hospital cover provides financial protection and a range of options when you are hospitalised, extras only cover is designed to help cover the cost of a selection of general treatments including optical, dental, physio, acupuncture and much more. Available in basic, mid-level and comprehensive form, health insurance cover can help you get the treatment you need whenever you need it.
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How is hospital and extras only cover different?
- Hospital cover: Under hospital cover, you’ll receive cover for the cost of in-hospital treatment and expenses such as hospital accommodation and theatre or surgical fees.
As a general rule, any medical services for which Medicare pays a benefit will be covered under a top-level private health insurance hospital cover policy. Certain other procedures, for example cosmetic surgery that is not medically necessary, are usually excluded from cover. Hospital cover ranges from the very basic, which provides a default level of protection for public hospital treatment, through to comprehensive policies that cover an extensive range of services.
- Extras cover: Also referred to as ancillary cover or general treatment cover, is designed to cover a wide range of treatments you’re more likely to receive on a day-to-day basis. Basic policies start out with an essential level of cover for things like dental, optical and physio, while comprehensive extras cover offers much more generous benefit limits and also includes treatments like orthodontic, podiatry, psychology, natural therapies and more.
You’re free to choose standalone hospital cover, standalone extras cover, or to combine hospital and extras together in one packaged policy.
Although the exact choice of extras policies available differs from one insurer to the next, there are typically three types of extras cover available: basic, medium and comprehensive. Let’s take a look at what each one covers and which type of policy is best for you:
What does extras health insurance usually cover?
Generally speaking, extras comes in three different levels of protection: Basic, Medium and Comprehensive. Basic extras health insurance cover usually includes the following:
- General dental. This includes the removal of plaque, the application of fluoride, filling procedures, X-rays, basic extractions and selected other preventative dental options.
- Optical. Optical benefits typically cover for the cost of glasses frames, lenses and contact lenses up to a certain limit. This can help correct problems with vision, such as short-sightedness or long-sightedness.
- Physio. This typically includes cover for an initial appointment with your physio and then for subsequent appointments, helping you to relieve pain, increase the range of movement in your limbs and joints, restore strength in your muscles and generally help you perform basic everyday activities.
- Emergency ambulance transport. Where you need ambulance transport in order to undergo medical treatment, this is covered by your extras policy. The transport will need to be defined as medically necessary by your treating doctor.
- Chiropractic. This includes therapies that involve manipulation to treat the nerve-related, skeletal and muscular conditions.
- Osteopathic. Osteopathic treatments involve manipulation to improve balance and mobility, including issues such as back and neck pain or work-related injuries.
- Natural therapies. Some of the natural therapies treatments commonly included in extras cover include remedial massage, acupuncture, myotherapy, naturopathy, herbalism, shiatsu massage and more.
Mid-level cover typically protects you against expenses associated with:
- All of the treatments covered in a basic extras cover policy, but to more generous annual benefit limits. For example, an annual benefit limit of $500 for general dental under basic cover might increase to $750 under mid-level cover.
- Major dental. This includes tooth extractions and complex fillings, root canal therapy and dental implants. Such procedures can be quite costly and so are not included in basic cover.
- Exercise physiology. When exercise is used as a form of treatment to help with your rehabilitation, many extras policies will cover the associated cost to a basic level. Exercise physiology can also be used to help you regain and maintain your independence and to prevent future health problems.
- Travel vaccines and immunisations. Some policies will cover the cost of certain travel vaccinations you may require before heading overseas, for example inoculation against yellow fever.
- Podiatry. Podiatry may be covered to a basic level under this type of policy and includes the prevention and treatment of conditions related to the feet and lower limbs, for example arthritis, ingrown toenails and callouses. Cover for orthotics, which can be added to your shoes to produce better lower limb movement, may also be included.
- Occupational therapy. Occupational therapy is used to help with recovery from the effects of injury or illness, psychological issue, or even to combat the effects of aging. This may include cognitive assessment, stress management practices and physical rehabilitation.
Finally, a comprehensive extras policy will cover everything a mid-level policy does but will again offer a much more generous range of benefit limits. It will also typically include cover for:
- Orthodontics. This benefit covers things like crowns and bridges, dentures, implants, the removal of wisdom teeth and other services offered by specialist orthodontists.
- Psychology cover. This often kicks in once your Medicare entitlement has been used up and covers individual or group sessions. Psychologists can help with stress, marital issues, family problems, phobias, anxiety, weight control problems and more.
- Dietetics. You can receive cover for the cost of consulting with a dietician or nutritionist to help develop a healthy eating plan and reach your wellbeing and weight loss goals.
- Audiology. Hearing aids and speech processors are often covered under this benefit to help improve your hearing.
- Speech pathology. Speech pathologists can help people with a stutter, children who have trouble communicating and patients who have suffered a stroke. Cover for speech pathology is included to help you communicate more effectively.
- Travel and accommodation costs incurred to obtain medical or hospital treatment which is not available locally. Some policies will include limited cover to help you meet these expenses you will need to pay to get the treatment you require.
- Pharmacy costs. Certain pharmaceutical items that are not part of the Pharmaceutical Benefits Scheme may be covered by your health fund. Check with your fund for details of the drugs that are covered.
Extras only limits to be aware of
Just as with any other form of insurance, it’s important to be aware of all the fine print that applies to your extras insurance cover policy to ensure that you don’t end up with any nasty surprises.
- Benefit limits of your policy: First of all, check any benefit limits that apply to your policy — these will typically be in the form of either a maximum annual benefit limit across the whole policy or individual service limits per year. However, certain benefits may attract longer limits (three or five years) or even a lifetime limit.
- How benefit is calculated: You’ll also need to check whether the total benefits you have received are calculated across the calendar year or the financial year, as you may exceed your annual benefit limit without realising and then be unable to claim for general treatment services. Some funds will charge family or singles limits that place a maximum ceiling on the amount of times you can claim on any one policy. Be aware of any limits before you take out cover.
- Waiting period applied: Another thing to be wary of is that a waiting period may apply to certain aspects of your extras cover. The waiting period is the time you have to wait before you can claim a benefit for any service included on your cover, and all health insurers impose waiting periods when you first take out cover or upgrade to a higher level of protection. A general waiting limit, for example two months, will apply to all services covered under your policy. Certain individual services such as orthodontic procedures may attract longer waiting periods.
Can I claim the tax rebate if I have extras only cover?
In order to help Australians meet the cost of their private health insurance cover, the Government offers a private health insurance tax rebate. This rebate is designed to help people of all ages and income levels take out the insurance protection they need, but the exact rebate you will be eligible for is affected by your income level and the level of cover you have in place. It is paid either as a reduction in your health insurance premiums or as a rebate in your annual income tax return. You can claim the rebate if you:
- Are eligible for Medicare
- Have a complying health insurance product that offers extras, hospital, or both cover
- Have an income below Tier 3 in the following table
The rebate and surcharge levels applicable from 1 April 2016 to 31 March 2017 are:
< Age 65
< Age 65
Medicare Levy Surcharge (MLS)
So if you earn less than $140,000 per year for singles or $280,000 per year for families, and if you meet the other criteria above, you can enjoy a private health insurance rebate when you have extras cover.Back to top
Unlike the waiting periods that apply to hospital cover, the waiting periods for general treatments covered by extras policies are set by individual health funds. As a general rule, you’ll need to serve a two-month waiting period before you are eligible for benefits for a range of common extras services, including general dental, optical, physio, chiro and natural therapies. However, keep an eye out for promotional offers from some health funds that may waive this general waiting period as part of an effort to attract new members. However, longer waiting periods apply to specific extras treatments, such as:
- Major dental. Expect to serve a 12-month waiting period.
- Hearing aids. The waiting period to receive a benefit for hearing aids can stretch out to up to 36 months.
- Health management programs. A six-month waiting period commonly applies.
Contact your health fund for further details about the waiting periods that apply to your extras cover.Back to top
While the Australian Government offers tax breaks to help make hospital cover more affordable, no such incentives apply to extras cover. The good news is that extras cover is generally quite affordable and can have a sizeable impact on the amount you pay for a wide range of general treatments. Depending on the policy you choose, your health fund might cover a percentage of your general treatment bill, for example 75%, or it may offer a fixed benefit amount for certain services. Some funds also have a network of health care providers, which can further help to reduce your out-of-pocket expenses.Back to top
While hospital cover is designed to provide cover for in-hospital services where Medicare pays a benefit, extras cover is designed to help you meet health care expenses for a range of out-of-hospital general treatments (also referred to as ancillary treatments or extras) for which Medicare does not pay a benefit. This includes:
- Glasses and contact lenses
- Trips to the dentist
- Hearing aids and other artificial aids
- Physiotherapy, occupational therapy, speech therapy and more
- Acupuncture, naturopathy and other natural therapies
- Chiropractic and osteopathic treatment
- Home nursing
Q. How much will I pay for extras only health insurance?
- A. This will depend on the policy you choose and the level of cover you are provided with. As a rough guide though for what you can expect to pay, ancillary cover for a single person is generally between $500 - $600 (justlanded.com)
Q. How can I pay less for ancillary cover?
- A. There are a number of steps you can take to reduce what you pay for cover;
- Increase the excess you pay in the event of a claim
- Choose a more basic policy with cover for only select treatments
- Compare different policy options. There are hundreds of different policies available with varying premiums
- It may be worth taking out hospital cover with one insurer and extras cover with another to save further
Q. Why even get extras cover?
- A. Extras cover provides peace of mind for health services that are non-hospital that you are likely to need on a regular basis. This can include dental, optical, physiotherapy, chiropractor treatment and much more. Comprehensive policies can also provide cover for additional services including ambulance use, dietetics, speech therapy and orthotic appliances.
Q. Why are waiting periods applied to policies?
- A. Waiting periods ensure that new fund members don't make a claim directly after joining.
Q. How long are waiting periods for non-hospital medical expenses?
- A. This will depend on the fund you choose though generally there is a waiting period of 2 months to 12 months applied to General Treatment services such as optical and dental.
Q. What if I suffer a serious injury from an accident?
- A. Accidents are generally covered from the date your policy is approved.
Q. What if I suffer a serious injury from an accident?
- A. Accidents are generally covered from the date your policy is approved.