Extras Cover Health Insurance

Claim benefits for expensive non-hospital treatment like dental and physiotherapy with extras cover.

There are two primary types of private health insurance currently available in Australia.

  • Hospital cover. For medical treatment that require you to be admitted to hospital, along with accomodation and other expenses.
  • Extras cover. For medical services outside of hospital, such as visits to the dentist and optician consultations.

This article aims to give you a detailed breakdown on extras cover that explains the different tiers of policy available, the services which are typically covered and other useful information that can help you make an informed health insurance decision.

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Details Features
Active Life Extras
Active Life Extras
Straightforward extras that covers you for vital out of hospital services while keeping premiums low. Treatments include general dental and optical, as well as healthy lifestyle benefits.
  • $500 general and major dental combined limit
  • $400 chiro and osteo annual limit
  • $400 physio annual limit
  • $400 alternate therapies annual limit
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Extras 50
Extras 50
With the Extras 50 policy health.com.au will pay 50% of the provider's fee.
  • From $10.58 weekly
  • 50% back on extras
  • Unlimited emergency ambulance transport cover
  • $500 general dental limit
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Super Extras is the highest level of extras cover available from AHM and provides cover for services ranging from major dental to diet and nutrition to health improvement benefits.
  • No family limits
  • Orthodontics
  • Outpatient care
  • Pre and postnatal
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Premium Options
Premium Options
Premium extras cover for all everyday healthcare services. Save 4% when you pay for 12 months of your cover upfront.
  • Dental and chiropractic cover
  • Osteopathy and optical
  • Occupational therapy
  • Orthoptic
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Platinum 80%
Platinum 80%
Platinum 80% provides you with 80% back on all included extras.
  • Claim up to $8500 on extras
  • General, complex and major dental and orthodontics
  • Pharmacy
  • Travel vaccinations
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Top Extras
Top Extras
Comprehensive extras cover that includes a wide range of non-hospital related treatments and services. Restricted fund: Only current and former employees of the Commonwealth Bank of Australia Group and their eligible families can join.
  • Generous overall limits on services
  • Major dental including orthodontics
  • Unlimited preventative dental
  • Hearing aids
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Gold Extras Set Benefits
Gold Extras Set Benefits
Top level extras cover including cover for a wide range of popular services including orthodontics, physiotherapy and optical.
  • Podiatry
  • Nursing
  • Pressure garments
  • Weight loss program
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Platinum Extras Cover
Platinum Extras Cover
Top level extras cover with highes range of cover for therapies and serivces.
  • 100% back on up to 2 dental visits per year
  • 100% back on initial chiro, physio, osteo
  • General therapies cover
  • Vaccinations and immunisations cover
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Top Extras
Top Extras
NIB's premier extras cover with up to $1,000 in General dental covered annually and cover for a range of therapies including Chiro & Osteo.
  • $1,000 general dental cover annual limit
  • $600 physiotherapy annual limit
  • Unlimited ambulance cover
  • $350 optical annual limit
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Top Extras
Top Extras
Top level extras cover with highest percentage back.
  • 60 - 100% back
  • $800 dental annual limit per person
  • $850 physiotherapy annual limit per person
  • $300 optical annual limit per person
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Find out about specific extras cover types:

What levels of extras cover are available?

Although the names of each tier of extras cover will vary between health funds, they will typically offer benefits for a comprehensive, medium or basic range of treatments and services.

  • Comprehensive extras cover. The highest level policy available and also the most expensive, it is designed to suit the needs of mature singles, couples, families and others with extensive health care needs. It covers the broadest range of non-hospital treatments and pays the highest benefits on claims. Common services covered include major dental, orthodontics, endodontics, home nursing, alternative therapies, remedial massage, weight loss programs and more.
  • Medium extras cover. If you are middle-aged or have a growing family, this intermediate policy can be a good choice for balancing affordability and cover. It pays benefits for a broad range of services with reasonable premiums and is typically suited to those with an average need for health care services. Services that you can expect to be covered for include major dental, optical, physiotherapy, occupational therapy and more.
  • Basic extras cover. Designed for those who are young, fit and healthy and not in need of a high level of cover, this policy will pay benefits for a limited selection of vital treatments such as general dental, optical and physiotherapy. While annual benefit limits will be smaller compared to medium or comprehensive extras policies, the cost of premiums for basic extras is also much lower.

What services are usually included in extras cover?

Below you can find examples of commonly claimed for medical services that basic, mid and comprehensive extras cover will pay benefits for. This is by no means an exhaustive list, and you will find most extras cover will include a wide range of services.

Comprehensive extras cover

Medium extras cover

Basic extras cover

How does extras cover affect Government penalties and incentives?

The Australian Government has introduced three incentives and penalties to encourage people to take out private health insurance. These are the private health insurance rebate, the Medicare Levy Surcharge (MLS) and the Lifetime Health Cover loading (LHC). So does holding extras cover only allow you to take advantage of, or avoid these schemes?

  • Private health insurance rebate
  • MLS (requires hospital cover to be exempt)
  • LHC (requires hospital cover to be exempt)

So in order to avoid the MLS and the LHC you will need to take out a combined hospital and extras policy which most health funds in Australia offer. Holding extras cover only still allows you to take advantage of the private health insurance rebate, which can be paid either as a premium reduction or as a tax deduction. The exact rebate you will be eligible for is affected by your income level and the level of cover you have in place.

What are the waiting periods for extras?

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.

How does extras cover affect your out-of-pocket expenses?

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.

Ancillary or ‘extras’ treatments

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

Some final questions you may have

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.

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