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Extras cover

Avoid costly bills for common treatments and items such as dentistry and glasses with extras health insurance.

Extras cover (or just extras) is a form of private health insurance that allows you to claim benefits for non-hospital related medical services that are not covered by Medicare. This article aims to give you a detailed breakdown of the different tiers of policy available, the services which are typically covered and other useful information so that you are able to compare this type of health insurance with confidence and make the best extras cover decision for you.

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What levels of cover are available?

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

  • Comprehensive extras. 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. 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, has 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. 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 can I typically claim for?

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

Comprehensive extras

Medium extras

Basic extras

Extras, taxes and premium loadings

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 an extras policy without hospital cover allow you to take advantage of, or avoid these schemes?

  • Private health insurance rebate. Extras only policyholders are eligible.
  • Medicare Levy Surcharge. Requires hospital cover to be exempt.
  • Lifetime Health Cover loading. 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, but holding extras 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 your level of cover.

Will I have to serve waiting periods on claims?

Like hospital cover, waiting periods for benefits apply to extras too. As a general rule you will need to serve a two month waiting period for your claim to be paid on treatments such as general dental, optical, physiotherapy and natural therapies. However, longer waiting periods may apply to more specialised services, some examples of which can be found below.

  • Major dental. Expect to serve a 12 month waiting period.
  • Hearing aids. The waiting period for hearing aids can range from 12 to 36 months.
  • Health management programs. A six month waiting period commonly applies.

One important point to keep in mind about extras health insurance is that, unlike with hospital cover, each health fund is free to set waiting periods of its choice. Therefore, keep an eye out for promotions which may waive waiting periods to attract new members, but also be more vigilant about checking the fine print before purchasing an extras policy.

How can I avoid or reduce out-of-pocket expenses?

Unless you are treated by a doctor that bulk bills, you may still have to pay out-of-pocket expenses for extras services if the medical practitioner charges above the Medicare Benefits Schedule (MBS) fee. Luckily, several policy and health fund features exist that can help prevent unpleasant surprises when the bill arrives.

  • Full gap cover. If you are willing to spend more on your extras policy opt for one that offers full gap cover. This will negate 100% of any additional costs you may incur.
  • Known gap cover. If cost is a concern, find an extras policy that includes known gap cover. While out-of-pocket expenses will not be completely negated you will know what the amount will be before being treated and can budget accordingly.
  • Preferred providers. Many health funds have a network of affiliated health care providers. Getting treatment or purchasing items such as glasses frames from these providers can further help to reduce your out-of-pocket expenses.

Answers to common extras questions

Why are waiting periods applied to extras?

Waiting periods ensure that new fund members don't make a claim directly after joining.

What are annual benefit limits?

These are the maximum amounts you can claim for specific treatments each calendar year. Sometimes health funds will also apply seperate sub-limits to multiple treatments under the same benefit, or combine several different treatments under one shared limit.

What is the difference between set and percentage benefits?

Set benefits apply a fixed amount to each service, such as $500 for general dental. Percentage benefits do what the name suggests and calculates the benefit as a percentage, such as 75% for optical claims.

How do I lodge extras claims?

You can claim for many extras services instantly using your membership card if the facility you are treated at has a HICAPS system available. Many health funds also allow you to claim for extras services using smartphone apps. More traditional methods of email, fax or post can also be used.

Compare extras health insurance available from Australian providers

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