What is medium extras private health insurance?
Extras policies offered by Australian private health funds provide cover for a wide range of general health care treatments and services that are not covered by Medicare. Also known as general treatment cover or ancillary cover, these policies can be taken out on their own or combined with private hospital cover.
There are three general categories of extras policies: basic, medium and comprehensive. To be classed as medium extras insurance, a policy must include cover for general dental, major dental, endodontics and any five of the following treatments: orthodontics, optical, non-PBS pharmaceuticals, physiotherapy, chiropractics, podiatry, psychology and hearing aids.
A medium extras insurance policy may also pay benefits on a wide range of other services, such as:
- Occupational therapy
- Naturopathy, homeopathy and other natural therapies
- Remedial massage
- Health management programs
What level of protection does medium extras insurance provide?
As the name suggests, medium extras insurance policies provide a medium level of cover. While they don’t offer a range of cover or benefit limits as generous as a comprehensive policy, they offer a higher level of cover than what you would find with a basic extras policy.
For example, a medium extras insurance policy might feature an annual benefit limit of $500 for physiotherapy services, compared to a $300 limit on a basic policy and a $1,000 limit on a comprehensive policy.
Medium extras insurance is also priced in the mid-range between basic and comprehensive policies. This means it is more affordable than high-level cover, but is not ideal for those who are on a tight budget.
However, cover needs vary greatly depending on your individual circumstances, so consider your health care requirements carefully before choosing an extras policy.
What services are covered medium extras policies from the funds in the finder.com.au panel?
|HIF Special Options||HIF Special Options cover provides cover for an extensive range of extras services. As well as cover for emergency ambulance transport, this policy also helps cover the cost of the following treatments: general and major dental, optical, physio, chiro, osteo, dietetics, acupuncture, naturopathy, remedial massage, pharmacy drugs and podiatry consultations. It also offers a range of benefits to help you live a healthier lifestyle, including cover for skin cancer screenings and weight loss programs.||More info|
|health.com.au Extras 50||Extras 50 health insurance from health.com.au provides cover for 50% of your bill (up to an annual limit) on a wide range of extras services. General treatments covered include general and major dental, orthodontics, optical, chiro, physio, osteopathy, massage and natural therapies, non-PBS prescriptions, dietetics psychology and health maintenance programs. Cover for emergency ambulance transport is also included.||More info|
|AHM Lifestyle Extras||AHM Lifestyle Extras covers emergency ambulance services and offers Health Improvement Benefits on a wide range of services, including quit smoking courses, health checks and exercise classes. It also covers the following general treatments: routine dental, complex and major dental, orthodontics, optical, physio, chiro, osteopathy, remedial massage, acupuncture, naturopathy, aromatherapy, a range of other alternative therapies and pharmacy.||More info|
|Australian Unity Silver Extras||An Australian Unity Silver Extras policy provides cover for the following general treatment options: general and major dental (excluding orthodontics), physio, acupuncture, remedial massage, shiatsu, myotherapy, chiro, optical, podiatry and dietetics. It also covers the cost of health aids such as wheelchairs and crutches.||More info|
|GMHBA Silver Extras||GMHBA Silver Extras covers ambulance subscriptions and transport, as well as a range of preventative health benefits such as quit smoking programs and melanoma photography. It also covers the following treatments and services: audiology, blood glucose monitors, chiro and osteo, general and major dental, orthodontics, dietetics, diabetes education, extremity pumps, eye therapy, speech therapy, fluoride supplements, hearing aids, naturopathy, homeopathy, acupuncture, nebuliser pumps, nursing, occupational therapy, optical, orthopaedic appliances, orthotics, pharmacy, physio, myotherapy, hydrotherapy, podiatry, pressure garments, prostheses, psychology and remedial massage.||More info|
|HCF Gold Extras||Gold Extras Cover from HCF provides cover for emergency ambulance services and a wide range of health management programs, for example, weight loss and swimming lessons. It also covers the following general treatments: general and major dental, orthodontics, optical, physio, exercise physiology, occupational therapy, psychology, chiro, osteo, remedial massage and myotherapy, acupuncture and Chinese herbal medicine, nutrition and naturopathy, Alexander technique, podiatry, dietetics, audiology, speech pathology, travel and accommodation, vaccinations, artificial aids and hearing aids.||More info|
|nib Core and Young at Heart Extras||This nib policy covers ambulance services, preventative tests, orthotics, dietary advice and health aids. It also provides cover for the following extras: general and major dental, endodontics, optical, non-PBS pharmaceuticals, physio, podiatry and hearing aids.||More info|
|Transport Health Healthy Choice Extras||Healthy Choice Extras policies from Transport Health provide cover for ambulance services, quit smoking programs, weight loss programs, first aid classes, stress management, skin tests and MRI scans not claimable through Medicare. They also pay benefits for the following extras services: general and major dental, endodontics, optical, non-PBS pharmaceuticals, physio, chiro and podiatry.||More info|
What isn't covered?
There are specific situations and circumstances when you will not be able to make a claim on a medium extras policy. These include:
- If your claim is for a service or treatment received outside Australia
- If the service was received or administered more than two years ago
- If your claim is for a service specifically excluded from your policy, for example, orthodontic treatment
- If you have already exceeded your annual benefit limit for a particular service
- If you have the right to recover your health care costs elsewhere, for example, from another insurer or through an employee benefit scheme
- If your claim is for the treatment of a pre-existing condition before you have served the initial 12-month waiting period
- If the service is received while your health fund membership is in arrears
- If the health fund deems the treatment to be inappropriate or unreasonable
- If your claim is for services that were not delivered face to face
- If the service was given by a provider not recognised by your health fund
- If your claim is for ambulance transfers between hospitals
- If there was no specific condition or symptoms treated
Who needs this level of private health insurance?
As a general rule, medium extras insurance is suitable for people with average health care needs. This includes families with young children, or singles and couples approaching middle age. For example, you may be looking for a policy that provides a high level of dental benefits for your children, or for a policy that offers an increased level of cover for services such as physio and optical as you age.
At the same time, medium extras insurance is designed to be more affordable than a comprehensive policy, offering a combination of cost-effective premiums and a broad range of benefits.
Other factors to be aware of
There are a few issues you should be aware of when taking out medium extras insurance, including:
- How benefits are calculated. Check to see how your health fund calculates the benefit amount you will receive. Will you be reimbursed for the full cost of your bill, or will your fund only cover a certain percentage of your health care fees? If your fund only covers a percentage of the costs, remember that you will have to cover the remaining “gap”.
- Waiting periods. Make sure you’re aware that waiting periods apply to certain features of your extras health insurance. For example, you may have to wait 12 months before you can receive any benefits for the treatment of pre-existing conditions, or wait six months before you can submit a claim for major dental. The details of any waiting periods that apply will be outlined in the product disclosure statement (PDS).
- Benefit limits. Read the PDS to find out the maximum benefit limits that apply to your policy. Not only will there be annual benefit limits for certain treatments – optical, dental, physio, etc – but there may also be smaller limits on the maximum amount you can claim for individual services. For example, there may be a limit on how much you can claim for a routine dental check-up, or for a pair of prescription glasses. In terms of annual limits, it’s vital to check whether your total benefits are tallied up over the course of the calendar year or the financial year. If you’re caught out by this trap, you could end up without any cover for certain services for several months.
- Claim options. Check whether your fund offers easy and convenient claim options for you, such as on-the-spot claiming, a claims apps and online claims centres.
- Provider schemes. Some health funds have negotiated special prices for their members with specific health care providers, while other large funds even offer their own dental and eyewear centres. This can help you cut your health costs even further.