Optical health cover

Prescription glasses and contact lenses aren’t covered by Medicare. That's why, if you want to be covered for optical, it’s important to take out extras cover from a private health fund that includes optical. Private health insurance can provide cover for a range services including glasses, contact lenses or prescription sunnies.

What's the best optical health cover?

Here are some extras policies that cover optical from Finder partners - all of them also cover a range of other extras services like physio and dental.

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Name	Product	Prescription glasses	Contact lenses	Optical Limit	Price Per Month	Hide CompareBox	Apply
Frank Easy Extras				$100	$13.55		Go to Site More Info	Compare	loading Fetching your data...
HBF Flex 50				$200	$27.59		Go to Site More Info	Compare	loading Fetching your data...
Qantas Basic Extras				$250	$33.05		1300 641 719 Go to Site More Info	Compare	loading Fetching your data...
ahm black 60				$200	$38.60		1300 670 233 Go to Site More Info	Compare	loading Fetching your data...
Medibank Essential Extras				$200	$40.10		1300 179 942 Go to Site More Info	Compare	loading Fetching your data...

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Are glasses and contact lenses covered by health insurance?

Australian private health funds provide cover for a wide range of optical services and treatments through their extras cover policies. some of these include:

• Prescription glasses and contact lenses
• Rebates on prescription sunglasses and prescription swimming goggles
• Eye check-ups

If you want cover for major optical procedures, for example cataract or eye lens surgery, you’ll need to take out hospital cover from a private health fund. These services are typically only included in high-level hospital cover policies, which attract higher premiums than basic policies.

However, it’s important to remember that levels of cover vary between funds and that some services only receive restricted cover, for example laser eye surgery. It’s essential to read the fine print associated with your policy to work out exactly what is and isn’t covered.

What should I look for in a health insurance policy?

There are some terms and conditions you should look out for when finding an insurance policy.

Exclusions

Exclusions are the things that aren't covered by your private health fund. Some frequently encountered exclusions are:

• Treatment outside of Australia. If you want to head abroad for cheaper laser eye surgery, for example, most health funds won't cover that. You might consider medical tourism insurance instead.
• No cover unless there is a specific, named health issue involved.
• No cover for additional costs like administration fees.

Limits

These are the maximum amounts your policy will pay in benefits, or how much you can claim before your benefits cap out. Your policy may have yearly or lifetime limits for a number of treatment sessions or an amount of money paid out.

• If the cost of a treatment is more than the limit of your policy, you will only be covered up to that limit and must pay the rest yourself.
• In the case of family or couple policies there may be limits for individuals as well as limits for the group as a whole.

Excess

This is an additional amount you must pay when making a claim and you may encounter one or more of these. If more than one excess applies, you must pay the total sum of all applicable excesses.

• Age related excess. The older you are the higher your risk levels. Certain age groups have this additional excess.
• Hospital excess. If someone on your policy goes to hospital this excess will apply to cover the additional costs involved.
• Special excess. Pre-existing conditions, ongoing health issues or a history of making many claims will drive up your special excess.

Compare extras cover for optical

You can compare even more Australian health funds using the tool below. Once you're on the results page, you can refine your search to "Optical" to compare the optical offerings from each brand.

Frequently asked questions

• Do all Australian health funds cover optical?

  Optical health insurance is a common feature of the vast majority of extras cover policies available from Australian health funds. However, as always, make sure you read any information from your health fund closely to find out whether optical services and treatments are covered and to what level.

• Can I buy glasses from anywhere and still get a refund?

  Australian private health funds will pay benefits for prescription glasses and/or contact lenses purchased from the vast majority of registered optical dispensers and eyewear stores across the country. If you're ever in doubt about whether a particular purchase will be covered, check with your health fund for confirmation.

  However, if you prefer to do your shopping online, be warned that not all online optical retailers will be covered by your fund. With this in mind, check to see whether your health fund provides a list of online optical stores where you can buy the products you need and still access a full or partial refund.

• Can I get cover for sunglasses?

  If you need prescription sunglasses, these will be covered by your health fund in the vast majority of cases. Check with your health fund to confirm this before parting with any money.

  However, non-prescription sunglasses are typically not included in your extras cover, but you may still be able to take advantage of discounted sunnies thanks to your health fund's partnership with an eyewear retailer.

• Can I get cover for laser eye surgery?

  If you're thinking of undergoing laser eye surgery so you can wave a permanent goodbye to prescription glasses and contact lenses, you should be aware that:

  • Procedures of this type are not covered by Medicare (unless it is required to treat certain eye diseases).
  • It's also not covered by many private health funds, although some funds will offer a limited level of cover as part of their top hospital or comprehensive extras policies.

  Even if your health fund says it covers laser eye surgery, check the fine print for more information on exactly how much of the total cost of the procedure will be covered. Also, keep in mind that:

  • Lifetime limits often apply to cover for laser eye surgery, as opposed to the annual limits quoted for many other extras services, so make sure you're aware of the maximum level of cover available.
  • You will typically have to serve a waiting period before you can access any benefits for laser eye surgery. Waiting periods vary from one fund to the next, but expect to have to wait one or possibly two years before you can claim a benefit.

• What optometry costs will your health fund cover

  While cover will vary depending on your policy, you can receive cover for:

  • Check ups and examinations
  • Glasses and contact lenses
  • Eye disease

  • Eye surgery for medical issues
  • Vision therapy
  • Laser eye surgery

  Medicare provides cover for some of these benefits, but for full cover you'll need private health insurance.

  Optometry service	Does Medicare cover it?	Can private health insurance cover it?
  Check ups and examinations	Yes	Yes
  Eye surgery for medical issues	Yes	Yes
  Eye disease	Yes	Yes
  Glasses and contact lenses	No	Yes
  Vision therapy	No	Yes, as an extra
  Laser eye surgery	No	Yes, as an extra

  Compare your health insurance options

• How do I make an optical cover health insurance claim?

  Depending on the procedure and your fund, there are a few ways to make a claim. Some claims may require more than one of these. For example, you might be able to claim a procedure online, but you may be required to fill out a claims form and mail it in to claim the related ambulance ride.

  • Use an app. Some health funds offer a mobile app you can use to make a claim. This is an easy way to do it but might not always be an option.
  • Claim online. Visit your fund's website to make a claim online. Login with your details and go to the claims section. From there you can follow the steps, provide the information required and have the benefit paid sent directly to your bank account or mailed as a cheque.
  • Send in a claims form. Download a claims form from your fund's website, fill it in and mail it off to the address provided. Your claim will be processed and handled accordingly.