Extras Cover: Learn more about what can be covered & compare policies*

Have you ever stopped and thought about how much you hate paying for stuff like new glasses, dentist visits and massages? If you have (or you’re thinking about it right now), it’s probably also occurred to you how much you like discounts. If that’s a yes, then you’re going to like the sound of Extras Cover. It’s kind of like a discount card for many of those nitty gritty appointments.

What is Extras Cover?

Extras Cover is a health insurance policy that covers some of the cost of various general treatments that happen outside of a hospital. These services are typically things you use quite a bit, like trips to the dentist or physio. Extras Cover is also sometimes called General Treatment or Ancillary Cover.

How is Extras Cover different to other kinds of insurance?

There are two types of health insurance policies:

Hospital Cover:

Hospital Cover comes in handy for private hospital treatment, helping to pay for some of those scary bills, like accommodation, theatres fees, medicine and doctor’s fees, depending on your particular policy

Extras Cover:

Extras Cover works a bit differently. It helps pay for a range of services  not covered by Medicare such as dental and physio.

I already have Hospital Cover; can I still get Extras?

Most health insurance providers offer a  combined extras and hospital cover. If you already have Hospital Cover, you can also consider buying Extras only cover separately from the same or a different provider.

What can I claim?

If you have Extras Cover, you can claim back part or sometimes even the full cost of the particular services named in your policy. Most policies allow you to claim either a percentage of the cost of an appointment or a certain amount for the same service each year¹ up to the policy limits. The total amount you can claim depends on the level of cover you have and will vary between policies and funds.

What are the different levels of cover?

There are typically three levels of Extras Cover¹. Obviously you don’t want to be paying for more than you need, so thinking about what services you actually use could save you a bit of money. What is included on each level of cover will vary depending on the policy you choose.

Basic Cover: If you’re an infrequent user, all you really need is Basic Cover. It typically includes dental check ups and cleans , optical, physio and/or chiro.

Medium Cover: If there’s something in particular you want covered, or see yourself using more services than what’s included in Basic Cover, you might need to go up a level. Medium Cover generally includes most dental procedures, optical, physio, chiro, podiatry and occupational therapy.

Comprehensive Cover: This can include a wider range of services, including most of the following: general dental, major dental, orthodontics, optical, podiatry, chiro, speech, eye and occupational therapy, physio, medical aids and appliances including hearing aids and pharmaceuticals.

What services are included?

Inclusions come down to your level of cover and your provider². It can range from practical services, like dental and optical cover, to slightly more fun activities, like remedial massages. You’ll find a list of what could be included below.

Dental Cover

• General Dental (check-ups, cleaning, fillings, mouthguards, teeth removal and X-rays)
• Major Dental (root canal, crowns and bridges, implants and dentures, treatment for gum disease)
• Orthodontics (braces)

Optical Cover

• Frames and prescription lenses
• Lens coatings
• Contact lenses

Clinical Therapies

• Chiropractic
• Physiotherapy
• Osteopathy
• Antenatal and Postnatal
• Podiatry
• Speech therapy
• Occupational Therapy
• Ante-natal/ Post-natal classes
• Audiology
• Dietetics/ dietary advice
• Eye Therapy
• Psychology

Natural therapies

• Acupuncture
• Osteopathy
• Chinese medicine
• Remedial massage

Lifestyle

• Exercise classes
• Exercise physiology
• Discounted gym membership
• Weight management programs

Lifestyle services can generally be claimed if it is for a medical purpose.

Pharmacy Medicines

• Prescription only medicines prescribed by a GP, not listed on the PBS.

Home Nursing

• Supportive care provided in the home.

Vaccinations

• Some policies may cover some of the costs of vaccinations. These may be limited to travel vaccinations.

Health Aids and Appliances

• Asthma puffers and ventilators
• Hearing aids
• Blood glucose monitors
• Braces and splints
• CPAP machines
• Orthotics

How much money could I save?

When it comes to Extras Cover, there are three ways to save money. How much, depends on the cost of the service and the level of cover your extras policy provides.

Percentage Benefits:

Rather than getting back a fixed amount for a service, some policies work with percentage benefits¹. For example, if you go to the dentist and pay $90 for a service, your policy will cover a percentage of that total (for example 60%). This is really helpful as you understand exactly what out of pockets costs you will have by simply calculating your refund. Make sure you check your policy for annual limits, as some providers might put a cap on what you can claim.

Provider Schemes:

Some policies also offer preferred provider schemes. Which means they’ve already gone to the optical store, or dentist and arranged a better rebate for you. You’ll usually get better rebates if you visit one of these places and may not have a gap to pay.

Free Stuff:

Some policies even offer free stuff—or at least heavily discounted. Like medically necessary gym memberships, exercise classes, and sunscreen.. They want you to be healthy and happy.

What is a gap payment?

Sometimes a service will cost more than the benefit paid by your policy, so you’re left to pay the difference. This is called a gap payment³ and will vary depending on your policy. That’s why it’s important to compare different Extras Cover policies to see what’s included.

What are the waiting periods for Extras Cover?

If you’re new to health insurance or you’re upgrading your plan, you’ll need to go through a waiting period before you can make a claim. These waiting periods vary, but generally they’re from 2 to 6 months for things like general dental, optical and physiotherapy, and up to 12 months for more expensive services like orthodontics or hearing aids. Waiting periods also apply if:

• You’ve re-joined after having a break in health cover;
• You upgrade your cover to a higher policy;

Can Health funds waive your waiting periods?

Health funds want to keep it fair between all members. But occasionally they may waive waiting periods for certain services, such as general dental or optical cover. Some funds also offer promotions. So it’s worth asking your provider before you sign up.

Is there a waiting period if I switch plans?

Here’s some good news if you’re switching plans: If your new health care provider includes the same benefits and services as your previous policy, then the waiting periods may be waived.  And you’ll be able to claim on those services straight away. Double check the policy brochure before you sign up to make sure.

Why are there waiting periods?

Waiting periods⁴ are frustrating. But they’re there for a reason. In short, waiting periods can help to reduce premiums protecting existing members. If they weren’t in place, someone could sign up to health insurance, make a big claim, and then cancel their policy. This could increase premiums and leave those paying consistently for their insurance to brunt the cost.

How do I make an extras claim?

Once you’ve made it past the waiting period, you can start making claims. If you visit a practice that has HICAPS, an electronic health claims and payment system it, you’ll get money back instantly. If not, you can make your claim manually with your provider via their claims process (usually via an app or website).

How long do I have to make a claim?

Most providers usually give you a bit of leeway time as long as you were holding your cover at the time the service was used. Depending on the fund, we’re talking a leeway time of up to 2 years after the date of service. So you’ve got no excuse not to submit your claim. 

Should I get Extras Cover?

Well, that depends on you. If you’re someone who goes to the dentist and needs optical cover or you enjoy a regular massage then it’s probably worth it.

It also depends on whether you’re buying it solely for yourself, you and your partner, or for the entire family.

Families: If you and your kid’s visit the dentist some funds offer free check and cleans for all the family so Health Insurance could be a pretty good call. 

Older People: Extras Health Insurance can be great for people aged between 55-74. This could help cover optical treatment and lenses for your reading glasses, as well as trips to the physio for any sore or aching joints.

Couples: Extras Health Insurance is a toss-up when it comes to couples. A couple’s policy normally costs the same as two single policies. In some cases it could be better value for you to buy separate extras policies that cater to your individual needs.

Is Extras Cover good value?

Extras Cover is exceptional value if you have a suitable policy and you make the most of it. The trick is to understand what you pay in premiums against what you get back in benefits. So if you’re struggling to pay for your policy, remember you can change your level of cover and/ or switch provider at any time.

How do I check if I’m making the most of my Extras Cover?

Step 1: Request an annual claims statement and a Private Health Information Statement (PHIS) from your provider or view your usage using the online member portal provided on the fund’s website.

Step 2: The claims statement will show you the total benefits you received in the last financial year, including the cost of the services and how much you got back from your insurer. Compare the refund total against your premium. Are you paying more than you’re getting in return? If your statement has both your Hospital and Extras cover on it, make sure you subtract your Hospital Cover. 

Step 3:  If your premium is a lot higher than your benefits, you may want to consider switching to a more suitable level of cover. Look at your PHIS statement. This will tell you what you can claim and help you to work out whether you could be getting more value out of your policy or if you need consider changing your level of cover. If you want some help with comparing policies*, chat to someone from our team on 13 19 20 or schedule a call.

Can I reduce the cost of my Extras Cover?

Some health Insurers offer discounts for people who⁵:

• Pay premiums in advance;
• Pay by payroll deduction;
• Pay by direct debit;
• Belong to a contribution group (i.e. your workplace organises your health insurance for you);
• Are not required to pay a state or territory levy (e.g. if you’re a pensioner or a low-income earner in NSW or ACT, your premium may be reduced because you’re entitled to free ambulance cover).
• Some funds also pay higher benefits to loyal customers. So make sure you ask your provider if they offer any discounts or loyalty benefits before you sign up.

If I have Extras Cover do I have to pay the MLS?

Extras Cover doesn’t exempt you from paying the Medicare Levy Surcharge. You need to have private health insurance with Hospital Cover.

How do I find a suitable policy?

The best thing you can do is compare Extras Cover policies from a range of providers and find the one that best fits in with your lifestyle. Or if you’d rather a little help, ring us on 13 19 20 and someone from our team can do it for you!

Sources:
1. https://www.health.gov.au/health-topics/private-health-insurance/what-is-covered-by-private-health-insurance/extras-and-ambulance-cover
2. https://www.privatehealth.gov.au/health_insurance/howitworks/treatments.htm
3. https://www.privatehealth.gov.au/health_insurance/howitworks/out_of_pocket.htm
4. https://www.privatehealth.gov.au/health_insurance/howitworks/waiting_periods.htm
5. https://www.privatehealth.gov.au/health_insurance/howitworks/managing_your_policy.htm

Last updated: 3/07/2020