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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.
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.
There are two types of health insurance policies:
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 works a bit differently. It helps pay for a range of services  not covered by Medicare such as dental and physio.
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.
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.
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.
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.
Lifestyle services can generally be claimed if it is for a medical purpose.
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.
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.
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.
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.
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.
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:
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.
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.
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.
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).
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.Â
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.Â
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.
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.
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.Â
Step 3:Â 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.
Some health Insurers offer discounts for people who5:
Extras Cover doesn’t exempt you from paying the Medicare Levy Surcharge. You need to have private health insurance with Hospital Cover.
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
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