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Extras Cover is a Health Insurance policy that covers some of the costs of some various general medical and healthcare services that happen outside of a hospital.1 These services are typically things you use quite a bit, like trips to the dentist, optometrist or the physio2 Extras Cover is also sometimes called General...
Have you ever stopped and thought about how much it costs to pay for new glasses, dentist visits or massages? If you have (or you’re thinking about it right now), then you’d probably also like help towards the cost of these kinds of necessities and services. That’s where private Extras Cover could help.
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.
family extras cover and family hospital policies cover very different things, so a lot of people actually get both. If you take out hospital cover and extras cover for your family you can usually combine them into a single policy You should also be able to combine different levels of cover to suit your needs, for example you might want gold hospital cover and a medium extras policy.
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 covered by 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 year up to the policy limits.5
The total amount you can claim depends on the level of cover you have and will vary between policies and funds.
While Extras policies offer benefits in the form of rebates, they have different limits on how much you can claim each year for each specific service or treatment.
If you’re wondering how much money you’ll get back, this will depend on the service you’re claiming for, as well as the maximum limit your policy outlines.
Health insurers pay benefits in the form of either a percentage of costs, or up to a set dollar amount.
Here are the different types of Extras limits:
Hospital Cover has defined product tiers, there is less consistency among Extras policies. However, Extras policies can generally be grouped into three different levels of cover: Basic, Medium & Comprehensive.
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.
Inclusions come down to your level of cover and your provider. They 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:
When it comes to Extras Cover, how much you get back depends on the cost of your service and level of cover your Extras policy provides. There are also a few different factors which impact how much you’re likely to get back which we’ve outlined below.
Some Extras policies cover a set amount for each service, up to an annual limit per year.6 For example, you might get around $40 back per genzeral dentist treatment, up to an annual limit of $350 per person per year.
Keep in mind that some policies group similar types of services together into a combined limit – such as physio, chiro and massage.
Rather than getting back a fixed amount for a service, some policies work with percentage benefits.7
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%).
Regardless of whether your policy offers dollar or percentage benefits, make sure you check your policy for annual limits, as some providers might put a total annual cap on what you can claim.
Some policies also offer preferred provider schemes, which means they’ve got agreements in place with specific service providers such as dentists and optometrists.
You’ll usually get better rebates if you visit one of these places and may not have a gap to pay.
Preventative health discounts
Some Extras policies may help cover the cost of preventative health services such as medically necessary gym memberships and exercise classes, programs to quit smoking, swimming lessons or even sunscreen.8
Discounts and freebies:
Other health funds offer loyalty or discount programs such as the AIA Vitality Points Program which offers policy holders discounts on flights, movies, spa treatments, shopping and more.9
Many health insurers work with certain providers for common Extras services such as dental, optical, or physio. This usually means that members have reduced costs to access services from these specific providers.
If you choose to use a provider that isn’t part of your Health insurer’s preferred provider network, then you may incur higher out-of-pocket costs.
More often than not, a service will cost more than the benefit paid by your policy, so you’re left to pay the difference. This is called an out-of-pocket cost or gap payment 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 12 months for more expensive services like orthodontics or hearing aids.
Waiting periods also apply if:
Occasionally, health funds may waive waiting periods for certain services, such as general dental or optical cover.10 Some funds also offer promotions for limited time periods, so it’s worth asking your provider before you sign up.
Here’s some good news if you’re switching plans. If your new healthcare provider includes the same benefits and services as your previous policy, then the waiting periods may be waived. Plus, you might be able to claim those services straight away. Double check the policy brochure before you sign up to make sure.
Waiting periods can be 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), 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). Note to claim on some benefits – such as gym memberships – you may need to provide further evidence like a doctors evidence.
Most providers usually give you a bit of leeway as long as you were holding your cover at the time the service was used.
While it does vary between funds, most give you up to two years to make a claim from the date of service.
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 could be well worth your while.
It also depends on whether you’re buying it solely for yourself, you and your partner, or for the entire family.
Extras Cover is exceptional value if you find 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 providers at any time.
Some Health Insurers may offer discounts, rebates or rate protections for people who:
Some funds may also pay higher benefits to loyal members, so make sure you ask your provider if they offer any discounts or loyalty benefits before you sign up.
Extras Cover doesn’t exempt you from paying the Medicare Levy Surcharge (MLS).
The MLS is income-tested, so from 1 July 2023 if you earn less than $93,000 for singles, or less than $186,000 for families (plus $1,500 for each dependent child after the first), then you may be exempt.11
If your taxable income is above these thresholds, then you will need to have Private Health insurance with Hospital Cover to be exempt.12
Look at your PHIS statement. This will tell you what you can claim and help you work out whether you could be getting more value out of your policy or if you need to consider changing your level of cover.
If you want some help with comparing policies*, chat to someone from our team on 1800 784 772 or schedule a call.