Compare Extras Cover

Well, that depends on you. When it comes to extras cover there’s no one-size-fits-all answer. All that matters is what’s most important to you.

Want more coverage across a range of specialist treatments? Or more benefits back from your appointments? You’ll find a range of options across different health funds. Some might give you the option to pick and choose extras, while others might bundle these together for different needs, like family extras or dental-specific services.

Choosing the best extras cover for your needs can be simple, if you think about the top medical services you use. There’s little point choosing a policy if it only has a small cap for your most used service. You can also think about this in relation to where you are in life. For instance, most families will value dental or optical cover for their young kids, while an older couple might need more chiro or physio.

A limit is the maximum amount your insurer can pay for benefits on your policy across a year. Each fund’s limits might work slightly differently, with some working by calendar year or financial year and others by membership year.

Here are the different types of extras limits:

• Annual limit: The maximum that you can claim for a service each year (calendar or financial, depending on the fund).
• Policy/family limit: Some services have an annual limit per policy or service, so if you’ve got more than one person on your policy, then make sure it allows all of you to make use of it.
• Limits per person: Some policies have limits on what each person can claim individually.
• Combined group limits: Some insurers group services together and limit them to a total amount. For example, if your policy groups major dental, general dental, and endodontic services together, then you’ll only have a set amount to use on all those services.
• Sub-limits: Some categories such as dental or physiotherapy have limits on specific services like root canals, crowns, or massages. So, if you need to use a specific service within one of these categories that exceeds the sub-limit, you’ll have to pay for the service.
• Lifetime limits: Some services are limited to a dollar amount over the lifetime of your policy. For example, if you’ve got a lifetime limit of $4,000 to claim on orthodontic services, any extra amount will need to be covered out of pocket. Remember, if you switch providers with a lifetime limit in place, you’d still have the same dollar amount from your previous fund carry over.

Hospital cover has defined product tiers. It wasn’t always this way, but now hospital cover comes in four flavours, starting with basic hospital cover and going all the way up to gold cover. Each tier level includes progressively more hospital treatments.

There’s less consistency among extras policies, but most extras policies can generally be grouped into three different levels of cover: basic, medium, and 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’s included on each level of cover will vary depending on the policy you choose.

• Basic extras cover: If you’re an infrequent user of health services, then basic extras cover might be suitable for you. A basic extras policy typically includes dental check-ups and cleans, optical, physio, and/or chiropractic (chiro).
• Medium extras cover: If there’s something in particular you want covered, or you see yourself using more services than what’s included in basic cover, you might need to go up a level. Medium extras policies generally include most dental procedures, optical, physio, chiro, podiatry, and occupational therapy.
• Comprehensive extras cover: Also known as top extras, this generally covers a wider range of extras services, including most of the following: general dental; major dental; orthodontics; optical; podiatry; chiro; speech, eye, and occupational therapy; physio; and medical aids and appliances, including hearing aids and pharmaceuticals.

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.

Here’s what could be included:

• General dental: Refers to routine dental care that includes check-ups, exams, X-rays, professional scale and cleanings, and fillings. It focuses on identification and prevention of dental issues.
• Major dental: Refers to more complex and restorative dental treatments, such as root canals, crowns, bridges, implants, dentures, and treatment for some gum disease.
• Orthodontics: Includes treatments like braces, Invisalign, and retainers to improve bite and alignment.
• Optical: Refers to services related to eye care, including eye exams, and the prescription and fitting of glasses and contact lenses.
• Chiropractic: Focuses on musculoskeletal issues, particularly those relating to the spine. It often involves consultations, X-rays, spinal adjustments, and back manipulation.
• Physiotherapy: Involves diagnosing and treating physical injuries and conditions through movement, exercise, and manual therapy. It helps with improving mobility, reducing pain, and supporting recovery after surgery or injury.
• Osteopathy: Uses techniques like soft tissue massage, articulation (gentle joint movements), and spinal manipulation.
• Antenatal and postnatal: Includes services provided during pregnancy (antenatal) and after childbirth (postnatal), such as midwifery clinics, maternal health support and childbirth classes.
• Speech therapy: Involves treating communication disorders, including speaking, language, or swallowing. For example, supporting children or those recovering from a stroke improve their speech, language, and communication skills.
• Occupational therapy: Helping individuals regain or improve the ability to perform daily tasks after injury, illness, or disability. It focuses on enhancing skills for activities like self-care, work, and leisure activities to improve overall quality of life.
• Audiology: Assessment and treatment for those needing help with hearing and balance. This can include getting devices such as hearing aids.
• Dietetics: Assessment and treatment for those needing help with diet, nutrition, weight loss, or disease management.
• Psychology: Assessment and treatment by a (clinical) psychologist using therapeutic techniques to support individuals in managing mental health conditions.
• Acupuncture: Insertion of tiny needles at strategic points in the body to help with stress management and wellbeing.
• Chinese medicine: Herbal remedies and therapies for physical and mental wellbeing.
• Remedial massage: Therapeutic technique used to treat musculoskeletal pain, injuries, and muscle tension through deep tissue massage. Sometimes other kinds of massage, like myotherapy, fall under this category, too.
• Exercise physiology: Rehabilitation and clinically prescribed exercise for management of injuries, chronic conditions, and disabilities.
• Health aids and devices: Ventilators, blood glucose monitors, braces and splints, and CPAP machines all fit under this category.
• Orthotics: Custom-designed devices, such as shoe insoles or braces, used to support, align, or help correct foot and limb abnormalities.
• Non-PBS medication: Prescription-only medicines prescribed by a doctor that aren’t listed on the PBS.
• Home care: Support and nursing provided in the home.
• Vaccinations: These may include travel vaccinations or childhood vaccines, like Meningococcal B.
• Discounts: For gym memberships and local retailers.

1. Request an annual claims statement and a private health insurance statement (PHIS) from your provider or view your usage using the online member portal provided on the fund’s website.
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.
3. 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.
4. If your premium is a lot higher than your benefits, you may want to consider switching to a more suitable level of cover.
5. Take another 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 whether you might want 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.

Extras cover doesn’t exempt you from paying the Medicare Levy Surcharge (MLS).

The MLS is an additional tax from the Australian Government to help fund Medicare if you’re a higher earner without private hospital cover.

It’s income tested, so from 1 July 2025, if you earn less than $101,000 for singles, or less than $202,000 for families (plus $1,500 for each dependent child after the first), then you may be exempt.

If your taxable income is above these thresholds, then you will need to have private health insurance with hospital cover to be exempt.

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 it will vary depending on your policy. That’s one reason 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 depend on what treatment you’re using and each provider. But for a general guideline most extras waiting periods are from two to six 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:

• you’ve re-joined after having a break in health cover
• you’ve upgraded your cover to a higher policy.

Occasionally, health funds may waive waiting periods for certain services, such as general dental or optical cover. 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. That means 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 for 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 bear the brunt of 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). Keep in mind that to claim on some benefits – such as gym memberships – you may need to provide further evidence like a doctor’s letter of support.

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.