A Guide to Private Health Insurance Extras Cover

Extras cover, also known as general or ancillary cover, provides cover for the routine treatments that Aussies tend to use regularly.

It's important to consider whether purchasing extras cover makes sense for you and/or your family, or whether you prefer to pay out of pocket for these regular treatments.

This guide outlines which services are covered under extras, what the benefits and limitations are of this cover, and the types of extras cover available in Australia.

What is extras cover?

Extras cover is sometimes called general or ancillary cover. Its purpose is to provide cover for the routine healthcare costs that happen out of hospital.

Extras cover can be purchased as a standalone policy or to complement a hospital policy, and it's available at different levels of cover .

APRA reported that as of December 2022, over 55% of Aussies had extras cover.

What services are covered by an extras policy?

The exact services covered by an extras policy vary between insurers and depend on your level of coverage.

It's worth reading your policy details carefully to ensure that you're covered for those services you use most often.

Common extras include the following:

• Acupuncture: Needle treatment for overall health.

• Chiropractic: Back pain, neck pain, and other musculoskeletal conditions.

• General Dental: Check-ups, cleaning, fillings, and preventative x-rays.

• Major Dental: Crowns, bridgework, dentures, and veneers.

• Hearing Aids: Assistive devices for hearing loss.

• Optical: Glasses or contact lenses.

• Orthodontics: Braces and retainers to straighten teeth or realign jaw.

• Physiotherapy: Joint and muscle pain, sports injuries.

• Podiatry: Foot pain or injury.

• Psychology: Diagnosis and treatment for conditions affecting the mind.

• Remedial Massage: Massage therapy to aid conditions.

• Speech Therapy: Speech and language problems.

Why do people buy extras cover?

People often think of hospital cover as the insurance they hope they won't need, while extras cover is in place to subsidise the services they know they're going to use.

For many Australians, most of their regular healthcare spending doesn't happen in a hospital; it happens at the dentist, the optometrist, the chiropractor, or the naturopath - all services that can be covered by your extras policy.

With extras insurance, your can get benefits back on the healthcare services you use throughout your year.

Levels of extras cover

Generally speaking, most health funds offer three levels of extras cover.

Inclusions, exclusions, and benefit levels will differ between funds, so it's worth comparing policies from different funds to find one that suits you and your family.

Basic Level

Best for: singles and couples, young and healthy.

Basic cover is the lowest level of cover and tends to be the most inexpensive.

It may include general dental and optical, with a small selection of other extras.

Benefit levels are the lowest in basic plans, which means you can claim back a limited amount throughout the year.

You may also find that benefit limits are combined across treatments.

This means that you have one benefit amount and it can be reached through any combination of extras treatments throughout the year.

Mid-Level

Best for: Families with young children and middle-aged people.

Mid-level extras cover is more comprehensive than basic, and includes a wider range of services and treatments.

Benefit levels are usually higher, and there may be separate limits for different treatments.

This gives you a higher level of overall cover.

Top Level

Best for: Seniors, families with adolescent children, people who use health services frequently.

This top level of extras cover is the most expensive, and also offers the most cover.

More expensive treatments such as orthodontics or laser eye surgery may be included at this level.

Benefit limits are also the most generous, so you can claim back more during the year.

Can I get a government rebate for an extras policy?

Yes. The Private Health Insurance Rebate is available to people who hold an eligible hospital, extras, or combined policy.

The rebate amount you qualify for depends on your income.

Your rebate can be claimed as a reduction to your health insurance premium or as a tax offset on your tax return.

Are there waiting periods for extras cover?

Yes, there are usually waiting periods associated with extras cover.

These are set by your fund and there may be different waiting periods depending on the benefits.

Unlike with hospital cover, there are no portability laws in place to prevent you from re-serving waiting periods on an extras policy with the same level of cover.

If you switch to a new fund, you may be required to serve a waiting period that you already served with your previous fund.

However, the good news is that most funds will let you off the hook and waive the new waiting period.

Be aware of benefit limits

Extras claims may be subject to various benefit limits.

Again, this will vary by fund and by level of cover.

If you're unsure of your limit or how much you've used, it's easiest to check through your online account or your fund's app, if they have one.

Otherwise, you can contact your fund.

Here are some common limits applied to extras benefits:

Annual limit: The maximum amount you can claim for a service during the year.

Unclaimed benefits do not rollover, but reset at the start of the new year (usually 1 January or 1 July but varies by fund).

Sub limit: This is a limit on a service that falls under your yearly limit, and is usually per person.

For example, you may be limited to $200 of acupuncture services under a larger umbrella limit of $500 total for natural therapies.

Per-Person limit: Each person covered by the policy may be limited to a maximum benefit level each year.

Overall limit: There may be an overall membership limit that governs the per-person limits on your policy.

This is not necessarily the sum of each individual limit, so check with your fund for details.

Lifetime limit: Funds often impose individual lifetime limits on certain expensive services, such as orthodontics or laser eye surgery.

These limits carry across all funds and don't disappear even if you switch funds.

Will extras cover reduce my out-of-pocket expenses?

Extras cover is designed to reduce out-of-pocket expenses for regular health-related services and treatments. What you'll pay depends on three main factors:

1. What your provider charges for the service you received.

2. Whether or not your provider has an agreement with your fund.

3. Your level of extras cover.

Your extras cover may offer a fixed dollar amount back on services, or you may receive a certain percentage of the fee back.

Compare policies to find a structure and premium price that meets your needs.

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Chris Stanley is the sales & operations manager of health insurance at Compare Club. With extensive experience and expertise, Chris is a trusted leader known for his deep understanding of health insurance markets, policies, and coverage options. As the sales & operations manager of health insurance, Chris leads a team of dedicated professionals committed to helping individuals and families make informed decisions about their health insurance needs.

Meet our health insurance expert, Chris Stanley

Chris's top health insurance tips

• 1

  Australia’s public health system is world-class, but wait times for public hospitals can be long, inconvenient - and leave you living in constant pain while you wait.

• 2

  An appropriate private health insurance policy can speed up your surgery, relieving your pain sooner.

• 3

  Family health cover means your children are covered under the same policy as you.

• 4

  Many health insurance policies come with a 12-month waiting period for pregnancy-related cover, so it’s a good idea to get a family policy organized well before starting your family. This means your child will be covered from birth until at least their early twenties (depending on which health fund you select).