Extras Cover — What Is It?
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Extras Cover — What Is It?

Katie Douglass

Katie Douglass

26/03/2021 • 5 minute read

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While Australia’s public health system — Medicare — ensures healthcare is accessible for everyone, not everything is covered. This is where extras cover can come in handy in paying some of the costs.

Below, we’ve put together a handy guide on extras cover including what it is, types of extras available, and whether it’s worth getting.

What is extras cover?

Extras cover (also known as ancillary cover or general treatment) helps pay for non-hospital treatment and services that are generally not covered by Medicare. Depending on the level of cover you take out, extras can include (but are not limited to): physiotherapy, optical, general and major dental, chiropractic, speech therapy, and podiatry.

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Did you know?

According to the Australian Prudential Regulation Authority (APRA), 53.5% of Aussies had extras cover as of September 2019.

Typically, private health insurers offer extras cover as a standalone policy or combined with hospital cover.

What is included in extras cover?

Depending on which provider you choose, there are a wide range of medical services and treatments that extras can provide cover for.

Below, we’ve put together a table of some of the most common services and treatments included in extras cover:

Ambulance If you live in Queensland and Tasmania, ambulance costs are covered by the State Government. However, in all other states, you’ll need to organise ambulance cover through a private health insurer to cover the costs of emergency transport.
Chiropractic Chiropractic treatment can include spinal and joint adjustments for musculoskeletal issues, x-rays, and general consultations. This type of medical service may be helpful if you currently experience spinal or joint issues including back pain, neck pain, migraines, or arthritis.
Dietetics Extras cover can help pay for consultations with a recognised dietician. This may be helpful for those who have specific dietary needs, require nutritional advice, or need assistance with weight management.
General Dental This helps cover for dental treatment including general check-ups, cleaning, x-rays, fillings, and surgical extractions.
Health Aid & Appliances This can include cover for health equipment such as crutches, blood glucose monitors, hearing aids, heart rate monitors, asthma pumps/nebulisers, and C-pap machines.
Lifestyle There are some private health funds that offer lifestyle extras including coverage for treatments such as weight management programs, quit smoking programs, gym memberships, and flu vaccinations.
Medication Provides cover for prescription medicines not subsidised under the Government’s Pharmaceuticals Benefit Scheme (PBS).
Optical Do you wear glasses? Extras cover can help pay for eye tests, frames, lenses, contact lenses, and prescription sunglasses.
Orthodontics / Major Dental Cover for major dental procedures including root canals, crowns, dentures, wisdom teeth removal, and veneers.

Plus, extras can include cover for orthodontics such as braces and retainers.

Physiotherapy This helps cover physiotherapy treatment which can be useful for those who have back, neck or knee pain, sports injuries, arthritis, or chronic illnesses.
Podiatry Podiatry treatment can help address feet issues such as bunions, corns, and ingrown nails, or walking disorders. In addition, extras can provide cover for equipment including shoe inserts, insoles, and orthotics.
Pregnancy Are you considering having a baby and want to go through the private system? Extras cover can help cover the cost of pre and post-natal services e.g. birthing classes, visits with a registered midwife.

Plus, having extras cover can generally allow you to choose your hospital, doctor, and request a private room.

Psychology Extras can help cover the cost of treatment by a psychologist and clinical psychologist. Keep in mind that some health funds only cover clinical psychology.
Natural Therapies This can include cover for remedial massage, acupuncture, myotherapy, and Chinese herbal medicine.

Do extras have waiting periods?

Generally, waiting periods apply to extras cover and vary depending on the provider and types of extras chosen. Unlike hospital cover, waiting periods for extras can be determined by the insurer themselves and are not subject to law.

According to the Private Health Insurance Ombudsman, waiting periods for general treatment are typically:

  • 2 months: For general dental services, chiropractic, and physiotherapy
  • 6 months: For optical
  • 12 months: For major dental, orthotics, pregnancy, and psychology
  • 1, 2, or 3 years: For orthodontics and hearing aids

Keep an eye out for health insurance offers in Australia, as providers will often waive waiting periods on extras to attract new members.

Are there limits on claiming extras?

Most private health funds place a limit on how much you can claim for extras services within a specific period of time. The amount you can claim will depend on your chosen health fund, level of cover, and the service you’re claiming.

Generally, annual limits apply to extras cover but there are other different types of limits insurers might use. These include a sub limit, person limit, and lifetime limit. We give a rundown of each below:

Annual limit

An annual limit is the total amount you can claim for an extras service within a year. For example, you might have an annual limit of $400 for physiotherapy and if you exceed this amount, you’ll have to pay the rest out-of-pocket. Keep in mind that if you haven’t used up your yearly limit, it resets the next year.

Sub limit

A sub limit in health insurance refers to when there’s an extra limit on a specific service or treatment. For instance, your policy may have a yearly limit of $600 for major dental but a sub limit of $200 applies to dentures. The sub limit amount is then deducted from the annual limit. If you reach that limit, you’ll have to pay the leftover expenses out-of-pocket.

Person limit

A person limit is common for those who share a private health insurance policy with their family. This is where an insurer sets a maximum amount that each individual can claim within a year.

Lifetime limit

There are some private health insurers who apply a lifetime limit on certain extras services. When you reach this limit, you cannot claim any more and it doesn’t reset even if you change health insurers or increase your level of extras. Health funds commonly place a lifetime limit on orthodontics/braces.

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Make sure to check with your private health fund as to when their annual limits reset. There are some insurers who use the calendar year (1 January to 31 December) or the financial year (1 July to 30 June).

Is extras cover worth it?

Ultimately, it comes down to your health needs, financial circumstances, and lifestyle.

For example, if you find yourself regularly attending physiotherapy appointments, then it could be worth taking out extras cover to reduce out-of-pocket expenses. Or, if you’ve got a big family, some insurers offer no-gap extras benefits for children.

While we can’t give you the answer, there are some questions you can ask yourself when considering whether to get extras cover. These include:

  • Do you play a sport or lead an active lifestyle?
  • Do you wear glasses?
  • Are you planning to have a baby soon?
  • Do you have a medical history of chronic illnesses (e.g. heart conditions, diabetes) in your family?
  • What is your budget?

Oiyo is a consolidated online resource, we are not financial advisors. We work with a range of industry professionals and compliance check our articles to ensure factual accuracy. However, we do not provide professional financial advice. Consider seeking independent legal, financial, taxation or other advice to check how the information and ideas presented in this article relate to your unique circumstances.

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Katie Douglass

Written by Katie Douglass

Katie Douglass is the Communications Manager at Oiyo and a writer. In recent years, Katie's work has appeared in publications such as Marie Claire, InStyle, and THE ICONIC. She has a Bachelor of Creative Industries in Fashion Communication & Journalism from the Queensland University of Technology. At Oiyo, Katie is responsible for overseeing editorial strategy.

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