Extras cover, also known as ancillary cover, is a type of private health insurance that provides coverage for a range of healthcare services not covered by Medicare or hospital-only policies. While hospital cover focuses on in-hospital treatments across four tiers (Basic, Bronze, Silver, and Gold), extras cover is designed to support out-of-hospital services like dental, optical, audiology, physiotherapy, and more.

In Australia, the cost of these services can add up quickly if you don’t have insurance, making extras cover a valuable option. It ensures you’re not left with large out-of-pocket expenses when you need routine care like dental check-ups or new prescription glasses.

You can choose extras cover on its own or combine it with hospital cover under a single policy, depending on your specific needs. Additionally, many extras policies offer flexibility, allowing you to tailor the coverage to include only the services you’re likely to use, so you’re not paying for unnecessary extras. This gives you the freedom to design a policy that fits your health requirements and budget perfectly.

Now that we have covered the difference between hospital cover and extras cover, let us dive deeper into the common services that are covered under an extras cover. Following is a detailed list of services that are generally covered in a private ancillary or extras cover:

Common Services Covered by Extras in 2024

Acupuncture

Acupuncture is covered under many extras policies. It is a form of alternative medicine in which thin needles are inserted into specific points on the body to treat various health conditions. Despite changes to natural therapies, acupuncture is still eligible for rebates.

Ante-Natal/Post-Natal Classes

Some health insurance extras policies cover antenatal (pre-birth) and postnatal (after-birth) classes, which are designed to support expecting and new mothers.

Audiology

This covers hearing tests and assessments, helping with hearing-related issues. Audiology is important for diagnosing hearing conditions and managing hearing loss.

Chinese Medicine

Some insurers cover Chinese medicine, including traditional herbal treatments. These can include herbal therapies and acupuncture, which remain eligible for rebates. Depending on the policy, other treatments may not be covered.

Chiropractic

Chiropractic services focus on spinal health and musculoskeletal issues. Most extras policies cover chiropractic sessions to manage back, joint, and other related issues.

General Dental

General dental services are covered, including routine check-ups, teeth cleaning, x-rays, fillings, and other basic dental care.

Major Dental

Major dental treatments like crowns, bridges, dentures, and root canals (endodontic services) are also covered, though these often come with higher annual limits.

Dietetics/Dietary Advice

Consultations with a dietitian to manage nutrition, weight loss, and general dietary health are often included in extras policies.

Endodontic Services

These services involve treatment of the dental pulp (such as root canal therapy) and are usually covered under major dental plans within extras cover.

Exercise Physiology

Exercise physiology services are often covered, helping patients manage chronic conditions through targeted exercise programs.

Blood Glucose Monitors

Some extras cover includes health aids like blood glucose monitors for people managing diabetes or other blood sugar-related conditions.

Health Management / Healthy Lifestyle Programs

Many insurers offer rebates for health management programs, such as gym memberships, quit smoking programs, or other lifestyle improvement initiatives.

Hearing Aids

Hearing aids and associated devices are covered under some extras policies, which is crucial for those managing hearing loss or impairment.

Home Nursing

Home nursing services are covered under some extras plans, providing in-home care for patients recovering from illness or surgery.

Non-PBS Pharmaceuticals

Some extra policies provide coverage for non-PBS (Pharmaceutical Benefits Scheme) medications, which helps cover certain medications not subsidized by the government.

Occupational Therapy

This covers therapy aimed at helping individuals develop or recover the skills needed for daily living and working, especially after illness or injury.

Optical

Covers the cost of prescription glasses, contact lenses, and sometimes optical appliances. Eye tests, however, are covered by Medicare, not by private extras insurance.

Orthodontics

Some policies cover orthodontic treatments, including braces and retainers to correct teeth alignment. However, these policies often have specific limits and require longer waiting periods.

Eye Therapy (Orthoptics)

Orthoptics covers therapies for eye movement disorders, such as treating lazy eyes or improving binocular vision. Some extra policies also cover it.

Orthotics (Podiatric Orthoses)

Orthotic devices, such as shoe inserts for correcting foot problems, are usually covered under podiatry or orthotic services in extras cover.

Osteopathy

Osteopathy is covered, focusing on treating musculoskeletal disorders with hands-on techniques to improve health and alleviate pain.

Physiotherapy

Physiotherapy treatments to manage pain, recover from injuries, and improve mobility are typically covered under extras policies.

Podiatry

Foot health treatments include foot pain, ingrown toenails, and other podiatric conditions.

Psychology

Mental health services, including psychologist consultations for therapy and counselling, are covered but may require a referral.

Remedial Massage

Remedial massage is covered for muscle pain, tension, and injuries. Check your extras for annual limits.

Speech Therapy

Speech therapy is covered for speech, language, or communication difficulties following injury or illness.

Vaccinations

Extras cover often includes vaccines not covered by the government or standard medical services like travel vaccines.

Waiting periods are the time you must wait after purchasing an extras cover policy before you can claim benefits for certain services. Unlike hospital cover, where waiting periods are fairly standardized (e.g., 2 months for new conditions, 12 months for pre-existing conditions), extras cover waiting periods vary significantly depending on the provider and service.

For example:

• Preventive dental, general dental, physiotherapy, and chiropractic services typically have a 2-month waiting period.
• Optical services may have a waiting period of 2 months to 6 months, depending on the policy.
• Hearing aids can have a waiting period ranging from 12 months to 36 months, depending on the insurer.
• Major dental, orthodontics, and medical aids generally have a 12-month waiting period.

It’s essential to understand the specific waiting periods for the services you expect to use before committing to a policy. If you’re switching to a new policy and have already served waiting periods, many insurers will recognize those waiting periods, meaning you won’t have to wait again. However, it’s important to confirm this with your new provider before switching.

The main cost associated with extras cover is your premium, which is the amount you pay regularly (monthly, quarterly, or yearly) to maintain the policy. Premiums vary based on:

• The level of cover (basic, mid-range, or comprehensive)
• Your age and income (this affects your Australian Government Rebate Tier)
• Your location (policies are priced differently in different states)
• The specific services and limits offered by the insurer

The value of an extras policy often comes from the rebates and annual limits offered for specific services. Higher-level policies generally come with higher premiums but also provide better rebates and higher annual limits, which can be especially valuable if you use services like major dental, physiotherapy, or orthodontics regularly.

One of the significant advantages of extras cover is the ability to claim rebates on a wide range of services. There are two main types of rebates you might encounter, depending on your policy:

• Percentage-based rebates:

  You receive a percentage of the total service cost back. For example, if your policy covers 60% of the cost of physiotherapy, you’ll get that portion reimbursed after each session.

• Fixed dollar amount rebates:

  You get a set amount reimbursed for specific services. For instance, if your policy offers a fixed rebate of $80 for a remedial massage, that’s the amount you’ll receive, regardless of the total cost of the treatment.

Each rebate type has its benefits. Percentage-based rebates are often more advantageous for pricier services like physiotherapy, where costs can be high. In contrast, fixed dollar rebates may offer better value for more routine services where the total cost is relatively consistent, such as remedial massage.

How to Claim

The most common and convenient way to claim is through HICAPS (Health Industry Claims and Payments Service). When you visit a healthcare provider that has HICAPS, you can swipe your health fund card, and the system will automatically calculate your rebate and apply it on the spot. It also updates your remaining annual limits, so you always know where you stand.

Other ways to claim vary depending on your health fund but typically include:

• Online portals:

  Most insurers allow you to submit claims by logging into their website.

• Mobile apps:

  Many health funds have apps where you can easily upload receipts and track your claims.

• Phone or mail claims:

  For those who prefer traditional methods, claims can often be made over the phone or by post, although processing times may be longer.

It’s essential to understand your policy’s annual limits and sub-limits. For example, your extras cover might include an annual limit of $500 for physiotherapy but have a sub-limit of $250 for remedial massage. This means you could claim up to $500 for physiotherapy services overall, but only $250 of that amount can be used for remedial massage. Managing these limits ensures you get the most value from your policy over the year.

Always review your policy documents or speak with your insurer to understand the full details of your cover and how best to claim.

You can decide the level or type of extras-only cover you need based on the stage of life you are at for example single, couple, family, or senior. The level of activity in your life and your general well-being will decide if you need to have a basic, medium, or comprehensive extras cover. If you are in your mid-thirties, a medium extras-only cover should be best for you given that you have an active lifestyle whereas if you are in your old age, a comprehensive extras-only cover might be a good way for you so you are covered for almost everything that there is to be covered for even for a remedial massage. In the end, the selection of the cover depends on your unique needs and what might work for others might not work for you so make the decision carefully.

Generally, people combine their eligible hospital cover and extras cover into a combined policy with one insurance provider. This combined hospital and extras policy may be useful for people who want to deal with only one insurance provider, pay a single premium each month, and may have special health needs. Some insurance providers may also offer packages for a combined policy that might be a financially viable option for you in contrast to getting two separate policies from two separate insurance providers.

The Medicare Levy Surcharge (MLS) is an additional tax paid by Australian taxpayers who earn above a certain income threshold and do not hold private hospital insurance. It’s important to note that holding extras cover alone will not exempt you from the MLS. Even if you have extras cover, you’ll still be liable for the surcharge if you don’t also have hospital cover.

To avoid the MLS, you need to have a private hospital insurance policy in place, not just extras cover. If you’re a single taxpayer earning above the threshold (currently $93,000), or a couple or family with a combined income above the threshold (currently $186,000), you’ll need to maintain hospital cover to be exempt from the surcharge.

Extras cover can provide valuable rebates for services like dental, optical, and physiotherapy, but it does not satisfy the requirements to avoid the Medicare Levy Surcharge. If avoiding the MLS is a priority, ensure that your policy includes hospital cover in addition to extras.

It is best that you review your extras cover annually to see what has changed in your health and how that may affect your premium and excess. Many insurance providers also offer great deals when you switch your cover. So we suggest that you review and make necessary changes to your policy annually. Furthermore, if you switch your policy, you will not be liable to go through any waiting periods and can instantly claim benefits after switching.

1. How Do Annual Limits Work?

Annual limits refer to the maximum amount you can claim for specific services within a policy year. These limits usually reset at the beginning of a new calendar year, although some insurers reset on a financial year. For example, if your policy has an annual limit of $200 for optical services, you can claim up to $200 for services like prescription glasses or contact lenses within that year. Once you reach this limit, no further claims for optical services can be made until the next reset period.

2. What Happens If I Switch Policies Mid-Year?

When you switch health insurance policies mid-year, any claims you’ve made in the current health fund year carry over to your new policy. For instance, if you’ve already claimed $150 of a $300 physiotherapy limit with your old provider, your new insurer will deduct that amount from your new annual limit, leaving you with $150 to claim under the new policy for the remainder of the year. It’s important to note that switching won’t reset your limits.

3. Can I Claim Dental and Optical Services in the Same Year?

Yes, you can claim for both dental and optical services in the same year, provided you haven’t reached the individual annual limits for those services. Each type of service, such as dental, optical, or physiotherapy, typically has its own separate annual limit, meaning you can claim across multiple categories as long as you stay within those limits.

4. What Happens If I Exhaust My Annual Limits?

If you exhaust the annual limit for a particular service, you won’t be able to claim any more for that service until your limits reset, typically at the start of the next calendar year. For example, if you’ve used your entire $600 annual dental limit, any additional dental expenses will need to be paid out of pocket until the new year, when the limit resets.

5. Do Unused Annual Limits Carry Over to the Next Year?

No, unused annual limits do not carry over. If you don’t use the full amount of a service within the year, the remaining balance does not roll over to the following year. For example, if you have a $500 annual limit for physiotherapy and only claim $300, the remaining $200 is forfeited when the limit resets, and the full $500 becomes available for the next year.

6. Are Rebates the Same for Every Service?

Rebates vary by service and by the specific policy you have. Some services offer percentage-based rebates (e.g., 60% of the cost of physiotherapy), while others may provide a fixed dollar amount (e.g., $80 for a dental check-up). The rebate percentage or fixed amount often differs between services, so it’s essential to review your policy and understand how much you’ll receive for each claimable service.

7. Can I Upgrade My Extras Cover for Higher Limits Immediately?

Upgrading your extras cover allows access to higher limits and additional services, but you may need to serve waiting periods for some benefits before claiming. For example, if you upgrade to a policy with orthodontic cover, you could face a 12-month waiting period before being able to claim for this service. Always check with your insurer to understand the waiting periods for upgraded benefits.

Here are the answers to a few of the common questions about family health insurance:

What is covered under hospital and extras cover?

Under this cover, a wide variety of your in-hospital and out-of-hospital services are covered. The specific covered service will depend on your insurance provider and the tier of coverage you select, but the most commonly covered services include hearing aids, dental, optical, and physiotherapy services. Additionally, you have the choice of a public or private hospital, a choice of specialist, and a private room option (if one is available), all chosen by you according to your needs.

How do I claim the Australian Government Rebate on Private Health Insurance?

There are two ways that you can claim rebates, according to Service Australia. One way is to claim it from your insurance provider, and the other way is to claim it from the Australian Taxation Office. You can claim the rebate from the insurance provider as an upfront reduction to your private health insurance premium, whereas you can claim the rebate through the ATO tax return if you don’t get it as a premium reduction. The choice is yours. You can read more about health insurance rebates for families on this page.

What are waiting periods?

Waiting periods refer to the initial time frames that begin as soon as you take out an Australian private health insurance policy. During this period, you won’t be able to claim or access any benefits covered by the policy. If you require medical services during this time, you’ll need to cover the full cost yourself. The length of these waiting periods can vary depending on the type of condition.

Here are the standard waiting periods for some common health insurance benefits:

• New Conditions: 2 months
• Pre-existing Conditions: 12 months
• Rehabilitation, Psychiatric Care, and Palliative Care: 2 months
• Pregnancy and Birth-related Services: 12 months
• IVF and Assisted Reproductive Services: 12 months
• Weight Loss Surgery: 12 months

Remember, if you’re switching to a new policy and have already served the waiting period with your previous insurer, you will not need to serve it again. For more details on waiting periods for senior health insurance, please visit this page.

How can I reduce my premiums?

There are a few foolproof ways that you can reduce your premiums on your family health insurance policy. These ways include comparing different policies and their rates, switching to policies with lower premiums, only getting cover for services you or your family members will require, and removing the services from the cover that are no longer required. Another way you can reduce your premium is by prepaying your policy premium for at least 12 months.

If you have any other family health insurance FAQs, we invite you to email us at enquiries@healthdeal.com.au.

We have covered everything that there is to know about the extras-only cover insurance. If you still have any questions, you can contact Health Deal at enquiries@healthdeal.com.au. You can speak to our experts at 1300 369 399 or fill out the online form here. Get in touch now to speak with our insurance experts for tailored advice and support in making viable health insurance decisions for you and your loved ones.

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