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.

Extras No Longer Covered (Due to Government Reforms)

• Aromatherapy
• Homeopathy
• Naturopathy
• Reflexology
• Iridology
• Kinesiology
• Shiatsu

These therapies were removed from private health insurance extra policies in 2019 as part of the Australian Government’s reforms to focus coverage on evidence-based treatments.

Levels of Extras Cover

Unlike hospital cover, which is divided into clear tiers like Basic, Bronze, Silver, and Gold, extras cover is much more variable. There are no strict categories like “basic,” “medium,” or “comprehensive.” Extras cover can vary significantly across providers based on services included, rebate percentages, annual limits, and out-of-pocket costs. So, make sure you compare policies and look beyond the labels.

Extras Cover: More Than Just Levels

The extras cover doesn’t follow a one-size-fits-all approach. A policy might be marketed as “basic” but could limit some services more than a mid-range or more expensive policy. For example, nib’s Core Extras is a lower-tier policy but has higher optical limits than many mid-range policies. Look beyond the level name and focus on the rebates, annual limits, and services covered.

Variables in Extras Cover:

• Rebate percentages: How much of the service cost your policy will cover (e.g. 50%, 60% or more)
• Annual limits: The maximum you can claim per year for specific services.
• Services included: Some policies cover only dental and optical, while others cover physiotherapy, chiropractic and even acupuncture.
• Out-of-pocket costs: Even with cover you may still need to pay part of the cost for each service.

Examples

Lower Tier Extras Cover

Lower tier (often called “basic”) extras policies include:

• General dental (check-ups, cleanings, fillings)
• Optical (prescription glasses, contact lenses)
• Physiotherapy

These policies are cheaper but have lower annual limits and may only cover part of the cost. But as seen with nib’s Core Extras, you might find a policy with high optical limits that could be as good as or better than mid-range policies. The extras cover doesn’t fit into neat categories.

Mid Range Extras Cover

Mid-range extras policies expand on the services included and have higher annual limits. They may include:

• Major dental (crowns, bridges, root canals)
• Chiropractic and physiotherapy
• Non-PBS pharmaceuticals
• Podiatry and Psychology

These services’ annual limits and rebates are higher than those on lower-tier plans, but not always. Some mid-range plans may include hearing aids or orthotics, but you’ll need to compare as these services require a higher level of cover.

Higher Tier Extras Cover

Higher tier or more comprehensive extras cover more services and higher annual limits. If you need access to more expensive treatments or services like:

• Orthodontics
• Hearing aids
• Speech therapy
• Occupational therapy
• Medical Aids

These policies cover a larger percentage of the cost, have higher annual limits, and have higher premiums. If you need specialised treatments like orthodontics or hearing aids, you’ll likely need to go for a more comprehensive policy.

Why Compare Extras Policies

Because extra cover varies so much, you must compare policies based on your health needs. Two policies marketed as “basic” or “mid-range” could have vastly different coverage on rebates, annual limits, and services. Extras cover is not standardised so take the time to review what’s important to you, whether that’s high limits for optical or comprehensive dental cover.

Unlike hospital cover, where the tiers are defined, extras cover is all about the details – rebates, annual limits and the services included. Don’t assume that higher-tier policies are better for you. Take the time to compare policies and think about what services you use most and what limits will suit your situation. This way, you’ll get the right level of extra cover without paying for services you don’t need.

Extras Cover Benefits

Here are the benefits of extras cover:

Access to Many Health Services

Extras cover gives you access to many health services not covered by Medicare. For some, these services may be a luxury, but for many, they are essential for health and wellbeing. Without extras cover, regular access to services like dental check-ups, physiotherapy or optical care becomes financially out of reach. Extras cover gives you peace of mind knowing these services are available when you need them.

Big Savings

Health services like dental treatments, physiotherapy and non-PBS pharmaceuticals can add up quickly if you’re paying out of pocket. A simple dental filling or physiotherapy session can be expensive without extra insurance. With extras cover, you get rebates on these services, reduce the overall cost and not get hit with big bills when healthcare needs arise.

Support for Preventive Health

Extras coverage can encourage better health maintenance by making preventive care more affordable. Services like dental check-ups, eye tests (covered by Medicare), and physiotherapy help you stay on top of your health and prevent small problems from becoming big ones. By keeping up with regular care, you can maintain better overall health and potentially avoid bigger medical bills down the track.

Flexible and Customisable

One of the big advantages of extra cover is its flexibility. You can choose a policy that suits your individual health needs. This means you only pay for the services you use most, whether that’s dental, optical or remedial massage. This customisation means you don’t pay for services you don’t use and still cover the ones you need most.

How to Choose the Right Extras Cover

Choosing the right extras cover can be overwhelming with so many options out there. But by considering your health needs, budget and the services you need most, you can find one that suits you. Here are some things to consider:

• Your current and future health needs.
• Annual limits and rebates.
• Waiting periods and exclusions.
• Services you need for your lifestyle.

Considering these, you can choose an extra cover that is value for money and fits into your health and budget.

Assess Your Health and Lifestyle

Start by reviewing your current and future health needs. Do you need regular treatments like dental, optical or physiotherapy services? Are there any upcoming health issues needing attention, like podiatry or chiropractic care? Knowing what services you’ll need in the short and long term will help you choose a policy that covers what’s important to you.

Set a Budget

Extras cover varies in cost depending on the services and limits. Set a budget that allows for adequate coverage without breaking the bank. Compare premiums and the services covered to balance your budget with your health needs.

Review Annual Limits

Every extras policy has annual limits, which are the maximum you can claim on a specific service in a year. Consider how often you use services like dental, physiotherapy, or remedial massage and whether the policy’s annual limits will be enough for your needs. Higher annual limits are more valuable if you use these services frequently.

Sub-Limits

Many extras policies also have sub-limits that apply to specific treatments within broader categories. For example, if you claim remedial massage, the overall annual limit for physiotherapy and related services may be high, but the sub-limit for remedial massage could be much lower. This means that even if your policy covers a wide range of treatments, the amount you can claim for each specific service may be capped. Make sure the sub-limits match your most used services.

Review Waiting Periods

Extras policies have waiting periods, which are when you must wait after taking out a policy before you can claim certain services. Waiting periods for major services like orthodontics or major dental can be up to 12 months or more. If you’re switching policies, check if your new insurer will honour the waiting periods you’ve already served, which can save you time.

Compare Percentage vs Fixed Dollar Rebates

Extras policies may offer percentage-based rebates (e.g., 60% of the service cost) or fixed-dollar rebates (e.g., $105 for a dental check-up). Both have advantages depending on your needs. For services like physiotherapy, where costs can vary, a percentage rebate can be more valuable. For services like dental check-ups, where the fee is fixed, a fixed-dollar rebate may be better value than a percentage rebate. Carefully consider which rebate structure suits your usage to get the most savings.

Preferred Providers

Some insurers have preferred provider networks, which offer higher rebates or lower out-of-pocket costs when you use specific healthcare providers. Before you choose a policy, check if your regular dentists, optometrists, or physiotherapists are in your insurer’s preferred network, as this could save you a lot of money.

Choosing the right extras cover is about balancing your health needs with your budget. By understanding your requirements, such as annual and sub-limits, waiting periods and how different rebate structures work, you can choose a policy that’s right for you. If you’re not sure where to start, our experts are here to help. Contact us on 1300 369 399 or fill out the online form for personalised advice on finding the right policy for you and your family.

Understanding Benefit Limits

When selecting an extras-only or ancillary cover policy, it’s essential to understand the different types of limits: annual limits, sub-limits, and lifetime limits. These limits can significantly impact how much you’re able to claim and how often. Here’s a breakdown of each type with examples, including a critical note about lifetime limits for orthodontics.

Annual Limits

Annual limits are the maximum amount you can claim for a particular service within a year. These limits usually reset at the start of a new calendar year, but checking with your insurer for the exact reset date is always a good idea. For instance, if your policy includes a $600 annual limit for dental services, you can claim up to $600 for eligible dental treatments within that year. Once you hit this limit, you won’t be able to claim further dental expenses until the next year, when the limit resets.

Sub-limits for Specific Services

Sub-limits are caps placed on individual treatments within a broader service category. For example, within an annual limit of $400 for natural therapies, you might have a $200 sub-limit for remedial massage. This means that although you can claim up to $400 for natural therapy services overall, only $200 of that can be applied to remedial massage. Sub-limits ensure that the total benefit for certain treatments is restricted, even if you haven’t reached your annual limit for the category as a whole.

Lifetime Limits for Certain Treatments

Lifetime limits apply to specific treatments, such as orthodontics and sometimes laser eye surgery, and they differ from annual limits in that they do not reset. For example, if your policy provides a $2,000 lifetime limit for orthodontics, once you’ve claimed the full $2,000, you won’t be able to claim further orthodontic expenses under that policy—even if you switch insurers.

However, there is a way to increase your lifetime limit for orthodontics: you can switch to a new policy that offers a higher lifetime limit. For instance, if your current policy has a $2,000 lifetime limit and you switch to a new one with a $3,000 lifetime limit, you could claim the additional $1,000. But keep in mind that when switching policies, you’ll need to serve a 12-month waiting period before you can access the new orthodontic benefits. This means that while switching can eventually offer more coverage, you won’t be able to claim those additional funds immediately.

Understanding the nuances of annual limits, sub-limits, and lifetime limits is crucial to choosing the right extras cover policy. If you need treatments like orthodontics, it’s important to plan ahead—especially if you’re considering switching policies to increase your lifetime limits. Be aware of the waiting periods and ensure that the policy you choose fits your long-term health needs. Always check with your insurer for specific details to avoid any surprises down the line.

• 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 recognise 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 effects 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.

If you would like more information on what is covered under hospital and extras, whether covered separately or in combination, here is the Health Deal Insurance Comparison tool. Use it to make an informed decision.

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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