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Extras Only Health Insurance

Key Points

  • Extras Cover Benefits: Extras cover helps with out-of-hospital services such as dental, optical, and physiotherapy.
  • Common Inclusions: Acupuncture, chiropractic, and major dental services are frequently included in extras cover policies.
  • Importance of Comparison: Annual limits and rebates vary significantly across extras policies, making it essential to compare options.
  • Preventive Care Matters: Regular services like dental check-ups and physiotherapy play a vital role in maintaining long-term health.
  • Optical Services: Coverage often includes glasses and contact lenses, though eye tests are covered by Medicare.
  • Comprehensive Coverage: Higher-tier extras policies offer more extensive benefits, such as orthodontics, hearing aids, and medical aids.
  • Flexible Options: Tailoring extras cover gives you the flexibility to pay only for the services you need most.
  • Ease of Switching: Switching extras cover is straightforward and often doesn’t require re-serving waiting periods.
  • Rebate Variations: Rebates may be percentage-based or fixed dollar amounts, depending on the service.
  • Annual Review: Reviewing your extras cover yearly helps ensure your plan adapts to changing health needs and coverage options.

Are you overdue for a dental check-up or looking to start physiotherapy? Extras-only private health insurance can help cover these services, saving you both time and money. Maintaining the right health insurance in Australia is crucial, providing access to a range of valuable benefits. Without it, routine services like dental visits, remedial massages, or even emergency ambulance rides can quickly become expensive.

With over 50 health insurance providers across the country, finding the ideal plan to suit your needs and budget can seem daunting. That’s where Compare Your Health comes in. Our comparison tool simplifies the process, helping you discover a policy tailored to your unique requirements—without straining your finances.

In this guide, we’ll explore the essentials of extras health insurance, what it covers, and how to choose the plan that’s right for you.

 

What is Extras Cover?

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

In Australia, the cost of these essential services can add up quickly if you don’t have insurance. Extras cover helps reduce out-of-pocket expenses, ensuring you can access routine care such as dental check-ups or new prescription glasses without financial stress.

You have the option to choose extras cover on its own or combine it with hospital cover in a single policy to suit your unique needs. Many extras policies also offer flexibility, allowing you to customize coverage to focus on the services you use most—ensuring you’re not paying for benefits you don’t need. This adaptability makes it easier to design a policy that aligns perfectly with your health priorities and budget.

Common Services Covered by Extras

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 for Extras Cover

Waiting periods are the time you must wait after purchasing an extras cover policy before claiming benefits for specific services. Unlike hospital cover, where waiting periods are relatively standardized, waiting periods for extras cover can vary significantly based on the provider and type of service.

  • Typical Waiting Periods by Service
    Preventive Dental, General Dental, Physiotherapy, Chiropractic: Typically, a 2-month waiting period.
  • Optical: Waiting periods are 2 months or 6 months, depending on the policy.
  • Hearing Aids: Waiting periods can vary widely, 12 months.
  • Major Dental, Orthodontics, Medical Aids: Generally have a 12-month waiting period.

Why Waiting Periods Matter

Understanding waiting periods is crucial, especially for services you plan to use soon after purchasing a policy. If you’re considering a service with a long waiting period (e.g., hearing aids or orthodontics), plan accordingly to avoid unexpected out-of-pocket expenses.

Switching Policies

If you’re switching to a new extras policy and have already served waiting periods, many insurers will recognize these periods. This means you won’t need to start the waiting period over for the same services. However, this is not automatic—confirm with your new insurer that they will honor waiting periods already served. Additionally:

  • Upgrade Caveat: the waiting periods will be served for the increased limits and for the increased amount only
  • Tips for Managing Waiting Periods
  1. Plan Ahead: If you anticipate needing services like orthodontics or major dental, start your extras cover early to account for waiting periods.
  2. Confirm Recognition: Always check with your new insurer to ensure any previously served waiting periods will transfer.
  3. Ask About Waivers: During promotional periods, some insurers may waive waiting periods for specific services, especially for new customers.

Costs and Premiums

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.

Claiming on Extras Cover

Extras cover offers the advantage of claiming rebates for a wide range of healthcare services, helping reduce out-of-pocket expenses. Understanding how rebates work and the claiming process ensures you get the most value from your policy.

Types of Rebates
Percentage-Based Rebates
  • You are reimbursed a percentage of the service cost.
  • Example: If your policy covers 60% of physiotherapy costs and your session costs $100, you’ll receive $60 back.
  • Best for: High-cost services where a percentage rebate can result in substantial savings.
Fixed Dollar Amount Rebates
  • You receive a set amount for a specific service, regardless of its total cost.
  • Example: A fixed rebate of $80 for a remedial massage means you’ll get $80 back, even if the session costs $120.
  • Best for: Routine services with consistent costs, like dental check-ups or remedial massages.
    Each rebate type has advantages, so consider which structure suits the services you use most frequently.

How to Claim
HICAPS (Health Industry Claims and Payments Service)

  • What it is: An electronic system used by many healthcare providers.
  • How it works: Swipe your health fund card at the provider’s location, and your rebate is calculated and applied instantly.
  • Benefits: Convenient, real-time claims processing and immediate updates on remaining annual limits.
Online Portals
  • Submit claims by logging into your insurer’s website.
  • Upload receipts and track claims easily.
Mobile Apps
  • Many insurers offer apps for quick claims submission.
  • Features often include uploading receipts, checking annual limits, and tracking claim history.
Phone or Mail
  • Submit claims traditionally by calling your insurer or mailing receipts.
  • Note: Processing times may be longer compared to digital methods.

Understanding Annual Limits and Sub-Limits

Annual Limits: The maximum amount you can claim for a specific service each year.

  • Example: A $500 annual limit for physiotherapy allows you to claim up to $500 for eligible sessions in a year.

Sub-Limits: Caps on specific treatments within a broader service category.

  • Example: If your physiotherapy limit is $500, but there’s a $250 sub-limit for remedial massage, you can only claim $250 for massages, even if the total physiotherapy limit is not reached.

Knowing these limits helps you plan treatments and avoid unexpected costs.

Tips for Maximizing Your Claims
  • Track Your Usage: Use your insurer’s app or portal to monitor claims and annual limits.
  • Plan Ahead: Schedule services early in the year to maximize your coverage before annual limits reset.
  • Compare Providers: Check if your healthcare providers participate in HICAPS or offer preferred rates through your insurer’s network.
  • Keep Receipts: Retain receipts for manual claims or for reference in case of discrepancies.

Extras Cover for Different Life Stages

Choosing the right extras cover depends on your stage of life, lifestyle, and unique health needs. Tailoring your policy ensures you get the most value and coverage for the services you’re likely to use. Here’s how extras cover can align with various life stages:

1. Singles

  • Lifestyle: Young, active individuals often focused on career or studies.
  • Recommended Cover: Basic or Medium Extras.
  • Key Services to Consider:
    Preventive care: Dental check-ups and optical (glasses or contact lenses).
  • Wellness support: Physiotherapy, chiropractic, and remedial massage for an active lifestyle.
  • Fitness-related services: Dietetics or gym memberships (if included).

Singles might prioritize affordability and focus on services that align with maintaining an active and healthy lifestyle.

2. Couples
  • Lifestyle: Often balancing work, hobbies, and planning for the future.
  • Recommended Cover: Medium Extras.
  • Key Services to Consider:
  • Shared benefits: Dental, optical, and physiotherapy for both partners.
  • Family planning support: Coverage for prenatal and postnatal services if starting a family is a consideration.

Couples benefit from shared coverage that addresses general health while preparing for potential future needs.

3. Families
  • Lifestyle: Managing health care for children and parents alike.
  • Recommended Cover: Comprehensive Extras.
  • Key Services to Consider:
  • Child-focused services: Orthodontics, pediatric dental care, and speech therapy.
  • General family needs: Optical for children and adults, physiotherapy, and chiropractic.
  • Preventive care: Routine dental and vaccination-related benefits.

Families should look for policies with high annual limits and broad coverage to manage the diverse needs of parents and children.

4. Seniors
  • Lifestyle: Focused on maintaining health and managing age-related conditions.
  • Recommended Cover: Comprehensive Extras.
  • Key Services to Consider:
  • Major dental: Dentures, crowns, and restorative work.
  • Hearing aids: Coverage for hearing devices and tests.
  • Remedial therapy: Massage, physiotherapy, and hydrotherapy to support mobility.
  • Vision care: Glasses, contact lenses, and cataract-related expenses (if included).
  • Home health aids: Walking frames, wheelchairs, or other medical aids.

Seniors typically benefit from broad coverage that ensures peace of mind for both routine and unexpected healthcare needs.

How to Decide?

The right extras cover depends on your specific lifestyle, health status, and priorities:

  • Evaluate Needs: Consider the services you’re likely to use frequently.
  • Assess Activity Level: Active individuals may need more physiotherapy and chiropractic coverage, while others might prioritize dental and optical.
  • Balance Cost and Coverage: Choose a level of cover that aligns with your budget while meeting your health needs.

Combining Extras with Hospital Cover

Combining hospital cover and extras cover into a single policy with one insurance provider can simplify your health insurance management and may provide additional benefits. Here’s what you need to know:

Advantages of a Combined Policy

Convenience:

  • Dealing with one insurer means managing a single premium, one set of policy terms, and a single point of contact for claims and queries.

Cost Efficiency:

  • Many insurers offer discounted rates or special packages for combined policies, which can be more affordable than purchasing separate policies.

Comprehensive Coverage:

  • A combined policy ensures you’re covered for both hospital-related expenses (e.g., surgeries, overnight stays) and everyday health services (e.g., dental, optical, physiotherapy).

Streamlined Claims Process:

  • Simplifies tracking annual limits and out-of-pocket expenses since all claims are processed through the same provider.
Who Should Consider a Combined Policy?
  • People with Complex Health Needs:
    Those who require regular services (e.g., dental or physiotherapy) in addition to hospital treatments may benefit from the simplicity and cost-efficiency of a combined plan.
  • Families:
    Parents managing multiple policies for themselves and children often find it easier to consolidate coverage.
  • Seniors:
    Those who frequently access both hospital services and extras benefits may prefer a single policy to reduce administrative hassle.

Key Considerations Before Combining

  • Compare Standalone vs. Combined Costs:
    While combined policies often provide value, in some cases, purchasing separate hospital and extras policies from different providers may result in better benefits or lower costs.
  • Assess Coverage Needs:
    Ensure the combined policy covers the hospital treatments and extras services you’re most likely to use.
  • Check Flexibility:
    Some combined policies may restrict your choice of providers or benefits compared to standalone extras policies.

Extras Cover and Tax

The Medicare Levy Surcharge (MLS) is a tax that applies to Australian taxpayers who earn above specific income thresholds and do not have private hospital insurance. While extras cover provides valuable benefits, it does not exempt you from the MLS. Here’s what you need to know:

Key Points About the MLS
Extras Cover Alone is Not Sufficient:

  • Holding an extras-only policy (for dental, optical, physiotherapy, etc.) does not exempt you from paying the MLS.

Income Thresholds for the MLS:

  • For single taxpayers, the MLS applies if your income exceeds $97,000 per year.
  • For couples or families, the MLS applies if your combined income exceeds $194,000 per year.

Hospital Cover is Required to Avoid the MLS:

  • To avoid the MLS, you need a private hospital insurance policy.
  • Hospital cover must meet minimum coverage standards as specified by the Australian Government.

How This Affects Your Policy Decisions

  • If your primary goal is to avoid the MLS, extras cover alone will not suffice.
  • Many people combine hospital and extras cover into a single policy to meet the MLS exemption requirement while also receiving benefits for routine healthcare services.
  • If you already hold extras cover, consider adding a basic hospital cover policy to avoid the surcharge.

Switching Extras Cover

It’s a good idea to review your extras cover annually to ensure that your policy still suits your health needs and financial situation. Changes in your health or lifestyle might require adjustments to your cover, and many insurers offer special deals when you switch your policy.

Here are some important points to consider when switching extras cover:

Why You Should Review Your Policy Annually:
Changes in Health Needs:

  • If your health needs change, such as requiring more dental or physiotherapy services, your existing policy may no longer be the best fit.

Premium and Excess Adjustments:

  • Insurance premiums and excesses can change, so it’s essential to compare your current policy with others to ensure you’re still getting the best value.

Better Deals from Different Providers:

  • Many insurers offer attractive deals or discounts when you switch policies, which could lower your premiums or provide additional benefits.

Switching Without Waiting Periods:
No Need to Serve Waiting Periods:

  • When you switch to a new insurer, you do not have to serve any waiting periods again, provided your new insurer recognizes your previous waiting periods.
  • This means that you can instantly claim benefits as soon as you switch, without having to wait for months like you would with a new policy.

Confirm with Your New Insurer:

  • Before switching, check with your new insurer to ensure they’ll honor your waiting periods from your old policy, so you don’t face any gaps in coverage.

Things to Consider When Switching:
Cover Comparison:

  • Compare what’s included in your current extras cover with the new options to ensure you’re still getting all the services you need.

Annual Limits and Rebates:

  • Make sure to check if the new policy offers similar or better annual limits and rebates for services you frequently use.

Policy Terms and Conditions:

  • Always read the fine print to ensure there are no hidden costs, exclusions, or conditions that might affect your coverage.

FAQs

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 Compare Your Health  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.

Compare Now: Extras-Only Cover Insurance

We’ve covered all the essential details about extras-only cover insurance, from understanding benefits and waiting periods to choosing the right policy based on your life stage. If you still have any questions or need personalized advice, we’re here to help!

Need Expert Advice?

if you need expert guidance,feel free to reach out to us:

Contact: Compare Your Health
Email: info@compareyourhealth.com.au
Phone: 1300 631 373

Get in touch with our experts for tailored advice and support in making informed health insurance decisions for you and your loved ones.

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Frequently Asked Questions

Depending on the policy, private health insurance can help cover the cost of your medical treatments in or out-of-hospital that Medicare sometimes won’t cover. Out of hospital treatment can include services such as Dental, optical, physiotherapy or even remedial massage

Private health insurance can help cover medical treatment received when hospitalised. Therefore, it is important to select the right level of cover for the clinical categories that are necessary to you.

Your private health insurance should change as often as needed to ensure you are covered at all the different stages of your life.

Also, private health insurance gives you the ability to choose your own doctor and avoid any public waiting lists for categories covered by your policy.

There are many top competing health funds, however you want to find one that is best suited to your individual health requirements and not just a health fund that is the best in the market.

This can sometimes be a difficult task for individuals, therefore companies like Health.Compare can offer comparisons of different health insurance policies to help you choose a policy that is catered to your health circumstances and budget.

Excess is the amount you pay upfront to cover some of the hospitalisation expenses if you ever get hospitalised. The higher the excess, the lower your private health insurance premiums will be. This usually applies to people with relatively lower health concerns who do not see themselves being in hospital anytime soon and in the event that they are hospitalised, they can agree to pay a higher excess, ultimately reducing their regular premiums.

Please be aware that excess amounts do vary depending on the health insurance provider, so it may be beneficial for you to consider your individual health and financial circumstances at the time of buying the insurance policy before agreeing to the Excess amount.

In Australia, health insurance is not tax deductible however you can receive rebates for your private health insurance. When taking out Private Health Insurance you choose whether or not to claim a rebate from the government. The government rebate is dependent on a number of factors including age and taxable income.

This can be applied to Hospital, Extras or combined products.

According to a recent report by APRA, 55.2% of Australians have extra cover, and 45.2% have hospital cover. These are the verified figures as of June 2022.

While the average cost of private health insurance adds up to $160 per month per person, your premiums may go up or down depending on the type of cover you choose or the excess amount you agree upon.

The starting point for many, is to look at your individual needs, preferences and financial circumstances.

We will help guide you through this conversation by first understanding and then matching your needs to a tailored level of cover. Ultimately, what’s best for you and your situation will be completely different to many others who are eligible for Private Health Insurance.

Yes you can have a private hospital insurance policy with one health fund and extras cover with another. This can be helpful as some funds might have a hospital policy you like, but not the extras cover you require for the specific out-of-hospital treatments.

Private health insurance provides many benefits to its members giving them access to a wide choice of health providers, faster access to medical services and the ability to avoid long wait times experienced in the public hospital system. In this FAQ we will answer some of the common questions about private health insurance.

What are the benefits of having private health insurance?

  • Access to private hospitals and faster treatment times
  • A wider range of treatment options
  • Ability to choose your own doctor and hospital
  • Reduced out-of-pocket expenses
  • Access to many health services and treatments not covered by the public system

Can I choose my own doctor and hospital if I have private health insurance?

Yes, with private health insurance you have the ability to choose your own doctor and hospital, giving you greater control over your health care to achieve a better overall health outcome.

How can I choose the right private health policy for me?

When choosing private health insurance, there are a few factors to consider:

type of cover required (hospital or extras)

  • your budget
  • your age and pre-existing medical conditions
  • the level of cover required
  • the range of health services you need to be covered for

Why should I get extras cover?

extras cover will give you further coverage on a range of treatments such as dental, optical, chiropractic, massage and physiotherapy.
some extras health policies also include further natural therapies such as acupuncture and Chinese medicine

How much does private health insurance cost?

The cost of a health policy in Australia varies depending on what type of cover you choose, your age, if you have any dependents and any pre-existing conditions. On average, the cost of private health insurance is around $2,000 per year for an individual and $4,000 per year for a family.#

In Australia, private health insurance is available to provide financial protection and contribution to medical expenses, but not all medical expenses are covered by your private health policy. In this FAQ we will explain the questions you have around what is typically covered and what’s not covered with private health insurance.

What is not covered by standard private health insurance?

The most common exclusions from private health insurance policies in Australia include:

  • Elective cosmetic operations, such as cosmetic surgery and cosmetic dentistry
  • Weight loss surgery, unless it is deemed medically necessary
  • Infertility treatments, such as IVF
  • Alternative therapies, such as homeopathy, aromatherapy, kinesiology, reflexology and iridology
  • Mental health services, such as counseling and psychotherapy, unless they are part of a hospital treatment plan
  • Non-medical services, such as transportation and accommodation for medical treatment
  • International travel for medical treatment
  • Experimental treatments or procedures that are not yet widely accepted or covered by Medicare

Does private health insurance cover dental services?

No, private health insurance does not generally cover routine dental services, such as check-ups, cleanings, and fillings. However, some private health insurance policies may offer coverage for more extensive dental procedures, such as orthodontics and oral surgery, that are performed in a hospital setting.

Does private health insurance cover optometry services?

Similar to dental, optometry services are not covered by private health insurance such as eye examinations although prescription glasses and contact lenses are covered by private health extras policies.

Am I covered for ambulance services?

Not all private health policies cover individuals for ambulance services. However, some states in Australia automatically cover policy holders through their state or territory.

Will my private health policy cover prescription drugs?

No, private health insurance policies in Australia do not cover prescription drugs. Prescription drugs are covered by the Pharmaceutical Benefits Scheme (PBS), which is a government-funded program.

In conclusion, it’s important to understand what is not covered under your policy to avoid any surprises when you need to make a claim. While most health insurance policies provide coverage for a wide range of medical expenses, there are still some things that are not covered, and it is important to understand these exclusions.

So, you have private health insurance and want to know how much you might have to pay for medical treatments out of your own pocket? We’ve got you covered with our easy guide FAQ.

What does ‘no gap’ mean when it comes to private health insurance?

Basically, it means that you won’t have to pay anything out of your own pocket for certain medical services, these are covered by your private health insurance. It’s the difference between what your doctor or hospital charges and what Medicare and your private health fund will pay and it’s known as the ‘gap’. With a ‘no gap’ arrangement, your insurance will cover the full cost of the service.

So, I won’t have to pay anything extra?

That’s right! With the ‘no gap’ arrangement, you won’t be left with any unexpected bills to pay. Your private health insurance will cover the full cost of the medical service, so you can focus on your health and recovery.

How does it work?

To be eligible for a ‘no gap’ service, you’ll need to use a provider who is part of your private health insurance provider’s ‘preferred provider’ network. This means that the provider agrees to charge you a set fee for a particular medical service, and your private health insurance will cover this fee in full. This way, you can be sure that you won’t have to pay anything out of your own pocket.

Can I get ‘no gap’ for any medical procedure?

Unfortunately, ‘no gap’ is only available for some medical services, and only if you use a provider who is part of your private health insurance provider’s ‘preferred provider’ network.

Is ‘no gap’ the same as ‘bulk billing’?

No, they’re not the same thing. ‘Bulk billing’ is when medical providers bill Medicare directly for their services, so you don’t have to pay anything out of your own pocket. ‘No gap’ is a service that’s offered by private health insurance providers, and it covers the full cost of certain medical services.

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