Understanding extras-only insurance
When most people think of private health insurance, hospital cover is usually the first thing that comes to mind. But if you’re someone who wants support for everyday health expenses like dental, optical and physiotherapy, you’ll need to look into extras-only health insurance.
If you don’t want a combined hospital and extras policy but do think you’ll get the most bang for your buck with extras-only cover, here’s how to choose the right plan for your needs.
What is extras-only health insurance?
Sometimes called ancillary cover, extras-only health insurance is a type of private health insurance that includes non-hospital treatments. In other words, it covers services that Medicare doesn’t – dental, optical, physiotherapy, chiropractic, psychology services and more. Instead of paying full price for these treatments, extras cover means you get to claim back a portion of the cost, up to your annual limit.
Unlike hospital cover, extras-only health insurance is not designed for emergencies or hospital admissions. Instead, it helps with the day-to-day health services that keep you and your family well.
What does extras cover include?
The specific services covered by health insurance extras cover plans will vary slightly depending on the insurer, but below are some of the most common inclusions:
1. Dental
Extras cover is very commonly used for general dental services like check-ups, cleanings and fillings. Some higher-level plans also include major dental procedures like crowns, bridges, root canals and more.
Expert tip: If you need orthodontic treatments, compare policies very carefully as not all of them will include this service.
2. Optical
You’ll get costs covered for eye care services, whether that’s prescription glasses or sunglasses, contact lenses and eye tests. Some extras policies will give you 100% back on optical expenses up to a set limit. Just bear in mind that those limits can be both annual and lifetime caps.
3. Physiotherapy
Extras plans will generally include physiotherapy for sports injuries, chronic pain management or rehabilitation.
4. Chiropractic and Osteopathy
Some plans also cover alternative therapies like chiropractic and osteopathy, which can help with musculoskeletal issues.
5. Natural Therapies
Depending on your policy, you could be covered for services like remedial massage and naturopathy.
6. Podiatry
Extras policies tend to include podiatry services for foot-related issues. Some higher-level plans also cover custom orthotics.
7. Psychology
Mental health support is becoming more common in extras cover plans, including consultations with psychologists and counsellors.
8. Health Programs
Many plans cover lifestyle and health programs like gym memberships, weight management programs or quit-smoking initiatives, but these will usually require that you get a GP referral.
What isn’t covered by extras-only health insurance?
While extras cover does indeed provide incredibly valuable support for everyday health services, it’s important to remember that it’s not a cure-all for everything. Some of the things it doesn’t include are:
- Hospital stays and surgeries: For these, you’ll need to take out a separate hospital cover policy or get combined cover.
- Emergency services: Extras-only policies won’t include emergency care.
- Unregistered providers: Claims can only be made with registered healthcare providers.
- Specific exclusions: Some services, like cosmetic dental procedures, might not be covered even under major dental plans.
How much will you get back?
The amount you can claim back depends on your policy and provider. However, most extras cover works in one of two ways:
1. Percentage back
- Some policies will give you a percentage back (e.g. 50% or 80%) on the cost of treatments, up to your annual limit.
- Example: If your physiotherapy session costs $80 and your plan covers 80%, you’ll get $64 back.
2. Fixed benefits
- Other policies will have a fixed-dollar amount per treatment, regardless of the provider’s fee.
- Example: you might get $50 back for a dental check-up, even if the service costs $90.
Portability
Don’t re-serve waiting periods when you switch to a new health fund or policy
“John was immediately covered for a hip replacement in private hospital because he had already served his waiting periods for joint replacements on his old policy”
Can you get extras cover with no waiting period?
Yes, some insurers will sell extras cover with no waiting periods for certain services – such as optical or general dental. But waiting periods will usually apply for more expensive services like orthodontics or major dental work.
If you’re switching providers, ask if your new insurer can waive the waiting periods for services already covered under your previous plan.
How to compare extras cover
When you get started on looking for the best health insurance extras cover plans, ask yourself the following questions:
1. What services do I need?
Choose a plan that matches your health needs. For example, if you wear glasses, make sure optical is included. And if you visit the dentist regularly, look for generous dental limits.
2. What are the annual limits?
Each service will have an annual limit attached to it, which is the maximum amount you can claim in a year. Compare these limits across different providers to find one that meets your needs.
3. How much of a percentage can I claim back?
Some plans will give you a higher percentage back but might cost more in premiums or have smaller annual limits. Decide whether a 50% or 80% back policy makes more sense for your usage.
4. How much are the premiums?
The amount you’ll pay for extras cover premiums will depend on the provider and the policy. Balance your budget with the number of benefits you need and any extra perks you want to take advantage of.
5. Do I have complete freedom of choice?
While some health insurers will let you visit any registered provider, be aware that other funds might require that you use specific clinics or specialists within their network. Otherwise, you might not be able to claim back the maximum benefits.
6. Are there any waiting periods?
Check if the insurer has no waiting periods for services you need immediately, which can be especially useful for new customers or those switching from another provider.
Who should consider extras-only health insurance?
Extras-only health insurance is great for:
- Families: Regular dental and optical visits can quickly add up, making extras cover a very cost-effective option.
- Young adults: If you don’t need hospital cover but still want support for everyday health expenses, extras cover is a good choice.
- Seniors: Plans with cover for podiatry and physio can be very beneficial for older Australians.
- The budget-conscious: Extras cover is a way to manage your routine health costs without the higher premiums of combined policies.
Is extras-only health insurance worth it?
The value of extras-only health insurance will ultimately come down to your health needs and how often you will actually use the covered services.
If you visit the dentist or physiotherapist regularly, an extras policy can save you plenty of money over time. But if you rarely use these services, you might be better off paying out of pocket and just having a hospital policy.
Conclusion
Make sure you take the time to compare extras cover plans to find one that suits your needs. Always look for flexible policies with reasonable annual limits, and check whether your preferred extras policy has no waiting periods for essential services. With the right plan, you can manage your healthcare costs while getting total peace of mind.
