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How Can I Find Reliable Optical Cover in Australia?

An ideal optical extras policy or hospital cover for eye surgery should cater to your unique needs. From prescription glasses and contact lenses to comprehensive eye exams and surgery, it’s important to have a policy that provides the cover you need at a price you can afford. At Fair Health Care Alliance, we can provide you with expert guidance to help you compare a range of options. Choose a cover that protects your vision and wallet today.
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What Is Private Optical Health Cover?

Private optical health cover is a type of health insurance that covers some of the cost of common optical services and treatments that aren’t covered by Medicare. With a private optical health cover, you can have more control over your optical health and access to a wider range of services and providers. This can include needs like prescription glasses, contact lenses, and eye exams.

It’s important to distinguish the difference between hospital cover and extras cover in how they can cover optical treatment. For instance, if you have private hospital cover, you may be eligible for in-hospital eye treatments or surgeries such as:

– Cataract removal
– Retinal detachment
– Eye infections
– Tear duct conditions
– Medically-managed trauma to the eye
– Macular degeneration
– Glaucoma
– Other Major or Minor eye surgery

Meanwhile, extras cover can come in handy when you need to buy eyewear like prescription glasses, contact lenses, or even prescription sunglasses. It can also help pay for treatments that improve your vision, such as eye therapy for issues like blurred vision, double vision, and lazy eyes. A very small selection of health funds can also partially cover the cost of corrective laser eye surgery on select extras policies.

How Many Levels of Optical Cover Can I Choose From?

When it comes to optical cover, you can expect to have access to a range of services that typically fall into three categories. However, it’s important to note that each health fund may have different levels of optical cover with varying benefits and limits.

Basic hospital cover can include minor eye surgery in a private hospital depending on the health fund you choose and whether you take out a Bronze or Bronze Plus level of cover. Coverage on Bronze, Silver or Gold cover generally includes hospital accommodation, theatre room fees, and up to 100% of the Medicare Benefit Schedule fee for the procedure.

Extras cover typically includes minimum benefits for prescription glasses, contact lenses, and basic eye examinations. This level of cover is generally the most affordable, but it may have limits on the amount you can claim or the number of services you can access.
All medium level hospital covers (also known as “Silver”) will generally insure minor eye surgery and eye cancer treatment in hospital. A medium level of extras will see slightly higher limits on prescription glasses or contact lenses, prescription sunglasses than the Basic covers. It may also include coverage for optical appliances like magnifiers or low-vision aids.
Top (Silver Plus and Gold) Hospital cover includes all the benefits of basic and medium cover but almost always also includes Major Eye Surgery and Cataract treatment. It’s important to note that not all Silver Plus hospital cover policies in the industry cover Major Eye Surgery and Cataracts, however most of them certainly do.

A Top Extras policy will have higher limits to spend at the Optometrist for prescription items, at the Eye/Vision Therapist or on corrective Laser Eye Surgery.

It’s very important to speak to a Fair Health Care Alliance adviser to ensure the policy you take out is the right one for what you need.

How Many Levels of Optical Cover Can I Choose From?

When it comes to optical cover, you can expect to have access to a range of services that typically fall into three categories. However, it’s important to note that each health fund may have different levels of optical cover with varying benefits and limits.

Basic hospital cover can include minor eye surgery in a private hospital depending on the health fund you choose and whether you take out a Bronze or Bronze Plus level of cover. Coverage on Bronze, Silver or Gold cover generally includes hospital accommodation, theatre room fees, and up to 100% of the Medicare Benefit Schedule fee for the procedure.

Extras cover typically includes minimum benefits for prescription glasses, contact lenses, and basic eye examinations. This level of cover is generally the most affordable, but it may have limits on the amount you can claim or the number of services you can access.
All medium level hospital covers (also known as “Silver”) will generally insure minor eye surgery and eye cancer treatment in hospital. A medium level of extras will see slightly higher limits on prescription glasses or contact lenses, prescription sunglasses than the Basic covers. It may also include coverage for optical appliances like magnifiers or low-vision aids.
Top (Silver Plus and Gold) Hospital cover includes all the benefits of basic and medium cover but almost always also includes Major Eye Surgery and Cataract treatment. It’s important to note that not all Silver Plus hospital cover policies in the industry cover Major Eye Surgery and Cataracts, however most of them certainly do.

A Top Extras policy will have higher limits to spend at the Optometrist for prescription items, at the Eye/Vision Therapist or on corrective Laser Eye Surgery.

It’s very important to speak to a Fair Health Care Alliance adviser to ensure the policy you take out is the right one for what you need.
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How Does Private Optical Cover Work?

Are there waiting periods for optical cover?

The waiting period for your optical coverage will depend on your health fund provider, the type of policy you have, and the service that you’re claiming.

– If you need hospital treatment or surgery for an eye-related issue, you may need to wait for two months for non-pre-existing conditions and up to twelve months for pre-existing conditions before you can claim your hospital insurance.
– For extras cover, you may have to wait between two to six months to claim optical benefits such as eye therapies, new glasses, or contact lenses. For complex procedures like laser eye surgery, you may have to serve a longer waiting period of up to 24 or 36 months; however, the exact time will depend on your specific policy and health fund.

Can I choose my own optometrist, optical provider or opthalmologist?

In most cases, you can choose your own optometrist or optical provider as long as they have a provider number in Australia or use Hi-Caps on-the-spot claiming, however, it’s important to check with your health fund provider first. When considering private eye surgery, it’s critical to ensure your health insurance fund has a contract with your local private hospitals or the private hospital your chosen private doctor attends.

It’s crucial to have insurance from a private health fund that is generous with its coverage at any provider in Australia, no matter which ophthalmologist, optometrist or optical provider you choose to visit.

Are vision therapy treatments covered by extras health insurance?

Extras health insurance policies may cover eye therapy by a recognised medical practitioner, but it could incur an additional cost and be subject to waiting periods and limits. Typically there’s a two-month waiting period to claim eye therapy benefits, but again, this varies depending on your policy and health fund. The amount you can claim for eye therapy services is often limited by per-visit or annual limits, group limits, or service limits. For example, a policy may cover $50 per visit or $350 per year, or may have a limit if eye, speech, and occupational therapies are grouped together. It may also cover a slightly higher amount for the initial consultation per year and then reduce to a slightly lesser rebate for any subsequent visits that year.

Comparing Private Optical Insurance in Australia with Fair Health Care

At Fair Health Care, we understand that managing your optical healthcare expenses can feel overwhelming. But with the right insurance policy, you can ensure that you receive the optical care you need without worrying about the costs. Our experienced advisors can assist you in evaluating your personal circumstances and requirements and finding a policy that suits your needs.

With a private optical extras cover, you can access a range of optical services and treatments in Australia without breaking the bank. Plus, extras cover can also help you access a range of other services, including hospital treatments, dental treatments, physiotherapy, remedial massage, chiropractic services, and more.

Get in touch with us today to discover how we can support your search for health cover that helps maintain your overall wellbeing!
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Fair Health Care Pty Ltd (ABN 86 622 966 303) is a subsdiary company of The ItsMy Group Pty Ltd (ABN 85 167 289 965), who are signatories to the Private Health Insurance Intermediaries Code of Conduct. All advice is provided within strict adherence to this code.

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