Written by Joshua Malin
Reviewed by Lana Hambilton
Last updated 04/09/2023
Extras cover in Australia is an important product to consider, so it’s essential to understand how this cover works, the included treatments, waiting periods and costs before deciding on a policy.
Extras cover is particularly useful if you use out-of-hospital medical services as it can be used to maintain your health and improve your quality of life. The benefits of an extras policy can include:
The right extras policy for you will depend on your budget and healthcare needs. However, there are a few things you might like to consider before you decide to take out a policy:
Our health insurance expert, Lana Hambilton, has put together some helpful tips on how to take advantage of extras health insurance.
Keep an eye out for the individual limits (the total amount you can claim) but also how much you can get back per visit. Take physiotherapy for example; people who regularly visit a physiotherapist may choose to have higher limits with lower returns, whilst others opt for a smaller limit with big returns as they might only visit now and then.
Some health funds have ‘preferred providers’ that they have agreements with for common extras services, such as dental and physiotherapy. These agreements usually provide members with more transparent pricing and reduced costs due to better negotiations. Just keep in mind that if you go to a provider outside of these agreements, you may have higher out-of-pocket costs.
The amount you can claim back on most extras resets annually, but it’s worth knowing that the definition of annual varies depending on the fund you’re with. The vast majority of funds refresh at the end of the calendar year, while others are based on the financial year or your membership year. Check your policy details for when your limits reset so you can get the most value out of your cover.
Extras cover is a type of health insurance that covers you for out-of-hospital medical care. Also called ancillary cover or general treatment, it covers a range of services that aren’t included under Medicare, like dental treatment, prescription glasses, physio, acupuncture and more. They’re typically treatments you may rely on regularly throughout the year and can attract ongoing costs each time you visit.
Depending on your level of extras cover, you can be covered for a range of services from accredited or recognised healthcare providers, including but not limited to:
Extras cover is typically available in three different levels. However, this can vary depending on your provider.
Top-level ancillary cover will typically include more extras services and have high payable benefit limits and annual limits. In comparison, lower-level policies (basic or medium extras) may limit you to a smaller range of services and pay a lower rebate or lower annual limit.
Lower-level basic extras policies may include (but aren’t limited to) cover for:
Basic policies may be subject to combined group limits and typically cover a lower percentage of service costs, which is why they generally cost less and have lower premiums than higher-level extras policies.
Medium-level extras policies usually provide good value for money. These policies will typically include (but aren’t limited to) cover for:
These policies will also typically include some of the following:
Medium-level policies typically have higher annual limits than basic policies, but aren’t as high as comprehensive policies.
Comprehensive extras are the most expensive out of the three levels, but will cover the widest range of healthcare services, have the highest limits and pay the highest percentage of service costs. Top-level comprehensive policies usually include (but aren’t limited to) cover for:
All extras policies have benefit limits on how much you can claim per year for each specific treatment.
The amount you’ll receive will depend on which service you’re claiming and the maximum limit your policy provides. Another factor is whether your health fund pays a certain percentage of the costs or up to a set dollar amount.
Some health funds and their policies cover a percentage of the costs associated with your treatment. For example, your policy may cover up to 60% of your dental costs, and you’ll have to pay the other 40% as an out-of-pocket cost, known as the gap payment.
Alternatively, your policy may cover 100% of the costs of listed items (like glasses), although this will likely still be subject to an annual limit.
Some extras health insurance policies will have a dollar limit on how much you can claim per service, applied either annually per policy, up to the group limit and sub-limit or per visit or item.
| Type of extras limit | Example of extras limit |
| Annual limit | The annual limit is the maximum that each person on the policy can claim for a service each calendar, financial or membership year. An annual limit can also have a policy/family limit. |
| Policy/family limit | Your level of cover could have a yearly limit of $600 per policy to spend on major dental, which means you’ll have to pay for any major dental work that exceeds this limit out of your pocket. Keep in mind that if there are multiple people on one policy, the limit is based on the policy and not people. So, if two people on the one policy each require $600 worth of work, the policy would only cover the cost once. |
| Sub-limit | Say you have a sub-limit of $300 for crowns (out of the $600 major dental limit); if you need to spend more than that on crowns, you’ll have to pay for the additional expenses yourself – you won’t receive the full $600 major dental limit for crowns alone. |
| Combined group limit | Extras cover may group services (e.g. major dental, general dental, endodontic) and have a total limit for all those included services. So, if you have a total limit of $1,000 and spend $800 on dental, you’ll only have $200 left to spend on the other services. |
| Per visit/item limit | Your policy could have a limit of $150 per pair of glasses or a maximum of $99 on surgical tooth extraction. Or, if you’re receiving physiotherapy, your policy may only cover $34 for your initial visit and $26 for subsequent visits. |
| Per person | If you have a couples or family extras health insurance policy, you may have additional coverage and higher limits. However, your policy may limit what each person can claim individually. |
| Service limit | The level of cover you choose may limit how many times you can access certain services. For example, it may have a service limit for dentures (e.g. a full denture replacement is limited to once every three years). |
| Lifetime limit | Your policy may have a dollar-value limit for certain services which doesn’t restart each year (e.g. you may have $3,000 to spend on orthodontics/braces over the lifetime of your policy). Any previously claimed services that have a lifetime limit will carry across with you even if you switch health funds. This means you cannot re-set your lifetime limit by switching health funds. |
| Read your policy brochure to find out what your specific limits are, and make sure you claim as much as you can throughout the year to get the most value from your policy. | |
Most limits on your extras policy will renew every year. This will either be on a membership, financial or calendar year, depending on the fund you’re with. Read your policy documents or contact your insurer for this information, as it can vary between services, policies and providers.
In terms of your health insurance extras benefits, you can either:
Extras could be worth it if you regularly visit non-Medicare services (like your dentist or chiro) or if you want to reduce surprise expenses. Based on the number of claims you make on your policy each year, an extras policy can be good value for money. Most people can find at least one feature in an extras policy they would benefit from year-round.
For example, if you don’t want to pay the full cost of dental check-ups yourself or you play sports and need regular physiotherapy appointments, you could benefit from an extras policy. Or if you have children who may require braces or glasses, having extras health insurance could help pay for these expensive products and services.
Extras-only health insurance generally costs less than a hospital insurance policy. However, your extras cover premiums do depend on which level of extras you get and who it covers. For example, extras policies that cover a variety of services with high limits will command a higher premium, while lower-level policies may cost less. If eligible, you may also be able to lower your costs by applying the Australian Government Rebate to your premiums.
Also, family extras cover will naturally cost more than single policies, as it will cover more people.
We’ve compiled some example prices below to give you an idea of how much extras cover may cost. Remember, your actual costs will vary depending on your circumstances and needs.
| Cost range per month | Cost range per year | |
| Extras policy for a single person* | $13.95 to $117.15 | $167.35 to $1,405.80 |
| Extras policy for a family^ | $29.21 to $289.35 | $350.16 to $3472.40 |
* Based on quotes for a single, 30-year-old Queensland male who is eligible for the full government rebate. Compared through our health insurance comparison service in February 2023. Age-based discount and lifetime health cover loading do not apply. ^ Based on quotes for a family in Queensland (including two partners aged 30 years old and three dependent children) who are eligible for the full Australian Government rebate. Compared through our health insurance comparison service in February 2023. Age-based discount and lifetime health cover loading do not apply. | ||
Everyone’s needs and budgets are different, which means it’s hard to say which type of policy you should get, whether it’s a hospital, extras or a combined policy. A combined policy joins the two types of insurance – hospital and extras – under one policy, so you can be treated both in and out of hospital by a range of healthcare providers.
If you want to keep on top of your health, extras can provide benefits for preventative and ongoing treatment. However, you may be more concerned about the cost of in-hospital surgeries (like knee replacements), in which case hospital insurance might be your preference.
However, you don’t necessarily have to choose one or the other. If a combined hospital and extras policy is within your budget, it can give you the benefits of both types of health insurance. A combined policy can also give you the peace of mind that you won’t have to pay for all of your healthcare when the time comes.
A standalone extras policy won’t exempt you from the Medicare Levy Surcharge (MLS). The MLS is a surcharge to high-income earners who don’t hold an eligible hospital insurance policy, designed to encourage them to use the private health system.
If you want to avoid the MLS, you’ll need to take out eligible hospital cover. However, if you still want the benefits of extras cover, you can take out a combined hospital and extras policy.
Extras health insurance policies will typically have waiting periods, varying from two months to three years or more depending on the service and the health fund.
The Commonwealth Ombudsman outlines examples of typical waiting periods for some services in the table below.1
| Extras service | Example of waiting period |
| General dental | 2 months |
| Optical (e.g. glasses or contact lenses) | 6 months |
| Major dental (e.g. crowns, bridges) | 12 months |
| Orthodontics | 1-3 years |
| Source: Commonwealth Ombudsman (Private Health Insurance Ombudsman) – Waiting periods for private health insurance. Accessed May 2023. | |
Unlike waiting periods for hospital benefits, which the government sets, health insurance providers set extras waiting periods themselves and can make waiting periods as long as they want (within reason).
However, you can potentially shorten your waiting period or get extras cover with no waiting period for particular services. Some health funds or policies allow you to start claiming on select extras services straight away with no waiting period, while some have promotions from time to time that waive some extras cover waiting periods to attract more members.
However, waivers usually only occur on certain policies or services (e.g. health funds may have promotions that waiver the two- or six-month waiting periods on included extras).
Some of the extras services that may waive waiting periods include:
That said, you’re unlikely to get waiting periods waived on more expensive services like major dental or orthodontics.
While you may have longer waiting periods on hospital cover with a pre-existing condition, this rule doesn’t apply to extras cover. This means that standard waiting periods will apply to your extras cover, even with a pre-existing condition.
In fact, there are extras health insurance policies for singles, couples, families and single parents. Health insurance for families will allow you to include your dependent children on your policy. Depending on your health fund and situation, they may be able to stay on your policy until they are 31.
As Head of Health, Life, and Income Protection Insurance at Compare the Market, Lana Hambilton is passionate about simplifying the comparison process and educating Australians about the value and benefits private health insurance can offer and the critical role it plays in our medical system. She firmly believes that health insurance provides choice in one of the most important aspects of life – our health – and has experienced countless cases over the years where peace of mind comes through the ability to choose when, where, and who will treat you.
Lana has 15 years’ experience in the health insurance and insurance comparison industries. She’s also a Board Member of the Private Health Insurance Intermediaries Association.
1 Commonwealth Ombudsman (Private Health Insurance Ombudsman) – Waiting periods for private health insurance. (accessed May 2023)
