Extras cover can be an important product to take out, but it’s essential to know about how this cover works, treatments that are included, waiting periods and costs before deciding on a policy. We answer these questions and more in this article.
Health insurance extras policies are so popular that 53.5% of Australia’s population had extras cover as of September 2019.1 That’s millions of Aussies covered by extras cover!
However, each extras policy will have different features and limits. So, here’s our guide on what extras cover is, how it works and how it can benefit you.
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 services Medicare doesn’t, like dental treatment, optometry, physiotherapy and more.
Health insurance extras cover helps pay for out of hospital health care services like trips to the dentist, visiting the physio, new glasses and remedial massage. If you purchase an extras policy, you’ll pay regular premiums to be covered for listed services in your policy. These services are typically subject to annual and lifetime limits.
Depending on your policy, extras insurance can provide cover for a range of different services from accredited or recognised service providers.
Here are the services your extras policy can potentially cover:
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. Also, top-level cover will usually have higher annual limits for your health insurance extras cover.
In comparison, lower-level policies (basic or medium extras) may limit you to just a few popular services and only pay a smaller percentage in rebates.
Lower-level basic extras policies may include 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.
Who may it suit?
Basic extras may be suitable for young Aussies who don’t have a history of complicated health issues, but like to go to optical or dental check-ups regularly, and would benefit from optical or dental extras cover.
Medium-level extras policies usually provide good value for money. These policies will typically include cover for:
These policies will also typically include five of the following:
Medium-level policies will typically have higher annual limits than basic policies, but not as high as comprehensive policies.
Who may it suit?
If you’re starting to get a bit older and you’re experiencing some health issues, or want to take care of your family’s health, a medium-level policy may provide adequate cover for common services at an affordable price.
Comprehensive extras are the most expensive out of the three levels, but it will cover the widest range of healthcare services, have the highest limits and will pay the highest percentage on service costs. Top-level comprehensive policies usually include cover for:
Who may it suit?
If you or your family have health issues and you require costly services or products like braces or glasses, or just want peace of mind with higher limits and broader coverage, you may benefit from a comprehensive extras policy.
The amount you’ll be able to claim will depend on the service you’re claiming and whether your health fund covers (a) a certain percentage of the costs or (b) benefits up to a set dollar amount.
All extras have a limit on how much you can claim per year (i.e. a certain percentage or dollar amount) for specific treatments.
Some policies or health funds may only cover a percentage of the costs. For example, your policy may only cover up to 60% of your dental costs, and you’ll have to pay the other 40% as a gap payment out of your pocket.
Alternatively, your policy may cover 100% of the costs of listed items (like glasses, for example) – although this may still be subject to a dollar limit per policy.
Some extras health insurance policies will have a dollar limit on how much you can claim per service, either (a) annually per policy, (b) up to the group limit or sub-limit or (c) per visit or item.
| Type of extras limit | Example of extras limit | |||
| Annual 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. Let’s say you’ve got a $500 cover limit on general dental and get a routine clean, you’ll have less to spend on other general dental 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 cover 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). Your lifetime limit will stay the same even if you switch health funds or increase your level of extras, which means once you hit it, that’s it. | |||
| 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. | ||||
Yes, extras health insurance policies will typically have waiting periods, which can vary anywhere from two months to three years, depending on the service and the health fund.
The Commonwealth Ombudsman outlines examples of typical waiting periods for some services in the table below.2
| Extras service | Example of waiting period |
| General dental, physiotherapy and chiropractic | 2 months |
| Optical (e.g. glasses or contact lenses) | 6 months |
| Major dental (e.g. crowns, bridges), orthotics and psychology | 12 months |
| Orthodontics and hearing aids (i.e. high-cost items/procedures) | 1 – 3 years |
Unlike hospital benefits, which are set by the government, health insurance providers set extras waiting periods themselves and can make waiting periods as long as they want (within reason).
However, this could work in your favour, as you may be able to find a health insurance provider that offers a shorter waiting period than the typical period.
You’ll be able to find your waiting periods on your policy brochure. Make sure you’re aware of your waiting periods before you receive treatment and try to claim on services.
You can potentially shorten your waiting period or get extras cover with no waiting period for particular services. Some health funds allow you to start claiming on higher-level extras cover straight away with no waiting period, while some have promotions from time to time that waive 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 state no two or six month waiting periods on included extras).
Some of the extras services you may waive waiting periods include:
That said, you’re unlikely to get waiting periods waived on more expensive services like major dental or orthodontics.
Extras cover can be worth it if you regularly access ancillary services or want to manage significant surprise expenses. Based on the number of claims you make on your policy every year; an extras policy can be good value for money. Most Aussies 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 for 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.
So, if you find a policy that’s within your budget and covers the services that are important to you, it can help manage your out of pocket expenses.
Extras cover costs less than hospital insurance. However, the cost of your extras cover depends on which level of extras you get and who it covers. Extras policies that cover a variety of services with high limits will command a higher premium, while lower-level policies will cost less.
Also, family extras cover could cost a little bit more than single policies, as it will have higher limits and cover more people.
| Cost range per month | Cost range per year | |
| Extras policy for a single person* | $13.45 to $44.00 | $161.85 to $528 |
| Extras policy for a family^ | $33.80 to $92.70 | $405.55 to $1112.90 |
*Based on extras cover 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 December 2019.
^Based on extras cover quotes for a family in NSW (including two partners 30 years old and 33 years old and three dependent children) who is eligible for the full government rebate. Compared through our health insurance comparison service in August 2020.
Limits on your extras policy will renew either on a financial year or a calendar year – depending on the fund you’re with. Read the PDS or contact your insurer for this information, as it can vary between policies and providers.
While extras cover won’t exempt you from the Medicare Levy Surcharge, you may be eligible for health insurance rebate, which can be claimed through your tax return or as a reduced premium. However, the actual rebate amount will depend on your age, income and whether you’re claiming for yourself or a couple or family.
No, the private health insurance reforms don’t affect extra policies – the reforms only affect hospital policies. There are no mandated tiers or inclusions for extras policies and the service covered by extras policies will vary between providers. We outline these changes in our private health insurance tiers guide.
Yes, you can get hospital and extras cover with a pre-existing condition. 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 typical waiting periods will apply to your extras cover, even with a pre-existing condition.
In terms of your health insurance extras benefits, you can either:
Yes, you can typically get extras health insurance for singles, couples, families and single parents. Health insurance for couples, families and single parents will usually have higher limits and may even have further benefits (e.g. gap free cover for kids).
However, while you may have higher limits, it doesn’t mean benefits are interchangeable. Even on family, couples or single parent policies, you’ll typically have a claim limit to use per person.
Everyone’s needs and budgets are different, which means we can’t tell you whether you should get hospital, extras or a combined policy. Hospital cover is completely different to extras, and each product has its benefits.
If you want to keep on top of your health, extras can provide benefits for preventative treatment. However, you may be more concerned about needing in-hospital surgery for a knee replacement, in which case you’d get hospital insurance.
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 will also give you the peace of mind that you won’t have to pay for all of your healthcare when the time comes.
Here are our top tips for selecting a health insurance policy.
Extras cover comparison is one of the most powerful ways to make sure you find a suitable extras cover for you.
Our private health insurance comparison tool allows you to compare extras cover from some of Australia’s largest health insurers in minutes, all in one place.
You’ll be able to see different policies side-by-side and compare which policies have higher limits and better coverage for the ancillary services you’ll actually use.
If you’re ready to purchase extras cover, compare your options today.
1. APRA – Statistics: Quarterly Private Health Insurance Statistics, September 2019. (released 19 November 2019)
2. Commonwealth Ombudsman (Private Health Insurance Ombudsman) – Waiting periods for private health insurance. (accessed December 2019)
