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 so 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 typically have higher annual limits than basic policies but aren’t as high as comprehensive policies.
Who may it suit?
If you’re starting to get a bit older and 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 will cover the widest range of healthcare services, have the highest limits and 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, require costly services (like braces or glasses) and want the peace of mind of higher limits and broader coverage, you may benefit from a comprehensive extras policy.
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 a gap payment out of your pocket.
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, 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.|
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 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 the Australian Government 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.
Yes, you can get hospital and extras cover with a pre-existing condition. While you may have longer waiting periods on hospital cover with such a 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. You’ll also typically have a claim limit to use per person, even on family, couples or single parent policies.
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 needing in-hospital surgery (like for a knee replacement), 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 will also give you the peace of mind that you won’t have to pay for all of your healthcare when the time comes.
1. APRA – Statistics: Quarterly Private Health Insurance Statistics, September 2021. (Accessed January 2022)
2. Commonwealth Ombudsman (Private Health Insurance Ombudsman) – Waiting periods for private health insurance. (accessed January 2022)