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Our sight is something we sometimes take for granted, as our eyes don’t need much maintenance early in our lives. But it’s important to care for our vision, and that means regular trips to the optometrist!

Taking out a health insurance policy means you can claim on things that make a big difference to your sight. If you want to get covered for optical, you’ll need to first consider the extent of coverage you need.

What can I get covered for?

  • General cover (e.g. checkups, glasses). General optical is typically covered by extras insurance, sometimes called ‘general treatment cover’.
  • Major coverage (e.g. cataract and eye lens procedures) is covered by hospital cover. Laser eye surgery is only partially covered by hospital policies – as it is not on the Medicare Benefits Schedule.1

One of the big benefits of getting covered for optometry is the subsidised (or free) glasses. But it doesn’t end there. You can also claim on contact lenses, prescription swimming goggles, and sunglasses – all through your cover.

There are some limitations, of course. For one, you can only claim a certain amount per year – usually locked at several hundred dollars. Additionally, you will only be able to pick up lenses/frames from certain stores.

Each year though, your annual limit resets and you can claim once more. 5 years of health cover could easily yield 4 or 5 pairs of glasses! If the practice has the HICAPS electronic claiming system, you may not need to pay anything on the day depending on the amount of optical extras cover you have.

Typical waiting periods

Your waiting periods for an extra policy may differ compared to someone who holds a policy with a different fund. This is because health funds set their own waiting periods for extra policies, while the periods for hospital treatment are mandated by the government.

The Private Health Insurance Ombudsman (PHIO) does outline some general waiting periods, to give you an idea how long you may need to wait. For optical, expect a six month wait before you can claim on glasses and lenses. Be aware you may sit longer waiting periods if you have a pre-existing condition.2

Sometimes, insurers will waive their waiting periods during a promotion. Take advantage of these if you’d like, but make sure you check the policy brochure so you understand the product you’ve signed up to.

Ready to take the next step? Try out our health insurance comparison service and compare some policies to see if you can find a product with great optical cover.


  1. http://www.privatehealth.gov.au/healthinsurance/howitworks/
  2. http://www.ombudsman.gov.au/__data/assets/pdf_file/0017/35612/09115-CO_Waiting-periods-04.pdf

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