Want to get more out of your health insurance? Extras cover may be a great way for you to claim back your healthcare costs.

For many Australians, it’s very important to take care of our mind and body so we can keep doing the things we love doing. However, along the way we often need a little bit of fine-tuning from a healthcare professional.

Extras health cover can be great way of ensuring you’re taking care of your mind and body plus saving money on what’s important for your lifestyle. But how does it actually work and will it help you?

Extras cover, also referred to as general treatment or ancillary cover, is a great way to claim health care expenses that Medicare doesn’t cover. If you’re unsure of the policy types and how you can benefit from extras, reading this guide will be very helpful.

You can save on medical expenses

Health insurance extras only policies are designed to help take care of the costs of health services delivered outside of a hospital and those that aren’t covered by Medicare. This includes dental treatment, physiotherapy, optical and alternative or natural therapies such as naturopathy and remedial massage.

Taking out an extras policy is a great way to help you maintain a healthy lifestyle without the exorbitant costs. A bit like travel insurance or ambulance cover, it also provides peace of mind if anything should happen.

For many people, extras cover allows them to take control of their health and actively work to prevent illness occurring. Think about it - you’re more likely to visit the dentist for regular dental check-ups to help prevent decay and more costly conditions from developing when you know you’re covered.

Or you may have a pre-existing condition so regular chiro or massage treatments could help get rid of persistent knots and aches. Or perhaps enjoy savings on your glasses or medication that isn’t covered by the Pharmaceuticals Benefits Scheme (PBS)

Services of extras only health insurance you can benefit from

Depending on the policy type, extras offers a variety of services to choose from. You’re almost guaranteed to find at least one feature of an extras policy that you can take advantage of.

Some of the most popular services for those with extras cover benefit from are:

  • Dental treatment including dental check-ups
  • Major dental and orthodontic treatment (with typical 12 month waiting period)
  • Chiropractic treatment
  • Physiotherapy
  • Podiatry
  • Occupational and speech therapy
  • Optical including eye check-ups, glasses and contact lenses
  • Medical aids such as glucose monitor and hearing aids
  • Prosthesis
  • Pharmaceuticals not covered by the PBS
  • Psychology
  • Alternative and natural therapies such as acupuncture, naturopathy and remedial massage

What are the types of extras cover?

As with any health insurance, your cover is divided into 3 levels which will dictate the cost of your policy and what services are claimable.

There are three main levels of extras cover:

  • 1. Basic extras

    Basic cover pays benefits for a limited number of essential medical services such as general dental and physio. The benefits payable for these ancillary services are also much lower than those offered under a higher level of cover. An advantage of basic extras is that the premiums are low, making it one of the more affordable health insurance options. A disadvantage of basic extras is that many policies combine their benefit limits. This means you may use up your annual limits quickly in just a few visits to your chosen health care providers.

  • 2. Medium extras

    Medium cover pays benefits to a broad range of services, providing a good balance between affordability and level of cover. A medium extras policy must provide coverage for general and major dental, endodontics and any five of these services: optical, orthodontics, non-PBS medication, physio, chiro, podiatry, psychology and hearing aids. The premiums are reasonable and they offer greater annual limits than a basic extras policy.

  • 3. Comprehensive extras

    If you’re looking for the top extras policy, comprehensive extras is the highest level of cover you can take out. It covers the most extensive range of medical treatments and returns the highest benefits when you claim. It’s also the most expensive option but you’re also paying for more peace-of-mind should you ever need any extras services.

Have you figured out which extras cover will suit you? The next step is to compare extras cover to ensure you’re getting the right policy for your needs. You can jump onto our comparison tool and in a few short steps see what type of extras cover will suit your health needs.

For example, if dental cover is important to you, you’ll want to find best cover for dental treatment rather than paying for services you won’t intend on using like medical aids or ambulance cover.

The Members Own online comparison tool is one of the quickest and easiest ways to find the right cover for you. You’ll also be happy to hear, our not-for-profit or mutual funds offer more benefits and better coverage to its members. It’s no wonder over one million Aussies are with a Members Own health fund.

Whether you’re in Victoria, NSW, Queensland, WA, South Australia or Tasmania, we can find the perfect cover options for you.

Which level of extras cover is right for you?

Finding out which level of cover which is right for you will depend on your health care needs and budget. After all, you don’t want to take out comprehensive insurance only to realise paying the premiums is a stretch and you’re not utilising all the benefits.

Typically, basic extras is ideal for young and healthy individuals that don’t have a complicated health history. These people use their cover to pay for dental treatments and the odd physiotherapy session.

Growing families or those singles and couples entering their middle age with average health care needs may benefit more from medium extras cover. It’s more affordable than comprehensive and can help cover the costs of your children’s dental treatments. Or you may use the benefits of optical and physio to combat the signs of ageing.

Comprehensive extras insurance is ideal for those who want to pay for a greater level of security. Families with children who have a family history of poor dental or eye health may benefit from this higher level of coverage. Comprehensive extras will help cover the costs of braces and crowns or prescription glasses and contact lenses.

Comprehensive extras could also be a wise investment to singles or couples who regularly utilise a range of out-of-hospital health care services and therapies. With some policies, you can even benefit from discounted gym memberships which will help you remain fit and healthy. It may be the very thing you need to get you off the couch and into the gym!

Extras cover policy costs versus benefits claimed

Weighing up the costs of getting extras insurance versus paying for health services up front? When you’re considering taking out an extras policy, it’s good to compare the costs of the annual premiums with the health care costs you currently incur.

The important thing to remember is that most people are encouraged to utilise health care more frequently when it’s covered by their insurance. That’s because preventive measures like general dental cleaning will help reduce your risk of needing more expensive dental treatments later. Let’s face it, going to the dentist for a clean is a whole lot more pleasant than enduring the discomfort of a filling, or worse still, a root canal!

You’ll also feel more inclined to visits health care services you’ve been putting off due to the cost, like podiatry or physio. You’re more likely to get that back issue treated by a physiotherapist if you know you’re going to be reimbursed for the majority of the bill.

If you’re using more ancillary health services than you were without extras, you’re more likely to be ahead in both costs and health benefits.

Compare health insurance now and get a quote


Who needs cover?

Hospital cover versus extras, what’s the difference?

Hospital insurance will help pay for the treatment you receive in a hospital due to an illness or injury. Extras cover, on the other hand, will help fund the cost of ancillary services that aren’t covered by Medicare like dental, physio and optical.

For some people, hospital cover will be more important to them than extras. Elderly people or those who are beginning to develop chronic health complaints may find hospital cover is a higher priority.

A young, healthy individual may benefit more from a basic hospital cover and a medium extras policy to help them maintain their lifestyle and good health. However, avoiding Lifetime Health Cover Loading before you turn 31 one main reason why people take out hospital cover.

Remember, you may not have to choose one over the other. Hospital and extras cover can easily be combined under the one policy or taken out as individual cover depending on your personal situation. It’s important to remember, if you do take out extras only insurance and don’t have hospital cover you won’t be exempt from the Australian Government’s Medicare Levy Surcharge or Lifetime Health Cover Loading.

One of the main advantages of combining your hospital and extras policy with the one fund is convenience. You’ll only have one premium to pay and one fund to contact when you need assistance. On top of that, you may be able to take advantage of the Australian Government rebate on private health insurance.

This is where Members Own comparison tool comes in handy. You can compare taking out extras as an individual policy, or compare the benefits of combining your cover with the one fund.

How your extras claims are paid with private health insurance

There are two methods health funds use to cover the costs of extra services which both come with advantages and disadvantages.

  • 1. Percentage Benefits

    Percentage benefits calculates the benefits as a percentage. For example, you might receive 100% back from general dental care or 70% back from your physio treatment. So if a single physio session is charged at $100 you will get back $70 of the total cost.

    The advantage of percentage benefits is that you’ll know what percentage you’ll be reimbursed regardless of the bill from the health care service.

    A downside of this method is that you’re unable to prioritise particular services as the percentage benefit is applied to all services under your policy. However, you may be able to agree on a higher premium in exchange for a higher percentage rebate.

  • 2. Set Benefits

    Set benefits offer a fixed annual amount to each service utilised. For example, you may get $300 back for physio and $500 for general dental every year. Unlike percentage benefits, calculating your out-of-pocket expenses is more difficult, unless you know how much your dentist or physio charges for your treatment.

    However, set benefits do come with the advantage of being able to customise your cover by selecting a policy that offers higher benefits for the services you use the most. Some health funds may even increase the benefits annually in return for your loyalty.

How extras cover benefit limits work

Health insurance funds set limits on the amount you can claim for specific treatments each calendar year. This will depend on your level of cover and the individual fund.

Typically, limits are broken down into the following categories:

  • Combined Limits

    Combined limits means several services are under one limit. For example, an extras policy with an overall physical therapy scheme may incorporate physio, chiro and remedial massage under the one benefit. In this case, once you’ve maxed out the limit of physio, you won’t be provided any additional benefits for chiro and remedial massage.

  • Sub-limits

    An extras policy with sub-limits means specific treatments under the one scheme will have individual benefit limitations. For example, a cover with an overall major dental benefit may have a limit of $600 for crowns and $400 for dentures.

  • Lifetime Limits

    Lifetime limits are not very common and typically only apply to orthodontic treatments. An extras policy with lifetime limits means that your limit isn't renewed annually. The lifetime limit will remain even if you increase your level of extras cover or switch to a new health fund.

Reading the fine print about waiting periods

Depending on your fund, you may need to serve a waiting period before you can take advantage of your extras benefits. At Members Own, we know just how important it is to read the fine print when comparing policies. The last thing you want is to take out an extras policy only to find out you have to wait an extended period before you can lodge a claim.

Here are some general waiting periods to keep in mind:

  • 2 months – most extras services including general dental, physiotherapy and chiropractic treatment.
  • 6 months – optical services including glasses and contact lenses.
  • 12 months – major dental, orthotic appliances and psychology consultations.
  • 12-36 months – orthodontics, assisted reproductive medications and hearing aids.

Hospital cover also has waiting periods, however, the waiting periods are regulated. With extras, individual funds are free to set their own waiting periods. That’s why comparing policies and reading the fine print is important. It’s also worth looking out for insurance ‘extras no waiting period’ promotions. These promotions see the waiting periods waived to attract new members to the fund.

Compare & Join

Ready to take control of your health and enjoy the many benefits of extras? With Members Own you can quickly and easily compare policies and find the right cover that suits your budget and health needs. It’s perfect for everyone: singles, couples, families, single parents and seniors.

Have more questions before you take out a policy? Our experienced Members Own team is waiting on the line to help make the process of finding the right health insurance less complicated. Give them a call today on 13 10 66.

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