Sometimes our eyes need a little help. With optical health insurance, you can improve your vision, save money and even look great in designer glass.

Our sight is one of our most valuable senses, yet over half the Australian population require glasses or contact lenses to see clearly. And most people will need some form of vision correction aids at some point in their lives.

Taking care of your vision is important for the health of your eyes now and into the future, which means regular visits to the optometrist.

Depending on the level of cover you take out, you may pay next to nothing for a brand new pair of specs. You can even claim sunglasses on health insurance! That’s why optical is one of the most popular features of private health cover.

Now’s the ideal time to review your health insurance policy or consider taking out cover that includes optical. If you’re feeling overwhelmed at the prospect of sorting through various policies to find the right one, you needn’t worry.

Members Own team have put together the following guide to provide you with the simple facts to make an informed decision. We’ll cover all the information you need to find optical cover that suits your needs. But if you think you’ve got a pretty good handle on the basics, you can always skip ahead and get started with an online quote right now.

Jump on the Members Own website and in just a few minutes our comparison tool will provide you with a range of options from our 20 not-for-profit and mutual health funds.

Members Own Health funds exist to give their members more benefits and better coverage, while investing a higher percentage of your premiums to improve services and keep you happy. In fact, over one million Australians are already with one of our not-for-profit and mutual funds.

Why get optical health cover?

Most of us take our vision for granted, but at some point in our lives our vision is going to deteriorate. For some that’s earlier than others. Maintaining good eye health is just as important as looking after our teeth. Just like visiting the dentist, seeing the optometrist regularly will ensure your vision is looked after.

While Medicare covers the cost of eye tests with a qualified optometrist, if you need glasses or contact lenses this will be an out-of-pocket expense. And it can be an expensive one at that!

That’s where optical health cover comes in. It helps you pay for the things that are going to improve your sight over the long term. You just need to find the right level of coverage for your health care needs.

What’s covered by optical health insurance?

Take out private extras cover and you can get a range of benefits that can make a big difference to your vision. One of the reasons optical cover is so popular is that the benefits don’t just include prescription glasses and contact lenses. You can even claim some or all of the cost of prescription sunglasses and swimming googles!

There are two main forms of cover for you to consider:

  • 1. General optical cover

    General optical cover typically falls under extras health insurance. This includes items such as check-ups, contact lenses and glasses.

    Optical treatments are offered as part of an extras policy, so you’ll have the option to enjoy the benefits from a variety of health care services including dental, orthodontics, remedial massage and natural therapies like naturopathy.

  • 2. Major optical cover

    Major optical cover is typically covered by hospital cover. This will include cataract surgery and eye lens procedures. For those looking for laser eye surgery private health insurance, this will fall under major optical cover. However it’s only partially covered by the policy as it’s not on the Medicare Benefits Schedule.

    Optical health cover is a common feature of extras policies provided by Australian health funds. However, as with all policies it’s important to remember that the level of cover will vary between funds. It’s always best to read the fine print and find out what services and treatments are covered and the level of your benefits before proceeding.

Can I purchase glasses from anywhere and receive a refund?

Health funds will provide you benefits for prescription eyewear and contact lenses sold by most registered optical dispensers and retailers across Australia.

As more optical retailers are operating online, many health funds will provide you with a rebate when shopping online from a list of approved stores.

This will vary from fund to fund, so it’s best to compare the best health insurance for optical and check the approved eyewear providers both in stores and online.

Can I claim sunglasses on health insurance?

Generally, prescription sunglasses will be covered under your health insurance policy and you’ll receive full or partial rebate. Unfortunately, non-prescription sunnies aren’t covered by optical insurance.

Can I claim laser eye surgery on health insurance?

Laser eye surgery is a popular treatment for those wanting to wave goodbye to prescription glasses and contact lenses for good! However there are some things you need to be aware of if you’re thinking of claiming this procedure on your health cover.

  • This procedure is not covered by Medicare, unless it’s required to treat a medical issue or eye disease.
  • Many private health funds do not cover laser eye surgery under their extras policies. Some funds will offer a limited level of cover for this procedure under top hospital or comprehensive extras policies.
  • If your health fund does provide a benefit for this procedure, lifetime limits may apply.
  • If you’re able to claim on laser eye surgery with your fund, you’ll have to serve a waiting period which could be 1-2 years depending on your provider.

Is bulk billing for eye tests available?

Just like bulk billing at your GP, optometrists can accept the Medicare benefit as a full payment. This means you’re not going to be left out of pocket when you get your eyes tested.

If you’re under 65 years old, you’re eligible to have a bulk billing eye test once every three years. If you’re over 65, you’ll be able to receive an eye test every year.

How much can you claim back?

The amount you can claim back on your extras cover for optical services will depend on your policy and your health fund provider. The benefit amount is calculated by the insurer using one of two methods:

  • 1. Percentage Benefits

    As the name suggests, percentage benefits are calculated as a percentage. For example, you might receive 50% back from your optical treatment. So if your treatment is $80, you will get $40 back.

    The percentage benefit structure allows you to know what you’ll be reimbursed from your health fund regardless of the cost of the treatment.

    However, there is a downside to percentage benefits which is that it applies to all services under your policy. That means you’re unable to prioritise the services that are most important to you. If you’re able to, paying a higher premium may result in a higher percentage rebate.

  • 2. Set Benefits

    With a set benefit, your rebates will be in the form of a fixed dollar about for eligible services claimed. For example, you may receive $100 back from prescription glasses costing $150, leaving you to pay the remaining $50. The advantage of set benefits is that you can customise your cover to select a policy that offers higher benefits for services you prioritise.

    The downside of set benefits is that calculating your out-of-pocket expenses is more challenging. Unless you know how much your optical treatment or products will cost you, you won’t be able to work out how much you need to pay.

Do annual limits apply to optical cover?

As with all extras cover, there are some limitations and annual limits is one of them. This means you’re only able to claim a certain amount each calendar year.

The annual limit on optical will depend on your chosen health fund and the level of extras cover. Typically, a higher level of cover will give you higher annual limits.

Limits on your extras cover are generally broken down into two categories:

  • 1. Combined Limits

    If your extras policy specifies combined limits, this means several services fall under the one limit. Max out your limit on one of the treatments and you won’t have any benefits remaining for the other combined services.

  • 2. Sub-limits

    Extras cover with sub-limits means specific treatments under the one category will have individual benefits.

Other limits to consider

Extras cover can have other limits you should consider when comparing policies.

These include the following:

  • 1. Time limits

    If time limits are applied to your extras cover, you must lodge your claim within two years of the date you received treatment.

  • 2. Service limits

    There also may be a service limit applied to your extras cover. This means there will be a limit on the number of times you can claim for the same service. For example, there may be a limit on the number of times in a calendar year you can claim on an initial consultation with a physiotherapist.

  • 3. Benefit limits

    It’s common for health funds to apply a limit on the benefits you can claim per day. For example, if you receive a couple of services within the one optical consultation, you may only be able to claim on one service.

    The good thing to know, is that annual limits are reset every year. That means if you hold your health cover for 4 years, you could easily gain 3 or 4 pairs of new prescription glasses!

How long will I have to wait to claim?

The waiting periods for extras cover are set by each individual fund, not by the government. As a general rule of thumb, you can expect to wait for 6 months before you can claim on glasses and lenses.

Provided you maintain the same level of cover, once you’ve served the waiting period, you can switch policies without worry about having to re-serve the waiting period.

You may see some health funds run promotions that waiver their waiting periods to attract new members. It’s worth keeping your eye out for these offers so you can claim sooner rather than later on health services. But always look for any special conditions for extras like optical as there could be restrictions on which providers you can claim benefits with.

Other benefits you can enjoy with extras cover

While optical one of the more popular benefits Aussies enjoy, there are a range of services you can claim under extras cover. Depending on your fund and the level of cover, you may be able to enjoy the benefits of:

  • Dental treatment including dental check-ups, major dental and orthodontic treatment

  • Chiropractic treatment

  • Physiotherapy

  • Podiatry

  • Occupational and speech therapy

  • 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

Ready to take the next step with your eye health?

Even if you have 20-20 vision now, optical health insurance can come in very handy as our eyes do deteriorate with age. In the event you need prescriptive eye wear, you’ll be able to enjoy substantial savings to put towards the more important things like travel and dining out.

To get the most out of your optical health cover, it’s important you choose an extras policy that best meets your health needs while providing security and peace of mind for the years ahead.

With the Members Own comparison tool, all the hard work is done for you. Within just a few minutes you can compare a range of extras cover options that includes optical from our Australian not-for-profit funds. Finding the right private health insurance policy for your eye health couldn’t be any easier!

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If you have any questions or queries with your optical health insurance, we have friendly staff who are all health insurance experts. You can call one of our team on 13 10 66.

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