What is Extras cover and how does it work?
Extras cover is a type of health insurance that helps pay for medical expenses not related to hospital care. This typically includes services like dental check-ups, eye exams and glasses, physiotherapy, chiropractic treatments, and other therapies that aren’t covered by Medicare. Having Extras cover can help you manage these out-of-pocket costs and access a wider range of healthcare services.
It usually involves choosing a policy that fits your healthcare needs and paying monthly premiums. Depending on your level of cover, you can claim a portion or even the full cost of treatment. You can often claim on your Extras cover there and then when you pay for the treatment.
One of the drawcards of taking out Extras cover is that you normally have at least three options based on the level of inclusions. This allows you to personalise your coverage to include services and treatments you will actually use, ensuring you get the most value from your policy.
Understanding Extras cover tiers
Most health insurance providers offer different levels of coverage and benefits to suit various needs and budgets. Here are the three main tiers of Extras cover:
1
Basic Extras cover
Generally provides a level of coverage for basic services such as general dental, optical, physiotherapy, chiro, and emergency ambulance services. You can usually claim a percentage (e.g. 60%) or all of your expenses, and there are often annual limits on claims. For instance, you might be able to claim up to $200 per year on general dental.
Choosing a basic level of cover might be a good option if you’re new to health insurance or expect to use only a handful of services. You can always start with basic coverage and upgrade later as your healthcare needs or family circumstances change. However, when upgrading to a higher level of cover, you may need to serve waiting periods to access the increased benefits.
2
Mid-level Extras cover
Offers a wider range of services and higher benefits than the basic tier. It typically covers a percentage of costs (e.g. 80%) or even the full amount for a broader array of services, including major dental work (think root canals and crowns), podiatry, exercise physiology, acupuncture, and remedial massage. While there are annual limits on claims, these are usually higher compared to basic coverage — often up to $750 for general dental.
This option might be ideal for singles or families who require regular care and want a good balance of affordability and coverage. With mid-level Extras cover, you can access essential treatments without facing overwhelming out-of-pocket expenses.
3
Top Extras cover
Provides the most comprehensive coverage with higher benefits across a broader range of services. It builds on mid-level cover and often includes antenatal and postnatal care for expectant and new mothers, some non-PBS pharmaceuticals (medications not covered by the Pharmaceutical Benefits Scheme), home nursing, speech therapy, and hearing aids.
While this level of cover offers greater peace of mind, it comes at a cost. Top Extras cover can be quite expensive, making it more suitable for high-income households or individuals who are willing to pay a premium for comprehensive coverage. This investment can provide you with reassurance knowing that you’re well-protected for a wide range of healthcare needs.
Extras cover products and tiers can vary a lot and often have different names, which can make comparing policies a bit tricky. For example, Bupa has 11 standalone Extras products listed on its website. That’s why it’s important to check the Product Disclosure Statement (PDS) for each policy. This will help you understand what’s included and ensure you don’t miss key details like waiting periods and exclusions.
Common services Extras cover generally includes
General dental
Includes common dental treatments like check-ups, scale and cleans, x-rays, fillings and extractions, such as wisdom teeth removal (excluding hospital charges). Waiting periods are typically two months. You can usually claim a portion of the expenses (e.g. 50-80%), or as a combined annual limit (i.e. $500) with other treatments and services.
Optical
Includes eye exams, optical services on prescription from an optometrist, including frames, prescription lenses, contact lenses and certain lens coatings. Waiting periods are typically two to six months, depending on the level of cover and insurer. You can normally claim a percentage of the expenses, or as a combined annual limit (i.e. $200) with other treatments and services.
Major dental
Includes services such as root canal, periodontics, crowns, dentures, bridges and veneers. Major dental coverage is typically available only with mid or top Extras cover, and waiting periods are usually 12 months.
Orthodontic
Includes treatment to change the position of teeth and jaws with devices like braces, retainers, and other corrective appliances. Coverage is often included in mid or top Extras plans, with waiting periods generally at least 12 months.
Physiotherapy
Includes treatments such as exercise programs and rehabilitation for injuries or movement disorders. This coverage is usually available under basic, mid and top policies, but the benefits to claim will vary. Waiting periods are commonly two to six months.
Chiropractic & osteopathy
Includes treatments like spinal adjustments, manipulation, and other hands-on therapies aimed at alleviating pain and improving mobility. These services are typically included in most Extras plans with benefits varying based on the level of cover (i.e. 50% or $600 annual limit per policy). Waiting periods are generally two months.
Non-PBS pharmaceuticals
Includes a range of prescription medications that are not listed on the Pharmaceutical Benefits Scheme (PBS), often encompassing specialty drugs and certain over-the-counter options. These medications are typically covered under some mid or top level Extras plans, with benefits varying based on the level of cover, such as a reimbursement rate of 50% or an annual limit of $400 per policy. Waiting periods often range from two to six months.
Podiatry
Includes diagnosing and managing conditions related to the feet, ankles, and lower limbs, including services such as foot assessments, orthotics, and therapeutic interventions. These services are typically covered under mid and top-level Extras plans, with benefits varying based on coverage level, such as a reimbursement rate of 70% or an annual limit of $500 per policy. Waiting periods usually range from two to six months.
Remedial massage
Includes treatments aimed at relieving muscle tension, improving circulation, and promoting overall well-being. This service is typically included in most Extras policies, but the benefits can vary, with reimbursement rates ranging from 50% to 100%. Most health insurers impose waiting periods of two to six months.
Exercise physiology
Includes treatments on the assessment and prescription of exercise programs tailored to improve physical health, manage chronic conditions, and enhance athletic performance. Typically included in mid and top levels of coverage with reimbursement rates often ranging from 50% to 100%. Waiting periods are generally two to six months.
Psychology
Includes services that focus on mental health support, including counselling and therapy for a range of issues such as anxiety, depression, and stress management. Available under most mid or top levels of Extras cover, with annual limits and reimbursement rates varying depending on the policy. Most insurers impose a two-month waiting period for psychology and mental health services.
Hearing aids
Includes hearing devices designed to assist individuals with hearing loss by amplifying sound. These services are typically covered under a top level of Extras cover with annual limits ranging from $800 to $1,200. Waiting periods generally range from 12 to 36 months.
Speech therapy
Includes diagnosing and treating communication disorders, including difficulties with speech, language, and swallowing. These services are typically included in many Extras plans, particularly at mid and top levels of coverage. Benefits can vary, with reimbursement rates generally ranging from 50% to 100%, and annual limits often set between $500 and $1,500 per policy. A common waiting period for speech therapy is two months.
Ambulance
Includes services that provide emergency medical transportation for individuals in need of urgent care. Ambulance coverage is generally included in most Extras cover policies; however, if you live in Queensland or Tasmania, these services are already provided by the state government. Typically, there are no annual limits or reimbursement percentages, and the standard waiting period is usually just one day.
Most health insurers have agreements with specific care providers, which means you may not receive the full benefits of your coverage if the medical practice or service you choose isn’t affiliated with your insurer. They typically have a network of healthcare providers, so it’s a good idea to check which insurers they partner with before scheduling an appointment. This way, you can ensure you’re getting the most out of your Extras cover.
How much does Extras cover cost?
The cost of Extras cover can vary widely depending on several factors, including the level of coverage, the insurer, and the specific services included in the policy. Generally, you can expect to pay anywhere from $20 to $280 per month for Extras cover in Australia.
Based on our analysis, basic Extras cover premiums typically range from $20 to $60 per month. Mid-level coverage usually costs between $60 and $150 per month, while top-level cover can range from $150 to $280 per month. When evaluating the cost, it’s crucial to weigh the pros and cons of private health insurance alongside each plan. This will help you determine which Extras cover offers the best value for your needs.
It’s important to remember that while lower-cost plans may be more affordable, they generally come with limited benefits or higher out-of-pocket expenses. Conversely, higher-cost plans typically provide more extensive coverage, but tend to be expensive.
We recently commissioned a survey that asked Australians why they don’t have private health insurance. Nearly four-fifths (79.8%) cited cost as the primary concern, while 15.9% expressed that they would never need it. Additionally, 10.6% felt they had enough savings to cover medical costs.
Our survey also found that health insurance premiums are Australians’ third most dreaded bills, only behind council rates and energy bills.
How to choose the best Extras health insurance
Choosing the best Extras health insurance involves assessing your specific circumstances, including your healthcare needs and budget. For singles, you might consider services that align with your lifestyle, such as dental and optical care. Those looking for couples health insurance, on the other hand, may want to explore plans that provide cost-effective options for covering both partners.
Families often have broader healthcare needs, so selecting a policy that covers a range of services could be most beneficial. In contrast, single-parent families may focus on policies that provide comprehensive coverage for children’s health needs while being relatively budget-friendly.
Budget is another significant factor. Assess how much you can comfortably afford to pay in premiums while also considering out-of-pocket expenses for services you’re likely to use. It’s worth comparing different policies and insurers by checking their benefits, limits, and waiting periods. Also, check if the services you require have reasonable reimbursement percentages and annual limits.
Our latest survey revealed that 13% of Australians have only Extras cover, while 68% have both Hospital and Extras cover.
Extras cover inclusions example
Here’s an example of what’s generally included with Extras cover health insurance based on basic, mid, and top levels of cover.
Service | General dental |
|---|---|
Basic cover | 50-60% reimbursement, $500 limit per year |
Mid cover | 70-80% reimbursement, $750 limit per year |
Top cover | 100% reimbursement, $1,200 limit per year |
Service | Optical |
Basic cover | 50-60% reimbursement, $150 limit per year |
Mid cover | 70-80% reimbursement, $250 limit per year |
Top cover | 100% reimbursement, $350 limit per year |
Service | Physiotherapy |
Basic cover | 50-60% reimbursement, $300 limit per year |
Mid cover | 70-80% reimbursement, $600 limit per year |
Top cover | 100% reimbursement, $1,000 limit per year |
Service | Chiropractic care |
Basic cover | 50-60% reimbursement, $300 limit per year |
Mid cover | 70-80% reimbursement, $500 limit per year |
Top cover | 100% reimbursement, $1,000 limit per year |
Service | Acupuncture |
Basic cover | Not covered |
Mid cover | 70-80% reimbursement, $400 limit per year |
Top cover | 100% reimbursement, $650 limit per year |
| Service | Basic cover | Mid cover | Top cover |
|---|---|---|---|
General dental | 50-60% reimbursement, $500 limit per year | 70-80% reimbursement, $750 limit per year | 100% reimbursement, $1,200 limit per year |
Optical | 50-60% reimbursement, $150 limit per year | 70-80% reimbursement, $250 limit per year | 100% reimbursement, $350 limit per year |
Physiotherapy | 50-60% reimbursement, $300 limit per year | 70-80% reimbursement, $600 limit per year | 100% reimbursement, $1,000 limit per year |
Chiropractic care | 50-60% reimbursement, $300 limit per year | 70-80% reimbursement, $500 limit per year | 100% reimbursement, $1,000 limit per year |
Acupuncture | Not covered | 70-80% reimbursement, $400 limit per year | 100% reimbursement, $650 limit per year |
Extras cover pros & cons
Pros
- Provides access to a range of routine healthcare services, like dental, optical, physiotherapy, and chiro.
- Can offset the costs of treatments that aren’t covered by Medicare, reducing out-of-pocket expenses.
- Encourages preventative care, such as regular dental check-ups and health screenings, which can help detect issues early and promote better long-term health.
Cons
- Adds to your overall health insurance costs, which may not be justifiable if you rarely use the services covered.
- Many policies impose waiting periods before you can access certain services, which can be inconvenient if you need immediate care.
- Often comes with limits on the amount you can claim for specific services, meaning you might still face out-of-pocket expenses.
What services do you actually need?
Extras health insurance offers a variety of services depending on the policy. Many people prioritise dental care, as regular check-ups and cleanings can help prevent more serious issues down the line. Optical services are also popular, particularly for those who wear glasses or contact lenses.
We recently commissioned a survey to understand why Australians choose their Extras cover. Here are the five main reasons:
- Dental check-ups and cleans
- Optical products like glasses and contact lenses
- Physiotherapy, chiropractic, occupational therapy, podiatry
- Health aids and appliances like asthma pumps/nebulisers, blood glucose monitors and hearing aids
- Massage and natural therapies
Extras cover terms and conditions to look out for
Benefit percentages
What is the percentage of the treatment cost that the policy will cover? It typically ranges from 50% to 100%. Some services may have different reimbursement rates, so it’s worth checking to see how much you’ll be getting back for each type of treatment.
Annual limits
Check for annual limits per person or per policy on how much you can claim for specific services. For example, general dental might have a limit of $500 per year, while optical services could have a lower cap.
Waiting periods
Be mindful of waiting periods for various services, which can range from two months to one year. This means you generally won’t be able to claim for those services until the waiting period is over.
Exclusions
Review the list of excluded services or treatments that are not covered under the policy. This can include certain cosmetic procedures or specific types of therapy.
Co-payments and gaps
Understand if there are any co-payments required for certain services and how gaps between the total cost and the reimbursement amount may affect your out-of-pocket expenses.
Provider networks
Some private health insurers may require you to use specific care providers to receive full benefits. Ensure you’re comfortable with the network of practitioners available to you.
Claims process
Familiarise yourself with the claims process, including how to submit claims, any documentation required, and how quickly you can expect reimbursement.
Policy changes
Check if there are any options to upgrade your policy or change coverage levels in the future, and understand any implications that may arise from such changes.
