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Use it or lose it – make the most of your extras insurance

Now's the time to get those new specs, a dental check-up or massage to ensure you're getting value for your cover.

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Last updated: 29 November 2021
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Need to know

  • Extras cover is an optional addition to hospital cover. It pays benefits for things such as glasses and dental, chiropractic, physiotherapy and mental health services
  • Your extras benefits will probably reset on 1 January, which means you have a limited time to get your money's worth before the end of the year
  • The average extras cover for a single person costs about $810 a year (without the health insurance rebate). But there's a wide range of cover and premiums, so it pays to shop around

Extended periods spent in lockdown this year mean you may not have been able to attend as many physiotherapy, chiropractic or dental appointments – and therefore haven't made the most use of your extras insurance. 

The average extras cover for a single person costs about $810 a year (without the health insurance rebate). And if you have extras health insurance, there may be only a few weeks left to use your benefits before you lose them.

Most health insurance funds reset their extras benefits on 1 January, so anything you haven't used before then will be lost. That's a lot of money you could have potentially wasted.

What does extras cover pay for?

Extras cover pays benefits for health costs including spectacles and contact lenses, dental check-ups, a set of braces or dentures, physiotherapy, podiatry, chiropractic, massage and counselling. It even helps with the cost of non-PBS medication and medical devices such as hearing aids or blood-glucose monitors.

Usually you get a set benefit per visit or service, capped at a yearly maximum benefit per type of service. 

Most funds reset extras benefits on 1 January

The annual maximum limit resets each year – and for most funds this happens on 1 January. Some funds reset at the end of the financial year, and a few on the date you joined. 

Only very few funds – such as Police Health and Emergency Services Health – let you claim unused benefits for some services during the next year.

If you have health insurance with one of the funds below, your extras benefits will reset on 1 January. This means that if you haven't claimed up to the limits you're entitled to, the opportunity will be gone. That could add up to hundreds of dollars in wasted premiums.

Is extras cover worth it?

It depends. Extras cover can be worth it, but only if it pays out more than the premiums that are coming out of your pocket – and if you actually use enough of the services to make it worthwhile. If you're not using your extras, it may be worth considering if you really need this cover.

If you're not using your extras, it may be worth considering if you really need this cover

Many people don't realise that extras are an optional addition to their standard hospital cover. You could even opt to shop around and buy your extras from a different provider from your standard hospital cover if you can find a better deal. 

If you do have extras, it's important to understand what you can claim for (and what the yearly limits for each service are) so you can assess if you'll really use it and whether it offers value for money.

How much could you be missing out on?

The average extras cover for a single person costs about $810 per year (without the health insurance rebate). But there is a wide range of covers and premiums, so it pays to compare health insurance from various providers to find the best one for you.

Remember, you've already paid for your extras cover, so if you don't use it, it's money that's going to waste. Here are some typical annual limits for various services, showing how much you can claim in a year.

What you may get back per service

How much you get back for each treatment depends on your policy, but here are some median figures:

  • General dental: $34 examination
  • Optical: $200 for single-vision spectacles
  • Physiotherapy: $42
  • Chiropractic: $40
  • Massage: $33.

Note: These are the median benefits per person (single policy in Victoria, November 2021) for the first service in a year – usually the benefits are smaller for subsequent services. Only policies with cash benefits for services were used for this calculation. A number of policies pay a percentage of your cost, usually between 50% and 100%.

Time to start a long-term treatment plan?

If it would help you to receive longer term treatment for something, and you have extras cover you haven't used, now could be a good time to start.

For example, if you've put off going to the physiotherapist to get treatment for back pain, you could start now and continue in the new year with your renewed cover, and have a longer period of uninterrupted treatment that you can claim on.

Important: Extras health insurance usually pays only a portion of your costs, so we're not recommending you go out and get treatment for things you don't need, because it will still cost you. 

How to get expensive glasses, free

Normally, you'll get about $250 a year for prescription glasses or contact lenses, with benefit limits usually ranging from $100 up to $600 on some premium policies. 

Often, that fully covers the cost of single-vision specs. But if you need multifocals (which correct both near and far vision), you can be out of pocket by hundreds of dollars.

To double your benefit and reduce your out-of-pocket costs, check whether your health fund will let you claim lenses in the current year and frames in the new year.

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