Health Insurance with Physio Cover

Have ongoing pain? Recovering from an injury? Some health insurance extras policies offer physiotherapy cover, which you can learn more about here.

Health insurance policies with physiotherapy cover

The table below displays a snapshot of hospital and extras policies on Canstar’s database that include physiotherapy cover, sorted by Star Rating (highest to lowest), then provider name (alphabetically). Please note the results are based on a couple aged 36-59 in NSW.

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What is physiotherapy cover?

Physiotherapy is treatment that aims to help people move more freely and with less pain. Physiotherapy cover, therefore, is an extras inclusion that can provide benefits when you see a physiotherapist.

Taking out a reliable health insurance extras policy to cover your physio needs could be worth considering if you are prone to or likely to suffer from any of the following:

  • Movement disorders
  • Recovery following an accident or injury
  • Certain chronic illnesses
  • Neurological disorders
  • Back and neck pain
  • Sports injuries and more

What’s included under physio cover?

Typically when you take out an extras policy with a physiotherapy inclusion, you could be covered for benefits that pay towards some or all of the costs incurred by out-of-hospital physiotherapy treatment.

What and how much you’re covered for will depend on what level of cover you have. A basic policy may have very limited coverage available, while more expensive policies will typically have more extensive cover.

If you have a health insurance extras policy with physiotherapy cover you may be able to claim for some or all of the following services:

  • An initial consultation and health diagnosis
  • Follow up consultations
  • The development of treatment plans
  • Rehabilitation
  • Dry needling

Can I claim on physio cover?

Depending on the type of extras policy you have with a physiotherapy inclusion, you will typically be eligible for one of the following types of cover:

  • Percentage benefits: under this benefit structure your rebate will take the form of a percentage (ie 50%) of the fee you’re charged for eligible claims
  • Set benefits: this sees your rebates come in a fixed dollar amount, such as $45.

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How to claim

Claiming on your health insurance for physio visits should be a simple process. You can generally:

  1. Present your private health insurance card at the front desk prior to your session
  2. Receive your ‘item number’ after the session is completed
  3. Lodge your claim either through your provider’s app, their online claims service, via email, fax, mail or in person. You’ll usually need to quote both of the above items.

Annual limits usually apply to the amount you can claim on physiotherapy – the higher level of cover you have will generally come with a higher annual limit.

Is physiotherapy covered by Medicare?

In most cases, Medicare does not cover out-of-hospital physiotherapy. However, Medicare should cover public hospital admittance for patients who need in-house treatment or rehabilitation. You are also covered for five sessions related to chronic health conditions (such as arthritis) in a calendar year (valid at the time of writing).

Waiting periods for physio claims

Waiting periods – the amount of time you need to wait after taking out a policy before making a claim – are set by the insurers, not the government. Because of this, waiting periods will vary from insurer to insurer. According to the Private Health Insurance Ombudsman, the average waiting period for physiotherapy is about two months.

Once you sit out these waiting periods, you can start claiming on physiotherapy treatment with your health insurance provider. Sometimes, an insurer will waive the waiting periods for general treatments such as physio and general dental in special circumstances. You’ll have to read the PDS (Product Disclosure Statement) of your policy to find out what these are.

There are also special signup deals on offer by various providers that can remove waiting periods if you apply before a certain date. However, as always, we’d encourage you to weigh up the price and features of a particular policy before making a decision.

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