What Is Extras Cover?

3 March 2017
What extras are included in Extras Cover? Do you need extras cover?

If you want to be treated as a private patient in a public hospital or be treated in a private hospital, you need Hospital Cover. But what if you just want to visit the dentist for your yearly check-up and cleaning? Or you suspect your child may need glasses to see the blackboard at school? Or you’ve put your back out and need to visit the chiropractor?

All of these medical services happen outside of a hospital, and they can be expensive in Australia, depending on what you need. That’s where Extras Cover health insurance comes in handy.

What is Extras Cover?

Extras cover is a type of health insurance policy that provides a benefit towards the cost of general treatment outside of a hospital, including medical services and some non-medical or allied health services. Depending on the level of cover you choose, a typical Extras Cover policy may include a benefit for dental, optical, physiotherapy, and/or chiropractic care.

Extras Cover is different to Hospital Cover, which covers the cost of treatment in a hospital. Find out more about the different types of health insurance and what they cover here.


What extras are included in an Extras Cover policy?

The extra treatments and medical services that are covered by an Extras Cover policy vary widely from policy to policy and from insurer to insurer.

What extras are included in an Extras Cover policy?

We’ve summarised what the different types of medical services and benefits usually mean in the table below. Not all policies cover all benefits. Read the product disclosure statement (PDS) for a policy to find out what cover that particular policy includes.

Dental Check what type of dental is covered:

  • General Dental – 6-monthly check-up and cleaning, fillings, X-rays, mouthguards, wisdom teeth removal, teeth removal
  • Major Dental – crowns and bridges, root canal treatment, dentures and implants, periodontal treatment of gum disease, complex oral surgery
  • Orthodontics – braces, retainers
Optical Usually covers:

  • Glasses frames and prescription lenses
  • Lens coatings – UV coating, scratch resistant coating, anti-glare coating
  • Contact lenses
Chiropractic Manipulation and realignment of bones, especially around the spine
Physiotherapy Physical rehabilitation for people with chronic conditions, injuries, or physical disabilities
Osteopathy Manipulation of bones and muscles through massage and stretching exercises
Antenatal and Postnatal Sessions with a registered midwife:

  •  Antenatal – pre-natal check-up sessions and pre-natal classes
  •  Postnatal – sessions after birth, usually regarding breastfeeding or feeding difficulties
Natural Therapies (a.k.a. Alternative Therapies / Alternative Medicine) Benefit may include:

  • Acupuncture
  • Exercise physiology
  • Naturopathy
  • Homeopathy
  •  Remedial massage, reflexology, Shiatsu massage
  •  Chinese herbalism
Healthy Living / Well-Being Usually only applies to patients referred by their GP as part of a health management program, weight management program, or chronic disease management program. Benefit options may include:

  • Exercise classes at the gym
  • Personal trainer sessions
  • Yoga
  • Pilates
  • Exercise physiology
  • Dietary advice
  • Swimming programs for children
  • Online health management program
  • Discounted gym membership, entry to fitness competitions or fun runs, fitness equipment, activewear, healthy food, and vitamin supplements

Read this article for more information.

Pharmacy Medicines Covers prescription only medicines prescribed by a GP, where the drug is TGA approved but is not listed on the PBS
Dietary Advice from a recognised dietitian (a health specialist in diet, weight management, and digestion disorders)
Psychology Counselling from a registered psychologist in one-on-one sessions, group sessions, couple’s counselling, or family counselling
Podiatry Benefit towards cost of seeing a registered psychologist in one-on-one sessions, group sessions, couple’s counselling, or family counselling
Speech Therapy Assessment and treatment of a communication disability regarding speech, hearing, using and understanding language, or reading and writing
Eye Therapy Physical therapy for the eyes and brain to develop eye coordination and treat visual problems such as crossed eyes, lazy eye, or double vision
Occupational Therapy Training people for their daily activities such as work or living independently after injury, illness, psychological or social disability, or learning difficulties
Home Nursing Nursing care after discharge from hospital or instead of admission to hospital – benefit may include:

  • Catheter care
  • Stomal therapy
  • Wound management
  • Medication administering
Health Aids and Appliances Benefit may include:

  • Hearing aids
  • Asthma spacers or ventilators, asthma pumps
  • Blood glucose monitors for diabetes
  • INR blood testing devices such as Coaguchek
  • CPAP and BPAP devices
  • Compression garments
  • Surgical stockings
  • TENS machines
  • Braces and splints
Travel and Accommodation Travel and overnight accommodation (outside of hospital) for essential medical or hospital treatment if you are unable to access this treatment where you live
Emergency Ambulance Services Riding in an ambulance to hospital, and emergency treatment by paramedics before and during transport to hospital
Source: www.canstar.com.au/health-insurance/

Research shows that Australia’s most common extras health insurance claims paid out in 2016 and also in 2015 were:

  1. Dental
  2. Optical
  3. Physiotherapy
  4. Chiropractic

Do extras cover policies all provide the same level of cover?

No. Extras policies typically come in three different levels of coverage, depending on your choice of policy (Health.gov.au):

General Treatment Comprehensive Cover: Includes most or all of general dental, major dental, orthodontics, optical, physiotherapy, chiropractic, occupational therapy, pharmaceuticals, podiatry, and hearing aids.
Medium Cover: Includes most or all of general dental, major dental, optical, physiotherapy, chiropractic, podiatry, and occupational therapy services.
Basic Cover: Includes at least one of general dental, optical, physiotherapy, and/or chiropractic.

What is the gap payment for Extras Cover?

There is often a gap payment required as an out-of-pocket expense with Extras Cover, when a health provider charges more than the benefit paid by your insurer. For a list of the common out-of-pocket expenses you can expense in Australia for extras medical services, read this article.

Always contact your insurer before receiving a new medical service or treatment, so that you know ahead of time how much you will back as a benefit and can estimate how much your out-of-pocket expenses will be for that service or treatment. Different insurers and different policies will provide higher or lower benefits for the same services or treatments, so it’s worth doing your research on Extras Cover policies before choosing one:


How to buy an Extras Cover policy

Extras policies can be added to Hospital policies or purchased separately as Extras Only policies.

You can get a quote to sign up for an Extras Cover policy through the Canstar website. Canstar regularly researches and rates Extras Cover health insurance for different profiles such as young singles, couples, older singles, families, and more. We compare different health insurance policies and providers for price and value for money, coverage and benefits, and terms and conditions of coverage.

The many benefits of taking out private health insurance should be quite clear, but it shouldn’t cost the moon to get a policy that covers what you need. Don’t settle for average cover at an expensive price – look for an Extras Cover policy with our 5-star rating for outstanding value:


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