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
- Most extras benefits reset on 1 January, which means you have until 31 December to get your money's worth on your cover
- The average extras cover for a single person in Victoria costs about $866 a year (without the health insurance rebate) and other states are similar. But there's a wide range of cover and it pays to shop around to ensure you're getting the best value
If you've been paying for Extras insurance all year – which pays you benefits for money you've spent on services such as physiotherapy, chiropractic or dental appointments – you likely have just a few weeks left to ensure you're getting the most for your money.
The average extras cover for a single person in Victoria costs about $866 a year (without the health insurance rebate) and other states are similar. That's a lot of money to spend if you're not actually using it to its full extent.
Most health insurance funds reset their extras benefits on 1 January, so anything you haven't used before then will be lost. Now's the time to book in those last-minute appointments to ensure you get bang for your buck.
What does extras cover pay for?
Extras cover pays benefits for health costs including glasses and contact lenses, dental check-ups, a set of braces or dentures, physiotherapy, podiatry, chiropractic, massage and counselling.
It can even help with the cost of non-PBS medication and medical devices such as hearing aids or blood-glucose monitors.
For the majority of services you get a set benefit per visit or service, capped at a yearly maximum benefit per type of service. A handful of services like hearing aids may only allow you to claim every three years, for example, and if you need braces there may be a lifetime limit that doesn't reset.
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 their limits at the end of the financial year, and a few on the anniversary of 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 whether you really need this cover.
If you're not using your extras, it may be worth considering whether 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?
Remember, you've already shelled out around $865 for your extras cover so if you're not paid back benefits that are equal to that or more, you may be better off dropping the cover completely.
Here are some typical annual limits for various services, showing how much you can claim in a year. There is a wide range of cover and premiums out there, so it pays to compare health insurance from various providers to find the best one for you.
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: $35 examination
- Optical: $225 for single-vision spectacles
- Physiotherapy: $40
- Chiropractic: $40
- Massage: $33
Note: These are the median benefits per person (single policy in Victoria, November 2024) 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 $1000 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.
Stock images: Getty, unless otherwise stated.
