Extras cover: compare dental, optical and physio cover
Compare extras cover by the dollar benefit it pays for each service you use, the annual limits on those services and the waiting periods. Extras, which the industry calls general treatment, pays towards health services outside hospital that Medicare does not cover: dental, optical, physiotherapy, chiropractic, podiatry, psychology, remedial massage, hearing aids and similar. You can buy it on its own as extras-only cover, or combined with a hospital policy.
Unlike hospital cover, extras is not tiered or standardised. Each fund decides which services to include, how much to pay per service and how much you can claim each year, which makes extras harder to compare and easy to overpay for.
By Better Rate Mate Editorial Team · Last reviewed
What extras cover typically includes
Extras packages are built from a menu of services. The more services and the higher the limits, the higher the premium. The common ones, as defined by privatehealth.gov.au:
- General dental: check-ups, cleans and simple fillings.
- Major dental: complex fillings, extractions, crowns and bridges. Each fund decides which items count as general or major.
- Orthodontics: braces and other appliances, usually with a lifetime limit rather than an annual one.
- Optical: prescription lenses, frames and contact lenses. Optometrist consultations are generally claimed through Medicare, not extras.
- Physiotherapy, chiropractic, osteopathy, podiatry, exercise physiology and dietetics.
- Psychology, where the policy includes it.
- Remedial massage, acupuncture and Chinese medicine, where included.
- Hearing aids, orthotics and blood glucose monitors, often from a shared 'health aids' limit.
- Non-PBS pharmaceuticals, usually after you pay the normal PBS co-payment.
- Speech pathology, audiology, eye therapy (orthoptics) and home nursing, where included.
- Ante-natal and post-natal classes, approved health management programs and some vaccinations, on some policies.
How to compare extras cover
Start with the services you will actually use in the next year. Then use each policy's Private Health Information Statement, which gives an example of the maximum benefit for common items, to fill in a table like the one below for each policy you're considering. The policy that pays the most for your services within its limits, after the premium, is the one to beat.
Ask the fund or check its website for the benefit on the exact item numbers you use, such as a check-up and clean, a physio consultation or a pair of glasses. A generous headline limit means little if the benefit per visit is low.
| Service you use | Benefit per visit or item | Annual limit (per person or per policy) | Waiting period | Better benefit at a network provider? |
|---|---|---|---|---|
| Check-up and clean | From the PHIS example | Check whether it's shared with other dental | Generally 2 to 6 months | Check the fund's dental network |
| Physiotherapy consultation | From the PHIS example | Check whether it's combined with chiro and osteo | Generally 2 to 6 months | Check the fund's network |
| Glasses or contact lenses | From the PHIS example | Check whether optical has its own limit | Generally 2 to 6 months | Check the fund's optical network |
| Major dental (crown, extraction) | From the PHIS example | Check whether major dental has its own limit | Longer; check the PHIS | Check the fund's dental network |
| Your own service |
Basic, mid and top extras: what changes
Extras isn't tiered by law the way hospital cover is, but most funds package it in levels with names like basic, mid and top. Moving up a level can add services (major dental, orthodontics, hearing aids, psychology), raise the annual limits and raise the share of each bill the fund pays. Because the levels aren't standardised, one fund's 'mid' can match another's 'top'. Compare the services and limits you need rather than the level's name.
Natural therapies funds can no longer cover
Since 1 April 2019, insurers cannot pay benefits for 16 natural therapies as part of a health insurance policy: Alexander technique, aromatherapy, Bowen therapy, Buteyko, Feldenkrais, western herbalism, homeopathy, iridology, kinesiology, naturopathy, Pilates, reflexology, Rolfing, shiatsu, tai chi and yoga. If one of these is why you are buying extras, no complying policy will pay for it.
How benefits and limits actually work
Funds pay either a percentage of the provider's fee or a fixed dollar amount per service, and then cap what you can claim. There are usually several caps stacked together: a per-service limit (for example, a yearly optical limit), sometimes a combined limit shared across several services, and for high-cost items like orthodontics a lifetime limit.
Most limits reset on a calendar or financial year basis set by the fund, and unused benefits are generally lost rather than carried over. A few funds reward loyalty by increasing some limits the longer you hold the policy. Your policy's Private Health Information Statement shows example benefits for common services, which is the easiest way to compare two extras policies on the same footing.
Is extras cover worth it? Do the arithmetic
Extras pays for itself only if what you claim back exceeds what you pay in. Write down a realistic year: two dental check-ups and cleans, a pair of glasses, a course of physio. Apply the fund's benefit per service and its limits to that list, then compare the total with twelve months of premiums.
People with predictable, recurring costs, such as families with children in orthodontics or anyone with regular physio, often come out ahead. People who see a dentist occasionally usually do not, and may be better off paying as they go and putting the premium aside.
Preferred providers and gap-free services
Most funds have networks of dentists, optometrists and allied-health providers with agreed prices. At a network provider you may pay no gap for some services, such as a check-up and clean, or a set range of frames. Outside the network the benefit can be noticeably lower. If you want to keep your current dentist or physio, check whether they are in the network before you choose a fund.
Extras waiting periods
Extras waits are set by each fund, not by legislation. privatehealth.gov.au notes they generally run from two to six months for items such as general dental, optical and physiotherapy, and 12 months or more for major items such as orthodontics and hearing aids. Some funds waive certain extras waits for new members as a promotion; the policy's PHIS shows what applies.
| Feature | How it works | What to check |
|---|---|---|
| Benefit per service | Percentage of the fee or a fixed dollar amount | The dollar benefit for the services you use most |
| Annual limits | Per service, per category or combined; reset yearly | Whether the limit is realistic for your usage |
| Lifetime limits | Common for orthodontics | How much of the treatment cost it covers |
| Waiting periods | Set by the fund; commonly 2 to 12+ months | The wait for the specific service you need |
| Provider network | Agreed prices at preferred providers | Whether your own dentist or physio is in it |
| Surcharge and loading | Extras does not count for the MLS or Lifetime Health Cover | Whether you also need hospital cover |
Extras cover with no waiting period
Extras waits are set by each fund, so a fund can shorten them or waive them. Some funds waive certain extras waits as a joining offer for new members. If you're joining for a particular service, check three things before you rely on an offer: whether it covers that service, whether it covers only the shorter waits (such as two months on general services) or also the longest ones on major dental, orthodontics and hearing aids, and whether it applies to switching members as well as new ones.
If you already have extras and switch funds at the same or a lower level, your new fund must recognise the waits you've served. Our guide to health insurance waiting periods covers the rules for hospital and extras.
Extras-only cover and the tax rules
You can hold extras without hospital cover, and many people do. Two consequences are worth knowing. Extras-only cover does not exempt you from the Medicare Levy Surcharge, because only hospital cover does. And extras does not count towards Lifetime Health Cover, so holding extras before 31 will not protect you from the loading if you later take out hospital cover. The government rebate does apply to extras premiums.
What to watch for
- Extras cover on its own does not exempt you from the Medicare Levy Surcharge or count for Lifetime Health Cover.
- A big headline annual limit means little if the per-visit benefit is low. Compare the dollar benefit for the services you use.
- Unused limits are generally forfeited when they reset, so time your claims within the limit year.
- Switching funds does not usually carry over accrued loyalty benefits or orthodontic limits already used.
- Check the waiting period for the specific service you are joining for. Major dental and orthodontics commonly carry 12 months.
Common questions
Can I get extras cover without hospital cover?
Yes. Most funds sell extras-only policies. They do not exempt you from the Medicare Levy Surcharge and do not count towards Lifetime Health Cover, so if you earn above the threshold or are approaching 31, consider hospital cover as well.
Is extras cover worth it?
Only if your realistic yearly claims exceed your yearly premium. List the dental, optical and allied-health services you actually use, apply the fund's benefit per service and limits, and compare the total with the premium.
Can I get extras cover with no waiting period?
Extras waits are set by each fund, so some policies have short or no waits on certain services, and some funds waive waits as a sign-up offer. Waits on major dental, orthodontics and hearing aids are usually longer. Check the PHIS for the exact service.
What is the difference between general and major dental?
General dental covers check-ups, cleans and simple fillings. Major dental covers complex work such as extractions, crowns and bridges. Each fund decides which items fall in each group, and major dental usually has a longer wait and a different limit.
Do extras limits roll over?
Usually not. Most limits reset each year and unused benefits are lost. Some funds increase certain limits the longer you stay, which can be worth weighing if you plan to keep the policy for years.
What are the most claimed extras in Australia?
Dental, by a wide margin. In the June 2026 quarter insurers paid $1,804.16 million in extras benefits, of which $1,001.79 million (about 56%) was for dental, followed by optical ($229.59 million), physiotherapy ($140.70 million) and chiropractic ($82.01 million), APRA's figures show. The best extras for you are the ones you'll use: compare the benefit and limits on those services.
About the figures on this page
Extras benefits, limits and waiting periods are set by each fund and can change at any time, usually with the 1 April premium round. The rules on this page were checked against privatehealth.gov.au on 2 October 2026. Check a policy's Private Health Information Statement for its current benefits.
