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LoansCredit CardsExtras cover — the industry calls it general treatment — helps with health costs incurred outside hospital. Dental, optical, physiotherapy, chiropractic, podiatry, psychology and remedial massage are the common ones.
Unlike hospital cover, extras is not tiered or standardised. Every fund designs its own packages, sets its own annual limits and decides its own benefit amounts, which makes extras genuinely difficult to compare and easy to overpay for.
Funds pay either a percentage of the fee or a fixed dollar benefit per service, and then cap what you can claim in a calendar year. There are usually two caps stacked on top of each other: a per-service annual limit and sometimes an overall extras limit. Some policies also apply a lifetime limit to high-cost items such as orthodontics and hearing aids.
Extras is worth having only if what you claim back exceeds what you pay in. Add up a realistic year of dental check-ups, glasses and physio, apply the fund's benefit rates and limits to that list, and compare the total against twelve months of premiums. For people with predictable ongoing costs it comfortably pays for itself. For people who visit the dentist irregularly, it often does not.
Most funds have networks of dentists, optometrists and allied-health practitioners with negotiated rates. Going to a preferred provider usually means a higher benefit or no out-of-pocket cost at all, while going elsewhere can substantially reduce what you get back. If you want to keep your existing dentist, check whether they are in the network before you switch funds.
Extras waits vary a lot more than hospital waits because they are set by the fund rather than legislation. Two months is typical for general dental and optical. Major dental, orthodontics and hearing aids commonly carry twelve months and sometimes longer. If you are joining specifically for a known upcoming expense, check the wait for that exact service first.
It depends entirely on what you claim. Work out a realistic year of dental, optical and allied-health visits, apply the fund's benefit rates and annual limits, and compare that against the annual premium. Predictable ongoing costs usually justify it; occasional use usually does not.
Yes. Most funds sell standalone extras policies. Just be aware it does not exempt you from the Medicare Levy Surcharge and does nothing towards being admitted to hospital.
Usually not. Most funds reset limits on 1 January and unused benefits are forfeited. A few funds let certain benefits accrue the longer you hold the policy, which is worth checking if you are comparing on more than price.
Medicare Levy Surcharge thresholds and government rebate percentages are reviewed regularly, so this page does not quote them. For the current figures see the ATO and the government's privatehealth.gov.au.
