Flexible Extras Cover
Expert tips for choosing extras insurance
Our health insurance expert, Steven Spicer, has some helpful tips for choosing the right extras insurance for you.
Steven Spicer
Executive General Manager – Health, Life & Energy
Choose the right level of extras for you
One of the key parts of choosing health insurance is deciding on the level of cover you want. You want your policy to be there when you need it, but you don’t want to be paying for extras services you never use. Consider you and your family’s health needs, your medical history and future requirements to help narrow down your extras cover options.
Make sure you understand your inclusions
When looking at extras products, it’s essential to know what your inclusions are and what these inclusions actually cover. For example, there are four different dental categories, each of which covers different procedures. Knowing what exactly your inclusions cover will help you choose your policy and ensure you’re not caught out down the track.
Your health fund may have preferred providers
It’s worth checking whether your health fund has ‘preferred providers’ with an agreement for standard extras services such as physio and dental. These agreements could mean more transparent pricing and reduced costs for members. Going to a healthcare provider outside of these agreements could mean more expensive treatment for you.
What is extras cover?
Extras insurance (ancillary cover and general cover) pays a benefit towards any included outpatient (out-of-hospital) services and medical care. These are often services you’ll visit regularly, and those that offer preventative treatment and attract ongoing costs, such as dental care and eyewear. What you’re covered for will vary depending on the inclusions and conditions in your policy.
This range of health services isn’t covered by Medicare, meaning that without extras cover, you’ll be left to pay all expenses yourself. While there may still be out-of-pocket expenses even with extras cover, having health insurance will reduce how much you need to pay for these services.
Hospital cover is for inpatient hospital treatment and elective surgeries. Many people get both hospital and extras cover. You can purchase this as a combined policy (both from the same health fund) or as a split cover (you have hospital and extras cover from different health funds). Both have pros and cons, and the best choice will depend on your situation.
Services covered by extras health insurance
Depending on your policy, there are a range of healthcare services that extras can cover, including:
- General dental (dental check-ups, fillings, etc)
- Major dental (crowns, bridges, etc.)
- Orthodontic
- Endodontic (root canal, etc)
- Optical
- Physiotherapy
- Remedial massage
- Chiropractic
- Osteopathy
- Podiatry
- Exercise physiology
- Non-PBS pharmaceuticals
- Lifestyle products
- Eye therapy
- Occupational therapy
- Speech therapy
- Hearing aids
- Dietician services.
In some states, you may need ambulance cover to help pay for ambulance services. This varies depending on where you live, so check with your health fund.
What is meant by flexible extras cover?
Many health funds will advertise that they offer ‘flexible extras’ cover. While each insurer may have a slightly different definition for this, it usually refers to a combined annual limit that you can use on a range of covered extras. You may see these referred to as flexi-limits by the health fund.
For example, if you had a combined annual limit of $600, a ‘flexible extras’ offering could allow you to claim this entire amount on physio or spread it out over a number of included extras. Not all your policy inclusions will be eligible for this flexible limit. For example, you may have optical, but it will have its own separate limit.
Additionally, some policies may allow you to select which extras services will be included on your policy for added flexibility.
How do extras limits work?
All extras policies will have limits on how much you can claim per year. Whether the limit covers a calendar or financial or membership year will depend on your health fund and may vary by included service. Most of these limits will refresh annually. Here are some terms you’ll encounter when looking at limits:
Annual limit: A yearly limit is the total amount of benefits payable towards services covered in your policy over the calendar year or financial year or membership year.
Combined limit/Flexible Limits: A combined limit is the maximum amount you can claim across several services.
Sub-limit: A sub-limit is the maximum amount of your annual or combined limit to claim towards a service (dental, etc).
Per-person limit: A limit that applies to each person on your cover. The exception would be if another limit, such as the family limit, has already been reached.
Family limits: A family limit is the total amount that all members of your policy can claim in a financial or calendar year or membership year.
What are percentage limits?
Some health funds or specific policies will cover a percentage of treatment costs. For example, your policy may cover 60% of your physiotherapist costs up to an annual limit. The remaining amount is known as a gap payment and will need to be paid out of your pocket.
Your policy may have higher limits or rebates for certain services, such as 100% cover for new prescription glasses, though this will still likely count towards your annual limit. Each policy will vary, so it’s important to check your policy documents and understand what cover you have.
Waiting periods for extras health cover in Australia
New members or those upgrading their policy will usually need to serve a waiting period for any new inclusion. Unlike waiting periods for hospital cover, which the government sets, the waiting periods for extras cover are set by the health funds themselves. This means waiting periods can vary between health funds.
Some policies may allow you to claim certain services without a waiting period (usually on less expensive services like general dental or physio). However, new members or those upgrading their policies should expect waiting periods for more costly services (e.g. major dental or orthodontics). Depending on the service, these waiting periods can range from two months to over a year.
Meet our health insurance expert, Steven Spicer
As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.