Guide to health insurance with optical cover

Yes, some extras policies don’t include optical at all, while others include optical but will have limits – which differ again depending on your level of cover. Extras policies at the higher end will typically provide higher rebates and claiming limits for optical services. Meanwhile, a lower level of cover may leave you with more out-of-pocket expenses.

A higher level of cover will typically come with a higher premium. For example, a policy that covers laser eye surgery will most likely cost you more than if you only wanted health insurance for glasses or contact lenses.

The amount you can claim back from your extras optical cover depends on your policy. If you’re claiming on prescription lenses and frames, some insurers will cover up to a particular dollar amount (e.g. $250) or reimburse you for a percentage of the costs (e.g. 60%), so you’ll pay the remaining amount.

Your waiting period will depend on your health fund, what you’re claiming and the type of health insurance policy you have.

If you want eye-related inpatient hospital treatment or surgery, you’ll typically have a two-month waiting period, or 12 months if it’s a pre-existing medical condition.³

If you’re looking to claim optical benefits on your extras policy, you may have to wait anywhere from two to six months to be able to claim on eye therapies or a new pair of glasses/contact lenses.³ Laser eye surgery typically attracts a longer waiting period, which depends on the fund and policy.

Sometimes, insurers may waive their two- and six-month waiting periods for extras cover during a promotion – meaning you’ll generally have no waiting period to claim for optical benefits such as eye therapy and prescription glasses. You can take advantage of these promotions but remember to check the policy brochure to understand exactly what the policy covers.

Some extras health insurance policies can provide benefits to help pay for eye therapy by a recognised medical practitioner; although, adding eye or vision therapy to your policy may come at an additional cost and may be subject to waiting periods and limits.

You’ll typically have a two-month waiting period to be able to claim eye therapy on your extras cover, although this can vary by policy and health fund.

Also, you can generally only claim optical extras services relating to eye therapy up to:

• An amount back per visit (e.g. $50 per visit)
• An annual limit per policy (e.g. $350 a year)
• A group limit (e.g. if eye, speech and occupational therapies are grouped together)
• A service limit (e.g. only covers one initial consultation per year)

As well as standard prescription eyeglasses, you may also be able to claim prescription sunnies, contact lenses and even prescription swimming goggles, all through your optical health insurance benefits. These benefits may vary between insurers and be subject to conditions or limits, so be sure to check your policy brochure or call your health fund.

While non-prescription sunglasses won’t be included on your health insurance policy, you may be able to get a discount through your health fund’s partnered optical retailers. Depending on your policy, you may also be able to get a percentage off contact lenses, tints, transition lenses and more.

Medicare bulk bills eye tests by optometrists. However, you’ll be limited to a number of covered eye tests, depending on your age:²

• Under 65s can get one bulk-billed eye test every three years.
• Over 65s can have one bulk-billed eye test per year.

Medicare does not cover contact lenses, glasses or eye therapy. However, state and territory governments may have programs or schemes that can help pay for glasses and contact lenses (depending on your circumstances).

If you’re eligible for your free annual or three-yearly eye test and your optometrist bulk bills your examination, you don’t need to pay anything. However, if the optometrist doesn’t bulk bill your eye test, you’ll have to pay the fee upfront and then claim back 85% of the schedule fee from Medicare.