A simple guide to extras insurance and how it works.
Extras insurance, also known as general treatment cover or ancillary cover, helps cover the cost of everyday health care services that Medicare doesn’t generally pay a benefit towards. These are things like a visit to the dentist, optometrist or physio.
If you’re a high income earner, having extras insurance will not help you avoid the Medicare Levy Surcharge. You will only be exempt from the Medicare Levy Surcharge if you have an appropriate level of hospital insurance.
Medicare generally doesn’t pay benefits for extras services. That means without extras insurance, if you went to an extras provider like a dentist, you’d have to pay the full cost of that treatment out of your own pocket.
Extras insurance policies generally fall into three levels of cover: basic, medium and top. Each level of cover includes a different number of services. The higher the level of cover, the more services you can claim on. Depending on your level of cover and the policy you choose, you may have to pay an out-of-pocket when you receive treatment.
If you’re buying extras insurance for the first time or you’re upgrading your policy, you may need to serve a waiting period. A waiting period is a set amount of time during which you can’t claim benefits. All health funds have waiting periods. They exist to stop people from joining, claiming and leaving without contributing premiums to the health fund.
The services covered and the amount you can claim depend on your level of cover and the type of extras insurance policy you select. Common extras services include:
There are some situations where Medicare will provide a benefit for an out-of-hospital service that health insurance doesn’t cover. For example, a visit to a doctor outside of hospital, like a GP, will never be covered by health insurance, no matter what fund you’re with – that’s covered by Medicare.
Common situations where Medicare provides a benefit where health insurance doesn’t include:
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