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.
Why extras 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.
How does it work?
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.
What is covered?
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:
- Dental treatment
- Optical - Glasses and contact lenses
- Chiropractic treatment
What is not covered?
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:
- Consultation fees for a doctor or specialist outside of hospital
- Tests and examinations a doctor might perform to help treat an illness, like x-rays and blood tests
- Eye tests performed by an optometrist