What is Extras Cover?

Extras cover, also known as 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 or physiotherapist.

If you’re a high income earner, having extras cover 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 cover.

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Why extras cover?

Medicare generally doesn’t pay benefits for extras services. That means without extras cover, 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.

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How does it work?

Extras cover ranges from basic to comprehensive. What you can claim for, and what benefits are available to you, depends entirely on the cover option you choose. With Extras, it’s important to take a careful look at what’s included on each level of cover so that you can choose an option that suits your needs.

A benefit is the amount you can claim back/the amount HBF will pay towards a service. Depending on your level of cover, you will likely have to pay an out-of-pocket cost when you receive treatment.

Annual limits also apply to Extras cover. An annual limit, also known as an annual maximum, is the maximum amount of money you can claim for a particular service within a calendar year. 

If you’re buying extras cover 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.

Related: How do Extras insurance policies work?

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What is covered?

The services covered and the amount you can claim depend on your level of cover and the type of extras cover you select. Common extras services include:

• Dental treatment
• Optical - Glasses and contact lenses
• Physiotherapy
• Chiropractic treatment
• Podiatry

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What is not covered?

There are some situations where Medicare will provide a benefit for an out-of-hospital service that health cover doesn’t include. For example, a visit to a doctor outside of hospital, like a GP, is not covered by health cover, no matter what fund you’re with – that’s covered by Medicare.

Common situations where Medicare provides a benefit where health cover doesn’t include:

• Consultation fees for a doctor or specialist outside of hospital
• Tests and examinations performed to investigate an illness, like x-rays and blood tests
• Eye tests performed by an optometrist

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