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How Do Extras Insurance Policies Work

Discover what’s covered, who’s covered and how the costs work.

Extras insurance policies generally fall into three different levels of cover: basic, medium and top. Levels of cover are defined by the number of services they include – the more services included, the higher the level of cover.

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How much do I get back?

The amount you can claim back (known as a benefit) on extras services depends on the level of cover and the specific policy you select. Nearly all extras insurance policies only cover services to a limited extent, which means you’ll usually pay for some of the service out-of-pocket; this is still better than the alternative, as without it you’d have to cover the full cost of treatment out of your own pocket.

Benefits for extras services are usually a set amount, or calculated as a percentage of the service cost. Generally, benefits for extras services have a maximum amount (known as an annual limit) that you can claim per year.


Who is covered?

Health funds generally offer three categories of membership that provide cover for individuals and family groups.

Number of people covered Usually listed as
1 adult Single
2 adults Couple
1-2 adults and any number of dependent children Family

What is a dependent child?

A dependant is a person without a partner under the age of 18 years.

At HBF, we choose to cover your children for free under a family policy until they reach 25, provided they are not married or living in a de-facto relationship, and are either:
  • Not earning a taxable income of more than $24 500 pa; or
  • A full time student

What is a waiting period?

A waiting period is a set amount of time during which you can’t claim benefits. If you’ve never had health insurance or you’re upgrading your level of cover, you may need to serve a waiting period before you can claim. All health funds have waiting periods. They exist to stop people from signing up when they need treatment, claiming and leaving without contributing money (known as premiums) to the fund.

If you’re switching from another health fund and you’ve already served your waiting periods, you’ll generally not have to re-serve them with the new fund.

While the government sets the maximum waiting periods for hospital services, they don’t have set maximums for extras services. Health funds set their own waiting periods for extras services. Generally, health funds set a 2 month waiting period on extras services; however, some services may have longer waiting periods.

Common extras services with longer waiting periods can include:

  • Optical items – glasses or contact lenses
  • Major dental – crowns or bridges
  • Orthodontics

As health funds set their own waiting periods for extras services, it’s important to reference your extras insurance policy to find out how long you’ll have to wait before you can claim on the services you’ll need.


How much will it cost?

The factors that contribute to the cost of an extras insurance policy vary from person-to-person. While the base price is the same for everyone thanks to community rating, the final cost of your extras insurance may be different to what your neighbour pays.

Several factors contribute towards the cost of your extras insurance:

  1. Level of cover

    The base price of your premium depends on whether you choose to purchase basic, medium or top level of cover, with further variation depending on the specific policy you choose.

  2. Australian Government Rebate on Private Health Insurance

    The rebate is an Australian Government initiative designed to make health insurance more affordable. It’s calculated based on your age and income, and comes in the form of a refund, which can be applied directly to your premium to reduce its cost, or be claimed at tax time.

  3. Scale

    The price of extras insurance changes depending on the number of people you’d like covered on your policy. Generally, as you add more people to a policy, the premium will increase.

    HBF shows prices based on a policy for a single person, but not all health funds display their pricing this way – that’s why it’s important to take note of how many people the listed policy price includes.
  4. Discounts

    Depending on your health fund and your health insurance policy, you may get a discount on your premium depending on when you pay.

    HBF Frequency Discounts
    Depending on how often you pay your premiums, you may receive a discount on eligible policies. This discount applies whether you pay by statement or by direct debit.
    Payment frequency Discount (%) Discount (weekly equivalent)
    Quarterly 0.48% 1/4 week per year
    Half yearly 1.92% 1 week per year
    Yearly 3.83% 2 weeks per year

Find extras cover that will suit your lifestyle View cover

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