Understand your extras cover

Also known as ancillary cover or extras cover, extras insurance helps cover the cost of everyday healthcare services including things like dental check-ups, physio appointments and glasses or contacts. These services are generally not covered by Medicare.

There are some situations where your health fund cannot pay a benefit (because they legally can't), but Medicare will. For example, a visit to a doctor outside of hospital, like a General Practitioner, is not covered by health insurance, no matter what health fund you're with — this is covered by Medicare.

Consultation fees for a doctor or a specialist appointment outside of hospital, tests and examinations like x-rays or blood tests and eye tests performed by an optometrist are common situations where your health fund won't pay a benefit but Medicare will.

When you buy extras insurance for the first time, there will generally be a waiting period you need to serve before you can claim if you haven't had continuous cover, or if you've just upgraded to a higher level of cover.

You can get health cover for yourself, you and your partner, or for your whole family. Generally, there are four categories of membership:

• 1 adult (single)
• 2 adults (couple)
• 2 adults and any number of dependant^* children (family)
• 1 adult and any number of dependant^* children (single parent)

A dependant is a child who is under the age of 21 and is:

• covered by a family or single parent policy; and
• is not married or living in a de-facto relationship.

At HBF we also cover dependants under 25 years of age provided they meet the criteria in the two points noted above and they: are a full-time student; or earn no more than $24,500 taxable income per calendar year.

A combined annual limit is the maximum amount of money you can claim, distributed across a group of services.

A sub-limit is the maximum amount of money you can claim for a specific service, which is deducted from a larger annual limit.

For example, a policy might have a combined annual limit of $500 for dentures, crowns and bridges, with a sub-limit of $300 for each service. That means you'd only be able to claim a maximum of $300 for any one of those services in the year. If you claimed $300 on bridges, you would not be able to claim more for that service during the year, while the remaining $200 could be claimed against one or both of the other services.

If you're switching to HBF from another health fund and you've already claimed some of your benefits in the same calendar year, any claims you have made with your previous fund this calendar year will result in an adjustment of the annual limit you can claim with us for the rest of the year. For example, if you have claimed $300 on Occupational Therapy with your current fund and you join HBF on Top 70, which has an annual limit of $400, you may be able to claim $100 with us this calendar year. Annual limits reset on 1 January each year.

If your new HBF cover has a service with a lifetime limit, we will take into account all claims you have made for that service previously, regardless of the year they were made.