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Health Insurance Extras Coverage

Jonathan April 1st, 2015 0 comments

The purpose of Hospital cover is to pay for emergency medical treatments or treatments for serious medical conditions that require admission to a public or private hospital. The hospital coverage you purchase does not provide for day-to-day routine care that may be necessary to achieve optimum health.

Extras cover, or general cover, provides insurance coverage for the routine treatments that virtually everyone requires.  It is important to consider whether purchasing extras cover makes sense for you or your family, or whether you would prefer to pay out of pocket for all routine treatments.

Why Do You Need Extras Cover?

For most people, the bulk of healthcare spending over the course of the year doesn?t come from a visit to a hospital. Instead, you pay for things like therapies.  Extras coverage means that some or all of the costs of this care is paid for by your insurer.  Extras policies may have substantial differences in the specific types of care that you can receive as part of the policy coverage.  If you require a certain kind of care, you should be sure to ask health funds about whether the policy you are looking at will provide that cover.

What Types of Care Do Extras Policies Cover?

Some of the typical types of care that may be covered by an Extras policy include:

  •  Chiropractic care – For back and neck pain and other musculoskeletal conditions
  • General Dental care – Regular check-ups, cleaning, fillings, preventative x-rays
  • Major Dental care – Restorations, crowns, bridgework, dentures
  • Orthodontics – Braces, retainers, straightening of teeth, jaw and bite alignments
  • In-home nursing care
  • Occupational therapy
  • Physiotherapy – Treatment of joint and muscle pain, sports injuries. Can also include pre- and post-natal care
  • Optical care – Glasses, contact lenses and repair under some policies
  • Osteopathy
  • Speech therapy
  • Podiatry – Treats sore, injured or diseased feet and ankles
  • Hearing aids – Help for those experiencing hearing loss
  • Orthotics
  • Acupuncture – Consultation and treatment with a recognised acupuncturist. Involves the therapist inserting fine needles into certain pressure points in the body to restore health and well-being
  • Naturopathy – Non-invasive treatments such as nutrition, herbal medicine and massage to help your body heal itself
  • Dietetics
  • Psychological care – Diagnosis, treatment and prevention of conditions affecting the human mind and behaviour

Not every policy offers the same types of coverage. An insurer must provide a written statement of the types of extras cover that are included in your policy so you are prepared for what to expect.

What Types of Extras Insurance Are There?

Extras cover plans can be broadly grouped into three different levels:

  • Basic is the best choice for singles and couples who are relatively young and healthy and who do not use a lot of services. For example, a basic policy may cover general dental services like a cleaning or filling a cavity but won?t cover braces, bridges, crowns or other more complex dental procedures. Benefits limits are lower for basic extra cover than for other policy types. For example, the average optical benefit may be set at $200 per person for basic cover and slightly more per person for medium or top cover.
  • Medium is typically the best choice for middle age people, as well as for families with young kids who have an average need for services. Medium cover is more comprehensive in terms of both types of cover and benefits limits compared with basic cover, but it often does not cover expensive procedures that top cover offers such as braces for kids.  While basics policies may have combined limits for therapies, both top and medium cover typically have separate limits so the total amount of covered care is greater.
  • Top is often the right option for older people, families with children in school, and others with higher levels of health care consumption. Top cover provides the broadest types of benefits. While premiums are more expensive, annual limits are higher so there will often be fewer out of pocket costs.  For example, a medium policy could provide $500 on average for hearing aids while a top cover policy provides an average of $800 for hearing aids.

In addition to choosing coverage levels, you can buy different types of extras cover depending upon your family situation. For example, you can purchase singles policies, couples policies, or family policies. Those in de facto relationships are eligible to purchase couples or family policies, as are people who are married.

What Are the Waiting Periods for Extras Cover?

Waiting periods are set by law for hospital cover; however, this is not the case for extras cover. Extras coverage policies may have different waiting periods for various type of benefits.  Some policies will provide specific types of benefits with no waiting periods when signing up for a policy. For example, a person who signs up for dental coverage may have immediate coverage for x-rays with no waiting period but will have a waiting period before certain more costly benefits like braces are covered.

When switching from one hospital policy to another, portability rules also forbid insurance companies from making you re-serve waiting periods. Again, these consumer protection laws do not apply to extras cover policies. However, the vast majority of insurers will not make you re-serve a waiting period if you switch to a new extras fund with the same level of cover as your old fund. If your new fund has more comprehensive coverage, you will have to serve a waiting period before getting the broader benefits.

Because waiting periods are not standardized by law when you purchase extras cover, you need to shop around among policies to try to minimize the time you must wait before necessary treatments are covered.

How Does Extras Cover Affect Your Out-of-Pocket Expenses?

There is no government rebate for on premiums for Extras cover but these policies are usually relatively affordable and purchasing Extras cover can significantly lower the total amount you spend on health care. You pay premiums for the policy but less out-of-pocket when you visit a care provider, giving you more control over your costs.

Extras cover may have e a fixed annual limit for services or it may cover a percentage of the costs such as 70 percent back on the costs of treatment.  Many extras funds have a network of providers, called provider schemes, that help to keep costs lower. Providers who participate with the insurer agree to charge a lower negotiated price for treatments.

Should You Buy a Combined Hospital and Extras Policy?

There are separate Extras cover policies that can be purchased independently or you can purchase a combined policy that has both hospital and Extras cover.  Compare the costs and the cover for each different kind of policy to decide which is right for you.

Still have questions? Let's talk!

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