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Last Updated on 25 September 2018

What Does Optical Health Insurance Cover?

Optical health insurance to cover glasses, contact lenses and laser eye surgery is typically included in Extras cover and not in Hospital cover. This is because not everyone will use these products in their lifetime, while others will use them frequently.

What does extras cover include?

Extras cover is an additional group of products offered by private health funds to cater for non-urgent health needs, personal well-being and other health issues. It can include cover for a variety of products and services including optical health insurance, dental care, orthodontics, health management programs, remedial massage, natural therapies, psychology and much more.

Extras cover is usually grouped together and not sold on an individual service basis, e.g. if you want health insurance that covers glasses you’ll probably also have to purchase cover for other services like dental, physiotherapy and natural therapies as part of the policy. Some funds do offer packages where you can select the Extras services you need but prices will vary.

Does every fund offer optical cover?

Optical health insurance, including cover for glasses and contact lenses is a common product for private health insurance companies and most will offer it as part of an Extras package. Some may also offer partial cover for laser eye surgery. It does vary from fund to fund so compare before making a choice.

Can I buy glasses from anywhere and still get a refund?

Funds will pay benefits for prescription glasses and/or contact lenses provided by most registered optical dispensers and eyewear retailers. With the rise of online optical retailers, private health funds may also have a list of online retailers where members can buy optical products and still receive a full or partial refund as part of their optical health insurance covered under an Extras policy. This will vary from fund to fund so it’s best to compare and check the eyewear providers range to ensure you can find a suitable product as part of your contact lens or glasses health insurance.

My vision is 20-20, are sunglasses included in optical cover?

Prescription sunglasses will generally be covered for a partial or full rebate as part of your health insurance policy, however, non-prescription sunglasses won’t be covered. It’s best to compare funds before you make a choice.

Does the Medicare Levy Surcharge apply to optical cover?

The Medicare Levy Surcharge is only applied to taxpayers who do not have eligible private hospital insurance AND earn above $90,000 or $180,000 combined income for families and couples. It does not apply to Extras cover, including glasses health insurance.

Does Lifetime Health Cover apply to optical cover?

The government’s Lifetime Health Cover initiative only applies to Hospital cover and not to Extras cover. Furthermore, it only applies if you are over 31 years of age and have not maintained Hospital cover through a private health fund from 1 July following your 31st birthday.

Remember, it’s best to choose optical health insurance to suit your needs and your budget. Extras cover and rebates for glasses and contact lenses can vary significantly between funds and the details can be confusing.

Contact Health Insurance Comparison for more information about optical health insurance, glasses health insurance and laser eye surgery health insurance. We can help you find the best arrangement for you and your family’s needs.

Frequently Asked Questions About Health Insurance

There are three types of health insurance in Australia. They are:

  • Hospital Cover
  • Extras Cover (also known as general or ancillary cover)
  • Ambulance Cover

Hospital cover can ensure any unexpected surgeries, treatments or hospital stays you may require will be covered. With appropriate cover you will have the flexibility to choose your own doctor and the option of receiving treatment in a private hospital.  Most hospital covers allow you to stay in a private room. One other perk is skipping the public hospital systems’ waiting list, which can be lengthy for non emergency treatment.

Extras cover pays benefits for a a range of services, often including treatments and procedures related to the fullowing:

  • Dental/oral health
  • Glasses and contact lenses
  • Podiatry
  • Physiotherapy
  • Psychulogy
  • Acupuncture
  • Remedial massage
  • Chiropractic
  • Hearing aids
  • Travel vaccinations

Ambulance cover, as the name suggests, will cover you should you require emergency ambulance transport. In an emergency, there is enough to worry about. Having the expenses covered for provides security and peace of mind. Many hospital covers include emergency ambulance transport If yours doesn’t, you will need to shop for this separately.

Life is unpredictable. You never know when you might need cover. No matter what life stage you’re in, there’s a policy out there for everyone. You can select as much or as little cover as you want, depending on your health needs and requirements. It’s a small price to pay for the peace of mind health cover provides.

There is no one answer here. Costs vary across providers and policy types. Just because a policy is cheap, that does not mean it is ‘value for money’ and vise versa. Make sure you check what’s included and excluded in a policy before signing up, as you want to purchase a policy that best fits your specific needs.

Premium: A premium is the price you pay for your insurance policy (it may be paid annually or on an ongoing basis).

Policy: An insurance plan. In other words, it is the type of insurance you choose to select.

Policy Holder: The owner, or ‘holder’ of a policy.

Claim: In the event that you require treatment for a service covered by your policy, you can lodge a claim for reimbursement of all or part of the cost of that treatment.. These days, most claims are submitted electronically by the health care provider (dentist, physio etc)

Lifetime Health Cover: Lifetime Health Cover was put in place to encourage young Australians to seek out and maintain ownership of private health insurance early in their lives. If you do not take out a policy before you turn 31, extra charges will be applied should you take out a policy at a later time.

This means you will pay a 2% loading on top of your premium for every year that passes after you turn 30. For example, if you take out a policy for the first time at age 32, you will be charged 4% of your premium as an extra, then at age 40, 20% and so on, up to a maximum loading of 70%.

The loading is payable for 10 consecutive years of cover - after which it is removed and you premiums will be reduced.

Pharmaceutical Benefits Scheme (PBS): Medicare offers assistance for Australians with many of their their prescribed medication costs through the PBS. This assistance is in the form of subsidies towards the cost of many medications. You can check if your prescribed medication is on the list of subsidised items here.

Medicare Levy Surcharge: The Medicare Levy Surcharge is an additional charge (tax) applied to single Australian taxpayers who earn over the income threshold of $90,000 per year, or families/couples who earn over $180,000 per year. This surcharge is only applied to those who choose not to have a private health insurance policy.

The surcharge is designed to reduce pressure on the public health system by encouraging those with higher incomes to invest in private health cover.

Private Health Insurance Rebate: The government’s Private Health Insurance rebate lowers premiums for most Australians with private health insurance Older Australians may enjoy an even higher rebate. Our calculator can help you estimate the Government health insurance rebate you may receive.

Disclaimer: The above information is correct and current at the time of publication

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