What You Need to Know About Extras Cover

October 24, 2018


What is extras cover? How would it benefit you? Under what circumstances should you consider paying for it?


Do you really need it? And is it necessary to have extras cover if you’re in need of physiotherapy services?


If extras cover is unfamiliar or confusing to you, read on to find answers to these questions and more. You’ll also discover why numerous Australians do choose to maintain extras cover, despite the fact that Australia freely offers exceptional universal healthcare services.


Medicare in Australia


The Australian Medicare system provides citizens and most permanent residents with essential healthcare services including emergency care, trauma care, maternity care and a broad variety of medications, surgeries, medical procedures and tests. However, Medicare does not cover every last sort of medical expense a person might incur. There are numerous healthcare products and services that Medicare does not provide cover for.


That’s where extras cover comes in.


What Is Extras Cover?


Extras cover refers to private health insurance cover for healthcare products, services and care that are not covered under Australian Medicare. There are a couple of other names for the same thing:


  • “General Treatment Cover”

  • “Ancillary Cover”


These types of services include physiotherapy, chiropractic therapy, podiatry, psychiatry, dentistry and some others. There are multiple healthcare services that Medicare might occasionally cover in certain limited circumstances but not in others; these include services provided by dietitians, dermatologists, acupuncturists and some other types of specialists. Extras cover health insurance policies might cover any of these types of services, depending on the policy and level of cover you choose.


Types of Extras Cover Policies


The Australian government defines 3 general types of extras cover health insurance policies:


1. Comprehensive Extras Cover – A policy in this category should include cover for physiotherapy services, general dental care, major dental care, orthodontic, endodontic, optical, podiatry and psychology services. Additionally, non-PBS pharmaceuticals should be covered. At this level of extras cover, you can expect to receive at least average and sometimes above-average benefit limits for major dental and orthodontic care.


2. Medium Extras Cover – Policies offering this level of extras cover should, at a minimum, include cover for both general and major dental care plus endodontic care. Additionally, they will also cover at least 5 of the following types of products and services:


  • Physiotherapy

  • Chiropractic

  • Optical

  • Orthodontic

  • Podiatry

  • Psychology

  • Hearing aids

  • Non-PBS pharmaceuticals


3. Basic Extras Cover – This category includes extras cover policies with lesser amounts of cover than the other two types mentioned above.


How Does Extras Cover Benefit You?


If you decide to pay for an extras insurance policy with a private health insurance provider, your health insurance provider will pay for a part of, or sometimes all of, any healthcare services you use that are covered in your policy. This is extremely beneficial if you have ongoing needs for physiotherapy, vision care, dental care or similar services, perhaps due to conditions such as arthritis, bursitis, myopia or periodontal disease.


You can also use your extras cover policy a bit like a budgeting tool. You never know when you will chip a tooth, break a lens on your glasses, or even worse, need a $1,200 ambulance pickup or a $10,000+ emergency helicopter transport. Surprise expenses like these can create havoc in your life.


When you choose to enrol in an extras health insurance plan, your premiums will come due like clockwork – unlike those real life emergencies. You can expect, plan and budget for them easily. When life’s inevitable emergencies do arise, they will surely be unpleasant -- but at least they won’t ruin you financially when you have the right insurance policy in place to cover them.


Do You Really Need Extras Cover?


Whether or not you need extras cover depends entirely on your unique situation. It comes down to a choice between paying entirely out-of-pocket for the healthcare services you use – or paying for health insurance premiums upfront, and then maximising your use of the benefits as the need arises.


If you don’t have any chronic health conditions such as arthritis that would cause you to need ongoing physiotherapy, or any vision, dental or other recurring health problems not covered under Medicare, perhaps you do not need extras cover.


Regardless, you would be wise to research the costs of ambulance care in Australia if you aren’t already aware of how much this emergency expense can mount up to. Then make sure you have enough cash reserves to cover the ambulance in case of emergency. Health insurance providers and state governments both provide ambulance cover schemes that can help you cover the costs of emergency ambulance transport in case you’re ever unfortunate enough to need it.


The Australian Prudential Regulatory Authority (APRA) has provided some demographic insights on which segments of the Australian population are drawing the most in extras cover benefits. According to APRA’s most recent data, Australians of all ages and both genders are using their extras cover benefits. The biggest extras cover beneficiaries in the recent past have been Australians aged 65-69.


In general, Australian health insurance providers are paying out an average of $400 worth of benefits on extras cover policies per insured person. The average pay-outs go higher than $400 per person for Australians between the ages of 40-94.


The main takeaway: If you’re over the age of 40, or if you have ongoing healthcare needs not covered by Medicare, those are the situations where extras cover is likeliest to provide an outstanding value for you.


Is It Necessary to Have Extras Cover If You’re in Need of Physiotherapy Services?


The answer to this question is largely dependent on your unique situation.


It is possible that Medicare might cover up to 5 physiotherapy sessions per year under the following circumstances:


  • If your GP decides your physiotherapy is medically necessary due to a chronic medical condition such as cancer, diabetes or cardiovascular disease, s/he may be able to refer you to a physiotherapy practitioner under the Chronic Disease Management program.

  • If your GP is coordinating an ongoing treatment and management plan for your child with autism, Down syndrome or fragile-x syndrome, the child may be eligible for assistance with physiotherapy expenses under the Better Start for Children with Disabilities program and / or the Helping Children with Autism program.


Even if Medicare covers your physiotherapy, keep in mind that 5 sessions are not very many -- although it is sufficient for some patients. For others, months’ worth of ongoing physiotherapy is needed. So it is possible, depending on your condition and goals, which you may need more than 5 sessions.


With physiotherapy services not typically being covered under Medicare, your remaining choices are to pay out of pocket for care, or to choose an extras cover policy that will provide cover for the care you need.


We hope this information is helpful to you as you decide whether extras cover would be a good investment in your situation. We invite you to contact us if you’d like to get started with physiotherapy, or if you have any questions regarding the health insurance we’re currently able to accept.

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