Extras cover, sometimes referred to as General Treatment or Ancillary cover, is a part of health insurance that helps pay for everyday healthcare services received outside of hospital.
It is designed to help reduce the cost of services such as dental, optical, physiotherapy and other common healthcare treatments that are not covered by Hospital Cover.
This article explains what Extras cover is, how it works and some of the important things to understand before choosing an Extras policy.
Key Points
- Extras cover helps pay for everyday healthcare services received outside of hospital.
- Extras cover can include services such as dental, optical, physiotherapy and chiropractic treatment.
- Extras cover helps reduce the cost of healthcare services, but you may still have out-of-pocket costs depending on your policy and provider.
- Different Extras policies include different services, limits and benefit amounts.
What does Extras Cover include?
Extras cover can include benefits for a wide range of healthcare services received outside of hospital.
Depending on the policy, this may include services such as dental, optical, physiotherapy, chiropractic, podiatry and remedial massage.
You can view a full list of recognised General Treatment services on the PrivateHealth.gov.au website.
Different Extras policies include different services, annual limits and benefit amounts.
Some Extras policies are designed to provide broader cover across a larger range of services, while others focus on more basic everyday healthcare needs.
What doesn’t Extras Cover include?
Extras cover does not cover treatment received as an admitted inpatient in hospital.
Services such as hospital accommodation, theatre fees and inpatient surgeries are instead covered under Hospital Cover.
Extras cover also does not always fully cover the cost of treatment, which means you may still have out-of-pocket costs depending on the provider, service and your level of cover.
How does Extras Cover work?
When you receive treatment from a provider, your Extras policy pays a benefit towards the cost of the service depending on your level of cover and available limits.
For example, if your physiotherapist charges $100 for an appointment and your Extras policy pays a $60 benefit, you would pay the remaining $40 yourself.
In many situations, claims can be processed on the spot using your health fund card or digital wallet, with you only paying any remaining out-of-pocket cost.
Most Extras services have annual limits, which means there is a maximum amount you can claim for certain services each year.
Do I need Extras Cover?
Whether Extras cover is worthwhile depends on your healthcare needs, budget and how often you use services outside of hospital.
People who regularly use services such as dental, optical, physiotherapy and other everyday healthcare treatments may find Extras cover helps reduce ongoing healthcare costs.
The right level of Extras cover depends on the types of services you use and the level of benefits and annual limits that best suit your needs.
Are there waiting periods for Extras Cover?
Yes. Extras cover does include waiting periods before you can claim benefits for certain services or treatments.
Different waiting periods apply depending on the service and the level of Extras cover you hold.
For example, some dental services or major treatments may have longer waiting periods than more general everyday services.
You can read more about this in our guide to Waiting Periods.
Can you still have out-of-pocket costs with Extras Cover?
Yes. Extras cover helps reduce the cost of services, but it does not always cover the full amount charged by your provider.
For example, if your dental appointment costs $180 and your Extras policy pays a $120 benefit, you would pay the remaining $60 yourself.
The amount you pay depends on the provider’s fee, your benefit amount and any annual limits that apply to the service.
Is Extras Cover different to Hospital Cover?
Yes. Extras cover and Hospital Cover are designed for different types of healthcare services.
Extras cover helps pay for services received outside of hospital such as dental, optical and physiotherapy, while Hospital Cover helps pay for treatment received as an admitted inpatient in hospital.
Some people choose Extras cover only, some choose hospital cover only while others combine Hospital and Extras cover together in one policy. It really depends on your individual needs and budget.
How do you choose the right Extras Cover?
The right Extras cover depends on the types of healthcare services you use most often and the level of benefits that are important to you.
Some people look for higher benefits on services such as dental or physiotherapy, while others prefer broader cover across a larger range of treatments.
It’s also important to consider annual limits, waiting periods and any out-of-pocket costs that may still apply when comparing Extras policies.
If you’re comparing extras cover options, you can explore Phoenix Health extras cover options online or call our team on 1800 028 817 and we’ll be happy to help explain the different levels of cover.
