What is Extras Cover?
Extras cover, also sometimes referred to as ancillary cover or general cover is an addition to a private health insurance plan that helps cover costs of healthcare treatments that fall outside the scope of those that are covered by Medicare. Extras are either purchased as a separate policy or as part of a hospital cover policy, and typically fall into three categories, basic mid-level and high.
The exact treatments covered by an extras package may vary between health insurance providers but typically covers a number of treatments and healthcare services that are not counted as in-hospital treatment or covered under Medicare. Extras that may be included in ancillary packages include:
- General Dental (such as check-ups, clean and scale, fillings)
- Major Dental (including crowns, root canal, dentures, veneers, bridges, wisdom tooth removal)
- Hearing Aids
- Naturopathy (may also include remedial massage massage as part of “Natural Therapies” cover)
- Occupational Therapy
- Optical (glasses, contact lenses and eye tests)
- Orthodontics (tooth and jaw realignment such as braces, retainers and dental plates)
- Speech Therapy
Some health insurers allow you to choose the extras you wish to have covered while others include different treatments depending on the type of extras package you purchase as part of your health insurance.
No matter what treatments are covered by your health insurance, you will still have to pay for treatments. Rather than operating like bulk billing (covering all of the cost of the treatment), extras cover instead reduces your out of pocket expenses by offering either a fixed dollar amount reduction on a treatment, or covering a percentage of the fee.
As an example, a number of Australian health insurers offer around a 60% dental rebate with their extras cover. According to Choice magazine, an average dental appointment covering a checkup, clean and scale and fluoride treatment comes to around $215 in Sydney. If your insurer is covering 60% of the dental fee, it will cover $129 of that fee, leaving you to pay $86. The amount covered by the health insurer is then subtracted from your yearly limit for that type of treatment or service.
Waiting Periods, Provider Schemes and Benefit Limits
Rebates available through extras cover are, of course, not limitless. Depending on the health insurance provider, the extras cover will feature different benefit limits and may also feature a waiting period.
Many health insurance policies contain waiting periods for certain services so as to limit people picking up a policy, using it immediately for cover potentially dropping it once the rebate has been used. In many cases these waiting periods are for pre existing conditions, but may also include specific services, such as major dental.
Preferred Provider Schemes
A provider scheme is a deal made between a health insurance company and a healthcare practitioner - typically a dental or optical chain or franchise - offering extra benefits to people with cover provided by that insurer. These benefits may include discounts on certain treatments or services, or offering a higher rate of reimbursement with the aligned healthcare practitioner.
A benefit limit is anything that limits the number or amount of reimbursements a person may get each year. Typically these annual limits take the form of a set dollar amount that puts a hard cap on the amount of money that can be reimbursed each year. A basic extras cover plan may put a $250 cap on dental. After the cap is reached, no more rebat are available that year.
The benefit limit may also limit the overall rebate available. Major dental is covered under many mid-level and high extras cover packages with a limit of around $1000. GIven that many major dental procedures may cost thousands of dollars, this limit may not cover the percentage stated in the policy, turning the rebate to a flat deduction on a single treatment.
Some policies may also feature limits on the number of a specific type of appointments that may be made a year. These limits are typically set on treatment types that are regularly repeated, such as chiropractic, physiotherapy and osteopathy. What this means is that rebates may be stopped after a set number of sessions even if you haven’t reached the dollar cap set by your extras package.
Some extras also carry what is referred to as a lifetime limit. This is a hard limit on the rebates available for certain expensive and typically once off treatments, such as orthodontics or laser eye surgery. These limits typically carry between different health funds, so if you have already claimed with one provider, switching to another will not renew the limit on these services.
Getting the Most From Your Extras Cover
The key to getting the most from your extras cover is to use it before you lose it. The vast majority of health insurance funds reset their cover on January 1st each year, so if you haven’t taken advantage of your yearly rebates, they will be lost.
Naturally this doesn’t mean that you should book appointments you don’t need just so you can take advantage of rebates, but it does mean that you should not put off booking the appointments that you need.
You will gain the most from your extras cover by booking appointments with aligned healthcare providers. Optical and dental are the two healthcare modalities most often included in preferred provider schemes, but any healthcare practice that is a franchise or known brand may also be included.
While existing relationships with healthcare providers will generally be more valuable to a patient than a slightly lower price, health and wellness appointments that should be seen to every year, such as dental checks and eye tests, can benefit greatly from preferred provider schemes, especially if you do not have a history of dental or optical issues.
If you haven’t already had your eyes tested, or your teeth checked this year and you have private health insurance, time is running out for you to receive your yearly rebate, and if you have been putting off booking a healthcare appointment due to cost, check with your health insurance provider to see if your extras cover either includes that treatment or can be modified to include the treatment.
Don’t let your yearly rebates run out. Search for and book appointments with healthcare providers quickly and easily through MyHealth1st.