Extras Cover
Physio, dental, optical, chiro or massage. Extras cover is here to help you for the life you choose and the one you don't.
What is extras cover?
Extras health insurance cover helps cover some of the cost of certain things that are generally not covered by Medicare. This includes physio, optical, dental, chiro and more. It's best to think about extras as a way that you can make common health treatments more affordable.
Whatever your budget or lifestyle, there’s an extras cover to suit you. View covers
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Understanding extras cover
Extras cover is health insurance that covers you for non-hospital services and treatments that aren’t generally covered by Medicare. You can purchase extras cover as a standalone extras-only policy, or as part of a combined hospital and extras package.
With health insurance extras cover, you can save money on common things like optical, dental, physio, chiro and even remedial massage and acupuncture. These services depend on your level of extras cover, and the inclusions on your policy.
With extras cover you can choose what level of cover suits you best and whether you would prefer to get your benefit as either a set amount or a percentage amount back for each visit, up to your annual benefit limits.
Benefit limits
A benefit limit is the maximum amount of money GMHBA will pay towards a service during a specific period of time (usually per calendar year). If you have already claimed up to your extras benefit limit, any additional services won’t be covered by GMHBA until your limits reset.
It’s important to check the various benefit limits on your policy to make sure you’ve got the right level of coverage. If you think you might exceed your benefit limit, that could be a sign that you need a higher level of extras cover.
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How does extras cover work in Australia?
While Medicare contributes towards things like GP visits, care plans and the public hospital system, extras cover in Australia offers people the choice to be covered for a broader range of services that Medicare don’t typically cover.
When selecting extras cover with GMHBA, consider whether you would prefer to have set benefits or percentage back benefits when claiming. These benefit types are what determines your out-of-pocket expenses. Set benefits usually give you a set amount back when you claim up to your annual limit (great if you claim regularly on a range of services). Percentage back typically gives you a higher amount back each claim, which is either 55%, 65% or 75% up to your annual limits, depending on the cover you choose (helpful if you don’t claim regularly, but you could reach your limits faster).
To make a successful extras claim, the health provider you choose must be registered in their field, in private practise and recognised by GMHBA (annual limits and waiting periods apply).
How do I claim?
With most providers, you’ll be able to claim at the time of the appointment by swiping your membership card, so that GMHBA can pay the benefit directly to the provider and you just pay the difference. If your provider does not have the means to accept electronic claims at the point of service, then you will be required to pay the bill in full and then submit a claim directly to GMHBA to receive the benefit you're eligible for.
Keep in mind different extras products have different limits and waiting periods, and different services have different claim criteria. The Important Information Guide offers a comprehensive guide on how to claim with us, and your Fact Sheet or Private Health Insurance Statement (PHIS) gives you the specifics of your chosen cover. But we're also here to help answer any questions you may have around extras and claiming.
The claims process
There are a number of ways to claim your extras benefits:
On the spot: Most claims can be processed when you have your appointment. Just swipe your GMHBA membership card and we’ll pay the provider directly. You’ll just need to pay the difference. Note: some providers may not have this facility.
Online: You can either claim via our mobile app or the member area. With the app it’s simple, login to the app , head to “Make a claim”, take a photo of your receipt and press submit.
In a branch: You can always drop by a GMHBA branch to make a claim in person. Check out our branch locations here.
You can visit and claim on any provider who’s registered with the appropriate board for their field, and practicing in a private practice. You just have to be covered for the relevant service at the time you receive it.
Whether you’re young and single, a family or recently retired, extras cover is a great way to reduce the costs of maintaining your health by reducing out-of-pocket costs on routine treatments, like getting a dental check-up or seeing a physiotherapist.
Finding the right extras cover
Like most insurance, the trick is to pick the policy that has the bundle of services most suited to your needs. That way you’re not paying any unnecessary premiums. Here’s a few tips for finding the most suitable extras cover.
Services included: Make sure you review the services covered in your policy and consider which services you may need in the future.
Benefit limits: If you need additional, ongoing treatment in a particular area, such as physiotherapy, check the benefit limits to make sure you’re maximising your coverage. You don’t want to be caught short or reach your claim limit too soon.
Waiting periods: Extras covers have waiting periods, and these waiting periods will differ based on the type of treatment and when you took out cover. We’ve outlined these wait periods in more detail here.
Making the most of extras cover
To make the most of your extras cover, you need to factor in the cost of the policy, how likely you are to use the various services, the benefit and service limits (up to annual limits), and any relevant wait periods.
With GMHBA extras insurance, you can claim on services like physio, chiro, optical, dental and remedial massage. Most GMHBA benefit limits reset every year on 1 January, so it’s a good idea to make sure you use as much of the limits as you can before they reset each year to get the most value from your cover.
Extras health insurance is not tax deductible and won’t exclude you from the Medicare Levy Surcharge (if you are a high income earner); you must hold either hospital cover or combined hospital and extras cover to exempt you from paying MLS (if applicable to you).
If you have extras cover – even without hospital cover – you’re able to claim the Australian Government Rebate on private health insurance as either a premium reduction, or as a lump sum in your annual tax return. Keep in mind, your eligibility for the rebate is still determined by your age and income – you don’t automatically receive a rebate simply by having extras cover.
At GMHBA, we’re committed to providing flexible extras cover for all Australians, regardless of budget or circumstance. To find out which extras policy is right for you, give one of our friendly team members a call or view our covers online.
Frequently asked questions about extras cover
Extras cover is a type of private health insurance. It pays benefits towards health services you might use like dental, physio, optical and massage. Provided you’re covered for the relevant service, haven’t used all of your benefit limits and have served any relevant waiting periods at the time you receive the service, with private extras insurance, you’ll pay less out-of-pocket every time you use these services (up to your benefit limits).
There are a range of extras covers you can choose from, depending on your budget and health needs. These range from Basic Extras Cover which covers minimal services, set benefits and lower annual limits, all the way to Top Extras 75%, which gives you 75% back on extras at any registered provider, provided its included on your cover, you’ve served your waiting periods and you’ve not reached your benefit limits. Typically, the more services and higher benefits included in your policy, the more expensive the premium will be.
When you use a registered health service that’s covered by your policy, GMHBA will pay a benefit towards your treatment. You can usually claim this at the time of the appointment electronically, meaning you’ll just pay the difference – the “out-of-pocket” – to the provider. Or, if you pay the provider in full, the benefit can be paid straight into your nominated bank account when you submit your claim to GMHBA using the mobile app or your member area. View more information on how to make a claim.
That all depends on your lifestyle, health needs, and your budget. If you find yourself using common health services, like dental, physio and optical regularly it might make sense to take out extras cover to help make the treatment more affordable.
Of course. You can buy an extras-only cover and forgo hospital cover or vice versa. It’s entirely up to you and your personal circumstances. Extras-only policies are generally much cheaper, although keep in mind you won’t be covered for any hospital related treatment, and it won’t help to avoid the Medicare Levy Surcharge if you’re a high-income earner.
No, extras cover is not considered a deductible expense. However, by taking out extras cover, and depending on your annual income, you may be eligible to receive the Australian Government Rebate on private health insurance, as a premium reduction or a lump sum when you lodge your annual tax return.
Extras cover, by itself, will not exempt you from the Medicare Levy Surcharge if you are a high income earner. For that you’ll either need hospital cover, or combined hospital and extras cover. You can learn more about the Medicare Levy Surcharge over here.