Is Extras cover worth it? What you need to know
You’ve probably heard the term "Extras cover" – but what is it exactly? And do you really need it? Whether you already have private health insurance or you’re just starting to explore your options, we’ve got you covered.
In Australia, there are two main types of private health insurance cover – hospital cover and Extras cover. With nib, for example, you can get both Hospital and Extras cover, or you can choose to take out one or the other, depending on the services you want to be covered for.
What is Extras cover?
Extras cover (sometimes referred to as "ancillary cover") can help you cover the cost of the everyday services you and your family use to stay healthy, like going to the dentist for a check-up, a visit to the optometrist for new glasses or seeing the physio. Depending on the cover you choose, Extras can also include natural therapies like acupuncture and remedial massage, and a range of healthier lifestyle options (like some gym memberships or quit smoking programs).
How much can I claim on Extras?
Your Extras cover gives you back a percentage of what you spend on services, up to an annual limit.
For example:
Your physio visit costs $100
Your cover pays 60% on physio
You pay just $40 (until you reach your limit for the year)
Your insurer pays the other $60.
Once you reach your annual limit, you won't be able to claim for that service again until your benefits reset at the start of the new calendar year..
It's worth noting that the covers offering the highest annual limits and the biggest percentage back on your claims are usually more expensive. Depending on your policy, other limits may also apply, so it's important to know what you’re covered for.
Tip: Keep track of your yearly limits in the nib App or your member account. Follow our step-by-step guide to check your annual limits.
Watch your waiting periods
If you're taking out private health insurance for the first time, or increasing your level of cover, you’ll probably need to wait a few months before you can claim on some, or all, of your inclusions. Make sure you read the details of your policy so that you’re fully aware of any waiting periods that may apply and when you can start making claims.
How do I claim on my Extras cover?
It’s easy to claim on your Extras when you pay for a service after your appointment, you may be able to tap or swipe your nib card through what’s called a HICAPS machine. As long as you’re covered for that service and haven’t reached your annual limit, we’ll pay your claim on the spot and you’ll only need to cover the gap.
If this isn’t an option for you, you can submit your claim through the nib App or your member account. It’s simply a matter of taking a photo of your receipts and pressing submit. Check our step-by-step guide to make a claim online for more options.
Your Extras cover FAQs
Q: How do I check my annual limits?
You can easily check your annual limits and how much you have left to claim in the nib App:
Log in to the nib App
Select 'Cover' on the main navigation
Choose 'My Extras usage' to see the full list of your Extras and how much you have left to claim for each service.
Follow our easy annual limits guide for more ways to check your annual limits.
Q: When do my Extras limits reset?
A: For most of our members, annual limits reset at the start of each calendar year.
Q: What is a lifetime limit?
A: A lifetime limit is the maximum you can claim on a specific service in your life. Once you reach it, you won't be able to claim on that service again, even if you switch insurers.
Q: What happens to my annual limits if I transfer from another health fund to nib?
A: Any benefits you've already claimed with your other health fund this calendar year will be deducted from your new cover with nib. For example, if you have an annual limit of $1,000 for major dental treatment and you've already claimed $400 this calendar year, you'll still have $600 remaining. If you've recently made the switch, your private health insurance annual limits will reset on 1 January.
Q: How do I compare Extras cover?
A: Start by listing down your specific needs - think dental, optical, physiotherapy and more. Next, look for health insurance policies that cater to these needs. Don't forget to check the annual limits, waiting periods and out-of-pocket expenses. Remember, the best Extras cover is one that suits your lifestyle and budget perfectly.
Q: When can I start claiming on Extras?
A: We're glad you're excited to start using your Extras cover! If you're new to nib or have recently upgraded your level of cover, you might need to serve a waiting period before you can start claiming on some or all of your Extras.
Be sure to read the details of your policy carefully. It's important to know about any waiting periods that might apply so you can plan when to start making claims.
Q: Do I still have to pay the Medicare Levy Surcharge if I have basic Extras cover?
A: That's a great question! The Medicare Levy Surcharge (MLS) is a tax that applies to individuals and families who don't have an appropriate level of private patient hospital cover and earn above a certain income.
You might be wondering, "Does my basic Extras cover count as private patient hospital cover?" The answer is, unfortunately, it doesn’t. Extras cover helps with the costs of services outside the hospital, like dental, optical, and physiotherapy. It's not the same as private patient hospital cover, which is what the Australian Tax Office considers when determining if you have to pay the MLS.
So, if you only have basic Extras cover, you may still need to pay the MLS, depending on your income.
Q: Does Medicare cover dental or physio?
Medicare generally doesn’t cover routine dental or physiotherapy. But there are some exceptions. For example, if you’re on Centrelink with a child under 17, then you might be able to get some of your dental appointments covered under the Child Dental Benefits Scheme.
Q: Can I get Extras cover without paying for Hospital cover?
A: Yes, you can get Extras cover on its own or pair it with Hospital cover. It just depends on what you need.
With nib, for example, you can combine Hospital and Extras cover for a comprehensive package. But if you prefer, you can also choose to take out just one or the other, depending on what services you want to be covered for. If you're young, fit and healthy, you may want to get basic Hospital cover and pair it with an Extras package that gives you more of what you need right now, like dental, optical or physio.
Feature | Hospital cover | Extras cover |
What it helps with | Covers treatment and care if you’re admitted to hospital | Covers everyday health services you use outside of hospital |
Examples of services | Surgery, overnight stays, rehab, private room, anaesthetist | Dental check-ups, optical, physio, chiro, massage |
Where it's used | In hospital | At dentists, physios, optometrists and more |
Main benefit | Avoid public hospital waitlists and get more choice over your care | Get money back on regular health services and reduce out of pocket costs |
Is it taxed if I don’t have it? | Yes – if you earn over the income threshold, you may pay the Medicare Levy Surcharge (MLS) | No – Extras cover doesn’t affect tax |
Can I get it on its own? | Yes | Yes |
With nib... | Choose from different levels of Hospital cover based on your needs | Pick Extras cover that suits your lifestyle and health goals |
Q: Can I customise my Extras cover?
You can customise your Extras cover to an extent. If you’re looking at nib Extras cover, there are different levels to choose from depending on the services you want to access and the amount you want to claim. Simply pick the cover that suits you.
Q: When is Extras cover really worth it?
There are times when Extras cover can be really important. If you’ve got a growing family or have lots of dental or optical needs, then Extras cover can be the best type of cover to help you get more out of those appointments. At the same time if you’re very active or want to focus on preventative health, then Extras can give you access to more health experts to help you on that journey.
Q: What is the best Extras cover for me?
A: Finding the best Extras cover is a bit like shopping for the perfect pair of jeans - it needs to fit you just right.
Let's say you're a rugby enthusiast. You love the thrill of the game, but it can be tough on your body. In this case, you might want an Extras cover that includes physiotherapy to help keep you in top form.
The beauty of Extras cover with nib is that it's flexible. You can change your cover at any time to suit your evolving lifestyle needs. Just keep in mind that if you add something new to your cover, you still might need to serve waiting periods before you can claim for them.
Not sure if you're making the most of your Extras? It might be time to review your cover. We're here to help you assess your needs and make sure your cover is working hard for you. Log in to the nib App or your member account to review or change your cover, or contact us to discuss your options.
Choosing the right Extras cover is easier than you think. Just look at your lifestyle, what you use now and what you might need in future.
Get a quote to check out the Extras options nib has available. Remember, the best Extras cover for you is the one that gives you added peace of mind and support for your health journey.