What is extras cover and do I need it?

Advertisements for health insurance almost always mention "Extras cover". You might already have private health insurance and not be sure if Extras cover is included in your policy or you may be wondering, what exactly is Extras cover and do I even need it?

In Australia, there are two types of private health insurance cover available – 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 what services you want cover for.

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).

Each Extras cover you look at will usually list a certain "percentage back" amount for services, up to an annual limit. For example, if the cover you're looking at gives you 60% back on physio, your $100 visit would only leave you $40 out of pocket, until you reach your limit for the year. Once you reach this limit, you won't be able to claim anything more for that particular service until your benefits are reset for 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 cover, other limits may also apply on particular services so it's important to understand your entitlements.

Tip: To avoid your annual limit creeping up on you unexpectedly, you can keep track of your usage throughout the year in Member Services.

If you're purchasing cover 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 to ensure you’re fully aware of any waiting periods that may apply so you know when you can start making claims.

Claiming on your extras cover is quick and easy. Depending on the provider you’ve been to see, when you pay for your service, you may be able to 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 sort out the gap.

If this isn’t an option for you, you can use either the nib app or member account from your phone, tablet or computer to submit your claim. It’s simply a matter of taking a photo of your receipts and pressing submit. Other claiming options are also available.

Q: How do I check my annual limits?

A: You can easily check your annual limits and how much you have left to claim. Just head over to the "My Usage" tab in your member account or in the nib App. Or, if you prefer a chat, you can always contact us.

Q: When do my Extras limits reset?

A: For most of our members, limits reset with the start of each calendar year.

Q: What is a lifetime limit?

A: A lifetime limit is the maximum amount you can claim on a specific service in your lifetime, even if you change health insurers. Once you reach this limit, you won't be able to claim on that service again.

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 previous 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.

Now, you might be wondering, "Does my basic Extras cover count as private patient hospital cover?" The answer is, unfortunately, no. 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: Can I get Extras cover without paying for Hospital cover?

A: Absolutely! In Australia, there are two main types of private health insurance cover – Hospital cover and Extras cover.

Think of them like a dynamic duo. They can work together, but they're also strong enough to stand alone. With nib, for example, you can pair up 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 like dental, optical or physio.

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 new services to your cover, you might need to serve waiting periods before you can claim for these services.

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. Give us a call to chat through your options.

Remember, the best Extras cover for you is the one that gives you peace of mind and supports your health journey.

Choosing the right extras cover and finding great value is much easier than it first appears. It’s a case of looking at your lifestyle and health requirements and selecting the health services and features you want and may need. To check out the Extras options nib has available, visit our Compare Extras page or get a quote.