Extras vs Hospital cover
Private health insurance in Australia has two parts. Hospital cover pays towards hospital stays and surgery. Extras (also called General Treatment) pays towards services outside hospital — dental, glasses, physio, massage, acupuncture, psychology and more. Many people hold both but forget about Extras, and the limits go unused every year.
Annual limits: the most you can claim each year
Extras usually sets a yearly limit per category, such as "general dental $700 a year" or "optical $250 a year". Each visit pays a set benefit until the limit is used up. Some categories share one limit — physio, chiro and osteo often do.
- Many insurers reset limits on 1 January; some use the financial year (1 July) or your membership anniversary. Check your policy.
- Unused limits usually don't carry over (a few policies offer loyalty top-ups).
Waiting periods: new cover can't be used straight away
New or upgraded policies have a waiting period for each category. Common examples: about 2 months for general dental and physio, about 6 months for glasses, and about 12 months for major dental (crowns, root canals) and orthodontics. Visits during the waiting period can't be claimed. Check your own policy.
The gap: what you pay after the rebate
The provider's fee minus your Extras benefit is the gap, which you pay yourself. Fees vary between providers, so the gap does too. Some insurers pay more — even "no gap" — at their partner providers.
How to check your limits
- Your insurer's app or member website shows each limit and how much you've used this year.
- Your policy's Private Health Information Statement (PHIS) is on privatehealth.gov.au.
- At the provider: ask reception to check your rebate via HICAPS before you pay.
- Or use our My Extras tool for a rough estimate of what's left.