HEALTH INSURANCE OPTICAL COVER
Optical cover through extras insurance helps pay for prescription glasses, contact lenses, prescription sunglasses, and eye tests. For anyone who wears corrective lenses, it can save hundreds of dollars each year — a single pair of progressive glasses costs {{PROGRESSIVE_GLASSES_COST}} out of pocket, while extras optical benefits cover a significant portion of that cost.
Most extras policies include optical benefits ranging from {{MIN_OPTICAL_LIMIT}}/year (Basic extras) to {{MAX_OPTICAL_LIMIT}}/year (Top extras), with a standard 2-month waiting period. Combined with dental and other services from the same extras policy, optical benefits often tip the value equation in favour of holding extras cover.
Optical extras is completely separate from eye surgery covered by hospital insurance. Extras pays for glasses and lenses at an optometrist. Eye surgery (cataracts, glaucoma, retinal procedures) requires hospital cover at the appropriate tier — see the Eye Surgery page (/conditions/ophthalmology/) for that information.
WHAT'S COVERED
| Service | Basic Extras | Mid Extras | Top Extras | Waiting |
|---|---|---|---|---|
| Prescription glasses (frames + lenses) | ✅ {{BASIC_OPTICAL_LIMIT}}/yr | ✅ {{MID_OPTICAL_LIMIT}}/yr | ✅ {{TOP_OPTICAL_LIMIT}}/yr | 2 months |
| Contact lenses (prescription) | ✅ In optical limit | ✅ In optical limit | ✅ In optical limit | 2 months |
| Prescription sunglasses | ✅ In optical limit | ✅ In optical limit | ✅ In optical limit | 2 months |
| Eye tests (optometry consultation) | ✅ Included | ✅ Included | ✅ Included | 2 months |
| Lens coatings (anti-reflective, blue light, transitions) | ✅ In optical limit | ✅ In optical limit | ✅ In optical limit | 2 months |
| Reading glasses (prescription) | ✅ In optical limit | ✅ In optical limit | ✅ In optical limit | 2 months |
| Safety glasses (prescription) | ⚠️ Some policies | ⚠️ Some policies | ✅ Most policies | 2 months |
| Repairs to existing glasses | ⚠️ Some policies | ⚠️ Some policies | ⚠️ Some policies | 2 months |
| Laser eye surgery (LASIK/PRK/SMILE) | ❌ Never | ❌ Never | ❌ Never | N/A |
| Non-prescription sunglasses | ❌ Not covered | ❌ Not covered | ❌ Not covered | N/A |
| Non-prescription reading glasses | ❌ Not covered | ❌ Not covered | ❌ Not covered | N/A |
HOW OPTICAL BENEFITS ARE CALCULATED
Most insurers pay a percentage of the cost (typically {{OPTICAL_BENEFIT_PCT_RANGE}}) up to your annual limit. Some insurers pay a fixed dollar benefit per item instead of a percentage.
Percentage-based example (Mid extras):
| Item | Retail cost | Benefit ({{MID_OPTICAL_BENEFIT_PCT}}) | You pay | Running total claimed |
|---|---|---|---|---|
| Frames | {{FRAMES_COST_EXAMPLE}} | {{FRAMES_REBATE_EXAMPLE}} | {{FRAMES_GAP_EXAMPLE}} | {{FRAMES_REBATE_EXAMPLE}} |
| Single-vision lenses | {{SV_LENSES_COST_EXAMPLE}} | {{SV_LENSES_REBATE_EXAMPLE}} | {{SV_LENSES_GAP_EXAMPLE}} | {{SV_RUNNING_TOTAL}} |
| Anti-reflective coating | {{AR_COAT_COST_EXAMPLE}} | {{AR_COAT_REBATE_EXAMPLE}} | {{AR_COAT_GAP_EXAMPLE}} | {{AR_RUNNING_TOTAL}} |
| Total glasses | {{GLASSES_TOTAL_COST}} | {{GLASSES_TOTAL_REBATE}} (capped at {{MID_OPTICAL_LIMIT}}) | {{GLASSES_TOTAL_GAP}} |
If the calculated benefit exceeds your annual limit, the insurer pays up to the limit and you pay the rest. For example, if your limit is {{MID_OPTICAL_LIMIT}} and the calculated benefit is {{GLASSES_TOTAL_REBATE_UNCAPPED}}, you receive {{MID_OPTICAL_LIMIT}} and pay {{GLASSES_CAPPED_GAP}}.
PREFERRED PROVIDERS AND NO-GAP OPTICAL
Most insurers have agreements with optical chains where you receive higher benefits — sometimes 100% coverage on selected frames and lenses within your limit.
How preferred optical providers work:
| Factor | Preferred Provider | Non-Preferred Provider |
|---|---|---|
| Benefit on frames | Up to 100% on selected range | {{OPTICAL_BENEFIT_PCT_RANGE}} of retail |
| Benefit on lenses | Up to 100% on standard lenses | {{OPTICAL_BENEFIT_PCT_RANGE}} of retail |
| Frames available | Curated range (selected brands/styles) | Any frames |
| Lens upgrades | Standard included; premium at extra cost | All at benefit percentage |
| Out-of-pocket (basic glasses) | Often $0 within limit | {{BASIC_GLASSES_GAP_RANGE}} gap |
| Out-of-pocket (premium glasses) | Gap on upgrades only | Full gap on everything |
Common preferred optical providers: Major optical chains (Specsavers, OPSM, Laubman & Pank, Big W Optical) are preferred providers for multiple insurers. Your insurer's app or website has a "Find a Provider" tool to locate preferred optometrists near you.
The trade-off: At preferred providers, you often get basic glasses for $0 out of pocket — but you're limited to a curated frame range. If you want designer frames or specific brands not in the preferred range, you'll pay the gap. At non-preferred providers, you choose any frames but pay a larger gap on everything.
Strategy: Get your eye test and basic glasses at a preferred provider (maximising your benefit). If you want a second pair of designer frames or prescription sunglasses, buy those separately and claim whatever limit remains.
OPTICAL vs EYE SURGERY — DIFFERENT INSURANCE
| Need | Insurance Type | Tier Required | What It Covers |
|---|---|---|---|
| Glasses, contacts, eye tests | Extras (optical benefit) | Any extras level | Out-of-hospital optical services |
| Cataract surgery | Hospital cover | Silver or Gold | Hospital admission for lens replacement |
| Glaucoma surgery | Hospital cover | Bronze and above | Hospital-based surgical procedures |
| Retinal surgery | Hospital cover | Bronze and above | Hospital procedures |
| Laser eye surgery (LASIK) | Not covered by any insurance | N/A | Must pay entirely out of pocket ({{LASIK_COST_PER_EYE}}/eye) |
You can have Gold hospital cover with full eye surgery coverage but no optical extras — meaning cataracts are covered but glasses aren't. To cover both, you need hospital cover (appropriate tier) plus extras with optical benefits.
EYE TESTS — MEDICARE vs EXTRAS
Eye tests (optometry consultations) are covered by both Medicare and extras, but the entitlements are separate:
Medicare: Comprehensive eye tests are bulk-billed (free) every 3 years for most adults. People with diabetes, glaucoma, or other eye conditions may be eligible for annual Medicare-covered tests. Medicare covers the clinical examination — refraction (prescription measurement) may have a small additional fee.
Extras: Eye tests are included in your optical benefit and can be claimed at any time (after the 2-month waiting period). Claiming an eye test on extras uses a portion of your annual optical limit.
Strategy: Use your Medicare entitlement for the eye test (free, every 3 years or annually if eligible). Save your extras optical limit for glasses and contacts. If you need an eye test in a year where you're not Medicare-eligible, claim it on extras.
MAXIMISING YOUR OPTICAL BENEFITS
Time purchases around your limit reset Annual limits reset on 1 January or your policy anniversary date. If your limit resets in January, buy glasses in December to use the current year's limit, then buy contacts or sunglasses in January under the new limit — effectively doubling your available benefits over a short period.
Separate glasses and contacts across years If you need both glasses and contact lenses, they share the same optical limit. Claim glasses one year and contacts the next (or vice versa) to stay within limits rather than exhausting the entire limit on both in one year.
Use Medicare for eye tests Preserve your extras optical limit for glasses and lenses by using your Medicare eye test entitlement instead. This is free and doesn't reduce your extras limit.
Check for end-of-financial-year offers Some optical providers run promotions in June (EOFY) and December/January (limit reset periods). Combining provider discounts with your extras benefit maximises value.
Consider total extras value Don't evaluate optical alone. Basic extras at {{MIN_BASIC_EXTRAS_PRICE}}/week combines optical ({{BASIC_OPTICAL_LIMIT}}/year) with dental ({{BASIC_GENERAL_DENTAL_LIMIT}}/year) and physio ({{BASIC_PHYSIO_LIMIT}}/year). A pair of glasses plus two dental check-ups often exceeds the annual premium.
TYPICAL COSTS — WITH AND WITHOUT EXTRAS
| Item | Retail Cost | Extras Rebate (Mid) | Your Out-of-Pocket | At Preferred Provider |
|---|---|---|---|---|
| Basic single-vision glasses | {{SV_GLASSES_COST}} | {{SV_GLASSES_REBATE}} | {{SV_GLASSES_GAP}} | Often $0 |
| Progressive/multifocal glasses | {{PROGRESSIVE_GLASSES_COST}} | {{PROGRESSIVE_REBATE}} (may hit limit) | {{PROGRESSIVE_GAP}} | {{PROGRESSIVE_PREFERRED_GAP}} |
| Annual supply contact lenses | {{CONTACTS_ANNUAL_COST}} | {{CONTACTS_REBATE}} | {{CONTACTS_GAP}} | {{CONTACTS_PREFERRED_GAP}} |
| Prescription sunglasses | {{RX_SUNNIES_COST}} | {{RX_SUNNIES_REBATE}} | {{RX_SUNNIES_GAP}} | {{RX_SUNNIES_PREFERRED_GAP}} |
| Eye test (optometry) | {{EYE_TEST_COST}} | {{EYE_TEST_REBATE}} (or free via Medicare) | {{EYE_TEST_GAP}} | Often bulk-billed |
| Designer frames + premium lenses | {{DESIGNER_GLASSES_COST}} | {{DESIGNER_REBATE}} (capped at limit) | {{DESIGNER_GAP}} | Not typically in preferred range |
COMPARE EXTRAS POLICIES BY OPTICAL BENEFITS
Filter Panel:
- Extras Level: [All] [Basic] [Mid] [Top]
- Min Optical Limit: [Slider: $0 — {{MAX_OPTICAL_LIMIT}}]
- Preferred Providers Near Me: [☐ Show policies with preferred optometrists in {{PROFILE_STATE}}]
Table Columns: Insurer | Policy Name | Extras Level | Optical Limit | Benefit % | Preferred Providers | Premium/wk | [Compare]
Query: SELECT i.insurer_name, p.policy_name, p.extras_level, eb.optical_annual_limit, eb.optical_benefit_pct, pp.preferred_optical_count, p.premium_weekly_after_rebate FROM policies p JOIN insurers i ON p.insurer_id = i.id JOIN extras_benefits eb ON p.policy_id = eb.policy_id LEFT JOIN (SELECT insurer_id, COUNT(*) as preferred_optical_count FROM preferred_providers WHERE service = 'optical' AND state = {{PROFILE_STATE}} GROUP BY insurer_id) pp ON i.id = pp.insurer_id WHERE eb.optical_included = true AND p.profile_id = {{CURRENT_PROFILE_ID}} ORDER BY eb.optical_annual_limit DESC
Frequently asked questions
What does optical cover include?
Extras optical covers prescription glasses (frames and lenses), contact lenses, prescription sunglasses, and eye tests. Benefits are paid as a percentage ({{OPTICAL_BENEFIT_PCT_RANGE}}) up to your annual limit ({{MIN_OPTICAL_LIMIT}}-{{MAX_OPTICAL_LIMIT}}/year depending on extras level). Laser eye surgery (LASIK/PRK) is never covered.
How much optical benefit do I get?
Basic extras: {{BASIC_OPTICAL_LIMIT}}/year. Mid extras: {{MID_OPTICAL_LIMIT}}/year. Top extras: {{TOP_OPTICAL_LIMIT}}/year. At preferred providers, you may receive up to 100% benefit on selected frames and standard lenses — effectively $0 out-of-pocket glasses within your limit.
Does optical cover laser eye surgery?
No. Laser eye surgery (LASIK, PRK, SMILE) for refractive correction is not covered by any tier of hospital insurance or extras cover. It's considered elective and must be paid entirely out of pocket — typically {{LASIK_COST_PER_EYE}} per eye.
Is there a waiting period for optical?
Yes, 2 months from the date you join or add extras. After that, you can claim immediately. If switching insurers with equivalent extras, your served waiting period transfers under portability rules.
Can I choose any optometrist?
Yes. Preferred providers (optical chains with insurer agreements) offer higher benefits — often 100% on basic glasses. Non-preferred optometrists are still covered at your policy's standard benefit percentage ({{OPTICAL_BENEFIT_PCT_RANGE}}), but with a larger out-of-pocket gap.
Does optical cover children's glasses?
Yes. Children on your family policy claim under the family's optical benefit. Some insurers have separate per-person limits; others share a family pool. Check your PDS for the limit structure.
How often can I claim new glasses?
As often as you like, up to your annual limit. Most people claim once per year for a new pair. Once your limit is reached, no further optical benefits are paid until it resets (1 January or policy anniversary).
Does extras cover eye tests?
Yes, under your optical benefit. However, Medicare also covers comprehensive eye tests every 3 years (annually for some conditions) at no cost. Use Medicare first to preserve your extras limit for glasses and contacts.
Are prescription sunglasses covered?
Yes. Prescription sunglasses are covered at the same rate as regular prescription glasses, from your optical annual limit. Claiming both glasses and sunglasses in one year may exceed your limit — consider splitting across years.
Is optical cover worth it just for glasses?
Optical alone may not justify extras at {{MIN_BASIC_EXTRAS_PRICE}}/week. But basic extras combines optical ({{BASIC_OPTICAL_LIMIT}}) with dental ({{BASIC_GENERAL_DENTAL_LIMIT}}) and physio ({{BASIC_PHYSIO_LIMIT}}). A pair of glasses plus two dental check-ups typically exceeds the annual premium — making extras worthwhile across combined services.
