What Extras Cover Includes: Complete Guide to Services and Limits

The Basics

Extras cover = Insurance for healthcare services Medicare doesn't cover

Main services:

• Dental (check-ups, fillings, crowns, orthodontics)
• Optical (glasses, contacts, eye tests)
• Physiotherapy
• Chiropractic
• Remedial massage
• Psychology (limited)
• Podiatry
• Other allied health

How it works:

1. You visit provider (dentist, optometrist, physio, etc.)
2. Pay provider in full
3. Claim from insurer (instant with HICAPS or submit later)
4. Receive rebate (percentage of cost, up to annual limit)
5. You keep the rebate, pay the gap

Feature	Hospital Cover	Extras Cover
What it covers	Hospital treatment as private patient	Dental, optical, allied health
Where	In hospital	Outside hospital (clinics, practices)
Medicare involvement	Medicare + Insurer both pay portions	Medicare doesn't cover (insurer only)
Limits	Usually unlimited claims	Annual limits per service
Waiting periods	2-12 months	2-6 months
Required?	For MLS avoidance (high earners)	Optional
Typical cost	$1,800-$5,000/year	$420-$1,080/year

Can have separately: Hospital-only, extras-only, or both combined

Hospital vs Extras vs Combined →

Medicare covers: ✓ Hospital treatment (public hospitals) ✓ GP visits ✓ Specialist consultations ✓ Tests and scans (with referral)

Medicare does NOT cover: ❌ Dental (adults) ❌ Optical (glasses, contacts) ❌ Physiotherapy ❌ Chiropractic ❌ Most allied health

Extras insurance fills this gap — covers services you'd otherwise pay 100% out-of-pocket.

1. Dental Services

General dental:

• Check-ups and cleaning
• X-rays
• Fillings (amalgam, composite)
• Simple extractions
• Fluoride treatments
• Mouthguards

Major dental:

• Crowns
• Bridges
• Root canals
• Dentures
• Implants (some policies)
• Complex extractions

Orthodontics (separate category):

• Braces
• Invisalign
• Retainers
• Usually lifetime limits ($2,000-$4,000 total)

2. Optical Services

Covered:

• Eye examinations
• Prescription glasses (frames + lenses)
• Contact lenses
• Prescription sunglasses
• Lens coatings (anti-reflective, etc.)

Not covered:

• Non-prescription sunglasses
• Reading glasses (non-prescription)
• Laser eye surgery (usually separate category or not covered)

3. Physiotherapy

Covered:

• Consultations
• Treatment sessions
• Sports injury management
• Post-surgery rehabilitation
• Chronic pain management

Common conditions:

• Back pain
• Neck pain
• Sports injuries
• Post-operative recovery
• Arthritis management

4. Chiropractic

Covered:

• Consultations
• Spinal adjustments
• Manipulations
• Treatment plans

Common uses:

• Back/neck pain
• Headaches
• Posture issues
• Sports injuries

5. Remedial Massage

Covered:

• Therapeutic massage
• Sports massage
• Deep tissue massage
• Injury treatment

Not covered:

• Relaxation massage (no medical purpose)
• Spa treatments

6. Psychology

Covered:

• Consultations with registered psychologist
• Mental health treatment sessions

Limits:

• Typically 6-12 sessions per year
• Some policies exclude psychology entirely
• Check your specific policy

Note: Medicare also provides psychology rebates (Better Access scheme). Can claim both Medicare + extras for same service.

7. Other Allied Health

Commonly covered:

• Podiatry (foot care)
• Dietetics (nutritional counseling)
• Occupational therapy
• Speech therapy
• Acupuncture
• Naturopathy
• Osteopathy

Coverage varies widely — some policies include many services, others exclude natural therapies.

Annual Limits Explained

Every service has an annual cap on how much you can claim.

Example:

• Dental limit: $800/year
• You claim: $600 (check-up, filling)
• Remaining: $200 for rest of year

Once limit reached: 100% out-of-pocket until next reset.

Limits reset:

• Calendar year (January 1) — most common
• Policy anniversary (your join date) — some insurers

Percentage Rebates

You don't get 100% back — you get a percentage up to the limit.

Example:

• Dental filling costs: $220
• Your policy: 80% rebate, $800 annual limit
• You claim: $176 (80% of $220)
• You pay: $44
• Remaining limit: $624

Common rebate percentages:

• Comprehensive extras: 75-100%
• Mid-level extras: 60-85%
• Basic extras: 50-70%

Combined Limits vs Separate Limits

Separate limits (most policies):

• General dental: $800
• Major dental: $1,200
• Optical: $300
• Physio: $500
• Each service separate

Combined limits (some policies):

• "All extras: $2,000 total"
• Use on any service
• More flexible but can run out faster

Before you can claim:

General services: 2 months (typical)

• Dental check-ups, optical, basic physio

Major dental: 6-12 months

• Crowns, root canals, dentures

Orthodontics: 12 months (typical)

Why they exist: Prevent people getting insurance just before expensive treatment, then canceling.

Full guide: Waiting Periods →

Comprehensive / Top Extras

Annual premium: $900-$1,200/year (singles, Feb 2026)

Typical limits:

Service	Annual Limit	Rebate %
General dental	$900-$1,200	75-100%
Major dental	$1,500-$2,000 per 2 years	60-80%
Optical	$400-$500 per 1-2 years	80-100%
Physiotherapy	$600-$800 (12-15 visits)	75-85%
Chiropractic	$500-$700 (10-12 visits)	75-85%
Psychology	$600-$800 (8-12 visits)	70-85%
Remedial massage	$400-$600 (10-12 visits)	70-80%

Total potential benefits: $2,500-$3,500/year

Best for:

• High extras users (regular dental, physio, chiro)
• Families (kids' dental, optical)
• Chronic conditions (ongoing physio/allied health)

Mid-Level Extras

Annual premium: $600-$800/year (singles, Feb 2026)

Typical limits:

Service	Annual Limit	Rebate %
General dental	$600-$800	60-80%
Major dental	$1,000-$1,500 per 2 years	50-70%
Optical	$250-$350 per 1-2 years	70-90%
Physiotherapy	$400-$600 (8-10 visits)	60-75%
Chiropractic	$300-$500 (6-10 visits)	60-75%
Psychology	$400-$600 (6-8 visits)	60-75%
Remedial massage	$300-$400 (6-8 visits)	60-70%

Total potential benefits: $1,500-$2,000/year

Best for:

• Moderate extras users
• Regular dental care + some allied health
• Budget-conscious but want solid coverage

Basic Extras

Annual premium: $350-$500/year (singles, Feb 2026)

Typical limits:

Service	Annual Limit	Rebate %
General dental	$400-$600	50-70%
Major dental	$600-$800 per 2 years	50-60%
Optical	$150-$250 per 2 years	60-80%
Physiotherapy	$200-$400 (4-8 visits)	50-65%
Chiropractic	$200-$300 (4-6 visits)	50-65%

Total potential benefits: $800-$1,200/year

Best for:

• Light extras users (dental check-ups only)
• Want some coverage but low budget
• Don't use allied health regularly

General Dental vs Major Dental

Insurers separate dental into two categories:

General dental (preventative/minor):

• Check-ups: 6-12 month intervals
• Cleaning/scale: Usually with check-ups
• X-rays: Annual or as needed
• Fillings: Cavities
• Simple extractions
• Fluoride treatments

Typical costs:

• Check-up + clean: $180-$300
• Filling: $150-$300 each
• X-rays: $40-$150

Annual limit: $600-$1,200 (depends on extras level)

Major dental (restorative):

• Crowns: $1,500-$2,500 each
• Root canals: $800-$2,000
• Bridges: $2,000-$4,000+
• Dentures: $1,500-$3,000+
• Implants: $3,000-$6,000 each (if covered)

Annual limit: $800-$2,000 (often per 2 years, not annual) Waiting period: 6-12 months (longer than general)

Orthodontics (Braces)

Separate category from general/major dental.

Covered:

• Traditional braces
• Invisalign (some policies)
• Retainers

Typical coverage:

• Lifetime limit: $2,000-$4,000 total
• Not annual — this is total over lifetime
• Percentage: 50-70% of costs

Example:

• Braces cost: $8,000
• Policy covers: $3,000 (lifetime limit)
• You pay: $5,000

Waiting period: 12 months Who benefits: Families with kids needing braces

Scenario: Annual dental usage Person: Moderate dental needs

• 2 check-ups + cleans: $400
• 1 filling: $220
• Total annual cost: $620

Mid-level extras ($720/year premium):

• Rebate (75%): $465
• You pay: $155 + $720 premium = $875 total

Without insurance:

• Pay out-of-pocket: $620

Result: Insurance costs $255 MORE than paying out-of-pocket.

When extras becomes valuable:

• If you need crown ($1,800): Claim $1,200 (major dental limit)
• Total claims: $465 (general) + $1,200 (major) = $1,665
• Premium: $720
• Net value: $945 ($1,665 claimed - $720 premium)

Key insight: Extras valuable if you have major dental work, not just check-ups.

What's Covered

Covered:

• Eye examinations (optometrist): $60-$150
• Prescription glasses (frames + lenses): $200-$800+
• Contact lenses: $200-$500/year
• Prescription sunglasses: $200-$600
• Lens coatings/treatments: Included

Not covered:

• Non-prescription sunglasses
• Fashion/reading glasses (non-prescription)
• Laser eye surgery (usually)

Optical Limits

Typical limits:

• Comprehensive: $400-$500 per 1-2 years
• Mid-level: $250-$350 per 1-2 years
• Basic: $150-$250 per 2 years

Reset: Often 2-year cycles (can claim every 2 years, not annually) Rebate percentage: 70-100% (up to limit)

Real Optical Value Example

Scenario: New glasses needed Glasses cost: $450 (frames $200 + lenses $250) Mid-level extras ($720/year premium):

• Optical limit: $300 per 2 years
• Rebate: $300 (100% up to limit)
• You pay: $150 + annual premium
• Frequency: Every 2 years = $360/year amortized premium
• Effective cost: $150 + $360 = $510 for $450 glasses

Without insurance:

• Pay: $450 every 2 years

Result: Insurance costs $60 MORE over 2 years for just optical.

When valuable: If you also use dental/physio heavily (amortize premium across all services).

Physiotherapy

Common uses:

• Back/neck pain
• Sports injuries
• Post-surgery rehab
• Chronic pain management
• Arthritis

Typical costs:

• Consultation: $80-$120 per visit
• Treatment includes: Assessment, hands-on therapy, exercise prescription

Annual usage:

• Acute injury: 6-10 visits
• Chronic condition: 12-20+ visits

Extras coverage:

• Limit: $400-$800/year (6-15 visits)
• Rebate: 60-85%
• Remaining: Pay gap or out-of-pocket after limit

Chiropractic

Common uses:

• Back/neck adjustments
• Headaches/migraines
• Posture issues
• Sports injuries

Typical costs:

• Initial consultation: $80-$120
• Follow-up adjustments: $60-$90 each

Annual usage:

• Occasional: 4-8 visits
• Regular maintenance: 12-24 visits

Extras coverage:

• Limit: $300-$700/year (6-12 visits)
• Rebate: 60-85%

Psychology

Common uses:

• Mental health treatment
• Anxiety, depression
• Stress management
• Relationship counseling

Typical costs:

• Session: $150-$250

Medicare also covers:

• Better Access scheme: Up to 10 sessions/year with rebate
• Can claim both Medicare + extras for same session

Extras coverage:

• Limit: $400-$800/year (4-12 visits)
• Rebate: 60-85%
• Note: Some basic extras exclude psychology

Combined benefit:

• Medicare rebate: ~$90-130 per session
• Extras rebate: $60-$150 per session (up to limit)
• Total: Can reduce $200 session to $20-50 out-of-pocket

Podiatry

Common uses:

• Foot pain, heel spurs
• Orthotics (shoe inserts)
• Diabetic foot care
• Nail surgery, ingrown toenails

Typical costs:

• Consultation: $70-$120
• Orthotics: $300-$600

Extras coverage:

• Limit: $300-$500/year (5-10 visits)
• Rebate: 60-85%

Services Not Covered by Extras

❌ Hospital treatment

• Surgery, hospital stays
• Use hospital cover for this

❌ GP visits

• Covered by Medicare (bulk-billed or gap payment)
• Extras doesn't cover

❌ Specialist consultations (outside hospital)

• Covered by Medicare with referral
• Extras doesn't cover

❌ Prescription medications

• Covered by PBS (Pharmaceutical Benefits Scheme)
• Extras doesn't cover

❌ Ambulance (usually)

• Sometimes included in hospital cover
• Sometimes separate membership
• Check your specific policy

Services Excluded by Many Policies

❌ Cosmetic treatments

• Teeth whitening
• Cosmetic dental work
• Cosmetic surgery

❌ Relaxation services (not therapeutic)

• Relaxation massage (vs remedial)
• Spa treatments

❌ Natural therapies (some policies)

• Herbal medicine
• Aromatherapy
• Reiki
• Many insurers phasing these out

❌ Laser eye surgery (most policies)

• Some comprehensive policies include
• Most exclude
• Check specific policy

The Value Formula

Extras provides value if:

Total annual claims > Annual premium

Example calculations:

Example 1: Light user (losing money)

Annual usage:

• 2 dental check-ups: $400
• Glasses: $450 every 2 years = $225/year average
• Total spending: $625/year

Mid-level extras:

• Premium: $720/year
• Claims back: $400 dental (80%) + $225 optical (100%) = $625
• Net cost: $720 premium - $625 claims = $95 MORE than out-of-pocket

Result: Losing $95/year by having insurance

Example 2: Moderate user (breaking even)

Annual usage:

• 2 dental check-ups + clean: $400
• 1 filling: $220
• Physio: 6 visits = $600
• Total spending: $1,220/year

Mid-level extras:

• Premium: $720/year
• Claims: $496 dental (80% of $620) + $450 physio (75% of $600) = $946
• Net cost: $720 - $946 = $226 value (claims exceed premium)

Result: Getting $226/year value

Example 3: Heavy user (strong value)

Annual usage:

• 2 dental check-ups: $400
• 1 crown: $1,800
• New glasses: $450
• Physio: 10 visits = $1,000
• Total spending: $3,650/year

Comprehensive extras:

• Premium: $1,080/year
• Claims:
• General dental: $400 (100%)
• Major dental: $1,440 (80% of $1,800, within limit)
• Optical: $450 (100%)
• Physio: $750 (75% of $1,000)
• Total claims: $3,040
• Net value: $3,040 - $1,080 = $1,960 benefit

Result: Getting $1,960/year value from extras

Quick Value Check

Calculate your annual extras spending:

1. Dental: Check-ups ($200-400) + any major work
2. Optical: Glasses/contacts ($200-600)
3. Allied health: Physio, chiro, massage visits × cost
4. Other: Psychology, podiatry, etc.

Total: $______ /year

Compare to premium:

• If spending <70% of premium: Skip extras, pay out-of-pocket
• If spending 70-100% of premium: Marginal, consider dropping
• If spending >100% of premium: Get extras, provides value

Get Extras If:

✅ High dental usage

• Major dental work needed (crowns, root canals)
• Family with kids (regular check-ups, potential orthodontics)
• Poor dental health requiring ongoing treatment

✅ Regular allied health users

• Chronic back pain (regular physio/chiro)
• Sports injuries (ongoing physio)
• Mental health treatment (psychology sessions)

✅ Annual extras spending >$1,000

• Will claim more than premium cost
• Mathematics works out

✅ Kids in family

• Dental: Kids get cavities, may need braces
• Optical: Kids need glasses
• High family utilization

Skip Extras If:

❌ Minimal usage

• Only dental check-ups ($400/year)
• Rarely need glasses
• Don't use allied health
• Would spend <$600/year out-of-pocket

❌ Claims <70% of premium value

• Paying $720/year premium
• Only claiming $400/year back
• Losing $320/year by having insurance

❌ Budget-constrained

• Can't afford both hospital + extras
• Prioritize hospital (more important, MLS implications)
• Pay extras out-of-pocket as needed

❌ Healthy teeth, don't need glasses, no chronic issues

• Low extras utilization profile
• Save money by skipping insurance

Middle Ground: Basic Extras

If you're unsure:

Get Basic extras ($350-500/year):

• Lower premium, lower risk
• Covers dental check-ups
• Some optical coverage
• If you don't use it much, less money wasted

vs Comprehensive:

• Higher premium ($1,080/year)
• Only valuable if you actually use the higher limits

Strategy 1: Know Your Limits

Track throughout year:

• How much claimed per service?
• How much remaining?
• Don't let limits go to waste

Example:

• Optical limit: $300 per 2 years
• Haven't claimed in 18 months
• Action: Get new glasses before limit resets

Strategy 2: Claim High-Value Services First

If you'll hit limits:

• Claim expensive services first (major dental, glasses)
• Cheaper services last (check-ups)

Example:

• Need: Crown ($1,800) + check-up ($220)
• Major dental limit: $1,500
• General dental limit: $800
• Do: Claim crown first (get $1,500), then check-up from general limit
• Don't: Claim check-up first (leaves more major work uncovered)

Strategy 3: Use HICAPS for Instant Claims

HICAPS = Health Industry Claims and Payments Service

How it works:

• Swipe health fund card at provider
• Rebate processed instantly
• Pay only the gap

Benefits:

• No waiting for reimbursement (2-5 days otherwise)
• Immediate discount at point of service
• 90% of dental/optical providers have HICAPS

Strategy 4: Combine Medicare + Extras (Psychology)

Psychology sessions can claim both:

• Medicare rebate (Better Access): ~$90-130/session
• Extras rebate: Up to limit

Example:

• Psychologist charges: $200
• Medicare rebate: $120
• Extras rebate (80%): $64 (80% of $80 remaining)
• You pay: $16 (vs $200 without any insurance)

Maximizes value from extras if you use psychology services.

Strategy 5: Time Major Services Strategically

If limits reset January 1:

December: Get treatment before limit expires

• Use remaining limits (they don't roll over)
• Example: $200 dental limit left → get cleaning before Dec 31

January: Get treatment early in new year

• Fresh limits available
• Plan major work for early year (have full limit available)

Strategy 6: Review Annually

Every year:

• Calculate: Total claimed vs premium paid
• If claiming <70%: Downgrade extras level or cancel
• If claiming >90%: Good value, maintain

Adjust as needs change:

• Kids grow up (less dental/orthodontics needed)
• Chronic condition resolves (less physio needed)
• Aging (may need more services)

Quick Decision Framework

Get Comprehensive Extras if:

• Annual extras spending >$1,500
• Family with kids (high dental/optical usage)
• Regular physio/chiro user (chronic issues)
• Need major dental work regularly

Get Mid-Level Extras if:

• Annual extras spending $800-$1,500
• Moderate dental needs
• Occasional allied health
• Want coverage without overpaying

Get Basic Extras if:

• Annual extras spending $400-$800
• Primarily dental check-ups
• Want minimal coverage
• Testing if extras is worthwhile

Skip Extras if:

• Annual extras spending <$400
• Only dental check-ups ($400/year out-of-pocket)
• Healthy teeth, don't need glasses
• No chronic conditions requiring allied health
• Would save $300-700/year by paying out-of-pocket

The Math

Break-even point: When your claims equal your premium

Most people need:

• 2 dental check-ups + major dental work (crown, root canal) OR
• Regular allied health (12+ physio visits) OR
• Combination (dental + glasses + some allied health)

To reach $720/year in claims (typical mid-level premium)

Tools & Resources

Value Calculator:

• Calculate your extras value →

Compare Extras:

• Compare extras levels →

Related Guides:

• Hospital vs Extras vs Combined →
• How to Reduce Costs →
• What Hospital Cover Includes →
• How Health Insurance Works →