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- How does health insurance extras cover work?
Comparing Extras Cover: Find the Best Extras Health Insurance
Extras cover, also known as general or ancillary cover, provides cover for the routine treatments that Aussies tend to use regularly.
It's important to consider whether purchasing extras cover makes sense for you and/or your family, or whether you prefer to pay out of pocket for these regular treatments.
COMPARE & SAVEKey Points
Extras cover (also called general or ancillary cover) pays benefits back on routine, out-of-hospital treatments Medicare doesn't cover, like dental, optical, and physio.
Whether extras is worth it comes down to your usage: if you claim back more than you pay in premiums, it pays off. The quick test is to add up a year of your likely claims and compare it to the annual premium.
Most funds offer three levels (basic, mid-level, and top) that rise in price, inclusions, and benefit limits. Australians pay roughly $696 to $2,016 a year for extras (APRA, December 2025).
There's no single "best" extras policy: the right cover depends on your needs (dental, optical, physio, or family) and who you're covering.
Watch your benefit (or rebates) limits and waiting periods: annual limits reset each year and don't roll over, and you may have to re-serve waiting periods when you switch funds (though many funds waive them).
Key Points
Extras cover (also called general or ancillary cover) pays benefits back on routine, out-of-hospital treatments Medicare doesn't cover, like dental, optical, and physio.
Whether extras is worth it comes down to your usage: if you claim back more than you pay in premiums, it pays off. The quick test is to add up a year of your likely claims and compare it to the annual premium.
Most funds offer three levels (basic, mid-level, and top) that rise in price, inclusions, and benefit limits. Australians pay roughly $696 to $2,016 a year for extras (APRA, December 2025).
There's no single "best" extras policy: the right cover depends on your needs (dental, optical, physio, or family) and who you're covering.
Watch your benefit (or rebates) limits and waiting periods: annual limits reset each year and don't roll over, and you may have to re-serve waiting periods when you switch funds (though many funds waive them).
What is extras cover?
Extras cover, also called general or ancillary treatment cover, is additional health insurance cover for routine, out-of-hospital health services that are not covered under Medicare.
According to the Australian Prudential Regulation Authority’s (APRA) quarterly report, as of March 2026, 55.5% of Australians hold extras cover with their private health fund.
Extras cover can be purchased as a standalone policy or to complement your hospital cover policy, and it's available at different levels of cover.
Learn more about health insurance with these guides
What does extras cover include?
The most common extras used are dental, optical, and physio. The exact services covered by an extras policy vary between insurers and depend on your specific extras policy.
It's worth reading your policy details carefully to ensure that you're covered for those services that you use most often.
Common extras include the following:
Service | What it Covers |
Needle treatment for overall health. | |
Back pain, neck pain, and other musculoskeletal conditions. | |
General Dental | Check-ups, cleaning, fillings, and preventative X-rays. |
Major Dental | Crowns, bridgework, dentures, and veneers. |
Assistive devices for hearing loss. | |
Prescription glasses or contact lenses. | |
Braces and retainers to straighten teeth or realign the jaw. | |
Joint and muscle pain, sports injuries. | |
Foot pain or injury. | |
Diagnosis and treatment for conditions affecting the mind. | |
Massage therapy to aid in conditions. | |
Speech Therapy | Speech and language problems. |
Why do people buy extras cover?
People often think of hospital cover as the insurance they hope they won't need, while extras cover is in place to offset the costs of services they know they're going to use.
For many Australians, most of their regular healthcare spending doesn't happen in a hospital; it happens at the dentist, the optometrist, the chiropractor, or the naturopath. These are all services that can be covered by your health insurance extras policy.
With extras insurance, you can get benefits back on the healthcare services you use regularly throughout the year.
Is extras cover worth it?
Whether extras cover is worth it depends on whether you claim back in benefits or rebates more than you pay in premiums and what your extras usage looks like. Unlike hospital cover, there is no tax incentive for purchasing extras, and it will not affect the Medicare Levy Surcharge (MLS).
Extras cover usually makes sense if you:
Have regular dental, optical, or physio needs
Have a family who need regular dental work
Require prescription glasses or contact lenses
Have ongoing allied-health appointments
However, if you rarely claim and are paying premiums for extras that you don’t use, you may want to reconsider what plan you’re on. The best way to know whether your extras cover is worth it is to add up a year of your claims and compare it to the annual premium you’re paying.
How much does extras cover cost?
The APRA reports that Australians pay a yearly average of $696 to $2,016 for extras cover, with singles averaging $58 to $167 per month and families averaging $115 to $186 per month.
Extras cover costs vary depending on the premium, fund agreement, and level of cover.
Levels of extras cover
Most extras policies are grouped into three levels: basic, medium, and comprehensive. These rise in price and inclusions, with tiered levels of benefits, depending on a chosen fund’s policy.
Health funds will also have different exclusions, so it’s worth comparing policies from a range of funds to find one that suits you and your family.
Cover level | Best for | Typical Inclusions | Benefit Limits |
Basic | Singles and couples, young and healthy | Basic cover is the lowest level of cover and tends to be the most inexpensive. It may include general dental and optical, with a small selection of other extras. | Benefit levels are the lowest in basic plans, which means you can claim back a limited amount throughout the year. You may also find that benefit limits are combined across treatments. This means that you have one benefit amount, and it can be reached through any combination of extras treatments throughout the year. Example: A policy may have a dental cover limit of $400 per person, per 12 months with maximum benefits of oral examination, scale and clean, fluoride treatment, and surgical tooth extraction at 50% of charge. |
Mid-Level | Families with young children and middle-aged people | Medium extras cover is more comprehensive than basic, covering a wider range of services and treatments. This gives you a higher level of overall cover than a basic policy. | Benefit levels are usually higher, and there may be separate limits for different treatments. Example: A policy may have dental cover for $600 per person, per 12 months, but an oral examination’s maximum benefit is $31.50 while a scale and clean’s maximum benefit is $60.90. |
Top Level | Seniors, families with adolescent children, and people who use health services frequently | Comprehensive extras cover is the most expensive and offers the most cover. More expensive treatments, such as major dental, orthodontics, or laser eye surgery, may be included at this level. | Benefit limits are also the most generous, so you can claim back more during the year. Example: A policy may have dental cover with no annual limit, per 12 months, with higher maximum benefits on specific treatments. |
Best extras cover for your needs
Finding the best extras cover for you is all about what health services you want to access for a balanced cost. Who you want to cover will also impact which policy you choose.
Best Extras for Dental
For the best dental cover, consider whether you need simple, general dental cover or major dental cover for more complex and expensive services like orthodontics. Also see which funds may offer no-waiting-period dental services and find what sub-limits and lifetime limits may be attached to major dental users.
Best Extras for Optical
Optical is one of the most common extras, and like dental, it has varying levels of services based on need. Basic optical cover is suitable for annual check-ups and covering prescription glasses or contact lenses. For elective procedures like laser eye surgery, you'll need a higher tier of cover.
Best Extras for Physio & Massage
Physiotherapy can be covered by Medicare under very specific conditions; however, these conditions are highly limited. For ongoing physio care, private insurance will likely be necessary, especially for:
Post-operative rehabilitation
Chronic pain management
Active sports players
Pregnancy and postpartum
Remedial massage can help support physiotherapy in managing aches, pains, and injury recovery and may be a necessary investment if you require rehabilitation of muscles, tendons, and ligaments.
Best Extras for Families
Family health insurance tends to be cheaper than taking out separate policies for individual family members. Ensuring you have a fund with children’s rebates, high annual limits, and policy flexibility on sharing limits (the maximum total each person on the plan can claim) tends to work best for families.
Many health insurers have a 12-month waiting period for pregnancy-related cover, so taking out a policy well in advance is ideal. Pregnancy cover is usually a couples or single parent policy, and isn’t always a family policy.
Best Extras for Couples & Singles
It's important to know that a couples’ insurance policy can be convenient and have potential tax benefits, but it must have the same cover. So, if you and your partner have differing health care needs, it may be a good idea to compare the total cost against two tailored singles’ health plans.
Can I get a government rebate for an extras policy?
Yes. The Private Health Insurance Rebate is available to people who hold an eligible hospital, extras, or combined policy.
The rebate amount you qualify for depends on your income and your age bracket. To receive the private health insurance rebate for the 2025/26 financial year, your taxable income needs to be less than:
$158,000 for singles
$316,000 for families
Your rebate can be claimed as a reduction to your health insurance premium or as a tax offset on your tax return. However, it’s important to note that extras cover does not exempt you from the Medicare Levy Surcharge (MLS), only hospital cover does.
Are there waiting periods for extras cover?
Yes, there are usually waiting periods associated with extras cover.
These are set by your fund, and there may be different waiting periods depending on your benefit limits.
However, there are no portability laws in place to prevent you from re-serving waiting periods on an extras policy with the same level of cover.
If you switch to a new fund, you may be required to serve a waiting period that you have already served with your previous fund.
However, the good news is that most funds will let you off the hook and waive the new waiting period.
COMPARE & SAVEBe aware of benefit limits
Extras claims may be subject to various benefit limits.
Again, this will vary by fund and by level of cover.
If you're unsure of your limit or how much you've used, it's easiest to check through your online account or your fund's app, if they have one.
Otherwise, you can contact your fund.
Here are some common extras benefit limits:
Annual limit: The maximum amount you can claim for a service during the year. Unclaimed benefits do not roll over, but reset at the start of each new year (usually 1 January or 1 July, and this varies by fund).
Sub limit: This is a limit on a service that falls under your yearly limit, and is usually per person. For example, you have a sub limit of $200 on acupuncture services under a larger umbrella limit of $500 total for natural therapies.
Per-Person limit: Each person covered by your policy may be limited to a maximum benefit level each year.
Overall limit: There may be an overall membership limit that governs the per-person limits on your policy. This is not necessarily the sum of each individual limit, so check with your fund for details.
Lifetime limit: Funds often impose individual lifetime limits on certain expensive services, such as orthodontics or laser eye surgery.
What's new in health insurance?
Biggest hike in years: Since 1 April 2026, health insurance premiums increased by the largest hike in 10 years, rising by an average of 4.41%.
Most Aussies face higher hikes: Compare Club's data suggests that, due to the five largest funds holding nearly 80% of the market, the average increase for the majority of policyholders is closer to 5.00%.
Review your policy: Now's the time to check whether your policy still fits, since better deals could be available for you.
Will extras cover reduce my out-of-pocket expenses?
Extras cover is designed to reduce out-of-pocket expenses for regular health-related services and treatments. What you'll pay depends on three main factors:
What your provider charges for the service you received.
Whether or not your provider has an agreement with your fund.
Your level of extras cover.
Your extras cover may offer a fixed dollar amount back on services, or you may receive a certain percentage of your fee back.
Compare policies to find a structure and premium price that meets your needs.
Frequently asked questions
Can I get extras cover without hospital cover?
Yes, you can purchase extras cover without taking out hospital cover. However, it's important to remember that extras-only cover does not exempt you from the MLS. If you wish to avoid the MLS, you need hospital cover.
Do extras benefit limits roll over each year?
No, extras benefit limits do not generally roll over each year. They reset at the beginning of the next year or on 1 July (depending on your insurer). To get the best out of your extras cover, try to use all of your benefit before the expiry date. There are a few specific health funds that can offer rollover benefits. That's why it’s important to compare a range of health insurance providers to find the one that suits you.
Is there health insurance with no waiting period?
No health insurance provider offers a complete no waiting period for hospital stays, but you can access certain extras immediately. If you are switching funds to an equal or lower cover level, then your waiting periods should transfer over to your new fund. You will need a Transfer Certificate when switching insurers.
What is the 80/20 rule for health insurance?
The 80/20 rule isn't about how much of a bill you pay. It's a Medicare compliance rule for providers, not patients. Under the 80/20 rule, a practitioner who renders 80 or more professional attendances on each of 20 or more days in 12 months is deemed to have engaged in "inappropriate practice" (a prescribed pattern of services) and is referred for review. It does not affect your extras benefits or out-of-pocket costs.
Is migraine covered under health insurance?
Yes, migraines can be covered under health insurance if your migraines are severe enough for inpatient treatment. This treatment would be covered under hospital cover.
Extras cover can also provide some coverage for migraine treatment with allied health services.
Related articles
The private health insurance rebate explained
What is the annual private health insurance premium increase in 2026?
Who pays the Medicare levy and the Medicare levy surcharge?
Chris Stanley is the sales & operations manager of health insurance at Compare Club. With extensive experience and expertise, Chris is a trusted leader known for his deep understanding of health insurance markets, policies, and coverage options. As the sales & operations manager of health insurance, Chris leads a team of dedicated professionals committed to helping individuals and families make informed decisions about their health insurance needs.
Meet our health insurance expert, Chris Stanley
Chris's top health insurance tips:
- 1
Australia’s public health system is world-class, but wait times for public hospitals can be long, inconvenient - and leave you living in constant pain while you wait.
- 2
An appropriate private health insurance policy can speed up your surgery, relieving your pain sooner.
- 3
Family health cover means your children are covered under the same policy as you.
- 4
Many health insurance policies come with a 12-month waiting period for pregnancy-related cover, so it’s a good idea to get a family policy organized well before starting your family. This means your child will be covered from birth until at least their early twenties (depending on which health fund you select).
