Private health insurance: optical cover explained

You’ve probably seen the phrase ‘use it or lose it’ creeping around your inbox lately.

This is because December doesn’t just mark the time for giving gifts and baking gingerbread!

It also marks the time when many of us Aussies make a last-minute dash to claim our unused health insurance benefits, like optical extras, before the end of the year.

If you’re one of many who have ever contemplated getting health insurance extras (but feel like it can all be a bit of a maze!), we answer some common questions below.

How does optical cover work?

Optical cover is incorporated into the extras cover of private health insurance, and it usually reimburses a portion of the cost of your prescription glasses, prescription sunglasses or contact lenses.

Extras-only cover differs from hospital or health insurance because its sole purpose is to cover some of the costs of products and services that Medicare doesn’t cover. Since most people will eventually require prescription lenses at some point in their life, having extras benefits, which includes optical cover, is a common option for many Aussies.

Most policies have a limit on how much can be claimed each year, and this typically pertains to your level of coverage. Some providers will operate on a calendar year (January to December), while others on a financial year (July to June). Most funds don’t ‘rollover’ your unused benefits – thus the phrase ‘use it or lose it!’.

Health insurance providers often have waiting periods for optical cover when you first sign up, so it’s advised to check with them first if you’re planning to claim any of the extras within the same year.

How much does optical cover cost?

This will vary depending on the policy and level of cover you opt for. We recommend using an online comparison tool to investigate different health insurance providers to see what extras would benefit you most. The best way to find out is by doing some good old-fashioned research!

What can you claim with optical extras?

Your optical extras can be used for glasses, contact lenses and even prescription sunglasses. This includes optical frames, prescription lenses and lens extras (such as anti-reflective coatings or UV coatings).

Extras cover usually reimburses you a percentage of the total cost – this is called a rebate. The remaining amount left over is called a ‘gap fee’, ‘excess’ or ‘out-of-pocket’ expense.

Some health funds will have a list of ‘preferred providers’, also known as ‘members’ choice providers’ or ‘members’ first choice providers’ – this just means they have a special relationship or arrangements with some stores, but it doesn't mean you have to go to these providers.

Most optometrists in Australia offer the convenience of being able to claim your rebate in store – if you are unsure, simply ask your optometrist when booking an appointment.

Is optical insurance worth it?

If updating your glasses and contact lens prescription is a routine expense for you, then having optical insurance is definitely worth considering! You need to evaluate the cost of what you would pay outright, and how often, against how much you will be reimbursed.

Because most health insurance extras don’t rollover, if you don’t make a claim within the year, you will end up losing the benefits you’ve paid for throughout the year. It’s important to make sure you make the most of your extras before the new year kicks in.

If it’s been a few years or more since your last comprehensive eye exam, it’s important you schedule an appointment before the year rolls out, especially if you have any unused benefits patiently waiting to be spent! You can use our find an optometrist tool to schedule an eye exam today.

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