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What are out-of-pocket expenses?

Out-of-pocket expenses are the additional costs you'll pay for a treatment or service, once all of the Medicare and private health insurance benefits have been expended. Usually, out-of-pocket expenses apply when you’re not fully covered for a particular treatment or service, or when a set benefit limit applies. For example, say you picked a pair of $700 Prada glasses, and your policy covers $210 per Membership Year, your out-of-pocket expenses will be $490 for that pair of glasses.

For extras services, we publish many of the benefits payable for the services covered by your policy here on our website, but you can also contact us to find out how much we'll cover.

To find out how much is payable on dental services, we recommend getting a quote from your dentist first and the item number that applies to each service so we can accurately let you know how much will be covered.

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What is Extras cover?

Extras cover pays benefits on a number of private health services, like dental, optical, podiatry, physio etc that aren't covered by Medicare.

We offer four levels of Extras cover. Premium and Essential Extras pay benefits on the biggest range of treatments and therapies, while Select Extras and Young Extras are more tailored to services you might use most frequently.

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What is ancillary cover?

Ancillary cover is another term for extras cover.

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What is a waiting period?

Waiting periods are exactly what their name suggests; the length of time a policy holder needs to wait before being able to make claims on services.

They apply when you join any health fund for the very first time, or when you upgrade to a higher level of cover.

Waiting periods are designed to keep health cover fair for everyone, by protecting the fund and Members against people who join intentionally to make big claims, and then cancel their membership.

If you're transferring from another fund and take out an equivalent level of cover, or if you've previously been covered by your parents' membership, we recognise that you've already served the waiting periods, so you can claim straight away. If you upgrade to a higher level of cover when you switch, you'll only need to serve the waiting period on the increased benefits.

Our table below outlines the waiting periods that apply to hospital and extras:


2 month waiting period appliesHospital

  • For all hospital treatments or services where there are no pre-existing conditions (excluding accidental injury ^)
  • Rehabilitation - eg. inpatient rehabilitation, stroke recovery, cardiac rehabilitation
  • Hospital psychiatric services
  • Palliative care


  • Dental
    • Diagnostic – includes examinations & consultations
    • Preventative – includes cleaning and scaling, fluoride treatment etc.
    • Simple extraction
    • Restorative – composite and amalgam fillings
    • General services – includes mouth guards and occlusal splints
  • Optical
  • Acupuncture
  • Audiology
  • Chiropractor
  • Remedial massage therapy/myotherapy
  • Osteopathy
  • Chinese Medicine
  • Dietician
  • Occupational therapy
  • Orthoptic therapy
  • Physiotherapy
  • Exercise physiology
  • Podiatry
  • Psychology
  • Speech therapy
  • Healthy Living benefits
  • Foot orthoses and orthopaedic shoes
  • Pharmaceuticals
  • School accidents^
  • Sporting accidents^

12 month waiting period appliesHospital

  • Pre-existing conditions (excluding rehabilitation, hospital psychiatric services and palliative care)
  • Pregnancy and birth
  • Mechanical aids and appliances
  • Surgery for assisted fertility programs such as IVF or GIFT, sterilisation or vasectomy, elective surgery
  • Mammograms and bone density tests
  • Hearing aids
  • Australian Hearing Services Card
  • Nursing Services
  • Mamograms and bone density tests
  • Hospital boarder
  • Nursing home type patients


  • Major dental services
    • Periodontics – specialised gum treatment
    • Surgical extraction – includes wisdom tooth extraction
    • Endodontic services – includes root canal therapy
    • Crowns and bridges
    • Prosthodontics – dentures
    • Orthodontics – braces etc.
    • Supply of hearing aids
  • Childbirth education

Emergency Ambulance

A one day waiting period applies to emergency ambulance treatment

^ Two month waiting periods apply for most other items or services. Cover for an accident is immediate provided it is not recoverable from another source such as Workers Compensation, third party or other liability provision. Sporting accidents sustained by sportspeople in activities relating to their fulltime employment as a sporting professional, including training and competition have a two month waiting period.



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Can I upgrade my cover?

If you're on one of our lower or medium levels of cover, you can choose to upgrade at any time by contacting us on 1800 623 893.

Upgrading could include:

  • Increasing the level of cover - for example, going from Intermediate to Value Plus Hospital
  • Adding a new cover - for example, adding extras cover
  • Reducing your excess - that is, going from $750 (Vital Hospital (Bronze+)) or $500 excess to $250

If you're upgrading, you may need to serve waiting periods on the upgraded portion of your cover. While you're waiting, we'll still honour the benefits of your previous cover. Conditions also apply to hospitalisation if you're changing your excess.

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Can I downgrade my cover?

If things are a bit tight financially, or if you want to change to a level of cover that's more practical, you can choose to downgrade your cover.

Downgrading may include:

  • Reducing the level of cover - for example, going from Better Hospital (Silver +) to Vital Hospital (Bronze+) cover
  • Removing a current cover - for example, dropping extras cover
  • Increasing your excess - going from a $250 to $500 excess or $750 for Vital Hospital (Bronze+)

If you choose to downgrade, you won't need to serve additional waiting periods, and your new excess applies to inpatient hospital services immediately.