Is Extras cover worth it?
Extras cover provides benefits for a wide range of health-related expenses, from dental to optical and physio.
But given the many considerations, some new members find Extras confusing and may even question its worth. This article will explain its exclusions, coverage, and limits to help you make a better-informed decision.
What is Extras cover health insurance?
As the name hints, Extras provides coverage for the little healthcare “extras” that aren’t covered (or are inadequately covered) by Medicare.
While Hospital cover is for in-hospital healthcare (rooms, equipment, medication, doctors, nursing, surgeons, etc.), Extras cover helps with the cost of out‑of‑hospital services like dental, optical and a range of Allied Health therapies. Common Extras services include:
- dental check‑ups and treatment
- optical (glasses and contact lenses)
- physiotherapy and chiropractic
- remedial massage and acupuncture
- vitamins and natural therapies (where eligible)
- orthodontics
- mental health support services (e.g., psychology)
Unlike Hospital cover, Extras does not have an excess.
What does Extras cover offer?
It depends on your policy and private health fund.
Westfund currently offers multiple Extras policies catering to different ages and healthcare needs. All our policies include ambulance cover and some degree of coverage for various healthcare services. It's important to note that annual limits apply and vary between policies.
By law, private health insurance does not cover outpatient GP visits, specialist consultations, or diagnostic imaging and tests.
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Policies |
Some Extras Inclusions |
Great for |
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● General dental/optical ● Limited therapies ● Mental health benefits |
Healthy young adults |
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● Dental/optical ● Physio, nutrition, vitamins, and preventive health checks ● Emergency and non-emergency transport |
Young adults and young families |
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Mid Extras (must be packaged with hospital cover) |
● Major dental/orthodontics ● Wide range of therapies ● Health aides |
Families seeking more benefits |
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● Major dental, optical, orthodontics ● Higher per-person limits ● Gym, vitamins, pharmaceuticals, health aids & more |
Mature singles and couples |
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● No annual dental limits and more orthodontic cover ● Family mental health ● Wider range of therapies |
Health-loving families |
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● Higher limits ● Extra categories ● Dental top-ups |
Proactive, health-conscious members |
This table provides a brief overview. See Extras cover for detailed information, or refer to the policy summary for each level of cover.
Are health insurance Extras worth it?
Many of our members find our Extras cover essential, while others prefer to keep it “just in case.”
Extras generally offers better value for members who frequently require Allied Health (outpatient) services like physio, massage, acupuncture, or mental health support.
When is Extras cover not worth it?
Westfund has a range of Extras policies to suit people with varying needs.
Nonetheless, some young, healthy members may feel Extras isn’t worth it because they don’t claim enough benefits. Certain older members with great teeth, exceptional vision, and no niggling conditions may prefer lower-level policies.
Extras cover is designed to soften the impact of unexpected medical costs. Members who don’t mind out-of-pocket expenses may feel they can live without it.
Can you just get Extras cover?
Most Westfund Extras policies can be taken out without Hospital cover, although there are some exceptions.
However, be aware that Extras on its own doesn’t exempt you from the Medicare Levy Surcharge (MLS) or the Lifetime Health Cover (LHC) loading. You’ll need an eligible Hospital cover policy to take advantage of these tax benefits.
How do Westfund Extras limits work?
Most Extras benefits have an annual limit, such as $600. This figure is the total amount Westfund will pay for that benefit during any given calendar year. Once you reach the limit, you must pay additional expenses out of pocket.
Limits vary by benefit and policy, with higher-level policies typically offering more generous limits; some have no annual limit. Benefits may be grouped, letting you choose where to spend your annual limit across select services (e.g., physio, chiro, or acupuncture). Certain benefits, like orthodontics, have lifetime rather than annual limits.
Many benefits also have item limits, the maximum Westfund will pay towards a certain service. For example, Westfund would pay up to $25 per private physiotherapy session under the Starter Extras policy.
Item limits vary by policy and sometimes by healthcare provider. We may offer more optical coverage at a Provider of Choice or a Westfund Eye Care centre than at an external service.
You’ll need to serve a waiting period before claiming any Extras benefits. Standard benefits, such as general dental/optical and prescriptions, typically have a short two-month coverage period. Meanwhile, more complex matters, such as major dental and orthodontic procedures, require a 12-month wait (up to 36 months for hearing aids or Laser eye surgery).
The rules can be a lot to digest. For a simplified summary of your available benefits and limits, please visit the Members Online portal or download the Westfund app.
Annual limits apply per calendar year – benefits reset on January 01.
Unused benefits don’t roll over, so you’ll start each calendar year with a fresh default limit according to your policy. With that in mind, we encourage members to book major healthcare services, especially dental and optical, before the end of the year.
The relevant policy summary on the Extras Cover page provides a detailed breakdown of every benefit. Members can review their benefit total, usage, and remaining balance at the Members Online portal or the Westfund app.
Can I have different health insurance for Hospital and Extras?
Although it might seem strange, many members choose to have Extras with one insurer and Hospital cover with another. If flexibility is important to you, several of our Extras policies can be taken out as a stand-alone product
One exception is the Extras Mid policy, which must be combined with Westfund Hospital cover. Likewise, some of our Hospital policies can only be taken in conjunction with a Westfund Extras policy.
But dealing with two separate health insurance providers can muddy the waters when monitoring limits and making claims. You may find it easier to stick with one provider.
Common Extras health insurance misconceptions
By now, we hope you have a clear understanding of what Extras can cover. However, it’s equally important to understand what it doesn’t cover.
- Medicare Levy Surcharge: You need an eligible Hospital policy to avoid the MLS.
- Full refunds: While some services are fully covered under some policies, many are only partially covered by a benefit.
- Limit roll-overs: Use them or lose them; annual benefit limits reset on January 01.
- Excess: All Extras benefits are 100% excess free.
- Instant claims: You’ll need to wait anywhere from 2 to 36 months after joining to make a claim.
- Medicare rebates: Extras isn’t a replacement for Medicare; it offers benefits where Medicare doesn’t.
- Specialists & scans: No private health insurance fund covers specialist appointments and radiology scans
Feel good with Extras cover.
Extras cover can help soften the blow of health expenses not covered by Medicare. Lower-level policies cater to the young and healthy, while members with poor vision, problematic teeth, or ongoing therapeutic needs might prefer more coverage.
As a member-focused, not-for-profit health fund, we’re dedicated to helping Australians feel good about their health. Browse Westfund’s Extras cover to see why we were awarded 'Best Health Insurance - Core Extras' in the 2024 Finder Health Insurance Award