Wellness Tips | 17 October, 2022

Are You Getting the Most out of Your Private Health Insurance?

Let’s be honest, the ins and outs of private health insurance can be complex and, quite frankly, a little bit mind-numbing. But getting a handle on what your insurance policy covers, as well as what added benefits are available to you, can make a huge difference to your dental - and overall - wellbeing.

Discover how your Private Health insurance policy works, what extra services are out there and how you can use it all to your advantage ...

Are you getting the most out of your Health Insurance?

As it turns out, many people are shelling out for private policies and wasting their hard-earned money on insurance they simply never get around to using. Many funds will operate on a year-to-year basis and start afresh on January the 1st. Because there are no rollovers into the next year, that means no accumulation and all those lost benefits!

So, do you know what you’re paying for monthly and yearly? It’s a good idea to dip into the details of your policy or give your provider a call to find out what you’re covered for annually. For example, a basic dental policy could include two check-ups within a calendar year, so you can happily keep up with the recommended half-yearly trips to your dentist. Find out what you’ve got and don’t let those visits go to waste. After all, you’ve paid for it!

What does Private Health Insurance Cover?

Private health insurance cover is generally divided into hospital cover, Extras cover, and ambulance cover, with different policies offering different levels of coverage.


What is Extras Cover?

Extras Cover is a policy for medical treatments that happen outside of the hospital and aren’t covered by Medicare - think eye checks, trips to the chiropractor and visiting your dentist for a clean. Medicare might not cover the costs, so without a private health policy, these services might be quite expensive.

The four most common areas of medical treatment that people use their Extras Cover for in Australia:


This category can generally be split into three types of cover.

  • General (bi-annual clean and check-up, X-rays, fillings, wisdom teeth removal, teeth removal)
  • Major (root canal treatment, dentures, implants, crowns and bridges, complex surgery)
  • Orthodontic (braces, retainers)


  • Prescription lenses, contact lenses, glasses frames and lens coatings


  • Rehabilitation for disabilities, chronic conditions and injuries.


  • Hands on physical manipulation and realignment of bones, with a focus on the spine.

But while Extras Cover is great for these areas of care, it still may not cover the whole fee and there may still be some out-of-pocket expenses involved. That’s where a service like No Gap really saves the day.

Ambulance Cover

Emergency transport and other ambulance services are not covered by Medicare, so Ambulance cover can be added to your policy to cover this. Note that Queensland and Tasmania residents do not require this cover as ambulance costs are covered by their respective state Governments.

You may be eligible for discounts if you hold a concession, health care, or Veterans Affair Card.

What is not covered by Private Health Insurance?

Nearly all services covered under general treatment are only covered to a limited extent, for example a limit per service, per year, or lifetime limits. Some services may not be covered at all, and specific services may be excluded, including:

  • Joint Replacements
  • Weight Loss Surgery
  • Sleep Studies
  • Insulin Pumps
  • Dialysis
  • Plastic Surgery/ Reconstructive Surgery

Additionally, depending on your provider, some services may be restricted, meaning you may have to pay more out of pocket, including:

  • Rehabilitation
  • Hospital Psychiatric Services
  • Palliative Care

You should check with your provider to see specific services that are not included in your private health insurance cover.