Sometimes Our Eyes Need a Little Help. With Optical Health Cover, You Can Improve Your Vision, Save Money and Look Great in a Designer Pair of Glasses.
Our ability to see is incredibly valuable, yet a large portion of the Australian population relies on prescription lenses or contact lenses to see clearly. In fact, it's highly likely that at some point in your life, you will need some form of vision correction.
Taking care of your vision is crucial for maintaining the health of your eyes now and in the long run, which is why regular visits to the optometrist are essential.
The good news is that depending on the level of coverage you have, you may end up paying very little for a brand new pair of glasses. You might be surprised to learn that you can even claim sunglasses on your health insurance! That's why optical coverage is one of the most sought-after features of private health insurance.
If you haven't reviewed your health insurance policy recently or if you're considering getting coverage that includes optical benefits, now is the perfect time to do so. If the thought of sifting through different policies to find the right one feels overwhelming, don't worry.
We've put together a comprehensive guide that provides all the necessary information to help you make an informed decision about your eye care and optical extras. We'll cover everything you need to know to find optical coverage that suits your specific needs.
However, if you already have a good grasp of the basics, feel free to skip ahead and start with an online quote right away.Why get optical health cover?
Many of us tend to take our vision for granted, but the truth is that at some point in our lives, our vision is bound to decline. For some, this may happen earlier than expected. Just like taking care of our teeth, maintaining good eye health is of utmost importance. Similar to regular visits to the dentist, seeing the optometrist on a regular basis ensures that our vision is well taken care of.
While Medicare does cover the cost of eye tests conducted by qualified optometrists, the expenses for glasses or contact lenses are not covered and will be an out-of-pocket cost. And let's face it, it can be quite an expensive one!
This is where optical health cover comes into play. It assists in covering the expenses associated with improving your vision over the long term. The key is to find the right level of coverage that aligns with your healthcare needs.
What’s covered by optical health insurance?
Take out private extras cover and you can get a range of benefits that can make a big difference to your vision. One of the reasons optical cover is so popular is that the benefits don’t just include prescription glasses and contact lenses. You can even claim some or all of the cost of prescription sunglasses and swimming goggles!
The Two Types of Optical Health Cover
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1. General Optical Health Cover
General optical cover typically falls under extras services health insurance. This includes items such as check-ups, contact lenses, and glasses.
Optical treatments are offered as part of an extras policy, so you’ll have the option to enjoy the benefits from a variety of health care services including dental, orthodontics, remedial massage, and natural therapies like naturopathy.
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2. Major Optical Health Cover
Major optical cover is typically covered by hospital cover. This includes cataract surgery and eye lens procedures. For those looking for laser eye surgery private health insurance, this will fall under major optical cover. However, it’s only partially covered by the policy as it’s not on the Medicare Benefits Schedule.
Remember, optical health cover is a common feature of extras policies provided by Australian health funds. However, as with all policies, it’s important to remember that the level of cover will vary between funds. It’s always best to read the fine print and find out what services and treatments are covered and the level of your benefits before proceeding.
Can I purchase glasses from anywhere and receive a refund?
Health funds will provide you benefits for prescription eyewear and contact lenses sold by most registered optical providers and retailers across Australia.
As more optical retailers are operating online, many health funds will provide you with a rebate when shopping online from a list of approved stores.
This will vary from fund to fund, so it’s best to compare the best health insurance for optical and check the approved optical stores.
Can I claim sunglasses on health insurance?
Generally, prescription sunglasses will be covered under your health insurance policy and you’ll receive a full or partial rebate. Unfortunately, non-prescription sunnies aren’t covered by optical insurance.
Can I claim laser eye surgery on health insurance?
Laser eye surgery is a popular treatment for those who want to wave goodbye to prescription glasses and contact lenses for good! However, there are some things you need to be aware of if you’re thinking of claiming this procedure on your health cover.
- This procedure is not covered by Medicare, unless it’s required to treat a medical issue or eye disease.
- Many private health funds do not cover laser eye surgery under their extras policies. Some funds will offer a limited level of cover for this procedure under top hospital or comprehensive extras policies.
- If your health fund does provide a benefit for this procedure, lifetime limits may apply.
- If you’re able to claim for laser eye surgery with your fund, you’ll have to serve a waiting period which could be 1-2 years depending on your provider.
Is bulk billing for eye tests available?
Just like bulk billing at your GP, optometrists can accept the Medicare benefit as a full payment. This means you’re not going to be left out of pocket when you get your eyes tested.
If you’re under 65 years old, you’re eligible to have a bulk billing eye test once every three years. If you’re over 65, you’ll be able to receive an eye test every year.
How Much Can You Claim Back with Optical Health Cover?
The amount you can claim back on your extras cover for optical services will depend on your policy and your health fund provider. The benefit amount is calculated by the insurer using one of two methods:
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1. Percentage Benefits
As the name suggests, percentage benefits are calculated as a percentage. For example, you might receive 50% back from your optical treatment. So if your treatment is $80, you will get $40 back.
The percentage benefit structure allows you to know what you’ll be reimbursed from your health fund regardless of the cost of the treatment.
However, there is a downside to percentage benefits which is that it applies to all services under your policy. That means you’re unable to prioritise the services that are most important to you. If you’re able to, paying a higher premium may result in a higher percentage rebate.
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2. Set Benefits
With a set benefit, your rebates will be in the form of a fixed dollar amount for eligible services claimed. For example, you may receive $100 back from prescription glasses costing $150, leaving you to pay the remaining $50. The advantage of set benefits is that you can customise your cover to select a policy that offers higher benefits for services you prioritise.
The downside of set benefits is that calculating your out-of-pocket expenses is more challenging. Unless you know how much your optical treatment or products will cost you, you won’t be able to work out how much you need to pay.
Do Annual Limits Apply to Optical Health Cover?
As with all
The annual limit on optical will depend on your chosen health fund and the level of extras cover. Typically, a higher level of cover will give you higher annual limits.
Limits on your extras cover are generally broken down into two categories:
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1. Combined Limits
If your extras policy specifies combined limits, this means several services fall under the one limit. Max out your limit on one of the treatments and you won’t have any benefits remaining for the other combined services.
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2. Sub-limits
Extras cover with sub-limits means specific treatments under the one category will have individual benefits.
Other limits to consider
These include the following:
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1. Time limits
If time limits are applied to your extras cover, you must lodge your claim within two years of the date you received treatment.
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2. Service limits
There also may be a service limit applied to your extras cover. This means there will be a limit on the number of times you can claim for the same service. For example, there may be a limit on the number of times in a calendar year you can claim on a consultation with a physiotherapist.
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3. Benefit limits
It’s common for health funds to apply a limit on the benefits you can claim per day. For example, if you receive a couple of services within the one optical consultation, you may only be able to claim on one service.
The good thing to know is that annual limits are reset every year. That means if you hold your health cover for 4 years, you could easily gain 3 or 4 pairs of new prescription glasses!
How long will I have to wait to claim?
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Provided you maintain the same level of cover, once you’ve served the waiting period, you can switch policies without worry about having to re-serve the waiting period.
You may see some health funds run promotions that waiver their waiting periods to attract new members. It’s worth keeping your eye out for these offers so you can claim sooner rather than later on health services. But always look for any special conditions for extras like optical as there could be restrictions on which providers you can claim benefits with.
Other benefits you can enjoy with extras cover
While optical is one of the more popular benefits Aussies enjoy, there are a range of services you can claim under extras cover. Depending on your fund and the level of cover, you may be able to enjoy the benefits of:
Occupational and speech therapy
Medical aids such as glucose monitor and 
Pharmaceuticals not covered by the PBS
Alternative and natural therapies such as acupuncture, naturopathy, and Ready to take the next step with your eye health?
Even if you currently have 20/20 vision, it's a fact of life that our eyes can't escape the passage of time. So why not be prepared with optical health insurance that's got your back? When the day comes when you need prescription eyewear, you'll be thanking your current self.
However, it's crucial to select an extras policy that suits your unique health needs. You want something that not only takes care of your eyes but also provides you with a sense of security and peace of mind for the years ahead.
With our handy comparison tool, all the hard work is taken care of for you. In just a few short minutes, you can compare a wide range of extras cover options that include optical benefits from top-notch Australian health funds.
If you have any questions or queries with your optical health insurance, we have friendly staff who are all health insurance experts. You can call one of our team on 1300 806 119
FAQs
1. Can I get a "no gap" deal on my glasses with optical cover?
Yes, many optical providers offer "no gap" deals for selected frames and lenses with optical cover. This means you won't have to pay any out-of-pocket expenses for those specific items.
2. Do popular optical retailers like OPSM and Specsavers accept optical health insurance?
Yes, OPSM and Specsavers are often registered optical providers that accept optical health insurance. You can take advantage of your coverage to claim benefits when purchasing glasses, contact lenses, or other eligible optical products.
3. Are non-prescription sunglasses covered by optical insurance?
Generally, non-prescription sunglasses are not covered by optical insurance. However, some optical policies may offer discounts or rebates on prescription sunglasses that provide both vision correction and sun protection.
4. Can I get a second pair of glasses at a discounted rate with optical cover?
Yes, some optical health insurance policies offer benefits for a second pair of glasses at a discounted rate. This can be beneficial if you want to have a backup pair or if you'd like to have different styles for different occasions.
5. Can I claim eye therapy sessions under optical cover?
Yes, certain optical health insurance policies may provide coverage for eye therapy sessions. Eye therapy involves exercises and treatments aimed at improving vision or treating specific visual conditions, and it can be included as part of optical extras services.
