Understanding Health Insurance Cover in Australia

Health insurance in Australia often comes with ‘extras cover’ that includes optical extras. Whether you’re insured with Medibank, Bupa, AHM, or HBF, your health fund provider may allow you to claim a portion of your costs for prescription glasses and contact lenses.

However, the specific level of cover, what’s included, and the rebate you’ll receive can vary widely.

Depending on your policy, you might be eligible for a single pair of glasses, a second pair, or even prescription sunglasses.

Making Sense of Your Optical Cover

Optical extras cover typically includes:

  • Prescription lenses for glasses
  • Contact lenses
  • Eye tests conducted by an optometrist
  • Consultations regarding your eye health.

Prescription sunnies, and special tints on your lenses might also be included in your optical benefits depending on the level of extras in your policy.

CHI Tip: Typically, you cannot claim any money back on non-prescription sunglasses.

Optical Benefits with Private Health Insurance

Typically, optical covers are valid for a period of 12 months per calendar or financial year. It means you have a whole year to utilise your optical benefits.

But here’s the catch: any unused benefits will expire at the end of that 12-month period. So, it’s crucial to take advantage of the benefits you’re entitled to before they slip away.

How it Works

Basically, optical retailers such as Specsavers and OPSM often collaborate with health insurance providers to offer special deals and benefits to their members.

With optical health insurance, you may be eligible for exclusive discounts on a range of eyewear products such as prescription glasses and contact lenses when you visit these retailers in-store.

Additionally, some health funds may offer bulk-billed eye tests for their members, which means the cost of the eye test is covered by the health insurance provider, so you don’t have to pay out of pocket.

Know Your Waiting Periods and Annual Limits

Waiting periods and annual limits are things to keep in mind when it comes to claiming optical extras with private health insurance. Waiting periods are a common feature, which means you may have to wait for a specific period before you can claim benefits for your shiny new prescription glasses or contact lenses. The length of the waiting period can vary depending on your extras policy, so it’s good to check the details.

Health funds often set annual limits on what you can claim. These limits are typically calculated on a calendar year basis, which means they reset at the start of each new year. Whether it’s for an individual or the entire family, these limits determine the maximum amount you can claim within that year. So, it’s a good idea to be aware of these limits and plan your optical expenses accordingly.


Does Medicare cover eye care?

Medicare in Australia covers some aspects of eye care, but it’s important to understand the details. For instance, you’re generally covered for bulk-billed eye tests performed by an optometrist and consultations with eye specialists. However, Medicare typically does not cover the cost of prescription glasses, contact lenses, or vision lenses. This is where having private health insurance with extras cover becomes beneficial.

What does single vision mean in the context of prescription glasses?

Single vision is a term used to describe lenses that have one prescription across their entire surface. These are the most common type of prescription lenses, typically used to correct nearsightedness, farsightedness, or astigmatism. If your health insurance covers optical extras, it will likely include single vision glasses.

Does hospital cover include eye care?

Hospital cover typically includes procedures and treatments that require admission to a hospital. Some eye surgeries, like cataract surgery or retinal repairs, would likely be covered under this type of insurance. However, routine eye care, including eye tests and prescription glasses or contact lenses, are typically covered under extras cover, not hospital cover.

What are out-of-pocket expenses when it comes to eye care?

Out-of-pocket expenses are costs that aren’t reimbursed by private health insurance. In terms of eye care, these might include the gap between the total cost of your prescription glasses or contact lenses and the amount your health fund provider reimburses, or the cost of certain lens extras that your policy doesn’t cover.

Can I get a quote from an optical provider before making a purchase?

Yes, absolutely. It’s a good idea to get a quote from your optical provider before purchasing new glasses, sunglasses, or contact lenses. This way, you can understand the full cost upfront and figure out what your out-of-pocket expenses might be after claiming from your health insurance.

What are lens extras and are they covered by health insurance?

Lens extras refer to additional features or enhancements on your prescription glasses or contact lenses, such as anti-glare coating, tinting, or transition lenses. Whether these are covered by your health insurance policy will depend on the specifics of your extras cover. It’s best to check with your health fund provider to understand what is and isn’t covered.

How can I find an optical provider that accepts my health insurance?

Most optical stores and providers in Australia have agreements with a range of health fund providers. You can typically find a list of participating stores on your health insurance provider’s website. Alternatively, you can ask directly at optical stores whether they accept claims from your specific health fund.

Let CHI Find the Right Optical Cover for Your Needs

Optical insurance can play a significant part in maintaining your eye health. Whether you need prescription glasses, contact lenses, or an eye test, your health cover can help you manage these costs in Australia. It’s all about understanding your level of cover, knowing your health fund’s requirements, and choosing optical extras that suit your needs.

If you’re searching for optical cover but are overwhelmed by all the choices available, don’t worry, we can help! Simply use our free online tool below to get personalised optical cover quotes from Australia’s leading health fund providers in minutes!