Is 'Extras Cover' Worth it?

Unexpected root canal therapy on one tooth recently cost me $1300 for the first visit and $1200 for the second. HCF limit on endodontics is $500. This week I had a filling in another tooth by an ordinary dentist - that was $350 - the HCF limit on that is $550 so I hope I don’t need another. I am about to have a gold crown on the root canal therapied
tooth and HCF limit on that is $800, so I hate to think how much out of pocket I will be. Given the huge amount we pay for extras health insurance - is it worth it?


That is actually an easy question to answer. Although your extras might be different from year to year, keep a tally of your costs and rebates for everything in your extras cover and compare your rebates to your premium. If the rebates are the same or more than your premium the extras are a good deal for you.

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Go to your insurer and ask for a statement [editted based on @PhilT’s comments] or log on and get how much you have claimed over say the last five years vs how much you have paid. Make sure you do it over as long a period as possible, because health issues tend to wax and wane, so the longer the period, the more representative it is likely to be.

Also take into consideration the likelihood of future health issues (make estimates for as many years ahead as possible), and what you would receive in rebates vs what you will pay.

Compare the cost (what you have and will pay) vs the benefit (what you have received + what you might get back). The answer to that equation will tell you whether it is worth it or not.

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Thank you. Good idea. I was being cross and lazy!!

That is usually available on their members’ web pages, time dependent for how long on any particular fund.

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I don’t have extras cover and recently needed dental work that was going to be expensive and not urgent. My dentist recommended I contact my health fund to see if the extras were worth it. I phoned Bupa (who I have other health insurance with) and asked them. They advised that it will never be worth it for their funds unless I claimed for multiple types of extras in the same year. For dental alone, I would receive back pretty much the same amount I paid as an annual premium - definitely not worth it, as I would need to pay 2 years of premiums to get past the 12 month waiting period. They said that if I also had optical, physio or other extras items to claim in the same year, that’s when it could be worth it. I didn’t have those and so didn’t take up the cover.


I have stopped paying extras 9 years ago. I put that exact amount of contribution into a separate account and fully pay my own expenses. We have now have accumulated our own " extras" fund of over $ 8000. Of course we have maintained our hospital cover; that is where the huge expenses can occur. This works well for a reasonably healthy elderly couple like in our situation, but probably not for a young family expecting or bringing up children.


I had Medibank extras and only received $200 from a specialist dentist’s fee of $6,000. I cancelled after that!
Open a savings account.


Use it, or lose it.

For those who take out this type of health cover, many funds reset the annual limits in January. This means if you haven’t claimed all your extras benefits (and with this type of cover, you should be using it to max), you will lose any remaining value.


I’d also ask if the costs of the medical services covered by extras are fair dinkum. The dentist I have used after moving starts by asking what cover we have and when I feign ignorance of the value offers to use my card to look it up. It seems there is always a large gap?

Some extras may be worth chasing down each year, but if all you are doing is paying a topped up price premium are you any better off?

While Bupa did have a mix and match option for lower cost cover, it appeared to leave out several key areas you paid for a more expensive inclusive package.

Where are the no claim bonuses for having paid 45 years of health cover with barely a day in hospital? If you don’t use extras which should have a separable fee, should they not have a carry over or forward component?

A second and broader observation is once you move away from any large city, there are few choices of medical service providers unless you choose to drive 20km, 35km, 100km …

How far do others travel to the dentist and what does an annual checkup and clean cost?

Where do you look up the recommended costs for any extras item?

It all adds up, whether you choose to self insure or pay for the cover.


In addition to the amounts covered the funds are playing ‘advertising games’ with their limits, and often have sub-limits that are not advertised until you ask.

A case is HCI with a $1,500 p.a.p.p. major dental benefit. A crown is subsidised to $800. Sounds OK. A reasonable expectation from the headlined amount is one crown is paid up to $800 and a second would be to $700. BUT there is a $1,000 sub-limit p.a.p.p. for crowns, so one is paid up to $800 but a second only to $200. All the funds play the game using headline cover that has some major gotchas, benefit and fund dependent.

How many questions need to be asked to find reality? Collect your item codes; you cannot always just ask without them, again fund dependent on how much they will willingly reveal.