Do you have private health insurance with optical cover?

If you answered yes then read along on how you can make the most out of your private health insurance.

It’s that time of year again!

Sleigh bells are ringing. The clock is ticking, and the countdown to the new year is on.

Mad dashes to the store to pick up those last-minute gifts have commenced, and with it, many Aussies are looking to quickly claim their unused health fund benefits.

Here’s how you can too.


    1. What can I claim?

Easy, you say, they cover glasses.

Well, not quite.

For your health fund to cover your stylish new specs, you have to get prescription eyewear. Those trendy sunnies your daughter got from Sportsgirl, aren’t going to be covered by your health insurance.

Your health fund wants to make sure you’re receiving the best care for your eye health. So, they will only offer coverage on prescription sunnies and glasses that have been certified by an optometrist

All Optometry practices must abide by these laws, so rest assured, you’re safe to purchase from your local Optometrist.

But what if I don’t like to wear glasses?

Not to worry, your health fund benefit also incorporates contact lenses.

It’s an either/or situation. Your health fund cover will go towards either your next glasses purchase OR your contact lenses, not glasses and contacts.


    1. How much does it cover?

That depends on who you’re with.

Some health funds only pay a percentage of the cost of your glasses. It’s normally written in the fine print when you sign up. It’s also why sometimes it seems like your health fund covers more when you buy 2-pairs of glasses, instead of 1-pair.

They’re technically not covering more, there are just more percentages from the higher cost.

It’s a little sneaky, but it’s all in the fine print, so they’re covered.

If your health fund doesn’t pay percentages, then they’re most likely paying a flat dollar value. So, no matter how many glasses you’re purchasing, they only cover the set amount they said. Nothing more, nothing less.

When it comes to extras on your lenses—extras being any thinner lenses, anti-reflection, polarisation etc. you may require—not all health insurance is created equal.

Some health funds are willing to cover your extras, while others simply won’t. You can determine this on your receipt.  If your receipt says ‘Not covered,’ then you know they don’t cover optical extras, however, ‘exceeds limit,’ means your health fund can, but in this case, you’ve used up all you can claim.


    1. Can I get free glasses?

Sorry, but no.

The fact that you pay for health insurance with optical coverage does not mean that you get free glasses.

Some people might—more power to you. 

It all depends on how much your health fund covers.

Most of us will have an out-of-pocket expense, known as a gap fee. So even though you pay for health insurance, you’ll most likely need to pay some amount of money for your new specs. It’s always a good idea to ask for a quote before committing, so you don’t have any nasty surprises.

My health fund offers a 2-pair no gap scheme.

That’s great! But please remember to read the fine print.

Schemes like these are made to capture your attention and have you rushing in-store. Once there, depending on if you ticked all the fine print requirements, you’ll either pay nothing or be left feeling duped.

I don’t want you to feel duped. 

The things to look out for are:

    • Which stores are affiliated with this scheme
    • What lens extras you’re allowed

    • What lens type it covers (it will most likely be for single-vision lenses only)

It’s a good idea to keep a note of the above requirements, so you’re aware if you fit into this scheme after the Optometrist recommends the right products for your needs.

So, there you have it!

As you’re picking up those last-minute items, don’t forget to head into the new year with some new prescription eyewear with a lower gap fee.

Knowing these top three things about your Health Insurance benefits will have you ready to claim.

It certainly is the most wonderful time of year.

Are you ready to make the most out of your Health Insurance?

Call us today on 03 87591746 or book online.