Optical health cover

What you need to know:

• Prescription glasses and contact lenses aren't covered by Medicare.
• An extras policy with optical cover can help pay for the cost of glasses and contact lenses from around $3 a week*.
• Optical insurance policies will all have a maximum annual benefit, as well as a 2-month waiting period.

*Prices are based on a single person living in Sydney earning less than $97,000 a year.

What optometry costs will your health fund cover?

While cover will vary depending on your policy, you can receive cover for:

Medicare provides cover for some of these benefits, but for full cover you'll need private health insurance.

Optometry service	Does Medicare cover it?	Can private health insurance cover it?
Check ups and examinations	Yes	Yes
Eye surgery for medical issues	Yes	Yes
Eye disease	Yes	Yes
Glasses and contact lenses	No	Yes
Vision therapy	No	Yes, as an extra
Laser eye surgery	No	Yes, as an extra

Extras policies that cover optical

Here are some extras policies with optical cover from Finder partners. All prices are based on a single individual with less than $97,000 income and living in Sydney.

Finder Score - Health Insurance Extras

Each month we analyse over 10,000 extras insurance products and rate each one on price and features. What we end up with is a nice round number out of 10 that helps you compare extras cover a bit faster.

We want to compare apples to apples, not apples to apple pie. It doesn't make sense to compare a top extras policy with coverage for hearing aids and braces against a policy designed only for dental. So we've separated all the extras policies on the market into pools and categories. Once in their pools and categories, each product gets a price score and a features score, which are then combined to give the Final Score.

Read the full Finder Score methodology

Are glasses and contact lenses covered by health insurance?

Australian private health funds provide cover for a wide range of optical services and treatments through their extras cover policies. some of these include:

• Prescription glasses and contact lenses
• Rebates on prescription sunglasses and prescription swimming goggles
• Eye check-ups

Health insurance for major eye surgery

If you want insurance for major optical procedures, you'll need a more comprehensive plan that you would need for basic optical. If you want health insurance for cataract surgery, you’ll need to take out hospital cover. Specifically, you'll need a gold-tier hospital policy.

If you want health insurance for laser eye surgery, you'll need a specific top-tier extras package that covers laser eye treatment. There are only a handful of products on the market that cover this, mostly because the cost of laser eye surgery is so high. Be sure to check our guides on this before you make a decision.

What should I look for in a health insurance policy?

There are some terms and conditions you should look out for when finding an insurance policy.

Exclusions

Exclusions are the things that aren't covered by your private health fund. Some frequently encountered exclusions are:

• Treatment outside of Australia. If you want to head abroad for cheaper laser eye surgery, for example, most health funds won't cover that. You might consider medical tourism insurance instead.
• No cover unless there is a specific, named health issue involved.
• No cover for additional costs like administration fees.

Limits

These are the maximum amounts your policy will pay in benefits, or how much you can claim before your benefits cap out. Your policy may have yearly or lifetime limits for a number of treatment sessions or an amount of money paid out.

• If the cost of a treatment is more than the limit of your policy, you will only be covered up to that limit and must pay the rest yourself. This is sometimes refered to as the 'gap'.
• In the case of family or couple policies there may be limits for individuals as well as limits for the group as a whole.
• Some no-gap optical policies do exist, if you would prefer not to pay any extra.

Excess

A health insurance excess is an additional amount you must pay when making a claim. If more than one excess applies, you must pay the total sum of all applicable excesses. Generally, excess' are only a feature of hospital policies, as well as combined policies.

• Age related excess. The older you are the higher your risk levels. Certain age groups have this additional excess.
• Hospital excess. If someone on your policy goes to hospital this excess will apply to cover the additional costs involved.
• Special excess. Pre-existing conditions, ongoing health issues or a history of making many claims will drive up your special excess.

• Do all Australian health funds cover optical?

  Optical health insurance is a common feature of the vast majority of extras cover policies available from Australian health funds. However, as always, make sure you read any information from your health fund closely to find out whether optical services and treatments are covered and to what level.

• Can I buy glasses from anywhere and still get a refund?

  Australian private health funds will pay benefits for prescription glasses and/or contact lenses purchased from the vast majority of registered optical dispensers and eyewear stores across the country. If you're ever in doubt about whether a particular purchase will be covered, check with your health fund for confirmation.

  However, if you prefer to do your shopping online, be warned that not all online optical retailers will be covered by your fund. With this in mind, check to see whether your health fund provides a list of online optical stores where you can buy the products you need and still access a full or partial refund.

• Can I use buy-now-pay-later on prescription glasses?

  Many Australian optometrists do have agreements with buy-now-pay-later companies, so you can use services like Afterpay for prescription lenses, to pay them off over time. However, you're generally better off if you have extras cover that covers with optical.

• Can I get cover for sunglasses?

  If you need prescription sunglasses, these will be covered by your health fund in the vast majority of cases. Check with your health fund to confirm this before parting with any money.

  However, non-prescription sunglasses are typically not included in your extras cover, but you may still be able to take advantage of discounted sunnies thanks to your health fund's partnership with an eyewear retailer.

• Can I get cover for laser eye surgery?

  If you're thinking of undergoing laser eye surgery so you can wave a permanent goodbye to prescription glasses and contact lenses, you should be aware that:

  • Procedures of this type are not covered by Medicare (unless it is required to treat certain eye diseases).
  • It's also not covered by many private health funds, although some funds will offer a limited level of cover as part of their top hospital or comprehensive extras policies.

  Even if your health fund says it covers laser eye surgery, check the fine print for more information on exactly how much of the total cost of the procedure will be covered. Also, keep in mind that:

  • Lifetime limits often apply to cover for laser eye surgery, as opposed to the annual limits quoted for many other extras services, so make sure you're aware of the maximum level of cover available.
  • You will typically have to serve a waiting period before you can access any benefits for laser eye surgery. Waiting periods vary from one fund to the next, but expect to have to wait one or possibly two years before you can claim a benefit.

• What optometry costs will your health fund cover

  While cover will vary depending on your policy, you can receive cover for:

  • Check ups and examinations
  • Glasses and contact lenses
  • Eye disease

  • Eye surgery for medical issues
  • Vision therapy
  • Laser eye surgery

  Medicare provides cover for some of these benefits, but for full cover you'll need private health insurance.

  Optometry service	Does Medicare cover it?	Can private health insurance cover it?
  Check ups and examinations	Yes	Yes
  Eye surgery for medical issues	Yes	Yes
  Eye disease	Yes	Yes
  Glasses and contact lenses	No	Yes
  Vision therapy	No	Yes, as an extra
  Laser eye surgery	No	Yes, as an extra

  Compare your health insurance options

• How do I make an optical cover health insurance claim?

  Depending on the procedure and your fund, there are a few ways to make a claim. Some claims may require more than one of these. For example, you might be able to claim a procedure online, but you may be required to fill out a claims form and mail it in to claim the related ambulance ride.

  • Use an app. Some health funds offer a mobile app you can use to make a claim. This is an easy way to do it but might not always be an option.
  • Claim online. Visit your fund's website to make a claim online. Login with your details and go to the claims section. From there you can follow the steps, provide the information required and have the benefit paid sent directly to your bank account or mailed as a cheque.
  • Send in a claims form. Download a claims form from your fund's website, fill it in and mail it off to the address provided. Your claim will be processed and handled accordingly.