Best health insurance plans for optical

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Your eyesight is precious! With the right health insurance, you can always rely on getting the best care without burning a hole in your pocket. But what exactly does the best health insurance look like and what are some of the biggest considerations to help you make an informed choice?

From understanding the basics to exploring all your optical options, read on to find out how you can give your eyes the care they deserve.

What does optical cover include?

Optical cover in Australia is pretty straightforward, and there are lots of providers that have policies to cover the costs associated with maintaining good eye health. Generally, this includes services and products related to your vision – like eye exams, prescription glasses, contact lenses and services provided by an optical specialist – without hefty out-of-pocket expenses.

Getting an eye examination regularly can help detect any potential issues before they cause your vision to deteriorate. The good news is many optical cover policies (even some cheap health insurance policies) include these costs. Depending on your provider, you may also get a contribution towards the cost of prescription glasses or sunglasses, whether you’re a round-the-clock glasses wearer or just need them for specific tasks like reading. If you prefer contact lenses, your optical cover may extend to cover part of this expense.

Be aware that the specifics of optical cover tend to vary between health insurance providers, so it’s always a good idea to review the policies carefully beforehand so you know exactly what you are getting into – and what is and isn’t covered.

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What’s the difference between general and major optical cover?

Not sure what level of cover you should go for? The more expensive option might have more inclusions, but if you won’t end up using them then it may not be cost-effective over the long term. So understanding the difference between general and major optical cover can help you choose the right plan for your needs.

In simple terms, general optical cover tends to include basic services and benefits for routine eye care, while major optical cover can include more extensive services and specialised treatments/procedures. Here’s a quick breakdown to help you decide:

General optical cover:

  • Routine eye check-ups: General optical cover should include benefits for standard eye exams annually.
  • Prescription glasses: This might cover a portion of the cost for prescription glasses or sunglasses. Be aware that it’s usually limited to once a year (or longer).
  • Contact lenses: Some policies include benefits for contact lenses.

Major optical cover:

  • Specialised eye treatments: In addition to all of the above, a major optical policy might also cover more advanced treatments, including those for specific eye conditions and diseases.
  • Advanced diagnostic tests: Cover for more in-depth tests and procedures to assess complex eye problems.
  • Surgical procedures: Major optical cover sometimes includes benefits for surgical interventions, like laser eye surgery or cataract removal.
  • High-cost eyewear: A larger contribution to take care of the higher cost of high-end glasses or contact lenses.

Does every private health insurance policy include optical cover?

Not all health insurers automatically include optical cover in their policies. In fact, for many providers, it’s built into their extras cover. It’s important to study the specifics of each policy to figure out whether it includes the cover for optical services that you’re after. Remember, while some policies will include basic optical benefits as part of their general cover, others might require you to add it on as an optional extra.

Here are four things you should consider about optical cover:

  1. Check all the policy inclusions: Go through the list of inclusions to see if basic optical services like eye exams and prescription glasses are covered. Some policies may include these by default.
  2. Explore optional extras: If your preferred policy doesn’t have an optical cover, you may have to add on extras cover to get optical services. The good news is that most providers will allow you to customise your plan so it meets your lifestyle needs.
  3. Think about your individual needs: Consider your own optical needs and what you want to get out of a private health policy. If you wear glasses or contact lenses every day, or if you expect that you’ll need specialised eye treatment in the near future, then it might be worth going for a policy with major optical cover.
  4. Review waiting periods: Be aware of all the waiting periods associated with optical cover. Most policies will require you to serve these waiting periods before you can make a claim on optical services.

Does optical cover include laser eye surgery?

Laser eye surgery is considered an elective procedure in Australia, and is therefore not covered by Medicare. This means you’ll either need to find a policy that specifically covers laser eye procedures, or you’ll be left to foot the (often hefty) bill yourself. Bear in mind that laser eye surgery isn’t included in most private health insurance policies, so you’ll need to do your research if this is a must-have.

With that being said, some private health policies do in fact have benefits for laser eye surgery, the extent of which may vary between providers. Take a close look at the policy’s Product Disclosure Statement (PDS) and speak directly with your insurer to understand the specific terms and coverage limits for laser eye procedures.

It’s also worth noting that even if a policy does provide cover for laser eye surgery, it might not cover the entire cost. You could still be left with high out-of-pocket expenses, and insurers will also impose waiting periods before you can claim any benefits for this elective procedure.

How much is laser eye surgery?

The cost of laser eye surgery depends on several factors, including where you are located (i.e. how much your preferred laser eye specialist charges), whether surgery is needed for just one or both eyes, as well as the specific type of surgery you want (such as PRK, LASIK or SMILE).

On average, you can expect to pay between $2,500 to $3,500 per eye for laser eye surgery in Australia. And remember that even if you have major optical cover, your policy may not cover this entire amount.

What waiting periods apply to optical cover?

When weighing up the pros and cons of different optical policies, one of the most important things to be aware of is the waiting periods. Many policies have waiting periods of around six months before you can claim any benefits for optical services. However, if you switch to a new policy on the same tier or lower, and you’ve already served the waiting period on your previous policy, then you should be able to claim straight away.

If you have any pre-existing optical conditions, be aware that some providers might extend the waiting period to 12 months. This means that if you have a history of eye-related issues the you might have to wait up to a year before being able to make a claim.

Final word

Choosing the right optical cover is pretty much like trying to find the perfect pair of glasses – you’ll need to test a few out to see what fits. An easy way to do that is to compare health insurance policies online, making sure to factor in the waiting periods, specific inclusions and whether there are any particular services you must have covered, like laser eye surgery. The best optical cover should match up with your individual needs without breaking the bank.

Simon Jones
Written by
Simon has spent more than 15 years covering the technology and finance sectors as both a journalist and content marketer. He is fascinated by the convergence of AI and big data, and spends what little free time he can scrape together either wrangling two kids or expanding his gin collection.

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