Extras insurance, also known as ancillary or ancillary cover, helps cover the cost of everyday healthcare services that are not covered by the standard hospital cover. These can be minor services like dental check-ups, new glasses, and physio appointments, to more major services like wisdom teeth removal and dental implants.

Medicare generally doesn’t cover extras services, so extras insurance can be a way to help cover those costs. Here are some other examples of extras services that are covered by Latrobe Health.

There are some services that are not covered by extras insurance, and they include services like:

• A visit to a doctor outside of hospital, like a General Practitioner (GP), as that’s covered by Medicare.
• Consultation fees for a doctor or a specialist appointment outside of hospital, tests and examinations like x-rays or blood tests and eye tests by an optometrist are also services that are covered by Medicare.
• Prescription medications subsidised by the pharmaceutical benefits scheme (PBS).

A limit is the total amount you can claim back on extras, over a set time period, per person or per family. Limits are reset at the start of each calendar year (1 Jan) unless it is a lifetime limit. You can find information about the limits that apply to each service in the policy documents.

A waiting period is the initial time period you’ll need to wait, before you can claim for certain procedures or services of your health insurance policy.

Waiting periods can be applied to new memberships or to any additional benefits when you change or upgrade your health insurance policy.

Why do we need waiting periods?

All health funds have waiting periods, this is to keep the cost of health cover as low as possible for members.

Waiting periods help reduce instances where new members join, claim, and then leave the fund with existing members having to pick up the tab through increased premiums to cover these costs.

When do waiting periods apply?

Waiting periods will apply if:

• you’re new to private health insurance.
• your private health insurance has lapsed, and you are starting over.
• you’re upgrading your cover (including reduced excess or increased benefits payable), you may have to serve waiting periods.
• for hospital covers, wait periods may apply if you have a pre-existing health condition.

For those who have previously served waiting periods and are upgrading their cover, you’ll only have to serve waits on the services and benefits that are over and above what your existing cover provides.

What happens to my waits periods if I switch health insurers?

If you’re switching to Latrobe Health from another fund (welcome!!) where you’ve already served your waiting periods, you won’t have to re-serve your waiting periods provided you are purchasing the same level of cover.

If you’re part-way through your waiting periods with your old fund, you’ll have to serve the remainder of the waiting period when you join Latrobe Health before being eligible to make a claim.

What happens to my waits periods if I switch my Latrobe Health cover or extras product?

If you’ve already served your initial waiting periods and you’re switching from one Latrobe Health cover or extras product to another Latrobe Health cover or extras product, then you only need to serve waiting periods on the services that were not covered on your previous cover level.

Any change from a higher hospital excess level to lower hospital excess level will require a 12-month waiting period. Find out more about switching hospital excess levels here. 

If you’re part-way through waiting periods for previous cover, you’ll have to serve the remainder of the waiting period before being eligible to make a claim.

What are Latrobe Health’s waiting periods? 

For hospital cover, the following waiting periods apply:

• Twelve months for pre-existing conditions.
• Twelve months for pregnancy and birth (if your policy covers this), or two months if upgrading from a single membership to a family membership for the birth of a child.
• Two months for psychiatric care, rehabilitation, and palliative care.
• Two months for treatments where no other waiting period is specified.
• One day for emergency ambulance transports.

For extras cover, the following waits generally apply.

• Twelve months for orthodontic, major dental and health appliances such as C-PAP machine, blood glucose monitors, and hearing aids.
• Six months for optical.
• Two months for general dental and allied health services such as physio and podiatry.
• One day for emergency ambulance transports.

See your policy documents for a full outline of what you’re covered for and what waiting periods apply.

Pre-existing conditions

Latrobe Health applies a waiting period of 12 months for pre-existing conditions, with the exception of psychiatric care, rehabilitation and palliative care.

A pre-existing condition is defined as any ailment, illness, or condition that you had signs or symptoms of during the six months before you took out hospital cover or upgraded to a higher hospital policy. You don’t have to have seen a doctor or received a diagnosis for it to be considered pre-existing.

You can find out more on pre-existing conditions on the Commonwealth Ombudsman’s website.

Pregnancy and birth

Latrobe Health applies a waiting period of 12 months for pregnancy and birth – and it is the mother that will need to be covered. If you are planning a pregnancy and have no current hospital insurance or a cover that does not include obstetrics, you will need to take out an appropriate private hospital insurance before you get pregnant.

Waiting periods will also apply if you are changing from a single membership to a family membership for the birth of a baby. In these circumstances, for your baby to be covered from birth, you will need to upgrade to a family membership at least two months before the expected due date.