6 Questions to Ask to Get the Most Out of Your Optical Benefits

Many patients who have never had eye health fund benefits come to our practices to enquire about their optical benefits. Here are questions you can ask to get the most out of yours:

1. Which health fund do you recommend?

There are many options in what it costs the consumer and what rebate the consumer gets in return. 

It also depends on what people’s expectations are. As we all know, insurance companies do not have a very good public image.

Whilst one fund at one level may have a high hospital rebate scheme, the same health fund may have a low or complex rebate for optical, so it is very important to work out the best option for yourself and your family. Optical staff are not health fund experts, so the best way to do this is to visit websites like Compare the Market and iSelect, where you can view the many options and cost.

What a lot of people do not realise is that optical, dental and ambulance cover is almost always linked under Extra Cover.

2. How do health fund optical benefits work?

Health fund optical benefits work by an item number system.

A contact lens, a frame, an SV lens, a bifocal lens, a multifocal lens and even a coating or a tint will have a recognised item number. This number allows the office person to make a claim on your behalf on the spot, saving you the trouble of having to chase up your claim. The amount you get, as stated above, can vary depending on your chosen cover. Remember, not all health funds pay the same amount. Some give a percentage of the recommended fee and some give a capped amount.

Example: MBP 1st choice extra cover:

Isn’t it great to shell out just $8.oo? The rest is covered by health fund.

All funds do have an annual limit, which is per person for individual family members.

3. What is the difference between health funds?

Generally, the more you contribute, the higher you rebate, but not always, so doing your research prior to making your decision will pay off, much like buying a car or a house.

Your payments over a period of 30 years can add up to $124,800 if the cost is $80 a week.

As you can see, it’s a substantial amount of dollars, so spending some time on research can pay off.

There are many choices as stated above with a lot of new online-only funds entering the market with no shopfront. These funds generally have lower contributions.

Many health funds claim to be ‘not for profit’ but have dental and optical outlets, which seems to be very contradictory as they operate much like a normal business and have to report to shareholders.

A little known fact is that it is very easy to switch funds if you are not happy with your current fund, and if you are financial with that current fund at time of switching, there is no waiting period.

4. Can I claim my rebate on the spot?

All Eyecare Plus practices have instant health fund rebates easily available. We use Australia’s leading health claims technology that allows convenient electronic claiming while at the counter, minimising messy paperwork and long queues.

5. How do I keep track of my claims?

Keep a physical or digital record of what your health funds offer and what you have claimed. Be aware of when your health fund cover and extras reset so you can use your entitlements before you lose it. Most benefits don’t roll over. Common reset dates are at the start of a new calendar year, financial year or membership year.

6. What happens if I don’t use my optical benefits?

If you don’t use it, you lose it! Since your optical extras don’t roll over, remember to use all of your optical entitlements before they’re gone! So if you already have your go-to pair of prescription glasses, consider claiming a spare pair, prescription sunglasses or contact lenses! Since you’re now keeping track of your claims, you would know how much you have left. If you don’t, you can always keep updated by contacting your health fund.

Do you have more questions about your optical health fund benefits? Enquire at our practices or go to www.eyecarevision.com.au for live chat support from our friendly staff.




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