Private health insurance extras can sometimes contribute to nursing, physiotherapy, occupational therapy or personal care. The cover varies enormously between funds and policies, and the exclusions matter as much as the benefits.
What might be covered
- Community nursing, where the fund offers it and the provider meets their criteria.
- Allied health, such as physiotherapy or occupational therapy, usually with a referral and a limit.
- Some personal care or domestic assistance under a "health management" or "independent living" extra.
Most funds do not cover everyday domestic help. Do not assume cleaning is claimable because nursing is.
What is usually excluded
Services that look like household maintenance. Support that is already funded by the NDIS or aged care. Services delivered without the required referral. Anything outside the annual limit.
Some funds also require the provider to be registered with them. Ask before you book.
How to check
- Find your policy's extras list and the annual limit for each item.
- Call the fund and ask whether home care nursing or personal care is covered.
- Ask what the provider needs to supply: a referral, a provider number, an invoice format.
- Confirm whether the provider is recognised by the fund.
- Ask what happens when the limit runs out.
Get the answer in writing or note the date, time and name of the person you spoke to.
Combining funding sources
You cannot claim the same service twice. If an hour is funded by the NDIS, it cannot also be claimed from private health. Keep the invoices separate and tell each fund what the other is paying for.
The useful question
"If I book this service with this provider, what exactly will you reimburse, and what paperwork do you need?" That single question prevents most rejected claims.
When it is not worth it
If the annual limit is small and the paperwork is heavy, the effort may exceed the benefit. Use the extras for something with a higher rebate, and pay privately for the rest.
Common questions
Does private health cover cleaning?
Rarely. Some policies offer limited domestic assistance under a specific extra. Check your policy.
Do I need a referral?
Often yes, particularly for allied health. Ask your fund.
Can I use extras and the NDIS for the same service?
No. You cannot claim the same service twice.
What if the provider is not recognised by my fund?
You may not be able to claim. Ask the fund before you book.
Does extras cover count toward the Medicare safety net?
No. Private health extras and Medicare are separate systems.
Sources and further reading
This guide is general information, not medical, legal or financial advice. If you are worried about your health, call your GP. In an emergency, call 000.