Eye surgery and health insurance explained
In shortIf you’re considering eye surgery, understanding how private health insurance works may help you plan for treatment costs, hospital care and future eye health needs*. |
On this page
- How private health insurance may help with eye surgery
- Eye surgery and treatment options explained
- Things to check before surgery
- Learn more about eye surgery cover with Police Health
- Frequently asked questions
How private health insurance may help with eye surgery*
When you’re admitted to hospital as an inpatient, Police Health’s Gold Hospital and Gold Combined cover includes benefits towards the investigation and treatment of the eyes and surrounding structures of the eye.
This includes benefits towards surgery for eye conditions, such as cataract surgery and lens replacement, as well as treatment for retinal detachment, tear duct conditions, eye infections and medically managed eye trauma.
Police Health also provides benefits for corrective laser eye surgery services for certain conditions for members with Gold Combined (not available when taking out either Gold Hospital or Rolling Extras only).
How Medicare and private health insurance work together
Below is a quick guide on where Medicare may pay benefits and when you claim under a Gold Hospital health insurance policy with Police Health.
Medicare*
Police Health*
Service performed as an outpatient (not admitted to hospital)
Yes, Medicare contributes towards the medical fees
No private health benefits available
Services performed as an Inpatient of a hospital
Yes, Medicare contributes towards the medical fees
Eye Surgery medical fees (gap) and hospital fees claimable under Gold Hospital & Gold Combined
Note: Laser Eye Surgery benefits (for certain conditions and not related to a Medicare service) claimable under Gold Combined.
Why some people choose Police Health's Gold Hospital or Gold Combined cover
Police Health's Gold Hospital covers all 38 clinical categories, which includes cataract surgery to remove cataracts and replace them with an artificial lens.
Lower levels of Hospital cover with other health funds do not always include cataract treatment, so choosing Gold Hospital or Gold Combined cover offers greater certainty if eye surgery is needed in the future.
Gold Combined cover can also help support ongoing eye health needs through Extras benefits for optometry services like glasses and contact lenses.
Get a personalised quote for Police Health
Eye surgeries and treatments explained
Eye surgery can refer to a range of procedures used to improve vision, treat medical conditions or help prevent further damage to the eye.
The good thing about Police Health's Gold Hospital cover and Gold Combined cover is that it covers all 38 clinical categories, including the below.
Eye (not cataracts)
This category is for the medical investigation and treatment of the eye and the contents of the eye socket.
For example: retinal detachment, tear duct conditions, eye infections and medically managed trauma to the eye.
Cataracts
This clinical category covers the in-patient surgery to remove a cataract and replace with an artificial lens.
All Gold Hospital covers include Cataracts as a clinical category and must include this category unlike lower levels of hospital covers.
Is laser eye surgery covered by private health?
Police Health's Gold Combined cover also includes partial benefits for laser eye surgery*.
It's commonly used to correct refractive vision errors so you can reduce or eliminate your need for glasses or contact lenses.
However, there are important details to remember.
Waiting periods and when you can claim
For a benefit to be paid, the laser eye surgery must meet the following conditions;
- Must be laser vision corrective surgery
- Must not be associated with or related to a Medicare service
- Must involve treatment to correct myopia, hyperopia, presbyopia and astigmatism
Myopia is more commonly known as short-sightedness, this can make objects that are distant seem blurry.
Presbyopia is a condition where your eyes become less able to focus with age.
Hyperopia is more commonly known as long-sightedness, this can make objects that are close seem blurry.
Astigmatism is a common eye condition where the cornea or lens of the eye is not perfectly curved, this can cause trouble focusing, blurred vision, headaches, eyestrain or difficulty seeing at night.
The Waiting Periods are 3 years membership with Police Health, and laser eye surgery is an outpatient procedure that is not covered by Medicare.
Procedures not covered by Police Health
The following are some of the Corrective Laser Eye Surgeries are NOT covered by Police Health;
- Automated lamellar keratoplasty (ALK)
- Reflective Lens Exchange (RLE), or CLE or RLR
- Presbyopic Lens Exchange (PRELEX)
- Intacs or Intracorneal Ring Segments (ICR)
- Phakic Intraocular Lens Implants
- Astigmatic keratotomy (AK)
(not an exhaustive list, subject to change)
Things to check before eye surgery
Confirm your level of cover
Different levels of Hospital cover may include different eye-related services and treatments.
Checking your cover before booking treatment can help you better understand what benefits may be payable and any Waiting Periods that may apply.
Ask about out-of-pocket costs
Even with private health insurance, there may still be costs not fully covered by Medicare or your health fund.
Before treatment, ask your specialist and hospital for informed financial consent so you understand any expected out-of-pocket expenses.
Speak with Police Health before treatment
If you're unsure what your cover includes, our team can help explain how your benefits work and what information you may need before going to hospital.
Learn more about eye surgery cover with Police Health
If you’re considering eye surgery or reviewing your health cover options, understanding what’s included before treatment can help give you greater certainty about future costs and hospital care.
Police Health’s Gold Hospital and Gold Combined cover includes all 38 clinical categories.
This includes cataracts, as well as benefits towards certain corrective laser eye surgery procedures under Gold Combined*.
Compare cover options or get a personalised quote online.
Eye therapy and eye surgery FAQs
The type of cover you may need can depend on the procedure and whether it’s performed as an inpatient or outpatient service.
Police Health’s Gold Hospital and Gold Combined cover includes all 38 clinical categories, including cataracts, while Gold Combined also includes benefits towards certain corrective laser eye surgery procedures*.
Learn more by reading our guide to eye surgery and private health.
Police Health’s Gold Combined cover includes partial benefits towards certain corrective laser eye surgery procedures*. Eligibility criteria, Waiting Periods and clinical requirements apply.
Learn more by reading our guide to eye surgery and private health.
Medicare generally does not cover laser eye surgery (such as LASIK or PRK) to correct short-sightedness or long-sightedness because it is classified as elective refractive surgery, not medically necessary treatment.
Learn more by reading our guide to eye surgery and private health.
All Gold level Hospital cover must include cataracts, which covers in-patient surgery to remove a cataract and replace it with an artificial lens.
Learn more by reading our guide to eye surgery and private health.
*All benefits may be subject to Waiting Periods, Limits and other conditions. Rollover applies once you’ve completed your first 12 months membership (2 years for Major Dental). Providers must be recognised by us. Review the cover tables on the Combined, Hospital and Extras pages, and your State Premium and Benefit Guide or contact us for more information. Laser vision corrective surgery is subject to a 3 year waiting period.