Every year, thousands of Australians with private health insurance let their optical extras benefit expire without using it. The benefit resets, usually on 1 January, and that money is simply gone. If you have optical cover as part of your extras policy, this guide will show you exactly what you're entitled to, how to claim it, and how to make the most of every dollar before the reset date.
At Prime Optometrists Auburn, we have HICAPS on-site, which means you can claim your health fund benefit instantly at the time of your appointment. No paperwork, no waiting for reimbursement.
When Do Health Fund Optical Benefits Reset?
Most Australian health funds reset optical extras on 1 January each year. This means any unused benefit from the previous year disappears on New Year's Day, regardless of how much you paid in premiums throughout the year. Some funds, however, run their benefit year from your policy anniversary date rather than the calendar year, so it's worth checking your specific policy.
The practical takeaway: if your fund resets on 1 January, December is the time to act. Book your eye test, select your frames and lenses, and claim your benefit before the clock runs out.
What Does Optical Extras Actually Cover?
Optical extras cover is for corrective eyewear and related fittings. What's typically included:
- Prescription spectacle frames
- Prescription spectacle lenses (single vision, bifocal, multifocal)
- Prescription contact lenses
- Contact lens fitting fees
What optical extras does not typically cover:
- The eye examination itself, that is covered by Medicare, not your health fund
- Non-prescription (plano) sunglasses, even from an optometrist
- Cosmetic contact lenses without a prescription
- OCT or other diagnostic scans, these are typically billed separately under Medicare
“A lot of patients assume their eye test comes out of their health fund. In most cases it doesn't, Medicare covers the consultation, and your health fund covers the glasses or contacts. The two systems work alongside each other.”
, Dr Zobaida Tahiri, Optometrist Auburn NSW
How Much Can You Claim?
Benefit amounts vary depending on your fund and the tier of your extras cover. At Prime Optometrists Auburn, we offer no-gap glasses options, meaning many patients pay nothing out of pocket for frames and lenses when their health fund benefit covers the full cost. As a general guide:
- Basic extras: typically $100–$200 per year for glasses or contacts
- Mid-level extras: typically $200–$300 per year
- Top extras / comprehensive cover: up to $300–$500 or more, depending on the fund
We accept all major Australian health funds including BUPA, Medibank, HCF, NIB, AHM, CBHS, Teachers Health, Police Health, and most other registered funds. We offer no-gap glasses options at our Auburn clinic, so depending on your fund and benefit level, you may pay nothing at all for your frames and lenses.
How to Use Your Health Fund at Prime Optometrists
The process at our Auburn clinic is straightforward:
- Step 1: Book your eye examination, bulk billed through Medicare for eligible patients at no cost
- Step 2: Select your frames and lenses from our range. Our optometrist and dispensing staff will guide you to the right lenses for your prescription and lifestyle
- Step 3: Present your health fund card at the counter. We process your claim on the spot using HICAPS, the benefit is deducted immediately and you only pay any remaining difference
- Step 4: Collect your glasses, usually within 7–10 business days depending on the lens type
No forms to post, no online portal to navigate, no waiting weeks for a reimbursement cheque.
Book your eye exam and glasses fitting in Auburn and bring your health fund card on the day.
Tips to Maximise Your Optical Benefit
- Check your balance before December. Log in to your fund's app or member portal to see exactly how much optical benefit you have remaining for the year.
- Book in November or early December if your benefit resets on 1 January. Glasses orders placed in late December may not be ready before the reset, the claim date is typically when the order is placed, not when the glasses are collected.
- Ask about our no-gap options. We offer no-gap glasses at Prime Optometrists Auburn, meaning your health fund benefit may cover the full cost of your frames and lenses with nothing left to pay.
- Use your benefit for contacts as well as glasses. Some funds allow you to split the optical benefit across both in the same year, or have a separate contact lens sub-limit.
- Bring your fund card. Without your physical card or the fund's digital card app, we cannot process a HICAPS claim on the day.
Can You Combine Medicare and Your Health Fund?
Yes, and this is how most patients at our clinic access care. The two systems are designed to work together:
- Medicare covers the eye examination itself for eligible patients. At Prime Optometrists, we bulk bill eligible patients, so the consultation costs nothing.
- Your health fund optical extras then cover the cost of glasses or contact lenses prescribed during that examination.
This means a patient with a valid Medicare card and optical extras could have their eye test bulk billed and their glasses largely or fully covered by their health fund, all in one visit. For more on the Medicare side, see our guide on bulk-billed eye tests in Australia.
Watch Out for Waiting Periods
If you have recently joined a health fund or upgraded your extras cover, be aware of optical waiting periods. Most funds impose a waiting period of 6–12 months before you can claim optical benefits. This is one of the most common surprises for new fund members who assume their cover is immediately active for all extras.
Check your fund's Product Disclosure Statement (PDS) or call your fund directly to confirm your optical benefit is active before booking specifically to use it for glasses.
How to Check Your Remaining Optical Benefit
There are several ways to check how much optical benefit you have remaining:
- Fund app: Most major funds (BUPA, Medibank, HCF, NIB, AHM) have smartphone apps showing remaining extras balances in real time
- Member portal: Log in to your fund's website and navigate to “extras” or “benefits remaining”
- Call your fund: Member services can confirm your remaining benefit over the phone in under a minute
- Ask us at the clinic: When you present your card for a HICAPS claim, we can run a benefits check before processing the transaction so you know exactly what you'll pay
Book Before Your Benefits Reset
If you've been putting off updating your glasses or fitting contact lenses, your health fund benefit reset is the prompt you need. Unused optical benefits represent money you've already paid for in your premiums, there is no rollover and no refund if you don't use them.
Prime Optometrists is located in Auburn NSW 2144, with easy access from Lidcombe, Granville, Parramatta, Berala, and Regents Park. We accept all major health funds, bulk bill eligible Medicare patients for eye examinations, and process HICAPS claims on the spot.
Book your appointment online, it takes two minutes, and your eyes and your wallet will both thank you.