Adelaide Wellbeing Society

Using Your Private Health Insurance for Allied Health Services in South Australia

Many private health funds in South Australia offer rebates under Extras (or Ancillary) cover for allied health services such as Occupational Therapy, Speech Pathology, and Exercise Physiology — but how much you can claim, and when, depends on your specific policy. Here’s what you should know:

✅ What Can Be Covered?

• Exercise Physiology — Some health funds include Exercise Physiology in extras cover, especially when the treatment aims to prevent, delay, or manage a chronic disease or injury (rather than general fitness). 

• Occupational Therapy — Many funds cover OT under their higher-tier extras policies. The rebate often covers part of the cost (for example, 60–75%) and may require the OT to treat a “medically diagnosable condition.” 

• Speech Pathology — Some funds include speech pathology in extras cover. The eligibility depends on your fund, your policy level, and whether your therapist is recognised by the fund. 

🔍 What You Need to Check with Your Health Fund

1. Does your extras cover include the service?
   Just because you have “extras cover” doesn’t mean it includes all allied health services. Ask specifically about your plan’s cover for Exercise Physiology, Occupational Therapy, and Speech Pathology. 

2. Waiting periods
   Many policies impose waiting periods before you can claim a rebate on these services after joining or upgrading your level of cover. 

3. Annual or service limits (caps)
   You may face a cap (e.g. dollar limit or number of sessions) for allied health rebates within a calendar or financial year. 

4. Therapist eligibility
   To claim, your therapist may need to have specific credentials (e.g. registered, accredited, or a member of the relevant professional body).

5. On-the-spot claiming / HICAPS
   Many clinics are set up with HICAPS (or similar) to process your private health claims immediately at the clinic, so you only pay the gap if there is one. 

6. No double-dipping
   You generally cannot claim a private health rebate for a session if you’ve already claimed a Medicare rebate or other government subsidy for that same session. 

🛠️ How to Use Private Health Insurance with Us

1. Check your policy
   Call your health fund and ask:

   • “Does my extras cover include OT / Speech / Exercise Physiology?”

   • “What is the rebate amount or percentage?”

   • “Are there waiting periods or annual limits?”

   • “Is the therapist required to be registered or accredited?”

2. Book your appointment
   Let us know that you intend to use your private health cover when booking.

3. Claim at the clinic
   We can process your private health claim via HICAPS (or similar) at the time of service, so you only pay the gap (if any). Or, we can provide you with a detailed invoice you can submit to your fund. 

4. Pay the gap (if applicable)
   Depending on your cover and the fee schedule, there may be a small out‑of‑pocket amount (the “gap”) after your fund rebate.

5. Track your usage
   Keep track of how many sessions you’ve claimed and how close you are to your fund’s limits.