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Exercise Physiology and Private Health Insurance: How to Understand Your Coverage

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Chris Dounis

Chris is an accredited exercise physiologist with over 15 years professional experience working with a wide range of clients.
Learn more about Chris here.

As exercise physiologists we’re passionate about the benefits of physical activity and exercise to improve health, rehabilitate injuries and prevent diseases. One of the main questions we get though, is this:

Is exercise physiology covered by private health insurance?

The short answer is yes! However, like most things in healthcare, there’s a few things to consider…

Private Health Insurance and Ancillary Benefits (extras)

In Australia, private health insurance typically includes both hospital and ancillary cover—also known as ‘extras.’ Extras cover a range of out-of-hospital services that aren’t usually covered by Medicare. This is where Exercise Physiology typically falls under.

Exercise Physiology Under Private Health Insurance: Coverage

Many health insurance companies in Australia do cover Exercise Physiology services under their extras cover. Each policy may differ, but generally, insurers pay a percentage of the cost incurred for each session. However, the amount of cover will depend on the level of extras cover you have.

At EP360 we are registered with all of the Private Health Funds and if you have a good level of cover, it is very likely that you will be able to claim a portion of your sessions back.

Understanding Your Coverage

To confirm if your private health insurance policy covers Exercise Physiology services, the best course of action is to call your insurer directly. Be prepared with your insurance policy details, and ask about the inclusion of Exercise Physiology services, annual limits, waiting periods, and percentage of cover.

How to Claim Your Exercise Physiology Private Health Rebate

Claiming your Exercise Physiology services varies depending on your insurer. At EP360, after paying for your session in full, we will issue you with a paid invoice via email. You can then claim your rebate from your insurer either online or in person.

The Role of Medicare

It’s worth noting the difference between Medicare and private health insurance in relation to Exercise Physiology services. Medicare, under the Chronic Disease Management plan, can also cover Exercise Physiology services, but only if you’re referred by your GP and diagnosed with a chronic or complex condition.

While Medicare provides specific, limited coverage, private health insurance may offer more comprehensive coverage under their extras cover for Exercise Physiology services.

Maximising Your Health Insurance Benefits

To maximise your private health insurance benefits for Exercise Physiology:

  • Understand your policy coverage level and annual limits.
  • Regularly review your policy to ensure it meets your health needs.
  • Make use of services before annual limits reset (typically at the start of each calendar year).
  • Regularly attend your Exercise Physiology sessions to manage your health conditions effectively.

Wrap up

Many private health insurance policies in Australia do cover Exercise Physiology services. Coverage depends on your extras policy level, annual limits, and whether you have served your waiting periods. Understanding your health insurance policy allows you to leverage the benefits of an Exercise Physiologist and enjoy a healthier lifestyle.

If you’ve got questions – reach out to us for a chat!

Disclaimer

This series does not serve as specific medical advice, and should be viewed as educational ONLY. Chronic pain is an individual and complex experience, and as such, any treatment needs to be tailored to the individual. Always seek advice from a relevant medical professional before undertaking any treatment or exercise program.

 

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