Physio for Kids and Private Health Rebates: How It Works

If you hold private health insurance, there is a good chance part of your child's physiotherapy is already covered. The detail sits in your extras policy rather than your hospital cover, and the amounts vary enormously between funds, so it pays to check before your first appointment rather than after.

Extras cover, not hospital cover

Physiotherapy rebates come from extras cover, sometimes called general treatment or ancillary cover. Hospital cover does not pay for outpatient physiotherapy visits. If your policy is hospital-only, there is no physiotherapy rebate available, regardless of the fund.

How the rebate is calculated

• Most funds pay a set amount or a percentage of the consultation fee, commonly in the range of half to three-quarters depending on the policy tier.
• Initial consultations often attract a higher rebate than follow-up visits.
• Every policy has an annual limit per person, and once that limit is reached you pay the full fee for the rest of the year.
• Many funds group physiotherapy with chiropractic, osteopathy and exercise physiology under a single combined limit, so other services can use up the same pool.
• Limits reset on either the calendar year or your policy anniversary. Check which applies to you.

Waiting periods

New policies and upgraded levels of cover usually carry a waiting period before you can claim general extras items, commonly around two months, and sometimes longer for major services. If you have just joined or just upgraded, confirm with your fund that physiotherapy is claimable before you book.

Claiming on the spot

Most physiotherapy practices, including ours, have HICAPS, which means you swipe your health fund card at reception, the rebate is processed immediately and you only pay the remaining gap. You do not have to pay the full fee and claim it back later. Bring the card that lists your child as a dependant.

Medicare and private health cannot both be used for the same visit

If your child has a GP chronic condition management plan, you can claim a Medicare rebate for up to five allied health sessions a calendar year, but you cannot also claim a private health rebate for those same sessions. Many families use the Medicare-subsidised sessions first, then move onto their extras cover, or alternate depending on remaining limits.

Questions worth asking your fund

• Is physiotherapy included on my extras cover, and at what rebate for an initial and a standard consultation?
• What is the annual limit per person, is it shared with other therapies, and how much is left this year?
• When does my limit reset?
• Do any waiting periods still apply for my child?
• Are home visits or visits at a childcare centre claimable under my policy?

Questions worth asking your physiotherapist

• What is the full fee for an initial assessment and for follow-up sessions?
• Do you have HICAPS, and can you process my fund on the day?
• How many sessions do you expect my child is likely to need before review?
• Is a home programme with fewer appointments an option for us?

A reassuring takeaway

Cost should not be the reason a child's movement concern goes unchecked. Between extras cover, Medicare plans where eligible, NDIS funding for those who qualify and public services, there is usually a workable path. Ask for a written estimate at the start so there are no surprises.

Policy details vary by fund and tier and change over time. Confirm your own cover directly with your insurer, or compare policies at privatehealth.gov.au.

Sources and further reading

privatehealth.gov.au --- Compare private health insurance policies

Services Australia --- Chronic condition management allied health items

Australian Physiotherapy Association --- Find a physio and consumer information

Suggested closing call to action

Still unsure about something you have noticed? A GP, child health nurse or paediatric physiotherapist can help you decide whether your child would benefit from an individual assessment. Contact PHYSITEK to ask about a paediatric physiotherapy visit.