Quick refresher: what OSHC is designed to cover

• Medically necessary treatment in Australia (inpatient/outpatient)
• Doctor (GP) and specialist services billed to Medicare Benefits Schedule (MBS)
• Prescription medicines with per-script and annual limits
• Emergency ambulance (usually included, but terms vary)

Everything beyond the above - especially dental, optical, and many allied-health services - is where most students run into exclusions.

Big-ticket items OSHC usually does not cover

1) Dental, Optical & Most Allied Health

• Dental: check-ups, fillings, root canals, crowns - typically not covered by OSHC.
• Optical: eye tests, glasses and contact lenses -usually excluded.
• Allied health: physiotherapy, chiropractic, osteopathy, podiatry, acupuncture, remedial massage are often excluded unless your policy includes specific extras or packaged benefits.

Workaround: Consider extras cover if you expect to use these services.

2) Routine & Preventive Services (outside medical necessity)

• Routine dental/optical, health screenings, and many preventive services are excluded unless clinically indicated and MBS-billable.
• Vaccinations may have limited or no cover; you often pay privately.

Tip: Ask your GP about low-cost clinic options for routine care.

3) Non-PBS & High-Cost Medicines

OSHC contributes to PBS-listed medicines only, and caps apply (per script + annual).

• Non-PBS drugs, high-cost brand preferences, or medicines beyond limits are usually out-of-pocket.

Tip: Ask for a PBS alternative and keep scripts within policy limits.

4) Services by Non-Registered Providers or Not on the MBS

• If a service isn’t MBS-listed or the provider isn’t appropriately registered, OSHC typically won’t pay.
• Experimental or not medically proven treatments are excluded.

5) Cosmetic & Elective Procedures

• Cosmetic surgery, elective enhancements, and non-medical procedures are excluded.
• Fertility treatment/IVF and elective sterilisation are usually not covered.

6) Treatment Outside Australia

• OSHC is built for treatment within Australia. Medical costs incurred overseas are excluded.

Tip: Buy travel insurance for trips outside Australia.

7) Repatriation & Medical Evacuation

• Returning you to your home country or medical evacuation is generally not included under OSHC.

Tip: Travel insurance often includes these benefits.

8) Private Room Choice & Gap Fees

• OSHC aims to cover shared ward accommodation in a public hospital setting for medically necessary care.
• Choosing a private room, non-contract private hospital or a doctor who charges above the MBS fee can create gap fees you must pay.

Tip: Ask for no-gap/known-gap providers before treatment.

9) Waiting Periods & Pre-Existing Conditions

• Waiting periods apply to some services (e.g., pregnancy or psychiatric inpatient care).
• A pre-existing condition may not be covered until you serve the waiting period.

Important: Pregnancy care might be covered after the waiting period; fertility services are typically excluded. Newborns aren’t covered unless added to a family policy.

10) Aids, Appliances & Consumables

• Items like hearing aids, glucose monitors, orthotics, crutches, and home nursing supplies are usually excluded or tightly limited unless specifically listed.

11) Non-Emergency Ambulance or Transfer Fees (policy-dependent)

• Many OSHC plans include emergency ambulance, but inter-hospital transfers, non-emergency transport, or call-out fees may not be covered.

Tip: Check your policy wording on “ambulance” closely.

Common “surprise costs” students face (and how to avoid them)

1. Specialist gap: The doctor charges more than the MBS fee.

• Fix: Ask for a fee estimate and whether they participate in no-gap arrangements.

2. Private hospital fees: You’re admitted to a private facility with higher charges.

• Fix: If clinically suitable, request treatment in a public hospital or a contract facility your insurer recognises.

3. Pharmacy over the cap: You hit your annual or per-script limit.

• Fix: Discuss PBS alternatives, buy generic where possible, and track your totals.

4. Pregnancy before serving waiting period: Costs may not be covered.

• Fix: If pregnancy cover matters, start OSHC early to serve the waiting period before you need care.

5. Dental emergency: Toothache on a Sunday - OSHC won’t cover it.

• Fix: Consider extras cover or budget a small emergency fund for dental.

OSHC vs Extras: when to consider add-ons

If you expect to use dental/optical/physio or want broader ambulance benefits, look at extras policies. Some providers bundle limited extras with OSHC; others sell them separately. Compare the extra premium vs likely usage—for many students, a basic extras tier quickly pays for itself with a dental check and a pair of glasses.