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Essential Extras

Better mid-range cover

Cover Highlights

  • Generous general dental cover
  • 100% cover on ten dental check up items up to 2 times per year
  • A very high level of optical cover for a product at this level
  • Good non-PBS pharmaceutical cover

  A wide range of therapies are covered

 Waiting periods

  • 12 months for major dental services, aids and appliances
  • 24 months for hearing aids
  • 2 months for all other services

Limits per person per calendar year, except where otherwise indicated

Limits

Items

Limits

Benefits Paid
General dental services
 $600 100% paid for ten general check up items up to two times per year, so long as the charges are within the range of usual, customary and reasonable charges. Fixed benefits paid for all other items.

Major dental services

    
Periodontic Periodontic services are included in the general dental limit Fixed benefits paid per item
Orthodontics Orthodontic services are included in the general dental limit, up to $250 per year of membership with a lifetime limit of $1,250

Optical category limit

 $500 limit over any 2 consecutive calendar years. Claims made in the current and prior year cannot exceed $500.  
Frames   $220
Single vision lenses   $200 
Bi-focal lenses   $250 
Multi-focal lenses   $320 
Contact lenses   $500 
Repairs   $50 
Non-PBS pharmaceuticals, mammograms, ThinPrep tests, bone density tests $300

Tests, one each per year
 After the current PBS cost, benefits paid are 85% of the remaining cost of a non-PBS script. $60 per test.
Physiotherapy, Psychology, Occupational therapy, Speech therapy, Orthoptics, Podiatry, Dietetics, Midwifery services, and remedial massage with specifically qualified practitioners $900 $100 per visit for psychology, all other therapies $30 per visit with calendar year sublimits per therapy type of $500
Aids & appliances including hearing aids $500

One set of hearing aids every 3 calendar years

75% of the cost of the item, except hearing aids
Single hearing aid $200
Two hearing aids $400
Hearing aid repairs $50
where use of the item was ordered by a registered practitioner

For other Fund approved consumable items, benefit paid twice per calendar year. For Fund approved non-consumable items benefits paid 2 years after the first supply.

Effective 1 April 2011

Limits per person per calendar year, except where otherwise indicated

Remedial massage cover

For benefits to be paid, the remedial massage service provider must be either a registered physiotherapist, or have accreditation in remedial massage therapy. They must belong to an organisation that adheres to the Department of Health’s governed systems for registration and recognition of remedial therapists.

The Doctors’ Health Fund now recognises more remedial massage therapists, as we have added to our list of complying organisations, which include, but are not limited to :

  • ATMS (Australian Traditional Medicine Society)
  • AMT (Association of Massage Therapists)
  • AAMT (Australian Association of Massage Therapists)
  • ANTA ( Australian Naturopathic Practitioners’ Association)
  • IRMA (Institute of Registered Myotherapists of Australia
  • ARM (Association of Remedial Masseurs)