|
ITEM
|
LIMITS
|
BENEFITS PAID
|
|
General dental services
|
No annual limits
|
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
|
|
|
|
- Inlays, onlays, facings
|
$700
|
Fixed benefits paid per item
|
|
- Endodontic/periodontic
|
$800
|
|
- Crowns & bridges
|
$1,000
|
|
- Dentures and prosthodontics
|
$800
|
|
- Orthodontics
|
Up to $250 per year of membership with a lifetime limit of $2500
|
|
Optical category limit
|
$500 limit over 2 years
|
|
|
- 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
|
$600
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.
|
|
One hearing aid
|
One set of hearing aids every 3 calendar years
|
$400
|
|
Two hearing aids
|
$800
|
|
Hearing aid repairs
|
|
$50
|
|
Audiology test
|
One visit per year
|
$40
|
|
Physiotherapy and remedial massage with specifically qualified practitioners
|
$600
|
$30 per visit
|
|
Psychology
|
$600
|
$100 per visit
|
|
Occupational therapy, Speech therapy, Orthoptics, Podiatry, Dietetics, Midwifery services
|
$1,000
|
$30 per visit with calendar year sublimits per therapy type of $600
|
|
Home nursing
|
$600
|
$30 per visit of up to 6 hrs
$60 per visit exceeding 6 hrs
|
|
Aids & appliances
|
$1,000
Benefits paid for replacement items 2 years after the first supply
|
75% of the cost of the item where use was ordered by a registered practitioner
|
