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Essential Extras

Better mid-range cover

Cover Highlights

  • Generous general dental cover
  • 100% cover on eleven frequently used 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

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Limits

Items

 

Limits

Benefits Paid

General dental services

$800

(combined limit with General and Major Dental)

Includes orthodontic sublimit - $250 per year of membership accumulating to a lifetime limit of $1,250

100% of the cost of check-ups, up to two times per year, and fissure sealings where the fees are within the range of usual, customary and reasonable charges. Fixed benefits apply to additional check-ups and all other items.

Check-ups (limited to an examination, fluoride and a scale and clean)

Examination items 011 to 017

Scale & Clean items 111, 114 and 115

Fluoride treatment item 121

Major dental services

Orthodontics

Major Restorative

Endodontic

Periodontic

Crowns & bridges

Dentures

Prosthodontic

Fixed benefits apply

Optical category limit

$500 limit over any 2 consecutive calendar years. Claims made in the current and prior year cannot exceed $500. No sub-limits apply. Use the full $500 for frames, lenses or contact lenses. Your choice.
Repairs Included in $500 optical limit $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, Mental health services, Occupational therapy, Speech therapy, Orthoptics, Podiatry, Dietetics, Pregnancy care services, and remedial massage with specifically qualified practitioners $900

$100 per visit for Mental health services

$40 per visit for Occupational and Speech therapy

$35 per visit for Physiotherapy, podiatry, dietetics and orthoptics

$20 per visit for group therapy and hydrotherapy

$30 per visit for all other services

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.

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)