Top

The Doctors' Health Fund

Flexible cover, choose and change to suit your needs

 

Hospital Options

Extras Options

  Smart Starter (* single or couple only) Prime Choice Top Cover
Gap Cover

Access Gap

The medical benefits paid under the Access Gap scheme are equivalent to most funds' premium products. The Access Gap scheme has a record of paying benefits at or above the industry average.

 Access Gap 

The medical benefits paid under the Access Gap scheme are equivalent to most funds' premium products. The Access Gap scheme has a record of paying benefits at or above the industry average.

AMA Gap

Our Top Cover is unique and pays medical benefits up to the AMA List fee. This is the highest medical gap scheme in Australia. Top Cover also provides complete freedom of choice of doctor in that your doctor does not have to agree to participate in the scheme for you to receive the benefits. Medical benefits for covered services may be paid under the Access Gap Cover Scheme for the first 12 months if you are upgrading your cover.*

 Excess Payable

 $500 per admission

$500 per admission if you are on an excess policy 

 NIL

Included Services:

Pregnancy related services including assisted reproductive services, sterilisation and reversal of sterilisation.
No
Yes
Yes
Hip and Knee replacements and revisions.
No
Yes
Yes
Cataract and glaucoma treatment.
No
Yes
Yes
Cardiothoracic surgery.
Yes Restricted
Cardiothoracic surgery limited to delivery as a private patient in a public hospital.
Yes
Yes
Renal dialysis for chronic renal failure.
Yes Restricted
Dialysis for chronic renal failure is limited to delivery as a private patient in a public hospital shared ward.
Yes
Yes
Psychiatric services and rehabilitation services.
Yes Restricted
Psychiatric services are limited to delivery as a private patient in a public hospital. Rehabilitation services following cardio thoracic, psychiatric, hip and knee replacement and revisions are limited to delivery as a private patient in a public hospital shared ward.
Yes
Yes
Gastric banding and obesity surgery.
No
Yes
Yes
Hearing loss related services.
Diabetes related services
Spinal surgery not related to an accident
No
Yes
Yes
All other in-hospital services where a Medicare benefit is payable
No
Yes
Yes
In-hospital services where no Medicare benefit is payable (e.g. most cosmetic surgery)
No
Yes Restricted
Default hospital accommodation benefits only. No medical benefits will be paid.
Yes Restricted
Default hospital accommodation benefits only. No medical benefits will be paid.

 

  Total Extras Essential Extras Basic Extras



               (* Only available with Smart Starter)

Included Services:

General Dental
Yes
Yes
Yes
  Limits Benefits Paid Limits Benefits Paid Limits Benefits Paid

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

No annual limits 100% of the cost* $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 up to two times per year* $500 100% of the cost once per year*
Fissure sealing 100% of the cost* 100% of the cost* 50% of the cost*
Bitewing x-ray 100% of the cost* Fixed benefits 50% of the cost*
Minor restorative Fixed benefits Fixed benefits 50% of the cost*
Oral surgery Fixed benefits Fixed benefits Not Covered Not Covered
Tooth whitening Fixed benefits Fixed benefits Not Covered Not Covered
Major Dental
Yes
Yes
Yes
  Limits Benefits Paid Limits Benefits Paid Limits Benefits Paid
Orthodontics $600 per year of membership accumulating to a lifetime limit of $3000 Fixed benefits $800



(combined limit with General and Major Dental) Includes orthodontic sublimit - $250 per year of membership accumulating to a lifetime limit of $1,250
Fixed benefits Not Covered Not Covered
Major restorative $1,000 Fixed benefits Fixed benefits Not Covered Not Covered
Endodontic $1,000 Fixed benefits Fixed benefits Not Covered Not Covered
Periodontic Fixed benefits Fixed benefits Not Covered Not Covered
Crowns & bridges $1,200 Fixed benefits Fixed benefits Not Covered Not Covered
Dentures & prosthodontic $1,000 Fixed benefits Fixed benefits Not Covered Not Covered
Optical Services
Yes
Yes
Yes
  Limits Benefits Paid Limits Benefits Paid Limits Benefits Paid
  $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. $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. $150 No sub-limits apply. Use the full $150 for frames, lenses or contact lenses. Your choice.
Non-PBS pharmaceuticals
Yes
Yes
Yes
  Limits Benefits Paid Limits Benefits Paid Limits Benefits Paid
  $600 After the current PBS cost, benefits paid are 85% of the remaining cost of non-PBS script*. $300 After the current PBS cost, benefits paid are 85% of the remaining cost of non-PBS script*. $150







(combined limit with Non-PBS pharmaceuticals and Aids & appliances)
75% of the cost of the item where use of the item was ordered by a registered practitioner*.
Aids & appliances
Yes
Yes
Yes
  Limits Benefits Paid Limits Benefits Paid Limits Benefits Paid
  $1000 For Fund approved consumable items, benefit paid twice per calendar year. For Fund approved non-consumables, benefit paid once every two years 75% of the cost of the item where use of the item was ordered by a registered practitioner*. $500 For Fund approved consumable items, benefit paid twice per calendar year. For Fund approved non-consumables, benefit paid once every two years 75% of the cost of the item where use of the item was ordered by a registered practitioner*. $150







(combined limit with Non-PBS pharmaceuticals and Aids & appliances) For Fund approved consumable items, benefit paid twice per calendar year. For Fund approved non-consumables, benefit paid once every two years
75% of the cost of the item where use of the item was ordered by a registered practitioner*.
Therapies
Yes
Yes
Yes
  Limits Benefits Paid Limits Benefits Paid Limits Benefits Paid
Physiotherapy $700 $50 (individual) $900 Includes sublimit of $500 for any one therapy $35 (individual) $400 $35 (individual)
$20 (group) $20 (group) $15 (group)
Remedial massage & Myotherapy $35 $30 $25
Mental health $600 $100 $100 $80
Occupational therapy $1000 Includes sublimit of $600 for any one therapy $45 $40 $35
Speech therapy $45 $40 $35
Orthoptics $35 $35 $30
Podiatry $35 $35 $30
Dietetics $35 $35 $30
Pregnancy services $35 $30 Not Covered Not Covered
Home nursing $600 $30 per visit under 6 hours



$60 per visit over 6 hours
Not Covered Not Covered Not Covered Not Covered
Hearing aids
Yes
Yes
No
  Limits Benefits Paid Limits Benefits Paid Limits Benefits Paid
  One set of hearing aids every 5 years $800 - one hearing aid







$1600 - two hearing aids
One set of hearing aids every 3 years

$200 - one hearing aid

$400 - two hearing aids

Not Covered Not Covered
Health Management Program
Yes
Yes
No
  Limits Benefits Paid Limits Benefits Paid Limits Benefits Paid

The current treatments recognised as Health Management Programs cover services (not goods) and are:



◾Exercise physiology



◾Quit Smoking



◾Acupuncture



◾Weight loss classes



◾Exercise classes conducted at a gym or by a personal trainer



◾Class physiotherapy

For more information, click here.



$200 limit per person with an overall policy limit of $400 for families 50% of the cost* Not Covered Not Covered Not Covered Not Covered

* fees must be within the range of usual, customary and reasonable charges