Limits

Things to remember:

  • Annual limits apply on a financial year basis, ie: 1 July - 30 June
  • All benefits in the table below are per person unless stated otherwise
  • Loyalty bonuses: for Extras Plus cover, higher annual benefits are payable after 5 years continuous cover. These Loyalty Limits are payable for crowns and bridgework, dentures and orthodontic treatment.

 

Extras Benefits & Limits as at 1 April 2017

Extras products can only be purchased as a combination (with a hospital cover)

 

Extras covers Extras Plus Basic Extras
Service Benefit
General dental Basic restoration (fillings)
Diagnostic services
Oral surgery
Periodontics
Endodontics
Set benefits per item
No annual limit
75% of cost
Limit - $550
High cost dental Crowns & bridges Set benefits per item
Limit - $1,000
($1,500 loyalty limit)
X
Dentures Limit - $650
($800 loyalty limit)
X
Implants Limit - $1,000 X
Orthodontics Lifetime Limit - $2,100
($2,600 loytalty limit)
X
Optical Glasses/frames & contact lenses 100% of cost
Limit - $275
100% of cost
Limit - $180
Laser eye surgery $500 per eye
Limit - $1,000 every 2 years
X
Pharmacy Prescriptions only 100% of cost
$65 per script
Limit - $500 / $1,000
75% of cost
$50 per script
Limit - $500 / $1,000

Note: Benefit applies after the maximum PBS amount has been deducted.
The PBS amount is $38.80 as at 1/1/17.

Physiotherapy and other therapy Physiotherapy Initial Consultation:                      $60
Subsequent Consultations 1-10: $40
Consultations 11+:                       $30
75% of cost
Occupational therapy Initial Consultation:             $60
Subsequent Consultations: $40
X
Hydrotherapy 80% of cost to $15
Limit - $200 / $400
X
Overall physio limit Limit - $500 / $1,100 Limit - $350 / $700
Complementary therapies Chiropractic x-rays 80% of cost
Limit - $115 / $230 
 
75% of cost
Chiropractic
Remedial massage
Osteopathy
Myotherapy
Homeopathy
Naturopathy
Herbal medicine
(Chinese or Western consultation only)
Acupuncture
Podiatry

 

Initial Consultation: $40
Subsequent Consultations 1-10: $30
Subsequent Consultations 11+:  $20
Limit - $435 / $870

Dietetics X
Orthotics
(limit each 2 years)
80% of cost
Limit - $250 / $500
X
Overall complementary therapies limit $750 / $1,500 $350 / $700
Additional benefits Pre/post-natal classes 80% of cost
Limit - $150
X
Home nursing 80% of cost up to $45 per visit / $90 per day
Limit - $1, 000
X
Speech therapy 80% of cost
$800 per year
X
Hearing aids
80% of cost
Limit - $1,500 per 5 years
X
Psychology

80% of cost to $120 (initial)
            or $80 subsequent
Limit - $500 / single or $650 family

X
Allergy treatment 80% of cost
Limit - $100
X
Surgical equipment / Health aids
(sub-limits apply. Contact us for more info).
50% of cost to $400
Loyalty benefits apply - 80% up to $1,000 after 5 years cover
Contact the fund for details
X
Health Management Programs

100% of cost
Limit - $150 / single of $300 / family

75% of cost
Limit - $100 / single
or $200 / family
Travel expenses (for in-patient services)

20c/km
Up to $100 / single and $200 / family

X
Ambulance National ambulance cover 100% of cost. No annual limits