Gold Combined Cover

Set Benefit: $800 per Service

Lifetime Limit: $1,600

Waiting Period: 3 years

Maximum rollover per person: N/A

Loyalty Bonus: Set Benefit and Lifetime limit increase after 10 years continuous membership. 

Loyalty Bonus Set Benefit: $1,200 per Service

Loyalty Lifetime Limit: $2,400

Loyalty Bonus Waiting Period: 10 years

Includes check-ups, x-rays, extractions, fillings, endodontic and periodontic treatment. 

Maximum of 2 Oral exams/consults, 2 Scale and Cleans, 2 Internal Teeth Whitening, 1 Mouth Guard per person per calendar year. 

Waiting Period: 2 Months

Maximum rollover per person: N/A

Includes crowns, dentures, inlays and implants.

Waiting Period: 12 Months

Maximum Rollover per person: $3,000

Rollover Waiting Period: 2 years

Lifetime Limit: $3,000

Waiting Period: 12 months

Maxmium rollover per person: N/A

Waiting Period: 2 Months

Frames: 100% up to $350 per frame

Maximum rollover per person: $700

Rollover Waiting Period: 12 months

^Combined annual limit is shared with Exercise Physiology

Waiting period: 2 months

Maximum rollover per person: $1,700 combined with Exercise Physiology

Rollover Waiting Period: 12 months

^Combined annual limit is shared with Physiotherapy

Waiting period: 2 months 

Maximum rollover per person: $1,700 combined with Physiotherapy

Rollover Waiting Period: 12 months

^Combined annual limit is shared with Acupuncture, Osteopathy, and Complementary Therapies. 

Waiting period: 2 months

Maximum rollover per person: $1,400 combined with Acupuncture, Osteopathy, and Complementary Therapies. 

Rollover Waiting Period: 12 months

^Combined annual limit is shared with Chiropractic, Osteopathy, and Complementary Therapies. 

Waiting Period: 2 months

Maximum rollover per person: $1,400 combined with Chiropractic, Osteopathy, and Complementary Therapies. 

Rollover Waiting Period: 12 months

^Combined annual limit is shared with Chiropractic, Acupuncture and Complementary Therapies. 

Waiting Period: 2 months

Maxmium rollover per person: $1,400 combined with Chiropractic, Acupuncture and Complementary Therapies. 

Rollover Waiting Period: 12 months

Remedial Massage Therapy, Remedial Therapy, Myotherapy & Chinese Medicine

^Combined annual limit is shared with Chiropractic, Acupuncture, and Osteopathy. 

Set benefit: Up to $30

Waiting period: 2 months

Maximum rollover per person: $1,400 combined with Chiropractic, Acupuncture, and Osteopathy.

Rollover Waiting Period: 12 months

Waiting period: 2 months

Rollover maximum per person: $1,700

Rollover Waiting Period: 12 months

Waiting Period: 2 months

Maximum rollover per person: $1,200

Rollover Waiting Period: 12 months

Waiting Period: 2 months

Maximum rollover per person: $1,200

Rollover Waiting Period: 12 months

Waiting Period: 2 months

Maximum rollover per person: $1,200

Rollover Waiting Period: 12 months

Includes custom made orthotics

Waiting Period: 2 months

Maximum rollover per person: $1,400

Rollover Waiting Period: 12 months

^Combined annual limit is shared with Counselling

Waiting Period: 2 months

Maximum rollover per person: $1,700 combined with Counselling

Rollover Waiting Period: 12 months

^Combined annual limit is shared with Psychology 

Waiting Period: 2 months

Maximum rollover per person: $1,700 combined with Psychology 

Rollover Waiting Period: 12 months

^To qualify as recognised providers, counsellor’s must be registered with the Australian Counselling Association Inc (ACA) or Psychotherapy and Counselling Federation of Australia (PACFA), be in private practice and meet a set of practice and educational criteria.

Waiting Period: 2 months

Maximum rollover per person: N/A

Excludes ambulance services covered by a third-party arrangement such as a State/Territory government ambulance scheme or ambulance subscription.

Available at any recognised pharmacy. Excludes government subsidised PBS prescriptions. 

Set Benefit: Per script up to $60 after you pay the first $23

Waiting Period: 2 Months

Maximum rollover per person: $1,200

Rollover Waiting Period: 12 months

Waiting period: 2 months

Maximum rollover per person: N/A

Includes blood glucose monitors, blood pressure monitors, hearing aids, TENS machines, blood coagulation monitors (IRN) and nebulisers. 
Doctor’s referral may be required for some appliances.

Waiting period: 12 months

Maximum rollover per person: N/A

For the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders.

For example: psychoses such as schizophrenia, mood disorders such as depression, eating disorders and addiction
therapy.

For physical rehabilitation for a patient related to surgery or illness.

For example: inpatient and admitted day patient rehabilitation, stroke recovery, cardiac rehabilitation.

For the investigation of sleep patterns and anomalies.

For example: sleep apnoea and snoring.

For the implantation, replacement or other surgical management of a device required for the treatment of pain.

For example: treatment of nerve pain, back pain, and pain caused by coronary heart disease with a device (for example an infusion pump or neurostimulator).

For the provision and replacement of insulin pumps for treatment of diabetes.

For surgery that is designed to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure.

For example: gastric banding, gastric bypass, sleeve gastrectomy.

For fertility treatments or procedures.

For example: retrieval of eggs or sperm, In vitroFertilisation (IVF), and Gamete Intra-fallopian Transfer (GIFT).

For investigation and treatment of conditions associated with pregnancy and child birth. Treatment for the baby is covered under the clinical category relevant to their condition. 

For dialysis treatment for chronic kidney failure.

For example: peritoneal dialysis and haemodialysis.

For surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses.  

For example: replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint, spinal disc replacement.

For surgery to remove a cataract and replace with an artificial lens.

To correct hearing loss, including implantation of a prosthetic hearing device. 

For the investigation and treatment of conditions affecting the foot and/or ankle, provided by a registered podiatric surgeon, but limited to cover for: accommodation; and the cost of a prosthesis as listed in the prostheses list set out in the Private Health Insurance (Medical Devices and Human Tissue Products) Rules, as in force from time to time. Does not include fees by the podiatric surgeon or related fees from the anaesthetist. 

For surgery to the teeth and gums. For example: dental implant surgery

Which is medically necessary for the investigation and treatment of any physical deformity, whether acquired as a result of illness or accident, or congenital.

For example: burns requiring a graft, cleft palate, club foot and angioma.

For the investigation and treatment of the back, neck and spinal column, including spinal fusion.

For example: sciatica, prolapsed or herniated disc, and spine curvature disorders such as scoliosis, kyphosis and lordosis. 

For the investigation and treatment of blood and blood-related conditions.

For example: blood clotting disorders and bone marrow transplants.

For the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest.

For example: lung cancer, respiratory disorders such as asthma, pneumonia, and treatment of trauma to the chest.

For the investigation and treatment of the heart, heart-related conditions and vascular system.

For example: heart failure and heart attack, monitoring of heart conditions, varicose veins and removal of plaque from arterial walls. 

For the investigation and management of diabetes.

For example: stabilisation of hypo-or hyper-glycaemia, contour problems due to insulin injections.

For the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy.

For example: breast lesions, breast tumours, asymmetry due to breast cancer surgery, and gynecomastia.

For the investigation and treatment of skin, skin-related conditions and nails. The removal of foreign bodies is also included. Plastic surgery that is medically necessary and relating to the treatment of a skin-related condition is also included.

For example: melanoma, minor wound repair and abscesses.

For pain management that does not require the insertion or surgical management of a device.

For example: treatment of nerve pain and chest pain due to cancer by injection of a nerve block.

For chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours. 

For the investigation and treatment of a miscarriage or for termination of pregnancy.

For the investigation and treatment of the female reproductive system.

For example: endometriosis, polycystic ovaries, female sterilisation and cervical cancer. 

For the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope.

For example: colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP).

For the investigation and treatment of a hernia or appendicitis

For the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel.

For example: oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids.

For the investigation and treatment of the male reproductive system including the prostate.

For example: male sterilisation, circumcision and prostate cancer.

For the investigation and treatment of the kidney, adrenal gland and bladder.

For example: kidney stones, adrenal gland tumour and incontinence.

Hospital treatment for surgery for joint reconstructions.

For example: torn tendons, rotator cuff tears and damaged ligaments.

For the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system.

For example: carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis and bone cancer.

For the investigation of the tonsils, adenoids and insertion or removal of grommets.

For the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck.

For example: damaged ear drum, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer.

For the investigation and treatment of the eye and the contents of the eye socket.

For example: retinal detachment, tear duct conditions, eye infections and medically managed trauma to the eye.

For the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system.

For example: stroke, brain or spinal cord tumours, head injuries, epilepsy and Parkinson’s disease.

For care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain.