Extras
| Service | Description | Benefit pp | Annual limit pp |
|---|---|---|---|
Ambulance Pensioners must claim the pensioner discount first | Transport costs (Please refer to page 30 of the Products and Benefits Guide for further clarification) | 100% | Unlimited |
Dental This is not a comprehensive list of our dental benefits, we are happy to provide our full Dental Benefits Schedule on request | Periodic examination Plaque removal Fluoride treatment Tooth extraction Crowns and bridges Fillings Periodontics Root canal treatment Implants Dentures Orthodontics | 80% up to $100 80% up to $100 80% up to $100 80% up to $120 80% up to $1,000 Up to 80% of cost Up to 80% of cost Up to 80% of cost Up to 80% of cost Up to 80% of cost Up to 80% of cost | $1,700 (For all dental $1,000 sub-limit $1,200 sub-limit $1,200 sub-limit 5 year progressive limit: $1,700 Lifetime limit: $3,600 |
Optical Must be accompanied by a relevant sight correction prescription | Single lens Lenses (pair) including single vision, bifocal and multifocal lenses. Frames (for prescription lenses) Contact lenses Contact lens solution Repairs | Up to $140 Up to $280 Up to $120 80% up to $280 80% of cost 80% of cost | $400 |
Pharmacy Available only on prescription | Prescriptions costing over the | Up to $100 per script, after deducting the PBS amount | $800 |
Physiotherapy/Hydrotherapy
Chiropractic / Osteopathy
Orthoptics Speech Therapy
Occupational Therapy
| Short treatment Standard treatment Extended treatment Initial treatment Subsequent treatment X-ray Eye therapy Standard treatment Extended treatment Initial individual assessment Subsequent individual assessments | 80% up to $20 80% up to $34 80% up to $40 80% up to $45 80% up to $32 Up to $85 80% of cost 80% up to $40 80% up to $50 80% up to $80 80% up to $65 | $850 |
Remedial Massage Acupuncture Naturopathy Herbalist / Homeopathy | Registered practitioner visit Registered practitioner visit Registered practitioner visit Registered practitioner visit | 50% up to $30 | $400 |
Allergy Management | Allergy testing, membership to Medic Alert (or equivalent), and tags, when ordered and performed by a registered practitioner | 50% of cost | $500 |
General Appliances With a letter from a registered practitioner | CPAP machine and accessories Other appliances including: blood glucose monitor, nebuliser, wheelchair plus more. (Contact us to confirm for a particular item) | Up to 80% of cost | 5 year limit $1,200 $1,200 |
Audiology | Hearing tests by a registered practitioner | 50% of cost | Unlimited |
Cardiac Rehabilitation | Program referred by a registered medical practitioner | 80% of cost | Unlimited |
Diabetes Education | Diabetes Australia certified training program, consultation | 50% up to $25 | $100 |
Dietetics | Registered practitioner visit | 80% of cost | $300 |
Hearing Aids Pensioners must claim any pensioner rebates first | Hearing aids, repairs and maintenance Hearing aid and cochlear implant batteries | 80% of cost | 3 year limit $1500 $200 |
Home Nursing | Services of a Registered Nurse when ordered by a registered practitioner | 80% of cost | $1,200 |
Mammography/Bone Density Testing | Screening tests where a Medicare benefit is not payable | 80% of cost | 1 test |
Maternity Services & Appliances
Midwife Services Only payable where a midwife is used rather than a Doctor | Prenatal classes, postnatal classes, settling classes, lactation consultations. When performed by an RN or registered midwife Appliances for hire or purchase including: breast pump, infant sound and respiratory monitor (to prevent SIDS), TED stockings, blood glucose monitor, TENS machine
Services of a registered midwife in private practice, including prenatal and postnatal visits (where not covered by Medicare) | 80% of cost | $500 per policy |
Orthopaedic Shoes With letter from a registered practitioner
Orthotics | Ordered by a registered practitioner for a medical condition
Orthotics, shoe modifications and repairs | 100% of cost above $100
80% of cost | $400 Limit 1 pair of shoes |
Podiatry/Chiropody | Treatment by a registered practitioner Outpatient only | 80% of cost | $400 |
Psychology No benefits are payable for educational assessments or reports. | Initial treatment Subsequent treatment Clinical assessment | 80% of cost up to $110 80% of cost up to $80 80% of cost up to $150 | $500 |
Surgical Corsets/Stockings and Braces | Ordered by a medical practitioner for a medical condition accompanied with letter | 80% of cost | $400 |
Vitamins, Minerals and Herbs | With letter from a General Medical Practitioner | 50% up to $20 per item | $200 |
Wound Care Clinics | Standard Treatment, including dressing costs Extended Treatment, including dressing costs | 50% of cost up to $20 50% of cost up to $30 | $200 |
*In order for benefits to be paid on general treatments, the health practitioner must be appropriately qualified and registered with their relevant association. To confirm exactly what benefit is payable on any particular treatment, contact ACA Health with the specific item number or description of the service.
**Annual limits do not rollover to the next calendar year. Benefits are paid according to the limit of the year in which the services are provided/purchased.
Download Complete Extras Cover Brochure
Waiting periods
- Optical – 4 months
- Dental – 9 months
- Hearing aids – 12 months
- Prescribed health appliances (including maternity appliances) – 12 months
- Foot orthotics & surgical shoes – 12 months
- All other services – 2 months
On joining general treatments cover for the first time, waiting periods must be served before benefits will be paid. If you have upgraded your general treatments cover, waiting periods will apply before the higher benefits will be paid.
What’s not covered?
- Services not listed above
- In-hospital accommodation for extraction of wisdom teeth
- Services while a membership is in arrears
- Services incurred before waiting periods are served
- Services where there is an entitlement under compensation insurance
- Services claimed over 2 years after the service date
- Products or services purchased in or from countries other than Australia
- Services performed by a Podiatric Surgeon (Inpatient)