Extras

ServiceDescriptionBenefit ppAnnual 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
items, including
orthodontics)

$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
Pharmaceutical Benefits Scheme (PBS) limit ($38.80 as at 1/01/2017)

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
combined

Remedial Massage

Acupuncture

Naturopathy

Herbalist / Homeopathy

Registered practitioner visit

Registered practitioner visit

Registered practitioner visit

Registered practitioner visit

50% up to $30

$400
combined

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
(Daily limit $100)

$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)
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