Top Extras is Defence Health's most comprehensive level of extras cover.
Most of the goods and services claimable under Top Extras have annual limits. In some cases a service may also have a sub-category limit. Once the annual limit has been reached, no further benefits are payable for those services until the next financial year (1 July through to 30 June). All services must be provided by an approved health practitioner in private practice. Health funds cannot provide a benefit where Medicare benefits have been paid. Please take a moment to examine the extensive benefits available under Top Extras.
Defence Health has set benefits for individual dental services. Some services are not payable in combination with others. Some are limited by the number of times they attract a benefit per year. Others may not attract a benefit at all.
Includes items like initial check-ups and scale & cleans, etc.
Does not contribute towards the $1,250 per person limit
2 months
e.g.
Description
Comprehensive oral exam One per person per financial year
Includes items like follow-up visits, x-rays, simple fillings, etc.
The orthodontic sub-category limit forms part of the overall $1250 per person dental limit. Set benefits are payable for individual dental services and may not attract the full sub-category limit.
$750 per person
12 months
From 1 July 2011, a major dental sub-category limit or $850 applies. It forms part of the overall $1250 per person dental limit. Set benefits are payable for individual dental services and may not attract the full sub-category limit.
$850 per person
If you are planning extensive treatment, ask your dentist for the item numbers and costs, then call us for a quote.
$255 per person
Single vision lenses
up to $85
up to $80
Ground single vision lenses
up to $100
up to $95
Bi-focal lenses
up to $110
up to $105
Multi-focal lenses
up to $160
up to $155
Frames
Contact lenses
up to $180
100% cover for all treatment provided by a registered ambulance service in Australia including emergency services, non-emergency services, mobile intensive care, air and sea ambulance services.
Unlimited
Initial consultation
up to $38
$550 per person
Subsequent consultation
up to $28
Group therapy session
up to $12
Hydrotherapy session
Ante/post natal class - maximum 10 classes (or full day ante-natal class up to $120)
up to $35
$450 per person up to $900 per family
up to $25
X-ray (maximum 2) Benefits on X-rays are paid only where the X-ray(s) are taken at your Chiropractic clinic.
up to $40
Consultation
$200 per person up to $600 per family
Benefits are paid only on consultations for acupuncture, homeopathy, aromatherapy, myotherapy, naturopathy, remedial massage, remedial therapy, chinese herbal medicine and western herbal medicine where the provider is recognised by the Australian Regional Health Group. Benefits are not payable on any prescribed medications, herbal or dietary preparations.
Per prescription
$500 per person
Defence Health provides a benefit for non-PBS pharmaceuticals. The benefit payable is the difference between the prescription amount and the PBS fee. The PBS fee is set by the Australian Government and is increased annually on 1 January.
Benefits are also payable for vaccinations not covered by the PBS (such as those recommended by doctors for overseas travel).
No benefit is payable for items not related to a medical condition, products that can be purchased without a script or pharmaceutical items supplied to a hospital inpatient.
up to $60
$400 per person up to $1,000 per family
up to $50
Family therapy session
up to $20
Psychology treatment that has been claimed through Medicare cannot be covered.
$300 per person
up to $32
up to $10
up to $57
up to $30
up to $26
$250 per person
$200 per person
A benefit for LASIK or PRK laser refractive eye surgery may be available when performed in a recognised day surgery centre registered with a State or Territory. If you are planning laser refractive eye surgery please contact Defence Health to confirm your benefit eligibility.
$1,000 per person claimable once every two financial years
Level 2 Senior First Aid course Benefits are payable once every 3 years and based on the date of completion.
$60 per person
Approved refresher course Not payable in the same benefit year as Level 2 Senior First Aid course
Benefits are paid only where a copy of your Level 2 Senior First Aid or refresher course certificate accompanies the claim.
Per visit
$1,000 per person
Benefits are paid only for visits by a registered nurse in private practice to attend to a person with a serious medical condition when requested by a medical practitioner. Benefits are not payable as a substitute for hospitalisation or for a nurse or housekeeper during convalescence.
For essential health care costs resulting from a school accident to your dependent child. Excludes Medicare services or expenses claimable from another source. Claims must be lodged within 2 years of the accident and be accompanied by notification of the accident on school letterhead.
$600 per person
Sub-category limit
Financial year limit
Waiting period
The following sub-category limits are payable when recommended by a physiotherapist, chiropractor, osteopath, podiatrist, chiropodist, occupational therapist or medical practitioner for a medical condition.
Hearing aids*
36 months
Mobility aids* Benefits are payable for the purchase of wheelchairs, crutches, walking frames, walking sticks, rolling walkers, seat riser cushions, reachers and adjustable canes only. Benefits are not payable for scooters or recliner lift chairs.
CPAP machine*
Blood glucose monitor*
Nebuliser & spacer*
$250 per policy
Blood pressure monitor*
TENS machine (including the Circulation Booster)*
Foot orthoses Benefits are payable for custom-tailored devices specifically crafted to meet the needs of a particular individual, including heat moulded orthotics.
$220 per person
Splints and braces Benefits are payable for splints, knee/leg/spinal/lumbar/sacral/wrist/ankle braces and surgical corsets only.
Orthopaedic shoes Benefits are payable if the shoes are custom-made by a specialist shoemaker for identifiable foot deformities.
Compression garments Benefits are payable for purpose-made garments that aid burn management, post-surgical recovery, lymphoedema treatment and deep vein thrombosis prevention.
$250 per item
Non-cosmetic prostheses Benefits are payable only for:
Epipen
$100 per person
Repair of appliance Benefits are payable for repair to foot orthoses and hearing aids.
Rental of appliance Benefits are payable for the rental of oxygen cylinders, soft collars, toilet seat risers, shower chairs, Continuous Passive Movement Machines (CPM) or any other appliance listed above.
$150 per person
This information is current as at 1 April 2011 and effective through to 31 March 2012. It replaces all earlier versions. Please read it carefully.
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