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Family Extras
Family Extras provides you with health insurance benefits for extra services not covered by Medicare and is open to singles, couples and families. Benefits include speech therapy, podiatry, and orthodontics, plus health improvement benefits. The table below shows the full range of benefits payable under Family Extras, effective 1 July 2011.
For more information, download the Family Extras policy. You can also call us on 134 246.
The wait is over
We believe it's important our members get all they're entitled to. That's why from 6 June 2011 we've removed the 2 and 6 months waiting periods from all our Extras covers.
Dental Benefits
These are examples of the most common dental services we pay benefits for. There are more services covered by this policy than we can include here so make sure you call us before you have any treatment to confirm the benefits you’ll receive.
| Routine | |||
| Diagnostic | |||
| Comprehensive examination | item 011 | $33.10* | |
| Periodic examination | item 012 | $31.05* | |
| Emergency examination | item 013 | $25.35** | |
| X-ray (one film) | item 022 | $21.00 | |
| Preventive | |||
| Clean and polish | item 111 | $29.25# | |
| Scale and clean | item 114 | $55.85# | |
| Topical fluoride application | item 121 | $22.70** | |
| Mouthguard – custom made | item 151 | $78.35** | |
| Extractions | |||
| Non-surgical extraction | item 311 | $56.45 | |
| Surgical extraction | item 324 | $157.90 | |
| Direct Restorations | |||
| Metallic restoration of 1 surface | item 511 | $48.50 | |
| Metallic restoration of 3 surfaces | item 513 | $70.35 | |
| Adhesive filling of 1 surface (front) | item 521 | $51.70 | |
| Adhesive filling of 3 surfaces (front) | item 523 | $72.75 | |
| Adhesive filling of 1 surface (back) | item 531 | $54.15 | |
| Adhesive filling of 3 surfaces (back) | item 533 | $83.50 | |
| Limits | 0 - 4 years | 5 - 9 years | 10+ years |
| Per person combined | $500 | $550 | $600 |
| Family limit | $1,250 | $1,375 | $1,500 |
| * Maximum 2 services per year combined ** Maximum 2 services per year # Maximum 3 services per year combined |
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| Complex | |||
| Periodontics | |||
| Non-surgical periodontic treatment | item 281 | $149.05 | |
| Endodontics (Root canal therapy) | |||
| Preparation of one root canal | item 415 | $117.05 | |
| Limits | 1 - 4 years | 5 - 9 years | 10+ years |
| Per person combined | $600 | $700 | $800 |
| Family limit | $1,500 | $1,750 | $2,000 |
| Major | |||
| Indirect restorations | |||
| Tooth coloured filling 1 surface | item 551 | $197.50 | |
| Crowns/bridges/implants | |||
| Fully veneered crown | item 615 | $495.40 | |
| Dentures (one complete set per person each 3 years) | |||
| Full upper or lower | item 711/712 | $324.05 | |
| Limits | 1 - 4 years | 5 - 9 years | 10+ years |
| Per person combined | $750 | $900 | $1,100 |
| Family limit | $1,750 | $2,250 | $2,750 |
| Orthodontics | |||
| Up to your yearly limit for specialist services | 100% | ||
| Up to your yearly limit for GP services | 70% | ||
| Limits | 1 - 2 years | 3 - 4 years | 5+ years |
| Per person | $600 | $750 | $900 |
| Lifetime limit | $1,800 | ||
General Benefits
| Optical | |||
| Frames, single lenses (pair), bi-focal (pair), multi-focal (pair), contact lenses, repair to frames or lenses (payable for scripted sight correcting products only) |
$180.00 | ||
| Combined per person | $180 | ||
| Family limit | $450 | ||
| Therapies | |||
|
Physiotherapy and osteotherapy |
Initial consultation† | $35.00 | |
| Subsequent consultation | $26.50 | ||
| Per class - Group hydrotherapy, pilates and antenatal exercises & rehabilitation* | $13.50 | ||
| Chiropractic | Initial consultation† | $35.00 | |
| Subsequent consultation | $26.50 | ||
| Limits | 0 - 4 years | 5 - 9 years | 10+ years |
| Per person per therapy | $250 | $275 | $300 |
| Per family per therapy | $625 | $675 | $750 |
| † 1 initial consultation per therapy per person per financial year * Benefits only paid where service is performed by an ahm registered physiotherapist |
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| Complementary and alternative therapies | |||
| Naturopathy, homeopathy, acupuncture, herbalism, remedial massage and exercise physiology | $21.50 | ||
| Combined per person | $300 | ||
| Family limit | $600 | ||
| Other therapies | |||
| Psychology and hypnotherapy (provided by an ahm registered psychologist) |
Assessment or initial consultation† | $70.00 | |
| Subsequent consultation | $41.00 | ||
| Group consultation | $21.00 | ||
| Speech therapy | Initial consultation† | $50.00 | |
| Subsequent consultation | $26.00 | ||
| Occupational therapy | Initial consultation† | $30.00 | |
| Subsequent consultation | $26.00 | ||
| Eye therapy (Orthoptics) | Initial consultation† | $25.00 | |
| Subsequent consultation | $22.00 | ||
| Podiatry | Initial consultation† | $31.00 | |
| Subsequent consultation | $25.00 | ||
| Casting | $25.00 | ||
| Podiatric surgery | $152.50 | ||
| Limits | 0 - 4 years | 5 - 9 years | 10+ years |
| Per person per therapy | $250 | $275 | $300 |
| Per family per therapy | $625 | $675 | $750 |
| † 1 initial consultation per person per therapy per financial year | |||
| Orthotics and orthopaedic shoes | |||
| Purchased from an ahm registered podiatrist or orthopaedic supplier only. Excludes benefits for sporthotics and formthotics. | $150.00 | ||
| Combined per person | $150 | ||
| Family limit | $300 | ||
| Hearing aids | |||
| Per hearing aid* | $600.00 | ||
| Repair* | $35.00 | ||
| Combined per person | $1,200 every 3 years | ||
| Combined limit | No limit | ||
| *Account must be fully paid before claiming | |||
| Pharmacy | |||
|
General items* |
Up to $50 each item above general patient PBS amount | ||
| Limits | 0 - 4 years | 5 - 9 years | 10+ years |
| Per person combined | $350 | $400 | $450 |
| Family limit | $700 | $800 | $900 |
| * Excludes PBS scripts, over the counter or off the shelf medicines, vitamins and herbal medicines | |||
| Maternity options# | |||
| Per visit - Pre and post natal consultation and classes including lactation consultants | $25.00 | ||
| Per course - Birthing courses must be provided by a registered midwife |
$120.00 | ||
| Limit per person | $250 per rolling year^ | ||
| # Where not claimable through Medicare ^ A rolling year begins on the date a service was first provided with the limit applying to that 12 month period |
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| Travel and accommodation* | |||
| Travel over 200 kms return trip | 15 cents per/km | ||
| Per night - Accommodation | $30.00 | ||
| Combined per person | $200 | ||
| Family limit | $400 | ||
| * For specialist medical appointments and outpatient procedures only | |||
| Medical gases | |||
| Per unit (such as oxygen) | $80.00 | ||
| per person limit | $1,000 | ||
| Joint fluid replacement injections | |||
| Per injection (eg. Synvisc, OsteoArtz, Hyalgan) | $320 per injection | ||
| Per person limit | $640 per rolling year* | ||
| * A rolling year begins on the date a service was first provided with the limit applying to that 12 month period | |||
| Ambulance | |||
| Emergency only | 100% | ||
| Financial year limit | No limit | ||
| Disease prevention | |||
| ahm Health Risk Assessment |
100% | ||
| Limit | 1 per person per 12 months | ||
| ahm Health Coaching Program | 100% | ||
| Limit | 1 per person per 6 months | ||
| Health improvement | |||
| Dietitian and nutritionist | Initial consultation† | $32.00 | |
| Subsequent consultation | $25.00 | ||
| Weight loss | Per class (approved providers only) | $8.00 | |
| Per course (ahm approved providers only with medical evidence of a BMI of 26 or over for adult claims and an unhealthy BMI for children's claims) |
$80.00 | ||
| Combined per person | $250 | ||
| Family limit |
$625 | ||
| † 1 initial consultation per therapy per person per financial year | |||
| More health improvement benefits | |||
|
Quit smoking |
Per course | $85.00 | |
| Per course - Laser acupuncture therapy | $85.00 | ||
| Per item - Nicotine replacement therapy (patches, gum, lozenges, inhalers) |
$40.00 | ||
| Disease management association fees | Per association - Asthma, Diabetes, Heart, Arthritis, Coeliac and Crohn's disease | $40.00 | |
| Cancer Council UV products | Per item - sunscreen, swimwear, hats and sunglasses (does not include cosmetics, shade or accessory items. Your receipt must identify the item as Cancer Council approved) |
$40.00 | |
| Stress management | Per course (recognised psychologist or ahm approved provider) |
$80.00 | |
| Preventive tests | Per test - Mammograms, skin cancer screenings, bowel cancer tests and scans and bone density tests (where not claimable through Medicare) |
Up to $52.00 | |
| Health checks | Per check# - Doctor health checks and Healthy Heart checks (where not claimable through Medicare, an employer or another party) |
$40.00 | |
| Exercise classes (When part of an ahm or a recognised health management program and by an ahm approved provider. To be eligible for exercise program benefits, please have your GP or provider complete a health improvement approval form.) |
Gym, Yoga, Pilates and exercise physiology |
Per class* | $12.00 |
| Per course* | $250.00 | ||
| Swimming lessons and training (0-17 years of age by an Austswim® or Swim Australia accredited swim school with evidence of asthma, diabetes, an unhealthy BMI or a doctor's recommendation to undertake this activity due to their condition) |
Per lesson | $8.00 | |
| Per course | $250.00 | ||
| Combined per person | $250 | ||
| Combined limit | $625 | ||
|
# 1 per person per financial year Note: all health improvement benefits are subject to benefit conditions. please refer to your policy document for more information. |
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What does it cost?
It's easy to check the cost of your health insurance cover, just use our Quick Quote.
To compare quotes for all our extras covers, check our Premiums at a Glance.
If you have a health insurance query, please contact us.
Please note: For definitions on the terms used above, please see Important Information.
This is important information about your policy. Please read this in conjunction with your policy document which you can download and save for future reference.