Treatment
Coverage
Wait (months)
Example rebates
Annual limits
Bone, joint and muscle
Description
Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system, e.g. carpal tunnel, fractures
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Brain and nervous system
Description
Hospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system, e.g. stroke
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Breast surgery (medically necessary)
Description
Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction / reduction following breast surgery, e.g. breast tumours
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Chemotherapy, radiotherapy & immunotherapy for cancer
Description
Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours. Surgical treatment of cancer is listed separately under each body system.
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Diabetes management (excluding insulin pumps)
Description
Hospital treatment for the investigation and management of diabetes, e.g. stabilisation of hypo- or hyper- glycaemia
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Digestive system
Description
Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel, e.g. irritable bowel syndrome
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Ear, nose and throat
Description
Hospital treatment 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, e.g. damaged ear drum
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Eye (not cataracts)
Description
Hospital treatment for the investigation and treatment of the eye and the contents of the eye socket, e.g. retinal detachment
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Gastrointestinal endoscopy
Description
Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope, e.g. colonoscopy
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Gynaecology
Description
Hospital treatment for the investigation and treatment of the female reproductive system, e.g. endometriosis
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Hernia and appendix
Description
Hospital treatment for the investigation and treatment of a hernia or appendicitis
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Joint reconstructions
Description
Hospital treatment for surgery for joint reconstructions, e.g. torn tendons
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Kidney and bladder
Description
Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder, e.g. kidney stones
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Male reproductive system
Description
Hospital treatment for the investigation and treatment of the male reproductive system including the prostate, e.g. male sterilisation, prostate cancer
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Miscarriage and termination of pregnancy
Description
Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy.
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Pain management
Description
Hospital treatment for pain management that does not require the insertion or surgical management of a device, e.g. injection of a nerve block
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Skin
Description
Hospital treatment for the investigation and treatment of skin, skin-related conditions and nails, e.g. melanoma
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Tonsils, adenoids and grommets
Description
Hospital treatment of the tonsils, adenoids and insertion or removal of grommets.
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Back, neck and spine
Description
Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion, e.g. sciatica, spinal disc replacement
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Blood
Description
Hospital treatment for the investigation and treatment of blood and blood-related conditions, e.g. blood clotting disorders and bone marrow transplants
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Dental surgery
Description
Hospital treatment for surgery to the teeth and gums.
For example: surgery to remove wisdom teeth, and dental implant surgery.
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Dialysis for chronic kidney failure
Description
Hospital treatment for dialysis treatment for chronic kidney failure.
For example: peritoneal dialysis and haemodialysis.
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Implantation of hearing devices
Description
Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device. Stapedectomy is listed separately under Ear, nose and throat.
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Heart and vascular system
Description
Hospital treatment for the investigation and treatment of the heart, heart-related conditions and vascular system, e.g. heart failure and heart attack
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Lung and chest
Description
Hospital treatment for the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest, e.g. lung cancer, asthma, pneumonia
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Podiatric surgery (provided by a registered podiatric surgeon)
Description
Hospital treatment for the investigation and treatment of conditions affecting the foot and/or ankle, provided by a registered podiatric surgeon
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Assisted reproductive services
Description
Hospital treatment for fertility treatments or procedures, e.g. egg retrieval, IVF
12
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Cataracts
Description
Hospital treatment for surgery to remove a cataract and replace with an artificial lens.
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Hospital psychiatric services
Description
Hospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders, e.g. schizophrenia, depression
2
Portion of hospital fees at agreement hospitals. Your chosen specialist may charge a gap amount.
No limit
Insulin pumps
Description
Hospital treatment for the provision and replacement of insulin pumps for treatment of diabetes.
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Joint replacements
Description
Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses.
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Pain management with device
Description
Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain, e.g. infusion pump
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Palliative care
Description
Hospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including pain alleviation
2
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Plastic and reconstructive surgery (medically necessary)
Description
Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity, e.g. burns requiring a graft
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Pregnancy and birth
Description
Hospital treatment for investigation and treatment of conditions associated with pregnancy and child birth.
12
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Rehabilitation
Description
Hospital treatment for physical rehabilitation for a patient related to surgery or illness, e.g. stroke recovery
2
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Sleep studies
Description
Hospital treatment for the investigation of sleep patterns and anomalies.
For example: sleep apnoea and snoring.
2
(12 if pre-existing condition)
100% of hospital/theatre fees at agreement hospitals, excluding excess. Your chosen specialist may still charge you a gap amount.
No limit
Weight loss surgery
Description
Hospital treatment for surgery that is designed to reduce a person’s weight, or remove excess skin due to weight loss, e.g. gastric banding
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-
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General dental
Description
Treatment for or relating to your teeth provided by a dentist or a dental surgeon. Typically this includes check-ups, cleans, and simple fillings. See also: Major dental.
2
(12 if pre-existing condition)
Periodic oral exam: 80%
Scale and clean: 80%
Fluoride treatment: 80%
$1800 per person
Major dental
Description
Significant dental services, such as complex fillings, tooth extractions, crowns and bridges.
12
(12 if pre-existing condition)
Extraction: 80%
Full crown veneered: 80%
Endodontic services
Description
Specialised dental treatment relating to dental pulp. This includes treating tooth pain and root canal treatment.See also: General dental, Major dental.
12
(12 if pre-existing condition)
Filling of one root canal: 80%
Orthodontics
Description
The branch of dentistry that specialises in the diagnosis, prevention and treatment of dental and facial irregularities. This generally involves the use of braces, removable appliances, functional appliances or headgear.
12
(12 if pre-existing condition)
Braces for upper and lower teeth plus fitting of retainer: 80%
Optical (glasses)
Description
Includes prescription lenses, spectacle frames, and contact lenses. Insurers do not pay benefits for optometrist's consultations as these are generally eligible for Medicare benefits.
6
(12 if pre-existing condition)
Single vision lenses and frames: 100%
Multi-focal lenses and frames: 100%
$1800 per person
Non-PBS Pharmaceuticals
Description
Includes prescription pharmaceuticals which are not listed on the Australian government’s Pharmaceutical Benefits Schemes (PBS). Pharmaceutical benefits usually require a co-payment from you.
2
(12 if pre-existing condition)
Per eligible prescription: 80%
$1800 per person
Vaccinations
Description
Some general treatment policies may cover some of the costs of vaccinations. These may be limited to travel vaccinations. Check with your insurer for details.
2
(12 if pre-existing condition)
Per eligible vaccination: $40.00
Ante-natal/Post-natal classes
Description
Ante-natal classes often include preparation for labour, birth and early parenthood. Post-natal classes may include settling and going home with your baby, breastfeeding and bathing your baby.
2
(12 if pre-existing condition)
Initial visit: 80%
$1800 per person
Exercise physiology
Description
An exercise physiologist specialises in the benefits of exercise for good health and the treatment of medical conditions.
2
(12 if pre-existing condition)
Initial visit: 80%
Physiotherapy
Description
Physiotherapists treat injury, disease and disorders through physical methods. Physiotherapy uses manual therapies, exercise programs and electrotherapy techniques to improve movement, reduce pain and stiffness, and increase quality of life.
2
(12 if pre-existing condition)
Initial visit: 80%
Subsequent visit: 80%
Chiropractic
Description
Chiropractors use spinal adjustments to treat health problems that are related to nerves, skeletons and muscles.
2
(12 if pre-existing condition)
Initial visit: 80%
Subsequent visit: 80%
$1800 per person
Osteopathy
Description
Osteopathy is a holistic approach to health that stresses manual readjustments and physical manipulation of muscle tissue and bones, e.g. individual exercise routines, relaxation techniques, or body awareness sessions.
2
(12 if pre-existing condition)
Initial visit: 80%
Podiatry
Description
Podiatrists are specialists in foot, ankle and lower limb health.
2
(12 if pre-existing condition)
Initial visit: 80%
Subsequent visit: 80%
$1800 per person
Psychology
Description
Psychologists deal with people in their everyday lives or within their work environment to help them function better and to prevent the development of problems in mental and physical health. Some general treatment policies provide benefits for psychology - check with health insurers for details.
2
(12 if pre-existing condition)
Initial visit: 80%
Subsequent visit: 80%
$1800 per person
Acupuncture
Description
Acupuncture treatment involves inserting small needles into various points in the body to stimulate nerve impulses.
2
(12 if pre-existing condition)
Initial visit: 80%
Subsequent visit: 80%
$1800 per person
Remedial massage
Description
Deep massage to treat injuries and speed recovery (for example, strains, sprains, bruising).
2
(12 if pre-existing condition)
Initial visit: 80%
Subsequent visit: 80%
Hearing aids
Description
A device to amplify and change sound to assist people with hearing impairments. Benefits for hearing aids may be deducted from an overall health aid limit.
12
(12 if pre-existing condition)
Hearing aid: 80%
$1800 per person
Blood glucose monitors
Description
A device to measure the concentration of glucose in the blood. Benefits for blood glucose monitors may be deducted from an overall health aid limit – check with your insurer for details.
12
(12 if pre-existing condition)
Blood glucose monitor: 80%
$1800 per person
Orthotics (podiatric orthoses)
Description
Specially designed shoe inserts that support the feet and improve foot posture. '1 appliance' generally means one pair of orthotics.
12
(12 if pre-existing condition)
Orthotics supply and fit: 80%
Audiology
Description
Audiologists specialise in the science and medicine of hearing. An audiologist can assess your hearing, give advice on whether you need hearing aids, provide counselling and teach lip-reading.
2
(12 if pre-existing condition)
Initial visit: 80%
$1800 per person
Occupational therapy
Description
An occupational therapist can help people improve their everyday motor skills after injury or illness.
2
(12 if pre-existing condition)
Initial visit: 80%
Eye therapy (orthoptics)
Description
Orthoptics is the study or treatment of irregularities of the eyes, especially those of the eye muscles that prevent normal binocular vision.
2
(12 if pre-existing condition)
Initial visit: 80%
Speech pathology
Description
Speech pathology is the assessment and treatment of communication and swallowing disorders. Speech pathologists can help with problems with speech, language, communication, fluency or voice, or problems with swallowing food or drinking safely.
2
(12 if pre-existing condition)
Initial visit: 80%
Dietetics/dietary advice
Description
Dietitians specialise in human nutrition based upon a persons medical condition and individual needs.
2
(12 if pre-existing condition)
Initial visit: 80%
$1800 per person
Health management / Healthy lifestyle
Description
Covers some of the costs of approved health-related programs e.g. weight management programs or nicotine replacement therapy.
2
(12 if pre-existing condition)
Health management: 80%
$1800 per person
