Our cover is designed to be used – not for the tragic (though that’s when you’ll really know our worth), but for the everyday things that keep you healthy in body and mind and out there protecting the rest of us.
* This provides a general description of what is not covered. Should you require information about a particular treatment or benefit please call us on 1300 703 703.
For the majority of services provided by recognised providers, Emergency Services Health pays a generous 80% of the cost.
The waiting periods outlined in the above table may not apply if they have been served with another insurer prior to joining. Further waiting periods may apply for pre-existing conditions. For a list of example benefits please download our State Premiums & Benefits Guide.
Like all private health funds, Emergency Services Health has waiting periods for new members, including people transferring from another insurer when taking out a higher level of cover. Waiting periods also apply to current members upgrading their cover.
Waiting periods are designed to protect the interest of our members. Without them, it would be easy for people to join only at the times when they need cover and to receive benefits. This would lead to higher premiums for all fund members.
At Emergency Services Health the waiting periods are:
Hospital benefits of Gold Hospital and Gold Combined:
Extras benefits for Rolling Extras and Gold Combined:
Gold Combined:
It is important to note that if you are transferring from another insurer, waiting periods only apply to the level of cover that is greater the previously held.
For instance, if you previously had a top hospital cover with the previous insurer but with an excess, the waiting period only applies to the excess when joining Emergency Services Health.
A government leaflet containing further information is available by clicking here.
Pre-existing conditions
If a new member has a pre-existing condition before joining Emergency Services Health, they may need to serve a 12-month waiting period under the terms of our policy before benefits are payable for the particular condition. This does not apply for psychiatric care, rehabilitation or palliative care.
A pre-existing condition is one where signs or symptoms of your ailment, illness or condition existed at any time during the six months preceding the day on which you purchased your insurance or upgraded to a higher level of cover.
A medical practitioner appointed by Emergency Services Health (not your own doctor) is the only person authorised to decide that a condition is pre-existing. The practitioner must, however, consider any information regarding signs and symptoms provided by your own treating doctor or specialist.
A government leaflet containing further information is available by clicking here
Most benefits for extra services, like your major dental, chiropractic and optical have Annual Maximums, which are renewed each calendar year.
To provide extra protection to our members we have developed our Rollover Benefit to give you greater assurance if something were to happen.
The Emergency Services Health Rollover Benefit allows members to carry over any unused Annual Maximum benefit that is not claimed during the previous calendar year into the following year. The Rollover Benefit covers most extras services, such as major dental and physiotherapy, and gives members more flexibility in using their limits.
Claims are always paid from the current year’s Annual Maximum before your Rollover Benefit is accessed.
New members are eligible for Rollover Benefit after just 12 months (2 years for major dental). The combined Rollover Benefit and the Annual Maximum are shown as the “Rollover Maximum”.
Emergency Services Health pays 80% back on most Extras services up to the benefit limits and subject to waiting periods, Annual Maximums and Rollover Benefits available.
To see examples of benefits paid please download a copy of our State Premiums & Benefits Guide.
Emergency Services Health - Unlimited Ambulance Cover Australia-wide
Did you know that to call an ambulance can cost around $900 depending on your state or territory?
In a medical emergency, the cost of calling an ambulance is not at the top of your mind, but the bill after can be quite a shock if you do not have an ambulance cover. Good news when you are insured with Emergency Services Health all policies include ambulance cover- Australia Wide no matter if you’re in your home state or visiting another part of Australia.
Comprehensive 100% Ambulance cover for emergency transport, clinically required non-emergency transport and treatment not requiring transport.*
What's not covered?
Benefits are not payable:
For elective ambulance transport or other non-eligible ambulance service, for example when you pre-book transport between locations such as going from a hospital to a nursing home.
When you’re covered by a third party arrangement**. For example where you are covered by an ambulance subscription or if you have access to a State/Territory ambulance transportation scheme.
If you are still serving waiting periods.
*May be subject to waiting periods and other conditions.
**Third Party Arrangements: Please note Queensland and Tasmanian residents have third-party arrangement ambulance services provided by state government schemes. In some other states, Department of Veterans Affairs Gold Card, pension and healthcare card holders may be exempt from paying for ambulance services. Under those arrangements, the relevant scheme is responsible for the cost and Emergency Services Health does not pay a benefit. If the benefit for any eligible ambulance treatment costs are not fully covered by an arrangement or scheme, Emergency Services Health will pay a benefit.
› Oral exam (2 every calendar year) 80% up to $52.80
› Scale and clean (2 every calendar year) 80% up to $103.50
› Filling - adhesive posterior 3 surface 80% up to $202.40
› Mouth Guard (1 every calendar year) 80% up to $176.00
› Oral exam (2 every calendar year) 80% up to $52.80
› Scale and clean (2 every calendar year) 80% up to $103.50
› Filling - adhesive posterior 3 surface 80% up to $202.40
› Mouth Guard (1 every calendar year) 80% up to $176.00
› Oral exam (2 every calendar year) 80% up to $60.85
› Scale and clean (2 every calendar year) 80% up to $130.25
› Filling - adhesive posterior 3 surface 80% up to $228.80
› Mouth Guard (1 every calendar year) 80% up to $198.00
› Oral exam (2 every calendar year) 80% up to $50.85
› Scale and clean (2 every calendar year) 80% up to $102.95
› Filling - adhesive posterior 3 surface 80% up to $202.40
› Mouth Guard (1 every calendar year) 80% up to $146.80
› Oral exam (2 every calendar year) 80% up to $51.15
› Scale and clean (2 every calendar year) 80% up to $107.00
› Filling - adhesive posterior 3 surface 80% up to $202.40
› Mouth Guard (1 every calendar year) 80% up to $176.00
› Oral exam (2 every calendar year) 80% up to $59.20
› Scale and clean (2 every calendar year) 80% up to $102.50
› Filling - adhesive posterior 3 surface 80% up to $215.60
› Mouth Guard (1 every calendar year) 80% up to $136.40
› Oral exam (2 every calendar year) 80% up to $51.20
› Scale and clean (2 every calendar year) 80% up to $102.10
› Filling - adhesive posterior 3 surface 80% up to $184.80
› Mouth Guard (1 every calendar year) 80% up to $145.20
› Oral exam (2 every calendar year) 80% up to $52.60
› Scale and clean (2 every calendar year) 80% up to $103.85
› Filling - adhesive posterior 3 surface 80% up to $206.80
› Mouth Guard (1 every calendar year) 80% up to $123.20
› Full crown-veneered 80% up to $1,311.20
› Complete upper & lower dentures (1 every 3 years) 80% up to $1,716.00
› Full crown-veneered 80% up to $1,311.20
› Complete upper & lower dentures (1 every 3 years) 80% up to $1,716.00
› Full crown-veneered 80% up to $1,434.40
› Complete upper & lower dentures (1 every 3 years) 80% up to $1,716.00
› Full crown-veneered 80% up to $1,364.00
› Complete upper & lower dentures (1 every 3 years) 80% up to $1,716.00
› Full crown-veneered 80% up to $1,364.00
› Complete upper & lower dentures (1 every 3 years) 80% up to $1,716.00
› Full crown-veneered 80% up to $1,408.00
› Complete upper & lower dentures (1 every 3 years) 80% up to $1,672.00
› Full crown-veneered 80% up to $1,320.00
› Complete upper & lower dentures (1 every 3 years) 80% up to $1,716.00
› Full crown-veneered 80% up to $1,311.20
› Complete upper & lower dentures (1 every 3 years) 80% up to $1,716.00
General Optical Providers:
› Standard single vision lenses 80% up to $114.40
› Standard progressive lenses 80% up to $281.60
› Contact lenses, disposable-spherical 80% up to $123.20
› Contact lenses, rigid 80% up to $228.80
› Frames set benefit up to $110.00
At OPSM and Laubman & Pank:
› Standard single vision lenses 100%
› Standard progressive lenses 100%
› Contact lenses, disposable-spherical 100%
› Contact lenses, rigid 100%
› Frames set benefit up to $110.00
General Optical Providers:
› Standard single vision lenses 80% up to $114.40
› Standard progressive lenses 80% up to $281.60
› Contact lenses, disposable-spherical 80% up to $123.20
› Contact lenses, rigid 80% up to $228.80
› Frames set benefit up to $110.00
At OPSM and Laubman & Pank:
› Standard single vision lenses 100%
› Standard progressive lenses 100%
› Contact lenses, disposable-spherical 100%
› Contact lenses, rigid 100%
› Frames set benefit up to $110.00
General Optical Providers:
› Standard single vision lenses 80% up to $100.30
› Standard progressive lenses 80% up to $236.70
› Contact lenses, disposable-spherical 80% up to $123.20
› Contact lenses, rigid 80% up to $228.80
› Frames set benefit up to $110.00
At OPSM and Laubman & Pank:
› Standard single vision lenses 100%
› Standard progressive lenses 100%
› Contact lenses, disposable-spherical 100%
› Contact lenses, rigid 100%
› Frames set benefit up to $110.00
General Optical Providers:
› Standard single vision lenses 80% up to $100.30
› Standard progressive lenses 80% up to $236.70
› Contact lenses, disposable-spherical 80% up to $123.20
› Contact lenses, rigid 80% up to $228.80
› Frames set benefit up to $110.00
At OPSM and Laubman & Pank:
› Standard single vision lenses 100%
› Standard progressive lenses 100%
› Contact lenses, disposable-spherical 100%
› Contact lenses, rigid 100%
› Frames set benefit up to $110.00
General Optical Providers:
› Standard single vision lenses 80% up to $100.30
› Standard progressive lenses 80% up to $255.20
› Contact lenses, disposable-spherical 80% up to $123.20
› Contact lenses, rigid 80% up to $228.80
› Frames set benefit up to $110.00
At OPSM and Laubman & Pank:
› Standard single vision lenses 100%
› Standard progressive lenses 100%
› Contact lenses, disposable-spherical 100%
› Contact lenses, rigid 100%
› Frames set benefit up to $110.00
General Optical Providers:
› Standard single vision lenses 80% up to $105.60
› Standard progressive lenses 80% up to $279.80
› Contact lenses, disposable-spherical 80% up to $123.20
› Contact lenses, rigid 80% up to $228.80
› Frames set benefit up to $110.00
At OPSM and Laubman & Pank:
› Standard single vision lenses 100%
› Standard progressive lenses 100%
› Contact lenses, disposable-spherical 100%
› Contact lenses, rigid 100%
› Frames set benefit up to $110.00
General Optical Providers:
› Standard single vision lenses 80% up to $108.20
› Standard progressive lenses 80% up to $264.00
› Contact lenses, disposable-spherical 80% up to $123.20
› Contact lenses, rigid 80% up to $228.80
› Frames set benefit up to $110.00
At OPSM and Laubman & Pank:
› Standard single vision lenses 100%
› Standard progressive lenses 100%
› Contact lenses, disposable-spherical 100%
› Contact lenses, rigid 100%
› Frames set benefit up to $110.00
General Optical Providers:
› Standard single vision lenses 80% up to $100.30
› Standard progressive lenses 80% up to $250.80
› Contact lenses, disposable-spherical 80% up to $123.20
› Contact lenses, rigid 80% up to $228.80
› Frames set benefit up to $110.00
At OPSM and Laubman & Pank:
› Standard single vision lenses 100%
› Standard progressive lenses 100%
› Contact lenses, disposable-spherical 100%
› Contact lenses, rigid 100%
› Frames set benefit up to $110.00
› Initial consult 80% up to $88.00
› Subsequent consult 80% up to $74.80
› Initial consult 80% up to $88.00
› Subsequent consult 80% up to $74.80
› Initial consult 80% up to $93.30
› Subsequent consult 80% up to $74.45
› Initial consult 80% up to $83.50
› Subsequent consult 80% up to $74.00
› Initial consult 80% up to $74.80
› Subsequent consult 80% up to $62.55
› Initial consult 80% up to $81.50
› Subsequent consult 80% up to $72.15
› Initial consult 80% up to $79.10
› Subsequent consult 80% up to $68.40
› Initial consult 80% up to $78.70
› Subsequent consult 80% up to $68.20
› Initial consult 80% up to $74.80
› Subsequent consult 80% up to $63.55
› Initial consult 80% up to $74.80
› Subsequent consult 80% up to $63.55
› Initial consult 80% up to $75.70
› Subsequent consult 80% up to $63.80
› Initial consult 80% up to $79.20
› Subsequent consult 80% up to $57.20
› Initial consult 80% up to $79.20
› Subsequent consult 80% up to $54.55
› Initial consult 80% up to $82.55
› Subsequent consult 80% up to $60.65
› Initial consult 80% up to $79.20
› Subsequent consult 80% up to $56.55
› Initial consult 80% up to $79.20
› Subsequent consult 80% up to $58.95
› Initial consult 80% up to $78.30
› Subsequent consult 80% up to $50.15
› Initial consult 80% up to $78.30
› Subsequent consult 80% up to $50.15
› Initial consult 80% up to $79.85
› Subsequent consult 80% up to $53.45
› Initial consult 80% up to $74.80
› Subsequent consult 80% up to $49.00
› Initial consult 80% up to $72.80
› Subsequent consult 80% up to $45.95
› Initial consult 80% up to $73.75
› Subsequent consult 80% up to $45.25
› Initial consult 80% up to $76.20
› Subsequent consult 80% up to $48.40
› Initial consult 80% up to $78.30
› Subsequent consult 80% up to $50.15
› Initial consult 80% up to $91.10
› Subsequent consult 80% (16-30mins) up to $77.95
› Initial consult 80% up to $91.10
› Subsequent consult 80% (16-30mins) up to $77.95
› Initial consult 80% up to $90.20
› Subsequent consult 80% (16-30mins) up to $81.20
› Initial consult 80% up to $87.10
› Subsequent consult 80% (16-30mins) up to $78.30
› Initial consult 80% up to $96.25
› Subsequent consult 80% (16-30mins) up to $75.75
› Initial consult 80% up to $79.20
› Subsequent consult 80% (16-30mins) up to $72.70
› Initial consult 80% up to $88.20
› Subsequent consult 80% (16-30mins) up to $75.00
› Initial consult 80% up to $84.65
› Subsequent consult 80% (16-30mins) up to $77.60
› Therapies consult $25
› Initial consult (46-90 mins) 80% up to $132.00
› Subsequent consult (46-90 mins) 80% up to $127.60
› Initial consult (46-90 mins) 80% up to $132.00
› Subsequent consult (46-90 mins) 80% up to $127.60
› Initial consult (46-90 mins) 80% up to $140.80
› Subsequent consult (46-90 mins) 80% up to $132.00
› Initial consult (46-90 mins) 80% up to $132.00
› Subsequent consult (46-90 mins) 80% up to $110.00
› Initial consult (46-90 mins) 80% up to $132.00
› Subsequent consult (46-90 mins) 80% up to $123.20
› Initial consult (46-90 mins) 80% up to $132.00
› Subsequent consult (46-90 mins) 80% up to $132.00
› Initial consult (46-90 mins) 80% up to $132.00
› Subsequent consult (46-90 mins) 80% up to $136.40
› Initial consult (46-90 mins) 80% up to $132.00
› Subsequent consult (46-90 mins) 80% up to $105.60
› Initial consult (76-90 mins) 80% up to $158.40
› Subsequent consult (under 30 mins) 80% up to $61.60
› Subsequent consult (over 30 mins) 80% up to $110.00
› Initial consult (76-90 mins) 80% up to $158.40
› Subsequent consult (under 30 mins) 80% up to $61.60
› Subsequent consult (over 30 mins) 80% up to $110.00
› Initial consult (76-90 mins) 80% up to $158.40
› Subsequent consult (under 30 mins) 80% up to $61.60
› Subsequent consult (over 30 mins) 80% up to $110.00
› Initial consult (76-90 mins) 80% up to $158.40
› Subsequent consult (under 30 mins) 80% up to $66.00
› Subsequent consult (over 30 mins) 80% up to $110.00
› Initial consult (76-90 mins) 80% up to $158.40
› Subsequent consult (under 30 mins) 80% up to $61.60
› Subsequent consult (over 30 mins) 80% up to $110.00
› Initial consult (76-90 mins) 80% up to $158.40
› Subsequent consult (under 30 mins) 80% up to $61.60
› Subsequent consult (over 30 mins) 80% up to $110.00
› Initial consult (76-90 mins) 80% up to $158.40
› Subsequent consult (under 30 mins) 80% up to $61.60
› Subsequent consult (over 30 mins) 80% up to $110.00
› Initial consult (76-90 mins) 80% up to $158.40
› Subsequent consult (under 30 mins) 80% up to $61.60
› Subsequent consult (over 30 mins) 80% up to $110.00
› Initial consult 80% up to $48.40
› Subsequent consult (<30 mins) 80% up to $39.60
› Initial consult 80% up to $48.40
› Subsequent consult (<30 mins) 80% up to $39.60
› Initial consult 80% up to $48.40
› Subsequent consult (<30 mins) 80% up to $39.60
› Initial consult 80% up to $48.40
› Subsequent consult (<30 mins) 80% up to $39.60
› Initial consult 80% up to $48.40
› Subsequent consult (<30 mins) 80% up to $39.60
› Initial consult 80% up to $48.40
› Subsequent consult (<30 mins) 80% up to $39.60
› Initial consult 80% up to $48.40
› Subsequent consult (<30 mins) 80% up to $39.60
› Initial consult 80% up to $48.40
› Subsequent consult (<30 mins) 80% up to $39.60
› Initial consult 80% up to $105.60
› Subsequent consult 80% up to $61.60
› Initial consult 80% up to $105.60
› Subsequent consult 80% up to $61.60
› Initial consult 80% up to $105.60
› Subsequent consult 80% up to $61.60
› Initial consult 80% up to $105.60
› Subsequent consult 80% up to $66.00
› Initial consult 80% up to $105.60
› Subsequent consult 80% up to $57.20
› Initial consult 80% up to $118.80
› Subsequent consult 80% up to $61.60
› Initial consult 80% up to $48.40
› Subsequent consult (<30 mins) 80% up to $39.60
› Initial consult 80% up to $105.60
› Subsequent consult 80% up to $61.60
› Initial consult 80% up to $71.80
› Subsequent consult 80% up to $59.85
› Initial consult 80% up to $71.80
› Subsequent consult 80% up to $59.85
› Initial consult 80% up to $73.70
› Subsequent consult 80% up to $63.35
› Initial consult 80% up to $70.40
› Subsequent consult 80% up to $61.95
› Initial consult 80% up to $71.30
› Subsequent consult 80% up to $60.70
› Initial consult 80% up to $71.80
› Subsequent consult 80% up to $58.50
› Initial consult 80% up to $71.95
› Subsequent consult 80% up to $65.80
› Initial consult 80% up to $74.60
› Subsequent consult 80% up to $62.85
› Initial and subsequent consult 80% up to $227.05
› Initial and subsequent consult 80% up to $80.00
Covered for emergency transport, clinically required non-emergency transport, and treatment not requiring transport.
> Excludes government subsidised PBS prescriptions
> Per script up to $50 after you pay the first $25.00 Note: While many medicines are covered, some are not. Your initial $25 may increase for dispensing greater than the maximum standard packaged quantity.
For more information please click here.
Additional benefits apply to clinically required services resulting from an accident whilst at or travelling to or from school (some restrictions apply) 100%
› Initial consult 80% up to $81.40
› Subsequent consult 80% up to $69.90
› Initial consult 80% up to $81.40
› Subsequent consult 80% up to $69.90
› Initial consult 80% up to $83.60
› Subsequent consult 80% up to $70.40
› Initial consult 80% up to $74.80
› Subsequent consult 80% up to $64.25
› Initial consult 80% up to $74.80
› Subsequent consult 80% up to $61.60
› Initial consult 80% up to $79.20
› Subsequent consult 80% up to $67.65
› Initial consult 80% up to $80.35
› Subsequent consult 80% up to $67.15
› Initial consult 80% up to $83.60
› Subsequent consult 80% up to $64.80
Products and benefits guide