Our Extras covers you for an extensive range of health services that help you to stay fit and healthy.

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.

Recognised health providers
State
FAQ Answer
Recognised health providers are those who are in private practice in Australia and recognised by us. We only pay benefits for services by these providers. If you wish to ensure that your provider is covered please refer to our online provider search (for a non-exhaustive list) or speak to us prior to treatment.
 
Annual Maximum
State
FAQ Answer
The Annual Maximum benefit payable for services received during the calendar year for particular service or group of services per person unless stated otherwise. The Annual Maximums start new on the 1st January each year (orthodontics maximum is determined by length of membership based on anniversary year).  Emergency Services Health also provides a Rollover Benefit to most Extras.
Extras -What is not covered (non-exhaustive list*)
State
FAQ Answer
  • Claims for a service that has exceeded the Annual Maximum and Rollover Maximum.
  • A second and subsequent consult with the same professional on the same day.
  • Where the service charge exceeds the fee recognised by Emergency Services Health, the benefit you receive may be less than 80% of your cost.
  • Where the service provider is a partner, child or parent of the person being treated. Business partners within the practice are also excluded.
  • Services incurred before a waiting period has been served.
  • Services where a Medicare benefit is payable.
  • Services that are provided outside of the Commonwealth of Australia.
  • Services where an entitlement exists or may exist under any compensation, sports club or third party insurance.
  • A claim for a service that is submitted more than two years after the date of service.
  • Services provided by practitioners not recognised by the fund.
  • Benefits for ambulance services covered by a third party arrangement such as a State/Territory transportation scheme.

* 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.

Extras - What's covered? 
State
FAQ Answer

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.

Waiting periods
State
FAQ Answer

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:

  • 2 months membership for all benefits, excluding accidents
  • 12 months membership for obstetric treatment
  • 12 months membership for pre-existing conditions, excluding psychiatric care, rehabilitation or palliative care.
  • 12 months membership for continuous positive air pressure (CPAP) machines, and goods and services under Non-surgically Implanted Prosthesis and Appliances and other aids and appliances.

Extras benefits for Rolling Extras and Gold Combined:

  • 2 months membership for all benefits, excluding accidents
  • 12 months membership for major dental (like crowns and dentures) and orthodontics, hearing aids, nebulisers, blood glucose & blood pressure monitors, blood coagulation monitor and for pre-existing conditions
  • 12 month membership for Rollover Benefit (2 years Major Dental).

Gold Combined:

  • 3 years membership for corrective laser eye surgery.

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

Rollover Benefit
State
FAQ Answer

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”.

Benefit limits for Extras
State
FAQ Answer

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.

Am I covered for ambulance?
State
FAQ Answer

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.

$41.80*

Join now
* Quote Date: 30/03/2020
The price shown excludes any LHC loading and includes Base Tier Australian Government Rebate on Private Health Insurance. Lifetime Health Cover (LHC) is a Government initiative designed to encourage people to take out hospital insurance. If you don't hold private hospital insurance from 1 July after your 31st birthday you may pay an extra 2% on premiums for each year you go without private hospital insurance. Calculations of premiums are simulations, subject to variation depending on your personal circumstances and indicative only and are subject to confirmation and the Fund Rules. No information appearing on these online services is to be taken as a quote, an offer or as having qualified for cover. Please read our Products & Benefits Guide together with our State Premiums & Benefits brochure for details.
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EXTRAS
All

General Dental

Major Dental

Optical

  • Optical
    Annual maximum per person:
    $320
    Rollover maximum per person:
    $640
    Waiting Period:
    2 months
    Rollover Maximum available after 12 months membership with extras cover, except major dental which requires 2 years of membership., 2020 Rollover Benefit shown. In 2019, The Rollover Benefit is capped at $2,800 for Optical.
    State
    Example Benefit

    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

    State
    Example Benefit

    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

    State
    Example Benefit

    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

    State
    Example Benefit

    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

    State
    Example Benefit

    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

    State
    Example Benefit

    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

    State
    Example Benefit

    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

    State
    Example Benefit

    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

Physiotherapy

Exercise Physiology

Chiropractic

Osteopathy

Complementary Therapies

Speech Therapy

Occupational Therapy

Eye Therapy

Dietary

Podiatry

Psychology

Counselling

Ambulance

  • Ambulance
    Annual maximum per person:
    Unlimited
    Rollover maximum per person:
    N/A
    Waiting Period:
    2 months
    Excludes ambulance services covered by a third party arrangement such as a State/Territory government ambulance scheme or ambulance subscription. Only the ambulance services described under “Example Benefits” are payable and ambulance service providers must be recognised by Emergency Services Health.
    Covered for emergency transport, clinically required non-emergency transport, and treatment not requiring transport.
    State
    Example Benefit

    Covered for emergency transport, clinically required non-emergency transport, and treatment not requiring transport.

Pharmaceutical

  • Pharmaceutical
    Annual maximum per person:
    $600
    Rollover maximum per person:
    $1200
    Waiting Period:
    2 months
    Available at any recognised pharmacy.
    Rollover Maximum available after 12 months membership with extras cover, except major dental which requires 2 years of membership.
    State
    Example Benefit

    > 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

School Accident

Acupuncture