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

We’re confident you’ll love our extras cover. It’s designed exclusively for the needs of the emergency services community providing you with exceptional benefits.

• For the majority of services provided by recognised providers, Emergency Services Health pays a generous 80% of the cost.
• You can visit the recognised health provider of your choice.
• The funds that are part of the Police Health Group, including Emergency Services Health, are the only funds in Australia to provide a Rollover Benefit. This means that for many service areas any unused Annual Maximum benefit that is not claimed during one calendar year can be rolled over to the following year, so you can get more from your cover.

What is covered
The waiting periods outlined in the adjacent 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.

What is not covered (non-exhaustive list*)

• 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.

Our Annual Maximum (the benefits allowable in any one calendar year per person) are generous (for example, major dental $1300; physio $850; optical $300 and no annual maximum to general dental). There is also a family limit on exercise physiology. To ensure even greater security and value, Emergency Services Health also provides exclusive Rollover Benefits.

Exciting benefits for Emergency Services Health members!

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”.

A waiting period is the period of time you need to be covered before you’re eligible to claim on certain procedures or services. Waiting periods may apply to new or upgraded policies.

If you’re transferring from another health insurer, we offer continuity of cover which means you won’t serve the same waiting periods twice. However, if you’re transferring to us from a lower level of cover, you’ll only be able to claim up to the level you were already covered for until you have served the waiting period.

But rest assured, there are no waiting periods applied for claims resulting from an accident occurring after joining.

Waiting periods for extras:

• 2 months membership for all benefits, excluding accidents.
• 12 months membership for major dental (such as crowns, bridges, inlays, indirect fillings and dentures), orthodontic, hearing aids, nebulisers, blood glucose and blood pressure monitors, other appliances, blood coagulation monitor and for pre-existing conditions.
• 12 months membership for Rollover Benefit and access to Rollover Maximum (2 years for major dental).

Pre-existing conditions
A pre-existing condition is one where signs or symptoms of your ailment, illness or condition, in the opinion of a medical practitioner appointed by us (not your own doctor), existed at any time during the six months preceding the day on which you purchased your health insurance or upgraded to a higher level of hospital cover.

The medical practitioner we appoint must consider any information regarding signs and symptoms provided by your own treating doctor and specialist.

If you’re new to health insurance, you may need to have held membership for 12 months before cover will be provided for treatment relating to pre-existing conditions.

If you’re transferring your existing health insurance, the 12 month wait on pre-existing conditions may apply to any increased level of cover you take with us. For example, if you have an excess, excluded or restricted treatment under your previous policy, you need to serve 12 months membership with us before your treatment is covered at the higher level of cover.

Psychiatric care, rehabilitation and palliative care are not subject to the 12 month wait on pre-existing conditions.

Like all private health insurers, we have limits on how often services are used and the way some services are combined.

We’ve developed a benefit structure with fewer limits. Our limits on regular services such as dental are generous by comparison.

For extras services such as physiotherapy, chiropractic or podiatry, we limit claims to one consultation per person per day per service type.

Private health insurers generally calculate an average charge for services and set their benefits based on those amounts.

Emergency Services Health goes further and in the majority of cases recognises charges up to 10% higher than the calculated average. This means that when members make a claim for extras with Emergency Services Health, they tend to get more back - 80% in the majority of cases.

If the service charge is higher than the fee we recognise, the percentage amount you receive will reduce accordingly.

Our 80% benefit applies to the net amount payable on an account, inclusive of any discounts the provider might be offering; this may vary where, for the benefit of our members, Emergency Services Health has negotiated specific agreements with selected providers. To see examples of benefits paid please download a copy of our State Premiums & Benefits Guide.

Under extras cover you’re eligible to receive pharmaceutical benefits towards prescription items that are not eligible for subsidy under the Government’s Pharmaceutical Benefits Scheme (PBS). Emergency Services Health’s pharmaceutical benefits cover a wide range of items that require a prescription when dispensed from private recognised pharmacies, Australia-wide.

Emergency Services Health doesn’t restrict you to a limited list of prescribed items or direct you to particular pharmacies before you can claim pharmaceutical benefits. You can go to any private pharmacy to have your prescription dispensed and still be able to claim pharmaceutical benefits on eligible prescription items.

All you need to do when you receive your prescription items is ask the pharmacist for a detailed receipt or tax invoice that also describes the prescription items supplied to you and then submit a claim to Emergency Services Health along with the receipt or invoice.

Emergency Services Health will refund your cost over and above the first $25, up to a maximum pharmaceutical benefit of $50 per prescription item supplied. Some simple conditions apply.

Complementary Therapies benefits

Emergency Services Health provides benefits for a broad range of recognised Complementary Therapies within extras cover. Complementary Therapies continue to rise in popularity as an alternative or adjunctive option in the treatment of many conditions, as well as assisting in the maintenance of good health.

In an area where the qualifications and skills of service providers can vary considerably, we employ the services of the Australian Regional Health Group (ARHG), an organisation providing expertise in the recognition of health service providers who assist 24 health funds around Australia. The ARHG applies a rigorous and well-considered criteria to the acceptance of the individual therapies and service providers, giving confidence to health funds and their members.

Note: Not a complete list.


Recognised service providers

While the vast majority of private service providers registered and practicing in Australia within an accredited therapy will be recognised by us for benefits, not all providers are recognised. Individual therapists are required to meet certain criteria in education, continuing work experience, professional education, hold appropriate professional indemnity and public liability insurance and have completed a prescribed number of hours work experience.

So when you’re treated by one of the 25,000 Complementary Therapy providers around Australia that we cover, you’ll rest assured they’ve met these well considered standards.

If you wish to ensure your provider is recognised by Emergency Services Health, please contact us prior to treatment.

Benefits paid

To provide for a fair distribution of Complementary Therapy benefits to all members we’ve established the following requirements:

• The amount paid for a Complementary Therapy consultation is a set benefit of $25.
• Waiting periods apply for new members or a member upgrading their cover.
• One benefit is payable per day per person insured under a policy. If an insured person receives a consultation from two different providers under Complementary Therapies on the same day, then a benefit will be paid for only one of the consults.
• If a service provider is recognised for more than one modality, say Remedial Therapy and Chinese Herbal Medicine, and provides both services to you on the same day, then a benefit will only be paid for one service.

Benefit limits

Benefits for Complementary Therapies are subject to the combined annual maximum applying to chiropractic, osteopathy, acupuncture and complementary therapies.

Emergency Services Health’s Rollover Benefit does not apply to Complementary Therapies, therefore once the combined Annual Limit has been reached by an insured member no further benefits for Complementary Therapies will be paid for services in that calendar year. However entitled Rollover Benefits may still be claimed on other services within the combined group e.g. chiropractic, osteopathy and acupuncture.

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.