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Pharmaceutical Benefits

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 $23, up to a maximum pharmaceutical benefit of $60 per prescription item supplied. Some simple conditions apply.

Which prescriptions are covered?

There are a multitude of rules which cover the dispensing of prescriptions. However, for simplicity we’ll divide them into two categories, Group 1 (PBS) and Group 2 (Non PBS).


Group 1 (PBS)

PBS items are those listed for a Government subsidy towards their cost. This subsidy is paid direct to the pharmacy by the Government. Health Funds are not permitted to pay benefits towards government subsidised items.


Group 2 (Non PBS)

Non PBS items cover virtually all prescription items other than those listed in the PBS. Some common Non PBS items include some asthma medications, antibiotics and contraceptive pills. Non PBS items attract Emergency Services Health Pharmaceutical benefits.

Conditions

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

  • You must pay the first $23 towards each prescription item supplied.
  • The maximum Pharmaceutical benefit paid by Emergency Services Health per prescription item supplied is $60.
  • The maximum Pharmaceutical benefits paid per person per calendar year is $600, but may be higher (up to $1200) where members are eligible for Emergency Services Health’s unique Rollover Benefit.
  • For prescriptions dispensed in quantities greater than the minimum standard packaged quantity (as determined by Emergency Services Health), the initial member cost of $23 may increase.
  • Waiting periods (2 months) may apply to Pharmaceutical benefits for new members or members upgrading cover.
  • Pharmaceutical benefits will only be paid for items that require a prescription for their supply and, for almost all items, they must be supplied through a pharmacy.
  • Excludes medication ordinarily available without a prescription, including where the medication is recommended, ordered, prescribed or supplied by a doctor.
  • Once the government lists a prescription item for subsidy on the PBS, Emergency Services Health will be unable to pay a Pharmaceutical benefit, and this includes restricted and authority required prescription items.*

*For a prescription item appearing on the PBS list with a restriction or authority requirement for subsidy on the PBS, Emergency Services Health may pay a Pharmaceutical benefit for the supply of the prescription item where the person does not meet the restriction or authority requirements.

Please note, changes within the PBS list occur frequently, where items previously covered and not covered change. This may affect Emergency Services Health Pharmaceutical benefits where items you may claim now may not be eligible for claims in the future and vice versa. For the most up to date PBS list visit https://www.pbs.gov.au/pbs/home or ask you pharmacist when filling your script.

This help guide is only intended as a brief outline of our Pharmaceutical benefits.

If you have any questions do not hesitate to contact Emergency Services Health on 1300 703 703

Refer a Mate Terms and Conditions

Refer a Mate Offer Terms and Conditions

(1) This offer is current as of 01 January 2019. Emergency Services Health reserves the right to alter or change the conditions of the offer at any time. Emergency Services Health also reserves the right to withdraw the offer at any time. 

(2) This offer is only available to current Emergency Services Health policy holders who refer a ‘new member’ to Emergency Services Health extras cover, hospital cover or hospital & extras cover. 

(3) A ‘new member’ is a person who has not been a policy holder of Emergency Services Health in the past four months. 

(4) A ‘new member’ does not include persons who come off of their parent’s policy, go from a single policy to family policy, family to sole parent etc.).

(5) Gift Cards will be for the value of $50 and will be issued to both the ‘new member’ and the referring Emergency Services Health member upon successful receipt of the first 30 days of premium payment. 

(6) Only 1 gift card is attainable for the referring Emergency Services Health member and the ‘new member’ per policy and will be sent via post.

(7) Gift cards are not refundable for cash and they are subject to their own Terms and Conditions of use. 

(8) This offer is not available to existing Emergency Services Health members whose policy is suspended or in arrears. 

(9) The ‘new member’ must note the promotion code ‘REFER’ on the application form or disclose the promotion code to the Customer Service Offer at the point of sale for the gift card to be issued. The Emergency Services Health Customer Service Team will contact the ‘new member’ to confirm the details of the referring Emergency Services Health member. 

(10) Employees and directors of Police Health Group or their immediate family are not eligible to participate in the promotion.  

(11) This offer is not available in conjunction with any other promotional offer from Emergency Services Health.

(12) Emergency Services Health do not accept any responsibility for lost, stolen, undeliverable or damaged gift cards and no replacement will be sent in the event of the aforementioned.

(13) Current Emergency Services Health members can refer a ‘new member’ to Police Health (Police Health Limited
 ABN 86 135 221 519). Providing the aforementioned 13 clauses are met, both the referring Emergency Services Health member and the ‘new member’ will be eligible for a gift card.

(14) Terms and conditions are subject to change without notice. Current as at 01/01/2019.

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