healthslips.com.au Policy Information

Doctors' Health Fund

Smart Starter Bronze Plus $750 Excess & Essential Extras

Restricted Insurer

$610.28 / month

(Before Rebate, Discount & Loading)

Available in NSW & ACT

You may be entitled to an Australian Government Rebate on the above premium. Your premium may also include a Lifetime Health Cover Loading, an Age-based Discount or an insurer discount. Check with your insurer for details.

This policy covers: Two adults & dependants, including non-student dependants (3 or more people, only 2 of whom are adults).

Children (0 - 17), non-classified* dependant (18 - 20), students (21 - 31) and non-students (21 to 31), as well as persons with a disability who qualify as a child, non-classified* dependant, student and non-student in these age ranges. *Non-classified dependant: A non-classified dependant is a child, stepchild or foster child between 18 and 21 years of age who does not have a partner and who may or may not be receiving full-time education at a school, college or university.

Restricted insurer: Membership of this insurer is restricted to Medical and allied health professionals, their families, medical students and AMA employees.

Policy ID: AMA/J9/NBVT2Y

Source: Private Health Information Statement (PHIS)

Hospital Cover

  • This policy exempts you from the Medicare Levy Surcharge.
  • This policy provides accident cover - check with insurer for details.
  • This policy provides benefits for travel or accommodation outside of hospital - check with insurer for details.
Covered
Restricted Cover
Not Covered
This policy includes cover for
Blood
Bone, joint and muscle
Brain and nervous system
Breast surgery (medically necessary)
Chemotherapy, radiotherapy and immunotherapy for cancer
Dental surgery
Diabetes management (excluding insulin pumps)
Digestive system
Ear, nose and throat
Eye (not cataracts)
Gastrointestinal endoscopy
Gynaecology
Hernia and appendix
Hospital psychiatric services
Joint reconstructions
Kidney and bladder
Lung and chest
Male reproductive system
Miscarriage and termination of pregnancy
Pain management
Palliative care
Plastic and reconstructive surgery (medically necessary)
Podiatric surgery (provided by a registered podiatric surgeon)
Rehabilitation
Skin
Sleep studies
Tonsils, adenoids and grommets

This policy does not include cover for

Assisted reproductive services
Back, neck and spine
Cataracts
Dialysis for chronic kidney failure
Heart and vascular system
Implantation of hearing devices
Insulin pumps
Joint replacements
Pain management with device
Pregnancy and birth
Weight loss surgery

The benefits paid for hospital treatment will depend on the type of cover you purchase and whether your fund has an agreement in place with the hospital in which you are treated. See ‘Agreement Hospitals’ on privatehealth.gov.au for which hospitals have arrangements with your insurer – https://privatehealth.gov.au/dynamic/agreementhospitals.

Under this policy, you may have to pay out-of-pocket costs above what you get from Medicare or your private health insurer. Before you go to hospital, you should ask your doctors, hospital and health insurer about any out-of-pocket costs that may apply to you.

The following payments may also apply for hospital admissions

Excess: You will have to pay an excess on admission. This is limited to a maximum of $750 per person and $1500 per policy per year.

Co-payments: No co-payments

The following waiting periods for hospital admissions apply to new or upgrading members

Waiting periods:

  • 2 months for palliative care, rehabilitation and hospital psychiatric treatments, even if pre-existing
  • 12 months for other pre-existing conditions
  • 2 months for all other treatments

Gap Cover

This provider offers 'known gap' or 'no gap' cover for medical bills for this product. The Medical Costs Finder (https://www.health.gov.au/resources/apps-and-tools/medical-costs-finder) lets you find out more about the cost of specialist medical services.

Other features of this hospital cover

This cover is categorised as Bronze Plus as the services covered exceed the minimum requirements for Bronze level cover. Smart Starter Bronze Plus has Silver inclusions such as lung and chest, blood, medically necessary plastic and reconstructive surgery, dental surgery, and podiatric surgery. It also includes cover for sleep studies which is generally only included in Gold level cover.

For further information about this policy see: https://www.doctorshealthfund.com.au/our-health-cover

Extras Cover

This health insurer does not operate a preferred provider scheme.

This policy includes General treatment (Extras) cover for

Treatment & waiting period (months)
Benefit limits per 12 months unless otherwise stated
Examples of maximum benefits
Acupuncture* 2

$200 per person up to $400 per policy

combined limit for acupuncture, health management / healthy lifestyle & other services

  • Initial visit: 75% of charge
  • Subsequent visit: 75% of charge
Ante-natal/Post-natal classes 2

$900 per person

combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services

sub-limits apply

  • Initial visit: $50
  • Subsequent visit: $30
Blood glucose monitors 12

$500 per person up to $250 per service

sub-limits apply

  • Per monitor: 75% of charge
Dietetics/dietary advice 2

$900 per person

combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services

sub-limits apply

  • Initial visit: $50
  • Subsequent visit: $35
Endodontic 12

$1,600 per person

combined limit for endodontic, general dental, major dental & orthodontic

  • Filling of one root canal: $131.75
Exercise physiology 2

$900 per person

combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services

  • Initial visit: $30
  • Subsequent visit: $30
Eye therapy (orthoptics) 2

$900 per person

combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services

sub-limits apply

  • Initial visit: $50
  • Subsequent visit: $35
General dental 2

$1,600 per person

combined limit for endodontic, general dental, major dental & orthodontic

  • Fluoride treatment: 100% of charge
  • Scale & clean: 100% of charge
  • Surgical tooth extraction: $153
  • Periodic oral examination: 100% of charge
Health management / Healthy lifestyle 2

$200 per person up to $400 per policy

combined limit for acupuncture, health management / healthy lifestyle & other services

  • Health management: 75% of charge
Hearing aids 24

$800 per person

  • Hearing aid: $400
Major dental 12

$1,600 per person

combined limit for endodontic, general dental, major dental & orthodontic

  • Full crown veneered: $765
Non PBS pharmaceuticals 2

$300 per person

combined limit for non pbs pharmaceuticals & vaccinations

sub-limits apply

  • Per eligible prescription: 85% of charge
Occupational therapy 2

$900 per person

combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services

sub-limits apply

  • Initial visit: $50
  • Subsequent visit: $40
Optical* 2

$500 per person

  • Multi-focal lenses & frames: 100% of charge
  • Single vision lenses & frames: 100% of charge
Orthodontic* 12

$1,600 per person

$1,600 lifetime limit

combined limit for endodontic, general dental, major dental & orthodontic

  • Braces for upper & lower teeth, including removal plus fitting of retainer: 100% of charge
Orthotics (podiatric orthoses) 12

$900 per person

combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services

sub-limits apply

  • Orthotics supply & fit: $150
Physiotherapy* 2

$900 per person

combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services

sub-limits apply

  • Initial visit: $50
  • Subsequent visit: $35
Podiatry 2

$900 per person

combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services

sub-limits apply

  • Initial visit: $50
  • Subsequent visit: $35
Psychology 2

$900 per person

combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services

sub-limits apply

  • Initial visit: $100
  • Subsequent visit: $100
Remedial massage 2

$900 per person

combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services

sub-limits apply

  • Initial visit: $40
  • Subsequent visit: $30
Speech therapy 2

$900 per person

combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services

sub-limits apply

  • Initial visit: $50
  • Subsequent visit: $40
Vaccinations 2

$300 per person

combined limit for non pbs pharmaceuticals & vaccinations

  • Per service: 85% of charge

Acupuncture*

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$200 per person up to $400 per policy}

{combined limit for acupuncture, health management / healthy lifestyle & other services}

Examples of maximum benefits

{Initial visit: 75% of charge}

{Subsequent visit: 75% of charge}

Ante-natal/Post-natal classes

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $50}

{Subsequent visit: $30}

Blood glucose monitors

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$500 per person up to $250 per service}

{sub-limits apply}

Examples of maximum benefits

{Per monitor: 75% of charge}

Dietetics/dietary advice

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $50}

{Subsequent visit: $35}

Endodontic

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$1,600 per person}

{combined limit for endodontic, general dental, major dental & orthodontic}

Examples of maximum benefits

{Filling of one root canal: $131.75}

Exercise physiology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services}

Examples of maximum benefits

{Initial visit: $30}

{Subsequent visit: $30}

Eye therapy (orthoptics)

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $50}

{Subsequent visit: $35}

General dental

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$1,600 per person}

{combined limit for endodontic, general dental, major dental & orthodontic}

Examples of maximum benefits

{Fluoride treatment: 100% of charge}

{Scale & clean: 100% of charge}

{Surgical tooth extraction: $153}

{Periodic oral examination: 100% of charge}

Health management / Healthy lifestyle

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$200 per person up to $400 per policy}

{combined limit for acupuncture, health management / healthy lifestyle & other services}

Examples of maximum benefits

{Health management: 75% of charge}

Hearing aids

Waiting period:  24 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

Examples of maximum benefits

{Hearing aid: $400}

Major dental

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$1,600 per person}

{combined limit for endodontic, general dental, major dental & orthodontic}

Examples of maximum benefits

{Full crown veneered: $765}

Non PBS pharmaceuticals

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

{combined limit for non pbs pharmaceuticals & vaccinations}

{sub-limits apply}

Examples of maximum benefits

{Per eligible prescription: 85% of charge}

Occupational therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $50}

{Subsequent visit: $40}

Optical*

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per person}

Examples of maximum benefits

{Multi-focal lenses & frames: 100% of charge}

{Single vision lenses & frames: 100% of charge}

Orthodontic*

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$1,600 per person}

{$1,600 lifetime limit}

{combined limit for endodontic, general dental, major dental & orthodontic}

Examples of maximum benefits

{Braces for upper & lower teeth, including removal plus fitting of retainer: 100% of charge}

Orthotics (podiatric orthoses)

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services}

{sub-limits apply}

Examples of maximum benefits

{Orthotics supply & fit: $150}

Physiotherapy*

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $50}

{Subsequent visit: $35}

Podiatry

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $50}

{Subsequent visit: $35}

Psychology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $100}

{Subsequent visit: $100}

Remedial massage

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $40}

{Subsequent visit: $30}

Speech therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

{combined limit for ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), physiotherapy, podiatry, psychology, remedial massage, speech therapy & other services}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $50}

{Subsequent visit: $40}

Vaccinations

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

{combined limit for non pbs pharmaceuticals & vaccinations}

Examples of maximum benefits

{Per service: 85% of charge}

Major dental paid at fixed benefits per item. Combined annual limit of $900 for physiotherapy, exercise physiology, dietetics, occupational therapy, speech therapy, podiatry, massage and more (sub-limits of $700 for mental health and $500 for other therapies). Group physiotherapy and hydrotherapy $20 per session. Benefit of $400 each for one left and one right hearing aid every 5 years. Pharmacy benefits paid at 85% of charge above the PBS co-payment to a maximum of $40 per prescription (sub-limit applies for weight loss medications).

This policy does not include General treatment (Extras) cover for

Audiology
Chinese medicine
Chiropractic
Home nursing
Osteopathy

Other features of this general treatment cover: Superior mid-range extras cover with substantial benefits including major dental and high-level optical cover. 100% back for 2 dental checkups per year (fixed benefits thereafter) at the provider of your choice. No sub-limits on optical benefits – use the full $500 limit on contact lenses or frames fitted with prescription lenses. Claim up to $700 per year (as part of the $900 overall limit for therapies) for mental health services. Health management includes services such as acupuncture, weight loss classes and class physiotherapy for the treatment of a specific diagnosed condition.

For further information about this policy see: https://www.doctorshealthfund.com.au/our-health-cover

Ambulance cover

In NSW & ACT this policy provides:

Emergency: Unlimited with a waiting period of 1 day.

Non-emergency: Unlimited transport with a waiting period of 1 day, or 1 day for pre-existing conditions.

Call-out fees: Will be paid for each attendance, including emergency treatment without transport to hospital.

Other features of this ambulance cover: National cover for emergency and medically necessary ambulance transportation costs except where there is an entitlement to Benefits under a State Government ambulance transport scheme or any other source.

For further information about this policy see: https://www.doctorshealthfund.com.au/our-health-cover

Insurer Details

Doctors' Health Fund

Smart Starter Bronze Plus $750 Excess & Essential Extras

Restricted Insurer

$610.28 / month

(Before Rebate, Discount & Loading)

Available in NSW & ACT

Disclaimer: This document is not a Private Health Information Statement (PHIS), and it is not intended to replace that document. The details contained in the healthslips.com.au Policy Information was provided by the insurer to the Australian Government. It is intended as general information. It may not take into account your circumstances. For further information contact the insurer. Information used is Licensed from the Commonwealth of Australia under a Creative Commons 3.0 licence.Private Health Information Statement is available from the Private Health Insurance Ombudsman website at https://privatehealth.gov.au/dynamic/Premium/PHIS/AMA/J9/NBVT2Y

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