Premium Extras

Our top level of extras cover. Must be packaged with one of our Hospital Cover options.

Premium Extras is our top level of extras cover and gives you benefits for a comprehensive range of therapies like dental, optical, physiotherapy, chiropractic and many more. Premium Extras gives you generous annual limits and high benefits per service (up to your limits) to keep your out-of-pocket expenses to a minimum.

Best suited for families, couples and singles wanting top cover.

Features:

  • Cover for an extensive range of dental, optical and therapy services
  • Cover for orthodontics
  • Generous per person limits
  • Our highest level of benefits
  • Keeps your out-of-pocket costs down
  • Membership loyalty rewarded with increasing limits
  • Must be packaged with one of our hospital cover options

How benefits work

Overall limits apply to dental, orthodontics, optical, therapies and other services. Sub-limits apply to certain services. Rewarding limits We also increase your overall benefit limits for dental (excluding orthodontics) and therapies by $50 after the first year of membership and then for each year after for the first five years of cover. We honour this loyalty limit for as long as you continuously hold the product. More information is available here.

What you're covered for

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General and major dental

$1,400 per person
Services covered Sub-limit per person per Membership year
Crowns and bridges
$800

12 month waiting period applies

Example benefits paid
Full veneered crown $800

Sub-limit increases to $1,500 per year after 2 years of membership providing overall dental limit is not exceeded in claiming. Actual item benefits do not increase.

Dentures
$850

12 month waiting period applies

Prosthodontic services like plates and dentures.

Example benefits paid
Full upper and lower denture $850
Diagnostic dental
$600

2 month waiting period applies

Includes services like examinations, consultations and x-rays.

Example benefits paid
Periodic oral exam $50
X-rays $32
Extractions
$700

2 month waiting period applies

Simple extractions

Teeth removal services. Simple extractions include those completed in a standard dental appointment.

Example benefits paid
Simple tooth extraction $105

Surgical extractions

12 month waiting period applies

Surgical extractions include wisdom teeth extraction, removal of impacted teeth. Benefits paid on dental item numbers only unless hospital cover is held and all waits have been served for any in-patient services.

Example benefits paid
Surgical tooth extractions $180

A $700 combined sub-limit applies to surgical and simple extractions.

Fillings
$800

2 month waiting period applies

Restorative dental treatments including composite and amalgam fillings.

Example benefits paid
One surface composite filling $90

 

General services
$500

Includes services such as occlusal splints.

2 month waiting period applies

Example benefits paid
Occlusal splits $300
Preventive dental
$800

2 month waiting period applies

Includes cleaning and scaling, fluoride treatment and mouth guards.

Example benefits paid
Scale and clean $84
Fluoride treatment $22
Mouth guard $150
Root canal treatment
$600

12 month waiting period appliesEndodontic services such as root canals and root fillings.

Example benefits paid
Root canal obturation $170
Specialised gum treatments
$500

12 month waiting period applies

Periodontics, such as specialised gum treatments

Example benefits paid
Up to sub-limit (individual item benefits apply) $500
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Braces and orthodontics

$3,000 lifetime limit per person
Services covered Sub-limit per person per Membership year
Braces and orthodontic services
Lifetime limit $3,000

12 month waiting period applies

Braces and orthodontic services.

Example benefits paid
Orthodontic services 85% of cost up to eligible benefit limit

Benefits are paid at 85% of cost up to eligible benefit limit based on years of Membership on Premium Extras Cover.

Benefit limits after initial waiting period (if applicable) start at $1,000 and increase to $2,000 after completion of two years' Membership on Premium Extras Cover, and to $3,000 after three years' Membership on Premium Extras Cover, up to a lifetime limit of $3,000. Lifetime limit will take into consideration all previous claims for orthodontic treatment, even under a previous funds’ cover.

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Optical

$285 per person
Services covered Sub-limit per person per Membership year
Glasses and contact lenses
$285

2 month waiting period applies

Glasses including frames, single vision lenses and progressive lenses, contact lenses, prescription sunglasses etc.

Example benefits paid
Optical items or services Up to $285

Through our Premier Provider Network, you can take advantage of discounts at preferred providers across Australia.

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Therapies

$1,400 per person
Services covered Sub-limit per person per Membership year
Acupuncture

2 month waiting period applies

Example benefits paid
Initial and subsequent consultation $35

Benefits are payable for services rendered by Australian Regional Health Group approved providers registered with Territory Health Fund.

Audiology

2 month waiting period applies

Example benefits paid
Consultation $50
Report $60
Chiropractic
$700 (combined)^

2 month waiting period applies

Example benefits paid
Initial chiropractic consultation $55
Subsequent chiropractic consultation $35
X-rays (not for reading of X-rays) $60

A $700 combined limit applies to chiropractic, remedial massage/Bowen therapy/myotherapy and osteopathic services for Premium Extras.

Chinese Medicine

2 month waiting period applies

Example benefits paid
Initial consultation $35
Subsequent consultation $35
Dietitian

2 month waiting period applies

Example benefits paid
Initial consultation $75
Subsequent consultation $40
Exercise physiology
$700 (combined)*

2 month waiting period applies

Example benefits paid
Initial consultation $50
Subsequent consultation $35
Monthly program fee $35
Group therapy $10

A $150 combined sub-limit applies for group therapy services provided under physiotherapy and/or exercise physiology.

* A $700 combined limit applies to physiotherapy and exercise physiology services under Premium Extras cover.

Foot orthoses and orthopaedic shoes
$150

2 month waiting period applies

Example benefits paid
85% of cost up to sub-limit for orthoses and custom made footwear  
Occupational therapy

2 month waiting period applies

Example benefits paid
Initial consultation $80
Subsequent consultation $40
Orthoptic therapy

2 month waiting period applies

Example benefits paid
Initial and subsequent consultation $60
Osteopathy
$700 (combined)^

2 month waiting period applies

Example benefits paid
Initial consultation $35
Subsequent consultation $35

^ A $700 combined limit applies to chiropractic, remedial massage, Bowen therapy, myotherapy and osteopathic services for Premium Extras.

Physiotherapy
$700 (combined)*

2 month waiting period applies

Example benefits paid
Inital consultation $55
Subsequent consultation $40
Group therapy $10

A $150 combined sub-limit for group therapy services provided under physiotherapy and/or exercise physiology.

* A $700 combined limit applies to physiotherapy and exercise physiology services under Premium Extras cover.

Podiatry
$600

2 month waiting period applies

Example benefits paid
Initial and subsequent consultation $40
Approved appliances (orthotics) 85% of cost up to sub-limit
Minor procedures 75% of cost up to sub-limit
Psychology

2 month waiting period applies

Example benefits paid
Initial and subsequent consultation $80
Report $80
Group therapy $80
Remedial massage and myotherapy
$700 (combined)^

2 month waiting period applies

Example benefits paid
Initial and subsequent consultation $35

Benefits are payable for services rendered by Australian Regional Health Group Limited approved providers registered with Territory Health Fund. 

^ A $700 combined limit applies to chiropractic, remedial massage, myotherapy and osteopathic services for Premium Extras.

Speech therapy

2 month waiting period applies

Example benefits paid
Initial consultation $70
Subsequent consultation $35
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Other services

Services covered Sub-limit per person per Membership year
Childbirth education
$60

12 month waiting period applies

Example benefits paid
Education session $60
Healthy living
$150 per person

2 month waiting period applies

As well as helping you to get well, we want to help you stay well. Our Healthy Living benefit helps you living a healthy lifestyle through:

  • Participation in a choice of approved weight management programs^^ 
  • Quit smoking programs
  • Approved health management programs* including gym memberships, personal training programs, Aquatic exercise/rehabilitation* including pool entry and exercise classes (excludes swim classes/lessons)
  • Skin checks through mole mapping
  • Consultation fees for diabetes education
  • Consultation fees for metabolic dieticians and nutritionists when providing assistance with weight management
  • Bowel screening tests and bone density tests
  • PSA test (one per year) – we cover a second yearly text not covered by Medicare.

*To comply with private health insurance legislation, you must have been referred by your health care professional to participate in a health management program to address or improve a specific medical condition. A Health Management Program Benefit Approval Form must accompany a claim for these benefits.

^^Before enrolling in a weight management program please contact the Fund to clarify the eligibility to benefits.

Example benefits paid
Healthy living benefits Up to $150
Pharmaceutical
$500

2 month waiting period applies

The Pharmaceutical Benefits Scheme (PBS) is a national pharmaceutical scheme funded by the Federal Government where patients contribute to the cost of prescribed drugs.

Territory Health doesn't cover pharmaceutical prescriptions covered by the Pharmaceutical Benefits Scheme or for contraceptives and items normally available without prescriptions. Prescriptions not covered by the Pharmaceutical Benefits Scheme (PBS), excluding contraceptives and items normally available without prescription and drugs not approved for sale in Australia. A co-payment applies to each prescription item equal to the current PBS.

We’ll pay benefits as outlined in the Extras table up to the claim limit for this category, with consideration to the maximum individual script benefit limit. The benefit amount per script is calculated by deducting the PBS general patient contribution amount from the purchase price (up to script benefit limit). This is conditional on the pharmaceutical prescription being listed in the MIMs Schedule as S4 or S8 and being dispensed in quantities in accordance with this schedule. We also pay for compound pharmacy scripts, as long as one of the ingredients meet this criteria.

A doctor's letter may be required for some pharmacy items.

The PBS contribution amount is reviewed annually by the Government and changes every year on 1 January. As at 1 January 2019, the PBS contribution is set at $40.30.

Example benefits paid
Pharmaceuticals Up to $70
School accidents
$750

2 month waiting period applies

Example benefits paid
100% of cost up to sub-limit