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.

Prosthodontic services like plates and dentures.

Includes services like examinations, consultations and x-rays.

Simple extractions

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

Surgical extractions

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.

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

Restorative dental treatments including composite and amalgam fillings.

Includes services such as occlusal splints.

Includes cleaning and scaling, fluoride treatment and mouth guards.

Endodontic services such as root canals and root fillings.

Periodontics, such as specialised gum treatments

Braces and orthodontic services.

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.

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

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

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

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

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.

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

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.

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.

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.

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 2020, the PBS contribution is set at $41.00.