Doctors’ Health Fund Extras Cover Policy Review

Get tailored extras cover if you work in the health industry for dental, optical, therapies and more with Doctors' Health Fund.

Doctors' Health Fund is for people who work in the health industry, including medical or health practitioners, students and their families. You can join if you are one of the following:

  • A registered medical practitioner
  • A registered health practitioner in a specified category
  • A person studying to become a medical or health practitioner
  • An overseas doctor who is registered for the AMC exams
  • An employee of a medical or health practitioner, or an employee of an incorporated medical or health practitioner practice
  • Employed in any role by a federal or state Australian Medical Association (AMA) or by an associated or subsidiary organisation
  • An officer, employee or contractor of Avant Insurance Limited or Avant Law Pty Limited
  • An eligible family member of any of the above
finder.com.au does not currently have access to this health insurance brand. You may wish to compare options available on the health insurance homepage.
Top 3 features
  1. Good for medical professionals
  2. Good for cumulative benefits can carry over
  3. Good for optical discounts with up to 21% off a wide range of optical retailers.

What extras cover is available?

Doctors' Health Fund provides three levels of extras cover, top-level, mid-range and entry level suited to a range of individuals, couples and families:

  • Total Extras: With high limits and a wide range of benefits, Total Extras cover includes physiotherapy, podiatry, psychology, dietetics, remedial massage, hearing aids, pregnancy care, occupational and speech therapy, health management, home nursing and health aids and appliances.
  • Essential Extras: This is comprehensive mid-range extras cover that provides a range of benefits with affordable premiums. It covers general dental and orthodontics, optical, physiotherapy, remedial massage, psychology, non-PBS pharmaceuticals, speech therapy, occupational therapy, dietetics, podiatry and midwifery services.
  • Starter Extras: Entry-level extras cover for the basics that's best for young professionals, singles and couples.
Total ExtrasEssential ExtrasBasic Extras
Annual limitsUnlimited$800 combined limit with major dental, 100% of cost up to twice per year$500
Check-ups 100% of cost100% of cost up to twice per year100% of cost once per year
Fissure sealing100% of cost100% of cost50% of cost
Bitewing x-ray100% of costFixed benefits50% of cost
Minor restorativeFixed benefitsFixed benefits50% of cost
Oral surgeryFixed benefitsFixed benefitsNo cover
Tooth whiteningFixed benefitsFixed benefitsNo cover
Total ExtrasEssential ExtrasBasic Extras
OrthodonticsFixed benefits, $600 per year accumulating benefit limit up to $3,000 lifetimeFixed benefits, combined $800 annual limit with general dental. $250 per year accumulating lifetime benefit limit up to $1,250.No cover
Major restorativeFixed benefits, $1,000 annual limitFixed benefits, $800 combined limitNo cover
Endodontics and periodonticsFixed benefits, $1,000 annual limitFixed benefits, $800 combined limitNo cover
Crowns and bridgesFixed benefits, $1,200 annual limitFixed benefits, $800 combined limitNo cover
Dentures and prosthodonticFixed benefits, $1,000 annual limitFixed benefits, $800 combined limitNo cover
Total ExtrasEssential ExtrasBasic Extras
Limits$500 every 2 years$500 every 2 years$300 every 2 years
Benefits paidGlasses, frames or contact lenses, no sublimitsGlasses, frames or contact lenses, no sublimitsGlasses, frames or contact lenses, no sublimits
Total ExtrasEssential ExtrasBasic Extras
LimitsBenefits paid$900 annual limit, $500 per therapy sublimitBenefits paid$400 annual limitBenefits paid
Physiotherapy$700$50 individual, $20 group$900, with $500 per therapy sublimit$35 individual, $20 group$400$35 individual, $15 group
Remedial massage and myotherapy$700$35$900, with $500 per therapy sublimit$30$400$25
Mental health$600$100$900, with $500 per therapy sublimit$100$400$80
Occupational therapy$1,000, with $600 per therapy sublimit$45$900, with $500 per therapy sublimit$40$400$35
Speech therapy$1,000, with $600 per therapy sublimit$45$900, with $500 per therapy sublimit$40$400$35
Orthoptics$1,000, with $600 per therapy sublimit$35$900, with $500 per therapy sublimit$35$400$30
Podiatry$1,000, with $600 per therapy sublimit$35$900, with $500 per therapy sublimit$35$400$30
Dietetics$1,000, with $600 per therapy sublimit$35$900, with $500 per therapy sublimit$35$400$30
Pregnancy services$1,000, with $600 per therapy sublimit$35$900, with $500 per therapy sublimit$30No coverNo cover
Home nursing$600$30 per visit under 6 hours, $60 per visit over 6 hoursNo coverNo coverNo coverNo cover
Total ExtrasEssential ExtrasBasic Extras
Hearing aids$800 per single hearing aid, one set every 5 years$200 per single hearing aid, one set every 5 yearsNo cover
Aids and appliances75% of item cost, $1,00075% of item cost, $50075% of item cost, $150 combined limit with non-PBS pharmaceuticals

For consumables, benefits are paid twice per calendar year. For non-consumables, benefits are paid once every two years.

Total ExtrasEssential ExtrasBasic Extras
Non-PBS pharmaceuticals85% after PBS prescription fee, $600 annual limit85% after PBS prescription fee, $300 annual limit75%, combined $150 annual limit with aids and appliances
Health Management programs50% of cost, $200 per person and $400 per family limitNo coverNo cover

Other benefits of Extras Cover

Doctors' Health Fund extras cover is different because it doesn't limit you to a fixed funds network. Instead, you can claim benefits from any registered practitioner.

Other benefits include the following:

  • Optical discounts. You can get up to 21% off at a wide range of optical retailers, including both large funds and many smaller independent ones.
  • A two-year optical claim limit with all Extras. The average length of time to keep the same pair of glasses is around two years, so this lets you get high-end eyewear at a lower cost than you could with most other health funds.
  • Cumulative benefits can carry over. If you switch to Doctors' Health Fund from another policy that includes growing loyalty limits, Doctors' Health Fund may recognize these increased limits.
  • Waiting periods transfer. Both fully served and partially served waiting periods transfer when you switch to Doctors' Health Fund, provided the same cover was available under your previous plan.

How do the costs work?

Extras cover includes healthcare services not covered by Medicare and generally applies to services you get outside of hospital such as dental, optical and physiotherapy. At Doctors' Health Fund, your extras benefits are paid per calendar year, except for optical, orthodontic and aids/appliances benefits. You can keep track of your remaining benefits and claim history through Doctors' Health Fund Online Member Services.

Waiting periods and limitations

For services that pay a set percent of the service cost, the expenses must be within the normal, reasonable range for that service.

For certain services, such as health aids or non-PBS medications, the service will need to have been medically recommended by a practitioner.

Naturally, you cannot claim within waiting periods. The following waiting periods apply:

  • 12 months for major dental, health aids and appliances
  • 24 months for hearing aids
  • 2 months for all other services

How to make a claim

You can swipe your membership card at funds with HICAPS systems. This allows you to claim and pay any difference on the spot.

Where HICAPS isn't available, you can use the Doctors' Health Fund mobile app to make claims simply by taking a picture of your receipt and submitting it through the app.

Alternatively, you can email a receipt and claims form to info@doctorshealthfund.com.au or mail it in to the address on the claim form.

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