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Doctors’ Health Fund extras cover

Get tailored extras cover if you work in the health industry for dental, optical, therapies and more with Doctor's 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

To quality for this category, you must be a registered health practitioner in any of the following areas:

  • Medical radiation (diagnostic radiographer, medical imaging technologist, radiographer, nuclear medicine scientist, nuclear medicine technologist or radiation therapist)
  • Optometry
  • Dental (dentist, dental therapist, dental hygienist, dental prosthetist or oral health therapist)
  • Occupational therapy
  • Physiotherapy
  • Psychology

These include the following:

  • Spouse or partner (including former spouses or partners)
  • Dependent children
  • Adult children, including those of a spouse or partner
  • Parents
  • Siblings, including those of a spouse or partner
  • Nieces and nephews
  • Grandchildren, including those of a spouse or partner
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.

The extras policies

Your three ancillary cover options are as follows:

  • Basic Extras is only available if you also select Smart Starter hospital cover.
  • Essential Extras
  • Total Extras

All limits are annual limits, unless otherwise specified.

General dental cover

Total ExtrasEssential ExtrasBasic Extras
Annual limitsUnlimited$800 combined limit with major dental, 100% of cost up to twice per year$500
Check-ups (examination, fluoride, scale and clean)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 benefits
  • no
Tooth whiteningFixed benefitsFixed benefits
  • no

 Major dental 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
Major restorativeFixed benefits, $1,000 annual limitFixed benefits, $800 combined limit
  • no
Endodontics and periodonticsFixed benefits, $1,000 annual limitFixed benefits, $800 combined limit
  • no
Crowns and bridgesFixed benefits, $1,200 annual limitFixed benefits, $800 combined limit
  • no
Dentures and prosthodonticFixed benefits, $1,000 annual limitFixed benefits, $800 combined limit
  • no

 Optical cover

Total ExtrasEssential ExtrasBasic Extras
Limits$500 every 2 years$500 every 2 years$150 per year
Benefits paidGlasses, frames or contact lenses, no sublimitsGlasses, frames or contact lenses, no sublimitsGlasses, frames or contact lenses, no sublimits

 Therapies

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$35$30$25
Mental health$600$100$100$80
Occupational therapy$1,000, with $600 per therapy sublimit$45$40$35
Speech therapy$45$40$35
Orthoptics$35$35$30
Podiatry$35$35$30
Dietetics$35$35$30
Pregnancy services$35$30
  • no
  • no
Home nursing$600$30 per visit under 6 hours, $60 per visit over 6 hours
  • no
  • no
  • no
  • no

 Health aids and appliances

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 years
  • no
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.

 Other cover

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 limit
  • no
  • no

 Are there any other advantages?

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 Total and Essential 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.

Conditions, limitations and waiting periods

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

Also, while you can choose any practitioner you like, they must still be an accredited practitioner. In the case of remedial massage and myotherapy, which use an unconventional accreditation system, the fund must be recognised as an accredited practitioner by the Department of Health and Ageing.

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 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.

Andrew Munro

Andrew writes for finder.com.au, comparing products, writing guides, sniffing out deals and looking for new ways to help people get the most out of their money.

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