Top Extras

Effective 14 April 2010

Top Extras (previously Ancillary Cover) is our most popular extra’s cover providing you with comprehensive cover for day-to-day services. A key feature of Top Extras is the broad dental benefits that include major dental and orthodontic treatment. For further information about the three categories of dental services covered please refer to the Important Information about Extras Cover.

The following information includes an overview of benefits and yearly limits which are per person, except where stated.

Top Extras

What’s covered	Benefit (up to)	Yearly limit per person	Yearly limit couples/families#
Dental *
General dental (2 month waiting period)
Comprehensive oral examination (011)	$30	No limit	No limit
Bitewing x-ray (022)	$23
Filling: 1 surface metallic (511)	$59
Filling: 3 surface metallic (513)	$87
Filling: 1 adhesive restoration (531)	$67
Filling: 3 adhesive restoration (533)	$91
Removal of tooth (311)	$75
Bi-maxillary mouthguard (153)	$127	1 services per person per calendar year	Per person limit applies to each family member
Periodic oral examination (012)	$30	2 services per person per calendar year	Per person limit applies to each family member
Topical application of reminralizing agent one treatment (121)	$22
Removal of calculus (114)	$46
Major dental (12 month waiting period)
Tooth-coloured restoration - one surface - indirect (551)	$273	$1,100 to $2,800 based on years of cover	Per Person limit applies to each family member
Tooth-coloured restoration - two surfaces - indirect (552)	$432
Bridge pontic - indirect (642)	$520
Crown - veneered (615)	$620
Dentures (upper and lower) (719)	$830
Orthodontia treatment (24 month waiting period) Benefits are paid once in a lifetime
Orthodontia - 100% of cost up to the maximum life time limit based on years of continuous membership on Top Extras Cover		$1,300 to $2,500 based on years of cover	Per Person limit applies to each family member
Optical (6 month waiting period)
Frames	$80	$250	Per Person limit applies to each family member
Single vision lens (pair)	$120
Bifocal lens (pair)	$120
Trifocal lens (pair)	$165
Repair of frames	$70
Contact lenses - rigid or soft	$175
Contact lenses - soft toric	$175
Contact lenses - disposable	$175
Body and mind therapies (2 month waiting period - except Clinical psychology 12 month waiting period)
Physiotherapy - First consultation	$40	$800 limit per person per year (sub-limit of $600 for Speech therapy included in the overall limit)	Per Person limit applies to each family member
Physiotherapy - Group Therapy/Pilates	$20
Physiotherapy - All other consultations	$32
Ante or post natal physiotherapy course per confinement	$78
Exercise physiology - First consultation	$40
Exercise physiology - Group Therapy/Pilates	$20
Exercise physiology - All other consultations	$32
Orthoptist (eye therapist)	$40 initial and $35 subsequent
Speech therapy - First consultation	$70
Speech therapy - All other consultations	$32
Chiropractic - First consultation	$40	$450	Per Person limit applies to each family member
Chiropractic - All other consultations	$30
Chiropractic - Group Therapy/Pilates	$20
Osteopathy - First consultation	$40
Osteopathy - All other consultations	$30
Osteopathy - Group Therapy/Pilates	$20
Occupational therapy - First consultation	$70	$500	Per Person limit applies to each family member
Occupational therapy - All other consultations	$44
Podiatry/Chiropody	$30	$400	Per Person limit applies to each family member
Audiology consultation	$45	No limit	Per Person limit applies to each family member
Dietician - First consultation	$60	$400	Per Person limit applies to each family member
Dietician - All other consultations	$35
Hypnotherapy	$30	$300	Per Person limit applies to each family member
Psychology - First consultation	$72	$400	Per Person limit applies to each family member
Psychology - All other consultations	$54
Psychology - Group sessions (limit of 10)	$12
Psychology – Assessments	$100
Natural therapies (2 month waiting period)
Acupuncture	$32	$400	Per Person limit applies to each family member
Alexander Technique, Aromatherapy, Chinese herbal therapy, Feldenkrais method, Homeopathy, Kinesiology, Myotherapy, Naturopathy, Reflexology, Remedial massage, Shiatsu, Western herbal medicine	$32	$400	Per Person limit applies to each family member
Healthy lifestyle (12 month waiting period)
Gym membership (referral required)**	75%	$150	$300 overall limit per couple/family
Stop smoking courses***	75%
Cardiac prevention***	75%
Diabetic education***	75%
Weight management***	75%
Medical health (2 month waiting period)
Pharmaceuticals (non-PBS pharmaceuticals requiring prescription by law)  ****	$60	$800 including    $280 sub limit  for vaccinations and $280 sub limit for  erectile  dysfunction medications	Per Person limit applies to each family member
Vaccinations (Contact fund for Details)	$60
Home nursing - per visit (under6 hours)	$33 $95	$800	Per Person limit applies to each family member
Home nursing - per day (over 6 hours)		$800
Medical appliances (12 month waiting period except where noted as different)
Surgical Shoes  (Must be custom made & prescribed by a medical Practioner)	75%	Up to $400 per person	Per person limit applies to each family member
Surgical stockings (2 months waiting period)	75%	$400 per person (sub limit of $130 per person for surgical stockings
Compression garments
Wigs (Chemotherapy, Alopecia)	75%	$350 (life time limit)
Hearing aids - 1 to 2 years	Single $300    Pair $600	$600	1 pair of hearing aids every 3 years per person
Hearing aids - 2 to 5 years	Single $600   Pair $1,200	$1,200
Hearing aids - 5 years plus	Single $900   Pair $1,800	$1,800
Hearing Aid repairs	$70	$140	Per person limit applies to each family member
Crutches/wheelchair hire (2 month waiting period)	75%	$140	Per person limit applies to each family member
Crutches - purchase (2 month waiting period)	50%
Wheelchair non-motorised (2 year waiting period)	50%	Up to $900 per person 1 per  lifetime	Per person limit applies to each family member
Wheelchair motorised (2 year waiting period)	50%	Up to $1,900 per person 1 per  lifetime
Miscellaneous benefits (2 month waiting period)
Country health travel must be for a serious medical condition with a distance travelled of more than 200 km return	15 cents per km	$400	Per person limit applies to each family member
Emergency ambulance	100%	$6,000	$12,000

*  A large number of dental services are claimable.  To check what is covered contact Teachers Health Fund on 1300 728 188

** Referral from approved health service provider

*** From approved providers only.  Check with Teachers Health Fund.

**** Benefits paid = cost minus Pharmaceutical Benefits Scheme (PBS) co-payment to $60 maximum

Major Dental

This covers more expensive types of dental work including periodontic services (such as gingervectomy, osseous surgery), endodontic services (such as root canal surgery, apicectomy), oral surgery including surgical extractions, crowns and bridges, prosthodontics (denture, repairs and components), onlays/inlays and veneer facings.

The amount of major dental claimable in a year is based on years of continuous membership of Teachers Health Fund Top Extras cover. Transfers from health funds are not credited with years of membership in the previous fund although waiting periods served are recognised.

Yearly limit per person	Years of Top Extras cover
$1,100	1-5 years
$1,350	5 -10 years
$2,000	10 -20 years
$2,800	20 plus years

Orthodontia

Orthodontic benefits are provided once per person in a lifetime. Transfers from other health funds are not credited with years of membership in the previous policy. If the previous policy did not include orthodontia benefits, a 2 year waiting period is applicable. Limits are calculated from the commencement of treatment. Contact Teachers Health Fund on 1300 728 188 for details of benefits and any waiting periods that may apply.

Yearly limit per person	Years of Top Extras cover
$1,300	2-5 years
$1,800	5 -10 years
$2,500	10 plus years

Key information

Please refer to Important information on extras cover regarding waiting periods and details of individual services and yearly limits.