What is covered? |
 General Dental
|
Benefits you receive
| Services |
Members First |
Other Providers |
Benefit examples
|
| Comprehensive oral examination |
$44.60 |
$34.00 |
| Scale and clean |
$76.50 |
$56.00 |
| Mouthguard |
$141.30 |
$60.00 |
|
At Members First providers you receive full cover for the first $500 per person per year, then fixed benefits of a least 90% apply. `No gap dental for kids' up to 25 years applies when treated at Members First providers on single parent, family and family plus memberships. Hospital costs relating to general dental treatment are not fully covered.
|
| Annual Maximums
| |
Per person |
| Every year |
Unlimited |
|
|
Major Dental
|
Benefits you receive
| Services |
Members First |
Other Providers |
Benefit examples
|
| Complete Denture |
100% of cost up to annual limit |
$640.00 |
| Full crown - veneered - indirect |
100% of cost up to annual limit |
$630.00 |
|
100% cover up to your Loyalty Maximum. Includes crowns, bridgework, precious restorations and dentures. No gap dental for kids' Major Dental when treated at Members First providers, if they are under a Family or Family Plus membership. Hospital costs relating to Major dental are not covered 100%. Benefits for the replacement of dentures payable every 3 years. Lower benefits apply for services by dentists not in the HBA Members First network.
*Set benefits are payable up to your Loyalty Maximum.
|
| Annual Maximums
| |
Per person |
| Year 1 |
No Cover |
| Year 2 |
$800.00 |
| Year 3 |
$960.00 |
| Year 4 |
$1,120.00 |
| Year 5 |
$1,280.00 |
| Year 6 |
$1,440.00 |
| Year 7+ |
$1,600.00 |
|
|
Orthodontics
|
Benefits you receive
| Services |
All Providers |
Benefit examples
|
| Complete course of orthodontic treatment |
Refer to special comments below. |
|
Benefit of 100% of the cost of treatment up to Loyalty Maximum. Lifetime limit of $3,200 per person. Members transferring from other funds will have the amount of orthodontic benefits paid at any previous funds deducted from their lifetime limit with HBA.
|
| Annual Maximums
| |
Per person |
| Year 1 |
No Cover |
| Year 2 |
$500.00 |
| Year 3 |
$600.00 |
| Year 4 |
$700.00 |
| Year 5 |
$800.00 |
| Year 6 |
$900.00 |
| Year 7+ |
$1,000.00 |
|
|
Optical
|
Benefits you receive
| Services |
Members First |
Other Providers |
Lenses
|
| Single Vision Stock |
$96.30 |
$57.00 |
| Bifocal lenses |
$128.50 |
$75.00 |
| Trifocal/progressive lenses |
$203.60 |
$125.00 |
Contact lenses
|
| Non Disposable |
$268.30 |
$135.00 |
| Disposable contact lenses, 1 month supply |
$64.20 |
$40.00 |
| Disposable contact lenses, 3 month supply |
$118.10 |
$70.00 |
Frames
|
| Frames for prescription lenses |
$240.90 |
$150.00 |
|
20% discount off frames at Members First optical providers (not with any other offer). Frames for prescription lenses, limited to one pair every 12 months.
|
| Annual Maximums
| |
Members First |
Other Providers |
| Every Year |
$350.00 |
$280.00 |
|
|
Physiotherapy
|
Benefits you receive
| Services |
Members First |
Other Providers |
Benefit examples
|
| Group therapy |
$18.90 |
$13.00 |
| Initial attendance |
$58.10 |
$32.00 |
| Subsequent attendance |
$46.40 |
$24.00 |
| Ante natal services |
$16.00 |
$13.00 |
| Hydrotherapy |
$18.90 |
$13.00 |
|
100% for the first 10 standard services per person per calendar year then benefits of at least 90% apply. Lower benefits apply for service providers not in the HBA Members First network.
|
| Annual Maximums
| |
Per person |
| Year 1 |
$750.00 |
| Year 2 |
$900.00 |
| Year 3 |
$1,050.00 |
| Year 4 |
$1,200.00 |
| Year 5 |
$1,350.00 |
| Year 6 |
$1,500.00 |
|
|
Chiropractic and Osteopathy
|
Benefits you receive
| Services |
Members First |
Other Providers |
Benefit examples
|
| Initial attendance |
$61.70 |
$49.40 |
| Subsequent attendance |
$40.10 |
$32.10 |
|
100% for the first 10 standard services per person per calendar year then benefits of at least 90% apply. Lower benefits apply for service providers not in the HBA Members First network.
|
| Annual Maximums
| |
Per person |
Per family |
| Year 1 |
$500.00 |
$800.00 |
| Year 2 |
$600.00 |
$960.00 |
| Year 3 |
$700.00 |
$1,120.00 |
| Year 4 |
$800.00 |
$1,280.00 |
| Year 5 |
$900.00 |
$1,440.00 |
| Year 6 |
$1,000.00 |
$1,600.00 |
|
|
Speech Therapy
|
Benefits you receive
| Services |
All Providers |
Benefit examples
|
| Initial attendance |
$75.00 |
| Subsequent attendance |
$46.00 |
| Group attendance |
$20.00 |
| Annual Maximums
| |
Per person |
| Year 1 |
$500.00 |
| Year 2 |
$600.00 |
| Year 3 |
$700.00 |
| Year 4 |
$800.00 |
| Year 5 |
$900.00 |
| Year 6 |
$1,000.00 |
|
|
Eye Therapy
|
Benefits you receive
| Services |
All Providers |
Benefit examples
|
| Initial attendance |
$60.00 |
| Subsequent attendance |
$40.00 |
| Annual Maximums
| |
Per person |
| Year 1 |
$500.00 |
| Year 2 |
$600.00 |
| Year 3 |
$700.00 |
| Year 4 |
$800.00 |
| Year 5 |
$900.00 |
| Year 6 |
$1,000.00 |
|
|
Occupational Therapy
|
Benefits you receive
| Services |
All Providers |
Benefit examples
|
| Initial attendance |
$56.00 |
| Subsequent attendance |
$37.00 |
| Group attendance |
$13.00 |
| Annual Maximums
| |
Per person |
| Year 1 |
$500.00 |
| Year 2 |
$600.00 |
| Year 3 |
$700.00 |
| Year 4 |
$800.00 |
| Year 5 |
$900.00 |
| Year 6 |
$1,000.00 |
|
|
Natural Therapies
|
Benefits you receive
| Services |
All Providers |
Benefit examples
|
| Acupuncture - Initial Attendance |
$35.00 |
| Acupuncture - Subsequent Attendance |
$25.00 |
| Naturopathy - Initial Attendance |
$35.00 |
| Naturopathy - Subsequent Attendance |
$25.00 |
Massage benefit examples
|
| Massage -per attendance |
$25.00 |
|
Includes acupuncture, Chinese herbalism, homeopathy, naturopathy and Western herbalism.
Massage include Bowen Technique, kinesiology, reflexology, shiatsu, therapeutic Massage. An annual sub-limit of $250 per person or $500 per family can be claimed per calendar year.
|
| Annual Maximums
| |
Per person |
| Year 1 |
$500.00 |
| Year 2 |
$600.00 |
| Year 3 |
$700.00 |
| Year 4 |
$800.00 |
| Year 5 |
$900.00 |
| Year 6 |
$1,000.00 |
|
|
Pharmacy
|
Benefits you receive
| Services |
All Providers |
Benefit examples
|
| Pharmacy |
Up to $75.00 |
|
Benefits for items not covered by the Government Pharmaceutical Benefits Scheme (PBS), except for those items specifically excluded by HBA. You pay an amount equal to the maximum patient contribution set by the Government under the PBS. HBA refunds 100% of the balance of up to $75 per script.
|
| Annual Maximums
| |
Per person |
| Year 1 |
$750.00 |
| Year 2 |
$900.00 |
| Year 3 |
$1,050.00 |
| Year 4 |
$1,200.00 |
| Year 5 |
$1,350.00 |
| Year 6 |
$1,500.00 |
|
|
Dietary
|
Benefits you receive
| Services |
All Providers |
Benefit examples
|
| Initial attendance |
$55.00 |
| Subsequent attendance |
$30.00 |
| Group attendance |
$13.00 |
| Annual Maximums
| |
Per person |
| Year 1 |
$500.00 |
| Year 2 |
$600.00 |
| Year 3 |
$700.00 |
| Year 4 |
$800.00 |
| Year 5 |
$900.00 |
| Year 6 |
$1,000.00 |
|
|
Psychology
|
Benefits you receive
| Services |
All Providers |
Benefit examples
|
| Initial attendance |
$83.00 |
| Subsequent attendance |
$78.00 |
| Group attendance |
$25.00 |
| Annual Maximums
| |
Per person |
| Year 1 |
$500.00 |
| Year 2 |
$600.00 |
| Year 3 |
$700.00 |
| Year 4 |
$800.00 |
| Year 5 |
$900.00 |
| Year 6 |
$1,000.00 |
|
|
Podiatry
|
Benefits you receive
| Services |
All Providers |
Benefit examples
|
| Initial attendance |
$40.00 |
| Subsequent attendance |
$30.00 |
| Annual Maximums
| |
Per person |
| Year 1 |
$500.00 |
| Year 2 |
$600.00 |
| Year 3 |
$700.00 |
| Year 4 |
$800.00 |
| Year 5 |
$900.00 |
| Year 6 |
$1,000.00 |
|
|
Health appliances
|
Benefits you receive
| Services |
All Providers |
Benefit examples
|
| Asthma pumps |
85% of cost up to a limit of $500, one per person every 3 years. |
| Blood Glucose Monitors |
85% of cost up to a limit of $500, one per person every 3 years. |
| Defined appliances |
85% of cost, annual combined total of $1,000 for all defined appliances. |
| CPAP/BPAP devices |
85% of cost up to a limit of $1,500 per person every 3 years. |
| Surgical Stockings |
100% of cost up to sublimit of $100. |
| Hearing Aid and Repairs |
100% of cost up to a limit of $850. Limit of one claim every 3 years. |
|
Defined Appliances include insoles, orthopaedic and corrective footware, pressure garments, braces, artificial limbs. Limits apply per item. CPAP Devices subject to eligibility. (No benefits payable on hearing aids where subsidised elsewhere.)
|
| Annual Maximums
| |
Per person |
| Every year |
Up to sub-limits per item |
|
|
Travel and accommodation
|
Benefits you receive
| Services |
All Providers |
Benefit examples
|
| Travel and accommodation benefits for essential medical treatment |
$200 for travel expenses and $75 per night up to $300 for accommodation expenses per year. |
|
Travelling benefits are payable for expenses associated with essential medical or hospital treatment where the total return distance travelled is at least 300 kilometres. Overnight non-hospital accommodation benefits are payable for the patient and an attendant for travel away from home for treatment unable to be provided by the patient's own doctor.
|
|
Annual Maximums
| |
Per person |
| Every year |
Up to sub-limits per item |
|
| |
