Part 9Benefits Paid for General Treatment

Part 9 Benefits Paid for General Treatment

General Treatment categories (HRF 601.1 headings)

These are examples only based on the types of services covered under General Treatment Products. This is not a comprehensive listing of all services.

Under the new legislation some of the items historically collected in this section are considered to be excluded from General Treatment. Therefore, insurers can only provide benefits for them as part of a complying health insurance product under the provisions of the Private Health Insurance Act 2007 paragraph 69-1 (1) (b) and the Private Health Insurance (Complying Product) Rules 2015 Rule 7. Some of them will be considered health related business rather than health insurance business.

<table cellspacing="0" cellpadding="0" style="border-collapse:collapse"><tbody><tr><td colspan="2" style="width:125.3pt; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Accidental Death/Funeral Expenses</span></p></td><td style="width:279.5pt; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Funeral parlour, burial or cremation expenses. These benefits are being phased out under paragraph 69-1 (1) (b) of the </span><span style="font-style:italic">Private Health Insurance Act</span><span> 2007 and Rule 7 of the </span><span style="font-style:italic">Private Health Insurance (Complying Product) Rules 2015</span><span>.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Acupuncture/Acupressure</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Acupuncture.</span></p><p style="margin-bottom:6pt"><span>Acupressure.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Ambulance</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Emergency ambulance transport, anywhere in Australia to the nearest appropriate hospital able to provide the level of care required, provided by an Ambulance Service</span></p><p style="margin-bottom:6pt"><span>OR</span></p><p style="margin-bottom:6pt"><span>Non-emergency ambulance transport, anywhere in Australia, provided by an Ambulance Service.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Chiropractic</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Chiropractic, Chiropractic X-Rays</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Community, Home, District Nursing</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Treatment for illness, disease, incapacity or disability when the purpose of treatment is dependent on nursing care excluding hospital-substitute treatment.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Dental</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Comprehensive examination or consultation.</span></p><p><span>Dental X-ray.</span></p><p><span>Clean, polish, Fluoride treatments.</span></p><p><span>Scale &amp; clean.</span></p><p><span>Custom-made mouthguard.</span></p><p><span>Tooth fillings.</span></p><p><span>Crowns and bridges.</span></p><p><span>Full upper or lower Denture.</span></p><p style="margin-bottom:6pt"><span>Major dental work.</span><br><span>Periodontics, endodontics, dentures and surgical extraction of teeth.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Dietetics</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Dietitian and nutritionist.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Domestic Assistance</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>A benefit for home assistance provided by councils.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Ex gratia Payments</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Payments for services not covered under the rules of the insurer. For example, the insurer may pay for drugs not normally covered as a gesture of good will.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Preventative health products/Health management programs</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Weight loss/ Weight management programs.</span></p><p><span>Quit smoking, nicotine replacement therapy.</span></p><p><span>Disease management association fees (Asthma, Diabetes, Heart, Arthritis and Coeliac).</span></p><p style="margin-bottom:6pt"><span>Cancer Council UV products (30+ sunscreen, rash vests and suits, hats, wrap sunglasses).</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Hearing Aids and Audiology</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Hearing Aids, Hearing Aid repair.</span></p><p style="margin-bottom:6pt"><span>Cochlear Speech Processor.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Hypnotherapy</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Hypnotherapy.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Maternity Services</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Pre and post-natal consultation and classes.</span></p><p style="margin-bottom:6pt"><span>Midwife delivery services.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Natural Therapies</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Alexander technique, Aromatherapy, Naturopathy, Biochemist, Bowen Therapy, Feldenkrais, Herbalist, Homeopathy, iridology, Kinesiology and One on One Pilates, Rolfing, Reflexology, Remedial Massage, Shiatsu.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Occupational Therapy</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Occupational Therapy.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Optical</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Single Vision glasses.</span></p><p><span>Bifocal glasses.</span></p><p style="margin-bottom:6pt"><span>Multi-focal glasses.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Optical</span></p><p style="margin-bottom:6pt"><span>(continued)</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Contact lenses disposable and hard.</span></p><p><span>Disposable contacts.</span><br><span>Prescription - sight correcting lenses.</span></p><p><span>Frames.</span></p><p style="margin-bottom:6pt"><span>Repair.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Orthoptics (Eye Therapy)</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Eye therapy</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Osteopathic Services</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Osteopathy</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Overseas</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Means a cover provided to a person who is not an Australian Resident, is not entitled to full Medicare benefits and is visiting Australian on a temporary or long stay visa for holiday, study or work purposes.</span><span> </span><span>Residents of Australian territories are deemed to be “overseas visitors” when visiting Australia.</span></p><p style="margin-bottom:6pt"><span></span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Pharmacy</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Pharmaceutical.</span><br><span>Hormonal implants.</span></p><p><span>Skin contraceptives.</span></p><p style="margin-bottom:6pt"><span>Preventive vaccines - Hepatitis A/B Injections, Flu, Travel and other approved vaccines.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Physiotherapy</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Physiotherapy.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Podiatry (Chiropody)</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Podiatry, Biomechanical Assessment, Casts, Orthotics</span><span> </span><span>- custom made sporthotics or formthotics.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Medical devices or human tissue products, Aids and Appliances</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Post operation aids (eg. surgical stockings), Braces and supports (eg. crutches), Medical aids (including Irlen lens), Non-surgical medical devices or human tissue products (including wigs), Artificial appliances, Wheel chairs, Walking frames</span></p><p style="margin-bottom:6pt"><span>Nebuliser, TENS machine, asthma spacer, blood glucose monitor.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Psych/Group Therapy</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Psychology.</span></p></td></tr><tr><td colspan="2" style="width:125.3pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>School</span></p></td><td style="width:279.5pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Benefits paid, as a result of a personal injury to a student covered by the policy while at school or travelling to or from school or any associated school activity and not paid or payable from any other source. This benefit is for essential health care services, other than services provided in hospital or those attracting a Medicare benefit.</span></p></td></tr><tr><td style="width:120.6pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Sickness and Accident</span></p></td><td colspan="2" style="width:284.2pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Accident means an unforeseen event, occurring by chance and caused by an unintentional and external force or object resulting in involuntary personal hurt or damage to the body of a person covered by a policy, which requires immediate medical advice or treatment from a registered practitioner. This General Treatment benefit is for essential health care services, other than services provided in hospital or those attracting a Medicare benefit.</span></p><p style="margin-bottom:6pt"><span>Note: The term “Sickness and Accident” historically included the business of undertaking liability to pay a lump sum, or make periodic payments, on the occurrence of a personal accident, disease or sickness, or was contingent on some treatment or services being provided to the insured, or on the payment of fees or charges for any treatment or services. The Act does not recognise payment of benefits in these circumstances as health insurance business.</span></p><p style="margin-bottom:6pt"><span style="font-style:italic">(Division 121, Private Health Insurance Act 2007 and Private Health Insurance (Health Insurance Business) Rules 2018).</span></p></td></tr><tr><td style="width:120.6pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Speech Therapy</span></p></td><td colspan="2" style="width:284.2pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Speech therapy.</span></p></td></tr><tr><td style="width:120.6pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Theatre Fees</span></p></td><td colspan="2" style="width:284.2pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Procedure room.</span></p><p><span>Outpatient theatre fee.</span><span style="color:#43586e"></span></p><p style="margin-bottom:6pt"><span>Medical gases (such as oxygen).</span></p></td></tr><tr><td style="width:120.6pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Travel and Accommodation</span></p></td><td colspan="2" style="width:284.2pt; border-top:0.75pt dotted #000000; border-bottom:0.75pt dotted #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:6pt"><span>Accommodation expenses for parent/partner to accompany a patient who is an in-patient of a public or private hospital.</span></p><p style="margin-bottom:6pt"><span>Travel costs where a patient receives treatment at a hospital more than a specified distance from a patient’s home. In circumstances where the patient chooses not to be an in-patient.</span></p></td></tr><tr style="height:0pt"><td style="width:131.4pt"></td><td style="width:4.7pt"></td><td style="width:279.5pt"></td></tr></tbody></table>