TOP WORKING COVER
MEDICAL AND HOSPITAL BENEFITS COVERED UNDER
YOUR TOP WORKING POLICY
In the event of medical treatment being required by you or any
dependants covered under your policy during the period of cover, wewill pay benefits for the following:
Service*You may incur out of pocket costs for hospital expenses above
your benefit amount. Payment of benefit subject to the same
rules/criteria as payment of a Medicare benefit for the sameservice.
Benefit per service*Out-patient medical services

Medical services provided by a doctor.

100% of the MBS fee.

All other medical services such as pathology and radiology(including specialists).

85% of the MBS fee.

In-patient medical services

Admitted medical services provided in hospital.

100% of the MBS fee.

Public hospital –The rate determined by State and Territory health authorities forservices charged to a patient who is not eligible for Medicare.

-Admitted patient treatment including:- overnight and day only hospital accommodation(including theatre, intensive care, labour wards, warddrugs); andFor admission-related PBS listed drugs, the benefit is equal to theAustralian Government’s PBS list price less the current PBS patientco-payment.

- post-operative services that are a continuation of careassociated with an early discharge from hospital.
-Emergency department treatment;-

PBS listed drugs (including discharge medications) that form
part of the episode of hospital care.

Private hospital/registered day hospital facility.

100% of the contracted charges for all insurable costs raised by
one of our agreement hospitals with a minimum of shared ward
accommodation.
Refer to “Private admission” on page 38.

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TOP WORKING COVER (CONTINUED)
MEDICAL AND HOSPITAL BENEFITS COVERED UNDER
YOUR TOP WORKING POLICY*You may incur out of pocket costs for hospital expenses above
your benefit amount. Payment of benefit subject to the same
rules/criteria as payment of a Medicare benefit for the same
service.

In the event of medical treatment being required by you or any
dependants covered under your policy during the period of cover, wewill pay benefits for the following:

ServiceBenefit per service*

Prescription Medicines

For medicines prescribed by your doctor or other medicalpractitioner and dispensed by a registered pharmacist.

Prescription medicines benefit for expenses exceeding the equivalentof the current PBS patient co-payment for general beneficiaries up
to a:

-

maximum benefit of $50 per prescribed item-

maximum amount per calendar year for Single cover of $300-

maximum amount per calendar year for Dual family and Multi
family cover of $600

For Dual family and Multi family cover, each individual member ofa family has a limit equivalent to a person with Single cover as longas the family maximum benefit has not been reached. Limits do not
apply to admission-related PBS listed drugs.
Surgically implanted prostheses

Surgically implanted prostheses and other items included on theFederal Government’s prostheses list.

100% of the minimum benefit as listed on the Federal Government’s
prostheses list.

Ambulance services

When medically necessary for admission to hospital or for
emergency treatment or for inter-hospital transfer for clinicalreasons.

100% of the charge for transport by an ambulance provided by orunder an arrangement with an approved ambulance service.

Medical repatriation benefit

Cover for you or your dependants’ repatriation to your home country
as a result of a life-altering illness or injury, or in the unfortunate
event of death, the repatriation of your or your dependants’ mortal
remains.

19100% of the costs authorised by us up to a maximum amount of$20,000 per policy.

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TOP WORKING COVER (CONTINUED)EXTRAS PROVIDED UNDER YOUR TOP WORKINGPOLICY

Services

Please note:This is a summary only and does not provide a full list of services
covered. It’s always best to give us a call before having any
treatment to check exactly what you’re covered for.
Benefits + Annual Limits

Benefit
Dental

OpticalPhysiotherapy

Services

Benefit

Annual Limit70%$1,000 Per Person$2,000 Per Family

Major Dental- Periodontics, Endodontics, Crowns &Bridges, Implants & Dentures70%$1,000 Per Person$2,000 Per Family

Orthodontics

70%$800 Per Person$2,400 Lifetime Limit

GlassesContact Lenses

100%$250 Per Person$500 Per Family

Laser Eye Surgery

70%$500 per eye$2,000 per family

General Dental- Preventative, X-rays, Basic
Restorations,Basic Surgery & Extractions

Physiotherapy
Occupational TherapyOrthoptics (eye therapy)

Initial: $51
Standard: $41$500 Per Person$1,000 Per Family

Exercise Physiology
Hydrotherapy

70%

Chiropractic

Chiropractic
Osteopathic Services

Initial: $45
Standard: $35$500 Per Person$1,000 Per Family

Complementary
Therapies

Acupuncture
Natural Therapy
Remedial Massage
Dietetics
Chinese Medicine consultation

Initial: $45
Standard: $35$350 Per Person$700 Per Family

Podiatry

Podiatry (Chiropody)

Initial: $45
Standard: $35$400 Per Person$800 Per Family

Psychology

Psych/Group Therapy

Initial: $90
Standard: $70$400 Per Person$800 Per Family

Speech Therapy

Speech Therapy

70%$400 Per Person$800 Per Family

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TOP WORKING COVER (CONTINUED)EXTRAS PROVIDED UNDER YOUR TOP WORKINGPOLICYServices

Please note:This is a summary only and does not provide a full list of services
covered. It’s always best to give us a call before having any
treatment to check exactly what you’re covered for.
Benefits + Annual Limits

BenefitServices

Benefit

Annual Limit$200 Per Person$400 Per Family

Health Management
Programs

Preventative Health

70%

Health Aids & Wellness

Equipment (1 every 3 years)
Health Services (allergy treatments)
Orthotics (1 every 2 years)

70%

Hearing Aids

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Hearing & Audiology

70% up to $150
70% up to $150
70%$500 Per Person$1,000 Per Family$1,000 every 5 years

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