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Product Summary

Singles Cover

Extras Service Waiting Period Yearly Singles Limit
Dental
- General

2 months
$500
- Major 12 months
Optical 6 months $120
Other Therapies
Chiropractic, Osteopathy, Physiotherapy, Hydrotherapy, Myotherapy, Naturopathy, Homeopathy, Acupuncture, Remedial Massage (combined)
2 months $400

Couples Cover

Extras Service Waiting Period Yearly Couples Limit
Dental
- General

2 months
$500 per person
- Major 12 months
Optical 6 months $120 per person
Other Therapies
Chiropractic, Osteopathy, Physiotherapy, Hydrotherapy, Myotherapy, Naturopathy, Homeopathy, Acupuncture, Remedial Massage (combined)
2 months $400 per person

Family Cover

Extras Service Waiting Period Yearly Family Limit
Dental
- General

2 months
$500 per person
(max. $1000 per family)
- Major 12 months
Optical 6 months $120 per person 
(max. $240 per family)
Other Therapies
Chiropractic, Osteopathy, Physiotherapy, Hydrotherapy, Myotherapy, Naturopathy, Homeopathy, Acupuncture, Remedial Massage (combined)
2 months $400 per person
(max. $800 per family)

Waiting Periods

If you’ve never had health insurance before, you’ll need to see out the relevant waiting period for your treatment. Once the waiting period has expired you can start claiming for treatments.

As an example, if your waiting period finishes on July 13, you can claim for any treatments you receive on and after July 14.

If you’re already with Budget Direct Health Insurance or another health insurer, you may not have to wait as long. It depends on what treatments you were covered for and how long you’ve already waited.

To find out more, check out the Product Detail.

Product Detail

Here’s everything you need to know about Budget Direct Health Insurance’s Basic Extras cover—what’s covered, what the limits are and how long you’ll have to wait.

Click on a topic below or scroll down for more information.

What’s covered, and the limits 
Waiting periods 
Exclusions

What’s Covered And The Limits

Singles Cover

Extras Service Waiting Period Singles Yearly Limit
General Dental 2 months  
Preventative Dental2 (e.g. checkups, scale and clean)   $250
Major Dental
Note: Major Dental does not include cover for dentures
12 months  
Orthodontic (e.g. braces)
Note: There’s a limit of $900 per course and a lifetime limit of $1,050.
  $300
Crown and bridgework3   $450
Indirect restorations4
These occur outside of the mouth (e.g. a filling modelled on a plaster cast).
  $350
Implants5 (e.g. a fake tooth permanently inserted into your gum)   $400
Optical6
Includes prescription glasses, contact lenses and frames. Does notinclude non-prescription sunglasses or repairs.
6 months $120
Other Therapies 
Chiropractic, Osteopathy, Naturopathy, Homeopathy, Acupuncture, Physiotherapy, Myotherapy, Hydrotherapy, Remedial Massage (combined)

Note: We will only pay a benefit for one consultation and/or treatment per provider per day*.
2 months $400

Too much information? Check out the Product Summary.

Couples Cover

Extras Service Waiting Period COUPLES YEARLY LIMIT
General Dental 2 months  
Preventative Dental2 (e.g. checkups, scale and clean)   $250 per person
Major Dental 12 months  
Orthodontic (e.g. braces)
Note: There’s a limit of $900 per course and a lifetime limit of $1,050.
  $300 per person
Crown and bridgework3   $450 per person
Indirect restorations4
These occur outside of the mouth (e.g. a filling modelled on a plaster cast).
   

$350 per person

Implants5 (e.g. a fake tooth permanently inserted into your gum)   $400 per person
Optical6
Includes prescription glasses, contact lenses and frames. Does notinclude non-prescription sunglasses or repairs.
6 months $120 per person
Other Therapies 
Chiropractic, Osteopathy, Naturopathy, Homeopathy, Acupuncture, Physiotherapy, Myotherapy, Hydrotherapy, Remedial Massage (combined)

Note: We will only pay a benefit for one consultation and/or treatment per provider per day*.
2 months $400 per person 

Too much information? Check out the Product Summary.

Family Cover

Extras Service Waiting Period FAMILY YEARLY LIMIT
General Dental 2 months  
Preventative Dental2 (e.g. checkups, scale and clean)   $250 per person (max. $500 per family)
Major Dental 12 months  
Orthodontic (e.g. braces)
Note: There’s a limit of $900 per course and a lifetime limit of $1,050.
  $300 per person
Crown and bridgework3   $450 per person
Indirect restorations4
These occur outside of the mouth (e.g. a filling modelled on a plaster cast).
  $350 per person 
(max. $700 per family)
Implants5 (e.g. a fake tooth permanently inserted into your gum)   $400 per person
Optical6
Includes prescription glasses, contact lenses and frames. Does notinclude non-prescription sunglasses or repairs.
6 months $120 per person 
(max. $240 per family)
Other Therapies 
Chiropractic, Osteopathy, Naturopathy, Homeopathy, Acupuncture, Physiotherapy, Myotherapy, Hydrotherapy, Remedial Massage (combined) 

Note: We will only pay a benefit for one consultation and/or treatment per provider per day*.
2 months $400 per person
(max. $800 per family)

Too much information? Check out the Product Summary.

Extras Waiting Periods

The standard waiting periods for Budget Direct Health Insurance Extras are:

  • 12 months - major dental (including root canals)
  • 6 months - optical
  • 2 months - all other services

Transferring From Another Health Insurer Or Budget Direct Health Insurance Cover?

If the treatment wasn’t covered by your old cover you’ll need to wait the standard waiting periods listed above.

If the treatment was covered by your old cover, and you’ve already completed the waiting periods for that treatment, you’ll be covered from day one of your new cover.

Otherwise, you’ll have to wait for whatever waiting period remains for that benefit. As an example, if you have done 9 months of a 12-month waiting period with your old cover, you’ll only have to wait 3 months with your new cover.

Note: If your new Budget Direct Health Insurance cover has higher benefits than your previous cover, you’ll need to complete the standard waiting periods to receive those higher benefits. But you’ll still be covered for your previous (lower) benefits during that time.

Adding Another Person To Your Membership?

Anyone you add to your Budget Direct Health Insurance membership will be fully covered from day one, provided they:

  • are your newborn baby
  • are your adopted or permanent foster child
  • have already served the waiting periods with Budget Direct Health Insurance or another fund (at an equal or higher benefit level).

If the person doesn’t meet any of these conditions, they’ll have to wait the standard waiting periods described earlier.

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Extras Exclusions

Budget Direct Health Insurance will not cover:

  • Natural remedies (including Modifast and Optifast)
  • Food supplements
  • Dental work not performed by advanced dental technicians (check with your provider to make sure they are)
  • Some dental procedures given on the same day (e.g. if you have a tooth filled and then removed, Budget Direct Health Insurance won’t pay for the filling). To find out what is and isn’t covered, give us a call.
  • Some dental procedures performed more often than the limit specified
  • Dental work where your dentist doesn’t supply tooth IDs
  • More than one consultation and/or treatment per provider per day
  • Dental treatments not done in person (e.g. advice given over the phone)
  • Foot orthotics from a physiotherapist or chiropractor
  • Lifestyle choices that take the form of sport, recreation or entertainment—running shoes, gym memberships and anything else not directly health-related
  • Any more than you were charged for a treatment. (Claiming the same treatment from someone else will also affect how much Budget Direct Health Insurance gives you)
  • Any treatment received while overseas
  • Extras services bought over the Internet (unless Budget Direct Health Insurance tells you otherwise)
  • Damages or compensation you can claim from someone else
  • Treatments you can get free from the government
  • Treatments you had more than a year ago
  • Anything not covered by your membership
  • Any equipment hire (e.g. crutches or an oxygen tent) unless Budget Direct Health Insurance tells you otherwise
  • Treatments performed by someone who doesn’t work in a private practice or for an organisation recognised by Budget Direct Health Insurance.
  • Where you are entitled to any rebate or reimbursement from Medicare for any extras services, you cannot claim any out of pocket expenses with us.

Budget Direct Health Insurance will also not cover you if:

  • Your membership is suspended, or you haven’t paid your fees
  • The person who treated you is:
    • a relative
    • your business partner
    • related to your business partner.

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* You can, however, claim for more than one service on the same day if performed by different providers.

1Dental Notes

There are many different dental treatments and rules around what is and isn’t covered. It is recommended that you get in touch with Budget Direct Health Insurance before getting treatment so you’ll know if you’re covered. This is important in respect of dental procedures where a limit on the number you can have has been exceeded.

Sub-Limits

The tables show the yearly limits for each type of dental service (e.g. the annual limit for crown and bridgework is $450). However, each service has further sub-limits. For example, the individual limit for one crown is $225.

If you’re getting treatment, get in touch with us first to see if any sub-limits apply to you.

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2Preventative Dental Sublimit

Preventative dental includes general dental treatment like checkups, cleaning and fluoride treatments but does not include x-rays or fillings.

This sublimit applies to dental item numbers: 011, 012, 013, 014, 015, 016, 017, 018, 111, 113, 114, 115 and 121.

Other preventative dental rules:

  • Maximum of one examination or consultation item per visit. Examination and consultation items include 011-017
  • Maximum of 3 checkups per person per calendar year. Checkups include items 011, 012 and 014.
  • Maximum of 3 scale and cleans per person per calendar year applies. Scale and cleans includes items 111, 114 and 115.

The preventative dental limit is included within the overall dental limit.

3Crown & Bridge Sublimit

Crowns cover the tooth completely, fitting just at the gum line to protect the remaining tooth. Crowns become necessary when teeth that are severely broken down from decay or fracture and can’t support a filling.

Crowns include items 611-629

Bridgework is used to replace missing teeth by bridging the gap with a false tooth using the surrounding teeth as a support.

4Indirect Restorations

Indirect restorations are a type of filling that is made outside of the mouth by using a plaster cast model of your tooth.

Indirect restorations include items 541-555

5Dental Implant Sublimit

A dental implant is a fake tooth that is permanently inserted into your gum.

Dental implants include items 661-663 and 678-691

6Optical notes

Includes prescription glasses, contact lenses and frames. Doesn't include non-prescription sunglasses or repairs. Doesn't include opthamology appointments

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This information is important and should be read and retained.

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