Things Frank won't pay on

What won’t Frank pay for as part of hospital cover?

• You can't claim on stuff that isn't covered by your membership (pretty obvious, really)
• If you have not served the appropriate waiting period for that service, we won’t pay
• Benefits towards the cost of outpatient services including non-admitted hospital visits and specialist consultations
• Services where Medicare does not pay a benefit
• You can't claim on treatment you can get free from the government, e.g. a traditional bulk billing GP visit or public hospital emergency department episode, as Medicare covers those
• If you can claim damages or compensation from someone else, you can't claim it from Frank
• You can't claim on treatment you had over 1 year ago
• If you're not paying us, we won't pay you. So if you suspend your membership or don't pay your fees, you can't claim on treatment you receive during that time
• If you hire equipment (like crutches or an oxygen tent) we won't pay for it
• If the person who treated you is a family member, you can't claim for that treatment. We also won’t pay if you are treated by your business partner, or the business partner of a family member. If you’re unsure who qualifies as ‘family’, check with us
• You're not covered for any treatment you have overseas
• If you're given drugs in hospital, there are limits on how much we will pay for them
• We won't pay at all for drugs purchased outside of the hospital (like from a chemist)
• The person treating you needs to be working in a private practice, for a registered hospital or for an organisation recognised by Frank. If not, your claim won't be covered
• You can't make a profit from your insurance, so we won't pay more than you were charged for a treatment
• If you're claiming the same treatment from another health insurer, it will affect how much we give you

What won’t Frank pay for as part of extras cover?

• Benefits are only payable on original, itemised accounts. Accounts which have been altered in any way won’t be accepted
• Where you are entitled to any rebate or reimbursement from Medicare for an extras service, you can’t claim any out-of-pocket expenses with Frank
• Services/treatment that you have a right to claim damages or compensation from any other person or body. For example, if you can claim from WorkCover, you can’t claim from Frank too
• Treatment where the member and/or dependant is eligible for free treatment under any Commonwealth or State Government Act
• Services/treatment you had more than 12 months prior to the date you’re claiming
• Services/treatment which is not covered by your membership and/or is rendered while the membership is in arrears or is suspended
• Services/treatment rendered by a practitioner not in a private practice and/or not recognised by bodies approved by Frank
• Hiring of equipment (unless otherwise stated)
• You can only claim on face to face services. This means services delivered remotely (like over the phone) aren’t covered by Frank
• You can’t claim benefits for lifestyle services that primarily take the form of sport, recreation or entertainment
• You can’t make a profit from your insurance, so we won’t pay more than you were charged for a treatment
• Benefits for services on treatment received overseas

Are there any extras cover restrictions?

Benefits may not be paid on or may be paid at a lower level where:

• You’ve reached your limits for the calendar year
• You have transferred to a Frank extras cover from another fund’s extras cover and have previously claimed for the service/treatment
• The health care account has been incompletely, incorrectly or inappropriately itemised
• The service is subject to a waiting period or other limit which has not been served/met
• If the person who treated you is a family member you can't claim for that treatment. We also won’t pay if you are treated by your business partner, or the business partner of a family member. If you’re unsure who qualifies as ‘family’ check with us
• You can only one consultation/treatment per provider per day

What are the dental rules for Frank’s extras cover?

There are also some rules which just apply to dental

• Dental procedures carried out and charged direct to the member/dependant by a dental mechanic, other than an advanced dental technician
• A range of dental procedures when provided on the same day. For example if your bill says you had a tooth filled and removed on the same day, we won’t pay for the filling
• There’s a limit to the number of times you can have certain dental procedures. If you exceed those limits we won’t pay.
• Tooth identification numbers (ID) must be supplied by the provider, or we won’t pay

Frank doesn't cover the following items:

• 018 - Written report (not elsewhere included).. Benefits are payable when billed by a specialist dentist or orthodontist and not included in another item number billed by them.
• 019 – Letter of referral
• 026 – Cone Beam Volumetric Tomography – Scan Acquisition, per visit
• 044 – Collection of specimen for pathology examination
• 047 – Saliva screening test
• 054 – Mucosal Screening
• 059 – Comprehensive head and neck cancer examination and risk assessment
• 061 – Pulp testing
• 085 – Electromyographic recording
• 086 – Electromyographic analysis
• 087 – Cone Beam Volumetric Tomography analysis and/or interpretation – small field of view (less than one complete dental arch)
• 088 – Cone Beam Volumetric Tomography analysis and/or interpretation – maxillary or mandibular dentition (single arch)
• 089 – Cone Beam Volumetric Tomography analysis and/or interpretation – maxillary and mandibular dentition (both arches)
• 090 – Cone Beam Volumetric Tomography analysis and/or interpretation – temporomandibular joints only
• 091 – Cone Beam Volumetric Tomography analysis and/or interpretation – orofacial structures
• 119 – Bleaching, home application - per arch
• 122 – Topical remineralizing and/or cariostatic agents, home application - per arch
• 123 – Concentrated remineralizing and/or cariostatic agents, application - single tooth
• 131 – Dietary advice
• 141 – Oral hygiene instruction
• 142 – Tobacco counselling
• 165 – Desensitizing procedure - per visit
• 237 – Guided tissue regeneration – membrane removal. Benefits are payable when billed by a specialist dentist
• 238 – Periodontal flap surgery for crown lengthening - per tooth. Benefits are payable when billed by a specialist dentist
• 332 – Ostectomy - per jaw. Benefits are payable when billed by a specialist dentist. A maximum of 2 per visit applies.
• 384 – Repositioning of displaced tooth/teeth
• 666 – Prosthesis with metal frame attached to implants - per tooth
• 711 – Complete maxillary denture
• 712 – Complete mandibular denture
• 713 – Provisional complete maxillary denture
• 714 – Provisional complete mandibular denture
• 715 – Provisional complete maxillary and mandibular denture
• 716 – Metal palate or plate
• 719 – Complete maxillary and mandibular dentures
• 721 – Partial maxillary denture - resin base - 1-4 teeth
• 721A – Partial maxillary denture - resin base - 5-8 teeth
• 721B – Partial maxillary denture - resin base - 9 or more teeth
• 722 – Partial mandibular denture - resin base - 1-4 teeth
• 722A – Partial mandibular denture - resin base - 5-8 teeth
• 722B – Partial mandibular denture - resin base - 9 or more teeth
• 723 – Provisional partial maxillary denture
• 724 – Provisional partial mandibular denture
• 727 – Partial maxillary denture - cast metal framework - 1-4 teeth
• 727A – Partial maxillary denture - cast metal framework - 5-8 teeth
• 727B – Partial maxillary denture - cast metal framework - 9 or more teeth
• 728 – Partial mandibular denture - cast metal framework - 1-4 teeth
• 728A – Partial mandibular denture - cast metal framework - 5-8 teeth
• 728B – Partial mandibular denture - cast metal framework - 9 or more teeth
• 731 – Retainer – per tooth
• 732 – Occlusal rest – per rest
• 733 – Tooth/teeth (partial denture)
• 734 – Overlays – per tooth
• 735 – Precision or magnetic denture attachment
• 736# - Immediate tooth replacement - per tooth
• 737 – Resilient Lining
• 738 – Wrought bar
• 739 – Metal backing – per backing
• 741 – Adjustment of a denture
• 743 – Relining - complete denture – processed
• 744 – Relining - partial denture – processed
• 745 – Remodelling - complete denture
• 746 – Remodelling - partial denture
• 751 – Relining - complete denture – direct
• 752 – Relining - partial denture – direct
• 753 – Cleaning and polishing of pre-existing denture
• 754 – Denture base modification
• 761 – Reattaching pre-existing clasp to denture
• 762 – Replacing/adding clasp to denture - per clasp
• 763 – Repairing broken base of a complete denture
• 764 – Repairing broken base of a partial denture
• 765 – Replacing/adding new tooth on denture - per tooth
• 766 – Reattaching existing tooth on denture - per tooth
• 768 – Adding tooth to partial denture to replace an extracted or decoronated tooth - per tooth
• 769 – Repair or addition to metal casting
• 778 – Inlay for denture tooth
• 915 – After-hours callout
• 916 – Travel to provide services
• 926 – Individually made tray - medicament(s)
• 927 – Provision of medication/medicament
• 941 – Local anaesthesia
• 944 – Relaxation therapy
• 945 – Low level laser therapy
• 948 – Dental acupuncture
• 949 – Treatment under general anaesthesia/sedation
• 985 - Repair/addition – snoring or sleep apnoea device
• 990 – Treatment not otherwise included (specify)
• 999 – GST