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)
• Services delivered remotely (like over the phone) that aren’t on Frank’s list of services eligible for telehealth benefits
• 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
• The person who treated you is a family member, business partner, or the business partner of a family member. If you’re unsure who qualifies as ‘family’ check with us
• You can only claim for 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.

Some dental items have sub-limits within the overall dental limit. These will be outlined in the fact sheet for your cover, so it’s always a good idea to check your benefits before you get any work done.

If you’re worried about what your out-of-pocket expenses might be and have a list of the dental item numbers for your treatment, you can use the benefit quote tool in your online member area or contact us to get an estimate.