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

  • If you can claim damages or compensation from someone else, you can't claim it from Frank
  • 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
  • You can't claim on treatment you had over 1 year ago
  • You can't claim on stuff that isn't covered by your membership (pretty obvious, really)
  • 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
  • If you have not served the appropriate waiting period or benefit limitation period for that service, we won’t pay

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
  • 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

We don’t cover the following items. Don’t let the length of the list freak out, it’s not likely that you will be billed for these items anyway

  • 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
  • 664 – Fitting of bar for denture - per abutment
  • 666 – Prosthesis with metal frame attached to implants - per tooth
  • 668 – Fixture or abutment screw removal and replacement
  • 669 – Removal and reattachment of prosthesis fixed to implant(s) - per implant
  • 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