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.
