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Hospital cover explained
Download hospital factsheetUnderstanding what's covered
Inclusions
Hospital treatment of the tonsils, adenoids and insertion or removal of grommets.
Hospital treatment for surgery for joint reconstructions.
Hospital treatment for the investigation and treatment of a hernia or appendicitis.
Hospital treatment for the investigation and treatment of the female reproductive system.
Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy.
Hospital treatment for surgery to the teeth and gums.
Restricted
Hospital treatment for physical rehabilitation for a patient related to surgery or illness.
Hospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders.
Hospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain.
Exclusions
Hospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system.
Hospital treatment for the investigation and treatment of the eyes and content of the eye sockets.
Hospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck.
Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system.
Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder.
Hospital treatment for the investigation and treatment of the male reproductive system including the prostate.
Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel.
Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope.
Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours.
Hospital treatment for pain management that does not require the insertion or surgical management of a device.
Hospital treatment for the investigation and treatment of skin, skin-related conditions and nails.
Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy.
Hospital treatment for the investigation and management of diabetes.
Hospital treatment for the investigation and treatment of the heart, heart-related conditions and vascular system.
Hospital treatment for the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest.
Hospital treatment for the investigation and treatment of blood and blood-related conditions.
Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion.
Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity.
Hospital treatment for the investigation and treatment of conditions affecting the foot and/or ankle, provided by a registered podiatric surgeon. Benefits are limited to only cover hospital accommodation and the cost of a prosthesis per the prosthesis list, as laid out in the Private Health Insurance (Prosthesis) Rules. Medical services such as the anaesthetist or the surgeon’s account in respect to podiatric surgery are not covered under hospital products.
Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device.
Hospital treatment for surgery to remove a cataract and replace with an artificial lens.
Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses.
Hospital treatment for dialysis treatment for chronic kidney failure.
Hospital treatment for investigation and treatment of conditions associated with pregnancy and child birth.
Hospital treatment for fertility treatments or procedures.
Hospital treatment for surgery that is designed to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure.
Hospital treatment for the provision and replacement of insulin pumps for treatment of diabetes.
Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain.
Hospital treatment for the investigation of sleep patterns and anomalies.
Hospital FAQs
- New members to health insurance
- Members who transfer from another health fund who haven’t fully served the required waiting periods
- New members that have had a gap in their hospital cover for more than 30 days
- Current members that upgrade their cover for newly included services
- Excluded on your level of cover
- Received whilst you are within waiting periods
- Treatment with unregistered providers
- Claims for people not listed on the policy
- Treatment outside of Australia
- Any outpatient emergency department service fees (e.g. observation, x-rays, drugs and lab tests
- Treatment that occurred outside of your policy being active
- Any outpatient medical cost
Extras cover explained
Download extras factsheet
Understanding what's covered
Inclusions
Includes dental treatments like check-ups, cleaning and fluoride treatments, x-rays, fillings and basic extractions.
* General and preventative dental annual limit is shared with acupuncture, chinese medicine, chiropractic, dietetics, exercise physiology, osteopathy, physiotherapy and remedial massage
Sub-limits and treatment limits apply. View Frank's dental treatment rules here
Annual limit:
$700 per person
Includes prescription glasses, prescription sunglasses and prescription contact lenses.
Doesn't include non-prescription sunglasses, repairs or frames purchased without prescription lenses or ophthalmology appointments.
Benefit:
100% back up to annual limit
Annual limit:
$150 per person
Chiropractic care uses manual treatments (including spinal manipulations – termed ‘adjustments’) to treat disorders of the musculoskeletal system. Benefits will only be paid for one consultation and/or treatment per provider per day. A sub-limit of 1 per year applies to chiropractic X-rays on products which cover chiropractic X-rays.
* Chiropractic annual limit is shared with acupuncture, chinese medicine, general and preventative dental, dietetics, exercise physiology, osteopathy, physiotherapy and remedial massage. Excludes chiropractic x-rays.
Benefit:
$28 per visit
Annual limit:
$700* per person
Osteopathy is a holistic system of medicine that emphasises the inter-relationship of the body's nerves, muscles, bones and organs, and uses a ‘whole body’ approach to treatment.
Benefits will only be paid for one consultation and/or treatment per provider per day.
* Osteopathy annual limit is shared with acupuncture, chinese medicine, chiropractic, general and preventative dental, dietetics, exercise physiology, physiotherapy and remedial massage
Benefit:
$32 per visit
Annual limit:
$700* per person
Physiotherapy is concerned with the assessment, diagnosis, and treatment of disease and disability through physical means.
Benefits will only be paid for one consultation and/or treatment per provider per day.
* Physiotherapy annual limit is shared with acupuncture, chinese medicine, chiropractic, general and preventative dental, dietetics, exercise physiology, osteopathy and remedial massage
Benefit:
$32 per visit
Benefit for group physiotherapy:
$14 per visit
Annual limit:
$700* per person
Exercise physiology can assist with the prevention and management of chronic diseases and injuries through exercise.
Benefits will only be paid for one consultation and/or treatment per provider per day.
* Exercise physiology annual limit is shared with acupuncture, chinese medicine, chiropractic, general and preventative dental, dietetics, osteopathy, physiotherapy and remedial massage
Benefit:
$22 per visit
Annual limit:
$700* per person
Acupuncture is a broad term covering techniques for inserting and manipulating thin needles into specific points on the body in order to restore health and wellbeing.
Benefits will only be paid for one consultation and/or treatment per provider per day. You cannot claim on any herbs, supplements or pills prescribed by the provider, only consultations.
* Acupuncture annual limit is shared with chinese medicine, chiropractic, general and preventative dental, dietetics, exercise physiology, osteopathy, physiotherapy and remedial massage
Benefit:
$25 per visit
Annual limit:
$700* per person
Remedial massage is a combination of massage techniques used to treat injuries of the muscles, tendons, ligaments or connective.
Benefits will only be paid for one consultation and/or treatment per provider per day.
* Remedial massage annual limit is shared with acupuncture, chinese medicine, chiropractic, general and preventative dental, dietetics, exercise physiology, osteopathy and physiotherapy
Benefit:
$22 per visit
Annual limit:
$700* per person
Dietetics looks at the science of nutritional planning and preparation of foods.
Benefits will only be paid for one consultation and/or treatment per provider per day.
* Dietetics limit is shared with acupuncture, chinese medicine, chiropractic, general and preventative dental, exercise physiology, osteopathy, physiotherapy and remedial massage
Benefit:
$25 per visit
Annual limit:
$700* per person
Chinese herbal medicine takes a holistic approach to disease and prophylactic care and focuses as much on the prevention of illness as the treatment of it.
Benefits payable towards consultations only and not on any herbs or medication purchases.
* Chinese medicine annual limit is shared with acupuncture, chiropractic, general and preventative dental, dietetics, exercise physiology, osteopathy, physiotherapy and remedial massage
Benefit:
$25 per visit
Annual limit:
$700* per person
Extras FAQs
A waiting period is the time between joining Frank and when you're covered for a treatment or service, if included in your cover.
Extras waiting periods apply to:
New members to health insurance, existing members who have upgraded their cover or anyone who has transfered to Frank from a previous fund and:
- Still have waiting periods to finish serving
- Joined on a higher level of cover and haven't served waits on any new services or increased benefit limits
- Had a gap in their extras cover for more than 30 days
Waiting periods for extras services are as follows:
Waiting Period: 2 months
Any services that are not specified below.
Waiting Period: 6 months
Optical
Waiting Period: 12 Months -
Major dental services including full & partial dentures, orthodontics, crown & bridgework, endodontic services such as root canal, gold fillings, indirect restorations, surgical extractions of a tooth/teeth (including wisdom teeth).
Waiting Period: 12 Months - Health appliances
Don’t go with someone you don’t know. It’s your health so we let you choose your own provider. For members to claim with Frank, providers must hold active accreditation, be operating in a private practice and considered an Australian Provider.
We've partnered with smile.com.au to make dental care more affordable and accessible for our members across Australia. This means lower out of pocket costs for all dental treatment, as smile.com.au dentists will reduce their fees by at least 15%.
With more than 2,500 approved dentists in the smile.com.au network, chances are there is one near you.
- Person limit – The total amount you can claim on a service within a year.
- Membership limit – The maximum amount a membership can claim in a calendar year.
- Sub-limit – The total amount you can claim on a particular service or treatment within the overall annual limit.
- Lifetime limit – The maximum amount a person can claim a service during the entire lifetime of a membership.
- Multi-year limit – The maximum amount you can claim, every few years.
We work on a calendar year so your limits run from January–December and reset on 1 January each year.
With set benefits gives you the same amount back per visit, regardless of how much your provider charges you.
With percentage back we pay the % back that is included on your cover up to your annual limits.
Disclaimer
Rates are effective 1 April 2025. | All contribution quotes by this calculator are subject to variation and should therefore be considered indicative contribution rates. | All prices include the Australian Government Rebate on Private Health Insurance as per selected income level and do not include any applicable Lifetime Health Cover loading. | All payments are only available via direct debit from a bank/ credit union account.| Frank does not issue payment notices or invoices.
