Limits

Limits

For some benefits there is a limit on the total amount the RBHS will pay each year. Benefits that can only be claimed once a year renew on 1 January each year.

All multiple year benefits (2 years and over) are calculated on a rolling year basis, from the date of service (instead of calendar year). Multiple year benefits (2 years and over) are divided over that period of time, with lifetime limits being paid over 5 years. For example: with a lifetime limit of $1,350, $270 is payable each year for 5 years. All rolling years incur a benefit limitation period.

The two, three and five-yearly benefits are determined from the date the service is first provided. We recommend that you check with us before your ‘service date’ to ensure that you will be covered. The ‘service date’ is defined as the date of the treatment or receipt of the item.

Members planning any comprehensive and expensive healthcare should get a quote from the provider, including item numbers and associated costs, and ask us for details of the benefit(s) payable.

Please note: Members who incur health care costs that are not specifically covered under the standard RBHS extras benefit policy may be eligible for consideration by the Board for payment of benefits under the “special claims” category. The Board Policy for these claims is available on request.

 

Service Benefit Limit (per person)*
General Dental No annual limit
Major Dental  
- Surgery $6,500 in any 5 years
- Crown and Bridges $6,000 in any 5 years
- Dentures $2,500 in any 5 years
Endodontic $1,700 in any 2 years
Orthodontic $4,450 lifetime limit
Optical  
- Glasses and Contact Lenses $920 in any 2 years
- Laser Eye Surgery $1,350 per eye in a lifetime
- Orthoptic Treatment $790 within 1 year
Non-PBS Pharmaceuticals $1,000 within 1 year
Physiotherapy $1,000 within 1 year
Chiropractic $920 within 1 year
Podiatry $750 within 1 year
Psychologist $920 within 1 year
Acupuncture $850 within 1 year
Naturopathy and Remedial Massage $850 within 1 year
Hearing Aids $5,440 in any 5 years
Ambulance No annual limit

 

* Per-item limits and waiting periods, including those for pre-existing conditions, may apply. As at 1 April 2017.