Optical, Eye Therapy and Eye Surgery Benefits Guide

A blue eye

Understanding Optical Benefits*

Emergency Services Health’s Optical benefits (included in Gold Combined and Rolling Extras cover) pays benefits towards the purchase of prescription contact lenses, prescription optical lenses and frames from your choice of optical store. 

While Emergency Services Health pay benefits towards the prescription lenses and frames, it’s important to note the eye test itself is generally covered by Medicare (Entitlements are subject to the rules and conditions set out by Medicare). Find out more about our Optical benefits.

Understanding Eye Therapy Benefits*

Emergency Services Health’s Eye Therapy benefits (included in Gold Combined and Rolling Extras cover) pays benefits towards the treatment of vision problems due to defects in the eye muscles (such as a squint or a lazy eye) or defects in visual habits.

It's used to treat eye strain, vision-induced headaches, cross-eyes or double vision. 

Therapy involves eye exercises and treatment to correct the alignment of the eyes.

Benefits are paid towards consultations with a recognised orthoptist (eye therapist).

Understanding Eye Surgery*

When you’re admitted to hospital as an inpatient, Emergency Services Health’s Gold Hospital & Gold Combined Cover provides benefits towards the surgery to the eye, such as to remove a cataract and replace with an artificial lens.

It also provides benefits towards the investigation and treatment of the eye and the contacts of the eye socket (e.g. retinal detachment, tear duct conditions, eye infections, and medically managed trauma to the eye). 

Emergency Services Health also provides benefits for corrective laser eye surgery services for certain conditions for members with Gold Combined (not available when taking out either Gold Hospital or Rolling Extras only).

* Subject to waiting periods, annual maximums, Rollover Maximums and other conditions. Providers must be recognised by Emergency Services Health, and all online lenses and frame purchases must be within Australia from a recognised provider.

For information about specific benefit entitlements and how to claim – see our product and benefit guide.

Below is a quick guide on where Medicare may pay benefits and when you claim under a health insurance policy with Emergency Services Health.  

 

Medical -Ophthalmologist & Ophthalmic surgeon

  Medicare1 Emergency Services Health2
Service performed not as an inpatient of a hospital Yes, Medicare contributes towards the medical fees No benefits available
Services performed as an Inpatient of a hospital Yes, Medicare contributes towards the medical fees Eye Surgery medical fees (gap) and hospital fees claimable under Gold Hospital & Gold Combined 
Note: Laser Eye Surgery benefits (for certain conditions and not related to a Medicare service) claimable under Gold Combined.
 

 

 

Optical Benefits

  Medicare1 Emergency Services Health2
Eye consultations by an optometrist Yes, Medicare contributes towards the fees No benefits available
Eye scans Medicare does not make a contribution Ultra-Wide Retina Scan (provided by OPSM & Laubman & Pank only) under Gold Combined and Rolling Extras.3 
Purchase of frames and prescription lenses Medicare does not make a contribution   Claimable under Optical benefits through Rolling Extras & Gold Combined 


 

Eye Therapy Benefits

  Medicare1 Emergency Services Health2
Eye therapy consultations by an orthoptist Medicare does not make a contribution towards the fees  Claimable under Eye Therapy benefits through Rolling Extras & Gold Combined 

 

Entitlements are subject to the rules and conditions set out by Medicare.
2 Benefits entitlements are subject to waiting periods, Annual Maximums, Rollover Maximums and other conditions, as applicable.  Providers must be recognised by Emergency Services Health.  
3Must let OPSM/Laubman and Pank Optometrist know you’re a Emergency Services Health member when booking your digital wide eye scan to receive benefits.  

 

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