Prescriptions and medications. What can I claim?
Prescriptions and medications. What can I claim?
We all know that the cost of prescription medications can add up.
That’s why it’s great to know that you may be covered for some of those high-cost prescription medications (medicines, vaccinations and injections) under your Extras cover.
Your RT Health Cover Guide is a good place to start when checking in to see what you’re covered for. Your benefit and benefit limit will be listed under ‘Pharmaceuticals’.
What can I claim?
There are a few things to know about claiming prescriptions and medications (once you’ve served any waiting periods). We’ve listed a few here for you.
So you can claim a benefit for your prescribed medication, it must:
Be prescribed to you by a registered medical practitioner in Australia
Be a S4 or S8 medication (that means it’s a prescription-only medicine)
Be purchased in Australia and approved by the Therapeutic Goods Administration (TGA)
Not already subsidised under the Pharmaceutical Benefits Scheme (PBS). The PBS is a government program that subsidises medicines to make them cheaper.
Cost more than the current PBS co-payment amount of $31.60 per item purchased (the amount set by the government for 1 January to 31 December 2024).
We’ll pay a benefit on your script costs on non-PBS items (after you’ve paid the PBS patient co-payment amount of $31.60). The amount you get back will depend on your level of cover.
What can’t I claim?
It’s also important to know there are medications you can’t claim (and the reasons why). RT Health can’t pay benefits on:
Over-the-counter medications that you can buy without a prescription
Medicines and pharmaceuticals listed on the PBS
Prescriptions and medications that cost less than the PBS amount of $31.60 (the amount set by the government for 1 January to 31 December 2024).
Items not prescribed, dispensed and/or purchased in Australia.
Pharmaceuticals not approved by the TGA for supply or sale in Australia.
Tips for quick claiming
There are a couple of things that will make paying your claim for pharmaceuticals and prescription medications easier.
Send us your Official Pharmacy Receipt with your claim. This is a more detailed receipt provided by your chemist/pharmacist that we need to make sure your claim is payable. Just ask your pharmacist for one when you fill your script. We need this receipt to pay your claim (we’re not able to accept register receipts, packaging or scripts when assessing your claim).
Not sure you can claim? We’re here to guide you. If you need some info on how and what you can claim, just give us a call on 1300 886 123 or send a quick email to help@rthealth.com.au
Use our app. Making claims on the app is quick and easy. Find out more here.
Extras cover. Your path to a fitter, more active you.
Extras cover. Your path to a fitter, more active you.
Having great Extras cover can really pay dividends when it comes to being proactive about your health and wellbeing. It’s like having a savings account that you can call on when it comes to self-care.
Great eyes. Great teeth. Great ears.
Being able to plan for regular check-ups to keep your teeth and eyes in great shape means you’re ahead of the curve when it comes to keeping your health in tip-top shape. Extras cover supports you to stay well be giving you the freedom to book and plan ahead … without having to worry so much about the cost. And once you’ve got a family to take care of, it becomes even more important.
At RT Health we pride ourselves on our Extras cover options. There really is something for everyone. Plus, our members can save even more by using our network of preferred providers for your dental and optical needs.
We have agreements with dental and optical providers. This makes things easier for you knowing there’ll be a reduced out of pocket (in most cases) when you visit our list of providers.
There’s all listed under ‘the ‘Heath Services’ tab on our website. You’ll find them listed under dental providers and optical providers.
And remember, you have access to HCF’s network of Eyecare and Dental Centres, if there’s one near you.
But if you have a provider you’ve come to know and trust, you’ll still be covered. RT Health will still provide benefits for claimable services from any registered dental or optical providers in Australia.
Hearing aids are also an important item for many Aussies. Extras cover provides that helping hand when it comes to claiming the cost of these vital aids. Your Extras cover also helps cover the cost of your audiology consultations.
Get paid for going to the gym
Well, not really. But we do give you a helping hand by paying benefits under ‘Health Improvement ‘towards your gym membership (as long as you're covered by your Extras).
If your gym is a registered fitness provider, you’ve filled in the special ‘Gym benefits authorisation and claim’ form (this is separate from the usual claim form) and have had it signed by your doctor or healthcare provider, you’ll get a benefit to pay towards your gym membership.
And, you can claim one every year by following the same process. How cool!
Specialist therapies when you need them
There’s nothing worse than living with pain. Specialist therapy treatments like chiro and physio can go a long way to providing relief. And if you’ve got Extras cover, you know you won’t need to foot the whole bill at your appointments.
Specialist therapies also includes access to services like occupational therapy, dietetics, osteopathy, podiatry, speech therapy and eye therapy (orthoptics).
So, depending on your level of cover, you’ll get some financial support in getting treatments when you need them.
Need a massage?
Alternative therapies are also included in the benefits paid on most Extras covers. That means you’ll get a benefit when you receive a remedial massage treatment (from a registered provider).
Acupuncture (so many people swear by it), Chinese herbalism and myotherapy may also be covered.
Mental health support
Many people don’t realise that psychology is covered by Extras (depending on the level of cover you choose). There are generous benefits under most RT Health’s Extras covers to provide members with access to great mental health support.
A helping hand with medicines
We all know that sometimes prescribed pharmaceuticals can cost a lot. That’s why it’s great to know that you may be covered for some of those high-cost items that have been prescribed for you.
We’ll pay a benefit on your script costs on non-PBS items (after you’ve paid the PBS patient co-payment amount of $31.60). The amount you get back will depend on your level of cover.
Nonetheless, it’s a great way your Extras cover support you to stay well.
(You’ll also need an Official Pharmacy Receipt when you submit your claim, so don’t forget to remind your pharmacist you need one).
You can read more about claiming prescriptions and medications here.
Health Aids and Services
There’s much, much more that’s covered by your Extras, so it’s worth doing a deep dive into your Cover Guide to see what you’re covered for.
You’ll need a referral letter from your healthcare provider to claim on benefits listed under Health Aids on your Cover Guide.
We’ve listed a few things here that you might not know you’re covered for by your Extras cover (these may depend on your level of cover).
Custom orthotics
Blood glucose monitors, blood pressure monitors
Compression garments (not sporting wear)
BPAP and CPAP machines
Wheelchairs, crutches.
Questions?
Being empowered to use your Extras cover to support your general health and wellbeing is an important aspect of private health cover.
That’s why we’re with you every step of the way. If you have a question, just give us a call. We’d be happy to help.
Potato-topped beef and mushroom pie
Potato-topped beef and mushroom pie
Prep time: 15 minutes
Cooking time: 30 minutes
Serves: 4
Ingredients
Olive or canola oil spray
2 onions, peeled and diced
2 carrots, peeled and finely chopped
2 cloves garlic, crushed
1 kg potatoes, peeled and chopped into 2cm cubes
400g lean beef mince
1 tbs plain flour
Pepper
400g mushrooms, sliced
2 tbs fresh thyme leaves or 1 teaspoon mixed dried herbs
250ml salt-reduced beef or chicken stock
100ml reduced-fat milk
1 cup reduced-fat cheddar cheese, grated
Method
1. Spray a large non-stick saucepan with oil and place on medium to high heat.
2. Cook onion and carrot for 3 minutes, stirring occasionally; add garlic and stir 1 minute.
3. Fill a large saucepan with water, add potatoes and place over high heat. Bring to the boil and simmer for 10 minutes until soft.
4. Add mince to onion mixture and brown for 5 minutes, stirring to break up lumps.
5. Sprinkle over flour, season with pepper and stir well; mix in mushrooms, thyme and add stock.
6. Reduce heat to medium; simmer covered for 15 minutes, or longer if time permits, stirring occasionally until thickened slightly.
7. Drain cooked potatoes and mash with milk until smooth.
8. Divide meat mixture between 4 small 1½ -cup capacity overproof bowls. Spread mash evenly over mince to the edge of each dish. Sprinkle with cheese and place under a preheated grill for 5 minutes or until browned lightly.
Nutritional information per serving
ENERGY – 2783 kJ or 655 calories. PROTEIN – 41g. FAT, TOTAL – 30g. FAT, SATURATED – 9g. CARBOHYDRATE - 41g (SUGARS – 12g). SODIUM 607mg. FIBRE 11g.
Adapted with permission from LiveLighter. LiveLighter® State of Western Australia 2023: www.livelighter.com.au