Brochure health benefits guide

Healthy You Healthy You T HE HEALTH BE N E FI TS GU I D E FO R EV E RYO NE DECEMBER 2016

Welcome

TO QUEENSLAND COUNTRY

OUR PURPOSE

OUR HISTORY

Queensland Country Health Fund exists to meet the health

Queensland Country has been in the business of providing

insurance needs of Queenslanders by:

private health insurance cover to Queenslanders for nearly

- Improving the health and wellbeing of their Members - Providing market leading benefits - Maintaining competitive premiums - Offering superior, personalised and genuine service

40 years. Established in 1977 as the MIM Employees Health Society, the Fund was developed to assist Members to protect themselves against the financial burden of rising hospital and ancillary (also known as extras) health care costs. In January 1999 we began trading as Queensland Country Health Fund continuing the traditions of affordable and comprehensive health cover backed by superior, personalised and genuine service.

Whether you’re new to health insurance or just thinking about making the switch, give us a call to find out how you can experience the difference with Queensland Country Health Fund.

We support health in your community!

WE’RE PROUD SPONSORS OF THE BOWEN TRIATHLON 2016.

[2]

CONTENTS Why private health insurance?

4

Have existing health insurance?

6

Why us?

8

Which cover is right for you?

10

Hospital cover

12

Choose your excess!

14

Extras cover

18

Cover packages

24

Manage your cover online

29

Online claiming

31

On-the-spot claiming

32

How to pay contributions

33

In more detail

34

Government initiatives

40

Private Health Insurance Complaints

42

“Queensland Country Health Fund mirrors my passion to give back to regional Queensland. Their community focus and commitment to Member-centric benefits and affordability is why I am delighted to be their brand ambassador.�

Laura Geitz,

Former Australian Netball Captain and Queensland Country Health Fund Member

[3]

WHY IS PRIVATE HEALTH INSURANCE

for me?

Whether you’re looking for yourself or your family, Queensland Country has you covered.

Doctor

With private hospital cover you can choose your own doctor and decide whether you will go to a public or private hospital that your doctor attends.

have long

Public System To n

si

R ep

of ov al

ry rg e Su t ra c

y rg er

265 Days

Su

332 Days

000

[4]

H

100

ea r

t

200

Queensland hospital waiting times at 90th percentile as reported by the Australian Institute of Health and Welfare, Australian Hospital Statistics 2015-2016

C at a

300

To t

DAYS WAITING

400

R em

K

ne

e

340 Days

al

500

ls

la

ce m

en

t

With private health insurance you avoid public hospital waiting times!

61 Days

Queensland Country Health Fund

MORE

C H O IC E

er alth Cov

He Lifetime

when choosing

Hospital

Take out hospital cover before 1st July and after your 31st birthday to avoid paying a Lifetime Health Cover loading.

Having private hospital cover generally gives you the choice of being treated in either a public or private hospital with more choice over the hospital you stay in!

as to when

Having private health insurance definitely has its rewards. It gives you the peace of mind and the security of health care options and benefits not available today through the public health care system.

11,522

*

36,322

*

Private HAVE TO PAY

24,700

*

Some of the most common hospital procedures if provided in a public hospital can have lengthy waiting lists. Alternatively, if the medical treatment is provided in a private hospital the cost could easily be thousands of dollars if you don’t have private hospital cover. * Source Queensland Country Health Fund claim records 2015/2016.

[5]

HAVE EXISTING HEALTH INSURANCE?

It’s too easy to transfer!

At Queensland Country we believe private health insurance should be easy to understand, easy to claim on, but most of all it should be easy to join or switch to us in the first place!

[6]

Will I need to serve any waiting periods when I switch to Queensland Country?

What we need!

If you switch from another Australian registered health

To complete the transfer to Queensland Country, you

fund, you are guaranteed ‘portability’ of cover by law. What

will be provided with a Transfer Certificate from your

this means is that you can transfer from one health fund to

previous health fund.

another without having to re-serve waiting periods you’ve already served with your current fund.

We’ll recognise any waiting periods (or portions of waiting periods) you’ve already served if you join us within 63 days of leaving your previous health fund.

This important document confirms your health cover history, your Lifetime Health Cover (LHC) status and ensures you receive continuity of cover.

Your Transfer Certificate is required before any benefits can be paid.

The only time waiting periods apply when you transfer to us from another fund is when your Queensland Country cover offers a higher level of benefits than your previous cover. In this case, you’ll be entitled to the same level of benefits as you had under your previous cover until you’ve served the waiting period for the higher level of benefits.

If you transfer from a cover with a higher excess to one with a lower excess (for example, from a $500 excess to a $250 excess), that counts as an upgrade in your cover. In this case you may have to pay your previous higher excess until you’ve served the waiting period for the new and higher level of cover.

We make switching easy - online, in person or on the phone!

[7]

Why Us?

97%

OF OUR MEMBERS ARE SATISFIED WITH THEIR MEMBERSHIP! Source: Member Satisfaction Survey 2016 in which 66% were very satisfied and 31% were somewhat satisfied with their health fund membership.

Member focused At Queensland Country our primary focus is on continually exploring ways to satisfy the needs of our policyholders.

medical practitioners throughout Australia. This ensures peace of mind and ensures that our policyholders receive maximum cover for in-hospital services within Australia, wherever they may go!

unique and refreshing.

Adult children are also covered

We are driven to design and deliver exceptional value private

Adult children can remain on a family cover up to the age of

health insurance products, whilst maintaining a simpler and

21 years at no extra cost and can continue to stay on their

more satisfying experience for our Members!

family’s policy up to the age of 25 years. Providing they are

We invest heavily in making our policyholders experience

Happy Members

studying full-time or are an apprentice earning up to $30,000 p.a. and are not married or in a de-facto relationship. If they are not studying full-time or an apprentice we are able to offer

To ensure we maintain our high service standards and

our Extended Family cover option, which is a cost effective

continually meet our policyholder’s needs, every year

alternative for those families with adult dependants ensuring

Queensland Country conduct a survey to keep in touch with

peace of mind for everyone.

what our Members really think!

For more information please see page 37.

The good news is that from our last Member survey in 2016

Home away from home

we were pleased to hear that 97% voiced that they were satisfied with us (66% were very satisfied and 31% were somewhat satisfied with their health fund membership).. We will always strive to improve our already highly regarded reputation for exceptional Member service, to keep our Members smiling!

National coverage Being the only health fund based in regional Queensland

As the majority of our policyholders live in regional and remote areas of Queensland, it is often necessary for people to travel to Townsville or Brisbane for essential medical treatment. This can mean high accommodation expenses for family accompanying the patient. Queensland Country offers two-bedroom furnished apartments in Brisbane (close to the Wesley Hospital) and in Townsville (near the Mater Hospital) to give our Members a home away from home.

enables us to understand the health care needs of people

These apartments are available for our policyholders at

in this state better than anyone. However, if you move, work

concessional rates on completion of two months membership

or play interstate you too can rest easy, because we provide

with us. They are exclusively for use only associated with a

nation-wide coverage. Queensland Country in conjunction

medical need.

with the Australian Health Service Alliance (AHSA) have

We are the only health fund in Australia to provide

entered into an agreement with most private hospitals and

this benefit!

[8]

Care Navigation Care Navigation is a service provided by Registered Nurses for our Members with Top Hospital cover. The service is aimed at supporting Members who require assistance immediately following a period of time in hospital or for those living with one or more chronic diseases.

Our Care Navigation team identify Members that could benefit from extra support and complete a screening process through a series of questions about their recent hospital treatment, medications and level of support at home. Based on this interview, the Nurse may initiate a short term program or offer ongoing education and support over the phone.

Care Navigation is just another way we contribute to improving the health and wellbeing of our Members.

Your own dental practice!

For more information visit

Queensland Country Dental is Queensland Country Health

www.qldcountryhealth.com.au/carenavigation

Sponsorships and community support Queensland Country is committed to supporting health in local communities. We are proud to sponsor and support

Fund’s dental practice located in the Queensland Country Centre in Aitkenvale, Townsville.

The practice offers a full range of general dental services and has a preventive focus with the aim of improving the oral health of our Members.

Townsville’s Women’s National Basketball League (WNBL) -

All health fund Members can access high quality dental care.

the Townsville Fire, as well as Cairn’s Intrust Super Cup Rugby

Members with Premium Extras will have low or no out of

League team - the Northern Pride.

pocket expenses on a range of diagnostic and preventive

Backing our commitment to healthier communities we also

treatments including check ups and scale and cleans.

sponsor the Townsville Running Festival, and the Mackay,

For further information on the dental practice go to

Bowen and Charters Towers Triathlons.

www.qldcountryhealth.com.au/dental

Queensland Country also supports local community groups through sponsorship of events and donations.

[9]

Hospital cover If you are concerned about public hospital waiting times and want to ensure that quality and timely care is available for yourself or your family by a doctor of your choice, then one of our private hospital covers may suit you!

Extras cover If you need assistance with the cost of visits to the dentist, optometrist, physio and other health services that Medicare does not normally provide a benefit for, then adding an extras cover is for you!

Please refer to page 16 for information on what health services are covered under our extras cover.

Top Hospital 250

Top Hospital 500

Premium Extras

Essential Extras

Intermediate Hospital 250 Select Extras Intermediate Hospital 500 Young Extras* Public Hospital *Young Extras is the only extras cover option that can be taken as a stand alone extras product. All other extras products need to be packaged with any of our hospital cover options.

[ 10 ]

Choose your level of hospital cover based on your needs and budget.

Private Hospital Cover

Description

Excess Options

Top Hospital 250

Provides an extensive hospital cover where you pay the first $250 towards any inpatient hospitalisation in return for a lower premium.

$250 excess per person per Membership Year up to a maximum of $500 for a family policy.

Top Hospital 500

Provides an extensive hospital cover where you pay the first $500 towards any inpatient hospitalisation in return for the lowest premium in our Top Hospital cover range.

$500 excess per person per Membership Year up to a maximum of $1,000 for a family policy.

Intermediate Hospital 250

Provides a great value mid level hospital cover ideal for a young or healthy person who doesn’t want to pay for hospital services they feel less inclined to need.

$250 excess per person per Membership Year up to a maximum of $500 for a family policy.

Intermediate Hospital 500

Provides a great value mid level hospital cover ideal for a young or healthy person who doesn’t want to pay for hospital services they feel less inclined to need.

$500 excess per person per Membership Year up to a maximum of $1,000 for a family policy.

Description

Excess Options

Public Hospital cover is exactly as the name suggests - cover in a public hospital. Limited benefits are paid towards inpatient treatment in a private hospital.

No excess payable.

Public Hospital Cover

Public Hospital

Choose your level of extras cover based on your expected frequency of use and budget.

Extras Cover

Description

Premium Extras

Provides superior visit benefits for an extensive range of dental, optical and therapy services with generous annual limits.

Essential Extras

Provides benefits for the same comprehensive range of services as our Premium Extras just with slightly lower benefits and annual limits, keeping the policy cost down.

Select Extras

Provides benefits for a select range of popular services ideally suited to young singles or couples and families with younger children.

Young Extras

Provides generous benefits for all the services that younger people generally use. It is tailor made to keep premiums low but the benefits high.

[ 11 ]

HOSPITAL COVER

WHAT YOU ARE COVERED FOR

This provides a summary of cover and isn’t intended to be a comprehensive list of all the services covered

TOP HOSPITAL COVER $250 EXCESS

$500 EXCESS

INTERMEDIATE HOSPITAL COVER $250 EXCESS

$500 EXCESS

Choice of Doctor/Hospital Public Hospital Accommodation as a Private Patient (Shared room, please refer

to page 35.)

Private Hospital Accommodation* Theatre Fees* Surgically Implanted Prosthesis Benefits Prosthesis

benefits (artificial hips, knees, etc) as per the Government listing.

Intensive Care* Medical Gap Cover for the 25% gap between the 75% Medicare Benefit and the Medicare Benefits Schedule fee for inpatient services.

Tonsils and Adenoids Removal^ Appendix Removal^ Colonoscopies^ Grommets in Ears^ Gynaecological Services^ Hernia Repair^ Joint Reconstructions^ Back Surgery^ Brain Surgery^ Plastic and Reconstructive Surgery^ In-Hospital Rehabilitation Treatment* Rehabilitation for

hospital services with restricted or excluded benefit entitlement will have reduced or nil benefit eligibility.

Obstetric Related Services* e.g. birth and pregnancy.

R

Assisted Reproductive Services* e.g. IVF.

R

In-Hospital Psychiatric Treatment* Cardiothoracic Procedures*

▵

R

eg. open heart surgery.

Major Eye Surgery*

R

e.g. cataracts and eye lens procedures.

Gastric banding, sleeving/ diversions or bypass (weight loss surgery)*

including replacements, repairs and adjustments.

Renal Dialysis* e.g. chronic failure Access Gap Cover The Access

Gap benefit, for inpatient services, is a benefit over and above the Medicare Benefits Schedule for participating Doctors.

[ 12 ]

R

▵

R R

PUBLIC HOSPITAL COVER NIL EXCESS

TOP HOSPITAL COVER $250 EXCESS

$500 EXCESS

INTERMEDIATE HOSPITAL COVER $250 EXCESS

$500 EXCESS

PUBLIC HOSPITAL COVER NIL EXCESS

Nursing Home Type Patients

We pay a benefit toward a nursing home type patient. This amount is determined by the Federal Government. Certification is required.

Hip and Knee Joint Replacement Surgery*

▵

Mechanical Appliances and Artificial Aids# Benefit up to 85%

of the cost or hire of mechanical appliances and artificial aids approved by Queensland Country Health with a limit of $2000 per person, per Membership Year.

Mammograms and Bone Density Test Benefit up to $50

limited to 2 services for each of the above tests, only if not claimable from another source.

The Membership Year limit is $200 per person covered.

Hearing Aids Benefit limit is

provided every 3 years with the limit amount applied based on your length of membership with Queensland Country Health: Up to 10 years $1000, 10-15 years $1500 and 15 years+ $2000. Benefits per person are calculated at 85% of purchase cost up to the appropriate limit of benefit. Any hearing aid cannot be replaced within 3 years from its original purchase date.

Australian Hearing Services

Benefit of $25 per Membership Year per eligible person for the cost of a Hearing Services Card.

Nursing Home and Bush — Benefit up to $50 per visit or $150 per day limited to $1000 per person, per Membership Year. Special — Benefit of up to $150 per day $750 per person, per Membership Year.

Hospital Boarder Benefits up to $35 per day to a maximum of four days per person listed on the membership, where such accommodation is necessary for the well-being of the patient.

Care Navigation provides assistance immediately following a period of time in hospital or for those living with one or more chronic diseases.

Cosmetic Surgery (hospital

treatment for which Medicare pays no benefit.)

I rrespective of which hospital cover you have chosen, any ancillary (extras) service provided during your hospital stay will not be able to be claimed against the fund unless you have cover for these services under an ancillary product eg. physiotherapy, dieticians, exercise physiologists etc. ^ * #

I f you have chosen Public Hospital cover and are an inpatient at a private hospital or day surgery, you will have a benefit entitlement to the default rate benefit only.

F or hospital services or treatments that have Restricted benefit availability under Intermediate Hospital Cover, no benefit is paid towards the cost of theatre charges raised for inpatient services in a private hospital or day surgery. If you have chosen Public Hospital cover and are an inpatient at a private hospital or day surgery, you will have a benefit entitlement to the default rate benefit only.

B enefits are not available on second hand equipment or on some consumables. A benefit is payable for short term hiring (up to 3 months) of some mechanical aids. The purchase of some machines and monitors are limited to once every 3 Membership Years.

Waiting periods will apply to all benefits outlined. Please refer to page 38 for further details.

Services we don’t pay benefits towards.

Stands for BLP - Benefit Limitation Period. Hospital benefits payable on these hospital services during the designated benefit limitation period will be the minimum benefit declared by the Minister for Health, except when a waiting period is being served, in which case no benefit applies. See Benefit Limitation Period information in this brochure.

Stands for Restricted Benefit. Covered for shared ward accommodation in a public hospital only. If you go to a private hospital or day surgery for these services it is likely to result in large out-of-pocket expenses.

For more information on our Hospital cover go to page 34 'In more detail'.

[ 13 ]

CHOOSE YOUR EXCESS

it keeps your premiums affordable!

[ 14 ]

AN EXCESS IS THE AMOUNT YOU AGREE TO CONTRIBUTE TOWARDS HOSPITAL COSTS IF YOU ARE ADMITTED TO A PUBLIC OR PRIVATE HOSPITAL OR A DAY SURGERY. THE MORE EXCESS YOU AGREE TO PAY, THE LOWER YOUR PREMIUM WILL BE. Our private hospital cover range has flexible excess options to ensure there is an affordable cover for everyone!

Our Top Hospital and Intermediate Hospital products have a choice of either a $250 or $500 excess, the choice is yours!

The excess is only payable if you or someone on your policy is admitted as an inpatient to a public hospital (as a private patient), private hospital or day surgery. It does not apply to extras cover.

The excess calculation is Membership Year based.* The most you’ll have to pay each Membership Year if you choose a cover with a hospital excess is outlined below: EXCESS TYPE

SINGLES COVER

COUPLES/FAMILY/SINGLE PARENT COVER

MAXIMUM PER MEMBERSHIP YEAR

MAXIMUM PER PERSON PER MEMBERSHIP YEAR

MAXIMUM PER POLICY PER MEMBERSHIP YEAR

$250 Excess

$250

$250

$500

$500 Excess

$500

$500

$1000

EXCESS EXEMPTION FOR YOUNG CHILDREN - TOP HOSPITAL COVER ONLY With our Top Hospital cover, you will not be charged an excess if your child up to and including the age of 12 years is admitted to hospital for medical treatment. This excess exemption for children 12 years and under is NOT applicable under our Intermediate Hospital cover. It is exclusive to our range of Top Hospital covers ONLY. * Membership Year is defined on page 37.

[ 15 ]

EXTRAS

As well as hospital cover, we also provide ancillary cover — better known as extras cover — which can be bundled together with your hospital cover.

We have four levels of extras cover here at Queensland Country and provide benefits for a range of general private health services that are not covered by Medicare. This includes dental, optical, physiotherapy and podiatry - just to name a few!

As well as looking after you if you are unwell, we also want you and your family to stay well. With our extras cover you’ll get great benefits on a whole range of healthcare treatments and services. It’s a great incentive to keep that sixmonthly dental check-up, get a new pair of glasses or even have a therapeutic massage.

With our four extras covers - Premium Extras, Essential Extras, Select Extras and Young Extras - you can be confident that you’ll be covered from head to toe.

Provides you and your family with a comprehensive range of therapies and benefits with PREMIUM EXTRAS

generous limits to ensure out-of-pocket expenses are kept to a minimum and can only be

ESSENTIAL EXTRAS

Provides a comprehensive range of therapies and benefits with lower limits and premiums

SELECT EXTRAS

purchased in conjunction with a hospital cover.

and can only be purchased in conjunction with a hospital cover.

Provides benefits for a select range of popular extras services ideally suited to younger singles or couples and families with young children. Select Extras can only be purchased in conjunction with a hospital cover.

Provides a broad range of therapies and a good level of benefits with limits on a per person

YOUNG EXTRAS

per policy basis and can be purchased on its own or in conjunction with a hospital cover.

Young Extras is designed as an entry level extras cover and is best suited for young people under the age of 30.

Dental and Optical Premier Providers Queensland Country has negotiated agreements with a large number of dental and optical providers. Services at one of our Premier Providers are well priced and are likely to reduce out of pocket expenses for Members.

Further details of these providers can be seen at http://www.qldcountryhealth.com.au/member/preferredprovider

[ 16 ]

HEALTHY LIVING BENEFITS

REWARDING LIMITS

As well as helping you to get well we want to help you to stay

Once you have held cover under either our Premium or

well. Therefore we have introduced benefits to encourage you

Essential Extras products for a year, we automatically increase

to live a healthy lifestyle. If you have Premium Extras we will

your annual claim limits for dental (excluding orthodontic)

pay up to $150 per person per Membership Year to assist

and our full range of therapies by $50 per year.

you to:

We provide this loyalty incentive for the first five years of

Participate in your choice of weight management

cover, and continue to honour this for as long as you hold

programs

cover under the above eligible products. For example, after

Participate in quit smoking programs Participate in other approved health management programs* including:

five years continuous cover on our Premium Extras product, the annual limit per person for dental would have increased to $1650 per person per Membership Year.

Loyalty limit increases do not apply to sub limits or individual

- Gym membership

service or item benefits.

- Personal training programs

The benefits outlined in the Health Benefits Guide are

Have your skin checked for skin cancers through

a summary of benefits payable and do not provide

mole mapping

comprehensive details of all benefits. To confirm the details

Consultation fees for diabetes educator

1800Â 813Â 415.

or any conditions that may apply, please contact us on

Consultation fees for metabolic dieticians and nutritionists when providing assistance with weight management Bowel screening tests and bone density tests (no doctors referral will be required) PSA Test (one per year). We will cover a second yearly test not covered by Medicare. * To comply with private health insurance legislation you must have been referred by your health care professional to participate in a health management program to address, improve or prevent a specific health or medical condition. A Health Management Program Benefit Approval Form available on our website must accompany claim for these benefits.

[ 17 ]

PREMIUM AND ESSENTIAL EXTRAS

Our most comprehensive choices:

Premium and Essential Extras provide high level benefits for a wide range of services ideal for families or frequent users due to the generous per person limits, and those who frequently use the health services included in our extras cover.

LIMITS PER MEMBERSHIP YEAR AND WHAT WE’LL PAY. PLEASE REFER TO THE NOTES BELOW FOR FURTHER CLARIFICATION ON THE BENEFITS PAYABLE.

TYPE OF SERVICE

WAITING PERIODS

PREMIUM EXTRAS EXAMPLE OF BENEFITS

OVERALL LIMIT

ESSENTIAL EXTRAS EXAMPLE OF BENEFITS

OVERALL LIMIT

DENTAL Diagnostic

This includes examinations, consultations and Xrays etc.

$600 sub limit^

eg. Periodic oral exam - $32 X-rays - $21

$400 sub limit^

2 months

eg. Scale and clean - $75 Fluoride treatment - $22 Mouth guard - $150

$800 sub limit^

eg. Scale and clean - $53 Fluoride treatment - $15 Mouth guard - $105

$500 sub limit^

2 months

eg. Occlusal splints - $300

$500 sub limit^

eg. Occlusal splints - $210

$300 sub limit^

2 months

eg. One surface composite filling - $90

$800 sub limit^

eg. One surface composite filling - $63

$500 sub limit^

2 months

eg. Simple extractions $105

2 months

eg. Periodic oral exam $45 X-rays - $30

Preventive

This includes cleaning and scaling, fluoride treatment and mouth guards

General services Restorative

composite fillings and amalgam fillings

Simple extraction

eg. Simple extractions - $74

Surgical extractions

Wisdom teeth extraction, removal of impacted teeth *Benefits paid on dental item numbers only, unless hospital cover is held and all waits have been served for any in-patient services.

12 months

Crowns or bridges

Prosthodontics eg. Dentures

Periodontics

eg. Specialised gum treatments

Orthodontics eg. Braces

$1400 overall benefit limit per person per Membership Year for all dental services (excluding orthodontics which has separate claim limits)

eg. Surgical extraction $126

$400 sub limit^

12 months

12 months

12 months

12 months

12 months

eg. Root canal obturation – one canal $170

eg. Full veneered crown - $800

eg. Full upper and lower denture $850

$600 sub limit^

$800 sub limit^ (accumulating to $1500 per year after 2 years of membership)

$850 sub limit^

$500 sub limit^

$1000 (increasing to $2000 after completion of 2 years membership* $3000 available after completion of 3 years membership*) $3000 Lifetime limit. All limits per person.

Benefits are paid at 85% of cost. *Years of membership refers to the actual period of cover on Premium Extras products only.

$900 overall benefit limit per person per Membership Year for all dental services (excluding orthodontics which has separate claim limits) Sub limits apply^

Sub limits apply^

Endodontic

eg. Root canal therapy and root fillings

eg. Surgical extractions $180

$700 sub limit^

eg. Root canal obturation one canal $119

eg. Full veneered crown - $550

eg. Full lower denture $350

$350 sub limit^

$550 sub limit^ (accumulating to $1000 per year after 2 years of membership)

$500 sub limit^

$300 sub limit^

$500 (increasing to $1000 after completion of 2 years membership* $1500 available after completion of 3 years membership*) $1500 Lifetime limit. All limits per person.

Benefits are paid at 50% of cost. *Years of membership refers to the actual period of cover on Essential Extras products only.

Note: Membership Year limits are calculated from the anniversary date of the establishment of the policy. ^ Dental Sub Limits: the maximum benefit amount claimable per person for treatment/service in a specific area of dentistry per Membership Year. This is providing an individual person’s overall dental benefit limit for the Membership Year has not already been reached. If this was the case no further dental benefits can be claimed by this individual on any area of dentistry until new Membership Year commences. Individual dental item benefits apply.

[ 18 ]

Our most comprehensive choices continued...

LIMITS PER MEMBERSHIP YEAR AND WHAT WE’LL PAY.

TYPE OF SERVICE

WAITING PERIODS

PREMIUM EXTRAS EXAMPLE OF BENEFITS

OVERALL LIMIT

ESSENTIAL EXTRAS EXAMPLE OF BENEFITS

OVERALL LIMIT

OPTICAL Single vision spectacles Bifocal spectacles Multifocal spectacles Contact lenses (hard or soft)

Total benefit for optical items or services is limited to a maximum of $200 per person, per Membership Year

Total benefit for optical items or services is limited to a maximum of $285 per person, per Membership Year

2 months

Repairs to frames or spectacle frames only or replacement lenses

THERAPIES Acupuncture*

2 months

Initial and subsequent - $35

Initial and subsequent - $25

Audiology

2 months

Initial and subsequent - $50 Report - $60

Initial and subsequent - $35 Report - $42

2 months

Initial and subsequent - $35 X-rays - $60 (not reading of x-rays)

Initial and subsequent - $25 X-rays - $50 (not reading of x-rays)

Remedial massage or bowen therapy or myotherapy*

2 months

Initial and subsequent - $35

Osteopathy

2 months

Initial and subsequent - $35

Naturopathy or Homeopathy*

2 months

Initial and subsequent - $35

Dietitian

2 months

Initial - $75 Subsequent - $40

Occupational therapy

2 months

Initial - $80 Subsequent - $40

Orthoptic therapy

2 months

Initial and subsequent - $60

2 months

85% of cost

2 months

Initial and subsequent - $40 Approved appliances (orthotics) 85% of cost Minor procedures 75% of cost

Chiropractic

Foot orthoses and orthopaedic shoes (orthoses and custom made footwear)

Podiatry

$700 combined sub limit#

Initial and subsequent - $25

$500 combined sub limit#

Initial - $28 Subsequent - $25 $1400 overall benefit limit per person per Membership Year for all therapy services Sub limits may apply

$900 overall benefit limit per person per Membership Year for all therapy services

Initial and subsequent - $25 Initial - $53 Subsequent - $28

Sub limits may apply

Initial - $56 Subsequent - $28 Initial and subsequent - $42

$150 sub limit

85% of cost

$105 sub limit

$600 sub limit##

Initial and subsequent - $28 Approved appliances (orthotics) 85% of cost Minor procedures 75% of cost

$400 sub limit##

*Benefits are payable for services rendered by Australian Regional Health Group Limited approved providers registered with Queensland Country Health Fund as well as Bowen Therapists that are registered with the Bowen Association of Australia (BAA) or Bowen Therapists Federation of Australia (BTFA). # Combined Sub limit: the maximum benefit amount claimable per person per Membership Year for a combination of Chiropractic, Remedial Massage/ Bowen Therapy/ Myotherapy and Osteopathic services. Group Therapy has a combined sub limit for services provided under Physiotherapy and Exercise Physiology. This is providing an individual person’s overall Therapies benefit limit for the Membership Year has not already been reached. If this was the case no further therapy benefits can be claimed by this individual on any therapy until new Membership Year commences. Individual visit benefits apply. ## Sub limits: the maximum benefit amount claimable per person per Membership Year for Podiatry services. This is providing an individual person’s overall therapies benefit limit for the Membership Year has not already been reached. If this was the case no further benefits can be claimed on this (or any) therapy until new Membership Year commences.

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Our most comprehensive choices continued...

LIMITS PER MEMBERSHIP YEAR AND WHAT WE’LL PAY.

TYPE OF SERVICE

WAITING PERIODS

PREMIUM EXTRAS EXAMPLE OF BENEFITS

OVERALL LIMIT

ESSENTIAL EXTRAS EXAMPLE OF BENEFITS

OVERALL LIMIT

THERAPIES (CONT.)

Physiotherapy

Exercise physiology

2 months

2 months

Initial - $55 Subsequent - $40 Group therapy - $10

Initial - $50 Subsequent - $35 Monthly program fee - $35 Group therapy - $10

Psychology

2 months

Initial and subsequent - $80 Report - $80 Group therapy - $80

Speech therapy

2 months

Initial - $70 Subsequent - $35

$700 combined sub limit# ($100 combined sub limit applies for group therapy services provided under physiotherapy and/or exercise physiology)

Initial - $39 Subsequent - $28 Group Therapy - $7

$1400 overall benefit limit per person per Membership Year for all therapy services.

Sub limits may apply

Initial - $35 Subsequent - $25 Monthly program fee - $25 Group therapy - $7

Initial and subsequent - $56 Report - $56 Group therapy - $56 Initial - $49 Subsequent - $25

$500 combined sub limit# ($70 combined sub limit applies for group therapy services provided under physiotherapy and/or exercise physiology)

$900 overall benefit limit per person per Membership Year for all therapy services.

Sub limits may apply

OTHER EXTRAS Pharmaceutical^

2 months

Up to $50 Limit of $500 per person per Membership Year

Up to $30 Limit of $300 per person per Membership Year

School accidents

2 months

100% - Limit of $750 per dependent child per Membership Year

100% - Limit of $450 per dependent child per Membership Year

Healthy Living (see Healthy Living benefits on page 17)

2 months

$150 per person per Membership Year

$125 per person per Membership Year

Childbirth education

2 months

$60

$42

^Prescriptions not covered by the PBS, excluding contraceptives and items normally available without prescription and drugs not approved for sale in Australia.

A co-payment applies to each prescription item equal to the current PBS General Patient Contribution. Please refer to page 42 for more information.

# Combined Sub limit: the maximum benefit amount claimable per person per Membership Year for a combination of Chiropractic, Remedial Massage/ Bowen Therapy/ Myotherapy and Osteopathic services. Group Therapy has a combined sub limit for services provided under Physiotherapy and Exercise Physiology. This is providing an individual person’s overall Therapies benefit limit for the Membership Year has not already been reached. If this was the case no further therapy benefits can be claimed by this individual on any therapy until new Membership Year commences. Individual visit benefits apply.

[ 20 ]

SELECT AND YOUNG EXTRAS

Covering you for the basics:

Ideally suited to singles and couples or families with very young children. Select and Young Extras provide great value benefits on a selection of the most popular services. A great choice for those not wishing to pay for what they may not use!

LIMITS PER MEMBERSHIP YEAR AND WHAT WE’LL PAY. PLEASE REFER TO THE NOTES BELOW FOR FURTHER CLARIFICATION ON THE BENEFITS PAYABLE.

TYPE OF SERVICE

WAITING PERIODS

SELECT EXTRAS EXAMPLE OF BENEFITS

OVERALL LIMIT

YOUNG EXTRAS EXAMPLE OF BENEFITS

OVERALL LIMIT

DENTAL Diagnostic

This includes examinations, consultations and Xrays etc.

2 months

eg. Periodic oral exam $36 X-rays - $24

eg. Periodic oral exam - $34 X-rays - $23

2 months

eg. Scale and clean - $60 Fluoride treatment - $18 Mouth guard - $120

eg. Scale and clean - $56 Fluoride treatment - $17 Mouth guards - $113

2 months

eg. Simple extractions - $84

2 months

eg. One surface composite filling - $72

Preventive

This includes cleaning and scaling, fluoride treatment and mouth guards

Simple extraction Restorative

Composite fillings and amalgam fillings

General services

2 months

$400 per person up to $800 per policy per Membership Year

Overall limit for all benefits payable under Select Extras (inclusive of Dental, Optical, Therapies, Pharmaceuticals and Healthy Living benefits)

eg. Occlusal splints - $240

Surgical extractions

Wisdom teeth extraction, removal of impacted teeth *Benefits paid on dental item numbers only, unless hospital cover is held and all waits have been served for any in-patient services.

Crowns or bridges

Periodontics

eg. Specialised gum treatments

$500 per person up to $1,000 per policy per Membership Year.

eg. One surface composite filling - $68 eg. Occlusal splints - $225

Combined limit claimable for general and major dental (surgical extractions and crowns and bridges)

up to $2,200 per person $4,400 per policy per Membership Year 12 months

(sub limits apply)

eg. Surgical extraction $126

eg. Surgical extraction $135

$600 per person

12 months

eg. Full veneered crown - $560

12 months

eg. Root canal - $119

Endodontic

eg. Root canal therapy and root fillings

eg. Simple extractions - $79

up to $1,200 per policy per Membership Year

eg. Full veneered crown - $500

X

X

12 months

Prosthodontics

X

X

Orthodontics

X

X

eg. Dentures

eg. Braces

OPTICAL Single vision spectacles

2 months

Bifocal spectacles

2 months

Multifocal spectacles

2 months

Total benefit for optical items or services is limited to a maximum of $230 per person.

Contact lenses (hard or soft)

2 months

Up to $460 per policy per Membership Year

Repairs to frames or spectacle frames only or replacement lenses

2 months

Overall limit for all benefits payable under Select Extras (inclusive of Dental, Optical, Therapies, Pharmaceuticals and Healthy Living benefits) $2,200 per person up to $4,400 per policy per Membership Year

Total benefit for optical items or services is limited to a maximum of $210 per person.

Up to $420 per policy per Membership Year

(sub limits apply)

Note: Membership Year limits are calculated from the anniversary date of the establishment of the policy.

X Service we don’t pay a benefit towards

[ 21 ]

Covering you for the basics continued...

LIMITS PER MEMBERSHIP YEAR AND WHAT WE’LL PAY.

TYPE OF SERVICE

WAITING PERIODS

SELECT EXTRAS EXAMPLE OF BENEFITS

OVERALL LIMIT

YOUNG EXTRAS EXAMPLE OF BENEFITS

OVERALL LIMIT

Initial - $42 Subsequent - $32 Group therapy - $8 (sub limit of $80 applies)

$400 per person up to $800 per policy

THERAPIES

Physiotherapy

Chiropractic

Remedial massage or bowen therapy or myotherapy*

2 months

eg. Initial - $44 Subsequent - $32 Group therapy - $8 (sub limit of $80 applies for group therapy)

2 months

eg. Initial and subsequent - $28

2 months

eg. Initial and subsequent - $28

$500 per person up to $1,000 per policy per Membership Year

$500 per person up to $1,000 per policy per Membership Year

Overall limit for all benefits payable under Select Extras (inclusive of Dental, Optical, Therapies, Pharmaceuticals and Healthy Living benefits) $2,200 per person up to $4,400 per policy per Membership Year

Podiatry

2 months

eg. Initial and subsequent - $32 Approved appliances (orthotics) 85% of cost Minor procedures 75% of cost

(sub limits apply) $400 per person up to $800 per policy per membership

Initial and Subsequent - $30 X-rays - $50 (not reading of x-rays) Initial and subsequent - $30 Initial and subsequent - $30 Approved appliances (orthotics) 85% of cost up to available policy limits

$300 per therapy $500 per person up to $1000 per policy

Minor procedures - 75% of cost up to available policy limits

Osteopathy

2 months

X

Initial and subsequent - $30

Naturopathy or Homeopathy

2 months

X

Initial and subsequent - $30

Dietitian

2 months

X

Initial - $55 Subsequent - $35

Acupuncture*

2 months

X

Initial and subsequent - $30

Audiology

X

X

Occupational therapy

X

X

Orthoptic therapy

X

X

Foot orthoses and orthopaedic shoes (orthoses and custom made footwear)

X

X

Exercise physiology

X

X

Psychology

X

X

Speech therapy

X

X

*Benefits are payable for services rendered by Australian Regional Health Group Limited approved providers registered with Queensland Country Health Fund as well as Bowen Therapists that are registered with the Bowen Association of Australia (BAA) or Bowen Therapists Federation of Australia (BTFA).

X Service we don’t pay a benefit towards

[ 22 ]

Covering you for the basics continued...

LIMITS PER MEMBERSHIP YEAR AND WHAT WE’LL PAY.

TYPE OF SERVICE

WAITING PERIODS

SELECT EXTRAS

YOUNG EXTRAS

OVERALL LIMIT

OVERALL LIMIT

OTHER EXTRAS

Pharmaceutical^

Healthy Living (see Healthy Living benefits on page 17)

2 months

Up to $40 limit of $400 per person up to $800 per policy per Membership Year

2 months

$125 per person up to $250 per person per Membership Year

Overall limit for all benefits payable under Select Extras (inclusive of Dental, Optical, Therapies, Pharmaceuticals and Healthy Living benefits) $2,200 per person $4,400 per policy per Membership Year (sub limits apply)

Up to $30 Limit of $150 per person up to $300 per policy per Membership Year

$125 per person up to $250 per policy per Membership Year

School accidents

X

X

Childbirth education

X

X

^ Prescriptions not covered by the PBS, excluding contraceptives and items normally available without prescription and drugs not approved for sale in Australia. A co-payment applies to each prescription item equal to the current PBS General Patient Contribution. Please refer to page 42 for more information.

X Service we don’t pay a benefit towards

[ 23 ]

COVER PACKAGES

We provide our policyholders with a simple, but flexible product range, allowing a choice of health cover to meet any budget or need To keep it simple and easy to understand you can choose one of our three broad hospital cover options – Top, Intermediate or Public. You then select an eligible excess option that you are comfortable with and that’s your hospital cover locked in!

Then if you wish you can add an extras cover that best suits you or your family’s needs. Choose between our Premium, Essential, Select or Young Extras covers.

You can even take Young Extras as a stand-alone product.

It’s that simple!

[ 24 ]

S i ngles cover SINGLE HOSPITAL PREMIUMS

WITH BASE TIER REBATE

PRODUCT

WEEKLY

TOP HOSPITAL 250

MONTHLY

YEARLY

$31.55

$136.75

$1,641.40

TOP HOSPITAL 500

$28.15

$121.95

INTERMEDIATE HOSPITAL 250

$21.55

INTERMEDIATE HOSPITAL 500 PUBLIC HOSPITAL

SINGLE HOSPITAL + EXTRAS PREMIUMS

PRODUCT

NO REBATE DEDUCTED MONTHLY

YEARLY

$43.10

$186.85

$2,242.10

$1,463.40

$38.45

$166.60

$1,998.95

$93.60

$1,123.70

$29.50

$127.90

$1,534.95

$18.50

$80.20

$962.65

$25.30

$109.60

$1,314.95

$18.55

$80.35

$964.50

$25.35

$109.80

$1,317.50

WITH BASE TIER REBATE

WEEKLY

MONTHLY

YEARLY

WEEKLY

NO REBATE DEDUCTED

WEEKLY

MONTHLY

YEARLY

TOP HOSPITAL 250 + PREMIUM EXTRAS

$43.35

$187.85

$2,254.80

$59.25

$256.65

$3,079.95

TOP HOSPITAL 250 + ESSENTIAL EXTRAS

$38.25

$165.85

$1,990.40

$52.30

$226.55

$2,718.85

TOP HOSPITAL 250 + SELECT EXTRAS

$37.85

$164.25

$1,970.85

$51.75

$224.35

$2,692.10

TOP HOSPITAL 250 + YOUNG EXTRAS

$36.70

$159.10

$1,909.60

$50.15

$217.35

$2,608.45

TOP HOSPITAL 500 + PREMIUM EXTRAS

$39.90

$173.05

$2,076.75

$54.55

$236.40

$2,836.80

TOP HOSPITAL 500 + ESSENTIAL EXTRAS

$34.80

$151.00

$1,812.45

$47.60

$206.30

$2,475.75

TOP HOSPITAL 500 + SELECT EXTRAS

$34.45

$149.40

$1,792.85

$47.10

$204.10

$2,448.95

TOP HOSPITAL 500 + YOUNG EXTRAS

$33.30

$144.25

$1,731.65

$45.50

$197.10

$2,365.35

INTERMEDIATE HOSPITAL 250 + PREMIUM EXTRAS

$33.40

$144.75

$1,737.05

$45.65

$197.75

$2,372.75

INTERMEDIATE HOSPITAL 250 + ESSENTIAL EXTRAS

$28.30

$122.70

$1,472.75

$38.70

$167.65

$2,011.70

INTERMEDIATE HOSPITAL 250 + SELECT EXTRAS

$27.90

$121.05

$1,453.15

$38.15

$165.40

$1,984.95

INTERMEDIATE HOSPITAL 250 + YOUNG EXTRAS

$26.75

$116.00

$1,391.90

$36.55

$158.45

$1,901.30

INTERMEDIATE HOSPITAL 500 + PREMIUM EXTRAS

$30.30

$131.30

$1,576.00

$41.40

$179.40

$2,152.80

INTERMEDIATE HOSPITAL 500 + ESSENTIAL EXTRAS

$25.20

$109.30

$1,311.70

$34.45

$149.30

$1,791.75

INTERMEDIATE HOSPITAL 500 + SELECT EXTRAS

$24.85

$107.70

$1,292.10

$33.95

$147.10

$1,764.95

INTERMEDIATE HOSPITAL 500 + YOUNG EXTRAS

$23.65

$102.55

$1,230.90

$32.35

$140.10

$1,681.35

PUBLIC HOSPITAL + PREMIUM EXTRAS

$30.35

$131.45

$1,577.90

$41.45

$179.60

$2,155.35

PUBLIC HOSPITAL + ESSENTIAL EXTRAS

$25.25

$109.40

$1,313.55

$34.50

$149.50

$1,794.25

PUBLIC HOSPITAL+ SELECT EXTRAS

$24.85

$107.80

$1,293.95

$34.00

$147.30

$1,767.50

PUBLIC HOSPITAL + YOUNG EXTRAS

$23.70

$102.70

$1,232.70

$32.40

$140.30

$1,683.85

YOUNG EXTRAS

$5.15

$22.35

$268.20

$7.05

$30.55

$366.35

[ 25 ]

Couple/Family cover COUPLE/FAMILY HOSPITAL PREMIUMS

WITH BASE TIER REBATE

PRODUCT

WEEKLY

TOP HOSPITAL 250

MONTHLY

YEARLY

$63.10

$273.60

$3,283.25

TOP HOSPITAL 500

$56.30

$243.90

INTERMEDIATE HOSPITAL 250

$43.20

INTERMEDIATE HOSPITAL 500 PUBLIC HOSPITAL

COUPLE/FAMILY HOSPITAL + EXTRAS PREMIUMS

PRODUCT

NO REBATE DEDUCTED MONTHLY

YEARLY

$86.25

$373.75

$4,484.80

$2,927.20

$76.90

$333.20

$3,998.45

$187.05

$2,245.20

$59.00

$255.55

$3,066.85

$37.00

$160.40

$1,924.90

$50.55

$219.10

$2,629.35

$37.05

$160.70

$1,928.75

$50.65

$219.55

$2,634.60

WITH BASE TIER REBATE

WEEKLY

MONTHLY

YEARLY

WEEKLY

NO REBATE DEDUCTED

WEEKLY

MONTHLY

YEARLY

TOP HOSPITAL 250 + PREMIUM EXTRAS

$86.75

$375.85

$4,510.45

$118.50

$513.40

$6,161.10

TOP HOSPITAL 250 + ESSENTIAL EXTRAS

$76.55

$331.70

$3,981.10

$104.60

$453.15

$5,438.05

TOP HOSPITAL 250 + SELECT EXTRAS

$75.80

$328.50

$3,942.15

$103.55

$448.75

$5,384.80

TOP HOSPITAL 250 + YOUNG EXTRAS

$73.45

$318.35

$3,820.05

$100.35

$434.85

$5,218.00

TOP HOSPITAL 500 + PREMIUM EXTRAS

$79.90

$346.20

$4,154.35

$109.15

$472.90

$5,674.70

TOP HOSPITAL 500 + ESSENTIAL EXTRAS

$69.65

$302.10

$3,625.05

$95.20

$412.65

$4,951.70

TOP HOSPITAL 500 + SELECT EXTRAS

$68.95

$298.80

$3,586.10

$94.20

$408.20

$4,898.45

TOP HOSPITAL 500 + YOUNG EXTRAS

$66.60

$288.65

$3,464.00

$91.00

$394.30

$4,731.65

INTERMEDIATE HOSPITAL 250 + PREMIUM EXTRAS

$66.75

$289.35

$3,472.40

$91.20

$395.25

$4,743.15

INTERMEDIATE HOSPITAL 250 + ESSENTIAL EXTRAS

$56.55

$245.25

$2,943.10

$77.30

$335.00

$4,020.15

INTERMEDIATE HOSPITAL 250 + SELECT EXTRAS

$55.85

$241.95

$2,904.05

$76.30

$330.55

$3,966.85

INTERMEDIATE HOSPITAL 250 + YOUNG EXTRAS

$53.50

$231.80

$2,781.95

$73.10

$316.65

$3,800.05

INTERMEDIATE HOSPITAL 500 + PREMIUM EXTRAS

$60.60

$262.65

$3,152.10

$82.80

$358.80

$4,305.65

INTERMEDIATE HOSPITAL 500 + ESSENTIAL EXTRAS

$50.40

$218.55

$2,622.75

$68.90

$298.55

$3,582.60

INTERMEDIATE HOSPITAL 500 + SELECT EXTRAS

$49.65

$215.30

$2,583.80

$67.85

$294.10

$3,529.35

INTERMEDIATE HOSPITAL 500 + YOUNG EXTRAS

$47.30

$205.10

$2,461.65

$64.65

$280.20

$3,362.55

PUBLIC HOSPITAL + PREMIUM EXTRAS

$60.65

$263.00

$3,155.95

$82.90

$359.25

$4,310.90

PUBLIC HOSPITAL + ESSENTIAL EXTRAS

$50.50

$218.90

$2,626.65

$69.00

$299.00

$3,587.90

PUBLIC HOSPITAL + SELECT EXTRAS

$49.75

$215.60

$2,587.65

$68.00

$294.55

$3,534.65

PUBLIC HOSPITAL + YOUNG EXTRAS

$47.40

$205.45

$2,465.55

$64.75

$280.65

$3,367.85

YOUNG EXTRAS

$10.30

$44.70

$536.75

$14.10

$61.10

$733.20

[ 26 ]

Single Parent cover SINGLE PARENT HOSPITAL PREMIUMS

WITH BASE TIER REBATE

PRODUCT

WEEKLY

TOP HOSPITAL 250

$50.45

$218.75

$2,625.45

TOP HOSPITAL 500

$45.00

$195.00

INTERMEDIATE HOSPITAL 250

$43.20

INTERMEDIATE HOSPITAL 500 PUBLIC HOSPITAL

SINGLE PARENT HOSPITAL + EXTRAS PREMIUMS

PRODUCT

MONTHLY

YEARLY

NO REBATE DEDUCTED MONTHLY

YEARLY

$68.95

$298.85

$3,586.25

$2,340.45

$61.50

$266.40

$3,196.95

$187.05

$2,245.20

$59.00

$255.55

$3,066.85

$37.00

$160.40

$1,924.90

$50.55

$219.10

$2,629.35

$37.05

$160.70

$1,928.75

$50.65

$219.55

$2,634.60

WITH BASE TIER REBATE

WEEKLY

MONTHLY

YEARLY

WEEKLY

NO REBATE DEDUCTED

WEEKLY

MONTHLY

YEARLY

TOP HOSPITAL 250 + PREMIUM EXTRAS

$74.05

$321.05

$3,852.60

$101.20

$438.55

$5,262.50

TOP HOSPITAL 250 + ESSENTIAL EXTRAS

$63.90

$276.95

$3,323.30

$87.30

$378.30

$4,539.50

TOP HOSPITAL 250 + SELECT EXTRAS

$63.15

$273.65

$3,284.30

$86.30

$373.85

$4,486.25

TOP HOSPITAL 250 + YOUNG EXTRAS

$60.75

$263.50

$3,162.20

$83.05

$359.95

$4,319.45

TOP HOSPITAL 500 + PREMIUM EXTRAS

$68.55

$297.30

$3,567.65

$93.70

$406.10

$4,873.25

TOP HOSPITAL 500 + ESSENTIAL EXTRAS

$58.40

$253.15

$3,038.30

$79.80

$345.85

$4,150.20

TOP HOSPITAL 500 + SELECT EXTRAS

$57.65

$249.90

$2,999.30

$78.80

$341.40

$4,096.95

TOP HOSPITAL 500 + YOUNG EXTRAS

$55.35

$239.75

$2,877.20

$75.60

$327.50

$3,930.15

INTERMEDIATE HOSPITAL 250 + PREMIUM EXTRAS

$66.75

$289.35

$3,472.40

$91.20

$395.25

$4,743.15

INTERMEDIATE HOSPITAL 250 + ESSENTIAL EXTRAS

$56.55

$245.25

$2,943.10

$77.30

$335.00

$4,020.15

INTERMEDIATE HOSPITAL 250 + SELECT EXTRAS

$55.85

$241.95

$2,904.05

$76.30

$330.55

$3,966.85

INTERMEDIATE HOSPITAL 250 + YOUNG EXTRAS

$53.50

$231.80

$2,781.95

$73.10

$316.65

$3,800.05

INTERMEDIATE HOSPITAL 500 + PREMIUM EXTRAS

$60.60

$262.65

$3,152.10

$82.80

$358.80

$4,305.65

INTERMEDIATE HOSPITAL 500 + ESSENTIAL EXTRAS

$50.40

$218.55

$2,622.75

$68.90

$298.55

$3,582.60

INTERMEDIATE HOSPITAL 500 + SELECT EXTRAS

$49.65

$215.30

$2,583.80

$67.85

$294.10

$3,529.35

INTERMEDIATE HOSPITAL 500 + YOUNG EXTRAS

$47.30

$205.10

$2,461.65

$64.65

$280.20

$3,362.55

PUBLIC HOSPITAL + PREMIUM EXTRAS

$60.65

$263.00

$3,155.95

$82.90

$359.25

$4,310.90

PUBLIC HOSPITAL + ESSENTIAL EXTRAS

$50.50

$218.90

$2,626.65

$69.00

$299.00

$3,587.90

PUBLIC HOSPITAL + SELECT EXTRAS

$49.75

$215.60

$2,587.65

$68.00

$294.55

$3,534.65

PUBLIC HOSPITAL + YOUNG EXTRAS

$47.40

$205.45

$2,465.55

$64.75

$280.65

$3,367.85

YOUNG EXTRAS

$10.30

$44.70

$536.75

$14.10

$61.10

$733.20

[ 27 ]

Extended Family Cover EXTENDED FAMILY HOSPITAL + EXTRAS PREMIUMS

WITH BASE TIER REBATE

PRODUCT

WEEKLY

TOP HOSPITAL 250 + PREMIUM EXTRAS

NO REBATE DEDUCTED

MONTHLY

YEARLY

WEEKLY

MONTHLY

YEARLY

$110.10

$477.30

$5,727.70

$150.45

$652.00

$7,823.80

TOP HOSPITAL 250 + ESSENTIAL EXTRAS

$97.25

$421.35

$5,056.65

$132.85

$575.60

$6,907.15

TOP HOSPITAL 500 + PREMIUM EXTRAS

$101.35

$439.15

$5,270.30

$138.45

$599.90

$7,199.00

TOP HOSPITAL 500 + ESSENTIAL EXTRAS

$88.40

$383.20

$4,599.20

$120.80

$523.50

$6,282.30

SINGLE PARENT EXTENDED FAMILY HOSPITAL + EXTRAS PREMIUMS

WITH BASE TIER REBATE

PRODUCT

WEEKLY

TOP HOSPITAL 250 + PREMIUM EXTRAS

NO REBATE DEDUCTED

MONTHLY

YEARLY

WEEKLY

MONTHLY

YEARLY

$94.10

$407.75

$4,893.10

$128.55

$557.00

$6,683.80

TOP HOSPITAL 250 + ESSENTIAL EXTRAS

$81.15

$351.85

$4,222.05

$110.90

$480.60

$5,767.15

TOP HOSPITAL 500 + PREMIUM EXTRAS

$87.05

$377.25

$4,527.60

$118.95

$515.35

$6,184.50

TOP HOSPITAL 500 + ESSENTIAL EXTRAS

$74.15

$321.35

$3,856.50

$101.30

$439.00

$5,267.80

[ 28 ]

HOW TO GUIDE:

Online Member Services (OMS) portal THIS IS YOUR ONLINE PORTAL WHERE YOU CAN ACCESS IM. YOUR POLICY MEMBERSHIP DETAILS AND MAKE A CLA

You can: Get to know your cover - Understand your limits and benefits keeping track of your benefit allowance.

Process claims online - Save time by submitting your claims Make use of useful tools - Explore features to access your Membership Card or search our Premier Provider Network.

SERVICES THAT CAN BE CLAIMED ONLINE#

by accessing your cover details, including

online... it’s easy!

Private Health Insurance Statement, order a new

SERVICES THAT CAN’T BE CLAIMED ONLINE*

Acupuncture

Pharmacy

Audiology

Group therapy services e.g. pilates

Chiropractic

Major dental (orthodontics, periodontics, surgical

General dental Dietetics Homeopathy

extractions, crowns or bridges, prosthodontics) Any service that holds a 12 month waiting period Any service that pays a % of cost

Massage

rather than a set benefit

Naturopathy

Healthy Living benefit

Occupational therapy

Medical access gap and hospital claims

Optical

Two way medical claims that have been processed

Osteopathy

by Medicare

Physiotherapy Podiatry (consultations only)

How can you claim on these services?

Psychology

We have six options available, so you can choose

Speech therapy

www.qldcountryhealth.com.au/members/claims

# Some of these services are not available on all extras covers.

Please refer to your cover details to see what you are covered for.

your preferred method. Visit

*Eligible benefits for these services have to be claimed either in person, by mail or via email claim lodgement. For more information on online claiming please consult our website www.qldcountryhealth.com.au

[ 29 ]

Online Claiming THIS IS HOW YOU DO IT...

WITH SO MANY OF US LIVING VERY BUSY LIFESTYLES WE HAVE MADE CLAIMING FOR CERTAIN SERVICE TYPES EVEN EASIER FOR OUR MEMBERS. To claim online, you will need to register with our Online Membership Services (OMS). You can register for this service via the home page of our website under “Register”. If you need help just send us an email or give us a call. Once you are registered for OMS, simply follow the step by step guide below to claim online.

1.

Log onto Online Member Services at

2.

ices

www.qldcountryhealth.com.au/members/online-member-serv

Hover over “Claims” and select “Online Claiming”.

3.

ead the terms and conditions, then R select “Next”. Confirm the bank account details are correct and Select “Next”.

4.

Complete the “Add Claim Lines” section with the service details.

NOTE: You can claim up to $400 per day on services received up to three months before the day you lodge your claim.

To add another service click on “Add New Service”. If you have finished adding all services click on “Next”.

5.

eview the details of the claim/s R you have entered. Confirm your claim by ticking the Declaration boxes and then clicking “Next”.

6.

Now click on "Submit".

Next

If there is an error, you will see a RED MESSAGE under “claim line assessing”. This means that this particular claim has not been processed and you need to contact Queensland Country Health Fund for further information. If the message reads a green APPROVED, your claim has been processed and payment will be made within two business days. You will also be provided with the claim result, benefit limit remaining after this claim has been paid and your claim number.

TERMS AND CONDITIONS DO APPLY FOR ONLINE CLAIMING SERVICE. YOU CAN FIND THESE ON OUR WEBSITE QLDCOUNTRYHEALTH.COM.AU [ 30 ]

WE BELIEVE THAT CLAIMING BENEFITS SHOULD BE QUICK & EASY

so you’ve got more time to relax & enjoy life!

[ 31 ]

On-the-spot claiming for extras To make it even easier to claim

Depending on your level of cover and

your benefit, participating health

if your provider has the appropriate

professionals have electronic

facility, you can claim these services

claiming facilities available.

through HICAPS:

HICAPS/iSoft allows you to simply

dentists, endodontists,

swipe your Queensland Country

periodontists, dental prosthetist/

Membership Card at the end of

advanced dental technicians,

your consultation or treatment,

prosthodontists, paediatric

automatically deducting your benefit

dentists

entitlement from the amount you’ve been charged. Then all you have to pay is the difference.

By using electronic claiming you don’t have to lodge a manual claim, so no need to fill out a claim form and no waiting for the claim to be processed.

dispensing optometrists, optical dispensers physiotherapists chiropractors osteopaths podiatrists occupational therapists

TO FIND OUT IF YOUR HEALTH SERVICE PROVIDER HAS HICAPS VISIT THEM ONLINE AT WWW.HICAPS.COM.AU

[ 32 ]

psychologists massage therapy

HOW TO PAY CONTRIBUTIONS Queensland Country offers you a variety of payment options so you can choose the best method for you. You can choose to pay weekly, fortnightly, monthly, quarterly, six monthly or yearly, whichever suits you. If you choose to pay by a method other than direct debit from a bank account or credit card and your payment frequency is quarterly or greater, we will send you a reminder notice as a courtesy.

As a policyholder it is your responsibility to ensure that the payment amounts are correct and made in advance, this avoids claims being rejected due to an un-financial status.

Your policy will commence from a future date that you nominate or simply the date that your application is received by us or Queensland Country Credit Union. We will then forward a Membership Card to your address.

Direct Debit

EFTPOS

Phone

BPAY

OMS

Direct debit from a

EFTPOS at any of our

Pay by phone –

BPAY our biller

OMS - Log on

bank account or

Health Fund Retail

call us on

reference code

and update your

credit card.

Centres located in

1800 813 415

is 91082 and the

details by accessing

Aitkenvale, Willows,

and select option 3 to

reference number for

My Details > My

Canelands, Ayr and

pay by phone with a

your policy can be

Contribution Details.

Mount Isa.

credit card. You can

provided on request.

also do this directly by speaking with a Member Service Officer.

Note: Deadlines may exist for one or more of these payment options.

Please consult our Membership Guide for further details.

[ 33 ]

IN MORE DETAIL...

Membership Guide We have prepared a Membership Guide to outline a summary of the rules that apply to your membership. Please ask for a Membership Guide or access it by visiting us at www.qldcountryhealth.com.au. It should be read in conjunction with this Health Benefits Guide.

Hospital Benefits TOP HOSPITAL COVER Queensland Country’s most comprehensive hospital product and popular with those looking for complete peace of mind.

Covering you for a complete range of hospital services including pregnancy, heart related procedures, major eye surgery and joint replacement surgery. Top Hospital can be taken on its own or packaged with any of our extras packages. To keep your premiums affordable you have a choice of paying either a $250 or $500 excess when admitted to a hospital or day surgery.

BENEFIT LIMITATION PERIODS Our Top Hospital cover requires a policyholder (who is new to private health insurance hospital cover) to be with Queensland Country for a period of 24 months before certain hospital services are fully covered. Benefit Limitation Periods (BLP’s) will apply to the following services: · Bariatric Surgery (weight loss surgery): including but not limited to gastric banding; gastric sleeving/diversion; and gastric bypass surgery; including replacement, repair or adjustments. During the first 24 months of cover (but after the standard 12 month hospital waiting period has been served) benefits payable for these services will be limited to a restricted benefit. · Hip or Knee Joint Replacements: During the first 24 months of cover (but after the standard 12 month hospital waiting period has been served) benefits payable for these services will be limited to a restricted benefit. · In-Hospital Psychiatric Treatment: During the first 24

Benefit Limitation Periods will not apply if you are transferring from another health fund’s hospital cover providing you are transferring within 63 days of ceasing the previous cover.

INTERMEDIATE HOSPITAL COVER A great value mid-level hospital cover ideal for a young or healthy person who doesn’t want to pay for hospital services they feel less inclined to need like pregnancy, IVF, heart surgery, major eye surgery, renal dialysis, in-hospital psychiatric care or even a hip or knee replacement. A very cost effective option if you want comprehensive cover for the vast majority of hospital treatments and are prepared to have limited or no cover for the restricted or excluded services under this cover.

RESTRICTED BENEFITS If a service is covered with a restricted benefit, this means

months of cover (but after the standard hospital waiting

you will be covered with your choice of doctor for shared

period have been served) benefits for these will be limited to

ward accommodation in a public hospital only. If you go to

restricted benefits.

a private hospital for a specific service which has restricted

Restricted benefits will only cover you for a stay in a shared

benefits, it is likely to result in large out-of-pocket expenses.

ward of a public hospital. It will not cover the cost for a stay

Restricted benefits are amounts set by the Government and

in a private room in a public hospital or a stay in a private

are generally not enough to cover accommodation costs in a

hospital and you will incur large out-of-pocket expenses to

private hospital. No benefit is paid towards the cost of theatre

cover the difference in costs.

charges raised for services in a private hospital.

[ 34 ]

Not every hospital cover product has benefit restrictions,

However, some doctors charge more than the MBS fee. This

please refer to hospital cover tables on pages 12-13 to

can result in significant out-of- pocket expenses. Queensland

determine benefit entitlement conditions for individual

Country’s private hospital cover can help reduce or avoid

hospital products.

these extra expenses through our Access Gap agreement.

Whilst cover with restricted benefits entitles you to your willing, or able, to treat you in a public facility.

ACCESS GAP - MINIMISE OUTOF-POCKET EXPENSES

Waiting periods may also apply to all restricted services.

Access Gap is a major feature of our hospital cover.

choice of doctor in a public hospital, your doctor may not be

EXCLUDED BENEFITS An excluded service means you will not be covered in a

Participation by your doctor in Access Gap could significantly reduce medical costs for inpatient hospital services, or in some cases, may eliminate them completely.

public or private hospital and will not receive a payment from

By making arrangements with your doctor before going into

Queensland Country for that service. If you think you may

hospital you will have an understanding of the costs for the

require treatment for any excluded services you may like to

medical procedure based on how the doctor will charge for

consider taking one of our Top Hospital cover products.

their services.

However, should you choose our Intermediate Hospital cover

Under this direct billing arrangement Queensland Country

and then require treatment for any of the services that are

will pay a higher amount to your doctor if he or she agrees

restricted or excluded, to have full benefit entitlement you

to participate and charge you fees in accordance with the

will need to upgrade your policy to our Top Hospital cover at

agreement.

least 12 months in advance of the required hospital admission.

If your doctor agrees, it means that they are willing to accept

PUBLIC HOSPITAL COVER Public Hospital cover is exactly as the name suggests cover for treatment in a Public Hospital.

a set fee for their services that is more than the MBS fee and means you are likely to have lower out-of-pocket costs, and in some cases, none at all!

Participation by your doctor in Access Gap is voluntary. There

Public Hospital cover is a basic level of hospital cover

is no obligation for your doctor to do so. Your doctor must

designed for those who want to be treated as a private

inform you of the total of any out-of-pocket expenses you will

patient in a public hospital. This cover option will allow you or

have to meet before you go to hospital. You can search for

your family to choose your own doctor (if he/she is willing, or

doctors who may participate in the Access Gap Scheme by

able to treat you in a public facility) and receive treatment as

referring to the AHSA website https://www.ahsa.com.au/web/

a private patient in a public hospital. This means we will pay

gapcoversearch

for the cost of shared ward accommodation only up to the level prescribed by the Federal Minister for Health, if admitted as a private patient. So if you choose to be admitted in a private room in a public hospital, you will incur further out-of-

We also recommend that you contact us before going into hospital or day surgery so that we can discuss the level of benefit your policy provides you.

pocket expenses.

However public hospital cover will not assist in avoiding waiting times in the public hospital system, and would also mean that if you require to be treated in a private hospital or

MEDICARE REBATE 75%

OUR BENEFIT 25% (MEDICAL GAP)

MEDICARE BENEFIT SCHEDULE (MBS) FEE

OUR BENEFIT (ACCESS GAP)

OUT-OF-POCKET EXPENSES

ACCESS GAP

day surgery you will face high out-of-pocket expenses, which may not be the case if you were to choose one of our Private

YOUR DOCTOR’S FEE

Hospital cover options.* * Some hospital services under our Intermediate Hospital cover have restricted or excluded benefit entitlement however. Please see Hospital Cover table for details of these restrictions and exclusions.

REDUCE YOUR MEDICAL COSTS Your doctor, surgeon and anaesthetist will all charge for their services separately to your hospital accommodation costs. Their fees are known as medical expenses. These medical expenses are assessed against the Medicare Benefits Schedule (MBS) fees, which are set down by the government.

If you are admitted to hospital as a private patient. Medicare will pay 75% of the MBS fee for your medical expenses.

Queensland Country will pay the remaining 25% of the MBS fee.

To help make the information above easy to understand, this image provides you with a visual on Access Gap. We hope it helps!

PRE-EXISTING CONDITIONS A pre-existing ailment, illness or condition is one where, after examining evidence, a medical adviser, or other relevant health care practitioner appointed by Queensland Country would consider that signs or symptoms would have been in existence at any time during the six (6) months preceding the application for membership or upgrade of cover. You may have a pre-existing condition, ailment or illness without being aware of it. In these cases, there is a 12 month waiting period before you are entitled to claim benefits for treatment.

[ 35 ]

It is not necessary for the signs or symptoms to have been

Private hospitals and day hospital facilities that have not

diagnosed by a doctor on joining or upgrading your existing

signed an agreement attract reduced benefits which will

level of cover.

mean you may incur out-of-pocket medical expenses for

Surgery for assisted fertility programs such as IVF or GIFT, Sterilisation or Vasectomy are elective and attract a 12 month waiting period as does obstetrics-related services.

The 12 month pre-existing condition waiting period can be applied to all hospital or hospital substitute treatment for which we pay benefits. However, a two (2) month waiting period applies to the following services: approved psychiatric treatment approved rehabilitation treatment, or palliative care.

The 12 month waiting period for the treatment of a pre-existing condition can also apply to ancillary (extras) services.

PROSTHESIS BENEFIT We provide a benefit towards surgically implanted prostheses and other items on the Federal Government prostheses list.

MECHANICAL APPLIANCES AND AIDS To help maintain your health we provide excellent benefits

in-hospital treatment. Go to our website to find a hospital most convenient to you. www.qldcountryhealth.com.au

BENEFIT CONDITIONS Queensland Country will only pay benefits when: Goods and services are provided in Australia

T he Member has been charged for the treatment or service A service or treatment is medically necessary and clinically relevant Services are part of a course of treatment recognised by Queensland Country The service is provided in person The service is provided to a person on the membership The service or treatment has been provided by a practitioner or therapist recognised by Queensland Country

T he treatment or service is covered under the Member’s level of cover

available exclusively under our Top Hospital cover. We pay up

For ancillary health care services, benefits are either to

to 85% of the cost of a selected range of mechanical aids and

be paid by the health fund or alternatively by Medicare,

appliances approved by Queensland Country. A Membership

benefits for the same service/treatment will not be able to

Year limit of $2000 per person applies. For some mechanical

be claimed from both sources

aids the benefit is for hire only. Products covered include:

There is no entitlement to a Medicare benefit under an

blood pressure monitor, glucometer, tens machine, crutches,

Allied Health Service program

walking frame, wigs etc.

Benefits are not available on second hand equipment or on consumables. A benefit is payable for short term hiring (up to 3 months) of some mechanical aids. The purchase of some machines and monitors are limited to once every 3 years from the date of purchase.

A letter of referral from your doctor or other practitioner may be required. Please contact us regarding benefit availability prior to purchasing an aid or appliance.

Mechanical Appliances and Aids coverage is not available on our Intermediate Hospital or Public Hospital cover products.

The conditions of the level of cover have been met For inpatient hospital treatments or services and the associated Medical costs (doctors fees), benefits are only payable where Medicare also provide a benefit entitlement A claim for a service rendered is submitted for payment within 24 months of the date of service The waiting period for that service has been served The Benefit Limitation Period (BLP) for that service has been served (where applicable) Benefits are not claimable from another source eg. workers compensation, motor vehicle accident insurance

HOSPITAL NETWORK

or third party liability. If Queensland Country has already

Queensland Country has negotiated Purchaser Provider

compensation has been paid in respect of an injury, the

Agreements with most of the participating private hospitals

insured person must repay to the health fund all benefits

and day hospital facilities Australia-wide. In most instances,

received in relation to the injury, upon settlement of the

the approved hospital charges for policyholders of a Top

claim for compensation.

Hospital policy will be covered in full once the agreed excess has been deducted. This means that you will benefit from capped fees we’ve negotiated and convenient billing as your invoice will be sent directly to Queensland Country.

paid benefits by way of provisional payments and; where

The amount of benefit is calculated on the cost of the treatment or aid to the Member, taking into account any allowances or discounts given by the provider. No benefit paid by Queensland Country can exceed the actual charge of the service or appliance.

[ 36 ]

MEMBERSHIP YEAR All yearly limits and excesses are calculated from the anniversary date of the establishment of the membership.

TYPES OF MEMBERSHIPS

Singles, Couples & Families Single: a single policy covers only one person.

Couple: a couple policy covers the person who establishes the policy as well as that person’s partner. The policy can be extended to cover dependant children at no additional cost.

Family: a family policy covers the person who establishes

If, at any time, your student dependant’s situation changes and they no longer meet all the above conditions then please contact us for further information.

Covering adult children Extended Family cover# will allow all adult children between 21 and 25 years to remain on their family or single parent policy (as long as they are not married or in a de facto relationship).

The Extended Family cover policy premium will of course be higher than our standard family or single parent family policy, but will prove to be a financially more economical option for eligible dependant children, in comparison to having them

the policy as well as that person’s partner and all dependant

take out their own cover at an equivalent level.

children (up to 21 years). Student and apprentice dependants

#

can be covered up to age 25*.

Single Parent Family: a single parent family policy covers the person who establishes the policy as well as that person’s dependant children (up to 21 years). Student and apprentice dependants can be covered up to age 25*.

Extended Family cover option will be restricted to Top Hospital and Premium Extras or Essential Extras packaged covers only. It will not be available to family or single parent policies with any Hospital Only Product, Intermediate Hospital, or Intermediate Hospital and Extras package, Private Hospital and Young Extras Product, Singles and Couples Combined cover Products or Public Hospital and Extras packaged covers.

CONTRIBUTIONS IN ARREARS A policyholder who fails to pay contributions within 63 days

Extended Family^^: a family policy option which covers the

of the day of which contributions were due and payable shall

person who establishes the policy as well as that person’s

be deemed to be unfinancial. No benefits are payable for

partner and all dependant children up to the age of 25* years.

services rendered whilst a membership remains in arrears.

In the case of a single parent family, the Extended Family

However, provided all outstanding contributions are paid

policy will cover the person who establishes the policy as

within 63 days of the due date, the membership will be re-

well as that person’s dependant children up to the age of 25* years. * As long as the dependant child is not married or living in a de facto relationship.

See Dependants information below for further details. ^^ Only Top Hospital and Premium/Essential Extras Packaged covers are available for Extended Family policies. Not available for any Hospital Only cover, Extras only covers, packaged Top Hospital and Select or Young Extras; or Public Hospital and Extras covers.

Dependants Dependants include a policyholder’s children and

instated. Membership of Queensland Country Health shall automatically cease for any policyholder whose contributions are more than 63 days in arrears.

LENGTH OF STAY Full hospital benefits are not available after 35 days of continuous hospitalisation unless your doctor certifies the need for continued hospital-level care.

the age of 21. Dependants turning 21 who are not eligible for

OVERSEAS SUSPENSION OF MEMBERSHIP

cover under a family policy as a student or apprenticeship

If you’re lucky enough to travel overseas, will be absent from

dependant are required to commence their own policy if

Australia for more than four weeks and less than 24 months

they wish to continue private health cover. The good news

and you’ve fulfilled all other criteria, you may apply for a

is that they can move straight across to their own single

suspension on your membership. For further information,

membership without having to serve any waiting periods.

please call us when you’re making your travel plans.

Alternatively, dependants between 21 and 25 years who do

If you develop a condition or ailment during the suspension,

not qualify as a student or apprentice dependant may stay on

you won’t be covered by your policy. Once you reactivate

your family policy for an additional premium. Please refer to

your policy pre-existing condition waiting periods for

the section “Covering Adult Children”.

that condition will apply. For information on pre-existing

Dependants will be covered as student dependants under

conditions, please see page 35.

stepchildren, legally adopted children or foster children under

their parent’s membership from 21 years of age up to 25 years of age, provided the following conditions are satisfied:

I s a full time student at a school, college or university who is not aged 25 years or over; or

I s an apprentice who is not aged 25 years or over and does

RECOGNISED PROVIDERS Queensland Country will only pay benefits for ancillary, dental and nursing services where the services are provided by practitioners recognised by Queensland Country. Recognition is subject to change without notice. There are no benefits

not earn more than $30,000 p.a;

payable for overseas hospitalisation or ancillary care.

I s not married or living in a de facto relationship

Recognition of providers is for the purpose of determining the payment of benefits and should not be taken or

[ 37 ]

considered in any way as approval of, or any recommendation as to the qualifications and skills of, or services provided by, a practitioner or therapist. Members should check with

WAITING PERIODS So when will I be fully covered?

Queensland Country that their practitioner is recognised

Waiting periods apply when you join any health fund for

before commencing treatment.

the very first time or when you upgrade to a higher level of

COOLING OFF PERIOD Queensland Country will allow any Member who has not yet made a claim to cancel their policy and receive a full refund of any premiums paid within a period of 30 days from the commencement of their policy or upgraded policy.

cover. But you won’t have to wait if you’re transferring to Queensland Country from an equivalent or higher level of cover with another health fund or if you’ve been covered by your parents’ membership and you’re just starting out on your own. For full details, please refer to our Membership Guide under the heading “Transferring from another fund”.

Waiting periods are necessary to keep health cover fair and

INFORMATION

aim to protect our existing policyholders who contribute to a

Please ensure that you read all documentation provided

fund over a period of time for when they may need cover. If

to you before any decision is made to purchase a health

we didn’t have these waiting periods people may join, claim

insurance product and ensure you retain a copy of the

for something planned and then leave. Always make sure you

documentation for future reference.

have waited the sufficient period before claiming, otherwise you may not be covered!

BENEFIT REPLACEMENT PERIOD

For those of you who are thinking of starting a family and you

A Benefit Replacement Period applies to certain mechanical

currently have a single policy, to be sure your baby has cover

appliances and hearing aids. This means that once you have

it is necessary to add a newborn baby to your policy within

been paid a benefit for a particular aid, you must wait for a

two months after their date of birth. Thus converting your

certain period of time from the date of purchase of the item

policy to either a family or single parent family cover.

before you are entitled to a benefit for the replacement of that item. These BLP’s apply per Member.

The baby will not have to serve any waiting periods* that have already been fully served by the policyholder providing that the change is made to the policy within this time frame.

BENEFIT REPLACEMENT PERIOD

If you want to change your existing level of extras cover for ITEMS

one that is more extensive you will be required to serve waits on the increased benefits only.

Blood glucose monitors — (Glucometer) Blood pressure monitor C-pap 3 years

machine and humidifier and initial mask and tubing Tens machine — (not circulation booster) Hearing aids

[ 38 ]

*For policyholders with no previous cover, the pre-existing condition waiting periods may apply to the baby within the first 12 months.

Waiting periods 2 MONTHS HOSPITAL Hospital:

2 MONTHS

12 MONTHS

12 MONTHS

EXTRAS Pre-existing conditions

For all hospital treatments or services where there are no pre-existing conditions (excluding accidental Injury^) Elective surgery Obstetrics-related services Mechanical aids & appliances Mammograms & bone density tests Surgery for assisted fertility programs such as IVF or GIFT, sterilization or vasectomy, elective surgery

Dental:

Major dental services:

Diagnostic — includes

Periodontics — specialised gum

examinations & consultations

treatment

Preventive — includes cleaning

Surgical extraction — includes

and scaling, fluoride treatment,

wisdom tooth extraction

mouth guards etc.

Endodontic services — includes

Simple extraction

root canal therapy

Restorative — composite and

Crowns and bridges

amalgam fillings

Prosthodontics — dentures

General services — includes occlusal splints Optical

Child birth education

Acupuncture Audiology Chiropractor Massage therapy

Hearing aids Osteopathy Australian hearing services

Naturopath

Nursing home type patients

Dietician

Nursing

Foot orthoses & orthopedic shoes

Hospital boarder

Occupational therapy Orthoptic therapy Physiotherapy Exercise physiology Podiatry Psychology Speech therapy Pharmaceutical School and sporting accidents Healthy Living benefits

^The 2 month Waiting Period is waived for treatment arising from an accident (excluding a school and sporting accident) that occurred after joining.

[ 39 ]

GOVERNMENT INITIATIVES AUSTRALIAN GOVERNMENT REBATE ON PRIVATE HEALTH INSURANCE The Australian Government Rebate on private health insurance was introduced in January 1999. The basis for the

LIFETIME HEALTH COVER Lifetime Health Cover (LHC) is a Federal Government initiative that came into effect on 1 July 2000. It is designed to reward people who join a private health fund earlier in life by securing lower premium payments.

scheme’s introduction was for the Federal Government to

Under LHC, if you don’t have hospital cover on the 1st of

assist Australians to reduce the premium costs of their private

July following your 31st birthday, then for each year you

health cover. The government has recognised Australians

delay joining, your membership fees will increase. In fact

with private health insurance not only make a substantial

you will pay a loading of 2% on top of the base rate on your

financial contribution to their own healthcare but also to

premium (or on your share of a couple or family premium)

Australia’s healthcare system, by taking pressure off the public

up to a maximum loading of 70%. Once you have stayed with

health system. The amount of rebate assistance provided

private hospital cover for 10 continuous years and keep it,

is determined by both the age of the oldest policyholder

you stop paying that loading as a reward for commitment

and income* level. It is your responsibility as a Member to

to the private health system. Be aware that the loading may

nominate an appropriate rebate tier(based on your age

be reapplied if you then cease to hold a hospital cover and

and income*.

subsequently take it up again.

The Australian Government Rebate on private health

By joining hospital cover as soon as possible, you can stop

insurance applies to the base hospital premium component

this continuous increase and your loading will be frozen at

and will not apply to any Lifetime Health Cover loading

the rate that matched your age when you joined (known as

component of the hospital premium. The rebate also applies

your Certified Age at Entry or CAE). As long as you maintain

to the extras component of your policy premium.

your Hospital cover, your loading percentage will continue to

You can choose to claim the appropriate rebate up front to lower the policy premium, however you can also nominate to claim a lower rebate than your entitlement, or in fact no rebate at all and reconcile this when lodging your annual tax

be set according to your CAE and will not increase each year.

People who took out and maintained a hospital cover dated prior to 1 July 2000 will pay a base rate premium regardless of their age.

return. The majority of people with private health insurance

People born before 1 July 1934 can take out hospital cover at

who are eligible for the rebate claim it as a reduction in the

any time and pay only the base rate.

amount of premiums they pay to us for their health cover.

When transferring hospital cover from another registered

Since 1 April 2014 the Australian Federal Government now

fund, make sure you use your CAE (the age at which you

indexes the private health insurance rebate by the lesser

joined), rather than the age you are now, to calculate the

of the Consumer Price Index(CPI) or the actual average

correct premium.

increases in premiums charged by insurers. If you are not eligible for the Rebate this change does not affect you. If you are eligible for the Rebate this change effectively means

Under the Federal Government’s LHC legislation the loading of 2% does not apply to extras cover.

that the rebate percentage you receive today is going to be

Note: Due to the Australian Government’s rounding rules

reduced every year that the average increase of premiums for

for the rebate, actual premiums for hospital and/or extras

all insurers is higher than the CPI.

coverage can vary from this calculation by up to 10 cents.

Premiums quoted by the Fund will take into consideration all of these variables once you have nominated the appropriate rebate tier. For current financial year income thresholds and rebate amounts please refer to table over page 41.

[ 40 ]

MEDICARE LEVY SURCHARGE

The MLS will not apply to any Queensland Country policyholder who

The Medicare Levy Surcharge (MLS) is levied on payers of

has a hospital cover.

Australian tax who do not have hospital cover under a private health insurance policy and who earn above a certain income.

The MLS is applied on a pro-rata basis.

The surcharge aims to encourage individuals to take out

If you take out hospital cover part-way

private hospital cover, and where possible, to use the private

through the financial year you’ll still avoid

hospital system to reduce the demand on the public health

the surcharge but only for the period you held hospital cover.

care system.

For current income thresholds refer to table below.

People who don’t have private health insurance hospital cover,

^ This information is intended as a guide only and does not take into account your

and who have an income for MLS purposes^ in excess of the

personal circumstances. There is a different income test for the application of

thresholds set down by the Australian Taxation Office (ATO) pay a surcharge of between 1.0% to 1.5% of income^. This

MLS, which is known as income for Medicare levy surcharge purposes. For more information about what is included as income for Medicare levy surcharge purposes, please seek the advice of your tax agent or Accountant or contact the Australian

surcharge is in addition to the standard MLS of 2%

Taxation Office (ATO) Help Line on 132 861 or visit the

of taxable income.

ATO website https://www.ato.gov.au/Individuals/Medicare-levy/Medicare-levysurcharge/Income-for-Medicare-levy-surcharge,-thresholds-and-rates/

AUSTRALIAN GOVERNMENT REBATE ON PRIVATE HEALTH INSURANCE REBATE TIER SINGLES

Income Threshold (2016/17 financial

year)

FAMILIES

Income Threshold (2016/17 financial

year)

BASE TIER

TIER 1

TIER 2

TIER 3

UP TO $ 90,000

$ 90,001-105,000

$105,001-$140,000

$ 140,001 AND ABOVE

UP TO $ 180,000

$ 180,001-210,000

$210,001-$280,000

$ 280,001 AND ABOVE

REBATE ENTITLEMENT^ BASED ON AGE (OF THE OLDEST PERSON ON YOUR COVER) AND INCOME*

< AGE 65

26.791%

17.861%

8.930%

0%

AGE 65-69

31.256%

22.326%

13.395%

0%

AGE 70+

35.722%

26.791%

17.861%

0%

0%

1%

1.25%

1.50%

MEDICARE LEVY SURCHARGE

Rebate percentages shown are equivalent to the actual rebate entitlement and are effective for payments made from 1 April 2016 and are indexed annually.

This information is intended as a guide only and does not take into account your personal circumstances. For information on the income including the calculation method for this income known as income for Medicare Levy Surcharge purposes, please seek the advice of your tax agent, financial advisor or contact the Australian Taxation Office (ATO) Help Line on 132 861 or visit their website at https://www.ato.gov.au/Individuals/Medicare-levy/Medicare-levy-surcharge/Incomefor-Medicare-levy-surcharge,-thresholds-and-rates/

[ 41 ]

PHARMACEUTICAL The Pharmaceutical Benefits Scheme (PBS) is a national pharmaceutical scheme funded by the Federal Government where patients contribute to the cost of prescribed drugs.

Queensland Country doesn’t cover pharmaceutical prescriptions covered by the PBS or for contraceptives and items normally available without prescriptions.

We’ll pay benefits as outlined in the extras table up to the claim limit for this category, with consideration to the maximum individual script benefit limit. The benefit amount per script is calculated by deducting the PBS General Patient

PRIVATE HEALTH INSURANCE COMPLAINTS If for any reason you’re not happy with something then please let us know. We will do whatever we can to fix it.

While we’re absolutely committed to providing you with the best possible service, we are only human and sometimes we may make mistakes or see things differently from our policyholders, so we have processes in place to make sure you’re absolutely satisfied.

Contribution amount from the purchase price (up to script

If you have any complaints, and we hope you don’t, then

benefit limit). This is conditional on the pharmaceutical

please contact us immediately -

prescription being listed in the MIMs Schedule as S4 or S8

Call:

1800 813 415

Website:

www.qldcountryhealth.com.au

Email:

info@qchfund.com.au

Address:

Queensland Country Centre

Level 1, 333 Ross River Road

and being dispensed in quantities in accordance with this schedule. We also pay for compound pharmacy scripts, as long as one of the ingredients meets this criteria. The PBS General Patient Contribution amount is updated by the Government and changes every year on 1 January. As at 1

January 2016, the PBS contribution is set at $38.30.

It’s important to note that a doctor’s letter may be required

Aitkenvale, QLD 4814

We take all complaints very seriously and our understanding

for some Pharmacy items.

staff are here to answer any questions and allay any fears

PRIVATE HEALTH INSURANCE CODE OF CONDUCT

priority and if you’re not completely happy with our service

Queensland Country Health is a signatory to the Private Health Insurance Code of Conduct. The code was developed by the health insurance industry and aims to promote the standards of service to be applied throughout the industry.

you may have. Your health and wellbeing is our number one we would like to know about it.

If after we’ve done all we can to rectify the situation and you’re not satisfied with the outcome, you have every right to contact the Private Health Insurance Ombudsman (PHIO).

The Ombudsman is an independent body formed to help resolve complaints and to provide advice and information

A full copy of the Code is available at

to members of private health funds. You can contact the

www.privatehealth.com.au/codeofconduct

Ombudsman directly at: Website:

www.ombudsman.gov.au

Online: www.ombudsman.gov.au/ making-a-complaint/contact-us

SUMMARY OF RULES The “In more detail” pages contain only a summary of the fund rules. The complete rules of the health benefits fund

Fax:

02 6276 0123

Email:

phio.info@ombudsman.gov.au

Phone: 1300 362 072 (Select option 4 for Private Health Insurance)

set out in full the terms and conditions of membership and liability under the fund.

These rules are available for inspection at Queensland Country Centre, Level 1, 333 Ross River Road, Aitkenvale QLD 4814.

Write to:

Private Health Insurance Ombudsman

Commonwealth Ombudsman

GPO Box 442

Canberra, ACT 2601

Australia Consumer website: www.privatehealth.gov.au Enquiries:

1300 737 299

PRIVACY POLICY We at Queensland Country are committed to managing personal information in accordance with our Privacy Policy.

Our Privacy Policy is available for your information on our website at www.qldcountryhealth.com.au, or from any of our Retail Centres or Queensland Country Credit Union branches.

[ 42 ]

QUEENSLAND COUNTRY HEALTH FUND Townsville Contact Centre: 1800 813 415 Email: info@qchfund.com.au Web: qldcountryhealth.com.au HEAD OFFICE Queensland Country Centre, Level 1 333 Ross River Road Aitkenvale Qld 4814 Phone: 07 4412 3500 Fax: 07 4412 3500 Post:

PO Box 42 Aitkenvale Qld 4814

AITKENVALE RETAIL CENTRE Queensland Country Centre 333 Ross River Road WILLOWS RETAIL CENTRE Willows Shopping Centre Kirwan

MOUNT ISA RETAIL CENTRE 70 Camooweal Street Mount Isa BURDEKIN RETAIL CENTRE 186 Queen Street Ayr MACKAY RETAIL CENTRE Caneland Central Shopping Centre QUEENSLAND COUNTRY DENTAL Queensland Country Centre 333 Ross River Road Aitkenvale

QUEENSLAND COUNTRY CREDIT UNION BEAUDESERT

Beaudesert Fair Shopping Centre

BOWEN

37 Williams Street

BRISBANE

MACKAY

Caneland Central Shopping Centre Mount Pleasant Shopping Centre

MOUNT ISA

70 Camooweal Street

Post Office Square Shop 2/270 Queen Street (Adelaide Street entrance)

STANTHORPE

BURDEKIN

Tieri Shopping Centre

Ayr - 186 Queen Street Home Hill - 6 Eighth Avenue

CAIRNS

Smithfield - Smithfield Shopping Centre Earlville - 514â&#x20AC;&#x201C;516 Mulgrave Road

CHARTERS TOWERS

Town Plaza Shopping Centre

COLLINSVILLE 13 Stanley Street

3 Maryland Street

TIERI

TOWNSVILLE

Aitkenvale - Queensland Country Centre, 333 Ross River Road Deeragun - Deeragun Village The Townsville Hospital - Main Foyer, Douglas Magnetic Island - Nelly Bay Kirwan - Willows Shopping Centre

WEIPA

Cnr Kerr Point Drive & Commercial Avenue

JIMBOOMBA

Jimboomba Shopping Centre

[ 43 ] [ 43 ]

HOW TO JOIN

It’s super easy to join Queensland Country Health Fund.

Call us on 1800 813 415 and complete an application over the phone

Visit a retail centre and let one of our friendly staff assist you

Go to our website and apply online through our online application process. The web address is www.qldcountryhealth.com.au

Drop in to one of Queensland Country Credit

Union’s 21 branches throughout Queensland

Queensland Country Health Fund Ltd ABN 18 085 048 237 is a Registered Private Health Insurer.