Brochure membership guide

MEMBERSHIP GUIDE This guide should be read in conjunction with one or more of the following: Health Benefits Guide Young Extras brochure

CONTENTS Welcome to Queensland Country Health Fund

4

Your Membership Card

8

Safeguard your Membership Card

8

Additional cards

8

Replacement cards

8

Transferring from another fund (portability) 9

Policy types

11

Dependant Children

12

Dependants to age 21

12

Student dependants up to age 25

12

Apprentice dependants up to age 25

12

Adult dependants up to 25

12

Cooling off period

9

Adding or removing a person from your membership 13

Medicare eligibility

9

Adding a newborn baby

13 14

Online Member Services

10

Suspending your membership

Registering is easy

10

General conditions for suspension 14

Membership Year

10

Overseas travel

Level of cover

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11

15

Medicare Levy Surcharge warning 15

Waiting periods

16

Benefit Limitation Periods

19

Pre-existing conditions

21

Restrictions and exclusions

22

Claiming your benefits

23

Excess 26

Direct debit request service agreement 39 Privacy Policy

42

Queensland Country Health Fund rules

42

Compliments and complaints

43

How to claim for extras

28

Private Health Insurance Code of Conduct

44

Paying your premiums

34

Intermediary remuneration

44

Government initiatives

36

Contact us

46

Australian Government Rebate on private health insurance

36

Medicare Levy Surcharge

37

Lifetime Health Cover

38

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Welcome

TO QUEENSLAND COUNTRY HEALTH FUND

This Membership Guide has been designed to help simplify private health insurance, and allow you to better understand your membership entitlements and responsibilities.

This Guide summarises Queensland Country Health Fund rules and policies. It also provides useful information about your Membership Card, online services, claiming, managing your membership premiums, and much more.

Please take some time to read this guide carefully particularly the sections on: • Waiting periods, including the pre-existing condition or ailment rule (page 21).

• Restricted and excluded benefits. If you have selected our Intermediate Hospital cover and Singles and Couples Combined Cover take time to review the list of restricted or excluded services and the explanation of how this may affect you if seeking treatment for these services (page 22).

• Benefit Limitation Periods (BLP). If you are new to private health insurance hospital cover (or it has been over 63 days since your cover lapsed) ensure you fully understand which services this applies to and how it may affect your entitlement to benefits (page 19).

Please read all documentation carefully before any decision is made to purchase a health insurance product. Retain all documentation for future reference.

It is important to contact us if you or anyone else on the membership are going to need treatment in order to check your benefit entitlement. Our contact details are listed in the back of this Guide.

And remember, as with all forms of insurance you should review your health cover from time to time to ensure you continue to have the cover that is best suited to you.

The information in this Membership Guide is current as at 12 December 2016 and is subject to change.

Thank you for choosing Queensland Country Health Fund!

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Before you get started...

Here is an explanation of some of the terms commonly used in this Guide: ‘We’, ‘us’ ‘our’ and ‘Queensland Country’ means Queensland Country Health Fund Ltd. ‘You’ means any Member of Queensland Country to whom this Guide applies.

‘Member’ means any person covered under a Queensland Country private health insurance policy.

‘Membership’ comprises all the Members covered under a Queensland Country private health insurance policy.

‘Policyholder’ is the person who ‘owns’ the Queensland Country private health insurance policy. This is the person we contact when we need to communicate about the policy.

Closed Products Throughout this Guide, reference may be made to health insurance products that are no longer available for sale by Queensland Country to new Members. These products are referred to as Closed Products.

Members covered by any of our Closed Products can be assured that we will regularly review the benefits paid under these products to ensure the benefits paid are aligned with the cost of treatment for the services covered.

A policyholder remains eligible to retain cover under a Closed Product providing they held this Closed Product cover prior to Queensland Country making this product no longer available for sale.

Role of the policyholder

By joining Queensland Country, you (as the policyholder) have agreed that you are responsible for the policy and that you: • will ensure that all information supplied to Queensland Country is true and correct.

• will keep your membership information up-to-date and notify us of any changes as soon as possible.

• will be the recipient of all correspondence for the policy.

• will ensure that all persons on the membership are aware of and abide

by Queensland Country’s Fund rules, policies, the information in this Guide and its Privacy Policy.

• agree to make the minimum advanced premium payments required to keep the policy financial.

• will be the only person who can add others to the policy.

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Delegated authority The policyholder may delegate authority to a nominated adult person to: • request policy details and other personal information, • change or update policy details, and • submit claims.

This authority generally takes the form of a written request to Queensland Country by the Member, or a person appointed: • as Attorney under a Power of Attorney.

• as Administrator by an Order of the Queensland Civil and Administrative Tribunal (QCAT) or equivalent body if appointed outside Queensland (order must be registered by QCAT).

• All delegations of authority are to be provided in writing and signed by the person of authority. Requests received by email will not be valid.

Please note: Disclosure of personal information relating to claims for a dependant aged 16 years and over will only be made available to a parent or legal guardian if authorised in writing and signed by the dependant under a delegation of authority

UNDERSTANDING AND MAKING THE MOST OF YOUR MEMBERSHIP

Here are a few things you can do to get your membership up and running smoothly…

1

If you have just joined us you will receive a welcome pack. This includes:

• Your Certificate of Cover This is a summary of your membership information, including your level of cover and your Australian Government Rebate on private health insurance entitlement.

• Product Summary of your hospital and/or extras cover This a snapshot of what you’re covered for, along with applicable waiting periods and exclusions or restrictions that apply to your cover.

• Standard Information Statement (SIS) This is a high-level summary of your cover and is provided to you in accordance with private health insurance legislation. The benefits and premiums on this statement are indicative only, and your actual premium amount can be found on your Certificate of Cover.

• Privacy notification In order to comply with our obligations under the Privacy Act we are required to provide you with a copy of our privacy notification.

Review all this documentation and if you have any questions or queries we’re here to help, so please contact us.

2 Register for Online Member Services (OMS) by visiting www.qldcountryhealth.com.au. The Register icon is located at the top right hand corner of the screen.

Once you have registered using your membership number and password, click on the Login tab and enter your membership number and password.

Now you’re ready to go!

3 Confirm your election in respect to the Australian Government Rebate on private health insurance once logged in to OMS you will be prompted to complete the rebate confirmation of the Australian Government Rebate Form if you have not completed it already.

Scroll to the bottom of the page and tick the declaration box, select View Form. To complete select Accept at the bottom of the page.

4 Email address Make sure we have your email address so we can communicate with you quickly and easily. You can update your contact details through OMS. We will also keep you updated each month via our monthly e-newsletter Health eBYTES - make sure you’re opted in to receive your copy!

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YOUR MEMBERSHIP CARD Your Membership Card is important. It identifies you as a Member of Queensland Country Health Fund when you go to hospital or make an electronic claim at an allied health service provider (e.g. dentist, optometrist, etc) displaying the HICAPS or iSoft logo.

Your Membership Card shows your membership number, who is covered and the date you joined, which is identified as your anniversary date. The importance of this date will be covered later in this Guide. If you add or remove people covered by the membership a new card will be issued.

Safeguard your Membership Card Your Membership Card gives your health provider direct access to your benefits.

Here are a few tips to help you safeguard your Membership Card: • Treat your Membership Card like a credit card and keep it in your wallet or purse.

• Advise us immediately if your card is lost or stolen.

• Never leave your card with a health provider.

• Always check the health provider’s receipt carefully before signing.

Additional cards As the policyholder you can request additional Membership Cards for those listed on your membership who are 16 years of age or over and/or living at another address.

Replacement cards If your Membership Card is damaged or has been misplaced you can order a replacement card.

To do this, you can log on to Online Member Service (OMS) via our website www. qldcountryhealth.com.au and order a replacement card yourself- it’s that easy (if you are not already registered for OMS please refer to page 7 for details on how to register) or alternatively you can contact us on 1800 813 415 or email info@qchfund. com.au and a replacement card will be arranged for you.

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Transferring from another fund (portability) When transferring from another health fund you will not have to re-serve applicable waiting periods provided that: • you join Queensland Country within 63 days of the date on which you ceased to be covered by another Australian registered health fund.

• you have served the applicable waiting periods with that former health fund.

• we have received your Transfer Certificate from that health fund showing previous level of cover.

Benefits will not be paid by Queensland Country for any services during the lapse period between the date you ceased cover with your former health fund and the date you join Queensland Country. We are unable to backdate the membership join date.

If these conditions are satisfied from the date of joining, you will not have to serve the normal waiting periods when transferring to an equal or lower level of cover. However when additional benefits or better conditions are gained by an Inter-fund transfer, normal waiting periods will apply to the additional or upgraded benefits and conditions.

In instances where you are transferring from another Australian registered health fund policy that did not provide any benefit entitlement for hospital treatments or services, you will be required to serve the applicable waiting periods for that hospital treatment or service with Queensland Country.

Any loyalty bonus or other similar entitlements (for example increased limits for orthodontics or package bonuses) built up with your former health fund will not transfer to Queensland Country. Where limits apply, including lifetime limits, any benefits paid under your previous cover are treated as if Queensland Country has paid them and this may affect the payment of benefits on items or services already claimed under your previous policy cover.

If you transfer to Queensland Country more than 63 days after your previous cover has ceased, you will have to serve all waiting periods applicable to your new cover.

Cooling off period If for any reason you change your mind within the first 30 days of commencement of your new policy or upgrade of cover and have not yet made a claim, we will cancel your policy and refund any premiums you have paid in relation to this cover.

Medicare eligibility Your Medicare Card indicates your eligibility for Medicare. Holding a reciprocal (yellow) Medicare Card or no Medicare Card at all, will affect the benefits you’re entitled to receive under private hospital cover. As a result you could be left with very large out-of-pocket expenses if you receive hospital treatment.

If you or any person on the membership have limited or no access to Medicare, you should call us to discuss whether the cover you’ve chosen is the most suitable.

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ONLINE MEMBER SERVICES (OMS) The Queensland Country Health Fund website provides you with the convenience of managing your membership online, at a time that suits you.

From the website you can access online services, which allows you to: • View your membership details • View your cover details • Update your address and contact details • Add dependants • L odge a claim for ancillary services (extras) See online claiming information in this Guide for further details • View your claims history • View your remaining limits • View your payment details • Set up direct debit for the automatic payment of your premiums • Set up direct credit for receiving your benefit payments • Change your password • Download your annual Private Health Insurance Tax Statement • Make a contribution payment by credit card • Order replacement Membership Cards

Registering is easy To register for Online Member Service (OMS) go to www.qldcountryhealth.com.au. To access OMS, all you need to do is register on the home page of our website www.qldcountryhealth.com.au. The Register icon is located at the top right hand corner of the screen. Once you have registered using your membership number and choice of password, click on the Login tab and enter your membership number and password. Now you’re ready to go!

Membership Year

Queensland Country Health Fund policies operate on a unique and individualised Membership Year. The original establishment date of your policy represents the start date of this Membership Year. This start date is referred to as the anniversary date of your membership. The anniversary date is printed on your Membership Card for your convenience.

Membership claim benefit limits and sub limits are based on an ongoing 12 month cycle from the anniversary date of the establishment of your membership. In order for you to maximise the benefits available on your chosen cover, it is important to understand when your Membership Year starts and finishes. An allocated benefit not claimed during any one Membership Year does not accrue to the next.

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The membership anniversary date, and proceeding Membership Year cycle is also the basis for the determination of payment of a hospital excess (if applicable) when admitted to hospital for an inpatient service. Refer page 26 of this Guide for further information on membership excess.

Please note: New person/s added to the policy after the original membership start date will have a different anniversary date applied for a period after joining in line with the waiting periods applicable to joining, transferring or upgrading their cover.

After all applicable waiting periods have been served, the individual’s anniversary date will synchronise with that of the membership they joined.

We believe that using the anniversary date of joining our health fund is the most fair and appropriate basis for determining the annual benefits available to you under your chosen level of cover.

Level of cover A person may be admitted as a policyholder Queensland Country to one of the following cover options: • Any one level of hospital cover, • Any combination of one level of hospital cover and one level of ancillary cover (extras), • Any combined product cover, such as Singles and Couples Combined Cover (Closed Product), or • Young Extras with no hospital cover.

Policy types Queensland Country Health Fund offers policies, which cover the following combinations of eligible persons: Single Membership - This consists of: • cover for one (1) person only.

Family Membership - a policy consisting of: • 2 Adults (and no-one else) • 2 or more people, none of whom is an adult • 2 or more people, only 1 of whom is an adult (Single Parent cover) • 3 or more people, only 2 of whom is an adult • 3 or more people, at least 3 of whom are adults (Extended Family cover is the only eligible option - refer to “Adult Dependents up to 25” on page 12) Where special circumstances exist, for example where one person would like to pay for the membership of another person, please contact us for further details on the conditions for this type of arrangement.

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DEPENDANT CHILDREN A dependant child means a legitimate child, an adopted child, a foster child, a stepchild, or an exnuptial child of the policyholder who has not attained the age of 21 years.

Dependants up to age 21 Your dependant child can remain covered under your family policy up to age 21 years.

The good news is that they can contact us and move straight across to their own single membership without having to serve any waiting periods, providing they have already been served on the family policy. The transfer must be arranged within 63 days of the termination date of the dependant child from the family policy.

Student dependants up to age 25 If your dependant child is single and studying full-time at a school, college or university they can remain covered under your family policy up to age 25 years.

To remain covered under your family policy their student status must be confirmed at the start of each school or study year. Student dependant status no longer applies when study ceases, defers or reduces to part-time or when the dependant child enters into a married or de facto relationship.

Apprentice dependants up to age 25 If your dependant child is single and working or training as an apprentice and earn no more than $30,000 p.a they can remain covered under your family policy up to age 25 years.

To remain covered under your family policy their apprentice status must be confirmed at the start of each training year.

Apprentice dependant status no longer applies when training ceases, the income threshold is exceeded or when the dependant child enters into a married or de facto relationship.

Adult dependants up to 25 If dependant children aged between 21 and 25 years wish to remain on your family policy (as long as they are not married or in a de facto relationship) our Extended Family* cover option will allow these eligible dependants to stay on your Extended Family policy up to the age of 25 years. *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, packaged products with Top or Intermediate Hospital with Select or Young Extras, Singles and Couples Combined Cover (Closed Product) or Public Hospital and Extras packaged covers.

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Adding or removing a person from your membership Let us know if you would like to add or remove a person from your membership.

Any person being added to the membership may have to serve waiting periods for benefits, depending on their previous cover or health insurance history. We will ensure that you continue to have the best level of cover for your needs if changes are made to your policy.

Adding a newborn baby If you have a single membership type, to add a newborn baby to your policy you will need to do this within 2 months from the date of their birth. The child will not have to serve any waiting periods* that have already been served by the policyholder, providing that the change is made to the policy within this time frame. The policy alteration will be backdated to the child’s date of birth. This change of membership means that you will have higher policy premiums.

If a newborn is added to the policy later than 2 months after their date of birth, the child will have to serve all waiting periods applicable to their cover commencing from the date they are added to the policy.

If you already have a couple or family membership for a period of 12 months, you can add your newborn by advising us of the baby’s name and date of birth. Their cover will be immediate with no waiting periods. *For policyholders with no previous cover and pre-existing conditions, waiting periods may apply to the baby within the first 12 months of cover.

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SUSPENDING YOUR MEMBERSHIP

General conditions for all types of membership suspension: • To suspend your cover you must make application to Queensland Country Health Fund, prior to the nominated suspension date. Applications for suspension will not be processed retrospectively.

• The period of suspension does not qualify for the purpose of completing Benefit Limitation Periods (BLP), or accumulative benefit entitlement.

• At the time of suspension, all waiting periods must have been served on your membership.

• Premiums must have been paid up to the date of suspension before a suspension can be considered.

• The total membership must be suspended.

• Benefits are not payable for treatment received during the period of suspension.

• For any condition, ailment and/or illness developed in the suspension period, pre-existing condition waiting periods (e.g. 12 months hospital cover) will apply.

• You must reactivate your membership within one month of the last date of suspension or the maximum date of suspension to avoid extra waiting periods.

• If your membership is not resumed from the last date of suspension, you may not be covered for hospital treatment and may also impact your premium under the Lifetime Health Cover (LHC) loading. For more information on how periods of absence may affect your premium, refer to the section of this Guide on LHC.

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Overseas­­ suspension If you’re going to be absent from Australia for a period of more than (four) 4 weeks and less than 24 months, you may apply for a suspension on your membership.

We may agree to your request based on the following criteria: • The suspension date will be the day after departure from Australia.

• T he total membership must be suspended; all those covered by the membership (including dependants) must be travelling overseas.

• Y ou will be required to apply in writing for reinstatement within one month of re-entry to Australia. Proof of your re-entry date must accompany this request for reinstatement.

• Proof of re-entry must be in the form of an International Movement Record covering the period of suspension from the original date of departure from Australia. This information can be obtained from the Department of Immigration on 131881. A Request for International Movement Records (Form 1359) can be accessed on the Department’s website www.immi.gov.au • The reinstatement date will be the date of re-entry into Australia.

If you are travelling for leisure you should consider taking out travel insurance.

A breach of any of the above conditions could result in the Membership Suspension Agreement being declared null and void.

Medicare Levy Surcharge (MLS) warning With the suspension of your private health insurance policy, you may be liable for the Medicare levy surcharge (MLS) if your income for MLS purposes exceeds the relevant threshold and you are still a resident for tax purposes during the time you are away. More information is available on the website of the Australian Taxation Office www.ato.gov.au under the heading “Medicare levy”.

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WAITING PERIODS

What is a waiting period?

A waiting period is an initial period of health fund membership, which no benefit is payable for certain procedures or services.

Waiting periods can also apply to any additional benefits when you upgrade your health insurance cover.

Why do waiting periods apply?

If there were no waiting periods, people could take out cover or upgrade to a higher cover only when they knew they required treatment, or suspected they might require treatment.

Their treatment costs would then have to be paid by the long-term Members of the fund leading to much higher premiums for all fund Members. This would not be fair.

Therefore, when you join a health fund or upgrade your existing cover you may have to wait a period of time before you can claim benefits.

When do waiting periods apply?

Waiting periods apply where a person: • i s insured for the first time or has not been insured within the previous two or more months. • u pgrades to a higher level of cover (includes reducing or removing an excess or copayment). • transfers

from another fund and has not completed our waiting periods for equivalent benefits or chooses to upgrade their cover when they transfer.

Note: When upgrading to a higher level of cover you will be entitled to the benefits applicable to your previous cover for the duration of applicable waiting periods for treatments or services mutually eligible for benefits under both policies.

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Waiting periods that apply to Queensland Country Health cover are: • 12 months for a pre-existing condition (excluding rehabilitation, psychiatric care and palliative care)# • 12 months for any elective surgery# • 12 months for obstetric (pregnancy) related services# • 12 months for surgery for assisted fertility programs such as IVF or GIFT, sterilisation or vasectomy, elective surgery# • 12 months cardio-thoracic procedures - for example open heart surgery# • 12 months for major eye surgery - cataract and eye lens procedures# • 12 months for gastric banding and obesity surgery#^ • 12 months for renal dialysis - for chronic renal failure# • 12 months for hip and knee joint replacement surgery#^ • 12 months for mechanical appliances and artificial aids# • 12 months for treatment under major dental categories including: −− Periodontics - specialised gum treatments# −− Surgical Extraction - includes wisdom tooth extraction −− Endodontic services - includes root canal therapy# −− Crowns and bridges −− Orthodontics - braces etc# −− Prosthodontics - dentures# • 12 months for the supply of hearing aids# • 12 months for childbirth education# • 2 months for all hospital treatments or services where there are no pre-existing condition (excluding accidental injury**) • 2 months for all other dental treatments including: −− Diagnostic - includes examinations and consultations −− Preventative - includes cleaning and scaling, fluoride treatment etc −− Simple extraction −− Restorative - composite and amalgam fillings −− General services - includes occlusal splints.

• School and sporting accidents* are subject to a 2 month waiting period.#

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• 2 months for optical services • 2 months for extras therapies including: −− Acupuncture# −− Audiology# −− Chiropractor −− Foot orthoses and orthopaedic shoes# −− Massage Therapy/Bowen Therapy/Myotherapy −− Osteopathy# −− Naturopathy# −− Dietician# −− Occupational Therapy# −− Orthoptic Therapy# −− Physiotherapy −− Exercise Physiology# −− Podiatry −− Psychology# −− Speech Therapy# • 2 months for Healthy Living benefits • 2 months for Pharmaceutical benefits * An ailment, illness, condition or injury associated with a school accident incurred prior to joining the health fund will be deemed to be a pre-existing condition and will be subject to 12 months waiting period.

Not every health cover product provides benefits for these services/treatments, please check the appropriate Product brochure to determine benefit entitlement conditions for these services.

#

^ Under our Top Hospital cover suite there are Benefit Limitation Periods (BLP) for these services for up to the first 24 months after joining us after having no previous hospital cover or having a lapse in hospital cover for a period greater than 63 days. See BLP information for further details. **Cover for an accident is immediate provided it is not recoverable from another source such as Workers Compensation, third party or other liability provision.

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BENEFIT LIMITATION PERIODS (BLP) A Benefit Limitation Period (BLP) is similar to a waiting period with a key difference.

A BLP is an initial period of time during which only a minimum (restricted*) benefit is paid by us for certain hospital treatments or procedures. A waiting period is an initial period of health fund membership where no benefit is payable for certain services, when joining Queensland Country with no previous health cover, or a lapse in cover in excess of 63 days.

If a BLP applies to a treatment or procedure, after the initial 12 month waiting period has been served benefits for these services are restricted to the minimum default benefit as determined by the Minister for Health and Aged Care for the remainder of the BLP. These default benefits are generally not adequate to cover private hospital costs and will only fully cover shared ward costs in a public hospital.

Undertaking treatment for the following hospital procedures during a BLP, would result in large out of pocket expenses if undertaking treatment in a private facility: • A BLP of two years (24 months) applies to bariatric surgery (weight loss surgery) including but not limited to gastric banding, gastric sleeving or diversion and gastric bypass surgery, including replacement, repair or adjustments.

• A BLP of two years (24 months) applies to hip or knee joint replacements • A BLP of two years (24 months) applies to in-hospital psychiatric treatment

To find out if BLP’s will affect you please turn the page

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Will Benefit Limitation Periods affect me?

I’M TRANSFERRING FROM ANOTHER HEALTH FUND BLP’s do not apply to new Members transferring from another private health insurer or to existing members changing their level of hospital cover, providing they are transferring within 63 days of ceasing their previous cover. The balance of any waiting periods not fully served on transferring from your previous health cover are required to be served prior to entitlement to any benefits in a private or public hospital. * See restricted benefits information in Restrictions and Exclusions section in this Guide.

I’M NEW TO PRIVATE HEALTH INSURANCE OR BEEN OUT OF IT FOR A WHILE! BLP’s will apply to joining Members who are new to private health cover and to Members rejoining after a lapse in hospital cover in excess of 63 days. In these instances applicable hospital waiting periods will need to be firstly served, after which the BLP conditions will apply to the above hospital treatments for the remaining period, up to the first 24 months of membership with Queensland Country.

After the BLP has elapsed, you would be entitled to full benefits for the condition or treatment applicable to your chosen level of hospital cover.

Other hospital treatments or services covered by Queensland Country under your chosen level of cover will not be affected by the BLP restrictions.

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PRE-EXISTING CONDITIONS

What is a pre-existing condition?

A pre-existing condition is an ailment, illness or condition where in the opinion of a medical practitioner appointed by Queensland Country the signs or symptoms of that ailment, illness or condition existed at any time in the period of six months, ending on the day on which the person became insured under the policy.

It is not necessary that you or your doctor were aware of your condition, or that the condition had been diagnosed.

A condition can still be classed as pre-existing even if you hadn’t seen your doctor about it before joining a hospital table or upgrading your hospital cover.

Risk factors, including family history of an ailment or condition, are not signs or symptoms of a pre-existing condition. They will not be considered when deciding whether an ailment or condition is pre-existing.

Who decides if I have a pre-existing condition?

The only person authorised to decide whether you have a pre-existing condition is a medical or other health practitioner appointed by Queensland Country. The practitioner will consider the opinion of and evidence presented by your treating practitioner/s before making an informed judgement.

If you have had your current cover for less than 12 months and need treatment, you should confirm with Queensland Country whether the pre-existing condition waiting period will apply.

Queensland Country may require you and your long-term treating practitioner/s to complete a Medical Report Form in order to obtain facts about your illness. The practitioner appointed by Queensland Country to review your case will need a number of business days to investigate and make an assessment.

Any fee charged by your treating practitioner/s for completion of reports will not be paid

by Queensland Country and will be have to be settled privately by the Member.

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RESTRICTIONS AND EXCLUSIONS

Restricted benefits If a service is covered as a restricted benefit, this means you will be covered with your choice of doctor for shared ward accommodation in a public hospital only.

If you go to a private hospital for a specific service which has restricted benefits, it is likely to result in large out-of-pocket expenses.

Restricted benefits are an amount set by the Government and are generally not enough to cover accommodation costs in a private hospital. No benefit is paid towards the cost of theatre charges raised for restricted services.

Not every health cover product has benefit restrictions, please check the appropriate product brochure to determine benefit entitlement conditions for individual hospital products.

Excluded benefits An excluded service means you will not be covered in a public or private hospital and will not receive a payment from Queensland Country for that service. If you think you may require treatment for any excluded services you may like to consider taking one of our Top Hospital cover products. Not every health cover product has excluded benefits, please check the appropriate product brochure to determine benefit entitlement conditions for individual hospital products.

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CLAIMING YOUR BENEFITS

Going to hospital It’s important to be aware that your hospital cover may not fully cover all of the costs associated with hospital treatment.

If your hospital stay was subject to any waiting periods and/or involved the payment of an excess or any personal expenses (e.g. telephone calls, newspapers, etc.) you will be responsible for the expense and the hospital may require settlement on discharge.

Hospital accommodation benefits do not include other things such as TV hire, telephone calls, newspapers, parking and take-home items. Queensland Country will not pay benefits for these (or similar) items and services. The hospital should discuss any charges with you.

As a Member of the Australian Health Services Alliance (AHSA), Queensland Country has negotiated Purchaser Provider Agreements with most of the participating private hospitals and day hospital facilities Australia-wide. Go to our website to find a hospital most convenient to you www.qldcountryhealth.com.au

Inpatient vs outpatient Hospital cover provides benefits when a member is treated as a private inpatient. An inpatient is someone who is admitted to hospital to receive medical care or treatment.

Services that are provided where a Member is not admitted to hospital are called outpatient services. Outpatient services include things such as visits to an emergency department, a general practitioner (GP) or a specialist.

Under government legislation, Queensland Country is not allowed to pay benefits for outpatient services. This is why we will not pay any benefits when a Member is not admitted to hospital. A rebate may be claimable from Medicare for outpatient services.

Informed financial consent Before going to hospital it’s important to ask your doctor/s and the hospital about any potential out-of-pocket expenses you might incur. This information should be provided in writing before your treatment or hospital admission and is known as informed financial consent.

If you’re admitted in an emergency, there may not be time for the hospital or doctor/s to seek your informed financial consent. Information about your out-of-pocket expenses should be provided as soon as possible after you receive treatment.

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Medicare Benefit Schedule (MBS) and medical services The Medicare Benefit Schedule (MBS) lists all of the medical services subsidised by the Australian government through Medicare. These medical services include: • doctors’ services e.g. general practitioners (GP) and specialists • diagnostic services e.g. blood tests, x-rays and ultrasounds provided by pathologists and radiologists.

Each service listed in the schedule has an item number and a corresponding fee that’s been set by the Government. The benefits we pay for inpatient medical services are based on a percentage of the MBS fee. If an inpatient service is listed in the MBS and included or restricted under your hospital cover Medicare will pay 75% and we will pay 25% of the MBS fee. This means where the provider charges you no more than the MBS fee, you will not have an out-of-pocket expense for inpatient medical services.

Doctors and providers are not restricted to charging the MBS fee and may choose to charge more for a particular service. Where this occurs you may have an out-of-pocket expense depending on their level of participation in our Access Gap cover scheme.

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Doctors’ fees and Access Gap Where your doctor/s charge more than the Medicare Benefit Schedule (MBS) fee, you will be left with an out-of-pocket expense you’ll need to pay. This is commonly referred to as the ‘gap’. To help you reduce or eliminate the gap, Access Gap is available on all of our hospital covers in relation to eligible services.

Access Gap enables Queensland Country to provide a higher benefit in return for your doctor agreeing to charge a ‘no-gap’ or ‘known-gap’ fee. If your doctor agrees, the most you will be out-of-pocket is $400 for each Medicare item number or $800 for obstetric services, plus any excess, co-payment or other costs associated with your hospital stay.

If your doctor won’t use Access Gap, you have the right to find a doctor who will. Access Gap accounts are sent directly to us by the doctor. All other medical accounts should be sent to Medicare first and then forwarded to us with the Medicare statement.

In summary there are a number of possible scenarios when it comes to doctor’s charges and your out of pocket expenses for inpatient hospitalisation: Please note: These scenarios relate to medical costs only. You may have to pay an excess, co-payment or other costs associated with your hospital stay.

No-gap scenario ‘MBS fee only’ Scenario

MBS fee+ Queensland Country benefit

Doctor/s only charges the MBS fee.

Your doctor participates in Access Gap and charges you no out-of-pocket for the treatment you receive as an inpatient. You pay $0

You pay $0

OR Known-gap scenario MBS fee+ Queensland Country benefit + you pay a known-gap Your doctor participates in Access Gap and charges you a limited out-of-pocket of no more than $400 for each Medicare item number or $800 for obstetric services for the treatment you receive as an inpatient.

‘Doctor not participating’ scenario MBS Fee + unlimited doctor’s charges As the doctor is not participating in Access Gap you will pay the difference between the MBS fee and the doctor’s fee for their service.

[ 25 ]

EXCESS

What is an excess?

An excess is the amount you pay up front if you go to hospital or day surgery. The higher the excess the less you pay in premiums.

The excess is applicable to all Members covered and applied to the full cost of hospitalisation, including children or dependants (excluding exempt children as per below) in both public and private hospitals and day surgery facilities.

Calculation of the excess amount will apply to hospitalisations in the order they are processed by Queensland Country.

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 POLICY

MAXIMUM PER MEMBERSHIP YEAR

MAXIMUM PER PERSON PER MEMBERSHIP YEAR

PER MEMBERSHIP YEAR

$250 EXCESS

$250

$250

$500

$500 EXCESS

$500

$500

$1000

NOTE: For Top Hospital products only, there is no excess payable for children 12 years and under If you have a dependant child up to and including the age of 12 years, who needs to be admitted as an inpatient of a hospital or day surgery facility, there would be no requirement for the hospital excess to be paid irrespective of the chosen hospital excess level.* *Note: The excess exemption for children 12 years and under is NOT applicable under our Intermediate Hospital covers or Singles and Couple Combined cover (Closed Product). It is exclusive to our Top Hospital cover suite ONLY.

[ 26 ]

Prostheses Many hospital procedures include the use of prosthetic items (surgically implanted medical devices, such as hip and knee joints and heart pacemakers). The Federal Government regularly issues a Prostheses Schedule to health funds. An industry group of clinical experts review all prosthetic items.

There will be at least one prosthetic item for every relevant procedure that is listed in the Medicare Benefits Schedule (MBS) that is fully covered by your hospital cover (a no gap item).

In some circumstances you and your surgeon may feel it is more appropriate to your individual medical needs to use a prosthetic item from the Prostheses Schedule other than the no gap item. Where the cost of the recommended prosthetic item is above the minimum prosthesis benefit from the Prostheses Schedule, you will be responsible for the additional amount.

It is recommended that prior to your surgery you discuss with your surgeon the cost of the surgery including any out-of-pocket expenses associated with either the surgery and/ or the recommended prosthesis item.

Benefits are not payable for any prosthesis associated with an excluded service under your hospital cover.

Mechanical appliances and artificial aids Eligibility for benefits for a wide range of mechanical appliances and artificial aids is only available under our Top Hospital cover suite. Benefits for some items are restricted to hire only for a maximum period of three (3) months. Benefit replacement period restrictions also apply to some items.

When claiming for these items, a letter from your doctor or relevant practitioner is required and in some circumstances only after an inpatient hospitalisation. Prior to purchase or hire of any mechanical appliance or artificial aid, please contact the us for the conditions of claiming the benefit.

Length of stay All Queensland Country hospital covers provide Members with cover as long as they require hospital treatment. Members must obtain certification of ongoing acute care after 35 days of continuous hospitalisation. If such certification is not provided, a lower benefit will be paid.

[ 27 ]

HOW TO CLAIM FOR EXTRAS

Easy on the spot claiming Your Queensland Country Health Fund Membership Card enables your benefit to be paid directly to participating allied health service providers who display the HICAPS or iSoft logo. After the services have been provided, your Membership Card will be swiped and your claim processed in seconds. The appropriate benefit for your level of cover is automatically credited to the health care provider, so you only need to pay the difference (if any) between the service cost and benefit. It is fast, convenient and there are no claim forms to fill in.

Major dental item benefits may not be able to be claimed through HICAPS or iSoft in the first 12 months of Membership with Queensland Country. Orthodontic benefits will not be able to be claimed at all through the HICAPS or iSoft systems.

SERVICES THAT CAN BE CLAIMED ONLINE#

SERVICES THAT CAN’T BE CLAIMED ONLINE*

Acupuncture

Pharmacy

Audiology

Group therapy services e.g. pilates

Chiropractic

Major dental (orthodontics, periodontics, surgical extractions, crowns or bridges, prosthodontics)

General dental Dietetics Homeopathy Massage Naturopathy

Any service that holds a 12 month waiting period Any service that pays a % of cost rather than a set benefit

Occupational therapy

Healthy Living benefit

Optical

Medical access gap and hospital claims

Osteopathy

Two way medical claims that have been processed by Medicare

Physiotherapy Podiatry (consultations only) Psychology Speech therapy

# Some of these services are not available on all extras covers. Please refer to your cover details to see what you are covered for.

[ 28 ]

How can you claim on these services?

We have six (6) options available, so you can choose your preferred method. Visit qldcountryhealth.com.au/members/claims *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

Fast online claiming We’ve now made it even easier to claim for a wide range of services when on-the-spot claiming isn’t available through your provider. Simply go online using your PC, tablet or smart phone! Log in to Online Member Services (OMS) through our website where you will find instructions on how to submit your claim, it’s really easy!!

Eligibility: • Hold an extras product • Policy is financial (paid up to date) Conditions: • Claim limit of $400 per day per person • The service being claimed must have been provided within the last 3 calendar months • Q ueensland Country does not require receipts to be sent in for online claims however subject to random reviews you may be required to present these receipts. Please retain your original receipts for 12 months after submission of your claim/s.

• Services must be provided by approved practitioners in private practice

Direct claims payment service Access your benefits quickly and easily with our direct claims payment service. Once we receive and process your claim, your benefits will be deposited into your nominated bank, credit union or building society account. You will not have to waste time in bank queues, or wait for the cheque to clear.

To register an account for direct claims payment: • call or email the details of your preferred direct claims payment account, • complete the account crediting information section on our claim form, or • log in to Online Member Service (OMS) and add or change direct credit details

By email To save time, you can also email us the completed claim form and associated invoices or receipts. If you use this method, please keep your original documents for a period of seven (7) years for audit purposes.

[ 29 ]

By fax To claim your benefit via fax, send through your completed claim form and original receipts directly to us on 07 4412 3500. We will then process and send benefit remittance via direct credit to your nominated bank, credit union or building society account.

Please keep the original invoices/receipts for a period of seven (7) years for audit purposes.

By mail To claim your benefit by mail, complete a claim form, attach your original invoices/receipts, and mail them to us.

Direct claims payment service To save time, you can also email us the completed claim form and associated invoices or receipts. If you use this method, please keep your original documents for a period of seven (7) years for audit purposes.

In person If you wish to claim in person you can visit one of our Health Fund Retail Centres or any Queensland Country Credit Union branch. Contact details for all of the above methods can be found in the “Contact Us� section in the back of this guide.

Obtaining a claim form Claim forms are available for download from our website, by phoning 1800 813 415 or from your local Queensland Country Credit Union branch.

Paid accounts If you have already paid the health care provider, we can credit your benefit payment directly into your nominated bank, credit union or building society.

Unpaid accounts When you submit a claim directly to Queensland Country for a service where the account is unpaid, benefits will be paid directly to the provider.

Where your provider submits a claim directly to Queensland Country or you send in an Access Gap Cover endorsed account; we will also pay your provider directly.

[ 30 ]

Things to remember when claiming • A claim for benefits must be lodged within two (2) years of the date of the service.

Benefits will be refused if a claim is lodged after this period.

• For

Queensland Country to assess your claim all invoices or receipts must be originals (or provider endorsed duplicates) and include the: −− appropriate item number or full description of the service or product −− patient’s name −− date of service −− fee charged −− provider’s name, qualifications and practice address, and provider number (if applicable) −− tooth numbers are required on dental accounts where treatment has taken place on individual teeth.

• Benefits

and limits are assessed having regard to the date on which the services were rendered or product supplied, except for courses of orthodontic treatment.

• Limits renew each anniversary date of your membership.

• Services

must be provided by approved practitioners in private practice, or salaried doctors in public hospitals.

• All documents submitted in connection with a claim become the property of Queensland Country, unless otherwise agreed, by the health fund.

• Benefits

are not payable for claims for services rendered while premiums are in arrears or the membership is suspended.

• Benefits

are not payable, or may be payable at a reduced rate, during any applicable waiting periods.

• B enefits payable on hospital services within a designated Benefit Limitation Period (BLP) 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.

• Benefits

are not payable for claims for services rendered outside Australia or, for items purchased or hired from overseas suppliers.

• Benefits

are not payable on claims subject to compensation, third party or other liability provision.

• Benefits

are not payable for treatment rendered by a provider to the provider’s partner (spouse or de facto) or dependant children or partner’s dependant children if a legally enforceable debt is not raised.

• Benefits for gym membership and personal training under Healthy Living benefits will only be payable on referral by your health care professional for you to participate in this health management program where it is to address, improve or prevent a specific health or medical condition.

Supporting documentation in the form of a Health Management Approval Form is to be completed by your health care professional and is required to be lodged along with a completed claim form. [ 31 ]

Registered providers It is a requirement that any practitioner is registered and recognised by us before benefits will be paid. Queensland Country will only pay benefits for extras, dental and other services if rendered by a provider or practitioner that is recognised by us. We reserve the right to refuse payment for services rendered by a provider who does not satisfy the criteria of Queensland Country.

Recognition of providers is for the purpose of determining the payment of benefits and should not be taken or 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 Queensland Country that their practitioner is recognised before commencing treatment.

Multiple services in one day Where a Member has two (2) or more consultations for the same type of service on the same day, benefits will only be payable where: • the consultations relate to two (2) separate conditions.

Where a Member has two (2) consultations with the same provider on the same day, benefits are payable where: • two (2) different types of services are provided, and • the provider is qualified to perform both types of service.

Where two (2) services are required to be performed on the same day, the health fund may ask for clinical evidence of the requirements for this, prior to payment of any benefits.

[ 32 ]

Compensation and damages Benefits are not payable in respect of services provided to a Member as a result of an accident, illness, injury, condition or other incident for which there exists in the opinion of Queensland Country, a right to claim compensation or damages from a third party or authority at law or under any insurance or scheme of arrangement.

Where Queensland Country has paid benefits, whether by way of provisional payments or otherwise and the insured person has received compensation in respect of the injury, the insured person must repay to the Health Fund all benefits received in relation to the injury, upon the determination or settlement of the claim for compensation.

The liability of the Member to repay shall apply regardless of whether the Member continues to be a Member of Queensland Country.

Claims paid in error In the event that a benefit has been paid incorrectly or in error, then Queensland Country shall, within 24 months of making the erroneous payment, be entitled to recover any such amount, that should not of been paid under the Fund Rules. Without prejudice to any remedy otherwise available to it, Queensland Country shall be entitled to offset against, and deduct from monies otherwise payable then or after by Queensland Country to the Member, any amount recoverable from a claim paid in error.

[ 33 ]

PAYING YOUR PREMIUMS

Premiums must be in advance As a policyholder it is your responsibility to ensure that the contribution amounts are correct and made in advance. This is to ensure the efficient processing of claims and hospital eligibility checks.

Premium Reviews All health funds undertake a once yearly review of their policy premiums. Every year after a careful review of operating cost and in particular cost of benefits paid, a submission is made to the Federal Minister for Health to request a premium increase for the following year. This review is necessary to ensure the continued sound financial standing of the Fund.

A written notification of any change to the premium payable is sent to all members prior to the annual April 1st rate change taking effect, in accordance with the requirements of the Private Health Insurance Act 2007.

Paying your premiums Queensland Country offers a range of payment options, including: • Direct debit This is the most popular and convenient method of payment. Facilities are available for policyholders who prefer to have premium payments automatically deducted from a bank, credit union or building society account; on the contribution due date. Payment frequencies are weekly, fortnightly, monthly, quarterly, half yearly and yearly.

• Credit Card* payment facilities are available for policyholders who prefer to pay via this option. Payments can be deducted under the Direct Debit payment system in accordance with your chosen payment frequency. Your first payment on joining will be deducted on the day policy is loaded or on the future start date of cover.

Payments can be deducted under the Direct Debit payment system in accordance with your chosen payment frequency. Your first payment on joining will be deducted on the day policy is loaded or on the future start date of cover.

• Pay by Phone You can also choose to pay your health insurance premiums over the phone by contacting our Call Centre on 1800 813 415. Payments can be accepted from a Debit or Credit Card only* • EFTPOS facilities are available at any of our Health Fund Retail Centres (locations listed in back of this guide).

[ 34 ]

• Online Member Service (OMS) if you are registered for OMS you are able to log in and make contributions via credit card with an immediate response. *We do not accept payments via American Express or Diners Club

• BPAY facilities are available to all policyholders who prefer to pay via this option. BPAY allows you to pay your health insurance premium via internet or phone banking. The BPAY biller code and your reference number appear on all statements. If you require the biller code and reference number please contact us. (This option is not available to eligible participants in a Corporate Health Plan).

Please note: BPAY- Payment deadlines. Your BPAY payment needs to reach us on or prior to your policy’s, Paid to Date, to ensure availability to the benefits of your chosen cover. Payments made via BPAY by 2pm Monday to Thursday will be processed the next day. If a payment is made via BPAY by 2pm, on a Friday, a weekend or public holiday, the payment may not be processed until the next business day.

Please check your financial institution’s processing deadlines to avoid being without availability to the benefits of your health cover.

• SmartBudget Service is offered by Queensland Country Credit Union through all their branches. SmartBudget is a budgeting and bill paying service that provides a fast and simple way to pay your bills. If you would like more information on this service please feel free to contact Queensland Country Credit Union on 1800 075 078.

• Payroll deduction for Members who are eligible participants in a Corporate Health Plan.

• Cheque or money order for those who prefer this type of payment method. Payments can be sent by post to PO Box 42 Aitkenvale QLD 4814.

Memberships in arrears A membership is in arrears whenever the ‘Paid to Date’ is earlier than the current date.

Benefits are not payable for any treatment provided during a period of arrears.

It is important to keep us up to date whenever you change your contact details so we can contact you should your membership fall into arrears.

Maximum period of arrears When a membership is more than 63 days in arrears, Queensland Country will terminate the membership. Notification of the arrears on the policy will be sent to the address on file prior to cancellation of the policy.

[ 35 ]

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 scheme’s introduction was for the Federal Government to assist Australians to reduce the premium costs of their private health cover. The government has recognised Australians with private health insurance not only make a substantial financial contribution to their own healthcare but also to Australia’s healthcare system, by taking pressure off the public health system.

The amount of rebate assistance provided is determined by both: - the age of the oldest policyholder, and - income* level.

It is your responsibility as a policyholder to nominate an appropriate rebate tier (based on your age and income*). The Australian Government Rebate on private health insurance applies to hospital and extras cover but won’t reduce any Lifetime Health Cover (LHC) loading that may apply to your hospital premiums.

You can choose to nominate your rebate tier in one of two ways as a: 1. reduction in your premiums, or 2. tax offset in your annual tax return If your income changes in the future, you may be entitled to a higher or lower rebate than you receive now. The income thresholds are normally indexed annually but are currently frozen by the government until June 2018.

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 on page 26. * This information is intended as a guide only and does not take into account your personal circumstances. For information on the Rebate 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 132 862 or visit their website at http://www.ato.gov.au/Calculators-and-tools/Incomefor-Medicare-levy-surcharge/

[ 36 ]

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

$ 90,001105,000

$105,001$140,000

AND ABOVE

UP TO $ 180,000

$ 180,001210,000

$210,001$280,000

AND ABOVE

$ 140,001

$ 280,001

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/Income-for-Medicare-levy-surcharge-thresholdsand-rates/

Medicare Levy Surcharge The Medicare Levy Surcharge (MLS) is levied on payers of Australian tax who do not have hospital cover under a complying private health insurance policy and who earn above a certain income. The surcharge aims to encourage individuals to take out private hospital cover, and where possible, to use the private hospital system to reduce the demand on the public health care system.

People who donâ&#x20AC;&#x2122;t have private health insurance hospital cover, and who have an income for MLS purposes^ in excess of the thresholds set down by the Australian Taxation Office (ATO) pay a surcharge of between 1.0% to 1.5% of income for MLS purposes^. This surcharge is in addition to the standard Medicare Levy of 2.0% of taxable income.

All Queensland Country Health Fund hospital covers exempt policyholders from paying the additional Medicare Levy Surcharge.

The Medicare Levy Surcharge is applied on a pro-rata basis. If you take out hospital cover part way through the financial year youâ&#x20AC;&#x2122;ll still avoid the surcharge but only for the period you held hospital cover. ^ This information is intended as a guide only and does not take into account your personal circumstances. There is a different income test for the application of MLS, which is known as income for Medicare levy surcharge purposes. For more information about the MLS and what is included as income for Medicare levy surcharge purposes, please seek the advice of your tax agent or Accountant or contact the Australian Taxation Office (ATO) Help Line on 13 28 62 or visit the ATO website www.ato.gov.au.

[ 37 ]

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.

Under LHC, if you don’t have hospital cover on the 1st of July following your 31st birthday, then for each year you delay joining, your membership fees will increase. In fact you will pay a loading of 2% on top of the base rate on your premium (or on your share of a couple or family premium) up to a maximum loading of 70%. Once you have stayed with private hospital cover for 10 continuous years and keep it, you stop paying that loading as a reward for commitment to the private health system. Be aware that the loading may be reapplied if you then cease to hold a hospital cover and subsequently take it up again.

By joining hospital cover as soon as possible, you can stop this continuous increase and your loading will be frozen at the rate that matched your age when you joined (known as your Certified Age at Entry or CAE). As long as you maintain your hospital cover, your loading percentage will continue to 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.

People born before 1 July 1934 can take out hospital cover at any time and pay only the base rate. Transferring hospital cover from another registered fund, make sure you use your CAE (the age at which you joined), rather than the age you are now, to calculate the correct fee. Under the Federal Government’s LHC legislation the loading of 2% does not apply to extras cover.

Note: Due to Federal Government’s rounding rules for the rebate, actual premiums for hospital and/or extras cover can vary from this calculation by up to 10 cents.

[ 38 ]

DIRECT DEBIT REQUEST SERVICE AGREEMENT

Definitions • Account means the account held at Your Financial Institution from which we are authorised to arrange for funds to be debited (which will decrease the available balance in the account).

• Agreement means this Direct Debit Request Service Agreement between you and us.

• Business Day means a day other than a Saturday or Sunday or a national public holiday.

• Debit Day means the day that you have authorised us to arrange for funds to be debited from your Account (which will decrease the available balance in your Account).

• Debit Payment means a particular transaction where a debit is made.

• Direct Debit refers to the process whereby you provide us with the Direct Debit Request which authorises us to arrange for funds to be debited from an account held with Your Financial Institution (which will reduce the available balance in that account).

• Direct Debit Request means the Direct Debit Request between you and us.

• Your Financial Institution is the financial institution nominated by you on the Direct Debit Request at which your Account is maintained.

• You means the customer who signed the Direct Debit Request • we,

our or us or We, Our or Us means Queensland Country Health Fund Ltd (ABN 18 085 048 237)

Debiting your account • By signing the Direct Debit Request or providing us with a valid instruction, you have authorised us to arrange for funds to be debited from your Account (which will reduce the available balance in your Account). You should refer to the Direct Debit Request and this Agreement for the terms of the arrangement between us and you.

• We will only arrange for funds to be debited from your Account (which will reduce the available balance in your Account) as authorised in the Direct Debit Request.

• If the Debit Day falls on a day that is not a Business Day, we may direct Your Financial Institution to debit your Account on the following Business Day. If you are unsure about which day your Account has or will be debited you should ask Your Financial Institution.

[ 39 ]

Changes by us • We

may vary any details of this Agreement or a Direct Debit Request at any time by giving you at least fourteen (14) day’s written notice.

Changes by you • I t you wish to stop or defer a Debit Payment or terminate this Agreement, you must notify us in writing at least seven (7) Business Days before the next Debit Day. • Y ou may change the arrangement (but not stop, defer or cancel) under a Direct Debit Request by telephoning us on 1800 813 415.

Your obligations • It is your responsibility to ensure that there are sufficient clear funds available in your Account to allow a Debit Payment to be made in accordance with the Direct Debit Request.

• If there are insufficient funds in your Account to meet a Debit Payment: −− you may be charged a fee and/or interest by your financial institution −− you may also incur fees or charges imposed or incurred by us; and −− you must arrange for the Debit Payment to be made by another method or arrange for sufficient cleared funds to be in your account by an agreed time so that we can process the Debit Payment.

You should check your account statement to verify that the amounts debited from your account are correct.

Disputes • I f you believe that there has been an error in debiting your account (which has resulted in your available balance in your account being reduced), you should notify our Contact Centre on 1800 813 415 and confirm that notice in writing with us as soon as possible so that we can resolve your query more quickly.

• I f we conclude, as a result of our investigations, that your account has been incorrectly debited (which has resulted in your available balance in your account being reduced) we will respond to your query by arranging for Your Financial Institution to adjust your account (including interest and charges) (which will result in your available balance in your account being increased). We will also notify you in writing of the amount by which your account has been adjusted.

• If we conclude as a result of our investigations that your account has not been incorrectly debited we will respond to your query by providing you with reasons and any evidence for this finding in writing.

[ 40 ]

• If we cannot resolve the matter or you are not satisfied with our proposed resolution, you can still refer it to your financial institution which will obtain details from you of the disputed transaction and may lodge a claim on your behalf.

If we cannot resolve the matter you can still refer it to your financial institution which will obtain details from you of the disputed transaction and may lodge a claim on your behalf.

Accounts You should check: • w ith your financial institution whether direct debiting is available from your account as direct debiting is not available on all accounts offered by financial institutions; • your

account details which you have provided to us are correct by checking them against a recent account statement; and • with

your financial institution before completing the Direct Debit Request if you have any queries about how to complete the Direct Debit Request.

Confidentiality • We

will keep any information (including your account details) in your Direct Debit Request confidential. We will make reasonable efforts to keep any such information that we have about you secure and to ensure that any of our employees or agents who have access to information about you do not make any unauthorised use, modification reproduction or disclosure of that information.

• We will only disclose information that we have about you: −− to the extent specifically required by law; or −− for the purposes of this Agreement (including disclosing information in connection with any query or claim).

We may provide a copy of the Direct Debit Request to another financial institution in the event any payment that is made in accordance with the Direct Debit Request is disputed.

Notice • I f you wish to notify us in writing about anything relating to this agreement you should write to: Queensland Country Health Fund Ltd PO Box 42 AITKENVALE QLD 4814 • W e will notify you by sending a notice in the ordinary post to the address you have given us in the Direct Debit Request.

• Any notice will be deemed to have been received two business day after it is posted.

[ 41 ]

PRIVACY POLICY Queensland Country has a legal obligation to comply with the Commonwealth Privacy Act 1988 and the Australian Privacy Principles. The Queensland Country Health Fund Privacy Policy informs you about how your personal information will be collected, held, used and disclosed, how you may gain access to that information and how you may complain about possible breaches of privacy.

A copy of the latest version of our Privacy Policy may be obtained from our website at www.qldcountryhealth.com.au or any Queensland Country Credit Union branch.

QUEENSLAND COUNTRY HEALTH FUND RULES All Members are bound by the fund rules of Queensland Country Health Fund Ltd. The complete rules of the Health Benefits Fund set out in full the terms and conditions of membership and liability under the health fund. These rules change from time to time and can be inspected at Queensland Country Centre, Level 1, 333 Ross River Road, Aitkenvale QLD 4814.

[ 42 ]

COMPLIMENTS AND COMPLAINTS Queensland Country values your feedback on our products and services which assists us to monitor our policies, procedures and systems to ensure we are meeting the needs of our Members.

Your health and wellbeing is our number one priority and if you’re not completely happy with our service we would like to know about it.

If you have any complaints, and we hope you don’t, then contact us immediately Call:

1800 813 415

Email:

info@qchfund.com.au

Website:

www.qldcountryhealth.com.au

Address: Queensland Country Centre, Level 1, 333 Ross River Road Aitkenvale, QLD 4814 We take all complaints very seriously. Your health and wellbeing is our number one priority and if you’re not completely happy with our service we would like to know about it. Our understanding staff are here to answer any questions and allay any fears you may have.

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.

The Ombudsman is an independent body formed to help resolve complaints and to provide advice and information to Members of private health funds. You can contact the Ombudsman directly at: Website:

www.ombudsman.gov.au

Online:

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

Fax:

02 6276 0123

Email:

phio.info@ombudsman.gov.au

Phone:

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

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

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PRIVATE HEALTH INSURANCE CODE OF CONDUCT Queensland Country Health Fund 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.

Under the code, Queensland Country agrees to: • work

towards improving the standards of practice and service in the private health insurance industry • provide information to you written in plain English • ensure that policy documentation is full and complete • ensure

that all persons providing information on health insurance are appropriately trained and able to provide clear explanations • ensure

information exchanged between you and Queensland Country Health Fund is protected in accordance with privacy principles • provide

you with easy access to our internal issues and complaints handling system and advise you of your rights to take an issue to the Private Health Insurance Ombudsman A copy of the Code of Conduct may be obtained from www.privatehealth.com.au/codeofconduct

INTERMEDIARY REMUNERATION Queensland Country pays remuneration to insurance intermediaries when we accept a policy the intermediary has arranged or referred to us. The type and amount of the remuneration varies and may include commission and other payments. If you require more information about remuneration we pay your intermediary, you should ask your intermediary.

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CONTACT US

Head Office

Mount Isa Retail Centre

Queensland Country Centre Level 1, 333 Ross River Road Aitkenvale QLD 4814

70 Camooweal Street Mount Isa

Phone: 07 4412 3500 Facsimile: 07 4412 3500 Postal Address: PO Box 42 Aitkenvale QLD 4814

Burdekin Retail Centre

Aitkenvale Retail Centre Queensland Country Centre 333 Ross River Road Willows Retail Centre Willows Shopping Centre Kirwan

186 Queen Street Ayr Mackay Retail Centre Caneland Central Shopping Centre

Call: 1800 813 415 E-mail: info@qchfund.com.au Web: www.qldcountryhealth.com.au

HOW TO CONTACT US If you have any questions or need more information, please contact us by: Branch Visit our website for a listing of all our branches.

Post PO Box 42, Aitkenvale Qld 4814 Website www.qldcountryhealth.com.au Email info@qchfund.com.au Call

1800 813 415

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

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