Membership Guide 1 December 2015

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

C O N T E NT S Welcome to Queensland Country Health Fund

4

Your membership card

6

Safeguard your membership card

6

Additional cards

6

Replacement cards

6

Online services

7

Registering is easy

7

Managing your membership

8

Membership year

8

Cooling off period

Dependant children

10

Dependants to age 21

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Student dependants up to age 25

10

Apprentice dependants up to age 25

10

Adult dependants up to 25

10

Changing your cover

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Change of membership details

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Upgrading your cover

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Downgrading your cover

12

8

Adding or removing a person from your membership

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Policy types

8

Adding a newborn baby

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Level of cover

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Role of the policyholder

9

Transferring from another fund (Portability)

13

Delegated authority

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Temporary suspension of membership 14

Government initiatives

32

General conditions for suspension

14

Overseas travel

14

Australian Government Rebate on private health insurance

32

Medicare Levy Surcharge warning

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Medicare Levy Surcharge

33

Waiting periods

16

Lifetime Health Cover

34

Benefit Limitation Periods

17

Direct debit request service agreement

35

What waiting periods apply at Queensland Country Health Fund?

19

Privacy Policy

38

Pre-existing conditions

21

Restrictions and exclusions

22

Claiming your benefits

23

Excesses

29

Premium information

30

Queensland Country Health Fund rules 38 Compliments and complaints

39

Private Health Insurance Code of Conduct

40

Intermediary Remuneration

40

Contact us

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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 and 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/ailment rule and hospital cover with restricted services and benefit exclusions applicable for Intermediate Hospital and Singles and Couples Combined cover products.

Please ensure that all documentation is read carefully before any decision is made to purchase a health insurance product and all the information is retained for future reference. Keep this guide in a safe place together with other Queensland Country Health Fund documents.

If you anticipate undergoing any treatment for which you are expecting a benefit from Queensland Country Health Fund, we recommend you contact us before commencing treatment, to confirm your benefit entitlement.

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 for you.

The information in this membership guide is current as at 1 October 2015 and is subject to change.

Thank you for choosing Queensland Country Health Fund!

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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 IBA Health logo.

Your membership card shows your membership number, who is covered and the date you joined the health fund 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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ONLINE SERVICES 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 claims history

View your cover details Update your address and contact details Change your level of cover Add dependants Lodge a claim for ancillary services (Extras) See Online claiming information in this Guide for further details.

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!

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MANAGING YOUR MEMBERSHIP Membership year Queensland Country Health Fund policies operate on a unique, 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 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.

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 27 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.

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 you have not yet made a claim, simply contact us to cancel your policy and we will refund any premiums you have paid in relation to this 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:

• •

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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 10 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.

Level of cover A person may be admitted as a policyholder to the fund in one of the above categories in respect to one of the following covers:

• 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 ie. Singles and Couples Combined Cover, or • Young Extras with no hospital cover

Role of the policyholder The policyholder is responsible for the policy and all correspondence will be addressed to them. The policyholder also agrees to make the minimum advance premium payments required to keep the membership financial. Only the policyholder is able to add others to the policy.

The policyholder is also responsible for communicating the details of this membership guide, together with the existence of health fund rules, to any current and future Members on the membership.

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.

The authority generally takes the form of a written request to the Health Fund by the Member, or a person appointed as Attorney under a Power of Attorney or as Administrator appointed 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.

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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, Top or Intermediate Hospital and Young Extras products, Singles and Couples Combined cover products or Public Hospital and Extras packaged covers. [ 10 ]

CHANGING YOUR COVER Change of membership details You are required to advise Queensland Country Health Fund of any change to your membership details.

In general, changes can be managed by you online or you can notify us by phone, email, fax or post.

Typical changes and accepted methods of notification include but are not limited to:

• • • • •

change of contact details change of name change of partner adding a new dependant changes to student/apprentice dependant status

All of the above changes, can be notified by going online, by a phone call to us or in writing via post, fax or email.

The following changes require a form to be completed:

• registering to receive the change to Australian Government rebate via reduced premiums • registering to pay your premiums automatically through a nominated bank account or credit card via the direct debit system

Upgrading your cover If you are upgrading your cover or transferring from another health fund you may need to serve waiting periods on the upgraded portion of your cover.

Upgrading your cover includes:

• • •

increasing the level of cover adding a new cover, and reducing or removing an excess*

You will, however, be entitled to the benefits of your previous cover for the duration of any waiting period. *Note: When an existing membership has an excess of $250 or $500 and the decision is made by the policyholder to select a lower level of excess i.e. Nil or $250, then any in-patient hospitalisation will be subject to the following excess conditions:

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CHANGING YOUR COVER CONT.

Within the first two (2) month period from the date of upgrade, the previous level of cover or excess will apply for in-patient hospitalisation.

Within the first twelve (12) month period after upgrade, any hospitalisation resulting from a Pre-Existing Condition, previous level of cover or excess will apply.

For accidental injury, cover or excess upgrades are immediate (excluding sporting and school accidents which are subject to a two (2) month waiting period) *Note: Payment of hospital excesses are based on a membership year as different funds have a different basis of calculation for this period, if you transfer or upgrade cover it is possible for an individual to pay two hospital excesses within the first 12 months of cover. This may be due to these hospital services falling under two separate identifiable Membership years due to the transfer or upgrade of cover.

Downgrading your cover You may choose to downgrade your cover by:

• • •

reducing the level of cover removing a current cover, or increasing or adding an excess.

In these circumstances you will not serve additional waiting periods and the new excess will apply to in-patient hospital services immediately.

However, waiting periods will apply should you subsequently upgrade at a later date.

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 To add a newborn baby to your policy you will need to do this within two months from the date of their birth. The child will not have to serve any waiting periods* that have already been served by the Policy holder 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 [ 12 ]

CHANGING YOUR COVER CONT.

will have higher policy premiums if you currently have a single cover. No change in premium will occur for existing single parent or family covers.

If a newborn is added to the policy later than two 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. *For policy holders with no previous cover, pre-existing condition waiting periods may apply to the baby within the first 12 months of cover.

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 Health Fund within sixty-three (63) days of the date on which you ceased to be covered by another Australian registered health fund; and

• you have served the applicable waiting periods with that former health fund; and • we have received your Transfer Certificate from that health fund showing previous level of cover.

Benefits will not be paid by Queensland Country Health Fund 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 Health Fund. We are unable to backdate membership join date.

If these conditions are satisfied then 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 the hospital component of your cover with our Fund.

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

If you transfer to Queensland Country Health Fund more than sixty-three (63) days after your previous cover has ceased, you will have to serve all waiting periods applicable to your new cover. [ 13 ]

TEMPORARY SUSPENSION OF MEMBERSHIP General conditions for 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, 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.

• To avoid additional waiting periods the membership must be reactivated within one month, of the relevant reason for suspension ceasing to apply, or the maximum period of suspension being reached.

• To avoid adding to the number of days in which you are without hospital cover which could, eventually impact on your premium, it is important that the membership be resumed and active from the date the reason for suspension ceased to apply, or the maximum suspension period was reached. (For further information on the effect which a period of absence from hospital cover may have on your premium refer to the section on Lifetime Health Cover.)

Overseas­­ travel If you’re lucky enough to travel overseas, and you’re going to be absent from Australia for a period of more than 4 weeks and less than 24 months, and provided you’ve fulfilled all the above criteria, you may apply for a suspension on your membership.

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The health fund may agree to your request on the following basis:

• •

The suspension date will be the day after departure from Australia.

•

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

•

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 re-instatement date will be the date of re-entry into Australia.

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

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 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 change (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 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:

• is insured for the first time or has not been insured within the previous two or more months. • upgrades to a higher level of cover (includes reducing or removing an excess or co-payment). • 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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BENEFIT LIMITATION PERIODS (BLP’S) A Benefit Limitation Period 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, where as a waiting period is an initial period of health fund membership where no benefit is payable for certain services, when joining the fund with no previous health cover, or a lapse in cover in excess of 63 days.

If a Benefit Limitation Period 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 for the remainder of the Benefit Limitation Period. 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 Benefit Limitation Period, would result in large out of pocket expenses if undertaking treatment in a private facility:

•

benefit limitation period of two years (24 months) applies to bariatric surgery (weight A loss surgery) including but not limited to gastric banding, gastric sleeving /diversion; and gastric bypass surgery; including replacement, repair or adjustments

•

A benefit limitation period of two years (24 months) applies to Hip or Knee Joint Replacements

•

A benefit limitation period of two years (24 months) applies to in-hospital psychiatric treatment

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. [ 17 ]

BENEFIT LIMITATION PERIODS (BLP’S) CONT.

I’M NEW TO PRIVATE HEALTH INSURANCE OR BEEN OUT OF IT FOR A WHILE! Benefit limitation periods however will apply to New Members 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 Benefit Limitation Period conditions will apply to the above hospital treatments for the remaining period, up to the first 24 months of membership with our Fund.

After the Benefit Limitation Period 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 our Fund under your chosen level of cover will not be affected by the Benefit Limitation Period restrictions.

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WHAT WAITING PERIODS APPLY AT QUEENSLAND COUNTRY HEALTH FUND? 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, sterilization or vasectomy, elective surgery# 12 months Cardiothoracic procedures - for example Open Heart Surgery# 12 months for Major Eye surgery - Cataract and eye lenses 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# 12 months Health Evaluations# 2 months for all hospital treatments or services where there are no Pre-existing Conditions (excluding Accidental Injury1) 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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WHAT WAITING PERIODS APPLY AT QUEENSLAND COUNTRY HEALTH FUND? CONT.

• •

2 months for Optical services 2 months for Ancillary 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 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 range there are Benefit Limitation Periods 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 Benefit Limitation Periods 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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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 Health Fund 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 Health Fund. 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 Health Fund whether the pre-existing condition waiting period will apply.

Queensland Country Health Fund 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 Health Fund 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 Health Fund 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 Health Fund 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 Hospital claims In most cases when you are discharged from hospital, your account will be settled directly with the hospital by Queensland Country Health Fund.

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

As a member of the Australian Health Services Alliance (AHSA), Queensland Country Health Fund 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

The Medicare Benefit Schedule and Access Gap The Medicare Benefits Schedule (MBS) is a list of fees for medical services issued by the Federal Government. If you have Private Health Insurance and are admitted to hospital as a private patient, Medicare pays a benefit of 75% of the MBS fee and the remaining 25% of the MBS fee is paid by Queensland Country Health Fund.

If a doctor raises a charge that is above the MBS fee, this amount is known as a “Medical Gap”.

Queensland Country Health Fund has an initiative which can help policyholders to minimise or, in some cases, eliminate out-of-pocket expenses (for inpatient services) by reducing or eliminating these “Medical Gaps”. This scheme is known as “Access Gap”.

Before admission to hospital you should ask your doctor to inform you of all medical fees that may be charged and whether he/she participates in our Access Gap scheme. If the doctor/s elects not to participate in the Access Gap scheme and charges above the MBS fee, this additional amount will need to be paid for by you. Before any hospital treatment you should confirm by asking for a written estimate of costs of treatment from your doctor/s. This is known as “Informed Financial Consent”.

The Access Gap scheme also applies to the costs of other specialists involved in your surgery such as, anaesthetists and assisting surgeons etc. These professionals should also be consulted in regards to any out-of-pocket expenses for their services. There is a search engine facility on the web to help you identify participating “Access Gap” doctors at: https://www.ahsa.com.au/web/gapcoversearch to ensure that the doctor is going to participate for your individual treatment. It is recommended that you personally consult the specialist in regards to the out of pocket expenses for the service. [ 23 ]

CLAIMING YOUR BENEFITS CONT.

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 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 3 months. Benefit replacement periods 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 fund for the conditions of claiming the benefit.

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

Ancillary (Extras) claims Using your membership card 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 IBA Health 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. [ 24 ]

CLAIMING YOUR BENEFITS CONT.

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 through our website where you will find instructions on how to submit your claim, it’s really easy!!

Eligibility:

•

A Member must have held membership with Queensland Country Health Fund for more than 3 months

• •

Hold an ancillary(Extras) product Policy is financial ( paid up to date)

Conditions:

• • •

Claim limit of $400 per day per person

• •

Services must be provided by approved practitioners in private practice

The service being claimed must have been provided within the last (3) calendar months Queensland 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 receipt for 12 months after submission of your claim/s.

Only claims for the following services# will be accepted using Online Claiming: -- Acupuncture -- Audiology -- Chiropractor -- Dental – General services only (NO major dental or Orthodontic treatment*) -- Dietetics -- Homeopathy -- Massage -- Naturopathy -- Occupational Therapy -- Optical -- Osteopathy -- Physiotherapy -- Podiatry consultations only ( Benefits for Orthotics and other appliance*) -- Psychology -- Speech Therapy

#Some of these services are not available on Young Extras cover * 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

[ 25 ]

CLAIMING YOUR BENEFITS CONT.

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 fax To claim your benefit via fax, simply fax 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. Alternatively we can send you a cheque in the mail. 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.

By email To save time, you can also email us the completed claim form and associated invoices/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.

[ 26 ]

CLAIMING YOUR BENEFITS CONT.

Unpaid accounts In most cases, where you submit a claim directly to Queensland Country Health Fund, you will receive a cheque in the name of the provider, to enable you to settle the account.

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

Claiming conditions

• 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 Health Fund to assess your claim all invoices/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 Health Fund, 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.

• Benefits 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 completed by your health care professional is required to be lodged along with a completed claim form. [ 27 ]

CLAIMING YOUR BENEFITS CONT.

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

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 Health Fund, that their practitioner is recognised before commencing treatment.

Multiple services in one day Where a Member has two or more consultations for the same type of service on the same day, benefits will only be payable where:

•

the consultations relate to two separate conditions.

Where a Member has two consultations with the same provider on the same day, benefits are payable where:

• •

two different types of services are provided, and the provider is qualified to perform both types of service.

Where two 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.

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 Health Fund, 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 Health Fund 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 Health Fund.

Claims paid in error In the event that a benefit has been paid incorrectly or in error, then Queensland Country Health Fund shall, within 24 months of making the erroneous payment, be entitled to recover any such [ 28 ]

CLAIMING YOUR BENEFITS CONT. amount, that should not of been paid under the Fund Rules. Without prejudice to any remedy otherwise available to it, Queensland Country Health Fund shall be entitled to off set against, and deduct from monies otherwise payable then or after by the Fund to the Member, any amount recoverable from a claim paid in error.

EXCESSES An excess is the amount you pay up front if you go to hospital or day surgery. You can choose an excess on your cover to save on your premium. The higher the excess, the less you pay in premiums.

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

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

No excess payable for children 10 years and under (Top Hospital product only) If you have a dependant child up to and including the age of 10 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 type.* *Note: The excess exemption for children 10 years and under is NOT applicable under Singles and Couples Combined cover or Intermediate Hospital covers. It is exclusive to our Top Hospital cover product ONLY.

[ 29 ]

PREMIUM INFORMATION 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 Health Fund offers a range of payment options, including:

•

irect debit deductions D This is the most popular and convenient method of payment. Facilities are available for policyholders who prefer to have premium payments automatically deducted from bank, credit union or building society accounts on the contribution due date. Payment frequencies are weekly, fortnightly, monthly, quarterly, half yearly and yearly.

•

Credit Card* payment facilities are available for policy holders 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.

You can also choose to pay your health insurance premiums over the phone by calling 1800 813 415 or at one of our Health Fund Retail Centres (locations listed in back of this guide). Alternatively if you are registered for Online Member Service (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.

[ 30 ]

PREMIUM INFORMATION CONT.

• 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)

• 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.

• Bill Paying Service is offered by Queensland Country Credit Union through all their branches. Bill Paying is a comprehensive budgeting and bill paying service that provides a fast and simple way to pay all 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/money order for those who prefer this type of payment method, 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 Health Fund 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.

[ 31 ]

GOVERNMENT INITIATIVES Australian Government Rebate on private health insurance The Federal Government rebate scheme was introduced in January 1999. The basis for the initiative was to provide a financial incentive to assist Australians in affording private health insurance cover.

Initially the scheme provided for a rebate of 30, 35 or 40% on private health insurance premiums, with entitlement based on the age of the oldest person on the policy.

The scheme, now known as the Australian Government Rebate on private health insurance introduced means testing of the rebate in 2012, which resulted in the rebate entitlement being determined by both your estimated income for surcharge purposes* and age.

This changed resulted in person/s on higher incomes having their rebate entitlement either reduced, or depending on their estimated income for surcharge purposes*, have no entitlement to receive any rebate assistance at all.

It is the responsibility of a Member to nominate an appropriate rebate tier (based on age and estimated income for surcharge purposes*).

The Australian Government Rebate on private health insurance will apply to the base hospital premium only and will not apply to the portion of hospital premium that has any Lifetime Health Cover Loading applied. (See Lifetime Health Cover section for further information) A Member can choose to claim the appropriate rebate up front as a lower premium; however can also nominate to claim a lower rebate than their entitlement, or in fact no rebate at all, and reconcile this when lodging their annual tax return.

The Australian Government Rebate on private health insurance under went further changes on 1 April 2015. Rebate eligibility is now based on a Member/s age and estimated income for surcharge purposes* but is indexed by CPI (Consumer Price Index) each year. Essentially this will mean that the standard rebate amounts that have historically applied are now being indexed each year using a ratio of the average industry premium increases and CPI. Premiums quoted by the Fund will take into consideration these latest changes and will require no additional input or calculation by our Members apart from the standard age and your estimated income for surcharge purposes* information. * 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/ Income-for-Medicare-levy-surcharge/

[ 32 ]

GOVERNMENT INITIATIVES CONT.

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 don’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 income^. This surcharge is in addition to the standard Medicare Levy of 1.5% 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 you’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.

AUSTRALIAN GOVERNMENT REBATE ON PRIVATE HEALTH INSURANCE REBATE TIER SINGLES

Income Threshold

(2015/16 financial year)

FAMILIES

Income Threshold

(2015/16 financial year)

BASE TIER UP TO $ 90,000 UP TO $ 180,000

TIER 1

TIER 3

90,001105,000

$

105,001140,000

$ 140,001 AND ABOVE

180,001210,000

$

210,001280,000

$ 280,001 AND ABOVE

$

$

TIER 2

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

< AGE 65

27.820%

18.547%

9.273%

0%

AGE 65-69

32.457%

23.184%

13.910%

0%

AGE 70+

37.094%

27.820%

18.547%

0%

0%

1%

1.25%

1.50%

MEDICARE LEVY SURCHARGE

[ 33 ]

GOVERNMENT INITIATIVES CONT.

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 Lifetime Health cover, 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 Lifetime Health cover 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 coverage can vary from this calculation by up to 10 cents.

[ 34 ]

DIRECT DEBIT REQUEST SERVICE AGREEMENT Definitions •

ccount means the account held at Your Financial Institution from which we are authorised A 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 •

y signing the Direct Debit Request or providing us with a valid instruction, you have B 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.

[ 35 ]

DIRECT DEBIT REQUEST SERVICE AGREEMENT CONT.

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 •

It 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.

•

You 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 •

If 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.

•

If 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.

[ 36 ]

DIRECT DEBIT REQUEST SERVICE AGREEMENT CONT.

• 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.

• 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:

•

with 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.

[ 37 ]

DIRECT DEBIT REQUEST SERVICE AGREEMENT CONT.

Notice

If 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

We 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 Days after it is posted.

PRIVACY POLICY Queensland Country Health Fund 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.

[ 38 ]

COMPLIMENTS AND COMPLAINTS Queensland Country Health Fund 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.phio.org.au

Phone:

1800 640 695 or

Write to:

Private Health Insurance Ombudsman Office of the Commonwealth Ombudsman GPO Box 442 CANBERRA ACT 2601

[ 39 ]

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 Health Fund 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 Health Fund 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.

[ 40 ]

[ 41 ]

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

[ 42 ]

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 C ONTACT 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.

QCHD0005 12/15