Health insurance for singles and couples

H EALTH I N S U RAN CE F OR

SINGLES AND COUPLES 1 JULY 2015

Welcome

TO QUEENSLAND COUNTRY In short, Queensland Country Health Fund (Queensland Country) has been at it for over 35 years, and takes pride in offering you a flexible, affordable and comprehensive health cover. Your health is our number one priority.

This brochure provides an overview of the features and benefits of Singles and Couples Combined Cover to enable a good understanding of the level of cover available. For more information regarding health insurance please refer to our “Membership Guide� or visit us at www.qldcountryhealth.com.au

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C O N T E NT S Why do I need health insurance cover?

How much are the premiums

14

Singles and Couples Combined Cover 5

Managing your health insurance cover online

16

Hospital cover

6

How to pay contributions

17

What’s covered in Hospital

8

In more detail

18

How it works in relation to doctor’s charges

10

Privacy policy & Private Health Insurance complaints

25

Extras Cover

11

Contact details

26

Extras Cover benefits

12

4

“ we offer you flexible, comprehensive and affordable health cover.”

HOW TO J O I N

call 1800 813 415 www.qldcountryhealth.com.au

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WHY DO I NEED HEALTH INSURANCE COVER? As a young person it’s sometimes hard to understand why it is necessary to have health insurance. What does health insurance offer for someone who is young and healthy?

Making health care services affordable Health insurance covers more than visits to the hospital. There are many health care services that young people need that are not covered by Medicare. Services like dental, optical, physiotherapy and massage are not normally covered by Medicare.

Private health insurance with Queensland Country can help cover the costs of these services ensuring you can afford to receive treatment when you need it.

Avoid higher health insurance costs Lifetime Health Cover is a Federal Government initiative that came into effect on the 1st July 2000. It is designed to reward people who join a private health fund earlier in life by securing lower premiums. Under Lifetime Health Cover, if you don’t have hospital cover on the 1st July following your 31st birthday, then for each year you delay joining, your premium will increase.

Avoid extra tax

The Medicare Levy Surcharge is a Federal Government initiative to encourage higher income earners to take out private health insurance. Under the Medicare Levy Surcharge you may have to pay an extra 1% to 1.5% in tax if your income* exceeds

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certain thresholds and you don’t have hospital cover.

You may well find that the cost of our Singles and Couple Combined Cover is less than the additional surcharge which means you may be better off financially and have the peace of mind of having a hospital cover as well.

Australian Government Rebate on private health insurance The Australian Government Rebate on private health insurance was introduced as a financial incentive to assist Australians afford private health cover, and to recognise the contribution that people with private health insurance are making to their own health care costs. Rebate entitlement depends on your age, and income*.

From 1 April 2014, the rebate is now indexed each year by the difference between CPI and the industry average increase in premiums using a Government-calculated formula.

It’s up to you to nominate a rebate tier (based on your age and income*).

Some people choose to take their rebate up front as a lower premium, but if you’d prefer to claim the rebate as a lump sum through your tax at the end of the financial year, you can simply choose to pay the full premium with no rebate deducted. * This information is intended as a guide only and does not take into account your personal circumstances. For more information regarding the Rebate and MLS, 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/

SINGLES AND COUPLES COMBINED COVER Getting started with health insurance has never been easier. Queensland Country offers our Singles and Couples Combined Cover designed to provide younger people with the cover they need, without paying for benefits that won’t be used. Singles and Couples Combined Cover provides: • Cover for Private Hospital treatment for a range of commonly needed treatments for conditions like tonsillitis, knee reconstructions, appendicitis etc. This hospital cover has some restricted and excluded benefits.

Queensland Country offers: V alue for money health insurance products with comprehensive benefits A ccess to your health insurance policy information via our Online Member Services V ery high levels of Member satisfaction which is confirmed with Member surveys

• Cover for a number of commonly used extras like dental, physiotherapy, massage, optical etc.

• Competitive pricing to make health insurance affordable

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HOSPITAL COVER Singles and Couples Combined Cover is a popular choice for young singles and couples. This covers you for the hospital services you are more likely to use. This means if you want the security of hospital cover at any hospital in our Australia-wide network but don’t want to pay for benefits you’re not likely to use (such as hip replacements) then this is the cover for you.

Private hospital cover helps you afford treatment in private or public hospitals. You can receive the required treatment when and where you want it, and it can be performed by the Doctor of your choice. So, as a patient, you have more control, and more importantly you can ensure you receive the best medical care.

Private Hospital cover also assists to cover the gap component over the Medicare Benefits Schedule for in-patient services*. *Singles and Couples Combined Cover has some excluded and restricted benefits

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A USTRALIA-WI DE PR IVATE HOSPITAL N ETWOR K PAY LESS WITH ACCESS GAP COVE R P EACE OF M I N D WITH TH E DOCTOR OF YOU R CHOICE C HOOSE A H IG H E R EXCESS TO LOWE R YOU R PR E M I U M

Excess

Hospital Network

Singles and Couples Combined Cover is available with the choice of a $250 or $500 excess for single membership or couples membership.

Queensland Country has negotiated Purchaser Provider Agreements with most of the participating private hospitals and day hospital facilities Australia-wide.

The excess that applies in any one membership year is $250 or $500, depending on which one you choose. This means for example that regardless of how many times hospitalisation is required throughout the year if you have the $250 excess, you would only pay a maximum of $250 for single membership, and $500 for couples membership. The excess applies to the full cost of hospitalisation at a public, private or day hospital facility and is applicable to both adults and dependants covered under this policy.

In most instances, the approved hospital charges for policy holders of a private hospital policy will be covered in full once the agreed excess has been deducted. This means that you will benefit from capped fees we’ve negotiated and convenient billing as your invoice will be sent directly to Queensland Country.

Out-of-Pocket Expenses

Private hospitals and day hospital facilities that have not signed an agreement attract reduced benefits which will mean you may incur out-of-pocket expenses for in-hospital treatment. Go to our website to find a hospital most convenient to you.

It is your right to know if there are any out-of-pocket expenses to help avoid any surprises later. Knowing how much your medical treatment will cost is called Informed Financial Consent and the Federal Government has introduced a checklist providing you with the questions you need to ask before going into hospital.

www.qldcountryhealth.com.au

We recommend that you contact us before going into hospital so that we can discuss what your policy will provide cover for.

If you do not have ancillary (extras) cover and exercise physiology, for example, is required in hospital as part of your treatment, then you will not be covered for these services if they are invoiced separately by the Provider. This is also the case for any allied services not covered under this policy.

We would also be happy to send you a copy of the checklist.

What’s Covered in Hospital We will pay benefits for in-patient services in a private hospital where a Medicare benefit is payable and waiting periods have been served, except for restricted services or services not covered (see table on page 8).

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WHAT’S COVERED IN HOSPITAL What’s covered Included services

✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Included services

Examples of in-hospital treatments we will pay benefits towards: Appendix treatment Accidents Removal of teeth Knee, shoulder and hip investigations Removal of tonsils Hernia surgery Digestive disorders Colonoscopies Kidney stone and gall stone removal Knee & ankle arthroscopy and reconstructions Shoulder arthroscopy and reconstructions Hospital and doctors’ benefits for included services

✔ ✔ ✔ ✔ ✔ ✔ ✔

Choice of doctor/hospital

✔ ✔

Plastic and reconstructive surgery (if medically necessary)

✔

Doctors charges in hospital where each doctor chooses to opt in to the Queensland Country Access gap scheme

✔

Radiography and pathology services charges ordered by your doctor in hospital. 100% cover where the practitioner participates in the Queensland Country Access gap scheme

✔

Most pharmaceuticals directly related to your admission

Private hospital accommodation Public hospital accommodation as a private patient (shared room) Theatre fees Surgically implanted prosthesis benefits* Intensive care In-hospital rehabilitation treatments (Rehabilitation for hospital services with restricted or excluded benefit entitlement will have reduced or nil benefit eligibility)

Medical Gap

* Some surgically implanted prostheses may be for an excluded benefit therefore no benefit would be payable in this circumstance, for example hip replacement.

Waiting periods will apply to all benefits outlined. Please refer to pages 20-21 for further details.

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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 amounts 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 these services.

Whilst cover with Restricted Benefits entitles you to your choice of Doctor in a public hospital, your Doctor may not be willing, or able, to treat you in a public facility.

What’s covered Restricted services

in-hospital treatments we will pay a restricted benefit towards:

restricted

In-hospital psychiatric treatment

restricted

Cardio-thoracic procedures — for example open heart surgery

restricted

Major eye surgery — cataract and eye lenses procedures

restricted

Obstetric related services — birth and pregnancy related services

restricted

Assisted reproduction services — for example IVF

restricted

Gastric banding and obesity surgery

restricted

Renal dialysis — for chronic renal failure

Waiting periods will apply to all benefits outlined. Please refer to pages 20-21 for further details.

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 need any of the procedures outlined below you may like to consider taking out a higher level hospital cover.

What’s not covered Excluded services

✘ ✘

in-hospital treatments we will not pay a benefit towards: Joint replacements — for example an artificial hip replacement Cosmetic surgery (hospital treatment for which Medicare pays no benefit)

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HOW IT WORKS IN RELATION TO DOCTORS’ CHARGES Medicare uses a Medicare Benefits Schedule fee (MBS) for calculating rebates on doctors’ charges. Queensland Country offers our Access Gap Cover Scheme and we encourage doctors to participate in the scheme. Under the Access Gap Cover Scheme participating doctors who provide a service in hospital can decide to accept up to the Health Fund benefit as full settlement of the account. This means you don’t have to make any additional payments for that particular service.

The doctor can also accept the fee as part of the payment and will inform you of any gap — called the known gap which you will have to pay.

If your doctor does not participate in Access Gap, we will only cover the 25% gap between the 75% Medicare Benefit and the Medicare Benefits Schedule fee which may result in larger out-of-pocket expenses for yourself.

It’s always a good idea to talk to your doctors about their charges prior to your treatment.

To find doctors who may participate in the Access Gap Scheme refer to the AHSA website: https://www.ahsa.com.au/web/gapcoversearch

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EXTRAS COVER Singles and Couples Combined Cover has been designed to provide good benefits for a broad range of therapies most likely to be used by young people while keeping the cover affordable. Whether you need a massage or a new pair of glasses, Queensland Country can help.

•G ENEROUS ANNUAL LIMITS FOR GENERAL DENTAL AND OPTICAL SERVICES

Online or on-the-spot claiming!

•E ASY CLAIMING WITH HICAPS/ IBA ON THE SPOT CLAIMING

To make it even easier to claim your benefit, participating health professionals have electronic claiming facilities available. HICAPS/IBA is an electronic health claiming and payments system that will process your claim for treatment, on the spot, without leaving the surgery or practice of your provider.

•C OVER FOR A WIDE RANGE OF ALTERNATIVE THERAPIES INCLUDING REMEDIAL MASSAGE AND PODIATRY

• COMPETITIVE PREMIUMS

Alternatively with Online Claiming we’ve now made it easier than ever to claim for a wide range of services when on-thespot claiming isn’t available through your provider.

Simply go online using your PC, tablet or smart phone!

You can claim up to $400 per day in benefits for services up to three (3) months from the actual date of service, treatment or visit.

For full terms and conditions visit our website www.qldcountryhealth.com.au

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

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EXTRAS COVE R B E N E FITS Services

Waiting Period

Benefit Limits

Examples of maximum benefits

per membership year

D E NTAL B E N E FITS G E N E RAL D E N TA L :

2 months

$500 per person up to $1000 per policy

Periodic oral examination – $34 X-rays – $23

Diagnostic

This includes examinations, consultations, x-rays etc.

Preventative

2 months

Scale & Clean – $56 Fluoride treatment – $17 Mouth Guard – $113

Simple Extraction

2 months

Simple extraction – $79

Restorative

2 months

One surface composite filling – $68

General Services

2 months

Occlusal splint – $225

Surgical Extraction

12 months

This includes cleaning and scaling, fluoride treatment, oral hygiene instruction and mouth guards

This includes composite and amalgam fillings

Occlusal splints

Wisdom teeth extraction, removal of impacted teeth

$500 per person up to $1000 per policy

Surgical extraction – $135

MAJOR D E N TA L : Periodontics

12 months

Treatment of acute periodontal infection (per visit) – $38

Endodontic

12 months

Filling of one root canal – $128

Crowns/Bridges

12 months

Full Veneered Crown – $500

Orthodontics

12 months

Braces for upper & lower teeth, including removal plus fitting of retainer – $500 Lifetime Limit – $1000 per person Benefits are paid at 70% of cost

Specialised gum treatment

Root canal therapy and root fillings

Braces etc

OPTICAL B E N E FITS Single & Multi-focal lenses & frames

2 months

$200 per person up to $400 per policy

Single vision lenses & frames – $200 Repair to frames – $200 Contact lenses – $200

$400 per person up to $800 per policy

Initial visit – $42 Subsequent visit – $32 Group Therapy - $8 (sub limit of $80 applies)

PHYS IOTH E RAPY Physiotherapy

2 months

* Benefits are payable for services rendered by Australian Regional Health Group approved providers registered with Queensland Country as well as Bowen Therapists that are registered with the Bowen Association of Australia (BAA) or Bowen Therapists Foundation of Australia (BTFA) # Prescriptions not covered by the PBS, excluding contraceptives and items normally available without prescription and drugs not approved for sale in Australia.

A co-payment applies to each prescription item equal to the current PBS General Patient Contribution. Please refer to page 23 for more information.

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Services

Waiting Period

Benefit Limits

Examples of maximum benefits

per membership year

ALTE R NATIVE TH E RAPI E S Chiropractic

2 months

Osteopathy

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

Initial visit – $30 Subsequent visit – $30 Chiro x-rays – $50

Remedial Massage Therapy* Bowen Therapy* Myotherapy* Podiatry

Initial visit – $30 Subsequent visit – $30 Orthotics – 85% of cost up to available policy limits Minor procedures – 75% of cost up to available policy limits

Acupuncture*

Initial visit – $30 Subsequent visit – $30

Naturopathy* Homeopathy*

Initial visit – $30 Subsequent visit – $30

Dietician

Initial visit – $55 Subsequent visit – $35

OTH E R S E RVICE S Pharmaceutical#

2 months

$150 per person up to $300 per policy

$30 per script

Healthy Living Benefit

2 months

$125 per person up to $250 per policy

Benefits up to the policy limit are available for:

Your choice of quit smoking programs

Your choice of weight

management programs

Participate in other approved health

management programs** including: - Gym Membership - Personal Training programs

Skin checks through mole mapping Consultation fees for metabolic dieticians and nutritionists when providing assistance with weight management

** To comply with private health insurance legislation you must have been referred by your health care professional to participate in a health management program to address, improve or prevent a specific or medical condition. A Health management Program Benefit Approval Form, available on our website must accompany claim for these benefits.

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HOW MUCH ARE THE PREMIUMS? What you’ll pay SI NG LES COVER

WITH BASE TIER REBATE

NO REBATE DEDUCTED

WEEKLY

MONTHLY

YEARLY

WEEKLY

MONTHLY

YEARLY

Singles and Couples Combined Cover 250

$24.90

$107.85

$1,294.55

$34.50

$149.45

$1,793.50

Singles and Couples Combined Cover 500

$22.05

$95.45

$1,145.85

$30.55

$132.30

$1,587.55

COU PLES COVER

WITH BASE TIER REBATE

NO REBATE DEDUCTED

WEEKLY

MONTHLY

YEARLY

WEEKLY

MONTHLY

YEARLY

Singles and Couples Combined Cover 250

$49.80

$215.80

$2,589.80

$69.00

$299.00

$3,588.00

Singles and Couples Combined Cover 500

$44.05

$191.00

$2,292.15

$61.05

$264.65

$3,175.65

Normal 2 and 12 month waiting periods apply with our combined products.

Premiums are quoted with and without an Australian Government Rebate on private health insurance.

Australian Government rebates depend on age and income levels. For more information see page 4.

Join Queensland Country today

Switch to Queensland Country Health Fund

Joining our fund is simple. Choose one of the following options that suit you:

If you are a member of another health fund, it’s quick and simple to transfer to us. Simply complete our membership application and cancel any direct debits you may have with your old fund.

We will contact your old fund and arrange for the transfer of cover of the commencement date of your policy.

• Call us on 1800 813 415 and complete an application over the phone • Visit a retail centre and let one of our friendly staff assist you • Go to our website and apply online through our online application process. The web address is www.qldcountryhealth.com.au • Drop in to one of Queensland Country Credit Union’s 23 branches throughout Queensland [ 14 ]

Money back guarantee If you are not completely satisfied with your new health insurance policy we will provide a refund of any premium paid (if a claim hasn’t been made) if you write to us advising that you are not satisfied with your policy within 30 days.

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MANAGING YOUR HEALTH INSURANCE COVER ONLINE Online Member Services (OMS) gives you the ability to update your membership details whenever you want, giving you greater control and easy access.

You can log on at any time of the day and check your cover; update address details, change your level of cover and even add a new addition to the family.

To access OMS, all you need to do is register on the homepage 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 your choice of password, click on the Login tab and enter your membership number and password.

Now you’re ready to go!

Below is a list of all the different services you can access by registering: Claims history View/print tax statement Update Membership details Change contact details Add new person Change personal details Add student dependant or apprentice Add Medicare card details Add previous cover details Make a contribution payment by credit card Change level of cover Update your method of payment pdate the way we pay benefits U eg. direct credit Contribution changes View benefit limits Make a claim for ancillary services* *not all ancillary services (Extras) are claimable through Online Claiming see website for further terms and conditions www.qldcountryhealth.com.au

Access to some functions may be limited for your spouse/ partner and dependants. [ 16 ]

HOW TO PAY CONTRIBUTIONS Queensland Country offers you a variety of payment options so you can choose the best method for you. You can choose to pay weekly, fortnightly, monthly, quarterly, 6 monthly or yearly, whichever suits you. If you do choose one of the latter options, we’ll send you a reminder notice as a courtesy.

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

Direct Debit

Credit Card

BPAY

BillPaying

Direct Debit facilities are

Credit Card* facilities are

BPAY facilities are available to

BillPaying Service —

available for policy holders

available to all policy holders

all policy holders who prefer

Queensland Country Credit

who prefer to pay through

who prefer to pay via this

to pay via this option. BPAY

Union offers a BillPaying

automatic deductions from

option. If this is your preferred

allows you to pay your health

service through all their

their Bank, Building Society,

method of payment, simply

insurance premium via internet

branch offices. BillPaying is

Credit Union accounts and

visit our website and make the

or phone banking, or at your

a comprehensive budgeting

Credit Cards. If this is your

payment online through Online

financial institution. The

and bill paying service that

preferred method of payment,

Member Services (OMS^).

BPAY biller code and your

provides a fast and simple

simply nominate this on the

Alternatively, phone us on

reference number appear on

way to pay all your bills. If you

application form, and complete

1800 813 415.

all statements. If you don’t

would like more information on

receive regular statements

this service, please feel free to

please contact us and we’ll

contact Queensland

be happy to supply you with

Country Credit Union on

Please see page 16 for

your BPAY biller code and

1800 075 078.

details on how to register

reference number. (This option

for OMS.

is not available to eligible

your details or visit our website.

A reminder notice is not issued if you pay by direct debit.

* We do not accept American Express or Diners Club. ^

participants in a Corporate Health Plan)

Note: Deadlines may exist for one or more of these payment options. Please consult our Membership Guide for further details.

You can choose to pay weekly, fortnightly, monthly, quarterly, 6 monthly or yearly, whichever suits you.

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In more detail We have included information you may need.

Additional information is available in the Membership Guide.

Pre-Existing Conditions A pre-existing ailment, illness or condition is one where, after examining evidence, a medical adviser, or other relevant health care practitioner appointed by Queensland Country would consider that signs or symptoms would have been in existence at any time during the six months preceding the application for membership or upgrade of cover. You may have a pre-existing condition, ailment or illness without being aware of it. In these cases, there is a 12 month waiting period before you are entitled to claim benefits for treatment. It is not necessary for the signs or symptoms to have been diagnosed by a doctor when a Member joined or upgraded their level of cover.

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

The 12 month Pre-existing condition waiting period can be applied to all hospital or hospital substitute treatment for which we pay benefits.

However, a two month waiting period applies to the following services: a ll other inpatient hospitalisation services/treatments a pproved psychiatric treatment (restricted benefit only) approved rehabilitation treatment, or palliative care.

The 12 month waiting period for the treatment of a Pre-existing Condition can also apply to ancillary (Extras) services. [ 18 ]

Benefit Conditions Queensland Country will only pay benefits when: ll applicable waiting periods have A been served oods or services are provided in G Australia (not including items imported by the user via an internet purchase) he Member has been charged for the T treatment or service service or treatment is medically A necessary and clinically relevant ervices are part of a course of treatment S recognised by Queensland Country

claim for a service rendered is A submitted for payment within 24 months of the date of service he waiting period for that service has T been served The amount of benefit is calculated on the cost of the treatment or aid to the Member, taking into account any allowances or discounts given by the provider. No benefit paid by Queensland Country can exceed the actual charge of the service or appliance. enefits are not payable for claims for goods B purchased or rendered outside of Australia or, for items purchased or hired from overseas suppliers (including internet purchases)

The service is provided in person he service is provided to a person on T the membership he service or treatment has been T provided by a practitioner or therapist recognised by Queensland Country he treatment or service is covered under T the Member’s level of cover o benefits are payable from another N source (e.g. compensation payment or Government benefit) he conditions of the level of cover have T been met

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Membership Year

Waiting Periods

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

So when will I be fully covered you ask?

Waiting periods apply when you join any health fund for the very first time or when you upgrade to a higher level of cover. But you won’t have to wait if you’re transferring to Queensland Country from an equivalent or higher level of cover with another health fund, or if you’ve been covered by your parents’ membership and you’re just starting out on your own.

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

Couple: a couple policy covers the person who establishes the policy as well as one other partner/spouse. The policy can be extended to cover dependant children at no additional cost.

Family: a family policy covers the person who establishes the policy as well as that person’s partner and all dependant children.

Single Parent Family: a single parent family policy covers the person who establishes the policy as well as that person’s dependant children.

Waiting periods are necessary to keep health cover fair and aim to protect our existing policy holders who contribute to a fund over a period of time for when they may need cover. If we didn’t have these waiting periods people may join, claim for something planned and then leave. Always make sure you have waited the sufficient period before claiming, otherwise you may not be covered!

For those of you who are thinking of starting a family, if you have a single policy, to be sure your baby has cover, it is necessary to add a newborn baby to your policy within two months after the date of their birth.

“Always make sure you have waited the sufficient period before claiming, otherwise you may not be covered”

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The baby will not have to serve any waiting periods* that have already been fully served by the policy holder providing that the change is made to the policy within this time frame. *For policy holders with no previous cover pre-existing condition waiting periods may apply to the baby within the first 12 months.

Waiting Period

Item / Service Hospital: For all hospital treatments or services where there are no Pre-existing Conditions (excluding Accidental Injury^).

Dental: D iagnostic — includes examinations & consultations P reventative — includes cleaning and scaling, fluoride treatment etc.

S imple extraction R estorative — composite and amalgam fillings G eneral services — includes mouth guards and Occlusal splints O ptical Acupuncture

2 months

Chiropractor Remedial Massage Therapy/Bowen Therapy/Myotherapy Osteopathy Physiotherapy Podiatry Dietitian Pharmaceutical Healthy Living Benefits Sporting & School accidents Pre-existing Conditions All Elective Surgery Obstetrics-related Services (restricted benefit) Major Dental services P eriodontics — specialised gum treatment

12 months

S urgical Extraction — includes Wisdom tooth extraction E ndodontic Services — includes root canal therapy C rowns and Bridges O rthodontics — Braces etc.

Surgery for assisted fertility programs such as IVF or GIFT (Restricted Benefit) Elective Surgery (such as sterilization or vasectomy)

^T wo month waiting periods apply for most other items or services. The 2 month Waiting Period is waived for treatment arising from an accident (excluding a school and sporting accident) that occurred after joining.

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Contribution in arrears

Dependants

A policy holder who fails to pay contributions within 63 days of the day of which contributions were due and payable shall be deemed to be unfinancial. No benefits are payable for services rendered whilst a membership remains in arrears. However, provided contributions are paid within 63 days of the due date, the membership will be reinstated. Membership of Queensland Country Health shall automatically cease for any policy holder whose contributions are more than 63 days in arrears.

Dependants include a policy holder’s children and stepchildren, legally adopted children or foster children under the age of 21.

Dependants turning 21 who are not eligible for cover under a family membership as a student or apprenticeship dependant are required to commence their own membership if they wish to continue private health cover.

The good news is that they can move straight across to their own single membership without having to serve any waiting periods.

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

Excess Singles and Couples Combined Cover is available with a choice of a $250 or $500 for single membership or couple membership.

The excess that applies in any one membership year is $250 or $500, depending on which one you choose. This means for example that regardless of how many times hospitalisation is required throughout the year if you have the $250 excess, you would only pay a maximum of $250 for single membership, and $500 for couple membership. The excess applies to the full cost of hospitalisation at a public, private or day hospital facility and is applicable to both adults and dependants covered under this policy.

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Dependants may be covered as either student or apprentice dependants under their parent’s membership from 21 years of age up to 25 years of age, provided the following conditions are satisfied: I s a full time student at a school, college or university who is not aged 25 years or over, or I s an apprentice who is not aged 25 years or over and does not earn more than $30,000 p.a.

And does not have a partner If, at any time, your dependant’s situation changes and they no longer meet all the above conditions then please contact us for further information.

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

Recognised Providers Queensland Country will only pay benefits for ancillary (extras) or dental services where the services are provided by practitioners recognised by Queensland Country.

Recognition is subject to change without notice. There are no benefits payable for overseas hospitalisation or ancillary care.

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.

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

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

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

This is conditional on the pharmaceutical prescription being listed in the MIMs Schedule as S4 or S8 and being dispensed in quantities in accordance with this schedule.

We also pay for compound pharmacy scripts, as long as one of the ingredients meets this criteria. The PBS General Patient Contribution amount is reviewed annually by the Government and changes every year on 1 January. As at 1 January 2015, the PBS contribution is set at $37.70.

It’s important to note that a doctor’s letter may be required for some Pharmacy items.

Overseas suspension of membership If you’re lucky enough to travel overseas, and you’re going to be absent from Australia for more than 4 weeks and less than 24 months, and provided you’ve fulfilled all other criteria, you may apply for a suspension on your membership. To get the full picture, please call us when you’re making your travel plans.

Summary of Rules The “In more detail” pages contain only a summary of the fund rules. The complete rules of the health benefits fund set out in full the terms and conditions of membership and liability under the fund. These rules are available for inspection at Queensland Country Centre, Level 1, 333 Ross River Road, Aitkenvale QLD 4814.

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.

A full copy of the Code is available at www.privatehealth.com.au/codeofconduct

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

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

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

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 and our understanding staff are here to answer any questions and allay any fears you may have.

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, 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: Telephone:

1800 640 695

Email:

info@phio.org.au

Website:

www.phio.org.au

Address: Suite 2, Level 22, 580 George Street, Sydney NSW 2000

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

Our Privacy Policy is available for your information on our website at www.qldcountryhealth.com.au, or from any of our Service Centres or Queensland Country Credit Union branches. [ 25 ]

C O NTACT D E TAI LS Head Office

Gladstone Retail Centre

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

Night Owl Centre

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

70 Camooweal Street Mount Isa

Aitkenvale Retail Centre Queensland Country Centre 333 Ross River Road

Mount Isa Retail Centre

Burdekin Retail Centre 186 Queen Street Ayr Mackay Retail Centre Caneland Central Shopping Centre

Willows Retail Centre Willows Shopping Centre Kirwan

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

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HOW TO J O I N It’s super easy to join Queensland Country Health Fund.

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

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

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

Drop in

to one of Queensland Country Credit Union’s 23 branches throughout Queensland

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