Docstoc

Singles _ Couples

Document Sample
Singles _ Couples Powered By Docstoc
					Singles & Couples




Effective 1 April 2009
Welcome to Medibank Private
Feel better with Medibank Private knowing you can
choose from a                     to suit your needs and
budget. You’ll feel confident with                    over
where you are treated, who treats you, and most
importantly, how soon. Have                     knowing
you’ll have access to greater value through our Members’
Choice network which includes the vast majority of
private hospitals and many extras providers
             We’re the choice for over 3 million Australians
who have private health insurance – and as one of our
members we’ll ensure you’re well looked after.
Contents
 Having private health insurance makes financial sense                                                                                                                 p5
 The value of private health insurance including the basics like the Medicare Levy Surcharge,
 the Federal Government Rebate, and other financial information.


 What’s right for you?                                                                                                                                                p6
 A snapshot of our covers and a guide to help you decide what’s right for you.



 Hospital covers                                                                                                                                                      p9
 Read about our hospital cover options to pick the cover that matches your health needs and lifestyle.                                                                Comparison
                                                                                                                                                                      table p11

 First Choice Hospital – basic cover                                                                                                                                  p12

 Intermediate Hospital – intermediate cover                                                                                                                           p13

 Blue Ribbon Hospital – comprehensive cover                                                                                                                           p15


 Extras covers                                                                                                                                                        p17
 Choose an extras cover to help with the cost of the everyday treatments you might use.                                                                               Comparison
 Includes dental services, optical items and alternative therapies.                                                                                                   table p18

 First Choice Extras – basic cover                                                                                                                                    p20
 Smart Choice Extras – intermediate cover                                                                                                                             p21
 Blue Ribbon Extras – comprehensive cover                                                                                                                             p23
 Blue Ribbon Extras Plus – comprehensive cover                                                                                                                        p23


 Packaged covers with a bonus                                                                                                                                         p25
 A range of covers that combine hospital and extras into one convenient bundle with                                                                                   Comparison
 an annual bonus.                                                                                                                                                     table p26

 MyOptions – basic cover                                                                                                                                              p30
 HealthyPlus – basic cover                                                                                                                                            p32
 SmartPlus – intermediate cover                                                                                                                                       p34
 AdvantagePlus – comprehensive cover                                                                                                                                  p36
 PremierPlus – comprehensive cover                                                                                                                                    p38


 Make the most of being a member                                                                                                                                      p41
 A snapshot of some of the features you can access as a member including Members’ Choice,
       health programs and value-for-money travel, life and pet insurance. Here you’ll also find
 the Things Worth Knowing section and our Glossary of terms.



The information contained in this brochure is current at the time of issue, 1 April 2009, and supersedes all previously published material. Membership of Medibank Private, including
entitlement to and payment of benefits, is subject to our Fund Rules and policies. If you anticipate treatment for which you are expecting a benefit from Medibank Private, please contact
us before commencing treatment to confirm that the benefit you expect will be paid. A summary of the main Fund Rules and policies is contained in our Membership Guide which is
issued to you when you join. Premium rates, and the Fund Rules and policies, change from time to time. Your personal information is handled in accordance with our Privacy Policy. You
can view a copy of our Fund Rules and Privacy Policy at any Medibank store, or online at medibank.com.au
The hospital and packaged covers described in this brochure are generally not suitable for visitors from overseas, including visitors from countries with which the Australian
Government has Reciprocal Health Care Arrangements. Please refer to our brochures for international students and visitors, for health cover that may be more appropriate.
    Did you know for some of the most common
    hospital procedures, in the public hospital
    system, waiting lists can be lengthy and you
    could wait up to:




    If you want to go to a private hospital but
    don’t have private health insurance you could
    be looking at costs of:




4
Having private health insurance
makes great financial sense

At Medibank Private we take pride in being the largest Australian-owned health insurer.
While we’re the choice for over 3 million Australians who have private health insurance,
we want you to get the most value out of having private health insurance. As a
member you’ll get a better deal at our Members’ Choice network through capped fees
and discounts to help reduce out-of-pocket expenses. You’ll also have access to
discounted travel, life and pet insurance. Here are some other reasons why it makes
sense to have private health insurance.

Pay less tax                                                          Private health insurance – it’s
If you don’t have an appropriate level of hospital cover and your     only fair
individual taxable income is over $70,000 a year, or for couples
                                                                      Private health insurance premiums work differently to the
your combined income is over $140,000 a year, you may have to
                                                                      insurance you may have for your home or car. All private health
pay the Medicare Levy Surcharge (MLS). This adds up to 1% on
                                                                      insurance funds follow a principle known as ‘community rating’.
your tax bill. So if your annual taxable income is $80,000, by
                                                                      This means the premium you pay with Medibank Private won’t
taking out hospital cover you can avoid the MLS and save up to
                                                                      vary according to things like your gender, health condition or
$800 on your tax bill.
                                                                      claims history.

Reduce your premium                                                   How much will it cost me?
Make your health cover more affordable. If you’re eligible, you
                                                                      This depends on things like the level of cover you select, what
can reduce your premium by at least 30% with the Federal
                                                                      state or territory you live in, whether you have an excess and
Government 30% Rebate on private health insurance. The
                                                                      your type of membership (for example, cover for just you or
easiest way to access the rebate is to ask us to organise it for
                                                                      you and your partner). See the premium sheet in the pocket at
you – we’ll automatically deduct your rebate amount from the
                                                                      the back of this brochure to find out the premium for your
premium you pay, saving you money. To find out more see
                                                                      preferred cover.
page 47.


Protect yourself from a
Lifetime Health Cover loading
If you take out hospital cover early in life, and maintain it, you
can avoid paying a Federal Government Lifetime Health Cover
loading on your premium.




 To know more                                                        To understand a term
 Go to Things Worth Knowing                                          Go to our Glossary



                                                                                                                                        5
    What’s right for you?

    You’ll have your own priorities when choosing private health insurance and we have options
    to suit every life stage and budget. This brochure has been designed to help you find the
    right cover easily. To get a feel for how private health insurance works, we’ve created
    scenarios that have been used throughout the brochure. To help with the tricky bits, you
    should take a look at the Things Worth Knowing section and our Glossary.




    Finding the right cover is easy


1.
          What type of cover do you need?
          Whether you’re looking for cover for just you or both you and your partner, you have a number of options to choose from.



          Do you only want help with the cost of hospital treatment including hospital accommodation, theatre fees and doctors’
          charges? If so, perhaps you should consider a          cover. See page 9.



          Or, would you prefer cover just for everyday health services like dental and physio? Then take a look at our       cover.
          See page 17.
          Remember, if you take out extras only cover, you won’t avoid the Medicare Levy Surcharge or any potential Lifetime Health
          Cover loading that may apply if you decide to change to a hospital or packaged cover in the future.



          If you’re interested in having both hospital and extras cover, you have a couple of options. Either mix and match our hospital
          and extras covers yourself or, choose a packaged cover where we’ve already combined hospital and extras in one neat bundle
          that also includes an annual bonus. For more about our               covers, see page 25.




    2.
          What level of cover do you need?
          The covers in this brochure are split into three levels:




                             for the widest range of services and highest benefits




6
3.
       What Medibank cover do you want?
       Here’s a snapshot of the range of covers you can choose from:



                                                           Hospital covers       Extras covers         Packaged covers



Basic                                                      First Choice
                                                           Hospital
                                                                                 First Choice
                                                                                 Extras
                                                                                                       MyOptions

Zoe is young, healthy and budget-conscious. She                                                        HealthyPlus
really just wants to protect against the unexpected
and avoid the Medicare Levy Surcharge. A basic
level of hospital or packaged cover is probably
going to be fine for her needs.



Intermediate                                               Intermediate
                                                           Hospital
                                                                                 Smart Choice
                                                                                 Extras
                                                                                                       SmartPlus

Matt loves his sport, but his body isn’t taking it
quite as kindly as it used to. Some physio wouldn’t
go astray and it’s probably a good idea to make
sure he has cover for unexpected injuries, so Matt
should think about taking out an intermediate
level of cover.



Comprehensive                                              Blue Ribbon
                                                           Hospital
                                                                                 Blue Ribbon
                                                                                 Extras
                                                                                                       AdvantagePlus

The last of John and Rosa’s children has just finished
uni and moved out, so they don’t need family cover                               Blue Ribbon           PremierPlus
anymore. Because Rosa needs a remedial massage                                   Extras Plus
now and again, and John’s family has a history of
heart disease, a comprehensive packaged cover or
combined hospital and extras cover could best suit
their health needs.


Comparison tables – for quick reference                    p11                   p18                   p26


4.
       Next steps
       If you would like to speak to someone directly, please give us a call or drop into a Medibank store. Otherwise if you
       know what you want, it’s easy to join.




        It’s easy to join                                         Go to medibank.com.au
                                                                  Visit a Medibank store
                                                                  Post your application forms



                                                                                                                               7
    Ben rolled his ankle playing soccer.
    As he was in excruciating pain and
    couldn’t put weight on it, his mates
    drove him to hospital. It was discovered
    he had snapped his achilles and he was
    admitted to hospital.
    This is when Ben’s hospital cover came
    into play, providing cover for hospital
    accommodation, surgery and
    in-hospital physio treatment.




8
Hospital cover introduction

Hospital cover gives you greater control over who treats you, where you are treated and
how soon. You can choose your own doctor and the hospital you’d prefer, whether it’s
private or public.


Get greater value at Members’                                           Pay less with GapCover
Choice hospitals                                                        Going to hospital shouldn’t leave you with unexpected
                                                                        expenses when you have hospital cover – but it can happen.
Our Members’ Choice network includes the majority of private
                                                                        That’s why we have a scheme called GapCover, used by a large
hospitals across Australia. And while you can choose to go to
                                                                        number of specialists, which can help reduce your out-of-pocket
any private hospital in Australia, you’ll receive greater value at a
                                                                        expenses. Before you go to hospital, you’ll need to talk to your
Members’ Choice hospital because your out-of-pocket expenses
                                                                        specialist to find out if they will participate.
will be lower than if you are admitted to a non Members’
Choice hospital.
                                                                        Ambulance transport
Don’t pay for things you’re less                                        You’re covered for medically necessary ambulance transport if
                                                                        you need to go to hospital and, because of your medical
likely to use                                                           condition, there’s no other way of getting there except by
If you’re happy with a cover that offers lower or no benefits for        ambulance. Benefits for this are included in all hospital covers in
services you’re less likely to use, you can choose an option            this brochure except where you’re entitled to claim costs of
with restricted or excluded services to help lower the cost of          ambulance transport from another source, such as ambulance
your cover.                                                             subscription or State Government ambulance transport schemes.


Choose an excess to lower
your premium
Another way to reduce your premium is to choose an excess,
which is an amount you’d pay if admitted to hospital. Some of
our hospital covers offer you a range of excess levels, so you can
help keep your premium down.




Comparison table                   First Choice Hospital               Intermediate Hospital            Blue Ribbon Hospital

 To know more                                                          To understand a term
 Go to Things Worth Knowing                                            Go to our Glossary
10
 Hospital cover comparison table
 Item / Service                    Basic                              Intermediate                       Comprehensive
                                   First Choice Hospital              Intermediate Hospital              Blue Ribbon Hospital

 Choice of doctor


 Choice of hospital

 Private hospital
 accommodation
 Public hospital accommodation
 as a private patient

 Excess                                                               Optional                           Optional


 Theatre fees                          No benefits for
                                       restricted services
 Surgically implanted
 prostheses and other items
 on the Federal Government’s
 Prostheses Schedule
 Medically necessary
 ambulance transport*
 In-hospital psychiatric
                                   Restricted
 treatment
 In-hospital rehabilitation
                                   Restricted
 treatment

 Cardio-thoracic procedures        Restricted


 Major eye surgery                 Restricted

 Hip and knee
                                   Restricted
 joint replacement

 Obstetrics-related services       Restricted


 Assisted reproductive services    Restricted

 Plastic and
                                   Restricted
 reconstructive surgery

 Renal dialysis


 Cosmetic surgery

 All other services where a
 Medicare benefit is payable


                                   Cover overview go to p12           Cover overview go to p13           Cover overview go to p15

* Benefits are not available where there is an entitlement to cover under third party arrangements such as State Government
  ambulance transport schemes or ambulance subscription services.

Restricted services
If you choose a cover with restricted services, we will pay lower benefits for these services in a private hospital. It’s important to
consider whether you’re likely to need these services, because the benefits for restricted services generally won’t cover the full cost
of treatment in a private hospital and you may end up with significant out-of-pocket expenses. See page 51 for more information.



 To know more                                                        To understand a term
 Go to Things Worth Knowing for information on waiting               For terms you don’t understand, go to our Glossary
 periods and other benefit assessment information

                                                                                                                                         11
     First Choice Hospital
     A great choice if you’re young, fit and healthy and just want cover to avoid
     the Medicare Levy Surcharge and protect against the unexpected.


     What’s covered?                                                                                   Key features:
     We’ll pay benefits towards (less any applicable excess):                                            Basic hospital cover with
      Private hospital accommodation                                                                    restricted services

      - Private room                                                                                    Choose a higher excess to
                                                                                                        reduce your premium
      - Same day admission
      - Intensive care
      - Theatre fees
      Public hospital accommodation as a private patient
      - Overnight accommodation in a shared or private room
      - Same day admissions (shared room only)
      Surgically implanted prostheses and other items on the Federal Government’s
      Prostheses Schedule
      Medically necessary ambulance transport.


     Restricted services
     We’ll pay lower benefits in a private hospital for:
      In-hospital psychiatric or rehabilitation treatment
      Cardio-thoracic procedures such as angiograms or open heart and bypass surgery                   Key information:
      Major eye surgery
      Hip and knee joint replacement surgery
      Obstetrics-related services
      Assisted reproductive services such as IVF and GIFT
      Plastic and reconstructive surgery.
     See page 51 to find out what we mean by restricted services.


     Your excess options
     An excess is an amount that you agree to pay if admitted to hospital in exchange for lower
     premiums. It is paid per member per calendar year. Your excess options are:

                                    Level 1                 Level 2                 Level 3

      Excess options                $150                    $250                    $500




      To compare covers                                   To join                              Back
      Go to the comparison table                          Fill out your application forms     pocket

      To know more                                        To understand a term
      Go to Things Worth Knowing                          Go to our Glossary


12
Intermediate Hospital
A good option with cover for a broad range of services.
Worth considering if you’re active and don’t have any particular health
issues or you’re thinking of starting a family in the next few years.


What’s covered?                                                                               Key features:
We’ll pay benefits towards (less any applicable excess):                                        Cover for a wide range of
 Private hospital accommodation                                                                services with some exclusions

 - Private room                                                                                Optional excess to help reduce
                                                                                               your premium
 - Same day admission
                                                                                               Includes obstetrics-related
 - Intensive care
                                                                                               services
 - Theatre fees
 Public hospital accommodation as a private patient
 - Overnight accommodation in a shared or private room
 - Same day admissions (shared room only)
 Surgically implanted prostheses and other items on the Federal Government’s
 Prostheses Schedule
 Medically necessary ambulance transport.


What’s not covered?
Excluded services:
 Major eye surgery
 Hip and knee joint replacement surgery                                                       Key information:
 Renal dialysis.


Your excess options
An excess is an amount that you agree to pay if admitted to hospital in exchange for lower
premiums. It is paid per member per calendar year. Your excess options are:


                       No excess                            Level 2

 Excess options        $0                                   $250




 To compare covers                                To join                             Back
 Go to the comparison table                       Fill out your application forms    pocket

 To know more                                     To understand a term
 Go to Things Worth Knowing                       Go to our Glossary


                                                                                                                               13
14
Blue Ribbon Hospital
Our top hospital cover, providing protection for an extensive range of
services. A great option if you want a comprehensive hospital cover or
you have particular health concerns.


What’s covered?                                                                                     Key features:
We’ll pay benefits towards (less any applicable excess):                                              Comprehensive cover
 Private hospital accommodation                                                                      No restricted or excluded
 - Private room                                                                                      services

 - Same day admission                                                                                Optional excess to help reduce
                                                                                                     your premium
 - Intensive care
                                                                                                     Includes obstetrics-related
 - Theatre fees
                                                                                                     services
 Public hospital accommodation as a private patient
 - Overnight accommodation in a shared or private room
 - Same day admissions (shared room only)
 Surgically implanted prostheses and other items on the Federal Government’s
 Prostheses Schedule
 Medically necessary ambulance transport.


Your excess options
An excess is an amount that you agree to pay if admitted to hospital in exchange for lower
premiums. It is paid per member per calendar year. Your excess options are:

                                                                                                    Key information:
                       No excess         Level 1             Level 2             Level 3

 Excess options        $0                $150                $250                $500




 To compare covers                                 To join                                  Back
 Go to the comparison table                        Fill out your application forms         pocket

 To know more                                      To understand a term
 Go to Things Worth Knowing                        Go to our Glossary


                                                                                                                                   15
     Jeff has recently started playing golf
     for the first time. He plays once a week
     with a golf coach but has been
     experiencing shoulder and lower back
     pain from the sessions. A visit to his
     Members’ Choice physio confirmed his
     pain was from straining unused
     shoulder muscles and that his lower
     back needed some manipulation. Jeff’s
     extras cover helped pay for his initial
     assessment and the three follow-up
     treatments he required.




16
Extras cover introduction

Choose the cover with the range of extras services that suits your needs and lifestyle.




Why choose Medibank Private                                         Easy claiming
extras cover?                                                       On-the-spot
Extras cover provides benefits for everyday health services like:    When paying for your treatment at participating providers,
 Dental treatment                                                   simply present your Medibank Private membership card and
                                                                    the benefit should be automatically deducted from your bill
 Physiotherapy
                                                                    there and then – you just pay the balance.
 Optical items
                                                                    Online

Greater value with Members’                                         Claiming is easy online. Go to medibank.com.au and register or
                                                                    log-in for Online Member Services to claim for a selected range
Choice extras                                                       of extras services. If a benefit is payable, we’ll send out a cheque
                                                                    or transfer the money into your preferred bank account.
You can choose to receive treatment from any recognised
provider that suits you, but if you choose a Members’ Choice
extras provider you’ll receive great value such as:                 Ambulance transport
 Free dental check-up, scale and clean twice a year – valued        You’re covered for medically necessary ambulance transport if
 at over $250 a year per member                                     you need to go to hospital and, because of your medical
 Deals on optical items with discounts including a minimum          condition, there’s no other way of getting there except by
 20% off the normal retail price of frames and 15% off              ambulance. Benefits for this are included in all extras covers in
 contact lenses.                                                    this brochure except where you’re entitled to claim costs of
See page 43 for more about the value you can get from our           ambulance transport from another source, such as ambulance
Members’ Choice network.                                            subscription or State Government ambulance transport schemes.




                                                                                                    Blue Ribbon Extras
Comparison table                  First Choice Extras              Smart Choice Extras
                                                                                                    Blue Ribbon Extras Plus

 To know more                                                      To understand a term
 Go to Things Worth Knowing                                        Go to our Glossary



                                                                                                                                          17
     Extras cover comparison table
     This table shows the annual limits and sub-limits that apply to benefits for extras items and services.

                                                Item / Service                     Description                                         Waiting period

                                                                                                                                       2 months*
       How much will my                         General dental                     Eg dental examinations, scale and clean             12 months for surgical
       benefit be?                                                                                                                      procedures and extractions


       information you’ll need, then call
                                                Endodontic services                Eg root canal treatment                             12 months
       us on        and we’ll provide
       you with a quote.                        Optical items                      Frames, prescription lenses and contact lenses      6 months

       Limits                                                                      Eg consultations (includes group pilates and
       Each of our extras covers has            Physiotherapy                      hydrotherapy sessions)
                                                                                                                                       2 months*
       annual limits and sub-limits.
                                                Pharmaceutical                     Includes most prescribed non-PBS items. Benefits
                                                                                                                                       2 months*
                                                prescriptions                      will be paid after a set charge has been deducted
       information.
                                                Medically necessary                                                                    2 months*
       The benefit payable for a                 ambulance transport†
       particular claim is likely to
       be less than the annual limit            Major dental
       or sub-limit.
                                                 Inlay/onlay restorative           Eg restorative fillings                             12 months
       Additional restrictions apply
       to the payment of benefits for             Dentures, crowns and bridges                                                          12 months
       some services. Please call us for
                                                 Orthodontic                       Eg braces                                           12 months
       more information.
       Benefit replacement period                 Periodontic                       Eg treatment of gum disease                         12 months
       You might need to wait for a
       period of time from the date of          Alternative therapies              Consultations for:
       purchase of some items before
       you’re entitled to a new benefit           Chiropractic & osteopathy                                                             2 months*

       for more information.                     Acupuncture                                                                           2 months*

                                                 Naturopathy                                                                           2 months*

                                                 Remedial massage                                                                      2 months*


                                                Other therapies                    Consultations for:

                                                 Podiatry                          Includes specified orthotics                        2 months*


                                                 Dietetics                         Includes Jenny Craig weight loss benefit            2 months*


                                                 Occupational therapy                                                                  2 months*

                                                 Speech therapy                                                                        2 months*

                                                 Orthoptics (eye therapy)                                                              2 months*


                                                Health appliances
           waived when the service arises
                                                 Hearing aids                                                                          36 months
           from an accident.
       #
                                                 Breathing appliances              Peak flow meters, nebulisers and spacing devices    12 months
           year of continuous membership
           to the maximums shown. You
           will be eligible for the increases    Blood glucose monitors            May need to be ordered by a medical practitioner    24 months
           once you have served one full
           calendar year’s membership.
                                                 Other health appliances           Some appliances must be ordered by a
       † Benefits are not available                                                                                                     2 months*
                                                 (including external prostheses)   medical practitioner
         where there is an entitlement
         to cover under a State scheme.         Clinical psychology                Consultations only                                  2 months*

                                                                                   For preschool, primary and secondary
                                                School accident                    school students
                                                                                                                                       2 months


                                                To know more                                                 To understand a term
                                                Go to Things Worth Knowing                                   Go to our Glossary


18
Unless otherwise shown, limits are per person, per calendar year.

Basic                                             Intermediate                                                 Comprehensive
First Choice Extras                               Smart Choice Extras                                          Blue Ribbon Extras & Blue Ribbon Extras Plus

                                                                                                               No annual limit
$500 Combined general dental and                  $800 Combined general dental and endodontic
                                                                                                               $300 sub-limit during the first 6 months
       endodontic services annual limit                   services annual limit

       $300 sub-limit during the first 6 months           $300 sub-limit during the first 6 months             $400–$800#

                                                                                                               $250 A sub-limit of $92 under Blue Ribbon Extras and
                                                  $225 A sub-limit of $92 for frames and $200 for
$200 A sub-limit of $92 for frames                                                                                    $115 under Blue Ribbon Extras Plus for frames
                                                          contact lenses
                                                                                                                      and $200 for contact lenses under both

$300                                              $300                                                         $700


$300                                              $300                                                         $600


No annual limit                                   No annual limit                                              No annual limit

                                                                                                               $2,000 For services in this category but not to exceed
                                                                                                                        the amount shown for each sub-category

                                                                                                                 $300–$700#

                                                                                                                 $400 – $800#

                                                                                                                 $400 – $800# Lifetime limit of $2,400 per member

                                                                                                                 $300 – $700#

                                                                                                               $500     For services in this category but not to exceed
                                                                                                                        the amount shown for each sub-category

                                                                                                                 $400

                                                                                                                 $400

                                                                                                                 $400

                                                                     $100 sub-limit                              $100

                                                                                                               $1,000 For services in this category but not to exceed
                                                  Flexi-Fund
                                                                                                                        the amount shown for each sub-category
                                                  Up to $300
                                                  per person up                                                  $400
                                                  to a maximum of
                                                  $600 per couple
                                                  membership         $200 per membership per calendar            $400 $200 per membership per calendar year and
                                                  across all these   year and $100 per person per lifetime              $100 per person per lifetime for Jenny Craig
                                                  covered services   for Jenny Craig weight loss benefit                weight loss benefit
                                                  (sub-limits
                                                  may apply)                                                     $400

                                                                                                                 $400

                                                                                                                 $400

                                                                                                               $1,000 For services in this category but not to exceed
                                                                                                                        the amount shown for each sub-category

                                                                                                                 $800 Sub-limits and other restrictions apply

                                                                     $180 per membership every 3 years           $180 per membership every 3 years

                                                                                                                 $240 per membership every 3 years and $150 per
                                                                     $240 per membership every 3 years
                                                                                                                 person for Blue Ribbon Extras or $180 per person for
                                                                     and $150 per person every 3 years
                                                                                                                 Blue Ribbon Extras Plus every 3 years


                                                                     Sub-limits and other restrictions apply     $500 Sub-limits and other restrictions apply

                                                                                                               $400

                                                                                                               $800


Cover overview go to                        p20   Cover overview go to                                p21      Cover overview go to                               p23


                                                                                                                                                                          19
     First Choice Extras
     Great for those who want extras cover for commonly used services like
     general dental, optical items and physiotherapy.


     What’s covered?                                                                              Key features:
     We’ll pay benefits towards:                                                                    Cover for basic services
      General dental & endodontic services (eg root canal)                                         Budget-friendly
      Optical items
      Physiotherapy
      Pharmaceutical prescriptions (non-PBS)
      Medically necessary ambulance transport (except in Qld and Tas).
     For information about annual limits and sub-limits for the above services,
     see the comparison table on page 18.




                                                                                                  Key information:




      To compare covers                                To join                            Back
      Go to the comparison table                       Fill out your application forms   pocket

      To know more                                     To understand a term
      Go to Things Worth Knowing                       Go to our Glossary


20
Smart Choice Extras
A smart option if you want more than the basics. It provides cover for
naturopathy and remedial massage as well as commonly used services like
general dental, optical items and physiotherapy.


What’s covered?                                                                              Key features:
We’ll pay benefits towards:                                                                    Generous annual limits for
 General dental & endodontic services (eg root canal)                                         general dental and optical items

 Optical items                                                                                Great options with Flexi-Fund
                                                                                              Cover for alternative therapies
 Physiotherapy
                                                                                              including acupuncture and
 Pharmaceutical prescriptions (non-PBS)
                                                                                              remedial massage
 Medically necessary ambulance transport (except in Qld and Tas).
For information about annual limits and sub-limits for the above services,
see the comparison table on page 18.


Flexibility with Flexi-Fund
Each year you’ll be able to claim up to $300 per person to a maximum of $600 per couple
membership to spend on the following services:
 Major dental such as orthodontic treatment
 Alternative therapies such as chiropractic and naturopathy
 Other therapies such as podiatry and speech therapy
 Health appliances such as nebulisers and blood glucose monitors
 Clinical psychology consultations.                                                          Key information:
Sub-limits may apply – see the comparison table on page 18 for more information.




 To compare covers                                To join                            Back
 Go to the comparison table                       Fill out your application forms   pocket

 To know more                                     To understand a term
 Go to Things Worth Knowing                       Go to our Glossary


                                                                                                                            21
     Faye makes the most of her extras cover by
     visiting a Members’ Choice dentist to
     receive her two free check-ups, scale and

     However, she was unlucky recently and
     chipped her tooth. Because she has Blue
     Ribbon Extras cover and her dentist is a
     Members’ Choice dentist she was able to
     minimise her out-of-pockets.




22
Blue Ribbon Extras
Blue Ribbon Extras Plus
With our top extras covers you’ll receive generous limits for an extensive
range of services including podiatry and remedial massage.



What’s covered?                                                                               Key features:
We’ll pay benefits towards:                                                                     Our top covers with benefits for
 General dental & endodontic services (eg root canal)                                          the widest range of services

 Optical items                                                                                 No annual limit on general dental
                                                                                               Generous annual limits for major
 Physiotherapy
                                                                                               dental including orthodontic
 Pharmaceutical prescriptions (non-PBS)
                                                                                               treatment
 Medically necessary ambulance transport (except in Qld and Tas).
                                                                                               Cover for alternative therapies
Plus you’ll also get:                                                                          such as remedial massage
                                                                                               and naturopathy
 Major dental such as orthodontic treatment
 Alternative therapies such as chiropractic and naturopathy
 Other therapies such as podiatry and speech therapy
 Health appliances such as hearing aids and blood glucose monitors
 Clinical psychology consultations.
For information about annual limits and sub-limits for the above services,
see the comparison table on page 18.




                                                                                              Key information:
   Blue Ribbon Extras Plus
   Blue Ribbon Extras Plus is our most comprehensive extras cover. It provides the same
   cover as Blue Ribbon Extras, but with generally higher benefits.
   See the comparison table on page 18 for more details.




 To compare covers                                To join                             Back
 Go to the comparison table                       Fill out your application forms    pocket

 To know more                                     To understand a term
 Go to Things Worth Knowing                       Go to our Glossary


                                                                                                                             23
     Karen & Stuart have had a packaged
     cover for three years. When they go
     to pick up their glasses from a
     Members’ Choice provider, in addition

     use their annual PackageBonus to
     reduce the amount they have to pay.




24
Packaged cover introduction

If you’re looking for peace of mind and convenience, one of our packaged covers could
be for you. We’ve combined similar levels of hospital and extras covers so you get the
best of both worlds – plus a yearly bonus.


Take the package, get a bonus                                            Pay less with GapCover
If you choose one of our packaged covers featured in this                Going to hospital shouldn’t leave you with unexpected expenses
brochure, you’ll be rewarded with a yearly bonus that can help           when you have hospital cover – but it can happen. That’s why
pay for a range of approved membership and health-related                we have a scheme called GapCover, used by a large number of
expenses. For MyOptions it’s called Flexi-Bonus and for all our          specialists, which can help reduce your out-of-pocket expenses.
other packaged covers, it’s called PackageBonus.                         Before you go to hospital, you’ll need to talk to your specialist to
                                                                         find out if they will participate.

Get greater value with our
Members’ Choice network                                                  Ambulance transport
                                                                         You’re covered for medically necessary ambulance transport if
Our Members’ Choice network includes the majority of private
                                                                         you need to go to hospital and, because of your medical
hospitals across Australia. And while you can choose to go to
                                                                         condition, there’s no other way of getting there except by
any private hospital in Australia, you’ll receive greater value at a
                                                                         ambulance. Benefits for this are included in all packaged covers
Members’ Choice hospital because your out-of-pocket expenses
                                                                         in this brochure except where you’re entitled to claim costs of
will be lower than if you are admitted to a non Members’
                                                                         ambulance transport from another source, such as ambulance
Choice hospital.
                                                                         subscription or State Government ambulance transport schemes.
And if you choose to receive treatment from a Members’ Choice
extras provider you’ll receive great value such as:
 Free dental check-up, scale and clean twice a year – valued at
 over $250 a year per member
 Deals on optical items with discounts from 20% off the
 normal retail price of frames and 15% off contact lenses.
For more information about Members’ Choice, see page 43.




Comparison tables                  MyOptions                           HealthyPlus                         SmartPlus


                                                                       To know more                         To understand a term
AdvantagePlus                      PremierPlus
                                                                       Go to Things Worth Knowing           Go to our Glossary



                                                                                                                                                25
29
     Packaged cover comparison table
     hospital component
      Item / Service                Basic                    Basic                    Intermediate             Comprehensive       Comprehensive
                                    MyOptions                HealthyPlus              SmartPlus                AdvantagePlus       PremierPlus

      Choice of doctor

      Choice of hospital

      Private hospital
      accommodation

      Private Room Guarantee
      Public hospital
      accommodation as
      a private patient
      Excess                        No excess applies                                                                              No excess applies

      Theatre fees                     No benefits for          No benefits for          No benefits for
                                       restricted services      restricted services      restricted services
      Surgically implanted
      prostheses and
      other items on the
      Federal Government’s
      Prostheses Schedule
      Injuries sustained in
      an accident
      Knee reconstruction
      surgery and investigations
      Shoulder reconstruction
      surgery and investigations

      Appendicitis treatment

      Removal of tonsils and
      adenoids
      Surgical extraction
      of wisdom teeth

      Obstetrics-related services                            Restricted

      Assisted reproductive
                                                             Restricted
      services
      Plastic and reconstructive
                                                             Restricted
      surgery
      In-hospital psychiatric
                                    Restricted               Restricted               Restricted
      treatment
      In-hospital rehabilitation
                                    Restricted               Restricted               Restricted
      treatment

      Cardio-thoracic procedures                             Restricted               Restricted

      Major eye surgery                                      Restricted               Restricted

      Hip and knee
                                                             Restricted               Restricted
      joint replacement

      Renal dialysis                Restricted

      Cosmetic surgery

      All other services where a
                                    Restricted
      Medicare benefit is payable
      Bonus                            Flexi-Bonus              PackageBonus             PackageBonus             PackageBonus         PackageBonus

                                    Cover overview           Cover overview           Cover overview           Cover overview      Cover overview
                                    go to p30                go to p32                go to p34                go to p36           go to p38

     Restricted services
     If you choose a cover with restricted services, we will pay lower benefits for these services in a private hospital. It’s important to consider whether
     you’re likely to need these services, because the benefits for restricted services generally won’t cover the full cost of treatment in a private
     hospital and you may end up with significant out-of-pocket expenses. See page 51 for more information.


      To know more                                                           To understand a term
      Go to Things Worth Knowing for information on waiting                  For terms you don’t understand, go to our Glossary
      periods and other benefit assessment information


26
     Packaged cover comparison table                                                                                                            – extras comp
     This table shows the annual limits and sub-limits that apply to benefits for extras items and services.
     How much will my             Item / Service                     Description                         Waiting period               Basic
     benefit be?                                                                                                                       MyOptions
     Go to page 47 to find
                                                                                                         2 months*                    No annual limit
     out the information                                             Eg dental examinations, scale
                                  General dental                     and clean                           12 months for surgical
     you’ll need, then call                                                                              procedures and extractions   $300 sub-limit during the first 6 months
     us on 132 331 and
                                  Endodontic services                Eg root canal treatment             12 months                    $400
     we’ll provide you
     with a quote.                                                   Frames, prescription lenses and
                                  Optical items                      contact lenses
                                                                                                         6 months                     $200 A sub-limit of $92 for frames
     Limits
     Each of our extras           Medically necessary                                                    2 months*                    No annual limit
     services have annual         ambulance transport˜
     limits and sub-limits.                                          Eg consultations (includes
     See page 53 for more         Physiotherapy                      group pilates and                   2 months*
     information.                                                    hydrotherapy sessions)
                                                                     Includes most prescribed
     The benefit payable           Pharmaceutical                     non-PBS items. Benefits will
     for a particular claim                                                                              2 months*
                                  prescriptions                      be paid after a set charge
     is likely to be less                                            has been deducted
     than the annual limit
     or sub-limit.                Major dental
     Additional restrictions
     apply to the payment          Inlay/onlay restorative           Eg restorative fillings             12 months                    Flexi-Extras
     of benefits for some                                                                                                              $350 – $750†
                                   Dentures, crowns and bridges                                          12 months                    You decide how
     services. Please call us
     for more information.                                                                                                            you spend the          Lifetime limit
                                   Orthodontic                       Eg braces                           12 months                    benefit on these       $2,400 per
     Benefit replacement                                                                                                               covered services.      member
     period                        Periodontic                       Eg treatment for gum disease        12 months
     You might need to
     wait for a period of
                                  Alternative therapies              Consultations for:
     time from the date of
     purchase of some items
                                   Chiropractic & osteopathy                                             2 months*                                           $300 sub-limit
     before you’re entitled to
     a new benefit to replace       Acupuncture                                                           2 months*
     the item. See page 49         Naturopathy                                                           2 months*
     for more information.
                                   Remedial massage                                                      2 months*                                           $100 sub-limit
                                                                     Consultations for myotherapy,                                    Flexi-Bonus
     *The 2 month waiting                                            reflexology, shiatsu, homeopathy,                                $100 – $200^
        period is waived when     Natural therapies                  Chinese herbalism, western          2 months*
        the service arises from                                      herbalism, Alexander technique,                                  Top up your benefits for natural therapies
                                                                     Bowen technique                                                  or any of the core and Flexi-Extra services.
        an accident.
     #
      Increases by $50 per
      calendar year of            Other therapies                    Consultations for:
      continuous membership
      to the maximums shown.       Podiatry                          Includes specified orthotics        2 months*
      You will be eligible
      for the increases once                                         Includes Jenny Craig
                                   Dietetics                                                             2 months*
      you have served one                                            weight loss benefit
      full calendar year’s
      membership.                  Occupational therapy                                                  2 months*
     †
      Flexi-Extras limit
                                   Speech therapy                                                        2 months*
      increases by $100
      each calendar year of        Orthoptics (eye therapy)                                              2 months*
      continuous MyOptions
      membership to a
                                  Health appliances
      maximum of $750.
     ^
       Flexi-Bonus limit
       increases by $25 each       Hearing aids                                                          36 months
       calendar year of                                              Peak flow meters, nebulisers and
                                   Breathing appliances                                               12 months
       continuous MyOptions                                          spacing devices
       membership to a                                               May need to be ordered by a
       maximum of $200.            Blood glucose monitors                                                24 months
                                                                     medical practitioner
     ˜ Benefits are not             Other health appliances           Some appliances must be ordered
        available where there                                                                            2 months*
                                   (including external prostheses)   by a medical practitioner
        is an entitlement to
        cover under a State       Clinical psychology                Consultations only                  2 months*
        scheme.                                                      For preschool, primary and
                                  School accident                    secondary school students           2 months

                                  To know more                                         To understand a term
                                  Go to Things Worth Knowing                           Go to our Glossary                             Cover overview go to                    p30


27
ponent
Unless otherwise shown, limits are per person, per calendar year.
Basic                                          Intermediate                                   Comprehensive                                  Comprehensive
HealthyPlus                                    SmartPlus                                      AdvantagePlus                                  PremierPlus
$500 Combined general dental and               $800 Combined general dental and               No annual limit                                No annual limit
       endodontic services annual limit               endodontic services annual limit        $300 sub-limit during the first 6 months       $300 sub-limit during the first 6 months
       $300 sub-limit during the first                $300 sub-limit during the first
       6 months                                       6 months                                $400–$800#                                     $400–$800#

                                               $225 A sub-limit of $92 for frames and         $250 A sub-limit of $92 for frames and         $250 A sub-limit of $115 for frames and
$200 A sub-limit of $92 for frames
                                                      $200 for contact lenses                        $200 for contact lenses                        $200 for contact lenses

No annual limit                                No annual limit                                No annual limit                                No annual limit


$300                                           $300                                           $700                                           $700



$300                                           $300                                           $600                                           $600


                                                                                              $2,000 For services in this category but       $2,000 For services in this category but
                                                                                                       not to exceed the amount shown                 not to exceed the amount shown
                                                                                                       for each sub-category                          for each sub-category

                                                                                                $300–$700#                                     $300–$700#

                                                                                                $400 – $800#                                   $400 – $800#

                                                                                                $400 – $800 Lifetime limit of $2,400
                                                                                                             #
                                                                                                                                               $400 – $800# Lifetime limit of $2,400
                                                                                                per member                                     per member

                                                                                                $300 – $700#                                   $300 – $700#

                                                                                              $500 For services in this category but not     $500 For services in this category but not
                                                                                                     to exceed the amount shown for                 to exceed the amount shown for
                                                                                                     each sub-category                              each sub-category
                                                                                                $400                                           $400
                                                                                                $400                                           $400
                                                                                                $400                                           $400


                                               Flexi-           Not available under this
                                                                                                Not available under this cover, may be        Not available under this cover, may be
                                               Fund             cover, may be claimed
                                                                                                claimed using your PackageBonus               claimed using your PackageBonus
                                               Up to $300       using your PackageBonus
                                               per person
                                               up to a
                                               maximum                                        $1,000 For services in this category but       $1,000 For services in this category but
                                               of $600                                                 not to exceed the amount shown                 not to exceed the amount shown
                                               per couple                                              for each sub-category                          for each sub-category
                                               membership
                                               across all                                       $400                                           $400
                                               these covered
                                               services      $200 per membership per            $400 $200 per membership per                   $400 $200 per membership per
                                               (sub-limits   calendar year and $100 per                calendar year and $100 per                     calendar year and $100 per
                                               may apply)    person per lifetime for Jenny             person per lifetime for Jenny                  person per lifetime for Jenny
                                                             Craig weight loss benefit                 Craig weight loss benefit                      Craig weight loss benefit
                                                                                                $400                                           $400

                                                                                                $400                                           $400

                                                                                                $400                                           $400

                                                                                              $1,000 For services in this category but       $1,000 For services in this category but
                                                                                                       not to exceed the amount shown                 not to exceed the amount shown
                                                                                                       for each sub-category                          for each sub-category
                                                                                                $800 Sub-limits and other                      $800 Sub-limits and other
                                                                                                restrictions apply                             restrictions apply
                                                                $180 per membership
                                                                                                $180 per membership every 3 years              $180 per membership every 3 years
                                                                every 3 years
                                                                $240 per membership
                                                                                                $240 per membership every 3 years              $240 per membership every 3 years
                                                                every 3 years and $150
                                                                                                and $150 per person every 3 years.             and $180 per person every 3 years.
                                                                per person every 3 years
                                                                Sub-limits and other            $500 Sub-limits and other                      $500 Sub-limits and other
                                                                restrictions apply              restrictions apply                             restrictions apply

                                                                                              $400                                           $400

                                                                                              $800                                           $800


Cover overview go to                     p32   Cover overview go to                     p34   Cover overview go to                     p36   Cover overview go to                     p38


                                                                                                                                                                                      28
   MyOptions Hospital + Extras + Bonus
   A popular choice for young singles and couples who are healthy and
   budget conscious. Provides cover for the hospital and extras services
   you’re more likely to use.


   Hospital                                                              Restricted services
                                                                         We’ll pay lower benefits in a private hospital for all other
   What’s covered?                                                       services where a Medicare benefit is payable.
                                                                         See page 51 to find out more about what we mean by
     Injuries sustained in an accident                                   restricted services.

     Knee reconstruction surgery and investigations
     Shoulder reconstruction surgery and investigations
                                                                         Extras
     Appendicitis treatment                                              Core services:

     Removal of tonsils and adenoids                                      General dental & endodontic services (eg root canal)

     Surgical extraction of wisdom teeth.                                 Optical items

   For these included services we’ll pay benefits towards:                 Medically necessary ambulance transport.

     Private hospital accommodation
     - Private room
                                                                         MyOptions includes Flexi-Extras and Flexi-Bonus. The
     - Same day admission                                                Flexi-Extras allows you to claim over and above the core extras
     - Intensive care                                                    services. And, the Flexi-Bonus is a yearly amount you can use to
     - Theatre fees                                                      top up your benefits on any of the extras services available as
                                                                         well as for specified natural therapy consultations.
     Public hospital accommodation as a private patient
                                                                         For information about annual limits and sub-limits for the above
     - Overnight accommodation in a shared or private room
                                                                         extras services, see the comparison tables on page 26.
     - Same day admissions (shared room only)
     Surgically implanted prostheses and other items on the Federal
     Government’s Prostheses Schedule.

   What’s not covered?


     Obstetrics-related services
     Assisted reproductive services such as IVF and GIFT
     Cardio-thoracic procedures such as angiograms or
     open heart and bypass surgery
     Hip and knee joint replacement surgery
     Major eye surgery
     Plastic and reconstructive surgery.




To compare covers                                                     To join                                                      Back
Go to the comparison tables                                           Fill out your application forms                             pocket

To know more                                                          To understand a term
Go to Things Worth Knowing                                            Go to our Glossary


                                                                                                                                            30
 Key features:



 Key information:




Flexi-Extras & Flexi-Bonus
Flexi-Extras                                Services                           Annual limits

Flexi-Extras is in addition to the core      Physiotherapy                     Year 1             $350
services covered under MyOptions.
                                             Pharmaceutical prescriptions
You choose how to use your extras                                              Year 2             $450
                                             (non-PBS)
benefits from this range of additional
services.                                    Major dental                      Year 3             $550
                                             (eg orthodontic treatment)
                                             Alternative therapies including   Year 4             $650
                                             chiropractic and naturopathy
                                                                               Year 5             $750

                                                                               Sub-limits apply


Flexi-Bonus                                 Services                           Annual limits

This yearly bonus works in three ways.       Myotherapy                        Year 1             $100
                                                                               Year 1             $100
You can:
                                             Reflexology
 top up your benefits on any of the                                            Year 2             $125
                                             Shiatsu                           Year 2             $125
 core services
                                             Homeopathy                        Year 3             $150
 top up your benefits on any Flexi-Extras
                                                                               Year 3             $150
 services listed above                       Chinese herbalism                 Year 4             $175
 use it towards consultations for the        Western herbalism
 listed natural therapies.                                                     Year 4             $175
                                                                               Year 5             $200
                                             Alexander technique
                                             Bowen technique                   Year 5             $200




                                                                                                         31
     HealthyPlus Hospital + Extras + Bonus
     A good choice if you don’t have any particular health concerns and
     you just want basic cover for most hospital services and commonly used
     extras services.


     Hospital                                                          Your excess
                                                                       This cover includes an excess of $200, which applies each time a
     What’s covered?                                                   member is admitted to hospital. You won’t pay more than $500
     We’ll pay benefits towards (less any applicable excess):           per single membership or $1,000 per couple membership each
                                                                       calendar year.
      Private hospital accommodation
      - Private room
      - Same day admission
                                                                       Extras
      - Intensive care                                                 What’s covered?
      - Theatre fees                                                   We’ll pay benefits towards:

      Public hospital accommodation as a private patient                General dental & endodontic services (eg root canal)
      - Overnight accommodation in a shared or private room             Optical items
      - Same day admissions (shared room only)                          Physiotherapy
      Surgically implanted prostheses and other items on the Federal    Pharmaceutical prescriptions (non-PBS)
      Government’s Prostheses Schedule.                                 Medically necessary ambulance transport.

     Restricted services                                               For information about annual limits and sub-limits for the above
                                                                       extras services, see the comparison tables on page 26.
     We’ll pay lower benefits in a private hospital for:
      In-hospital psychiatric or rehabilitation treatment
      Cardio-thoracic procedures such as angiograms or open heart
      and bypass surgery
      Major eye surgery
      Hip and knee joint replacement surgery
      Obstetrics-related services
      Assisted reproductive services such as IVF and GIFT
      Plastic and reconstructive surgery.
     See page 51 to find out more about what we mean by
     restricted services.




      To compare covers                                                 To join                                                    Back
      Go to the comparison tables                                       Fill out your application forms                           pocket

      To know more                                                      To understand a term
      Go to Things Worth Knowing                                        Go to our Glossary



32
 Key features:
    Restricted services
    Budget friendly



 Key information:




Take the package, get a bonus
PackageBonus
It’s an amount of money that accumulates each year to help pay for a range of approved membership and health-related
expenses. See page 53 for more details.
How the PackageBonus works
Each member may claim PackageBonus benefits up to their individual cumulative limit. When a membership consists of three or
more persons, it is not possible for all the members to claim their full individual PackageBonus within the same calendar year.
PackageBonus entitlements
There is a 6 month waiting period, and entitlements apply from 1 January each year.

                                                                 Couple membership
                                Single membership
                                                                 Per person                      Overall

First calendar year
                                $50                              $50                             $100
of membership

Second calendar year of
membership and each             $100                             $100                            $200
calendar year thereafter

Maximum limit
                                $500                             $500                            $1,000
at any one time



Any unused PackageBonus will be added to the following year’s entitlement up to the maximum limit shown above.




                                                                                                                                  33
     SmartPlus Hospital + Extras + Bonus
      MyOptions Hospital + Extras + Bonus
        A popular choice for young singles and couples who are healthy and
     A great option if you’re young and healthy, and want cover for more than
        budget conscious. Provides cover for the hospital and extras services
     just the basics.
        you’re more likely to use.


     Hospital
       Hospital                                                          Extras lower benefits in a private hospital for all other
                                                                           Restricted services
                                                                           We’ll pay
     What’s covered?
        What’s covered?                                                  What’s covered? a Medicare benefit is payable.
                                                                            services where
     We’ll pay benefits towards (less any applicable excess):                   pay benefits towards:
                                                                         We’llSee page 51 to find out more about what we mean by
      Private hospital accommodation
           Injuries sustained in an accident                                  restricted services.
                                                                          General dental & endodontic services (eg root canal)
      - Private room
            Knee reconstruction surgery and investigations                 Optical items
      - Same day admission
          Shoulder reconstruction surgery and investigations
                                                                              Extras
                                                                           Physiotherapy
      - Intensive care treatment
           Appendicitis                                                    Pharmaceutical prescriptions (non-PBS)
                                                                             Core services:
      - Theatre fees                                                          General dental ambulance transport.
                                                                           Medically necessary & endodontic services (eg root canal)
          Removal of tonsils and adenoids
      Public hospital accommodation as a private patient                       Optical items
          Surgical extraction of wisdom teeth.                           Flexibility with Flexi-Fund
      - Overnight accommodation in a shared or private room
         For these included services we’ll pay benefits towards:                Medically necessary ambulance allows you
                                                                         SmartPlus includes a Flexi-Fund which transport. to
      - Same day admissions (shared room only)                           claim up to $300 per person to a maximum of $600
           Private hospital accommodation
      Surgically implanted prostheses and other items on the Federal     per couple membership across the following services
           - Private room
      Government’s Prostheses Schedule.                                       MyOptions includes
                                                                         (sub-limits may apply): Flexi-Extras and Flexi-Bonus. The
           - Same day admission                                               Flexi-Extras allows you to claim over and above the core extras
                                                                           Major dental such as orthodontic treatment
     Restricted services
           - Intensive care                                                   services. And, the Flexi-Bonus is a yearly amount you can use to
     We’ll pay lower fees                                                  Alternative therapies such as chiropractic and naturopathy
                                                                              top up your benefits on any of the extras services available as
           - Theatre benefits in a private hospital for:
      In-hospital hospital accommodation as treatmentpatient                  well as for specified podiatry and speech therapy
                                                                           Other therapies such asnatural therapy consultations.
          Public psychiatric or rehabilitation a private
       Cardio-thoracic procedures such as angiograms private room
                                                                              For appliances about nebulisers and blood
                                                                           Health informationsuch as annual limits and sub-limits for the above
            - Overnight accommodation in a shared or or open
       heart and bypass surgery
                                                                              extras services,
                                                                           glucose monitors see the comparison tables on page 26.
            - Same day admissions (shared room only)
       Major eye surgery                                                   Clinical psychology consultations.
            Surgically implanted prostheses and other items on the Federal
       Hip and knee joint replacement surgery.
            Government’s Prostheses Schedule.                            For information about annual limits and sub-limits for the above
     See page 51 to find out more about what we mean by                   extras services, see the comparison tables on page 26.
          What’s not covered?
     restricted services.

     Your excess
            Obstetrics-related services
     This cover includes an excess of $200, which applies each time a
            Assisted reproductive services such as IVF and GIFT
     member is admitted to hospital. You won’t pay more than $500
            Cardio-thoracic procedures such as angiograms or
     per single membership or $1,000 per couple membership each
            open heart and bypass surgery
     calendar year.
           Hip and knee joint replacement surgery
           Major eye surgery
           Plastic and reconstructive surgery.




     To compare covers                                                     To join                                                      Back
     Go to the comparison tables                                           Fill out your application forms                             pocket

     To know more                                                          To understand a term
     Go to Things Worth Knowing                                            Go to our Glossary



34                                                                                                                                                30
 Key features:
    Cover for a wide range of hospital treatments
    Some restricted services
    Greater extras options with the Flexi-Fund feature


 Key information:




Take the package, get a bonus
PackageBonus
It’s an amount of money that accumulates each year to help pay for a range of approved membership and health-related
expenses. See page 53 for more details.


Each member may claim PackageBonus benefits up to their individual cumulative limit. When a membership consists of three
or more persons, it is not possible for all the members to claim their full individual PackageBonus within the same calendar year.


There is a 6 month waiting period, and entitlements apply from 1 January each year.

                                                                  Couple membership
                                 Single membership
                                                                  Per person                       Overall

First calendar year
                                 $50                              $50                              $100
of membership

Second calendar year of
membership and each              $100                             $100                             $200
calendar year thereafter

Maximum limit
                                 $500                             $500                             $1,000
at any one time



Any unused PackageBonus will be added to the following year’s entitlement up to the maximum limit shown above.




                                                                                                                                     35
     AdvantagePlus Hospital + Extras + Bonus
     Comprehensive hospital and extras cover in one convenient package.
     A great choice if you have particular health concerns.



     Hospital                                                           Extras
     What’s covered?                                                    What’s covered?
     We’ll pay benefits towards (less any applicable excess):            We’ll pay benefits towards:
      Private hospital accommodation                                     General dental
      - Private room                                                     Endodontic services (eg root canal)
      - Same day admission                                               Optical items
      - Intensive care                                                   Physiotherapy
      - Theatre fees                                                     Pharmaceutical prescriptions (non-PBS)
      Public hospital accommodation as a private patient                 Medically necessary ambulance transport.
      - Overnight accommodation in a shared or private room
                                                                        Plus you’ll also get:
      - Same day admissions (shared room only)
                                                                         Major dental such as orthodontic treatment
      Surgically implanted prostheses and other items on the Federal
                                                                         Alternative therapies such as chiropractic and naturopathy
      Government’s Prostheses Schedule.
                                                                         Other therapies such as podiatry and speech therapy
     Your excess
                                                                         Health appliances such as hearing aids and blood
     This cover includes an excess of $200, which applies each time a    glucose monitors
     member is admitted to hospital. You won’t pay more than $500
                                                                         Clinical psychology consultations.
     per single membership or $1,000 per couple membership each
     calendar year.                                                     For information about annual limits and sub-limits for the above
                                                                        extras services, see the comparison tables on page 26.




      To compare covers                                                   To join                                                      Back
      Go to the comparison tables                                         Fill out your application forms                             pocket

      To know more                                                       To understand a term
      Go to Things Worth Knowing                                         Go to our Glossary



36
 Key features:
    No restricted services
    Cover for alternative therapies
    No annual limit on general dental
    Generous annual limits for things like physio and optical items

 Key information:




Take the package, get a bonus
PackageBonus
It’s an amount of money that accumulates each year to help pay for a range of approved membership and health-related
expenses. See page 53 for more details.


Each member may claim PackageBonus benefits up to their individual cumulative limit. When a membership consists of three or
more persons, it is not possible for all the members to claim their full individual PackageBonus within the same calendar year.


There is a 6 month waiting period, and entitlements apply from 1 January each year.

                                                                      Couple Membership
                                 Single Membership
                                                                      Per Person                Overall

First calendar year of
                                 $50                                  $50                       $100
membership

Second calendar year of
membership and each              $100                                 $100                      $200
calendar year thereafter

Maximum limit
                                 $500                                 $500                      $1,000
at any one time


Any unused PackageBonus will be added to the following year’s entitlement up to the maximum limit shown above.




                                                                                                                                  37
     PremierPlus Hospital + Extras + Bonus
     Our top hospital and extras packaged cover. The best option if you want cover
     for a wide variety of extras or you have particular health concerns.



     Hospital                                                           Extras
     What’s covered?                                                    What’s covered?
     We’ll pay benefits towards:                                         We’ll pay benefits towards:
      Private hospital accommodation                                     General dental
      - Private room                                                     Endodontic services (eg root canal)
      - Same day admission                                               Optical items
      - Intensive care                                                   Physiotherapy
      - Theatre fees                                                     Pharmaceutical prescriptions (non-PBS)
      Public hospital accommodation as a private patient                 Medically necessary ambulance transport.
      - Overnight accommodation in a shared or private room
                                                                        Plus you’ll also get:
      - Same day admissions (shared room only)
                                                                         Major dental such as orthodontic treatment
      Surgically implanted prostheses and other items on the Federal
                                                                         Alternative therapies such as chiropractic and naturopathy
      Government’s Prostheses Schedule.
                                                                         Other therapies such as podiatry and speech therapy
     Private Room Guarantee
                                                                         Health appliances such as hearing aids and blood
     We recognise our PremierPlus members’ desire for privacy when       glucose monitors
     they are being treated or recuperating overnight at a Members’
                                                                         Clinical psychology consultations.
     Choice hospital, that’s why we offer the Private Room Guarantee.
                                                                        For information about annual limits and sub-limits for the above
     If there isn’t a private room available at a Members’ Choice
                                                                        extras services, see the comparison tables on page 26.
     hospital you may be entitled to receive $50 a night up to a
     maximum of five nights per stay. See page 54 for more
     information.




      To compare covers                                                   To join                                                      Back
      Go to the comparison tables                                         Fill out your application forms                             pocket

      To know more                                                       To understand a term
      Go to Things Worth Knowing                                         Go to our Glossary



38
 Key features:
    No restricted services
    No excess
    Private Room Guarantee
    No annual limit on general dental
    Cover for an extensive range of extras services paying typically higher
    benefits than AdvantagePlus

 Key information:




Take the package, get a bonus
PackageBonus
It’s an amount of money that accumulates each year to help pay for a range of approved membership and health-related
expenses. See page 53 for more details.


Each member may claim PackageBonus benefits up to their individual cumulative limit. When a membership consists of three or
more persons, it is not possible for all the members to claim their full individual PackageBonus within the same calendar year.


There is a 6 month waiting period, and entitlements apply from 1 January each year.

                                                                   Couple membership
                                 Single membership
                                                                   Per person                   Overall

First calendar year of
                                 $50                               $50                          $100
membership

Second calendar year of
membership and each              $100                              $100                         $200
calendar year thereafter

Maximum limit
                                 $500                              $500                         $1,000
at any one time


Any unused PackageBonus will be added to the following year’s entitlement up to the maximum limit shown above.




                                                                                                                                  39
     Annie has always been conscious of
     looking after her teeth. She does
     everything she can to avoid major repair
     work, listens when the dentist tells her
     to floss regularly and has a check up
     twice a year. Because she goes to a
     Members’ Choice dentist, she doesn’t
     need to pay any extra for these
     check-ups, she gets them for free with

     a year.




40
Make the most of being a member

Once you’re a member with us, here are just some of the great features you’ll also
be able to enjoy.


Greater value from our                                             Competitively priced travel, life
Members’ Choice network                                            and pet insurance
As a member, you’ll have access to one of the largest health       Medibank Private is giving you the opportunity to access
provider networks in Australia. Get more from your cover at a      value-for-money travel, life and pet insurance. The best news
Members’ Choice hospital or extras provider with higher            is, as a Medibank Private member, you’ll receive an additional
benefits in most cases, capped fees and special deals to help       10% discount off already competitively priced premiums.
you reduce your out-of-pocket expenses. See page 43 for more       See page 45 to find out more.
about Members’ Choice.

                                                                   Learn more about your cover
Look after yourself with                                           It’s really important that you choose the right cover to suit your
betterhealth                                                       health needs and for the way you live your life. To help you
                                                                   understand exactly what you’re getting, we’ve put together
Take advantage of our health and wellbeing support
                                                                   answers to some frequently asked questions you may have
programs, known as betterhealth. Our betterhealth Online
                                                                   about the information in this brochure. See the Things Worth
program includes dietary advice, help with preparing for sports
                                                                   Knowing section on page 47.
events and health management programs. See page 44 for
more details.




 To know more                                                     To understand a term
 Go to Things Worth Knowing                                       Go to our Glossary


                                                                                                                                        41
42
Enjoy greater value from our
Members’ Choice network
Take advantage of our Members’ Choice network and get more from your health cover.
Our agreements with most private hospitals and many extras providers across Australia
mean you can minimise your out-of-pocket expenses through capped fees and discounts.

Members’ Choice hospitals                                             Members’ Choice extras providers
By using a Members’ Choice hospital for services covered by our       Choose to visit a Members’ Choice extras provider and you can
agreements and which are not restricted under your cover, you         access capped fees and discounts, as well as receive generally
can expect:                                                           higher benefits than you would with a non Members’ Choice
 Full cover for accommodation including in an intensive care          extras provider. Members’ Choice has a wide range of extras
 unit (less any applicable excess)                                    providers including:

 Full cover for the use of an operating theatre                        Dentists                 Dental prosthetists
                                                                       Optical retail outlets   Chiropractors
 Full cover for no gap surgically implanted prostheses and other
 items on the Federal Government’s Prostheses Schedule                 Physiotherapists         Podiatrists

 Full cover for PBS pharmaceuticals intrinsic to your care             Acupuncturists           Naturopaths.

 Reduced out-of-pocket costs compared with non Members’               Members’ Choice offers great deals
 Choice hospitals
                                                                      At a Members’ Choice dentist you’ll get a:
 Convenient billing (your invoice is sent directly to us for
                                                                       Free dental check up, scale and clean twice a year – valued at
 payment of benefits).
                                                                       over $250 a year per member.
And, at most Members’ Choice hospitals you can expect to be
                                                                      And through our optical retail network:
covered for things like:
                                                                       At least 20% off the normal retail price of frames
 In hospital services including physiotherapy and occupational
 therapy to aid your recovery                                          At least 15% off lenses, contact lenses, add-ons and sunglasses

 Local phone calls, TV and newspapers.                                 No out-of-pocket expenses on a selected range of glasses for
                                                                       most members (subject to annual limits and sub-limits).

Out-of-pocket expenses                                                Members’ Choice extras providers are limited in number
When you go to a Members’ Choice hospital, you may have               and may not be available in some areas. Arrangements
some out-of-pocket expenses including medical services                with providers may vary depending on their location.
provided by your surgeon or anaesthetist. The hospital and
doctors treating you should inform you about their costs before
you go to hospital.
It’s also good to talk to us to find out what benefits will be paid,
so you know upfront if you will have any out-of-pockets and
can focus on what’s important – getting better sooner.
For more information about our assessment rules and
out-of-pockets, see page 50 and 51.




 Find a Members’
 Choice provider                                               Go to medibank.com.au


                                                                                                                                         43
     Look after yourself with
     betterhealth

     There’s a lot of wisdom in the saying, prevention is better than cure. To help you take
     better care of your health we’ve got together with our health partners to offer our
     members a range of betterhealth programs.


     Feel better with                                                      betterhealth On Call
     betterhealth Online                                                   Fee         with 24 hour support
                                                                           For members with a hospital or packaged cover (described in
     This free online tool is a fantastic resource for your health and
                                                                           this brochure) who have conditions such as diabetes or other
     wellbeing. You can get great health and exercise tips, and find
                                                                           long term heart, respiratory or mental health conditions, we
     programs to help you quit smoking and stay on track.
                                                                           offer a phone-based service, betterhealth On Call. You can
     You’ll be able to:                                                    access support 24 hours a day from health professionals such as
                                                                           registered nurses and diabetes nurse educators. A 12 month
      Complete a Wellness Record and receive a confidential
                                                                           waiting period applies to this program and you will need to
      Wellness Report
                                                                           meet clinical eligibility criteria.
      Receive regular email support to keep you motivated
      Access our health information and resource library                   Want to know more about betterhealth On Call?

      Be involved with the Active programs listed below.                   Call 1800 817 635

     Want to register for betterhealth Online?
     Once you’re a Medibank Private member, just go
     to medibank.fitness2live.com.au




      Active Health                                 Active Sport                                Active Care



      Weight loss 1: Step by Step Weight Loss       Fun runs                                    Glucose management
      for Men and Women

      Weight loss 2: Take the Next Step to          Open water swimming                         Stop smoking programs
      Sustained Weight Loss

      Fitness Express                               Strength training                           Back care

      DIY: Diet and workout plans                   Skiing                                      Heart health

      Healthy Eating: Developing healthy habits     Sprint distance triathlons

      Healthy Ageing: Keeping you young at heart    Marathon preparation

      Vegetarian weight loss lifestyle

      Stress management




44
Competitively priced travel, life and
pet insurance

Once you’re a Medibank Private member you’ll have access to other insurance
products at a 10% discount.


Medibank Travel Insurance*                                                                       Medibank Life Insurance*
The big wide world doesn’t seem so big when you’re dealing                                       What could be more important than safeguarding the financial
with one of Australia’s trusted names, Medibank Private. As well                                 future for your loved ones? That’s why we’re pleased to tell you
as competitive prices and a choice of plans, with Medibank                                       about Medibank Life Insurance. It’s comprehensive, affordable
Travel Insurance you can enjoy peace of mind with:                                               and offers:
  Overseas emergency medical assistance                                                             Cover for up to $1.5 million – depending on your age
  A 24 hour worldwide hotline                                                                       Simple application – no medicals required
  Cover for luggage, personal items, travel documents, credit                                       Optional Permanently Unable to Work Cover
  cards and cash                                                                                    Advance payment to help with funeral costs.
  Cancellation cover.


Medibank Pet Insurance*
Giving your four-legged friend the best care is easier with
Medibank Pet Insurance. You’ll feel better knowing that you
have cover to help you give the furriest member of your family
the care they deserve. It’s really something worth getting your
paws on, with:
  Up to 100% cover on vet bills
  Affordable cover for cats and dogs
  Cover options for accidents, illness and routine care
  Your choice of vet.



                            Medibank Travel Insurance                                                   Go to medibank.com.au/travelinsurance
                                                                                                        Visit a Medibank store


                            Medibank Pet Insurance                                                      Go to medibank.com.au/petinsurance
                                                                                                        Visit a Medibank store


                            Medibank Life Insurance                                                     Go to medibank.com.au/lifeinsurance
                                                                                                        Visit a Medibank store

*Medibank Private Limited ABN 47 080 890 259 AR 286089 is an authorised representative of ETI Australia Pty Ltd ABN 52 097 227 177, AFSL 245631 who arranges Medibank Travel Insurance,
and The Hollard Insurance Company Pty Ltd ABN 78 090 584 473, AFSL 241436 (“Hollard”) who arrange Medibank Life Insurance and issue and underwrite Medibank Pet Insurance. Medibank
Travel Insurance is issued and underwritten by Allianz Australia Insurance Limited ABN 15 000 122 850, AFSL 234708. Medibank Life Insurance is issued and underwritten by Swiss RE Life &
Health Australia Limited ABN 74 000 218 306, AFSL 324908.
Any advice provided here is general only and does not take into account your individual objectives, financial situation or needs. You should consider the relevant Product Disclosure Statements
for each product available from medibank.com.au to decide if the product is right for you before making a purchase.




                                                                                                                                                                                                  45
46
Things Worth Knowing
A lot of this is vital information, so make sure you have a look over it before you decide
on the cover that’s right for you. And if you’re unsure of a term or phrase used, check
out our Glossary on page 57.

About Medibank Private                                             About the Federal
membership                                                         Government Rebate and
Once I join, what do I get?                                        Medicare Levy Surcharge
Once you join you’ll receive a Welcome Pack which includes
                                                                   The Federal Government 30% Rebate on private health
your membership card(s), a Certificate of Cover and a
                                                                   insurance makes it more affordable by reducing your premium
Membership Guide. The Membership Guide is a handy
                                                                   when you’re eligible.
reference that will help you understand what being a member
of Medibank Private means and what your membership                 How much is the Federal Government 30% Rebate if
entitlements and responsibilities are. And whenever you change     I take out health insurance?
your cover in the future, we’ll send you a new pack so you         That depends on your age:
always have the latest information.
                                                                    30% off your premium if you’re 64 or under
Is there a cooling-off period?                                      35% off your premium if you’re 65-69
Yes. Within the first 30 days of joining or amending your cover      40% off your premium if you’re 70 or over.
you have two options if you’re not entirely satisfied with the
                                                                   You can claim the 35% or 40% rebate on your entire
cover you’ve chosen. You can either transfer to a more suitable
                                                                   membership as soon as at least one member fits into either of
cover or we can refund your premium in full, as long as no
                                                                   the relevant age categories.
claims have been made against your policy.
                                                                   How do I access the rebate?
What if I move interstate?
                                                                   If you’re eligible for the rebate there are three ways you can
Premiums and benefits can vary between states and territories,
                                                                   access it:
so it’s important that you pay the right premium for where you
live. If you move interstate, you need to notify us of your new                                                    – just fill in and
address within two months.                                           return the registration form in your application forms booklet
                                                                     inserted at the back of this brochure. The rebate will then be
What is a provider?                                                  automatically deducted from your premium.
We refer to health or medical professionals who provide a                                  – contact us to request your Medibank
service or item as ‘providers’. This could be a doctor, dentist,     Private receipt and then take it to any Medicare office to
anaesthetist, acupuncturist, or someone who provides health          claim your rebate.
aids or items such as hearing aids, mouthguards or nebulisers.
                                                                                        – at the end of each financial year, you’ll
For extras, how do I find out how much I might get back               receive a Private Health Insurance Statement from us. Refer to
from a claim?                                                        this statement to find out the amount you’re eligible to claim
                                                                     on your tax return.
To find out what extras benefit you would receive from us,
call your provider and ask them for:
 Their provider number
 Item number for service or treatment you require
 The proposed appointment date and cost.
Then call us on 132 331 and we’ll give you a quote for the
benefit we’ll pay towards your service or item.




                                                                                                                                       47
     How does the Medicare Levy Surcharge work?                           Former members of the Australian Defence Force
     The Medicare Levy Surcharge works like a tax and applies to          Australian Antarctic Division staff
     higher income earners, if you’re an Australian resident for tax
                                                                          Refugees and all other categories of migrants to Australia.
     purposes. If you have a taxable income over the applicable
     threshold and you don’t have an appropriate level of hospital       If I have a LHC loading will I have it forever?
     cover for yourself, your spouse/partner and all your dependants,    No, the loading will be removed after you’ve held hospital
     the Medicare Levy Surcharge will add on an extra 1% to your         cover continuously for 10 years.
     tax bill. This is on top of the standard 1.5% Medicare Levy you
     already pay. The Medicare Levy Surcharge applies                    What if I drop my hospital cover or let it lapse?
     proportionately for the period during the financial year when        If you drop your hospital cover for a total of three years (1,094
     an appropriate level of hospital cover was not held.                permitted days) or more, in most circumstances you’ll have to pay
     The annual taxable income thresholds for the 2008/2009              a LHC loading once you take out hospital cover again. If you’re
     financial year are:                                                  already paying the loading when you drop your cover or let it
                                                                         lapse, it may continue to increase until you take out cover again.
      $70,000 for singles
                                                                         There are some situations when you won’t incur the loading if
      $140,000 for couples and most families (for families, the          you drop your cover:
      threshold increases by $1,500 for each additional child
                                                                          If you are living overseas for more than one year continuously
      after the first).
                                                                          (this includes visits back home of 90 days or less at a time,
     These thresholds will be reviewed and indexed annually by the
                                                                          during which you are still considered to be living overseas)
     Federal Government for each subsequent financial year.
                                                                          If your health fund has agreed to a period of suspension

     About Lifetime Health Cover (LHC)                                    Any further periods that, in combination, amount to 1,094
                                                                          days or less.
     What is LHC?
                                                                         What happens if I change health funds?
     Under the Federal Government’s LHC initiative, a loading can be
                                                                         If you switch to us from another fund we recommend that you
     applied to your premium if you take out hospital cover later in
                                                                         keep your cover with your old fund until the date you transfer to
     life. It’s aimed at encouraging people to take out hospital cover
                                                                         Medibank Private. This way you avoid using up any of the
     early in life, and maintain it, by allowing them to pay lower
                                                                         1,094 permitted days you can be without hospital cover
     premiums throughout their lifetime compared with those who
                                                                         during your lifetime.
     take out hospital cover when they’re older or let it lapse for
     more than a total period of three years.
                                                                         About waiting periods
     When does the loading apply?
     If you don’t have hospital cover on 1 July following your 31st      When does a waiting period apply to me?
     birthday, you’ll pay more for your premium once you take out        A waiting period is the time you have to wait before you’re
     cover because a LHC loading will apply. This means for every        entitled to receive benefits. Waiting periods apply to you
     year you don’t have hospital cover, you’ll pay a 2% loading on      if you are:
     top of a base rate on your premium – or your share of a couple       A new member
     or family premium (up to a maximum loading of 70%). The
                                                                          Rejoining Medibank Private
     loading applies only to hospital cover or the hospital component
     of our packaged covers, not to extras covers.                        Changing to a different level of cover with us, although,
                                                                          during the waiting period, you will be entitled to benefits
                                                                          under either your new or old level of cover, depending on
     Bob turns 31 on 1 Dec 2007. If he takes out cover by 1 July          which is the lesser
     2008, he will pay the base rate premium. If he takes out cover       Transferring from another fund, where there is a difference
     on 2 July 2008, he will pay a 2% loading. If Bob further delays      between the benefits under your former cover and your new
     taking out hospital cover, for every subsequent year ending 30       cover. During the waiting period, you will be entitled to
     June, he will pay an additional 2% loading.                          benefits at either the level of your former cover or your
                                                                          Medibank Private cover, depending on which is the lesser.
     Are there any exceptions?
     Yes. Exceptions apply to:                                           Please note, any excess that was part of your previous level of cover
                                                                         will transfer across with you until you have served the waiting
      Anyone born on or before 1 July 1934.
                                                                         periods for your Medibank Private cover.
     Special rules apply to:
                                                                         Benefits are not payable for items and services obtained while you
      Australians returning from overseas
                                                                         are serving a waiting period.
      Norfolk Islanders
      Veterans’ Affairs Gold Cardholders



48
How long is the waiting period?
That depends on the services or items you need.
                                                                      About benefit replacement
                                                                      periods
 2 months
                                                                      What is a benefit replacement period?

 All services, except those below:                                    A benefit replacement period is the period of time you need to
                                                                      wait after purchasing an item covered by us before you can
 6 months                                                             receive benefits to replace the item. For example, if you use
                                                                      insulin delivery pens you can only receive a benefit for replacing
 Optical items
                                                                      them every two years. Please see the benefit replacement
                                                                      period table for replacement periods.
 PackageBonus
                                                                      How long is the benefit replacement period?
                                                                      It varies from item to item and applies per member except
 12 months
                                                                      where shown.

 Pre-existing ailments. However, the 12 month pre-existing ailment
                                                                       12 months
 waiting period does not apply to hospital or hospital-substitute
 treatment for psychiatric treatment, rehabilitation treatment or
 palliative care.                                                      External mammary prostheses

 Obstetrics-related services. However, benefits are payable during
                                                                       Repairs of external prostheses and health appliances
 this waiting period for premature births and complications arising
 from the pregnancy where a medical practitioner confirms that the
 baby was not expected to be born until after the waiting period.      2 years

 Major dental services                                                 Wigs

 Endodontic services (eg root canal)                                   Hip protectors

 Dental surgical procedures and surgical extractions
                                                                       Insulin delivery pens
 (eg wisdom teeth)


 Nebulisers                                                            3 years


 Peak flow meters                                                      Blood glucose monitors


 Spacing devices                                                       Breathing appliances
                                                                         – nebulisers
                                                                         – peak flow meters (per membership)
 24 months
                                                                         – spacing devices

 Blood glucose monitors
                                                                       Mouthguards (for members up to 18 years of age, benefits may be
                                                                       payable for a replacement mouthguard each calendar year)
 36 months
                                                                       Dentures, crowns and bridges
 Hearing aids
                                                                       Other health appliances and external prostheses
Please note, waiting periods may apply to some betterhealth
programs.                                                              5 years

The 2 month waiting period is waived for treatment arising from
                                                                       Hearing aids
an accident (excluding a school accident) occurring after joining
or changing cover. However, the applicable longer waiting              Sleep Apnoea – continuous pressure devices and other similar
periods specified still apply.                                          approved appliances under our hospital cover (excluding MyOptions
                                                                       and Accident Cover)




                                                                                                                                           49
     About the pre-existing                                                  Benefits are not payable for hospital procedures not
                                                                             recognised for Medicare benefit purposes such as
     ailment rule                                                            cosmetic surgery.
                                                                            Please call us on       for information on your
     What is a pre-existing ailment?
                                                                            benefits entitlement and recognised providers before
     A pre-existing ailment is an ailment, illness or condition where       commencing treatment.
     signs or symptoms existed at any time during the six months
     prior to you either taking out your new cover or transferring to
     a cover with higher benefits.                                           About transferring from another
     A medical or health practitioner appointed by Medibank Private         fund (portability)
     is the only person authorised to decide whether you have a
                                                                            If I transfer to Medibank Private from another registered
     pre-existing ailment, based on information provided by the
                                                                            health fund am I covered immediately?
     practitioner(s) treating you.
                                                                            You’ll be covered for services that were covered by your former
     What if I have a pre-existing ailment?                                 fund from the date you join if:
     If your ailment, illness or condition is considered pre-existing and    You join us within two months of leaving your former fund
     you are:
                                                                             You have served any waiting periods (equivalent to Medibank
      A new member – you’ll have to wait 12 months                           Private’s) with your previous fund.
      Transferring to Medibank Private or are a Medibank Private            Benefits will not be paid for treatments you receive before
      member changing your cover to include higher benefits –                joining Medibank Private.
      you’ll have to wait 12 months to receive the higher benefits,
                                                                            You’ll need to serve the waiting periods that apply before you
      including benefits for services not previously covered. Please
                                                                            are entitled to the higher benefits. And, any excess applied to
      note, any excess that applied under your former cover will
                                                                            your old cover will transfer with you until you have served the
      transfer with you until you have served the waiting periods for
                                                                            waiting periods for your new Medibank Private cover.
      your Medibank Private cover.
     The 12 month pre-existing ailment rule can be applied to all           What if I’m still serving waiting periods with my
     hospital or hospital-substitute treatment (except for psychiatric,     former fund?
     rehabilitation and palliative care) and extras services (except        If you haven’t fully served the equivalent Medibank Private
     general dental).                                                       waiting periods with your former fund, then you’ll need to serve
                                                                            the balance of these waiting periods with Medibank Private

     About other assessment rules                                           before you’re eligible for benefits.
                                                                            Please note, any excess that was part of your previous level of
     Are there any other assessment rules I need to                         cover will transfer across with you until you have served the
     know about?                                                            waiting periods for your Medibank Private cover.
     Yes. Other rules to keep in mind include:
                                                                            I’ve accrued a loyalty bonus with my former fund.
      Benefits are only payable for items and services delivered by
                                                                            Can I transfer this?
      Medibank Private recognised providers
                                                                            Any loyalty bonuses or other entitlements accrued with your
      Restrictions apply to some specific benefits. For example, for
                                                                            former fund, such as increased annual limits for dentures and
      an initial consultation for an extras service, the higher benefit
                                                                            crowns, can’t be transferred to your Medibank Private
      (if any) is generally paid only once in a course of treatment
                                                                            membership.
      Limited hospital benefits apply to podiatric surgery (performed
      by an accredited podiatrist) and dental procedures that are           What if I want to change back to my former fund or go to
      performed in a private non Members’ Choice hospital                   another fund?

      If you no longer need acute care and stay in hospital for more        You can join or leave Medibank Private at any time. The Private
      than 35 days, the hospital must classify you as nursing home          Health Insurance Ombudsman has published a brochure called
      type patient. If this happens, Medibank Private will only pay a       The Right to Change, which describes the rules that apply when
      small portion of the benefit per day and you will need to              you transfer between funds.
      contribute towards the cost of your care. If you are in a private     If you decide to transfer, get a transfer certificate request form
      hospital, these costs may be substantial                              from the fund you wish to switch to. Once you have completed
      Benefits are not paid for services or treatments where you are,        the form your new fund can arrange to transfer your
      or may be, entitled to compensation and/or damages. For               membership on your behalf.
      example State Government workers’ compensation schemes
      and traffic accident schemes




50
About different levels of                                               If you have a packaged cover, the excess is $200 each time a
                                                                        member is admitted to hospital. However, you will pay no
hospital cover                                                          more than $500 per single membership, and no more than
                                                                        $1,000 per couple, family or single parent family membership
What’s the difference between included, restricted and                  each calendar year.
excluded services?
                                                                       Please note, the excess does not apply to extras claims under
You’ll generally receive higher benefits for included services
                                                                       a packaged cover. MyOptions and PremierPlus don’t have
than for restricted services. An excluded service is one you’re
                                                                       an excess.
not covered for at all.

What does restricted services mean?                                    About out-of-pocket expenses
The benefits we pay towards private hospital accommodation
                                                                       What is an out-of-pocket expense?
for services listed on your cover as restricted services are paid at
                                                                       It’s any expense that has to be paid out of your own pocket
the minimum benefit level as set by the Federal Government.
                                                                       when you go to hospital or use on extras service. Having private
No benefit is paid for the costs of labour wards or operating
                                                                       health insurance helps reduce your out-of-pockets but you may
theatres. You need to pay any costs over and above the benefit
                                                                       still have to pay for some things.
we pay.
If you choose a cover with restricted services it’s crucial you        How can I reduce my hospital out-of-pockets?
consider if you’re likely to need the restricted services because if   When you’re a Medibank Private member with hospital
you claim for these services, you could end up with significant         cover, there are two key ways to help reduce your
out-of-pocket expenses. For example, if you’re young, you may          out-of-pocket expenses.
be less likely to need hip or knee replacements. Or if you’re
                                                                       The first way is to find out if your specialist participates in our
planning a family you should consider cover that has
                                                                       GapCover scheme to help reduce your in-hospital medical costs.
obstetrics-related services and assisted reproductive services.
                                                                       This scheme is detailed on page 52.
So what sort of cover do I have for a restricted service in a          The second way is to take advantage of our Members’
private hospital?                                                      Choice network. When you go to a Members’ Choice
In a private hospital the benefits we pay towards your hospital         hospital you may need to pay some costs, but these should
accommodation (including intensive care) will be paid at the           be limited to:
minimum benefit level as set by the Federal Government.                  Any excess you may have with your cover
No benefit is paid for the costs of labour wards or operating
                                                                        Any difference between what your doctor charges
theatres.
                                                                        (including pathology and radiology fees) and the Medicare
And in a public hospital?                                               Benefits Schedule fee not covered by GapCover or our
                                                                        arrangements with medical practitioners (see the section on
In a public hospital, if you’re treated as a private patient, your
                                                                        page 52 about GapCover)
hospital accommodation will be fully covered (less any
applicable excess) in a shared room or private room for                 Any pharmaceuticals not covered by our agreement with
overnight admission and a shared room for same day                      the hospital. This includes the cost of any drugs issued on
admissions. If you’re treated as a private patient in a private         discharge from hospital
room for same day admissions, you may have to pay extra                 The gap for surgically implanted prostheses and other items on
towards your accommodation.                                             the Federal Government’s Prostheses Schedule. We call these
                                                                        gap prostheses. See page 58 for more information
About the excess options                                                Costs for procedures not recognised for Medicare benefit
                                                                        purposes. No benefits are payable for cosmetic surgery
What is an excess?
                                                                        Costs for services not covered, or fully covered, by our
An excess is an amount that you agree to pay if admitted to
                                                                        agreement with the hospital
hospital in exchange for lower premiums. Your excess is deducted
from the benefits we pay when you make a hospital claim.                 Costs for services such as physiotherapy, occupational therapy
                                                                        and speech therapy, that aren’t covered in a small number of
How does an excess work?                                                Members’ Choice hospitals
 If you have First Choice Hospital, Intermediate Hospital or Blue       Costs for treatment in an emergency department that aren’t
 Ribbon Hospital the excess applies per member per calendar             covered by Medicare.
 year. For example, if you’re on a single membership and have
 chosen a $250 excess, once you’ve paid $250 towards a
 hospital admission in a calendar year, your excess won’t be
 applied again until the following calendar year. For a couple
 membership, each of you would only pay an excess of up to
 $250 in any calendar year.


                                                                                                                                           51
     What if I’m treated in a non Members’ Choice hospital?               How do I take advantage of the GapCover scheme?
     If you are treated in a non Members’ Choice hospital you may         If you anticipate being admitted to hospital for treatment or a
     have significant out-of-pocket expenses. These expenses may           procedure, we recommend that, before proceeding, you ask
     vary between hospitals and are typically not subject to a            your doctor(s) whether they will participate in Medibank
     maximum limit. For full details of benefits paid for treatment in     Private’s GapCover scheme. A listing of specialists who have
     a non Members’ Choice hospital, please call us on 132 331.           participated in GapCover in the past is available on our website
                                                                          at medibank.com.au
     About in-hospital medical cover                                      How exactly does the GapCover scheme reduce my costs?
     Generally any out-of-pocket expenses for medical costs
                                                                          Under GapCover, a specialist who treats you in hospital can elect
     associated with a hospital stay arise when a specialist charges
                                                                          to charge you either no gap or a limited known gap for their
     more than the Medicare Benefits Schedule (MBS) fee.
                                                                          services. For a no gap service, you’ll have no out-of-pocket
     When you go to hospital or a day facility, the benefits you’re        expense. For a known gap service, the specialist must notify you
     entitled to for the in-hospital medical services you receive are     of any out-of-pocket expenses for their services, usually before
     based on the MBS fee. Medicare pays 75% of the MBS fee, and          your treatment starts.
     Medibank Private pays 25% (if the treatment is covered under
                                                                          GapCover does not eliminate amounts that you’ve agreed to
     your policy).
                                                                          pay under your policy with Medibank Private, such as any
     To help members lower out-of-pockets when a doctor charges           applicable excess or other hospital charges. And it only applies
     more than the MBS fee, we have a scheme called GapCover.             to medical procedures performed by specialists in hospital or day
                                                                          hospital facilities.
     About GapCover                                                       Can I use GapCover when I go to the doctor?
     What is GapCover?                                                    No, it applies to in-hospital medical services only, not for visits
     GapCover is Medibank Private’s scheme which helps to                 to your GP or out-patient specialist appointments.
     minimise or eliminate out-of-pocket expenses for in-hospital
                                                                          What’s not covered under GapCover?
     medical services by paying higher benefits for our members
                                                                          Generally our GapCover arrangements do not apply to services
     where a doctor charges above the MBS fee.
                                                                          provided by specialist pathologists and radiologists, such as
     Am I eligible for GapCover?                                          blood tests and imaging. This means you will have some
     You will be eligible to participate in our GapCover scheme if (for   out-of-pocket expenses where these providers charge more
     a particular in-hospital medical service):                           than the MBS fee and are not covered under other agreements
                                                                          with Medibank Private. However, for these services you will still
      You are eligible to receive Medicare benefits;
                                                                          be entitled to receive 75% of the MBS fee from Medicare and
      You are eligible to receive benefits from Medibank Private; and      25% from us (if the treatment is covered under your policy).
      Your doctor agrees to participate in the scheme.
     Please note, doctors are free to use the GapCover scheme on a
     case-by-case or episode-by-episode basis and more than one
     doctor may be involved in your treatment or procedure.
     People who hold Medibank Private’s Visitors Covers or Overseas
     Student Health Cover are not eligible for GapCover.




                                                                                                        Medibank Private GapCover can
                                                                                                        help you minimise or even avoid
                                                                                                             this out-of-pocket expense.




                                    DOCTOR’S TOTAL CHARGE FOR IN-HOSPITAL MEDICAL SERVICES

       Medicare Benefits Schedule (MBS) fee. This fee is set by the Federal Government.                  The gap is the amount your
                                                                                                        doctor may charge over and
                                                                                                        above the MBS fee, leaving
      in-hospital medical services.                   fee for in-hospital medical services.             you out-of-pocket.

     Note: Doctors can choose whether they participate in GapCover on a case-by-case or episode-by-episode basis.




52
About extras limits                                                  ACT or NSW and have a Commonwealth concession card you
                                                                     might be exempt from paying the ambulance levy.
How do the annual limits and sub-limits on extras work?              Please call us on 132 331 for a quote.
An annual limit is the maximum amount you can claim for                                        – you may be entitled to
the services and items within a particular extras category            cover for ambulance transport under the State
(for example general dental), within a calendar year. Within          Government scheme.
these categories there may be sub-limits that restrict the
amount you can claim for specific services and items.                How does it work for the different types of cover?

Once you’ve reached your annual limits or sub-limits for an
extras category or item within a calendar year, you have to         You’re eligible for benefits for medically necessary ambulance
wait until the next calendar year before you can claim on           transport under all hospital and packaged covers described in
these services or items again.                                      this brochure, except where there is an entitlement to benefits
The benefits payable for a particular claim are likely to be less    under third party arrangements such as ambulance subscription
than the annual limit or sub-limit.                                 services or State Government ambulance transport schemes, like
                                                                    those operating in the ACT, NSW, Qld and Tas.
For example, if you have Smart Choice Extras and have both
glasses and contact lenses, the most you can claim for items
listed under optical items is $225 a year (annual limit). But of    Under our extras cover you’ll be eligible to receive benefits for
that $225, the maximum you can claim for contact lenses             medically necessary ambulance transport, except if you live in
is $200 (sub-limit) leaving you $25 available for other services    Qld or Tas where State Government ambulance transport
or items.                                                           schemes operate.


About prostheses
Does Medibank Private cover all surgically                          About the annual bonus with
implanted prostheses?
                                                                    a packaged cover
Most of the common items found on the Federal Government’s
Prostheses Schedule are fully covered under your hospital           Our packaged covers include a yearly bonus that can help pay
cover (no-gap prostheses). However, you will have to contribute     for a range of approved membership and health-related
towards the costs of some surgically implanted prostheses and       expenses. There are two types of bonuses available:
other items (gap prostheses). For every relevant procedure listed    Flexi-Bonus for MyOptions
in the Medicare Benefits Schedule there will be at least one
                                                                     PackageBonus for HealthyPlus, SmartPlus, AdvantagePlus
no-gap prosthesis available.
                                                                     and PremierPlus
It’s important to discuss with your doctor the prosthesis
                                                                    If you have MyOptions, go to page 30 to find out how you can
that’s best for your needs, and ask for an estimate of your
                                                                    use your Flexi-Bonus.
out-of-pocket expenses.
                                                                    How can I use my PackageBonus?
About ambulance transport                                           You can use your PackageBonus towards any of the following:

What is medically necessary ambulance transport?
It’s cover for ambulance transport which is necessary because        Payment towards your hospital excess
your medical condition means you can’t be transported any            Payment towards the shortfall for approved claims for hospital
other way. All our covers described in this brochure include         charges and extras expenses, such as dental.
medically necessary ambulance transport. But, there are
differences between the three types of cover.
                                                                     Travel vaccinations
Don’t I already have ambulance cover?                                Health management program costs approved by Medibank
                                        – you may be eligible        Private (excludes goods purchased)
 for free or subsidised ambulance services. If eligible for          Appliances or equipment such as wheelchairs and blood
 subsidised services, you may be able to claim the remaining         pressure monitors
 cost from Medibank if you have medically necessary
                                                                     Stop smoking programs
 ambulance transport included in your cover.
                                                                     Any out-of-pocket expenses related to the cost of non-PBS
                                   – you’ll pay an ambulance
                                                                     pharmaceutical prescriptions
 levy as part of your hospital cover premiums, and you’re
 entitled to cover under your State scheme. When you receive         A range of other health-related expenses including services,
 an account for ambulance transport, you should take it to           appliances and equipment approved by Medibank Private.
 one of our stores for endorsement, then send it to the              Please call us on 132 331.
 administrator of the relevant scheme. Note: if you live in the

                                                                                                                                       53
     What can’t I use my PackageBonus for?                              Will my baby be covered when I’m in hospital for
      Your premium                                                      the birth?

      Any contributions towards PBS prescriptions                       When a newborn baby is in hospital with its mother,
                                                                        no accommodation charges apply for the baby unless the
      Out-of-hospital medical expenses covered by Medicare
                                                                        baby becomes an admitted patient in their own right.
      The difference between a Medicare Benefits Schedule fee            This happens when:
      and a doctor’s charge for in-hospital medical expenses
                                                                         The baby requires admission to a neo-natal intensive care unit;
      Other non-approved expenses or expenses and costs                  or
      precluded by law from being paid.
                                                                         It is the second or later child of a multiple birth.
     The expenses you can use your PackageBonus on are subject to
     review and can change. If you anticipate expenses that you’re      If I have children, how long will they be insured on
     expecting a PackageBonus benefit for, please call 132 331           my cover?
     before incurring the expense to confirm the benefit you expect       If your little ones are getting bigger they can still be covered at
     will be paid.                                                      no additional cost on your family or single parent family
                                                                        membership until they turn 21 and, if they are full-time
     About adding additional                                            students, until they turn 25.
                                                                        We also have our Families With Adult Children membership
     members to your membership                                         option. This allows you to have your adult children on your
     What if I want to add a spouse/partner to my                       cover if they are:
     single membership?                                                  Aged at least 21 and under 25
     It’s easy to change from a single to a couple membership,           Not full-time students
     but you should note that higher premiums apply to a
                                                                         Not married or in a de facto relationship.
     couple membership and waiting periods may apply to
                                                                        You will pay a higher premium, but generally it’s a more
     your spouse/partner.
                                                                        economical option than if they were to take out their own cover
     What if I want to add a dependant child to my
                                                                        at the same level. Once they have served their waiting periods
     single membership?
                                                                        your children can enjoy the benefits of your cover.
     You can change from a single to a family or single parent family
     membership without serving additional waiting periods              Which covers include the adult children option?
     following the birth of your baby or at the time of adopting or     The Families With Adult Children membership option is available
     fostering a child.                                                 to members with family or single parent membership under
     Your child must be added within two months of the birth or         most of our hospital and extras covers.
     being included in your family unit. This change to your            Exceptions to this include: MyOptions, Accident Cover, Visitors
     membership comes into effect on the date that your child was       Cover, Overseas Student Health Cover and Ambulance Cover.
     born, adopted or fostered. If other family members are added at
     this time waiting periods may apply.
                                                                        About the Private Room
                                                                        Guarantee
     Will my premium increase if I add a child to my single             What is the Private Room Guarantee?
     membership?                                                        The Private Room Guarantee is a benefit which is only available
     Higher premiums will apply if you change from a single             with our PremierPlus cover. It pays you $50 a night up to a
     membership to a family or single parent family membership.         maximum of five nights per stay, if there isn’t a private room
     But it doesn’t increase if you change from a couple to family      available at a Members’ Choice hospital and you’re eligible to
     membership, or you’re already on a family membership.              receive benefits under your cover for the treatment you received
                                                                        during your stay. You need to make sure you request a private
                                                                        room at least 24 hours before your stay.
                                                                        The Private Room Guarantee does not apply if your doctor
                                                                        considers that you should be located in a shared room for
                                                                        clinical reasons or for same day admissions or admissions for
                                                                        sleep studies.




54
Other important information                                           Medibank Private employees are competently trained to deal
                                                                      with your enquiries
How often should I review my cover?                                   Medibank Private protects the privacy of your information in
At different stages of your life you may have different health        line with the privacy legislation
cover needs. So it makes sense to review your health cover            You have access to a reliable and free system of addressing
regularly – especially if your situation has changed. For example,    complaints with Medibank Private.
if you’re planning your wedding or starting a family, kids are
                                                                     A copy of the code is available online at
leaving home or either you or someone in your family has
                                                                     privatehealth.com.au/codeofconduct
developed a chronic illness. And if you ever have any questions
just call us on 132 331 or drop into a Medibank store.               Disclaimer
                                                                       Medibank Private encourages providers to offer high-quality
We value your feedback
                                                                       products and services at competitive prices to its members.
If you have any feedback about our products and services,
or would like further explanation on anything to do with your          Where Medibank Private recognises a provider, advertises
membership, you can contact us:                                        on behalf of a provider, or appears by reference of logo or
                                                                       otherwise in an advertisement of any provider, to the fullest
 Call 132 331
                                                                       extent allowed by the law, such advertising or reference
 Email ask_us@medibank.com.au                                          should not be construed as: a) an endorsement; b) an
 Visit any of our Medibank stores                                      acknowledgment or representation as to fitness for purpose;
 Write to us at Medibank Private GPO Box 9999 in                       or c) a recommendation or warranty of, for, or in relation
 your capital city.                                                    to, the product and/or service of the provider. Accordingly,
                                                                       Medibank Private neither takes nor assumes any
What if I have a complaint?                                            responsibility for the product and/or service provided.
We’re committed to efficient and fair resolution of complaints          Members should make and rely on their own enquiries and
and to using the feedback you give us to ensure our products,          seek any assurance or warranties directly from the provider
policies and service continue to adequately address our                of the service or product.
members’ needs.
We’ll try to resolve any complaint you may have the first time
you raise it with us – please contact us with any issues through
the contact points listed. If you believe your complaint has not
been satisfactorily dealt with, please let us know and we will
escalate your complaint. You can also write to our Customer
Resolutions team at Medibank Private, GPO Box 9999,
Melbourne, VIC 3000.
Free independent advice is also available from the Private Health
Insurance Ombudsman on 1800 640 695.

Private Patients’ Hospital Charter
Prepared by the Federal Government, this booklet is designed to
inform you about what you can expect from your health fund,
doctors and hospitals as a patient with hospital cover. A copy is
available from any Medibank store.

Private Health Insurance Code of Conduct
Medibank Private is proud to be a signatory to the Private
Health Insurance Code of Conduct. The code was developed
by the private health insurance industry and aims to promote
the standards of service to be applied throughout the industry.
The code is designed to help you by ensuring that:
 Information which we provide to you is written in
 plain language




                                                                                                                                       55
56
Glossary
If some of the words and phrases used in our brochure have you a little stumped,
you’ll find a quick explanation here.


Accident                                                              Dependant child
An unforeseen event occurring by chance and caused by an              A dependant child under a Medibank Private family or single
external force or object, resulting in involuntary injury to the      parent family membership can only be:
body which requires immediate treatment, but does not include          An unmarried child of the contributor or their spouse/partner,
unforeseen conditions, the onset of which were brought on by           up to the age of 21
medical causes.
                                                                       An unmarried child of the contributor or their spouse/partner,
Adult dependant                                                        aged 21 or over but under 25 and undertaking full-time study
A child of the contributor or spouse who is at least 21 but under      in an approved course as defined by Medibank Private.
25 years old, not married or in a de facto relationship, not a
                                                                      Note: ‘married’ includes two people living in a de facto
full-time student and is a member of an eligible cover or
                                                                      relationship.
combination of eligible covers. An adult dependant does not
need to be living at home.                                            Endodontic services
                                                                      Endodontic treatment (eg root canal treatment) is a method
Annual limit
                                                                      of saving infected or damaged teeth. It involves the treatment
An annual limit is the maximum amount of benefits payable for
                                                                      of infections of the dental pulp (nerves) of teeth by removing
particular groups of extras services within a calendar year.
                                                                      the nerve. The nerve canals are filled and the tooth can then
Benefit                                                                be structurally restored. A 12 month waiting period applies to
                                                                      endodontic services.
A benefit is an amount of money payable by Medibank Private
to, or on behalf of, a member for an expense approved by              Excess
Medibank Private.
                                                                      An excess is an amount that you pay when admitted to
Calendar year                                                         hospital in exchange for lower premiums. Please see page 51
                                                                      for more information.
A 12 month period commencing 1 January and ending
31 December.                                                          Excluded service

Cardio-thoracic procedures                                            An excluded service is a service for which no benefits
                                                                      are payable.
Includes open heart and bypass surgery, and invasive cardiac
investigations and procedures, such as angiograms,                    External prostheses
angioplasties and stent insertions.
                                                                      Manufactured items designed to replace external parts of
Condition                                                             the body such as an arm. Benefits for external prostheses
                                                                      are only paid under certain Medibank Private extras and
A condition means any actual or perceived state of health for
                                                                      packaged covers.
which treatment is sought. It includes but is not limited to states
variously described as: abnormality, ailment, disability, disease,    Federal Government’s Prostheses Schedule
disorder, health problem, illness, impairment, impediment,
                                                                      This is a list of surgically implanted prostheses and other items
infirmity, injury, malady, sickness or unwellness.
                                                                      issued by the Federal Government. It sets out the benefits
Contributor                                                           payable for surgically implanted prostheses and other items by
                                                                      registered private health funds to members with hospital cover
The person who owns the Medibank Private membership is the
                                                                      that includes cover for any associated treatment.
contributor. The contributor is the person we contact about
changes to your cover, membership benefits and premiums as             Federal Government 30% Rebate
well as major changes to our Fund Rules.
                                                                      An initiative introduced by the Federal Government to make
                                                                      private health insurance more affordable, regardless of your
                                                                      income level. Please see page 47 for more information.




                                                                                                                                          57
     Fund Rules                                                          Major eye surgery
     These are the rules of Medibank Private membership.                 Includes cornea and sclera transplants and cataract surgery.
     Some of the more important Fund Rules are summarised in
     the Membership Guide sent to all new members. The Fund              Medically necessary ambulance transport
     Rules can be viewed at medibank.com.au or at any of our             Cover for transportation by ambulance which is necessary
     Medibank stores.                                                    because, due to the patient’s medical condition, they cannot be
                                                                         transported by any other means. Please refer to page 53 for
     All members are subject to the Fund Rules as varied from time
                                                                         further information.
     to time with the approval of the Minister for Health and Ageing.
                                                                         Medicare Benefits Schedule
     GapCover
                                                                         This schedule lists all the services for which Medicare pays
     This is a billing scheme we’ve created to help minimise
                                                                         benefits and the rules that apply to the payment of those
     your out-of-pocket expenses when a doctor charges above the
                                                                         benefits. Each service has a fee that has been set by the Federal
     Medicare Benefits Schedule fee. Please see page 52 for
                                                                         Government for the purpose of calculating the Medicare benefit
     more information.
                                                                         payable for that service.
     Gap prostheses
                                                                         Medicare Levy Surcharge
     Items on the Federal Government’s Prostheses Schedule for
                                                                         Please see page 48.
     which you will have to pay an amount towards the cost.
                                                                         Member
     General dental
                                                                         Any person covered under a Medibank Private membership.
     General dental services include preventative treatments, fillings
     and extractions. It does not include orthodontic, periodontic,      Membership
     dentures, crowns, and bridges or endodontic services.
                                                                         A membership consists of one or more persons, being:
     A 12 month waiting period applies to surgical procedures
                                                                          The contributor in the case of a single membership
     and surgical extractions (eg extraction of wisdom teeth),
     and a 2 month waiting period applies to all other general            The contributor and spouse/partner for a couple membership
     dental services.                                                     The contributor, spouse/partner and dependent children for a
                                                                          family membership
     Hospital charges
                                                                          The contributor and dependent children for a single parent
     Charges raised by a hospital for accommodation and nursing
                                                                          family membership
     care (including accommodation involving intensive and coronary
     care), theatre fees, surgically implanted prostheses and other       The contributor and/or spouse/partner and/or dependant
     items, but may not include charges for extras services, such as      children and adult dependant(s) for a Families With Adult
     physiotherapy or fees levied by your hospital doctor.                Children membership option.

     You should contact Medibank Private on 132 331 and/or the           Members’ Choice hospital and Members’ Choice extras
     hospital to check your benefit entitlement before admission.         provider (Members’ Choice provider)

     Included services                                                   A hospital or extras provider who has entered into a Members’
                                                                         Choice agreement with us. Members who use their services can
     These are services for which we pay benefits under the hospital
                                                                         generally get greater value from their private health insurance
     component of MyOptions. Benefits for included services are
                                                                         such as higher benefits, capped fees and discounts to help
     typically higher than restricted services.
                                                                         reduce out-of-pocket expenses.
     Lifetime Health Cover (LHC)
                                                                         No-gap prostheses
     This Federal Government initiative is designed to encourage
                                                                         Items on the Federal Government’s Prostheses Schedule for
     people to take out hospital cover early in life and maintain it.
                                                                         which you will be fully covered.
     It allows them to pay lower premiums throughout their life,
     compared with others who take out hospital cover when they’re       Obstetrics-related services
     older, or who allow their cover to lapse for long periods. Please
                                                                         All treatment specified in the Medicare Benefits Schedule (MBS)
     see page 48 for more information.
                                                                         as ‘obstetrics’ including antenatal and post-natal care and
     Major dental                                                        management of labour and delivery.

     Dental services relating to orthodontic (eg braces and corrective
     plates), periodontic, dentures, crowns, bridges
     and inlay/onlay restorative services.




58
PackageBonus                                                        Sleep Apnoea – continuous pressure device
A yearly bonus, when you have a HealthyPlus, SmartPlus,             Benefits for Sleep Apnoea devices or similar devices as approved
AdvantagePlus or PremierPlus packaged cover that you can use        by Medibank Private, are payable only under hospital cover
to help pay for a range of approved membership-related and          when the member has undergone an investigation for Sleep
health-related expenses. See page 53 for more about                 Apnoea for which treatment is listed in the Medicare Benefits
PackageBonus.                                                       Schedule, and when the device is requested by a treating
                                                                    medical practitioner. The device must be purchased or hired
Pharmaceutical Benefits Scheme (PBS)                                 within 12 months of undergoing the investigation. Benefits for
This Federal Government scheme allows for many                      replacement devices are not payable for a period of five years
pharmaceuticals to be supplied to Australian residents at           from the date of the original purchase or hire.
reduced or no cost.
                                                                    Sub-limit
Pharmaceutical prescriptions (non-PBS)                              A sub-limit is a limit applied annually (or within other defined
Prescription-only items not covered by the Pharmaceutical           periods of time) on benefits paid for a certain item or service
Benefits Scheme. Benefits are payable up to a set amount              within an overall annual limit. For more about extras limits,
for each prescription, by state, and after a set charge has         see page 53.
been deducted. The set charge is equivalent to the current
PBS patient contribution. No benefits are payable for oral           Surgically implanted prostheses
contraceptives or for pharmaceutical prescriptions when             Approved manufactured items that are surgically implanted or
prescribed for cosmetic purposes.                                   applied, generally during a hospital surgical procedure. Benefits
                                                                    for surgically implanted prostheses are payable only under
Pre-existing ailment                                                Medibank Private hospital covers. However, benefits are not
An ailment, illness or condition where signs or symptoms            payable for prostheses associated with an excluded service
existed at any time during the six months before you either took    under your cover.
out your new cover or transferred to a cover with higher
benefits. The only person authorised to decide if you have a         Waiting period
pre-existing ailment is a medical practitioner appointed by         A waiting period is a period of time a member must wait before
Medibank Private. A different rule is applied to waiting periods    benefits are payable. Benefits are not payable for goods and
for pre-existing ailments. For information about how the            services obtained while you are serving a waiting period.
pre-existing ailment rule works, see page 50.                       A two month waiting period applies to all services, but some
                                                                    services have longer waiting periods, as specified on page 48.
Recognised providers
A provider approved by Medibank Private for the purpose of
paying benefits. To check if a provider is recognised, please call
us on 132 331.

Restricted services
These are services for which we pay lower benefits in private
hospitals. Please see page 51 for further information.

Same day admission
An admission to, and discharge from, a hospital or day hospital
facility on the same day (where the stay does not extend
beyond midnight).

School accident
An accident suffered by a dependant child who is a pre-school,
primary or secondary school student. Covers services that are
provided within 12 months of an accident that occurs while
attending, or travelling to or from, school or an organised
school activity. Excludes services covered by Medicare or
where compensation or damages are payable.




                                                                                                                                       59
Phone
132 331
Email
ask_us@medibank.com.au
Join online
medibank.com.au
Visit us
Visit our website at medibank.com.au
for your nearest Medibank store
Write to us
Medibank Private GPO Box 9999
in your capital city




                      Medibank Private
                      is a signatory to
                      the Private Health
                      Insurance Code
                      of Conduct.


Medibank Private Limited ABN 47 080 890 259
The Private Health Insurance Code of Conduct logo
is a trademark of, and is used under authorisation from,
Australian Health Insurance Association Limited.
MPLM21710409

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:15
posted:11/22/2011
language:German
pages:60