Corporate Health Cover _Monash University_

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					                         COV E R FO R
                         C O R P O R AT E
Effective 1 April 2011




                                            A
ABOUT                                                ABOUT BUPA
CORPORATE                                            AUSTRALIA
HEALTH COVER
Corporate health cover gives you peace               Bupa Australia is a leading private health
of mind and puts you in control of your              insurer – providing Australians with affordable,
healthcare. We offer a wide range of                 high-quality health cover.
affordable covers to suit different lifestyles       Bupa Australia provides national coverage
and budgets – plus, you have access to               for our members. With a presence in every
special corporate benefits to ensure you              Australian state and territory, we operate under
receive more for your membership.                    the trusted and respected brands HBA, MBF
                                                     and Mutual Community, covering over three
                                                     million Australians.
                                                     We provide real value for members across
                                                     a wide range of health services including:
                                                     hospital; medical; extras; ambulance and
                                                     pharmacy. As part of this, our members can
                                                     save by using our extensive, national network
                                                     of hospital and extras providers.
                                                     More good news—we are about more than
                                                     health insurance. Our vision is to help our
                                                     members lead longer, healthier, happier lives.
                                                     As part of this we have created a range
                                                     of health programs and online resources,
                                                     in conjunction with experts, to support
                                                     our members.
                                                     If you would like to discuss any information
                                                     in this brochure:
                                                     Call 1800 649 406 for HBA and Mutual
                                                     Community enquiries or 1300 653 525
                                                     for MBF enquiries
                                                     Visit hba.com.au/corporate,
                                                     mbf.com.au/corporateplan or
                                                     mutualcommunity.com.au/corporate
                                                     Pop by your local centre




                                                 B
                                          Hospital Cover

W E LCO M E
                                          If you want cover for treatment in hospital, we’ve got
                                          three levels of hospital cover to choose from. You can
                                          take out hospital cover on its own, but many people also
                                          choose to combine it with extras cover.

We want to make it as simple as
possible for you to find health cover
that suits your needs and allows you
to focus on the important things—like     Extras Cover
enjoying life.
This brochure and the corporate
                                          We call them ‘extras’ because they are services that
benefits guide enclosed contains
                                          Medicare often doesn’t cover. Extras services include:
information you need to find the
                                          dental; physiotherapy; chiropractic; optical; massage and
cover to suit you. It is important
                                          much more. There are three levels of extras cover and you
information and should be carefully
                                          can take it on its own or with hospital cover.
read and retained.




CONTENTS                                  Packaged Cover


Why get private health insurance?     3
                                          Our packaged cover combines both hospital and extras
Why choose us?                        4
                                          cover into one easy package. This is a great option
Hospital Cover                        6   for people who want cover for hospital treatment and
  Hospital Cover comparison           8   extras services.
  Understanding Hospital Cover      10
Extras Cover                        14
  Extras Cover comparison           16
  Understanding Extras Cover        19    Additional member benefits
Packaged Cover                      22
  Packaged Cover                    24
  Hospital at a glance                    Our health cover affords members more than you
  Packaged Cover                    26    might think. We offer a range of health programs and
  Extras at a glance                      online resources to support our members long term.
                                          Look out for our member discounts too!
Additional member benefits
  Health programs                   28
  In2life partners                  30
Join today                          32
  Easy ways to claim                34    Join Today
  Important information             36


                                          There are a number of easy ways to join. Simply fill out
                                          the application form included, or call us to join over the
                                          phone. Also find out how easy we make it to claim.




                                             1
2
W H Y G E T P R I VAT E
H E A LT H I N S U R A N C E ?

           Going private may save you money
           Taking out private hospital cover may save you money. That’s because
           the Government charges a 1% Medicare Levy Surcharge if you don’t
           have private hospital cover but earn more than $80,000 a year (for
           singles) or more than $160,000 a year* combined (for couples). This
           is on top of the 1.5% Medicare Levy paid by all eligible taxpayers. You
           should ask your tax adviser for more information or visit ato.gov.au
           *On family memberships this increases by $1,500 per child after the first child. Thresholds
           effective 1 July 2011 and are indexed annually.


           Get 30% back on your premiums
           The Federal Government 30% Rebate on private health insurance
           makes going private more affordable for you. The Rebate is available
           to all Australians who have full Medicare rights and applies to all
           products in this brochure. It’s quick and easy to claim too—you can
           choose to get it as a reduced premium or as a lump sum at tax time.

           Avoid Lifetime Health Cover Loading
           You may be charged a Lifetime Health Cover (LHC) Loading under the
           Federal Government’s LHC initiative depending on what age you first
           take out hospital cover. The loading increases 2% a year to a maximum
           of 70% and once attracted will apply for 10 continous years. You
           can avoid paying any loading if you take out hospital cover by 1 July
           following your 31st birthday and maintain it without a break (or any
           break less than three years).

           Private health insurance = choice
           Private health insurance covers most private hospital costs. This
           means you can choose your own doctor and where you are treated
           without worrying about treatment costs or public waiting lists in most
           instances. You can also enjoy cover for a wide range of extras services
           including: dental; optical; physiotherapy and massage, which are often
           not covered by Medicare.


           Peace of mind
           There are a number of good financial and practical reasons for getting
           private health insurance. But when it comes down to it, the peace of
           mind it gives you and your loved ones is just as important. You can
           rest easy knowing that your health insurance needs are covered.



                                   3      3
WHY CHOOSE US?



Our experience                                    Get more back on Extras
We are a trusted and respected name in            These are just some of the great benefits
health insurance and have spent more than         you can get by using our MBF MemberCare
60 years providing Australians with quality       and Members First network providers:
health cover. We are now part of Bupa
                                                  O    up to 100% and at least 70% back on all
Australia, which operates under the trusted
                                                       general dental treatment*
brands MBF, HBA and Mutual Community.
                                                  O    up to 100% and at least 70% back
Save with our Australia-wide provider                  on most optical, physiotherapy and
networks                                               chiropractic services*
Our extensive MBF MemberCare and
                                                  O    a range of fixed-price packages on
Members First provider networks offer
                                                       glasses and contact lenses at no
nationwide access to dental; optical;
                                                       additional cost*
physiotherapy and chiropractic services.
If you have extras cover with us, you can         O    up to $100 off a wide range of fashion
save money by choosing these providers,                frames#
rather than non-network providers, because
their fees and any discounts have been            O    20% off a variety of sunglasses and
negotiated and agreed upfront. Plus you                non-standard contact lenses.#
can expect less out-of-pocket expenses
and upfront notice of any gap amounts in                            %        90 %
most instances.
                                                               80
Visit our website to find a network provider
near you. Also, keep an eye out for the
                                                      70 %




                                                                                        100
following logos at your providers:
                                                                                             %




                                                  *The percentage you get back and optical benefits
                                                  are dependant on your level of cover and are
                                                  subject to waiting periods and annual maximums.
                                                  #
                                                   Not in conjunction with any other offer.

                                                  Other Optical Partner benefits
                                                  Our optical partnership means you benefit
Choose from thousands of                          from a choice of fixed-price frames and
                                                  lenses packages, depending on your level
network providers across
                                                  of cover, annual maximums and waiting
Australia and enjoy on-the-                       periods. Visit our website to find an optical
spot claiming!                                    partner store near you.




                                              4
Great Extras product features                    Better customer service
    Loyalty maximums – On selected covers        Some members prefer to contact us by
    and services, we increase the amount         phone or go online. Others just want to pop
    you can claim each year by 20% (applies      into their local centre to get their claims
    after first 12 months) up to double the       paid on the spot, or talk to us face to face
    original annual maximum.                     about their existing cover. That's what sets
                                                 us apart—we are about giving you options
Full cover as a private hospital patient         for how you do business with us.
With us you are fully covered as a private
patient in most Members First and Network        Exciting member discounts
hospitals, and all public hospitals across       Get discounts on movie tickets, theme
Australia>. Plus, if you need to be admitted,    parks, airfares, fitness programs and much
in most cases you will be covered for all in-    more! See page 30 for more details about
hospital medical charges. See page 10 for a      our in2life deals.
list of what’s covered.
>
                                                 Ongoing support for members
 A small number of Members First and Network
hospitals may have a service where a fixed fee    We are committed to helping our members
applies. An excess may apply depending on your   lead longer, happier, healthier lives. This
chosen cover.
                                                 means giving ongoing support to help them
                                                 get value from their cover. We also offer
                                                 preventive health and wellness programs
                                                 for their long-term benefit such as Living
                                                 Well and Positive Health. See page 28 for
                                                 more details.




                                                                   Get up to 100%
                                                                   and at least 70%
                                                                  back when treated
                                                                    by our network
                                                                      providers.*




                                                  5
H O S P I TA L                                                              You can save on

COV E R                                                                     your premiums by
                                                                            including an excess


At any stage of life, it is important to have the right level of
hospital cover to suit your needs and give you peace of mind.



 TO P
 C O R P O R AT E           Corporate Hospital Top Cover provides you with full coverage for
 H O S P I TA L             your hospital expenses at any private hospital in our extensive
                            network, or public hospital in Australia.




 INTERMEDIATE
 C O R P O R AT E           An ideal option if you want a high level of hospital cover, but don’t
 H O S P I TA L             want to pay for some treatments you don’t think you’ll need until
                            later in life.




 S AV E R
                            This is a great choice if you’re young and healthy and not ready
 C O R P O R AT E           to start a family just yet, but you still want the protection of
 H O S P I TA L             hospital cover.




                                              6
H O S P I TA L C O V E R




                           7
                           7
H O S P I TA L C O V E R
C O M PA R I S O N
                                                                                            Saver                   Intermediate

Services Covered
For inpatient Services included on cover:
Accommodation for Overnight and Same-day Stays
Operating Theatre, Intensive Care, Ward Fees
Medical Gap Scheme
Allied Services (e.g. Physiotherapy in hospital)
Inpatient Services included on cover:
Accidents
Arthroscopy or Meniscectomy
Appendicitis
Removal of Tonsils and Adenoids
Dental Surgery
Minor Gynaecological Surgery
Psychiatric                                                                              Restricted
Rehabilitation                                                                           Restricted
Pregnancy Related Services (including childbirth) and Assisted
Reproductive Services
Cardiac and Cardiac Related Services (e.g. open heart and bypass
surgery and invasive cardiac procedures)
Renal Dialysis for Chronic Renal Failure
Cataract and Eye Lens Procedures                                                                                     Restricted
Hip/Knee Replacement                                                                                                 Restricted
All other Joint Replacement including revisions
(e.g. shoulder, elbow)
All other Inpatient Treatments receiving a Medicare benefit
Additional Items:
Baby Care (see page 13 for details)
Emergency Ambulance Services*
Health Subscription Refunds
Special Benefits that help pay for certain in-hospital
parent/partner accommodation or meals
Excesses
Excess Options^                                                                       Nil, $250, $500              Nil, $250, $500
   Excluded – Procedures receive no benefits from the health fund.
   Restricted – procedures receive benefits for shared-room accommodation in a public hospital only,
                with your choice of doctor. If you go to hospital as a private patient for a restricted service.
*There are different state ambulance arrangements across Australia. Please see page 37 in the Important Information section.
^^Health Subscription Refunds applies to Corporate Hospital Top, Levels 1 and 2 only (i.e. nil and $250 excess).
^Excess Bonus feature applies to the $250 excess level on Corporate Hospital Top, Intermediate and Saver Cover (Level 2) only.




                                                            8
                                     H O S P I TA L C O V E R
                      Want to know
                      more details
                      about what
                      is and isn't
                      covered? See
                      pages 10-11.




     Top




       ^^




Nil, $250, $500




                  9
U N D E R S TA N D I N G
H O S P I TA L C O V E R

What is covered?                                    An excess may apply depending upon your
Hospital costs                                      selected cover.

With private health insurance, you can              Medical costs
choose to be treated as a private patient in        These are the fees charged by a doctor,
either a public or a private hospital. With us      surgeon, anaesthetist or other specialist for
you are fully covered as a private patient in       any treatment given to you in hospital. Private
most Members First and Network hospitals,           health insurance provides you with the choice
and all public hospitals across Australia. A        of your own doctor, and you decide whether
small number of Members First and Network           you will go to a public or a private hospital
hospitals may have a service where a fixed           that your doctor attends. You may also have
fee applies. There are also a small number of       more choice as to when you are admitted
‘fixed fee’ hospitals that charge a fixed daily       to hospital.
fee for a maximum number of days per stay.
If you’re attending a ‘fixed fee’ hospital, you      You are covered for:
should contact them before you book to
                                                    O   the cost of these medical treatments up to
confirm what the fee will be.
                                                        the Medicare Benefit Schedule (MBS) fee.
When admitted to hospital, in most cases
                                                    The MBS fee is the amount set by the
you will be covered for all in-hospital charges
                                                    Federal Government for each medical service
including:
                                                    covered by Medicare. You must be eligible
O   accommodation for overnight or same-            for Medicare in order to be covered up to the
    day stays                                       MBS fee.

O   operating theatre, intensive care and           If you choose to be treated as a private
    labour ward fees                                patient in a hospital (public or private),
                                                    Medicare will cover you for 75% of the MBS
O   supplied pharmaceuticals approved by            fee for associated medical costs and we
    the Pharmaceutical Benefits Scheme               will cover the remaining 25% of the MBS
    and provided as part of your in-hospital        fee. If your specialist charges more than the
    treatment                                       MBS fee there will be a ‘gap’ for you to pay.
O   allied services including physiotherapy,        However, our Medical Gap Scheme can help
    occupational therapy and dietetics              eliminate or reduce the gap for you if your
                                                    doctor/s choose to use it.
O   medication, dressings and other
    consumables                                     What is not covered?
O   most diagnostic tests                           Hospital costs
    (e.g. pathology, radiology)                     Situations when you are likely not to be
O   no gap prosthesis that are surgically           covered include:
    implanted, Government recognised and            O   during a waiting period
    remain in-situ upon discharge
                                                    O   when specific services or treatments
O   single room where available.                        are excluded or restricted from your level
                                                        of cover


                                               10
                                                                                                          H O S P I TA L C O V E R
                                                                                 Please ensure
                                                                                 you also read
                                                                                 the Important
                                                                                 Information section
                                                                                 on pages 36-42.




O   when you are treated at a non-agreement            Waiting periods
    or fixed fee hospital                               A waiting period is the time between when
O   when you have not been admitted into a             you joined us and when you are covered for a
    hospital and are treated as an outpatient          service or treatment. If you receive a service
    (including emergency room treatment)               or treatment during this time, you are not
                                                       eligible to receive a benefit payment from
O   hospital treatment provided by a                   us, regardless of when you submit the claim.
    practitioner not authorised by a hospital          Different waiting periods apply for different
    to provide that treatment                          services, please see below.
O   hospital treatment for which                       O   The initial waiting period and the waiting
    Medicare pays no benefit, including                     period for palliative care psychiatric and
    most cosmetic surgery                                  rehabilitation services – two months.
O   if you are in hospital for 35 days and you
                                                       O   The waiting period for pre-existing
    have been classified as a ‘nursing home
                                                           ailments, illnesses or conditions and
    type’ patient. In this situation you may
                                                           pregnancy related services (including
    receive limited benefits or be required to
                                                           childbirth) – 12 months.
    make a personal contribution towards the
    cost of your care                                  Pre-existing ailments
O   benefits for pharmaceuticals supplied               A pre-existing ailment is any ailment, illness,
    upon discharge from the hospital                   or condition that you had signs or symptoms
O   if you choose to use your own allied               of during the six months before you joined or
    health provider rather than the hospitals          upgraded to a higher level of cover with us. It
    practitioner for services that form                is not necessary that you or your doctor knew
    part of your in-hospital treatment (e.g.           what your condition was or that the condition
    chiropractors, dieticians or psychologists)        had been diagnosed.

O   where compensation, damages or benefits             A condition can still be classed as pre-existing
    may be claimed by another source (e.g.             even if you hadn’t seen your doctor about it
    workers compensation)                              before joining or upgrading to a higher level
                                                       of cover.
O   any treatment or services rendered
    outside Australia.                                 If you knew you weren’t well, or had signs of
                                                       an ailment that a doctor would have detected
Medical costs
                                                       (if you had seen one) during the six months
You will not be covered for:                           prior to joining or upgrading, then the ailment
                                                       would be classed as pre-existing.
O   medical services for surgical procedures
    performed by a dentist, surgical podiatrist        A doctor appointed by us decides whether
    or any other practitioner or service that          your ailment is pre-existing, not you or your
    are not eligible for a rebate by Medicare.         doctor. The appointed doctor must consider
                                                       your treating doctors’ opinions on the signs
                                                       and symptoms of your ailment, but is not
                                                       bound to agree with them.



                                                  11
Inpatient vs outpatient
An inpatient procedure is where you are             The Excess Bonus Feature, available on
admitted into hospital for either a same-day        Corporate Hospital Top, Intermediate
or overnight admission. If you are admitted as      and Saver Level 2, means singles and
a private inpatient, you will be covered for        single parents won't have to pay the first
the services listed in your chosen level of         excess per calendar year and families
hospital cover. If you receive treatment as an      won't have to pay the first two excesses
outpatient (i.e. you are not admitted), in most     per calendar year. So you get quality
instances you will not covered by private health    cover without an excess in most cases.
insurance.

Medical Gap                                        Certainty when you go to hospital
This refers to the difference between what         We’ve negotiated with most private hospitals
your doctor charges and the amount Medicare        and day surgeries to ensure you get certainty
pays for inpatient procedures.                     about the costs associated with the hospital
                                                   treatment you receive there. Most of the
If your doctor charges up to the Medicare
                                                   time you will receive a no-out-of-pocket
Benefit Schedule (MBS) fee or is participating
                                                   experience when you use our Members First
in our Medical Gap Scheme, in most cases you
                                                   and Network hospitals. At Members First
will have no medical gap costs to pay.
                                                   day surgeries, a no-out-of-pocket expenses
For doctors who are not participating in           agreement extends to medical treatment
our Medical Gap Scheme and are charging            (treatment from medical practitioners) too.
above the MBS fee, we will pay the difference
                                                   A small number of hospitals may charge a
between the Medicare benefit and the MBS
                                                   fixed daily fee, capped at a maximum number
fee. Any amount above the MBS fee will be
                                                   of days per stay. These hospitals should inform
the amount you are required to pay and this is
                                                   you of this fee when you make a booking.
referred to as the ‘Medical Gap’.
                                                   We recommend you call us first before making
                                                   a booking to confirm that your hospital of
 To ensure peace of mind, ask your doctor          choice gives you certainty of full cover. We
 about their fees for your hospital treatment      can discuss any excess that may be applicable
 prior to admission and whether they participate   to your level of cover. You can find out if a
 in our Medical Gap Scheme for your                hospital has an agreement with us by checking
 treatment. Remember to also ask your doctor       our website.
 about the fees for other practitioners who
 may be involved in your hospital treatment        Planning for a baby
 such as: the anaesthetist; radiologist;           Planning for a baby is a great reason to join
 pathologist and assistant surgeons.               hospital cover or upgrade your existing level
                                                   of cover. It is very important to consider your
                                                   hospital cover during the planning stages
Excess                                             to ensure you will not be impacted by
To lower the cost of your hospital cover, on       waiting periods.
selected covers you can choose to include an       When planning for a baby, first check the
excess. Excesses are only payable on inpatient     level of cover you are currently on and ask:
hospital treatment in any hospital.                “Does it cover pregnancy related services
An excess is a set amount you pay upfront          including childbirth?” and “Does it cover the
before your benefit is paid. The excess is paid     baby once born?”.
when you are admitted into hospital, and is        Cover for the mother and the birth
capped at $500 for singles and $1,000 for
                                                   The majority of our hospital covers include
single parents and families per calendar year.
                                                   cover for inpatient pregnancy related services
                                                   and cover for the birth, please see the table
                                                   over the page and check which level of cover
                                                   you are currently on.


                                              12
                                                                                                H O S P I TA L C O V E R
Waiting periods                                 Baby Care
Mother                                          On Corporate Hospital Cover Top and
                                                Ultimate Corporate Health Cover, you
There is a 12 month waiting period
                                                will not be charged an excess on hospital
applied to all pregnancy related services
                                                admissions for children under the age of
(including childbirth) and assisted
                                                3. Plus, you’ll also receive a special gift
reproductive services.
                                                of two free parent-friendly books – the
                                                pre-natal book What to expect when
Baby
                                                you’re expecting when you tell us you’re
No waiting periods will apply to the newborn    having your first baby and Toddler Taming
provided they have been added to the            following your child’s first birthday. Just
appropriate family hospital cover within        visit a centre to collect your books.
2 months of their birth.

Pregnancy related services included in your hospital cover




                                                                Intermediate
                                               Saver




                                                                                  Top
 Cover for Pregnancy Related Services
 (including childbirth)


 Cover for Birth (mother only)


 Baby Care



Ambulance services included in your cover

The covers listed in this brochure cover you for one emergency service (including on-the-spot
treatment) each calendar year for a singles membership or two services for single parent and
family memberships. If you combine hospital and extras cover you will still only receive one
service per calendar year on singles and two on single parent and family covers.

You’re not covered for non-emergency transport (including ongoing treatment like
chemotherapy and dialysis) such as trips from a hospital to your home, a nursing home or
another hospital.

There are different state Ambulance arrangements across Australia. Please refer to page
37 of the Important Information section for more details.




                                               13
EXTRAS                                         Loyalty Maximums:
                                               On selected covers, we increase the

COV E R                                        amount you can claim each year by
                                               20% for most services (applies after
                                               first 12 months) up to double the
                                               original annual maximum.




C O R P O R AT E
A DVA N TAG E
                   A wide range of services with higher benefits and annual maximums.




C O R P O R AT E
CLASSIC            This cover includes a wide range of services with generous
                   benefit payments.




C O R P O R AT E
ESSENTIALS         Cover for services you think you may need, with a good level
                   of benefits.




                                   14
                                                        E X T R AS COV E R
Finding a network provider for your extras
cover is easy!
Simply go to our website and enter your
state and postcode to find one near you.
Also, you can now search for a provider
using our iPhone application which is
available on iTunes.
iPhones and iTunes are a trademark of Apple Inc.




                                                   15
E X T R AS COV E R
C O M PA R I S O N


                                      Corporate Essentials          Corporate Classic         Corporate Advantage
                      Waiting
Services                               At least 70% cover†         At least 80% cover†          At least 90% cover†
                      periods
                                                                  Year       Amount

                                                                    1           $400
General                                                             2           $480
                     2 months                                       3           $560                  Unlimited
Dental
                                                                    4           $640
                                                                    5           $720
                                              $350                  6           $800
                                            Combined
                                             annual               Year       Amount
                                            maximum
                                                                    1            $0
                                                                    2           $400
Major Dental†       12 months                                       3           $480                    $800
                                                                    4           $560
                                                                    5           $640
                                                                    6           $720
                                                                    7           $800

                                                                      $1,600 lifetime            $1,200 per person
Orthodontics        12 months                                        annual maximum               $2,400 lifetime
                                                                     for orthodontics            annual maximum


Optical              2 months                 $200                         $225                         $250

                                                                  Year       Amount            Year       Amount

                                                                    1           $200             1           $300
                                                                    2           $240             2           $360
Physiotherapy        2 months                 $150                  3           $280             3           $420
                                            Combined                4           $320             4           $480
                                             annual                 5           $360             5           $540
                                            maximum                 6           $400             6           $600

Chiropractic
and                                                                 $500 per person              $600 per person
                     2 months
Osteopathy                                                          $1,000 per policy            $1,200 per policy

Antenatal
                     2 months                                              $350                         $400
and postnatal

  = Loyalty Maximums which apply after the first 12 months. Other figures relate to annual maximums which apply per calendar
year. †For most items at network providers. Annual maximums and waiting periods apply.




                                                       16
Services                                              Waiting periods                      Corporate Essentials
Natural Therapies
Includes acupuncture, Alexander
Technique, Chinese herbalism, exercise
physiology, Feldenkrais, homeopathy,
                                                                                     Combined with Physiotherapy
iridology, naturopathy, Western herbalism                  2 months
                                                                                          annual maximum
and massage. Massage includes
aromatherapy, Bowen Technique,
kinesiology, reflexology, shiatsu, and
remedial massage.
Living Well (see p24)                                      6 months                                 $100




Pharmacy^^                                                 2 months                                 $150




Psychology                                                 2 months

Dietary                                                    2 months

Podiatry                                                   2 months

Speech Therapy

Eye Therapy                                                2 months

Occupational Therapy

Home Nursing                                               2 months
                                           +
Health Aids and Appliances (Overall)



Sub-Limits



  Asthma Pumps
  Blood Glucose Monitors or INR Blood
  Testing Devices (Coagucheck)
                                                           12 months
  Defined Appliances^
  Surgical Stockings
  CPAP Devices#
  Hearing Aids
  TENS Machine
  Blood Pressure Monitors

  Hire, Repair and Maintenance of Health
  Aids and Appliances

Travel and Accommodation                            No waiting period

Accident Benefit~                                    No waiting period

Emergency Ambulance Services*                       No waiting period                   1 service per calendar year

   = Loyalty Maximums which apply after the first 12 months. Other figures relate to annual maximums which apply per
calendar year. ^^Benefits for prescription items that are non-PBS, TGA approved for the use of that condition and not
appearing on our exclusions list. +A combined annual maximum applies to this service category. ^Defined Appliances
includes insoles, orthopaedic and corrective footwear, pressure garments, braces and artificial limbs.


                                                      17
                                                                                                                                E X T R AS COV E R
                Corporate Classic                                                  Corporate Advantage

       Year                          Amount                                Year                           Amount
        1                               $300                                 1                               $175
        2                               $360                                 2                               $210
        3                               $420                                 3                               $245
        4                               $480                                 4                               $280
        5                               $540                                 5                               $315
        6                               $600                                 6                               $350


                          $100                                                              $100

       Year                          Amount                                Year                           Amount
        1                               $150                                 1                               $300
        2                               $180                                 2                               $360
        3                               $210                                 3                               $420
        4                               $240                                 4                               $480
        5                               $270                                 5                               $540
        6                               $300                                 6                               $600
                                                                           $500 per person, $1,000 per policy

                                                                           Year                           Amount

      Combined with Natural Therapies                                        1                               $300
            annual maximum                                                   2                               $360
                                                                             3                               $420
                                                                             4                               $480
                                                                             5                               $540
                                                                             6                               $600

                       $350                                                                 $350




      Combined with Natural Therapies
                                                                                            $850
     annual maximum (sub-limits apply)




               1 claim every 3 years                                        1 claim every 3 years up to $300

            1 claim per calendar year                                     1 claim per calendar year up to $500

              $500 per calender year                                              $500 per calendar year
              $100 per calendar year                                               $100 per calendar year
               1 claim every 2 years                                         1 claim every 2 years up to $750
               1 claim every 3 years                                         1 claim every 3 years up to $850
              $175 per calendar year                                               $175 per calendar year
              $175 per calendar year                                               $175 per calendar year

              $100 per calendar year                                               $100 per calendar year

                   $100 – Travel                                                       $100 – Travel
              $150 – Accommodation                                                $150 – Accommodation
    $2000 per person, $4000 per policy                                   $2000 per person, $4000 per policy

            1 service per calendar year                                          1 service per calendar year

Limits apply per item. Subject to eligibility. Call us for details. ~When an accident requires urgent hospital treatment, can
                      #

boost annual maximums on extras or pay for your hospital excess. *There are different state ambulance arrangements
across Australia. Please see p37 for details.



                                                                   18
U N D E R S TA N D I N G                                                      Please ensure
                                                                              you also read
E X T R AS COV E R                                                            the Important
                                                                              Information section
                                                                              on pages 36-42.




What is covered?                                    What is not covered?
Extras cover provides you with benefits for          Extras benefits will not be payable:
services that are not claimable by a third
                                                    O   where a third party, including Medicare or
party (e.g. Medicare).
                                                        another Government body, has provided a
Medicare does not provide benefits for                   benefit (except for hearing aids and breast
the below:                                              prosthesis items)
O   most dental examinations and treatment          O   for different services within the same
                                                        modality from the same provider on the
O   most physiotherapy, occupational therapy,
                                                        same day. For example, if you went to
    speech therapy, eye therapy, chiropractic
                                                        see an acupuncturist and then received a
    services, podiatry or psychology services
                                                        massage from the same provider on the
O   acupuncture (unless part of a doctor’s              same day, you cannot claim for
    consultation) or other natural therapies            both services
O   glasses and contact lenses                      O   when a prescribed treatment is
O   most health aids and appliances                     not custom made (e.g. orthotics,
                                                        surgical shoes)
O   home nursing.
                                                    O   when they do not meet the criteria set
With extras cover you can claim benefits for
                                                        out in our policies and Fund Rules.
extras services which are listed as part of your
chosen level of cover.
You will receive benefits as long as:
O   the treatment is given by a private
    practice provider who is recognised by us
O   the provider meets the criteria set out in
    our policies and Fund Rules.




                                               19
Waiting periods                                       Pre-existing ailments
A waiting period is the time between when             A pre-existing ailment is any ailment, illness,
you joined us and when you are covered for a          or condition that you had signs or symptoms
service or treatment. If you receive a service        of during the six months before you joined
or treatment during this time, you are not            or upgraded to a higher level of cover with
eligible to receive a benefit payment from             us. It is not necessary that you or your doctor
us, regardless of when you submit the claim.          knew what your condition was or that the
Different waiting periods apply for different         condition had been diagnosed.
services, please see below.
                                                      A condition can still be classed as pre-
O   initial waiting period – two months               existing even if you hadn’t seen your doctor
                                                      about it before joining or upgrading to a
O   hire, repair and maintenance of health
                                                      higher level of cover.
    aids and appliances and Living Well
    Programs – six months                             If you knew you weren’t well, or had signs of
                                                      an ailment that a doctor would have detected
O   major dental; orthodontics; selected
                                                      (if you had seen one) during the six months
    health aids and appliances and pre-
                                                      prior to joining or upgrading, then the
    existing ailments – 12 months.
                                                      ailment would be classed as pre-existing.
                                                      A doctor appointed by us decides whether
                                                      your ailment is pre-existing, not you or your
                                                      doctor. The appointed doctor must consider
                                                      your treating doctors' opinions on the signs
                                                      and symptoms of your ailment, but is not
                                                      bound to agree with them.




    GET A PAIR ON US
    Check out our Corporate Benefits
    Guide to see how you can get a pair of
    spectacles or supply of contact lenses
    completely covered by us!†.
    †Conditions apply. Please refer to the
    Corporate Benefits Guide for full details.




                                                 20
E X T R AS COV E R




                     21
PA C K A G E D                                                For details on the covers,
                                                              see page 24 for hospital and
COV E R S                                                     page 26 for extras cover.




    ULTIMATE
                        Enjoy our highest level of health cover
    CORPORATE           available to corporate customers with             INCLUDES
    H E A LT H          a packaged option that combines
                                                                           L O YA LT Y
                        comprehensive hospital and extras cover.
    C OV E R            This cover includes a range of additional         MAXIMUMS!
                        benefits with no excess or co-payment.




!   Gap Bonus                                    !   Loyalty Maximum

Receive a $200 Gap Bonus when you join           We increase how much you can claim each
and another $200 each calendar year with         year by 20% of the initial amount for most
Ultimate Corporate Health Cover. You can use     services (applies after the first 12 months up
this to pay for any medical gaps you incur       to double the original annual maximum)
during a hospital stay. Unused bonus amounts
can accumulate. The Gap Bonus may not be
used for gaps other than inpatient medical
gaps e.g. toiletries and phone calls.




                                           22
                                                                                                             PACKAGED COVER
Ultimate Corporate Health Cover                         Medical costs
When admitted to hospital, you'll receive 100%          These are the fees charged by a doctor,
cover for all in-hospital charges including:            surgeon, anesthetist or other specialist for
O   accommodation for overnight or                      any treatment given to you in hospital. Private
    sameday stays                                       health insurance provides you with the choice
                                                        of your own doctor, and you decide whether
O   operating theatre, intensive care and               you will go to a public or a private hospital that
    labour ward fees                                    your doctor attends. You may also have more
                                                        choice as to when you are admitted to hospital.
O   supplied pharmaceuticals approved by
    the Pharmaceutical Benefits Scheme                   You are covered for:
    and provided as part of your
    in-hospital treatment                               O   the cost of these medical treatments up
                                                            to the Medicare Benefit Schedule (MBS)
O   allied services including physiotherapy,                fee. The MBS fee is the amount set by the
    occupational therapy and dietetics                      Federal Government for each medical
                                                            service covered by Medicare. You must be
O   medication, dressings and
                                                            eligible for Medicare in order to be covered
    other consumables
                                                            up to the MBS fee.
O   most diagnostic tests
                                                        If you choose to be treated as a private
    (e.g. pathology, radiology)
                                                        patient in a hospital (public or private),
O   no gap prosthesis that are surgically               Medicare will cover you for 75% of the MBS
    implanted, Government recognised and                fee for associated medical costs and we
    remain in-situ upon discharge                       will cover the remaining 25% of the MBS
                                                        fee. If your specialist charges more than the
O   single room where available.
                                                        MBS fee there will be a ‘gap’ for you to pay.
You'll also receive 100% back on extras cover           However, our Medical Gap Scheme can help
up to your Loyalty Maximums.                            eliminate or reduce the gap for you if your
                                                        doctor/s choose to use it.
For example:
                                                        Additional benefits
O   100% back on general dental up to the first
    $500 per person per year at any recognised          100% cover for laser eye surgery
    dentist, then high set maximums apply
                                                        Receive 100% cover for laser eye correction
O   100% back on major dental at any                    surgery by a fund-recognised provider.
    recognised dentist up to your annual                A three year waiting period applies.
    maximum
                                                        Waiting periods
O   100% back on orthodontics (includes a
                                                        O   initial waiting period – two months
    lifetime limit per person) up to your annual
    maximum                                             O   hire, repair and maintenance of health aids
                                                            and appliances and Living Well Programs
O   100% back on a range of fixed-price
                                                            – six months
    packages on spectacles and contact lenses
    at no additional cost.                              O   major dental; orthodontics; selected health
                                                            aids and appliances and pre-existing
O   100% back on physiotherapy for first $350
                                                            ailments – 12 months
    at any recognised provider, then high set
    benefits apply                                       O   laser eye correction surgery – 3 years.
O   100% back on chiropractic for first $350
    at any recognised provider, then high set
    benefits apply




                                                   23
PA C K A G E D C O V E R
H O S P I TA L AT A G L A N C E
                                                                                          Ultimate Corporate
                                                                                             Health Cover
Services
For inpatient Services included on cover:
Accommodation for Overnight and Same-day Stays
Operating Theatre, Intensive Care, Ward Fees
Medical Gap Scheme available
Allied Services (i.e. physiotherapy in hospital)
In-patient services included on cover:
Accidents
Arthroscopy or Meniscectomy (minor knee surgery)
Appendicitis
Removal of Tonsils and Adenoids
Dental Surgery
Minor Gynaecological Surgery
Psychiatric
Rehabilitation
Pregnancy Related Services (including childbirth)
and Assisted Reproductive Services
Cardiac and Cardiac Related Services (eg open heart and bypass surgery
and invasive cardiac procedures)
Renal Dialysis for Chronic Renal Failure
Cataract and Eye Lens Procedures
Hip/Knee Replacement or Arthroplasty (including revisions)
All other Joint Replacement including revisions (e.g. shoulder, elbow)
All other inpatient Treatments receiving a Medicare benefit
Additional Items:
Baby Books
Emergency Ambulance Services^
Laser Eye Surgery
Health Subscription Refunds
Special Benefits (see p39 for details)
Excesses / Copayment
Excess / Copayment Options                                                                         Nil

^There are different state ambulance arrangements across Australia. Please see p37 for details. Depending on your
state ambulance arrangements, you can receive 100% refund on a subscription with your state ambulance provider.




                                                        24
PACKAGED COVER




                 25
 PA C K A G E D C O V E R
 E X T R A S AT A G L A N C E
                                                                                           Ultimate Corporate
                                                                                              Health Cover
                                                                   Waiting                  up to 100% cover
 Services                                                          periods
 General Dental                                                    2 months                    Unlimited
 Major Dental                                                                       Year            Amount
                                                                                      1                 $0
                                                                                      2               $800
                                                                  12 months           3                $960
                                                                                      4               $1,120
                                                                                      5               $1,280
                                                                                      6               $1,440
                                                                                      7+              $1,600
 Orthodontics                                                                             $1400 per person
                                                                  12 months
                                                                                         $3200 Lifetime Limit
 Optical
                                                                                             $420 (network#)
                                                                   2 months
                                                                                           $300 (non-network)

 Physiotherapy                                                                      Year            Amount
                                                                                      1                $750
                                                                                      2               $900
                                                                  2 months            3               $1,050
                                                                                      4               $1,200
                                                                                      5               $1,350
                                                                                      6+              $1,500
 Chiropractic and                                                                   Year            Amount
 Osteopathy
                                                                                      1                $500
                                                                                      2                $600
                                                                                      3                $700
                                                                  2 months            4                $800
                                                                                      5                $900
                                                                                      6+              $1,000

                                                                                   $800–$1600 per membership~

 Antenatal and
 Postnatal                                                        2 months                        $500

 Natural Therapies                                                                  Year            Amount
 Includes acupuncture, Alexander Technique,
 Chinese herbalism, exercise physiology,                                              1                $500
 Feldenkrais, homeopathy, Iridology, naturopathy                                      2                $600
 and Western herbalism. Massage includes                                              3                $700
 aromatherapy, Bowen Technique, kinesiology,                      2 months            4                $800
 reflexology, shiatsu, and remedial massage.                                           5                $900
                                                                                      6+              $1,000

                                                                                    Includes sub-limits for massage:
                                                                                           $250 per person
 Living Well (see p28)                                             6 months                       $100
  = Loyalty Maximums (see p5). Other dollar amounts relate to annual maximums which apply per calendar year. Annual
maximums apply. #Our network optical providers include Blink Optical, Kevin Paisley Fashion Eyewear, National Pharmacies
Optical, Prevue Eyewear, Stacey and Stacey Optometrists and selected independents.~Per membership amount increases from
$800 by $160 every year up to $1600 in year 6 and beyond.

                                                             26
                                                                                                                                  PACKAGED COVER
                                                                       Waiting                  Ultimate Corporate
 Services                                                              periods                     Health Cover
 Pharmacy^^                                                                              Year             Amount
                                                                                           1                 $750
                                                                                           2                 $900
                                                                      2 months             3                $1,050
                                                                                           4                $1,200
                                                                                           5                $1,350
                                                                                           6+               $1,500
 Dietary                                                                                   1                 $500
                                                                                           2                 $600
                                                                                           3                 $700
                                                                      2 months             4                 $800
                                                                                           5                 $900
                                                                                           6+               $1,000
 Psychology                                                                                1                 $500
                                                                                           2                 $600
                                                                                           3                 $700
                                                                      2 months             4                 $800
                                                                                           5                 $900
                                                                                           6+               $1,000
 Podiatry                                                                                  1                 $500
                                                                                           2                 $600
                                                                                           3                 $700
                                                                      2 months             4                 $800
                                                                                           5                 $900
                                                                                           6+               $1,000
 Speech Therapy                                                                            1                 $500
                                                                                           2                 $600
                                                                                           3                 $700
                                                                      2 months             4                 $800
                                                                                           5                 $900
                                                                                           6+               $1,000
 Eye Therapy                                                                               1                 $500
                                                                                           2                 $600
                                                                                           3                 $700
                                                                      2 months             4                 $800
                                                                                           5                 $900
                                                                                           6+               $1,000
 Occupational Therapy                                                                      1                 $500
                                                                                           2                 $600
                                                                                           3                 $700
                                                                      2 months             4                 $800
                                                                                           5                 $900
                                                                                           6+               $1,000
 Home Nursing                                                          2 months                         $400
 Health Aids and Appliances                                                                             $1000
   Asthma Pumps                                                                                 1 claim every 2 years
                                                                                                      up to $500
   Blood Glucose Monitors or INR blood testing devices
   (Coagucheck)                                                                           1 claim per year up to $600

   Defined Appliances^                                                                                   $1,000
   Surgical Stockings                                                 12 months                         $100**
                                                                                                1 claim every 2 years
   CPAP Devices                                                                                      up to $1,000
   Hearing Aids                                                                              1 claim every 3 years
                                                                                                   up to $850
   TENS Machine                                                                             Up to $1,000 per item**
   Blood Pressure Monitors                                                                  Up to $1,000 per item**
   Hire, Repair and Maintenance of Health Aids
                                                                       6 months                         $100
   and Appliances
                                                                                                $200 – Travel, $300 –
 Travel and Accommodation                                              2 months                   Accommodation

  = Loyalty Maximums (see p5). Other dollar amounts relate to annual maximums which apply per calendar year. Annual
maximums apply. ^^Benefits for prescription items that are non-PBS, TGA approved for the use of that condition and not
appearing on our exclusions list. ^Defined appliances includes: insoles; orthopaedic and corrective footwear; pressure garments;
braces and artificial limbs. Annual maximums apply per item. †Subject to eligibility. Call us for details. **Included in defined
appliances annual maximums.



                                                               27
H E A LT H
PROGRAMS


Positive Health Programs                         Living Well Programs
If you have a chronic health condition,          Our Living Well Programs help cover health
we’d like to help you get on the road to         related programs from approved, recognised
recovery as soon as possible. Our Positive       providers on selected extras covers.
Health Programs provide valuable
                                                 These programs include:
information on how to help better manage
your condition together with your doctor or      O     first aid courses
health professional.
                                                 O     nicotine replacement therapy
Our programs are created using evidence-         O     weight management programs
based medicine and research, in consultation           —fees only and some weight loss drugs
with health experts and top national health
                                                 O     gym membership fees
organisations. They include action plans to
further assist you in managing your condition;   O     yoga courses
help you reduce the symptoms you may             O     Pilates.
experience; and minimise any impact on your
                                                 Please note that a Living Well Programs
everyday life.
                                                 approval form must be completed by your
The following programs are available on          doctor for gym memberships, yoga and Pilates
selected levels of hospital cover:               to confirm the program is medically necessary.
                                                 Other benefit and recognition criteria apply.
O   Arthritis Management Program
                                                 Subject to annual maximums.
O   Asthma Management Program
O   Back Pain Management Program                 Subscription Refunds
O   Chronic Obstructive Pulmonary Disease        Members who hold selected hospital cover can
    Management Program                           also access benefits for the following:
O   Congestive Heart Failure Program             O     Asthma Foundation membership fees
O   Coronary Artery Disease and Angina           O     Diabetes Australia membership fees
    Management Program
                                                 To find out more visit us online or talk to one of
O   Depression Management Program
                                                 our corporate customer service consultants.
O   Diabetes Management Program
O   Osteoporosis Management Program.                 Bowel cancer is the most frequently
                                                     occurring cancer in Australia to affect both
                                                     men and women. The good news is that it’s
                                                     one of the most curable types of cancer
                                                     if detected early.* We will pay a benefit
                                                     towards selected bowel cancer screening
                                                     kits. Contact us for details.
                                                     *Sourced from the Bowel Cancer Australia website.




                                            28
                         ADDITIONAL MEMBER BENEFITS
          We are
       committed to
     helping members
     to better manage
      their health for
       the long term.




29
29
IN2LIFE
PA R T N E R S

                                                       For a complete list of in2life partner
                                                       discounts and full terms and conditions,
in2life partners
                                                       visit one of the following websites:
in2life brings you a range of discounts and
                                                       MBF members mbf.com.au/in2life
deals from specially selected partners to
help you enjoy some health and wellness                HBA members hba.com.au/in2life
perks at an affordable price. Whether it’s             Mutual Community members –
fitness and sports you’re interested in or rest,        mutualcommunity.com.au/in2life
relaxation and travel—you can choose what
suits your needs from our range of in2life
partner discounts.




                             OFF                                    OFF
                                                  Receive a 10% discount on a 12-month
                                                  membership, one month membership at a
 Get great value with up to 25% off Hoyts,
                                                  reduced price OR a free health assessment
 Event Cinemas, Greater Union, Birch, Carroll
                                                  and personal training session at Goodlife
 & Coyle and Village Cinemas tickets when
                                                  Health Clubs. Visit in2life (website listed
 you purchase online through in2life (website
                                                  above) for more information.
 listed above).



  UP TO


                                                                            OFF
                             OFF

                             OFF
  Save up to 10% on selected fares when           Take a self-help approach to health and
  you book online and fly with British             fitness with 20% off tailored home fitness
  Airways. Visit in2life (website listed above)   programs when you purchase online at
  for more information.                           guyleechfitness.com. Visit in2life
                                                  (website listed above) for more information.


                                             30
                                                                                                    ADDITIONAL MEMBER BENEFITS
                              OFF
                                                                                OFF

 Enjoy $30 off any RedBalloon experience
 when you spend $129 or more and purchase
 online through in2life (see web address on           Simply present your membership card
 opposite page).                                      to receive a 20% discount off the usual
                                                      retail price on a range of sunglasses
                                                      displayed at any Blink Optical or
                                                      National Pharmacies Optical store.




                              OFF

                                                                                 OFF


                                                     Simply present your membership card and
                                                     enjoy two full-priced games and shoe hire
 Simply present your membership card to
                                                     with 25% off at any AMF Bowling Centre.
 receive up to 20% off the usual retail price
 on selected frames, lenses and contact
 lenses; and up to 10% off the usual price
 of sunglasses.



                                                                                 OFF

                  OFF


                                                     Receive a 15% discount on the admission
 Warner Village theme parks will give you a          price to Dreamworld and WhiteWater
 10% discount on day admission for adults,           World on the Gold Coast, when you
 children and pensioner passes. Just present         purchase tickets online through in2life (see
 your membership card at the entry gate.             web address on opposite page).

Another benefit for members


                              Travel Insurance
                              As a member you can receive up to 15% off your travel
                              insurance. See the back of the brochure for contact details.
                   OFF

                                                31
J O I N TO DAY



It’s easy to join but before you do, please read the details of your chosen cover in this
brochure. This includes the Important Information section on pages 36-42. Also refer to
the Corporate Benefits Guide that has been inserted to provide more information.




                           Only one form to fill in
                           Fill in the application form and:
                           O   mail it to us using our reply paid address
                           O   drop it into your local centre
                           Or you can simply:
                           O   join over the phone




                           Easy ways to pay
                           You can choose to pay via Direct Debit or payroll deduction*.




                           Transferring is simple
                           Transferring to us from your existing health fund is simple. Just fill in
                           our application form and cancel any direct debit arrangement you have
                           with your existing fund. In some instances you may be asked to fill in a
                           clearance certificate request form. We will then contact your existing
                           fund on your behalf to make all the other arrangements for you. If you
                           have received a clearance certificate from your previous fund, please
                           send it to us with your application form.




*Please check with your employer if this option is available under your corporate health plan.




                                                  32
                                    J O I N T O D AY
Top 5 reasons to join now:
1. going private may save
   you money
2. get at least 30% back
   on your premiums
3. avoid Lifetime Health
   Cover Loading
4. private health
   insurance = choice
5. peace of mind.

See the front of this
brochure for
more information.




                             3333
E A S Y WAY S                                                            Save time and effort
                                                                         by claiming on the

TO C L A I M                                                             spot at around 40,000
                                                                         provider locations
                                                                         throughout Australia




Claiming for Extras

                        On the spot
                        On the spot electronic claiming is the easiest way to claim on your
                        extras cover. Simply swipe your membership card after your treatment
                        at one of around 40,000 provider locations around Australia, and
                        your claim is processed automatically. You may be asked to then pay
                        the balance of the bill.




                        Online claiming
                        Our online claims service is a quick and convenient way for you to
                        claim on selected extras where you have paid the provider in full*. In
                        many instances you’ll receive fast payment into your bank account.
                        Claiming is subject to the standard conditions of your cover including
                        waiting periods and annual maximums.




Claiming for hospital

                        Medical Gap Scheme
                        Our Medical Gap Scheme is a direct billing system designed to help
                        our members reduce or eliminate any out-of-pocket expenses for
                        hospital treatment.
                        If your specialist uses our Medical Gap Scheme they will bill us directly.
                        So you either won’t pay any out-of-pocket expenses or you’ll know
                        about any 'gap' payable for that specialist prior to treatment.
                        All specialists that are registered with us can choose to use the
                        Medical Gap Scheme. Ask your specialist about it before undergoing
                        treatment.




* The following services are not claimable online: Medical Gap, pharmacy, health aids and
appliances, ambulance services, orthodontic, travel & accommodation, hospital claims.

                                            34
Claiming for both Hospital and Extras


                       By mail
                       You can make a hospital or extras claim by mail. Simply print out a
                       claim form from our website and complete it, then attach the original
                       account(s) or receipt(s) that you received from your healthcare
                       provider(s). Then mail it to us at: GPO BOX 9809 Brisbane QLD 4001.




                       In person
                       You can submit your claims at your local centre. Most centres are
                       able to process claims on the spot and provide you with benefits,
                       either by cash (limits apply), cheque or bank transfer.




                       Claim queries
                       Remember that claims can only be paid within two years of the date
                       that the service was provided.
                       Contact us if you have a question about:
                       O   the status of your claim
                       O   how to fill in a claim form
                       O   what documents you need to attach to your claim form
                       See the back of this brochure for full contact details.




                                             35
I M P O R TA N T
I N F O R M AT I O N

Over the next few pages you will find               O   submit your claims within two years of
information to help you understand how your            when the service was given (we do not
health cover with us works.                            pay benefits for any claims that are older
We recommend you keep this information in              than this).
a safe place so that you can always refer to it.   2. Accidents
From time to time, things can change.              An accident is an unforeseen event, occurring
Before you seek any treatment call us so           by chance and caused by an unintentional
we can give you the most complete and              and external force or object resulting in
up-to-date information.                            involuntary hurt or damage to the body,
Please be aware that these rules apply in          which requires immediate (within 72 hours)
addition to our Fund and Policy Rules.             medical advice or treatment from a registered
                                                   practitioner other than the policyholder.
1. Premium and Benefits
You must pay the premium and the Lifetime          3. Suspension Rules
Health Cover Loading that applies to you.          A membership may be suspended when
Premiums differ from state to state due            travelling overseas for work or leisure.
to different state charges. If you move to         If you are travelling overseas, you may
another state your premium will change too.        choose to suspend your membership during
Therefore you must let us know about any           this period of time. You can suspend your
change of address.                                 cover for the following period of time:
To receive the benefits available on your           O   a minimum period of two months
cover, you need to:                                    travel; and
O   fully complete the application process         O   a maximum period of two years
    and pay your premiums one month in                 per suspension.
    advance. If you’re on a corporate plan,
                                                   A maximum of three continuous suspension
    it’s up to you to make sure payments are
                                                   periods of two years is allowed before your
    made during times of unpaid leave or if
                                                   membership will be cancelled.
    your employment ends
                                                   One month contributions are required
O   ensure that newborns are enrolled onto
                                                   between each suspension period.
    a family membership within two months
    of their birth to avoid any waiting periods    To be eligible to suspend your cover you must:
    for your baby                                  O   have been a financial member for at least
O   enrol your adult children under their              12 months
    own names within 60 days after they no         O   apply for suspension prior to the
    longer qualify under your cover (to avoid          departure date
    a break in their cover)
                                                   O   provide overseas travel documentation
O   provide proof of purchase of what you              showing your departure and return dates
    have spent before we can reimburse you
                                                   O   notify us of your return to Australia within
    for any services received
                                                       30 days of your arrival; and
                                                   O   complete an overseas travel
                                                       suspension form.


                                              36
4. Emergency Ambulance Definition                       ambulance transport, simply send it to us and
When you take out our hospital cover or                we’ll endorse it for you to send back to the
extras cover, you will receive capped cover for        appropriate ambulance transport scheme.
recognised emergency ambulance transport               QLD and TAS members: If you reside in
and on-the-spot treatment. An emergency                Queensland or Tasmania, you are covered
is when there is reason to believe that the            under your state service scheme.
patient’s life may be in danger or the patient         VIC, SA, WA and NT members: If you reside
should be attended to without undue delay.             in Victoria, South Australia, Western Australia
Whether the transportation is deemed an                or the Northern Territory you will receive
emergency is determined by the paramedic               cover for recognised emergency ambulance
and usually recorded on the account.                   transport and on-the-spot treatment from
Emergency ambulance transportation                     us. This is as long as you don’t have an
will mean a journey from the place where               ambulance subscription with your state
immediate medical treatment is sought to the           ambulance service or other state-based
casualty department of a receiving hospital.           arrangement.
Emergency ambulance transportation is                  Most state schemes cover their respective
defined as transportation of an unplanned               residents within their state of residence only.
and of a non-routine nature for the purpose            However, some states have entered into
of providing immediate medical attention               reciprocal agreements that allow you to be
to a person.                                           covered for ambulance services when you travel
                                                       outside your state of residence. You should
Benefits are not payable for:
                                                       check with your state ambulance provider for
O   transportation from a hospital to                  when these reciprocal arrangements apply and
    your home                                          the level of cover offered.
O   transportation from a hospital to a                If you fall outside your state based
    nursing home                                       arrangement (including any reciprocal
O   transportation from a hospital to                  agreement) and are not covered for
    another hospital where the customer                ambulance services, you will be covered by
    has been admitted to the transferring              Bupa Australia as long as your level of cover
    (first) hospital; or                                contains ambulance cover and the services
                                                       are provided by a recognised provider.
O   transportation from the person’s
    home, a nursing home or hospital                   6. Recognised Ambulance Providers
    for ongoing medical treatment,                     Bupa Australia will only pay benefits towards
    e.g. chemotherapy, dialysis.                       ambulance services when they are provided
                                                       by any of the following recognised providers:
5. Ambulance Cover
                                                       O   ACT Ambulance Service
We recommend that you take out an
ambulance subscription with your recognised            O   Ambulance Service of NSW
State Ambulance Provider if it's available in          O   Ambulance Victoria
your state (VIC, SA, NT and rural postcodes
                                                       O   Queensland Ambulance Service
in WA).
                                                       O   South Australia Ambulance Service
We will only provide ambulance benefits, in
accordance with your level of cover, when you          O   St John Ambulance Service NT
do not hold a subscription with an ambulance           O   St John Ambulance Service WA
provider and a state ambulance scheme does             O   Tasmanian Ambulance Service.
not provide cover.
                                                       Certain types of concession cards issued by
NSW and ACT members: If you reside in New              Centrelink or the Department of Veterans
South Wales or the Australian Capital Territory        Affairs (DVA) entitle the cardholders to free
and you have hospital cover, you pay an                ambulance services. These arrangements also
ambulance levy as part of your premium. This           vary per state so should be checked directly
entitles you to free ambulance transport under         with Centrelink or the DVA.
the State Government ambulance transport
schemes. When you receive an account for


                                                  37
7. No Gap or Known Gap prostheses                   pocket expenses, and receive only the minimum
Surgically implanted prostheses are                 benefit amount set by the Government. This will
classified by the Government as No Gap or            not be enough to cover your costs in a private
Known Gap prostheses. Prostheses' include           hospital expenses.
pacemakers, defibrillators, cardiac stents, joint    11. Pharmaceuticals
replacements, intraocular lenses and other
                                                    If you choose to be treated with drugs that
devices that are surgically implanted during a
                                                    are not approved by the Pharmaceuticals
stay in hospital. If your doctor chooses a No
                                                    Benefits Scheme you may not be fully
Gap prosthesis you will not have any out-of-
                                                    covered and the hospital may charge you
pocket expenses where the prosthesis item is
                                                    for part of the cost. You’ll be advised by the
implanted as part of hospital treatment. If the
                                                    hospital of any charges before treatment.
prosthesis item used is listed as a Known Gap
prosthesis you’ll have to pay any gap charged       12. Pre-existing ailments
by the hospital. You can ask your specialist to
                                                    A pre-existing ailment is any ailment, illness,
choose a No Gap prosthesis as there is one
                                                    or condition that you had signs or symptoms
available for every surgical treatment.
                                                    of during the six months before you joined or
8. Out-of-Pocket Expenses                           upgraded to a higher level of cover with us. It
                                                    is not necessary that you or your doctor knew
You are likely to experience out-of-pocket
                                                    what your condition was or that the condition
expenses when you are not fully covered for
                                                    had been diagnosed.
services and benefits, or when a set benefit
applies. You should read the section on             A condition can still be classed as pre-existing
what is and what is not covered within this         even if you hadn’t seen your doctor about it
brochure for your relevant level of cover to        before joining or upgrading to a higher level
determine when an out-of-pocket expense             of cover.
may occur. You should also refer to our             If you knew you weren’t well, or had signs of
Fund Rules for any additional information on        an ailment that a doctor would have detected
benefits payable. A copy of our Fund Rules           (if you had seen one) during the six months
can be found on our website.                        prior to joining or upgrading, then the ailment
It is important to ensure when being admitted       would be classed as pre-existing.
to hospital that Informed Financial Consent is      A doctor appointed by the fund decides
provided to you for a pre-booked admission          whether your ailment is pre-existing, not you
to allow you to understand any out-of-pocket        or your doctor. The appointed doctor must
expenses upfront.                                   consider your treating doctors’ opinions on
If you have received any out-of-pocket              the signs and symptoms of your ailment, but
expenses and require clarification, please           is not bound to agree with them.
contact us directly.
                                                    13. When to contact us
9. Exclusions                                       If you have less than 12 months membership
Exclusions for specific procedures or services       on your current hospital cover, make sure
means you will not be covered and may have          you contact us before you are admitted to
significant out-of-pocket costs should you           hospital and find out whether the pre-existing
require treatment for an excluded service.          ailment waiting period applies to you.
No hospital cover provides any benefits for          We need about five working days to make the
services not covered by Medicare. Always            pre-existing ailment assessment, subject to
check with us to determine if your treatment        the timely receipt of information from your
will be covered.                                    treating medical practitioner(s).
                                                    Make sure you allow for this timeframe when
10. Restricted cover/benefits
                                                    you agree to a hospital admission date.
If you are covered with restricted benefits
                                                    If you proceed with the admission without
this means you are covered for shared-room
                                                    confirming benefit entitlements and we
accommodation in a public hospital only, with
                                                    (the health fund) subsequently determine
your choice of doctor. If you go into a private
                                                    your condition to be pre-existing, you will
hospital it is likely you’ll incur large out-of-


                                               38
be required to pay all hospital charges and              and massage professions. However, you cannot
medical charges not covered by Medicare.                 claim for two or more of the same services, for
                                                         example two chiropractic consultations or two
14. Emergency admissions                                 natural therapies consultations at the same
In an emergency, we may not have time to                 provider on the same day.
determine if you are affected by the pre-                No benefits are payable for items that are
existing ailment rule before your admission.             not custom-made as a result of a prescribed
Consequently, if you have less than 12 months            treatment.
membership on your current hospital cover
you might have to pay for some or all of the             18. Calendar year
hospital and medical charges if:                         We pay benefits based on the calendar year
O   you are admitted to hospital and you                 and between the periods of 1 January to
    choose to be treated as a private                    31 December.
    patient; and we later determine that your
                                                         19. Health aids and appliances
    condition was pre-existing.
                                                         To receive benefits for health aids and
15. Special Benefits                                      appliances you’ll need to visit one of our
If you’re on a cover that provides Special               recognised providers. You’ll also need to
Benefits cover, you could receive benefits for             meet the eligibility criteria, provide proof
accommodation and meal costs if your partner,            or purchase and a clinical referral where
immediate family member, carer or next of                required. It is important to note that benefits
kin is required to stay at hospital with you or          are not payable when a prescribed treatment
a person on your membership. They will be                is not custom made (e.g. orthotics). Visit our
covered for $60 per night for accommodation              website for more information.
in hospital and up to $30 a day for hospital
                                                         20. Hire, repair and maintenance of health
meals, capped at $1000 per person, per year.
                                                         aids and appliances
Hospital meals are covered when provided at a
hospital cafeteria, kiosk or patient meal menu.          Benefits are not payable: in the first 12 months
                                                         after purchasing an item; within 12 months
16. Baby care                                            following the repair; or on items where hire
On Corporate Hospital Cover Top, you will not            and repair are deemed inappropriate.
be charged an excess on hospital admissions for
children under the age of 3. Plus, you’ll receive a      21. Home nursing
special gift of two free parent-friendly books –         Benefits are payable towards some home
the pre-natal book What to expect when you’re            nursing services that do not need to take place
expecting when you tell us you’re having your            in a hospital and are provided in the home.
first baby and Toddler Taming following your
child’s first birthday. Just visit a centre to collect    22. Living Well Programs
your books.                                              Our Living Well Programs help cover health-
                                                         related programs from approved, recognised
17. Extras Cover
                                                         providers. You can visit our website for a list of
With extras cover, you can claim benefits for             our recognised providers. A Living Well Programs
services which are listed on your cover and              approval form must be completed by your
not claimable elsewhere. To receive benefits
                                                         doctor for gym memberships, yoga and Pilates to
for your extras services, you must visit
                                                         confirm that the program is medically necessary.
professionals who are recognised by us. If
                                                         Other benefit and recognition criteria apply.
you would like to check that your provider is
registered with us please call us, drop into a           23. Pharmacy
local centre, or visit our website.
                                                         Pharmacy covers you for prescription
You’re also able to claim more than once in a            items that are non PBS (Pharmaceutical
day at the same provider for different services,         Benefits Scheme) listed drugs and are TGA
as long as that provider is recognised by us in          (Therapeutic Goods Administration) approved
each profession. For example, if you went to
                                                         for that condition.
see a practitioner for a dietary consultation
and then a massage, you could claim for                  There are some items that are not covered by
both services as long as your practitioner is a          our pharmacy benefit and these include:
recognised provider with us in both the dietary          O   over the counter items



                                                    39
O   compounded items                                 paid by your old fund will be counted
O   non-prescription items                           towards yearly maximums in your first year of
                                                     membership with us.
O   weight loss medication (some weight loss
                                                     It’s important to note that when you change
    medication are covered under the Living
                                                     to Bupa Australia from another fund you
    Well Program)
                                                     may need to wait before you can receive
O   body enhancing medications (e.g.                 your new benefits. In this situation, your
    anabolic steroids) and                           benefit entitlements are based on our nearest
O   erectile dysfunction drugs, unless               equivalent cover to what you previously held.
    prescribed by a specialist.                      Where your new cover is higher than what
When you make a claim, we will deduct a              you had with your old fund, the lower benefit
pharmacy co-payment and pay the remaining            (including different excess levels) will apply
balance up to the set amount under your              as follows:
chosen level of cover.                               For extras cover:
                                                     When changing to a higher level of extras
24. Pharmacy Saver
                                                     cover, a lower level of benefit applies for:
Add Pharmacy Saver to your extras cover              O the initial two-month waiting period
and enjoy savings on your pharmaceutical
                                                     O six months for Living Well Program
and healthcare purchases all year round at
                                                          benefits and hire, repair and maintenance
National Pharmacies stores. With Pharmacy
                                                          of health aids and appliances; and
Saver you'll receive a 20% discount on a
                                                     O 12 months on pre-existing ailments,
variety of health-related products.*
                                                          illnesses or conditions, major dental,
You can take advantage of your Pharmacy                   orthodontics, health aids and appliances.
Saver product feature by going online at
                                                     For hospital cover:
nationalpharmacies.com.au, and at
                                                     When changing to a higher level of hospital
National Pharmacies stores in South
                                                     cover, a lower level of benefit applies for:
Australia and Victoria.
                                                     O the initial two-month waiting period
*These are products designed to manage or prevent
disease, injuries or a condition, or prescribed in   O two months for palliative care, psychiatric
connection with an episode of hospital treatment.         and rehabilitation services; and
Pharmacy Saver is not available for prescriptions
on which the Government does not allow discounts.    O 12 months on pre-existing ailments,
Visit a National Pharmacies store or go to                illnesses or conditions and pregnancy
nationalpharmacies.com.au for more information.           related services (including childbirth).
                                                     If you choose a lower level of cover than
25. Travel and accommodation
                                                     you held previously, then the lower benefits
If you’re travelling for essential medical or        on your new cover will apply immediately.
hospital treatment because treatment you             This may include a different excess level
need cannot be provided by your own doctor,          or restricted benefits. You may also need
we will help cover the cost when the total           to serve waiting periods for services or
return distance is 300 kilometres or more. We        treatments that weren’t covered on your
also give a benefit towards your overnight            previous cover. In this case you won’t be
accommodation outside of hospital for you            covered during the waiting period.
and a caregiver. Check your extras cover to
                                                     27. Changing your cover with us
determine if you are covered for this benefit.
                                                     If you change your health cover, you may
26. Changing from another health fund                need to wait before you can receive your
If you’re changing from another Australian           new benefits. Where your new level of cover
health fund to Bupa Australia, you’ll continue to    is higher than what you previously held, the
be covered for all benefit entitlements that you      lower level of benefit applies as follows:
had on your old cover, as long as these services
                                                     For extras cover:
are offered on your new cover with us. This is
referred to as ‘continuity of cover’. To receive     When changing to a higher level of extras
continuity of cover, you’ll need to transfer to us   cover, a lower level of benefit applies for:
within 60 days of leaving your old fund.             O   the initial two-month waiting period
When changing health funds, extras benefits           O   six months for Living Well Program

                                               40
    benefits and hire, repair and maintenance            the Private Health Insurance Act 2007 (Cth)
    of health aids and appliances; and                  and related legislation. We may also collect
O   12 months on pre-existing ailments,                 personal and health information about you
    illnesses or conditions; major dental;              from health service providers for the purposes
    orthodontics; health aids and appliances.           of administering or verifying any claim. We
                                                        may disclose your personal information to
For hospital cover:
                                                        our related entities and bodies corporate, or
When changing to a higher level of hospital             to third parties such as healthcare providers,
cover, a lower level of benefit applies for:             government and regulatory bodies, other
O   the initial two-month waiting period                private health insurers and any persons or
                                                        entities engaged by us or acting or our behalf.
O   two months for palliative care, psychiatric
                                                        If you are the policy holder, you’re responsible
    and rehabilitation services; and
                                                        for ensuring that each person on your policy
O   12 months on pre-existing ailments,                 is aware that we collect, use and disclose their
    illnesses or conditions and pregnancy               personal information as set out here and in
    related services (including childbirth).            our Information Handling Policy. Each person
During this time you will be covered, however           on a policy aged 17 or over may complete a
you will receive the lower benefits of the two           ‘Keeping it confidential’ form to specify who
covers (this includes any applicable excess).           should receive information about their health
If you choose a lower level of cover than               claims. You are entitled to reasonable access to
you previously held, then the lower benefits             your personal information. We reserve the right
on your new cover will apply immediately                to charge a reasonable fee for collating such
and may include different excess levels                 information. If you or any other person on your
or restricted benefits. You may also need                membership do not consent to the way we
to serve waiting periods for services or                handle personal information, or do not provide
treatments that weren’t covered on your                 us with the information we require, we may be
previous cover. In this case you won’t be               unable to provide you with our products and
covered during the waiting period.                      services. We may use your personal (including
                                                        health) information to offer you health
If you have any questions about transfers
                                                        management programs and services. When
or waiting periods, just contact us.
                                                        you take out cover with us, you consent to us
28. Proof of identity and/or age                        using your personal information to contacting
                                                        you (by phone, email, SMS or post) about
Bupa Australia may require you to provide
                                                        products and services that may be of interest
proof of identity and/or age when joining,
                                                        to you. If you do not wish to receive this
changing your level of cover or in relation to
                                                        information, you may opt out by contacting us.
any other transaction with us.
                                                        30. Direct Debit Service Agreement
29. Privacy and your personal information
                                                        If you’ve chosen to pay your premiums by
Your privacy and maintaining the
                                                        direct debit then you’ve accepted the terms
confidentiality of your personal information is
                                                        of our Direct Debit Service Agreement.
important to Bupa Australia Pty Ltd (“we”, “us”,
“our”). This statement provides a summary               This agreement outlines the responsibilities
of how we handle your personal and health               of Bupa Australia Pty Ltd (“we”, “us”, “our”)
information. For further information about              and you. We will confirm the direct debit
how we handle your personal information, you            arrangements prior to the first drawing
should refer to our Information Handling Policy,        (including the premium amount and frequency)
available on our website or by calling us.              and debit your nominated account. Deductions
                                                        will occur on the nominated day, except for
We will only collect personal information
                                                        deductions nominated for the 28th, 29th, 30th
(including health information) about you and
                                                        or 31st, which will occur on the first day of the
those people insured under your policy to
                                                        following month. If the nominated day falls on
provide, manage and administer our products
                                                        a weekend or public holiday, deductions will be
and services to you and to operate an efficient
                                                        made on the closest business day. We will debit
and sustainable business. We are required to
                                                        all payments in advance and will automatically
collect and maintain certain information about
                                                        vary the deduction amount if your premiums
you and those on your policy to comply with

                                                   41
or level of cover change. If we vary the            31. 30-day cooling off period
deduction amount, we will give you at least 14      We’re confident you’ll be happy with your
days written notice, except when the previous       cover. However, if you decide to cancel, we’ll
deduction is dishonoured, when we will deduct       refund any premiums you have paid within the
the previous period’s payment together with         first 30 days of your membership commencing
the current amount due. If you pay premiums         provided you have not made a claim.
at three, six, and twelve month intervals, then
should your financial institution dishonour          32. Ending your membership
a drawing, we will draw the payment on the          We have the right to end a person’s
nominated day of the following month. If two        membership as set out in our Fund Rules,
or more drawings are returned unpaid by your        including where contributions have not been
financial institution, we will also stop deducting   paid or on notice at the reasonable discretion
your premiums from your nominated account           of Bupa Australia.
and will start sending you renewal notices,
pending further instructions from you. We           33. Can we help?
will maintain the privacy and confidentiality        If you have any questions we’re always
of your billing information (unless you have        happy to help. Simply refer to the back cover
requested or consented that we can disclose         for our contact details and call us, visit our
it to a third party or the law requires or allows   website or pop by your local centre.
us to do so). We may provide information to         If you would like more information about
our or your financial institution to resolve a       our Fund Rules or the Federal Government’s
dispute on your behalf. You must ensure your        Private Health Insurance Industry Code of
nominated account permits direct debiting           Conduct, you can find this information on
and that sufficient cleared funds are available     our website.
in that account on the due date to cover the
                                                    The Federal Government’s Private
premiums due. Your financial institution may
                                                    Patient’s Hospital Charter is available
charge a fee if the payment cannot be met.
                                                    at privatehealth.gov.au
You must ensure the authorisation given to
draw on the nominated account is identical          34. Resolution of problems
to the account signing instruction held by the
                                                    If you have any concerns or you don’t
financial institution where the account is based.
                                                    understand a decision we have made, we’d
You must notify us if the nominated account
                                                    like to hear from you. You can contact us by:
is transferred or closed. You must pay your
premium by an alternative method if either you      Telephone:   1800 802 386
or we cancel the direct debit arrangements.         Fax:         1300 662 081
You must ensure your payments are up-to-date,       Email:       customerrelations@bupa.com.au
whether a notice is received from us or not.        Mail:        Customer Relations Manager
                                                                 PO Box 14639
If paying by credit card, you need to advise
                                                                 Melbourne VIC 8001
us of your new expiry date prior to expiry. You
may request that we cancel or alter the debit       If you’re still not satisfied with your outcomes
drawing arrangements by contacting us and           from Bupa Australia you may contact the
providing at least five working days notice of       Private Health Insurance Ombudsman on
any requested changes. These changes may            1800 640 695.
include deferring the debit, altering the debit
dates, stopping an individual debit, suspending
the direct debit arrangement or cancelling the
direct debit completely. You can dispute any
debit drawing or terminate the deductions at
any time by notifying us in writing not less than
seven days before the next scheduled debit
drawing. If you have any queries about your
direct debit agreement, please contact us.
We undertake to respond to queries
concerning disputed transactions within five
working days of notification.

                                              42
43
For more information
Call
1800 649 406
HBA and Mutual Community enquiries
1300 653 525
MBF enquiries
Visit
hba.com.au/corporate
mbf.com.au/corporateplan
mutualcommunity.com.au/corporate
Pop by
your local centre
Mail to
GPO Box 9809
BRISBANE QLD 4001




                                                               Bupa Australia Pty Ltd
                                                                ABN 81 000 057 590
                                          Trading as HBA, MBF and Mutual Community
                                                                        09662-07-11S

                                     44

				
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