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Bupa Australia Fund Rules

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					BUPA AUSTRALIA PTY LTD


     FUND RULES




     Effective from 1 July 2011




                                  1 of 545
CONTENTS

SECTION                                                     PAGE
NUMBER

A INTRODUCTION                                                     3


B INTERPRETATION AND DEFINITIONS                                   6


C MEMBERSHIP                                                       12


D CONTRIBUTIONS                                                    19


E BENEFITS                                                         23


F LIMITATION OF BENEFITS                                           28


G CLAIMS                                                           33


H HOSPITAL TREATMENT TABLES                                        34


I GENERAL TREATMENT TABLES                                         41


J COMBINED HOSPITAL TREATMENT and GENRAL TREATMENT TABLES          275




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A INTRODUCTION
A1 Rules Arrangement
A1.1   These rules consist of the:

       (a)     General Conditions; and

       (b)     Schedule of Tables.

A1.2   Terms which are defined in Rule B2.1 appear in italics when used in these rules.




A2 Health Benefits Fund
A2.1   The Company, Bupa Australia Pty Ltd ABN 81 000 057 590, conducts health
       insurance business and health related business under the PHI Act, providing
       health insurance under the brands of HBA, Mutual Community, ANZ Health
       Insurance, MBF, SGIO Health Insurance, SGIC Health Insurance and NRMA
       Health Insurance.

A2.2   The rules are the terms of the policy between the Company and each policy holder
       for the provision of hospital treatment or general treatment.



A3 Obligations to Insurer



A4 Governing Principles


A5 Use of Funds
A5.1   The Company may apply the assets of the health benefits fund in accordance with the
       PHI Act.

A5.2   The Company may debit to the fund amounts related to its health insurance business and
       health related business in accordance with the PHI Act.




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A6 No Improper Discrimination
A6.1   When making decisions in relation to a person insured under a complying health
       insurance policy, the Company must disregard the following matters:

   1. the suffering by the person from a chronic disease, illness or other medical condition or
      from a disease, illness or other medical condition of a particular kind;

   2. the age of the person, except in relation to the calculation of a Lifetime Health Cover
      loading (refer Rule D4);

   3. the frequency with which the person needs hospital treatment or general treatment;

   4. the amount, or extent, of the benefits to which the person becomes, or has become,
      entitled during a period under a complying health insurance policy (except to the extent
      allowed under section 66-15 of the PHI Act);

   5. the gender, race, religious beliefs or sexual orientation of the person;

   6. where a person lives, except to the extent allowed under the PHI Act;

   7. any other characteristic of a person (including, but not just, matters such as the
      occupation or leisure pursuits) that are likely to result in an increased need for hospital
      treatment or general treatment; or

   8. any matter set out in the Private Health Insurance (Complying Product) Rules 2007.



A7 Changes to Rules
A7.1   The Company may change the rules on notice to the policy holder at any time and in
       accordance with the PHI Act with effect as set out in the relevant notice, whether or not
       premiums have been paid in advance.

A7.2   The Company must:
       (1)   give a Standard Information Statement to each adult insured every year in
             accordance with the PHI Act;
       (2)   give reasonable advanced notice of any change to the rules that would be
             detrimental to the adult insured whether or not a Standard Information Statement
             is required in accordance with the PHI Act; and
       (3)   give a newly insured person an up to date copy of the relevant Standard
             Information Statement, details about what the policy covers and how benefits are
             provided, and a statement identifying the referable health benefits fund when they
             join.
       (4)   if a person asks about a complying health insurance product, tell the person that a
             Standard Information Statement is available and, if they ask for a copy, give that
             person an up to date copy of that Standard Information Statement.


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       A change to the rules means a change to the amount of premiums payable in respect of a
       complying health insurance policy, the treatments covered by such a policy or a benefit
       for treatment covered by such a policy.

       If more than one adult is insured under a single complying health insurance policy the
       Company need only provide this information to one of the adults on the complying health
       insurance policy.


A7.3   Subject to the PHI Act, the Company may provide details of changes to these rules by providing
       details of the change in any publication generally made available to policy holders.



A8 Dispute Resolution
A8.1   For any queries regarding a complying health insurance policy or the Company’s rules,
       please contact the Company’s customer service consultants or email the Company’s
       internet response team. The Company’s consultants will endeavour to resolve any issues
       or refer the query to the person in the Company’s organisation best placed to deal with it.

A8.2   An insured person/s may submit complaints through the Company's complaint
       mechanism by telephone or in writing to the Company’s Customer Relations Manager.
       The Company will address all such complaints and at all times endeavour to operate in
       the best interests of the individual policy holder after taking into account these rules,
       governing laws and the best interests of all policy holders.

A8.3   If the policy holder is unhappy with the resolution provided under Rule A8.2, the policy
       holder may contact the Private Health Insurance Ombudsman for assistance. The Private
       Health Insurance Ombudsman has been set up by the Commonwealth Government to
       deal specifically with inquiries and complaints about any aspect of private health
       insurance and may be contacted on 1800 640 695.

A8.4   Notwithstanding the above, a policy holder, may at any time directly contact the Private
       Health Insurance Ombudsman about a complaint or otherwise.


A9 Notices
A9.1   Copies of these rules are available to policy holders upon request.

A9.2   The Company will send written notice, where required, to the address last supplied by the
       policy holder, except as otherwise agreed. Such notice given will be effective even if the
       policy holder has left the address last notified.




A10 Winding Up
A10.1 The Company’s health benefits fund may be terminated in accordance with the PHI Act.




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A11 Other

B INTERPRETATION AND DEFINITIONS
B1 Interpretation
B1.1     The following rules shall apply to the interpretation of these rules:

   1. These rules shall be interpreted so as not to conflict with the Company's Constitution;

   2. Any terms used in these rules and also in the Constitution shall have the same meaning in
      these rules as they bear in the Constitution;

   3. Unless otherwise specified, any terms used in these rules defined in the PHI Act or in any
      associated legislation or rules or the Health Insurance Act have the same meaning in
      these rules;

   4. The masculine gender shall include, where applicable, the feminine gender;

   5. Words in the singular number shall include the plural and words in the plural shall
      include the singular.

   6. A reference to any legislation will be taken as a reference to that legislation as amended
      from time to time.

   7. A reference to a State includes a reference to a Territory.



B2 Definitions
1. B2.1      In these rules unless the intention appears to be otherwise:

   (1)       "Accident" means an unforeseen event, occurring by chance and caused by an
              unintentional and external force or object resulting in involuntary hurt or damage to
              the body, which requires immediate medical advice or treatment from a registered
              practitioner other than the policy holder.

   (2)       "Accident benefit" means benefits in relation to any Accident occurring after
             commencement of the complying health insurance policy resulting in urgent hospital
             attention as soon as practicable after the Accident;

   (3)       “adult” means a person who is not a dependent child or a dependent child non-
         student.


   (4)       “Australia” for the purposes of these Fund Rules:




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          (a) includes the six States, the Northern Territory (NT), the Australian Capital Territory
              (ACT),

                the Territory of Cocos (Keeling) Islands and the Territory of Christmas Island, but

          (b) excludes Norfolk Island and other Australian external territories;

(5)       "Australian Resident" or “Australian Residency” has the same meaning as that in
           the Health Insurance Act, that is, a person who resides in Australia and who is:

          (a)                    an Australian citizen; or
          (b)                    the holder of a valid permanent entry permit; or
          (c)                    a New Zealand citizen who is lawfully present in Australia; or
          (d)                    lawfully present in Australia and whose continued presence in
              Australia is not subject to any limitation as to time imposed by law; or
          (e)                    the holder of a temporary entry permit and for whom the
              Government believes there are special circumstances relating to asylum seekers,
              refugees, relatives of permanent entry permit holders, people authorised to work
              in Australia, or compassionate, humanitarian grounds.

(6)       “Base rate” has the meaning set out in subsection 34-1(2) of the PHI Act.

(7)       “Company” means Bupa Australia Pty Ltd.

(8)      "complying health insurance policy" or “policy” means an insurance policy that
      meets:

          (a) the community rating requirements in Division 66 of the PHI Act;
          (b) the coverage requirements in Division 69 of the PHI Act; and
          (c) if the policy covers hospital treatment, the benefit requirements in Division 72 of
              the PHI Act; and
          (d) the waiting period requirements in Division 75 of the PHI Act; and
          (e) the portability requirements in Division 78 of the PHI Act; and
          (f) the quality assurance requirements in Division 81 of the PHI Act; and
          (g) any requirements set out in the Private Health Insurance (Complying Products)
              Rules for the purposes of this paragraph.

      (9) “complying health insurance product” is a product made up of complying health
          insurance policies.

(10)    “Cosmetic Surgery” means surgical procedures and any follow up care associated
    with cosmetic procedures:

      (a) listed in the Plastic and Reconstructive Section (Subgroup13) of the Commonwealth
          Medicare Benefits Schedule that:
          (i) are not clinically relevant; or
          (ii) do not meet the eligibility conditions for the payment of Medicare benefits; or

      (b) of a plastic or reconstructive nature that are not listed in the Commonwealth
          Medicare Benefits Schedule.



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(11)    “cover” in relation to an insurance policy has the meaning set out in section 69-5 of
    the PHI Act.

(12)       "dependant child" means a person who does not have a partner and is;
                (i) aged under 21; or
               (ii) is receiving a full time education at a school, college or university recognised
               by the Company and who is not aged 25 or over

(13)       “dependant child non-student" has the meaning given to it in the Private Health
           Insurance (Complying Product) Rules 2007.(No 3)

(14)       “dependant” means dependant child and dependant non-student.

(15)       “Emergency” means:

       (a) For the purposes of emergency benefits in non contracted hospitals, an emergency is
           when immediate hospital treatment is required for a patient:
           •   at risk of serious morbidity or mortality and requiring urgent assessment and
               resuscitation; or
           •   suffering from suspected acute organ or system failure; or
           •   suffering from an illness or injury where the viability of function of a body part
               or organ is acutely threatened; or
           •   suffering from a drug overdose, toxic substance or toxin effect; or
           •            experiencing severe psychiatric disturbance whereby the health of the patient or
               other people is at immediate risk; or
           •   suffering from severe pain where the viability or function of a body part or organ is suspected to be acutely
               threatened; or
           •   suffering acute significant haemorrhaging and requiring urgent assessment and treatment.


(16)       "general treatment" has the meaning set out in section 121-10 of the PHI Act.
(17)       “gold card” has the meaning set out in subsection 34-15(3) of the PHI Act.

(18)       "health benefits fund" has the meaning set out in section131-10 of the PHI Act.


(19)    "Health Insurance Act" means the Health Insurance Act 1973 (Cth) as amended
    from time to time.

(20)       "health insurance business” has the meaning set out in Division 121 of the PHI Act.

(21)       "health related business” has the meaning set out in section 131-15 of the PHI Act.

(22)       "hospital” has the meaning set out in subsection 121-5(5) of the PHI Act.

(23)       "hospital cover" has the meaning set out in section 34-15 of the PHI Act.

(24)     "hospital-substitute treatment" has the meaning set out in section 69-10 of the PHI
    Act.




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(25)      "hospital treatment” has the meaning set out in section 121-5 of the PHI Act.

(26)      “improper discrimination” has the meaning set out in section 55-5 of the PHI Act.

(27)      “insured person” means:

                      (a)      a policyholder;

                      (b)      a partner named on a policy;
    (c)       a dependant named on a policy;

(28)    “insurance” means insurance to which paragraph 51(xiv) of the Constitution applies
    and “insure” has a corresponding meaning.

(29)      "lifetime health cover age", in relation to an adult who takes out hospital cover after
           his or her lifetime health cover base day, means the adult's age on the 1st July before
           the day on which the adult took out the hospital cover.

(30)     “lifetime health cover base day” has the meaning set out in section 34-25 of the PHI
    Act.

(31)      “Living Well Programs” means those programs approved by the Company for this
          purpose, together with such rules and guidelines as the Company deems appropriate
          in relation to the payment of benefits for such programs.

(32)   "medical practitioner" means a medical practitioner within the meaning of the
    Health Insurance Act.

(33)     “Medicare benefit" means a medicare benefit under Part II of the Health Insurance
    Act.


(34)     “Medication Assistance Service” means a one-on-one consultation with a pharmacist
    approved by the Company for the purpose of reviewing the medications being taken by
    the insured person, and is to be provided in accordance with these rules.

(35)      “Minister” means the Federal Minister or his or her delegate with the powers vested
          in the Minister by the PHI Act.

(36)      “Nursing Home Type Patient” has the meaning set out in the Private Health
           Insurance (Benefit Requirements) Rules.

(37)      “Nursing Home Type Patient’s Benefit” means the default benefit declared by the
           Minister for Nursing Home Type Patients from time to time.

(38)      "Obstetric Patient" means a patient who is hospitalised in to the management of
          pregnancy, labour and childbirth, including ante and post-natal care including but
          not restricted to Obstetrics-related Services.

(39)      “overseas” has the meaning given to it in section 34-30 of the PHI Act.



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(40)    “partner" means a person of either sex with whom the insured person lives in a bona
        fide domestic relationship and includes a person to whom the contributor is legally
        married and has the meaning given to it in section 34-30 of the PHI Act.


(41)   “premiums reduction scheme” means the scheme provided for by Division 23 of the
    PHI Act.

(42)    “premium group” means

            (i)     employees of a particular business enterprise or group of enterprises; or

            (ii)     members of a professional association; or

            (iii)    any other group deemed by the Company to be a premium group, or

           (iv)     a group of policy holders approved for the purposes of Fund Rule D1.6

(43)    “Pharmaceutical Benefits Schedule” means the Schedule of Pharmaceutical
        Benefits as published by the Commonwealth Department of Health and Ageing.

(44)    “PHI Act” means the Private Health Insurance Act 2007 (Cth).

(45)    "Private Health Insurance Ombudsman" means the Private Health Insurance
        Ombudsman appointed for the purposes of Part 6-2 of the PHI Act.

(46)     "policy holder", of a health benefits fund means a holder of a policy that is referable
    to the Company.

(47)    "pre-existing condition" has the meaning set out in section75-15 of the PHI Act.

(48)    "private health insurer" means a person registered under Part 4-3 of the PHI Act.

(49)    "private practice" means a practice operating on an independent and self supporting
        basis either as a sole, partnership or group practice but not under an agreement with,
        or the subsidy by, another party for the provision of accommodation, facilities or
        other services or practitioners. Practitioners in practice at public hospitals or any
        other type of publicly funded facility do not meet the guidelines of private practice.

(50)    "product" has the meaning set out in subsection 63-5(2) of the PHI Act.

(51)    “product rules” means rules applying to a complying health insurance product that
        are not inconsistent with the rules.

(52)    “product subgroup” has the meaning set out in subsection 63-5(2A) of the PHI Act.




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(53)    “prosthesis” means (except in the case of general treatment) an item that is
        implanted whilst in hospital and is a “listed prostheses” determined by the Minister
        as described in the Private Health Insurance (Prostheses) Rules. The list provides
        details of no gap prostheses and gap permitted prostheses, for which the Minister
        determines the minimum benefits payable. In relation to general treatment prosthesis
        is an external appliance or device approved by the Company, normally associated
        with a physical replacement of some part of the human body.

(54)    “PBS” means the Pharmaceutical Benefits Scheme.

(55)    "recognised practitioner" means a practitioner other than a registered medical
        practitioner in respect of whom the Company will pay benefits for particular
        services rendered by that practitioner. The Company has sole and absolute discretion
        in determining whether an individual remains or becomes a recognised practitioner
        and which particular services the Company will pay benefits for in respect of any
        recognised practitioner.

(56)    “restricted benefits” means the reduced benefits that apply for a service once the
        relevant waiting periods have been served, being the minimum default benefits
        determined by the Minister from time to time for that service.

(57)    "rules" means the body of rules established by the Company that relate to the day-to-
        day operation of its health insurance business and (if any) health related business.

(58)   “Standard Information Statement" has the meaning set out in section 93-5 of the
    PHI Act.

(59)    "State of Residence" means the state in which the policy holder resides for the
        greatest period, either continuously or in broken periods, in any twelve-month
        period.

(60)    “TGA Approved” means an item that has been ‘registered’ on the Australian Register
        of Therapeutic Goods

(61)   "transfer", in relation to a person, has the meaning set out in section 75-10 of the
    PHI Act.


(62)    "waiting period" has the meaning set out in section 75-5 of the PHI Act




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C MEMBERSHIP
C1 General Conditions of Membership
C1.1   A person or persons may join as a policy holder in one of the following categories of
       insured groups:

       (1) only one person;

       (2) 2 adults (and no one else);

       (3) 2 or more people, only one of whom is an adult;

       (4) 3 or more people, only 2 of whom are adults;

       (5) 3 or more people, at least 3 of whom are adults;

       (6) such other categories of insured groups as are permitted under the Private Health
           Insurance (Complying Product) Rules 2007 from time to time (including until 31
           December 2008, a policy that covers dependant child non-students).

C1.1A Subject to Fund Rule C1.1B, in relation to a complying health insurance policy a policy
      holder is the only insured person authorized by the Company to perform all of the
      following:

       (1) change any of the details of the policy;

       (2) change the level of cover or level of cover(s);

       (3) apply to add or remove a person as dependent or a policy holder;

       (4) receive a benefit for an insured person; and

       (5) terminate the policy.

C1.1B The Company will permit a policy holder to request in writing, or by any other means
      approved by the Company, that their partner or another person (nominated person) be
      treated as authorised to operate the policy (except to cancel the policy) as though the
      partner or the nominated person is the policy holder. The authority provided by the
      policy holder may be withdrawn by the policy holder at any time by notification to the
      Company in writing.

C1.1C The Company will treat the policy holder as responsible for ensuring that the premiums
      are paid and that the policy remains financial at all times.




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C1.2   The Company offers the following types of complying health insurance products:

       (1)     stand-alone products that only cover hospital treatment as set out in Schedule H;

       (2)     stand-alone products that only cover general treatment (other than hospital-
               substitute treatment) as set out in Schedule I;

       (3)     combined and pre-packaged products that consist of both hospital treatment and
               general treatment set out in Schedules J.

       Policy holders can choose to take out a product from Schedule H and a product from
       Schedule I.

       Policy holders are not permitted to take out more than one product that covers hospital
       treatment and/or one product that covers general treatment offered by the Company.

       Policy holders can choose to take out “Ambo Cover” as set out in Schedule I, Rule I12
       with another complying health insurance product only in the following circumstances;

             1. in the case of a product that covers hospital treatment, the product is the
                Company’s “Basic Hospital Cover” as outlined in Schedule H, Rule H8; and

             2. in the case of a product that covers general treatment, any product from Schedule
                I.



C2 Eligibility for Membership
C2.1   Except as otherwise approved by the Company, any person who is aged 17 or over may
       apply to become a policy holder of the Company’s health benefits fund.

C2.2   A person may not be covered by a complying health insurance policy with the Company
       if that person has an equivalent or corresponding complying health insurance policy with
       another private health insurer.


C2.3   Eligibility to hold a Policy

       Subject to these rules, the Company will treat any natural person currently legally residing in
       Australia as eligible to be a policy holder or registered as an insured person under a policy on any
       level of cover. Where an insured person is officially advised that their permanent Australian
       Residency has been granted from a date prior to the date of the advice, for the purposes of these
       rules, the permanent residency is taken to be effective only from the date of the official advice.

C2.4   An insured person may only be covered under a policy in respect of the policy holder's
       State of Residence.




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C3 Dependants
C3.1   The Company may elect not to make a complying health insurance product available to a
       category of insured group that includes dependant children.

C3.2   Not withstanding C2.2 of these rules, the Company may, at its absolute discretion, permit
       a policy holder to register as a dependant child, a person already registered as a
       dependant child on another policy (whether with the Company) or another private health
       insurer’s health benefits fund) provided that the policy holder is the parent of the person
       and has legal custody of the person. Any benefits paid under the original policy for such
       dependant child will be taken into account in calculating policy limits applicable to the
       policy holder’s level of cover.


C4 Membership Applications
C4.1   A policy holder, upon joining, must give complete information as required by the
       Company on all relevant matters relating to the policy holder and any other adults or
       dependants covered by the complying health insurance policy, including:

       (1) proof of identity;

       (2) proof of age such as, original birth certificate, current driver's license or current
           passport. At the Company's discretion, other forms of proof of age may be accepted;

       (3) details of any existing illness, ailment or injury; and

       (4) details of any actual or potential claims against any third party regarding any illness,
           ailment or injury.

C4.2   A policy holder must inform the Company as soon as reasonably practical after a change
       in any information provided at the time of joining.

C4.3   Insured persons agree to be bound by these rules, when they take out a complying health
       insurance policy with the Company.

C4.4   The Company must not refuse to insure a person under a complying health insurance
       policy if to do so would result in improper discrimination. An application to be covered
       under a complying health insurance product may not be refused, subject to the applicant
       and all the intended insured persons satisfying all relevant rules.

C4.5   The Company will maintain up to date Standard Information Statements at all times for
       each product subgroup of each complying health insurance product that it makes
       available and under which it provides cover.

C4.6   When a policy holder takes out cover with the Company’s health benefits fund the policy
       holder consents to the collection, use and disclosure by the Company of the personal and
       health information of all insured persons covered by the policy in accordance with the
       Company’s policy, titled “Bupa Australia Information Handling Policy” (as amended
       from time to time), available online or calling the Company.




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C5 Duration of Membership
C5.1   A person's insurance policy shall commence from the later of:

       (1) the date that person applies to take out cover; or

       (2) a later selected commencement date as agreed by the insured person and the
           Company

       provided that they have paid the first month’s premium and all enrolment procedures are
       completed to the satisfaction of the Company.

C5.2   An insurance policy continues until the date the policy holder notifies the Company in
       writing that the policy holder wishes to cease the policy under rule C7, or the Company
       notifies the policy holder that the policy has ceased under rule C8.



C6 Transfers
C6.1   When a policy holder changes his or her level of cover with the Company or from
       another private health insurer, waiting periods apply to any higher benefits not covered
       on the previous level of cover.

C6.2   If a person transfers to a complying health insurance policy (the new policy) from
       another complying health insurance policy (the old policy) either within the Company or
       from another private health insurer, the waiting period that applies to that person will be
       no longer than:

       (1) for a benefit for hospital treatment or hospital-substitute treatment that was not
           covered under the old policy - the period allowed under section 75-1 of the PHI Act;
           and
       (2) for a benefit for hospital treatment or hospital-substitute treatment that was covered
           under the old policy - the balance of any unexpired waiting period for that benefit
           that applied to the person under the old policy.

       If a higher excess or higher co-payment applied under the old policy than applies under
       the new policy, for a benefit for hospital treatment or hospital-substitute treatment, any
       period during which the higher excess or higher co-payment continues to apply but will
       be no longer than the waiting period allowed under section 75-1 of the PHI Act.

C6.3   If a policy holder takes out another complying health insurance policy either within the
       Company or from another private health insurer, the Company may apply
       restrictedbBenefits to any hospital treatment or hospital-substitute treatment.

C6.4   The Company will take into account any benefits paid by a policy holder in respect of
       any previous complying health insurance policy held with the Company or any other
       private health insurer.

       When a policy holder on a policy with another private health insurer transfers to the
       Company with a break in coverage of two (2) months or more, the Company may apply
       all relevant waiting periods as set out in Fund Rules C.6.


                                                                                        15 of 545
       Where a policy holder on a policy with another private health insurer transfers to the Company or
       recommences their policy on any level of cover with the Company with a break in coverage of
       greater than two (2) months, the Company will treat that person as a new policy holder for all
       purposes except those relating to Lifetime Health Cover as specified at rule D4.


C6.5   For the purposes of this rule C6, a person transfers to a policy (the new policy) from
       another policy (the old policy) if:
       (1) either:
                         (a)    the person is covered under the old policy at the time the person
                                  becomes covered under the new policy; or
                         (b)    the person ceased to be covered under the old policy no more than
                                7 days, or a longer number of days allowed by the new policy's
                                private health insurer for this purpose, before becoming insured
                                under the new policy; and
       (2) the old policy is a complying health insurance policy; and
       (3) the person's premium payments under the old policy were up to date at the time the
           person became covered under the new policy.

C6.6   The Company may apply all relevant waiting periods in accordance with Fund Rule C6.4
       in relation to general treatment benefits (excluding hospital-substitute treatment), to the
       unexpired portion of a benefit replacement period or limit governing the supply or
       replacement of an appliance or prosthesis. A benefit replacement period is a continuous
       period of time that must pass between any two purchases of the same type of item before
       benefits are payable in respect of the later purchase.


C6.7   Subject to other rules, where a policy holder transfers from another private health insurer or to a
       different level of cover within the Company, any relevant benefits that have been paid in a
       specified time period under the previous cover may be taken into account in determining the
       benefits payable under the new level of cover. Any relevant benefits include, but are not limited to,
       benefits that are subject to an annual or other limits or a maximum number of times a benefit may
       be payable. Where a policy holder has transferred to the Company from another private health
       insurer, the Company may at its discretion recognise a period of coverage with the previous
       private health insurers in determining annual limits for benefits under the new level of cover.




                                                                                                16 of 545
C7 Cancellation of Membership
C7.1    Subject to Rules C7.4, C7.5 and C7.5A, a policy holder may cancel his or her policy by
        advising the Company in writing or as otherwise agreed by the Company. The date of
        cessation of the policy will be the later of the date requested by the policy holder, which
        may not be more than 30 days after receipt of the request for cancellation or the date of
        the most recent claim paid in respect of the policy. If no date of cessation is elected by
        the policy holder, the date of cancellation will be the date of receipt of the request for
        cancellation.

C7.2    Subject to Rule C7.4 and C7.5, the Company will reimburse the policy holder any
        premiums paid in advance where a policy holder wishes to cease the policy before the
        paid to date.

C7.3    Refunds under Rule C7.2 and C7.4 may incur an administration fee determined by the
        Company from time to time.


C7.4    On the basis that no claim has been made under their policy and subject to Rule C7.3, a
        policy holder may cancel their policy in accordance with Rule C7.1, within 30 days of
        commencement of their policy and the Company will reimburse the policy holder any
        premiums paid in respect of their policy.


C7.5    The Company may allow a policy holder to retrospectively cancel their policy, and
        receive a refund of premiums paid where the request to cancel is within 30 days of the
        cancellation date or in other cases determined by the Company, at its discretion. In the
        case that a policy holder has elected to retrospectively cancel their policy, in accordance
        with this rule (C7.5) and a claim has been paid within 30 days from the relevant request
        the cancellation will apply from the date of payment of that claim.


C7.5A In the case of cancellation of a policy as the result of the death of an insured person
      (affected person), the Company will refund any premiums paid, from the date of the
      affected person’s death,


C7.6    A dependant child, who has reached the age of 18, may remove themselves from a policy
        by advising the Company in writing. The date of cessation of the dependant child from
        the policy will be the later of the date requested by the dependant child or the date of
        receipt by the Company of the relevant correspondence.



C8 Termination of Membership
C8.1    The Company may elect to terminate an insurance policy on notice to the policy holder,
        including, without limitation, if, in the Company’s reasonable opinion:

    (a) the policy holder and/or an insured person has been involved in any fraudulent, negligent
        and/or criminal act in relation to the operation of the health benefits fund and/or the
        Company; and/or



                                                                                          17 of 545
    (b) the policy holder and/or an insured person have acted in a way that could be construed as
        threatening to an employee of the Company or could be viewed as negatively affecting
        the working environment of any employees of the Company,

    provided that in the case of a complying health insurance policy the grounds for such
    cessation do not contravene rule A6.

C8.2    The Company will give written notification of the reason for cessation to the policy
        holder.

C8.3    The Company will, if a person ceases to be an insured person under a complying health
        insurance policy and does not become insured under another policy of the Company, give
        the person a certificate under section 99-1 of the PHI Act within 14 days.

C8.4    The Company may terminate an insurance policy immediately in the following
        circumstances:
    (a) after an insured person has reached the maximum suspensions for overseas travel, in
        accordance with Rule C9.4; or
    (b) if a policy is in arrears of two months or more in accordance with Rule D5.3; or



C9 Temporary Suspension of Membership
C9.1    A policy holder who has been covered under a complying health insurance policy with
        the Company for at least twelve months may apply to the Company to suspend the policy
        in cases of overseas travel, financial hardship or as a result of imprisonment.

C9.1A A policy holder who has been covered under a complying health insurance policy for at
      least twelve months may apply to the Company to suspend the cover under a policy in
      respect of any insured person in cases of overseas travel or as a result of imprisonment.

C9.2    The policy holder must provide overseas travel documents to verify departure and return
        dates. Any documentation reasonably requested by the Company must be provided by a
        policy holder to substantiate a case of financial hardship.

C9.3    The policy holder must make an application for suspension for overseas travel prior to the
        date of departure. Suspension for overseas travel takes effect from the day after
        departure. Suspension for financial hardship takes effect from the day after application is
        approved by the Company.

C9.4    Suspension for overseas travel must be for a period of between two months and two
        years. A maximum of three periods of suspension for overseas travel are permitted and
        there must be a period of at least one month with premium payments between each such
        suspension. Suspension for financial hardship may be for an individual period of no less
        than 3 months, with the total of all periods of suspension for financial hardship under this
        rule (C9.4) not able to exceed 12 months during the time a person is covered by a
        complying health insurance policy with the Company. Suspension as a result of
        imprisonment applies for a maximum of 4 continuous years.

C9.5   Suspensions are allowed twice per calendar year.



                                                                                           18 of 545
C9.6    If the policy has not been terminated, the policy will recommence, with the applicable
        premium payments due and payable:

        (1) in the case of suspension for overseas travel, upon the return date of overseas travel;

        (2) in the case of suspension due to financial hardship, upon the return date following the
            cessation of financial hardship; and
        (3) in the case of suspension as a result of imprisonment, upon the date the policy holder
            is released, as evidenced by a release form issued by the Department of Correctional
            Services.

C9.7    If the policy holder's level of cover is no longer available on return from suspension, the
        policy holder may choose another level of cover. Rule C6 will apply to that transfer.

C9.8    No benefits are payable for treatment during a period of suspension. Waiting periods and
        restricted benefits that were applicable to the policy holder at the start of suspension
        continue to apply on resumption of the policy holder.

C9.9    Periods of suspension do not count towards the serving of waiting periods or periods of
        restricted benefits.

C9.10 (a) If the policy holder has identified their proposed date of return on or before the date of
      departure, then the Company will require that the policy holder notify the Company of
      this date and the policy will automatically recommence from the identified date of return.
      The policy holder must pay the relevant premium to confirm the recommencement of the
      policy.
      (b) If rule C9.10(a) does not apply, a suspended policy must be recommenced within one
      month of the earlier of the date of which the reason for suspension ceases to apply, or the
      date on which the maximum suspension period has been reached.


C11 Other




D CONTRIBUTIONS

D1 Payment of Contributions
D1.1    Premiums are as set in Schedule K. These premiums do not include the increased
        premiums described in rule D4.

D1.2    A policy holder, shall at the time the policy holder first becomes insured under a
        complying health insurance policy, pay at least one calendar month's premiums in



                                                                                         19 of 545
       advance. For any subsequent payment, premiums are payable by the date they are due
       and must be paid for at least one calendar month in advance (unless premiums are paid
       by payroll deduction, in which case the minimum payment period is one week).

D1.3   A premium is paid to the Company only once it has been received by the Company from
       the policy holder.

D1.4   Where a policy holder’s State of Residence changes, the premiums payable to the
       Company will be adjusted so that the policy holder who arranges and is responsible for
       payment pays the premium for the complying health insurance policy applicable in the
       new State of Residence.

D1.5   The Company will require that a policy holder pay contributions at the premium for the chosen
       insured groups and level of cover.


D1.6   The Company may at its discretion approve any group of policy holders as a premium group.

D1.7   Unless otherwise specified or agreed by the Company, the Company may refuse to accept
       a payment of premiums, that would cause a policy to be paid up to a date which exceeds
       12 months in advance of the date of payment. Where through any other circumstance the
       period in which the policy is financial exceeds 12 months from the current date, the
       Company may refund the portion of the premiums in excess of 12 months.

D2 Contribution Rate Changes
D2.1   The Company may adjust the premiums that apply to a complying health insurance policy
       in accordance with section 66-10 of the PHI Act.

D2.2   Policy holders that have paid any premiums for a period that ends after the date that a
       change in premiums becomes effective, may be adjusted to reflect the change in those
       premiums.


D3 Contribution Discounts
D3.1   The Company may only offer a discount if to do so will comply with section 66-5 of the
       PHI Act.



D4 Lifetime Health Cover
D4.1   The Company must increase the amount of premiums payable for hospital cover in
       respect of an adult if:

       (1) the adult did not have hospital cover on his or her lifetime health cover base day;

       (2) the adult ceases to have hospital cover after his or her lifetime health cover base day.

       The amount by which the premium will be increased is set out in Division 34 of the PHI
       Act and is calculated by reference to a policy holder’s lifetime health cover age. An adult
       is taken to have hospital cover at any time during which the adult holds a gold card.


                                                                                            20 of 545
D4.2   The Company must stop increasing the amount of premiums payable by a policy holder
       for hospital cover where required, in accordance with the requirements, under Division
       34 of the PHI Act

D4.3   The premiums will not be increased for a policy holder under this rule D4 where:

       (1) at the time the policy holder first took out hospital cover with a private health
           insurer, the 1 July following the policy holder’s 31st birthday had not arrived; or
       (2) the policy holder had hospital cover at 1 July 2000 and has maintained it since then;
           or
       (3) the policy holder was born on or before 1 July 1934; or
       (4) a policy holder who turned 31 on or before 1 July 2000 was overseas on 1 July 2000;
           or
       (5) the policy holder is the subject of a determination (with effect immediately before 1
           April 2007) under clause 10 of Schedule 2 of the National Health Act 1953 (Cth).

D4.4   The premium payable by a policy holder for hospital cover:

       (1) under rule D4.1 (1) increases by 2% of the base rate for each year a policy holder’s
           lifetime health cover age is above 30. The maximum amount of any premium
           increase under this rule is an amount equal to 70% of the base rate; and

       (2) under rule D4.1 (2) increases by 2% for each year the policy holder is without
           hospital cover (calculated in accordance with section 34-5 of the PHI Act).

D4.5   The amount of increased premiums for a membership with more than one adult is
       calculated by averaging the increased premiums applicable to each adult in accordance
       with section 37-20 of the PHI Act.

D4.6   The Private Health Insurance (Lifetime Health Cover) Rules 2007 contain special
       provisions for certain groups of people including the following:

       (1) people who have health services provided by the Australian Antarctic Division of
           the Department of the Environment and Heritage;
       (2) members of the Australian Defence Forces (and their adult dependants) on
           continuous full time service and whose health services are provided by or through
           the Australian Defence Force.


D5 Arrears in Contributions
D5.1   A policy holder will be in arrears if premiums are not paid by the due date.

D5.2   If a policy holder is in arrears in respect of a complying health insurance policy, then
       benefits will be paid as if the policy holder is not in arrears for two months, provided a
       payment is made to cover the amount in arrears. The policy holder will not be entitled to
       receive any benefits after this two months has elapsed.




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D5.3   The Company may cease a policy under a complying health insurance policy if the period
       of arrears exceeds two months.


D6 Other
D6.1   If a policy holder ceases to be covered by a complying health insurance policy, he or she
       will be entitled to receive a refund of any premiums paid in respect of the complying
       health insurance policy for the period after the date on which the policy holder ceases to
       be covered by that complying health insurance policy (calculated on a pro rata basis) less
       any administration costs incurred by the Company.




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E BENEFITS
E1 General Conditions
E1.1    The rules in force on the date a treatment is rendered to an insured person will determine
        whether the person is eligible for and the amount of benefits payable.

E1.2    Benefits for goods and services cannot exceed the actual charge for the goods and
        services received.

E1.3    Where the Company has paid an amount to a policy holder which was not then lawfully
        due to the policy holder as the result of an error, and the Company has informed the
        policy holder within 2 years of the date of payment, the Company shall be entitled to
        recover the amount from the policy holder.

E1.4    The Company may recover from the policy holder any benefit given or refuse to pay any
        benefit where it is found that the information supplied on the enrolment form, claim form
        or any other official Company form is in error in any matter that may have affected the
        decision of the Company to pay benefits.

E1.5    The Company may offset any amounts recoverable under these rules against any benefits
        that would otherwise be payable.

E1.6    The Company may, in its sole discretion make ex-gratia payments in respect of claims
        that would not otherwise attract benefits under these rules.

E1.7    The Company shall not be liable to a policy holder for any losses, costs, damages, suits or
        actions arising through the provision of services to an insured person by any recognised
        practitioner.

E1.8    No insured person may receive benefits in respect of the same treatment from more than
        one policy of the Company.

E1.9    The Company will not pay any benefits where the product rules determine no payment is
        payable.

E1.10 Benefits in respect of a treatment will be determined on the basis of the state of residence
      of the insured person, who received the treatment and is not payable based on the state in
      which the treatment was received by the insured person.

E1.11 In lieu of monetary benefits payable to a policy holder the Company may in its absolute
      discretion apply services or appliances to an insured person.




                                                                                        23 of 545
E2 Hospital Treatment
E2.1   Hospital benefits are only payable for hospital treatment provided by a person authorised
       by a hospital to provide hospital treatment.

E2.2   Hospital benefits for hospital treatment are not payable for any of the circumstances
       outlined in Rule E 4.

E2.3   The length of stay in hospital is calculated with reference to the date of admission to but
       not inclusive of the date of discharge from hospital.

E2.4   The Company must ensure that complying health insurance policies that cover hospital
       treatment meet the benefit requirements set out in section 72-1 of the PHI Act and the
       Private Health Insurance (Benefits Requirements) Rules 2007. Medical benefits are
       payable by the Company in accordance with section 72-1 of the PHI Act for hospital
       treatment or hospital-substitute treatment covered by the complying health insurance
       policy where a Medicare benefit is payable for that treatment.

E2.5   The Company may, from time to time, for the benefit of policy holders enter into
       agreements with hospitals (referred to as Members First, Network Agreement and
       Participating Hospitals) and medical practitioners (referred to as Medical Gap Scheme).
       The benefits that apply within these agreements may differ from those shown in these
       rules. Lists of such hospitals and medical practitioners are available to policy holders
       upon request.

E2.6   For all complying health insurance policies that cover hospital treatment, the Company
       will pay the costs that a policy holder incurs for a PBS item received by an insured
       person under the policy while admitted to a hospital with which the Company has an
       agreement as outlined in rule E2.4. No benefits are payable by the Company for:

       (1) PBS items received while admitted to a non-agreement hospital;

       (2) pharmaceuticals supplied on discharge from hospital; or

       (3) where the cost to a policy holder for a PBS item is less than the pharmaceutical
           benefit co-payment (as determined by the Commonwealth Department of Health and
           Ageing).

E2.7   For all complying health insurance policies that cover hospital treatment, the Company
       will pay costs that a policy holder incurs for each pharmaceutical item that is not covered
       by the PBS received while admitted to an agreement hospital. For the purposes of this
       rule E2.7, a course of treatment of the same pharmaceutical item is regarded as one
       pharmaceutical item. No benefits are payable for non-PBS items received while admitted
       to a non-agreement hospital. To be eligible for the benefit, the pharmaceutical item must
       be:

       (1) intrinsic to the hospital treatment;



                                                                                        24 of 545
       (2) clinically indicated;

       (3) essential for the meeting of satisfactory health outcomes for the policy holder;

       (4) directly related to treatment of the condition or ailment for which the policy holder
           was admitted;

       (5) a non-experimental drug or compound item;

       (6) provided by the hospital during your hospital admission and not provided upon
           discharge; and

       (7) the reason for admission to hospital was not solely for the administration of the
           pharmaceutical item.

E2.8   The Company will pay benefits for a prosthesis item where that prosthesis item is
       implanted as part of hospital treatment under a complying health insurance policy. In the
       case of a no-gap prosthesis item the benefits will fully cover the cost of that item. For a
       gap permitted prosthesis item, the benefits will not fully cover that item, but will cover
       the amount set out as the minimum benefit in section 72-1 of the PHI Act.

E2.9   All complying health insurance policies cover hospital-substitute treatment provided by
       a general or specialist nurse recognised by the Company in the course of private practice
       provided that:

       (1) a medical practitioner has certified that the care is instead of hospitalisation; and

       (2) the certification is assessed by a medical practitioner appointed by the Company to
           be medically reasonable and appropriate.

E2.10 Once a policy holder is a Nursing Home Type Patient, the Company will pay Nursing
      Home Type Patient’s Benefits for the duration of their classification as a Nursing Home
      Type Patient. Nursing Home Type Patients must make a contribution to their care as
      declared by the Minister from time to time.


E2.11 Where a policy holder is classified as a Nursing Home Type Patient, the Company can
      request an Acute Care Certificate and any additional supporting information from the
      medical record.


E3 General Treatment
E3.1   The Company may determine an insured person’s entitlement to a benefit for general
       treatment (other than hospital-substitute treatment) under a complying health insurance
       policy in respect of a period by having regard to the amount of benefits for that kind of
       treatment already claimed for the person in respect of the period. The Company may not
       apply this rule across more than one period.

E3.2   The Company will pay a benefit under a complying health insurance policy for general
       treatment only (and not where services or appliances are provided as part of hospital
       treatment) where the general treatment has been rendered:


                                                                                          25 of 545
        (1) by or on behalf of a recognised practitioner in private practice;
        (2) on premises registered with the Company, unless approved otherwise by the
        Company.

E3.3    General treatment benefits are not payable for any of the circumstances outlined in Rule
        E4.

E3.4    General treatment benefits are payable in accordance with the schedule of benefits and
        General Treatment Guidelines (which may be viewed on request) maintained by the
        Company and subject to the following:

        (1) Dental benefits are payable in accordance with the schedule of dental benefits and
        Dental Claims Guidelines (which may be viewed on request) maintained by the
        Company. All treatments are inclusive of routine post-operative care.

        (2) Major dental services include crowns, bridgework, complete dentures, partial dentures
        and denture repairs, prosthodontic services, implant procedures, periodontics, oral
        surgery, endodontics and oral appliances for sleep apnoea.

         (3) Pharmacy benefits are payable for prescriptions supplied by a pharmacist in private
        practice and prescribed by a registered medical practitioner. Benefits are payable for
        non-PBS prescription items which are TGA Approved and where such approval is for that
        condition. Pharmacy benefits are not payable if they are excluded by the Company.
        Benefits are not payable for PBS items.

        (4) Asthma pumps must be approved by the Asthma Foundation and blood glucose
        monitors must be approved by Diabetes Australia for benefits to be payable by the
        Company.

        (5) Defined Appliances benefits are payable for items listed in the schedule of benefits
        when provided by a recognised practitioner and, in relation to orthoses and surgical
        shoes, fully custom made.
-
        (6) Local and interstate travelling benefits are payable for expenses associated with
        essential medical or hospital treatment where the total return distance travelled is at least
        300 kilometres.

(7) Overnight non-hospital accommodation benefits are payable for the patient and an attendant
for travel away from home for treatment unable to be provided by the patient's own doctor.

        (8) Where a complying health insurance policy states that a benefit is payable for
        Medication Assistance Service, the Company will pay a benefit in accordance with its
        agreement with the relevant recognised practitioner.

        (9)Where a complying health insurance policy states that an Accident benefit is payable,
        the Company will pay a benefit in provided that proof that the occurrence of the Accident
        and documentary evidence of admission to hospital or to the emergency department of a
        hospital is provided to the Company upon request.




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E3.5   The amount of a benefit for a treatment under a complying health insurance policy may
       be different from the amount of a benefit for the same treatment under another complying
       health insurance policy that is in the same product, if the difference is only because the
       insured persons under the policies live in a different state.

E3.6   The Company may, from time to time, for the benefit of its policy holders enter into
       agreements with providers of general treatment. The benefits that apply within these
       agreements may differ from those shown in these rules and may be determined on the
       basis of the state of residence of the provider. Lists of agreements with providers of
       general treatment are available to policy holders upon request.


E3.7   If a policy holder takes out general treatment cover with the Company, the Company will
       only pay benefits:

   (a) for a single service of general treatment provided to a policy holder by a recognised
       practitioner in private practice on a given day; and

   (b) for more than one service of general treatment on a given day provided by a recognised
       practitioner in registered premises in private practice who is recognised by the Company
       in more than one profession.


E4 Other
E4.1   Benefits are not payable for:
   1. Any costs incurred as a result or consequence of criminal activity.
   2. Any service rendered by a suspended practitioner.
   3. Professional services or hospitalisation rendered in connection with a policy holder or
      dependant child’s employment.
   4. Services that may be paid or provided by the Commonwealth, the State, a local governing
      body, or an authority established by any law.
   5. Services rendered more than two years ago (unless the Company, in its absolute
      discretion, chooses to pay benefits in cases of hardship or for claims relating to
      unsuccessful compensation or damages cases).

   6. Professional services rendered or goods supplied by a policy holder to the policy holder’s
       dependent child or business associate or their partners or dependent children unless
       otherwise approved at the discretion of the Company.

   7. Any services rendered contrary to a law of the Commonwealth or State in which they
      were rendered.
   8. Any service that was not rendered as claimed or is insufficiently described in the claim.
   9. Any services which the Company reasonably believes are excessive and not reasonably
      necessary for the adequate care of the policy holder or their dependent children.




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   10. Any services provided overseas.
   11. If, in the Company’s reasonable opinion, the policy holder may receive any
       compensation, damages, or benefits, from another source for a condition, injury or
       ailment (even if the compensation, damages, or benefits is stated to exclude any medical
       expenses).
   12. Benefits not payable by Medicare including any Cosmetic Surgery procedure unless the
       procedure is deemed clinically relevant or experimental or clinical trial pharmaceuticals.
       Any follow up care pertaining to non-Medicare recognised cosmetic surgery is paid at
       minimum benefits.

   13. Unless otherwise specified by the Company, outpatient services, that is services provided
       to patients who are not admitted patients.


F LIMITATION OF BENEFITS
F1 Co Payments
F1.1   The complying health insurance policy chosen by a policyholder may require that a co-
       payment be made in respect of an insured person. The co-payment will apply for any
       overnight or same day admissions where an insured person is admitted to a hospital.

F2 Excesses
F2.1   Policy holders may choose a complying health insurance policy that covers hospital
       treatment tables that include an excess.

F2.2   An excess is deducted from benefits that would otherwise be payable by the Company
       under these rules for hospital treatment.

F2.3   Any excess that applies to a complying health insurance policy will be outlined in
       accordance with Schedules H and J.


F3 Waiting Periods
F3.1   Waiting periods apply to policy holders joining a private health insurer for the first time
       and apply from the date of joining before any benefits can be claimed. Where a policy
       holder leaves another private health insurer and takes out cover with the Company, the
       Company may require the policy holder to serve a waiting period for a particular service
       if he or she takes out a cover which pays a benefit for service for which he or she was not
       covered for with the other private health insurer.

F3.2   Where a policy holder changes cover with the Company to a table of cover which pays a
       benefit for a service that was not previously covered or for which a higher benefit is
       payable, the Company may require the policy holder to serve a waiting period in respect
       of the new benefit from the date of changing cover. No benefits are payable to new policy
       holders during waiting periods. Policy holders transferring to a higher table of cover with
       the Company receive benefits at the previous lower level of cover during waiting periods.




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F3.2A In the case of a dependant, where they cease to be covered under a complying health
      insurance policy (the old policy) as a dependant with the Company and within 60 days
      become a policy holder of a complying health insurance policy (the new policy) with the
      Company with the same and/or lower levels of cover than the old policy they will be
      deemed to have served the same waiting periods as the old policy. In the case of any
      changes in levels of cover, waiting periods apply to any higher benefits not covered
      under the old policy.

F3.3   If a policy holder adds a new dependant to their complying health insurance policy (other
       than a newborn), any waiting periods and periods of restricted benefits that apply to that
       complying health insurance policy must be served in full by the new dependant. A
       newborn will be deemed to have served the same waiting periods and periods of
       restricted benefits as the policy holder.

F3.4   In the case of a newborn on a family or sole parent cover;

       (1) Where the relevant cover was in existence prior to the birth of the newborn, the
           newborn will not be required to serve waiting periods.

       (2) Where the relevant cover was not in existence prior to the birth of the newborn, the
           newborn will not be required to serve waiting periods where the newborn is added
           within 2 month of birth.

F3.5   In the case of a dependant where they rejoin a complying health insurance policy where a
       parent is a policy holder they will be deemed to have served the same waiting periods and
       periods of restricted benefits as the policy holder.

       A waiting period will not apply to any hospital treatment or general treatment covered
       by a complying health insurance policy where that person:

   (a) held a gold card, or was entitled to treatment under a gold card, before applying for the
       insurance; and

   (b) applies for the insurance no longer than two months after the person ceased to hold, or be
       entitled under, the gold card.




F3.6   (a) For all products made available by the Company the waiting periods that apply for
       hospital treatment benefits are as follows:

           Type of Case                            Waiting Period

           Pre-existing condition                 Twelve Months
           Obstetric Patient                      Twelve Months
           Laser Eye Correction Surgery           Three Years
           Psychiatric*                           Two Months
           Rehabilitation*                        Two Months
           Palliative Care*                       Two Months
           All Other Cases^                       Two Months



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           * This waiting period applies whether or not there is a pre-existing condition
           ^No waiting periods apply for benefits provided in relation to accidents proved to occur after the policy
           commences.




F3 Waiting Periods – (contd)
F3.6   (b)The waiting periods that apply for general treatment benefits are as follows:

           Type of Case                                   Waiting Period

           Pre-existing condition                         Twelve Months
           General Dental                                 Two Months
           Major Dental                                   Twelve Months
           Orthodontics                                   Twelve Months
           Appliances                                     Twelve Months
           Heart Screening Tests                          Twelve Months
           Living Well Program                            Six Months
           Hire, Repair and Maintenance of                Six Months
           Appliances
           All Other Cases^                               Two Months
               ^No waiting periods apply for benefits provided in relation to accidents proved to occur after the
               policy commences or Accident benefit included as a benefit for accidents occurring after the policy
               commences



F4 Exclusions
F4.1   Unless otherwise stated in these rules, there are no total exclusions applicable to any
       types of hospital treatment on any of the Company’s hospital treatment tables.


F5 Benefit Limitation Periods
F5.1   The Company has benefit limitation periods (“BLPs”) for specific types of services.
       Benefit limitation periods are the reduced benefits that apply for a service for a fixed
       period of time once the relevant waiting periods have been served, being the minimum
       default benefits determined by the Minister from time to time for that service. These
       periods may range from 1 to 2 years, depending on the service. BLPs apply to new policy
       holders or dependant children and may apply to policy holders who transfer to this level
       of cover.

F5.2   During a BLP, eligible claims will be paid by the Company at the minimum default
       benefit levels as determined by the Minister from time to time. These benefits are
       generally not adequate to cover private hospital costs, but fully cover shared ward costs
       in a public hospital. BLPs apply from the date of joining Overseas Visitors Hospital
       Cover.

F5.3   Services for which BLPs may apply on the Company’s products include:



                                                                                                       30 of 545
       •   All Psychiatric services (except eating disorders and post natal depression)
       •   Assisted reproductive services (including IVF)
       •   Hip or knee replacement
       •       Cataract surgery
       •       Renal dialysis or chronic renal failure
       •   Bone marrow transplants

F5.4   BLPs on the Company’s products are served concurrently with waiting periods.



F6 Restricted Benefits
F6.1   Restricted benefits may apply to the following:
   •   Pregnancy related services (including childbirth)
   •   Heart, artery, cardiac related services
   •   Psychiatric services
   •   Assisted reproductive services (including IVF)
   •   Hip, knee or joint replacement
   •   Rehabilitation services
   •   Cataract and eye lens procedures & surgery
   •   Cosmetic surgery
   •   Renal dialysis or chronic renal failure
   •   Hospital admissions for services not eligible for Medicare rebate


F7 Compensation Damages and Provisional Payment of Claims
F7.1   Benefits are not payable in respect of a condition, injury or ailment which is the subject
       of a claim where an insured person has claimed and received or established a right to
       receive a payment by way of compensation or damages from a third party.

F7.2   Where the amount of a claim for compensation or damages is in the opinion of the
       Company less than the benefits that would have otherwise been payable, benefits are
       payable. The amount of benefits payable shall not exceed the difference between the
       benefit that would have otherwise been payable and the amount of compensation or
       damages.

F7.3   Where the Company believes that a condition, injury or ailment is one which may give
       rise to a claim for compensation or damages or benefits have been paid which relate to
       such a claim, the Company may require the insured person to sign an undertaking, in a
       form acceptable to the Company, before payment or further payment of benefit occurs.
       The undertaking will require the insured person to make a claim for compensation or
       damages, to pursue the claim with all diligence, and to include in such claim all hospital,
       medical, dental, paramedical and related expenses. Proceeds from the claim are to be
       used to reimburse the Company for any benefits that were paid for the condition, injury
       or ailment.


F7.4   Benefits are not payable if it appears to the Company that the insured person may be


                                                                                          31 of 545
        entitled to payment by way of compensation or damages but has not yet established the
        right to such payment. The insured person will be required to establish such right, and
        inform the Company of any decision to pursue a claim for compensation. If it is
        established that there is no right to compensation or damages, then benefits are payable.

F7.5    Where a insured person establishes a right to compensation or damages and accepts a
        settlement, and such settlement includes terms specifying that moneys paid do not relate
        to past or future expenses in respect of which benefits would otherwise be payable, or
        part of the claim is abandoned or compromised so that such expenses are excluded or
        represented by a nominal amount only, then benefits are not payable.

F7.6    Where an insured person has received compensation in relation to the injury they must
        inform the Company immediately upon determination of the settlement of the claim for
        compensation.

F7.7    Where in the Company’s opinion an insured person appears to have a right to make a
        claim for compensation in respect of an injury but that right has not been established, the
        Company may withhold payment of benefits in respect of expenses incurred in relation to
        that injury.

F7.8    Where a claim for compensation in respect of an injury is in the process of being made or
        has been made and remains unfinalised, the Company may in its absolute discretion make
        a provisional payment of benefits in respect of expenses incurred in relation to the injury.

F7.9    Any provisional payment may be conditional upon the insured person signing an
        undertaking or other conditions required by the Company.

F7.10 If the insured person does not comply with the requirements of the undertaking or
      conditions required by the Company, the Company may discontinue any provisional
      payments and where required by the Company repays the Company of any provisional
      payments already paid.

F7.11 Any provisional payments of benefits by the Company may be regarded as a debt payable
      to the Company.

F7.12 Where the insured person is under 18 years of age, the policy holder will be principally
      responsible and must assume any responsibility in signing the undertaking.

F7.13 Where an insured person and a policy holder complete an undertaking, both parties may
      be liable for any provisional payment.

F7.14 References to an insured person receiving compensation includes:

        (i)Compensation paid to another person at the direction of the insured person; and

        (ii)Compensation paid to another insured person on the same policy in connection with
        an injury suffered by the insured person.




                                                                                         32 of 545
F8 Other




G CLAIMS
G1 General
G1.1   Claims must be submitted within two years of the date of service, otherwise benefits are
       not payable.

G1.2   The Company, in its absolute discretion, may waive rule G1.1 in cases of hardship or for
       claims relating to unsuccessful compensation or damages cases.

G1.3   Claims for benefits must:

1) be made in a manner approved by the Company; and
2) Be supported by accounts and/or receipts on the providers letterhead or showing the
   provider’s official stamp and showing the following information:
3) the provider’s name, number and address;
4) the insured persons full name and address;
5) date and description of service;
6) the amount(s) charged; and
7) any other information that the Company may reasonably request.


G2 Other




                                                                                      33 of 545
H1 SCHEDULE HOSPITAL TREATMENT TABLES
H1 1 Table Name or Group of Table Names

Public Hospital

H1 2 Eligibility
Product closed to new members from 30th November 2010.


H1 3 General Conditions



H1 4 Hospital Treatment Payments
The Company will pay to Hospitals for Hospital Treatment received by a Policy Holder, the following
payment:

    •    The Minister’s Default Benefit


H1 5 Medical Services Payments while admitted
Where there is an MPPA, PA or Gap Cover Scheme in place, the Company will pay to Medical
Practitioners for medical services received by a Policy Holder while an Admitted Patient, the MPPA, PA or
Gap Cover Schemes Payment.

Where there is no MPPA, PA or Gap Cover Scheme in place, the Company will pay the Schedule Fee Gap
Benefit for medical services received by a Policy Holder while an Admitted Patient:

(1) to the Policy Holder; or

(2) where the Policy Holder assigns the benefit to the Medical Practitioner, to that Medical
Practitioner.


H1 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals


H1 7 Non PBS Pharmaceuticals



H1 8 Surgically Implanted Prostheses
Benefits for qualifying surgically implanted prostheses are payable in accordance with Rule E2
of the General Conditions, whichever is applicable.


                                                                                             34 of 545
H1 9 Nursing Home Type Patients
Benefits for Hospital Treatment provided to Nursing Home Type Patients are payable in
accordance with Rule E2 of the General Conditions.



H1 10 Co Payments


H1 11 Excesses
.

H1 12 Benefit Limitation Periods

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:




                                                                                    35 of 545
H1 13 Restricted Benefits
    1. Assisted Reproductive Services:

    2. Pregnancy Related Services:

    3. Sterilisation and Reversal of Sterilisation:

    4. Cardiothoracic:

    5. Psychiatric:

    6. Rehabilitation:

    7. Plastic and Cosmetic Surgery:

H1 14 Exclusions
    1. Assisted Reproductive Services:

    2. Pregnancy Related Services:

    3. Sterilisation and Reversal of Sterilisation:

    4. Cardiothoracic:

    5. Plastic and Cosmetic Surgery:

    6. Hip Replacements:

    7. Other:



H1 15 Loyalty Bonuses



H1 16 Other Special
Health Management Programs

The Company offers each person covered under this Policy participation in the Company Preventive
Program or other approved health management programs offered by the Company.




Bowel Cancer Screening Kits




                                                                                     36 of 545
All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.




H2 SCHEDULE HOSPITAL TREATMENT TABLES
H2 1 Table Name or Group of Table Names

Basic Hospital Cover (L)


H2 2 Eligibility

Product closed to new members from 30th November 2010.


H2 3 General Conditions


H2 4 Hospital Treatment Payments

Benefits are paid according to the minimum default benefits prescribed by the Minister. These
benefits are not adequate to cover private hospital costs and may result in large out of pocket
expenses for policy holders.


H2 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are
also payable for the fee that is above the Government schedule fee in cases where the medical
practitioner either has a medical purchaser provider agreement with the Company or uses the
Company's Ezyclaim system.




H2 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
The Company will pay the costs that a policy holder incurs for a PBS item received while
admitted to a hospital with which the Company has an agreement. No benefits are payable for
PBS items received while admitted to a hospital with which the Company does not have an
agreement, or for pharmaceuticals supplied on discharge from hospital.




                                                                                         37 of 545
H2 7 Non PBS Pharmaceuticals
The Company will pay up to $500 for the costs that a policy holder incurs for each
pharmaceutical item not covered by the PBS received while admitted to a hospital with which the
Company has an agreement. No benefits are payable for non-PBS items received while admitted
to a hospital with which the Company does not have an agreement, or for pharmaceuticals
supplied on discharge from hospital.



H2 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The
Company will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis
item is implanted as part of the hospital treatment. The Company will pay the minimum benefits
determined by the Minister for a gap permitted prosthesis.




H2 9 Nursing Home Type Patients
Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




H2 10 Co Payments



H2 11 Excesses



H2 12 Benefit Limitation Periods

2. Assisted Reproductive Services:


3. Pregnancy Related Services:


4. Sterilisation and Reversal of Sterilisation:


5. Cardiothoracic:




                                                                                       38 of 545
6. Psychiatric:


7. Rehabilitation:


8. Plastic and Cosmetic Surgery:


9. Hip Replacements:


10. Other:


H2 13 Restricted Benefits

   1. Assisted Reproductive Services:


   2. Pregnancy Related Services:


   3. Sterilisation and Reversal of Sterilisation:


   4. Cardiothoracic:


   5. Psychiatric:


   6. Rehabilitation:


   7. Plastic and Cosmetic Surgery:

   8. Hip Replacements:


   9. Other:


H2 14 Exclusions




                                                     39 of 545
    1. Assisted Reproductive Services:


    2. Pregnancy Related Services:


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless
       deemed clinically necessary


    6. Hip Replacements:


    7. Other:



H2 15 Loyalty Bonuses


H2 16 Other Special
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.




                                                                                         40 of 545
I1 SCHEDULE GENERAL TREATMENT TABLES
I1 1 Table Name or Group of Table Names

EMERGENCY AMBULANCE COVER

I1 2 Eligibility

This product is not available to Policy holders in Queensland or Tasmania.

Product closed to new members from 30th November 2010.


I1 3 General Conditions


I1 4 Loyalty Bonuses



I1 5 Dental



I1 6 Optical



I1 7 Physiotherapy



I1 8 Chiropractic



I1 9 Non PBS Pharmaceuticals



I1 10 Podiatry




                                                                             41 of 545
I1 11 Psychology and Counselling



I1 12 Alternative Therapies



I1 13 Natural Therapies



I1 14 Speech Therapy



I1 15 Orthotics



I1 16 Dietetics



I1 17 Occupational Therapy



I1 18 Naturopathy



I1 19 Acupuncture



I1 20 Other Therapies



I1 21 Non Surgically Implanted Prostheses and Appliances




                                                       42 of 545
I1 22 Hearing Aids



I1 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.


I1 24 Ambulance Transportation


I1 25 Accident Cover



I1 26 Accidental Death Funeral Expenses



I1 27 Other Special




                                                                                         43 of 545
I2 SCHEDULE GENERAL TREATMENT TABLES
I2 1 Table Name or Group of Table Names
YOUNG EXTRAS COVER

I2 2 Eligibility


I2 3 General Conditions


I2 4 Loyalty Bonuses



I2 5 Dental
Benefit

Benefits for Dental services are payable as set out in the Company’s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

Annual Limit
General Dental and Preventive Dental- $350 per person; $700 per membership.
Major Dental – No coverage for major dental services.
Orthodontia – No coverage for orthodontic services.



I2 6 Optical
Benefit
                        NSW/ACT         QLD            SA          TAS           VIC          WA        NT
Frames                   $89.60        $97.45      $100.00        $95.20      $100.00       $95.20   $100.00
Single Vision Lenses     $62.30        $62.30       $72.25        $62.30       $62.30       $62.30    $67.20
Multifocal Lenses       $100.00       $100.00      $100.00       $100.00      $100.00      $100.00   $100.00
Contact Lenses-           70%           70%          70%           70%          70%          70%       70%
Disposable

Benefits are limited to one appliance (frames and lenses or contact lenses) per person per year.

Annual Limit

$150 per person up to a maximum of $300 per Policy.




                                                                                         44 of 545
I2 7 Physiotherapy
Benefit

                     NSW/ACT          QLD            SA         TAS            VIC          WA           NT
Initial Visit        $34.30          $31.20       $32.30       $32.05        $31.90       $33.10       $32.75
Subsequent Visit     $27.15          $25.60       $25.85       $25.20        $25.60       $26.80       $26.15
Group Session         $8.65           $7.75        $8.95        $8.95         $8.95        $8.40       $14.75
Ante/Post Natal      $15.40          $10.50       $10.45       $10.50        $11.20       $10.45       $15.75
Visits

Annual Limit

$350 per person up to a maximum of $700 per Policy combined with chiropractic and osteopathy
services and ante and post natal classes by a midwife. From 1 November 2010, the Company will
not pay benefits for services which have an MBS item number and are provided outside a hospital
by a participating midwife.


I2 8 Chiropractic
Benefit

                     NSW/ACT          QLD             SA         TAS           VIC          WA           NT
Initial Visit          $39.00         $32.00        $35.00       $33.00       $34.00       $35.00       $35.00
Subsequent Visit       $25.00         $23.00        $25.00       $23.00       $24.00       $25.00       $25.00

Annual Limit

$350 per person up to a maximum of $700 per Policy combined with physiotherapy and
osteopathy services and ante and post natal services by a midwife. From 1 November 2010, the
Company will not pay benefits for services which have an MBS item number and are provided
outside a hospital by a participating midwife.



I2 9 Non PBS Pharmaceuticals
Benefit

Ancillary Pharmaceutical Items

After deducting an amount equal to the current Commonwealth PBS co-payment, the Company
will pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50
per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Medical Assistance Service




                                                                                          45 of 545
The Company will pay a benefit of up to $40 for a Medical Assistance Service with a pharmacist
that is approved by the Company.

Benefits for a Medical Assistance Service is payable in accordance with the rules set out in
Section E3 of the General Conditions.

Annual Limit

(1) Ancillary Pharmaceutical Items - $100 per person to a maximum of $200 per Policy

(2) Medical Assistance Service – One medication Assistance service per person

I2 10 Podiatry



I2 11 Psychology and Counselling



I2 12 Alternative Therapies



I2 13 Natural Therapies
The following Natural (Complimentary) Therapies are covered:-

Remedial massage, aromatherapy, alexander technique, feldenkrais, kinesiology, homoeopathy,
iridology, bowen technique, herbalist, shiatsu, reflexology, exercise physiology:

Benefit

Benefits are payable as set out in the Company’s Benefit Schedule.

Annual Limit

$100 per person up to a maximum of $200 per Policy for all Complimentary Therapies (including
Acupuncture and Naturopathy).


I2 14 Speech Therapy



I2 15 Orthotics




                                                                                        46 of 545
I2 16 Dietetics



I2 17 Occupational Therapy



I2 18 Naturopathy
Benefit

                   NSW/ACT         QLD            SA        TAS          VIC         WA          NT
Initial Visit        $25.00        $25.00       $25.00      $22.00      $25.00      $22.00      $25.00
Subsequent Visit     $22.00        $20.00       $20.00      $20.00      $21.50      $20.00      $22.00

Annual Limit

$100 per person up to a maximum of $200 per Policy for all Complimentary Therapies (including
Acupuncture and all Natural Therapies listed in Rule I2.13).


I2 19 Acupuncture
Benefit

                   NSW/ACT         QLD            SA        TAS          VIC         WA          NT
Initial Visit        $28.00        $28.00       $31.00      $25.00      $28.50      $32.00      $30.00
Subsequent Visit     $22.00        $22.00       $23.00      $23.00      $21.50      $25.00      $25.00

Annual Limit

$100 per person up to a maximum of $200 per Policy for all Complimentary Therapies (including
Naturopathy and all Natural Therapies listed in Rule I2.13).

I2 20 Other Therapies
Osteopathy

Benefit

From 1 November 2010, the Company will not pay benefits for services which have an MBS
item number and are provided outside a hospital by a participating midwife.


                   NSW/ACT         QLD            SA        TAS          VIC         WA          NT
Initial Visit        $39.90        $35.00       $40.60      $32.90      $36.40      $32.65      $35.00
Subsequent Visit     $37.10        $31.10       $27.65      $26.25      $31.50      $27.45      $31.95

Ante Natal and Post Natal Classes by a Midwife



                                                                                   47 of 545
Benefit

                     NSW/ACT          QLD            SA         TAS           VIC          WA           NT
Per Visit              $17.50         $29.55       $28.00       $28.00       $28.00       $31.50       $29.55

Annual Limit

$350 per person up to a maximum of $700 per Policy combined with physiotherapy and
chiropractic services.

I2 21 Non Surgically Implanted Prostheses and Appliances



I2 22 Hearing Aids



I2 23 Prevention Health Management

Living Well Programs

The Company will provide a cover towards selected Company approved health related services
and health management programs that are designed to prevent or relieve a specific health
condition or conditions.

Benefit

50% of the cost

Annual Limit

$50 per person


Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.


I2 24 Ambulance Transportation
For policy holders who do not belong to an ambulance subscription scheme, the Company will
pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by
    a fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar



                                                                                         48 of 545
    year for policy holders who contribute to a policy that covers only one person (a single cover)
    and two trips per calendar year for policy holders who contribute to either a single parent or
    family cover.


I2 25 Accident Cover
Benefit

The Company will provide payments to persons covered under this Policy for the cost of accident
related health care services, except for services that are covered by Medicare, incurred as a direct
result of an Accident after joining where:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted;
   and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
   Benefit as set out in the Company’s Benefit Schedule for the respective type of services
   involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

(1) $2000 per person up to a maximum of $4000 per Policy.

(2) $2000 per Accident per person up to a maximum of $4000 per Accident per Policy.


I2 26 Accidental Death Funeral Expenses



I2 27 Other Special




I3 SCHEDULE GENERAL TREATMENT TABLES
I3 1 Table Name or Group of Table Names

CLASSIC EXTRAS



                                                                                          49 of 545
I3 2 Eligibility
Product closed to new members from 30th November 2010.


I3 3 General Conditions


I3 4 Loyalty Bonuses



I3 5 Dental
Benefit

Benefits for Dental services are payable as set out in the Company ‘sBenefit Schedule and in
accordance with the Rules set out in Section E3.11 of the General Conditions.

Annual Limit

Preventive Dental – No limit
General Dental - $300 per person
Major Dental - $800 per person
Orthodontia – Lifetime limit of $2000 per person

I3 6 Optical
Benefit

                       NSW/ACT          QLD            SA        TAS           VIC          WA         NT
Frames                  $89.60         $97.45      $108.65      $95.20      $106.40       $95.20    $100.80
Single Vision Lenses    $62.30         $62.30       $72.25      $62.30       $62.30       $62.30     $67.20
Multifocal Lenses      $123.20        $135.55      $151.20     $136.65      $136.60      $130.80    $138.35
Contact Lenses-          70%            70%          70%         70%          70%          70%        70%
Disposable

Annual Limit

$225 per person


I3 7 Physiotherapy
Benefit

                    NSW/ACT         QLD            SA         TAS           VIC          WA          NT
Initial Visit       $34.30         $31.20       $32.30       $32.05       $31.90       $33.10      $32.75
Subsequent Visit    $27.15         $25.60       $25.85       $25.20       $25.60       $26.80      $26.15
Group Session        $8.65          $7.75        $8.95        $8.95        $8.95        $8.95      $14.75
Ante/Post Natal     $15.40         $10.50       $10.45       $10.50       $11.20       $10.45      $15.75



                                                                                       50 of 545
Visit

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.




I3 8 Chiropractic
Benefit

                     NSW/ACT          QLD             SA         TAS           VIC          WA          NT
Initial Visit          $40.00         $35.00        $40.00       $35.00       $38.00       $40.00      $40.00
Subsequent Visit       $30.00         $25.00        $28.00       $25.00       $28.00       $30.00      $30.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I3 9 Non PBS Pharmaceuticals
Benefit

Ancillary Pharmaceutical Items

After deducting an amount equal to the current Commonwealth PBS co-payment, the Company
will pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50
per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Medical Assistance Service

The Company will pay a benefit of up to $40 for a Medical Assistance Service with a pharmacist
that is approved by the Company.

Benefits for a Medical Assistance Service is payable in accordance with the rules set out in
Section E3 of the General Conditions.

Annual Limit

(1) Ancillary Pharmaceutical Items - $300 per person.

(2) Medical Assistance Service – One medication Assistance service per person.




                                                                                          51 of 545
I3 10 Podiatry
Benefit

                    NSW/ACT          QLD            SA        TAS         VIC         WA         NT
Initial Visit         $35.00         $35.00       $40.00      $35.00     $35.00      $40.00     $36.00
Subsequent Visit      $30.00         $30.00       $32.00      $30.00     $30.00      $30.00     $32.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.

I3 11 Psychology and Counselling
Benefit

                    NSW/ACT          QLD            SA        TAS         VIC         WA         NT
Initial Visit         $75.00         $70.00       $90.00      $70.00     $75.00     $110.00     $85.00
Subsequent Visit      $65.00         $60.00       $75.00      $65.00     $65.00      $75.00     $70.00
Group Treatment       $35.00         $35.00       $68.00      $60.00     $60.00      $65.00     $36.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I3 12 Alternative Therapies



I3 13 Natural Therapies
The following Natural (Complimentary) Therapies are covered:-

Remedial massage, aromatherapy, alexander technique, feldenkrais, kinesiology, homoeopathy,
iridology, bowen technique, herbalist, shiatsu, reflexology, exercise physiology:

Benefit

Benefits are payable as set out in the Company ‘s Benefit Schedule.

Annual Limit

$200 per person for all Complimentary Therapies (including Acupuncture and Naturopathy).




                                                                                    52 of 545
I3 14 Speech Therapy
Benefit

                   NSW/ACT          QLD            SA       TAS           VIC         WA         NT
Initial Visit        $75.00         $65.00       $80.00     $60.00       $65.00      $82.00     $70.00
Subsequent Visit     $35.00         $40.00       $50.00     $35.00       $40.00      $37.00     $45.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I3 15 Orthotics
Benefit



Foot Orthotic – custom made              $105.00

Annual Limit

$500 per person combined with Non Surgically Implanted Prostheses and Appliances.

I3 16 Dietetics
Benefit

                   NSW/ACT          QLD            SA       TAS           VIC         WA         NT
Initial Visit        $55.15         $50.40       $56.60     $49.35       $51.85      $52.50     $55.00
Subsequent Visit     $30.00         $25.00       $30.00     $27.50       $27.20      $30.00     $30.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.

I3 17 Occupational Therapy
Benefit

                   NSW/ACT          QLD            SA       TAS           VIC         WA         NT
Initial Visit        $68.00         $60.00       $70.00     $55.00       $55.00      $65.00     $60.00
Subsequent Visit     $38.00         $45.00       $55.00     $35.00       $43.00      $35.00     $40.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.




                                                                                    53 of 545
I3 18 Naturopathy
Benefit

                    NSW/ACT         QLD           SA        TAS           VIC         WA         NT
Initial Visit         $30.00        $30.00      $30.00      $25.00       $30.00      $30.00     $30.00
Subsequent Visit      $25.00        $25.00      $25.00      $23.00       $25.00      $25.00     $25.00

Annual Limit

$200 per person for all Complimentary Therapies (including Acupuncture and all Natural
Therapies listed in Rule I3.13).


I3 19 Acupuncture
Benefit

                    NSW/ACT         QLD            SA       TAS           VIC         WA         NT
Initial Visit         $33.00        $32.00       $35.00     $30.00       $35.00      $35.00     $35.00
Subsequent Visit      $26.00        $26.00       $25.05     $26.00       $25.00      $28.00     $28.00

Annual Limit

$200 per person for all Complimentary Therapies (including Naturopathy and all Natural
Therapies listed in Rule I3.13).

I3 20 Other Therapies
Osteopathy

Benefit

                    NSW/ACT         QLD            SA       TAS           VIC         WA         NT
Initial Visit         $39.90        $35.00       $40.60     $32.90       $36.40      $32.65     $35.00
Subsequent Visit      $37.10        $31.10       $27.65     $26.25       $31.50      $27.45     $31.95

Eye Therapy

Benefit

All States

Initial Visit      $45.00
Subsequent Visit   $38.00

Ante Natal and Post Natal Classes by a Midwife


From 1 November 2010, the Company will not pay benefits for services which have an MBS item
number and are provided outside a hospital by a participating midwife.




                                                                                    54 of 545
Benefit

                     NSW/ACT          QLD            SA         TAS           VIC          WA           NT
Per Visit              $17.50         $29.55       $28.00       $28.00       $28.00       $31.50       $29.55

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I3 21 Non Surgically Implanted Prostheses and Appliances
Benefit

Benefits for non Surgically Implanted Prostheses and Appliances are payable as set out in the
Company’s Benefit Schedule and in accordance with the Rules set out in Section E3.15 of the
General Conditions.

Annual Limit

$500 per person combined with Orthotics.

I3 22 Hearing Aids


I3 23 Prevention Health Management

Living Well Programs

The Company Benefit will provide a cover towards selected Company approved health related
services and health management programs that are designed to prevent or relieve a specific health
condition or conditions.

Benefit

50% of the cost

Annual Limit

$100 per person


Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.




                                                                                         55 of 545
I3 24 Ambulance Transportation
For policy holders who do not belong to an ambulance subscription scheme, the Company will
pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by
    a fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar
    year for policy holders who contribute to a policy that covers only one person (a single cover)
    and two trips per calendar year for policy holders who contribute to either a single parent or
    family cover.




I3 25 Accident Cover
Benefit

The Company will provide payments to persons covered under this Policy for the cost of accident
related health care services, except for services that are covered by Medicare, incurred as a direct
result of an Accident after joining where:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted;
   and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
   Benefit as set out in The Company’s Benefit Schedule for the respective type of services
   involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

(1) $2000 per person up to a maximum of $4000 per Policy.

(2) $2000 per Accident per person up to a maximum of $4000 per Accident per Policy.

I3 26 Accidental Death Funeral Expenses



I3 27 Other Special




                                                                                          56 of 545
I4 SCHEDULE GENERAL TREATMENT TABLES
I4 1 Table Name or Group of Table Names

SELECT 80 EXTRAS

I4 2 Eligibility


I4 3 General Conditions


I4 4 Loyalty Bonuses



I4 5 Dental
Benefit

Benefits for Dental services are payable as set out in the Company ‘s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

Annual Limit

Preventive and General Dental - $250 per person
Major Dental - $1000 per person
Orthodontia – Lifetime limit of $2500 per person


I4 6 Optical

Benefit

                       NSW/ACT          QLD            SA        TAS           VIC          WA        NT
Frames                  $89.60         $97.45      $108.65      $95.20      $106.40       $95.20   $100.80
Single Vision Lenses    $62.30         $62.30       $72.25      $62.30       $62.30       $62.30    $67.20
Multifocal Lenses      $123.20        $135.55      $151.20     $136.65      $136.60      $130.80   $138.35
Contact Lenses-          70%            70%          70%         70%          70%          70%       70%
Disposable

Annual Limit

$150 per person

I4 7 Physiotherapy
Benefit


                                                                                       57 of 545
                     NSW/ACT          QLD            SA         TAS            VIC          WA           NT
Initial Visit        $34.30          $31.20       $32.30       $32.05        $31.90       $33.10       $32.75
Subsequent Visit     $27.15          $25.60       $25.85       $25.20        $25.60       $26.80       $26.15
Group Session         $8.65           $7.75        $8.95        $8.95         $8.95        $8.95       $14.75
Ante/Post Natal      $15.40          $10.50       $10.45       $10.50        $11.20       $10.45       $15.75
Visit

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.




I4 8 Chiropractic
Benefit

                     NSW/ACT          QLD             SA         TAS           VIC          WA           NT
Initial Visit          $40.00         $35.00        $40.00       $35.00       $38.00       $40.00       $40.00
Subsequent Visit       $30.00         $25.00        $28.00       $25.00       $28.00       $30.00       $30.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I4 9 Non PBS Pharmaceuticals
Benefit

Ancillary Pharmaceutical Items

After deducting an amount equal to the current Commonwealth PBS co-payment, the Company
will pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50
per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Medical Assistance Service

The Company will pay a benefit of up to $40 for a Medical Assistance Service with a pharmacist
that is approved by the Company.

Benefits for a Medical Assistance Service is payable in accordance with the rules set out in
Section E3 of the General Conditions.

Annual Limit


                                                                                          58 of 545
(1) Ancillary Pharmaceutical Items - $250 per person.

(2) Medical Assistance Service – One medication Assistance service per person.

I4 10 Podiatry
Benefit

                    NSW/ACT         QLD            SA        TAS          VIC         WA         NT
Initial Visit         $29.20        $27.85       $31.50      $26.95      $31.50      $34.15     $28.20
Subsequent Visit      $25.90        $24.50       $25.20      $23.10      $25.90      $26.55     $24.50

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I4 11 Psychology and Counselling
Benefit

                    NSW/ACT         QLD            SA        TAS          VIC         WA         NT
Initial Visit         $70.00        $63.00       $84.00      $61.10      $70.00      $98.00     $77.00
Subsequent Visit      $61.45        $52.50       $66.50      $56.00      $58.30      $66.20     $56.55
Group Treatment       $31.50        $26.75       $55.65      $55.65      $55.65      $55.65     $26.75

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.

I4 12 Alternative Therapies



I4 13 Natural Therapies



I4 14 Speech Therapy
Benefit

                    NSW/ACT         QLD            SA        TAS          VIC         WA         NT
Initial Visit         $68.95        $56.00       $73.15      $52.50      $58.45      $77.00     $57.70
Subsequent Visit      $31.50        $28.20       $42.00      $27.80      $31.25      $33.35     $34.50

Annual Limit



                                                                                    59 of 545
$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I4 15 Orthotics
Benefit



Foot Orthotic – custom made              $105.00

Annual Limit

$500 per person combined with Non Surgically Implanted Prostheses and Appliances.




I4 16 Dietetics
Benefit

                   NSW/ACT          QLD            SA       TAS           VIC         WA         NT
Initial Visit        $55.15         $50.40       $56.60     $49.35       $51.85      $52.50     $55.00
Subsequent Visit     $30.00         $25.00       $30.00     $27.50       $27.20      $30.00     $30.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I4 17 Occupational Therapy
Benefit

                   NSW/ACT          QLD            SA       TAS           VIC         WA         NT
Initial Visit        $64.70         $43.90       $60.85     $47.05       $50.40      $59.90     $52.45
Subsequent Visit     $34.70         $37.80       $46.05     $27.35       $37.80      $30.40     $32.70

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.

I4 18 Naturopathy



I4 19 Acupuncture
Benefit


                                                                                    60 of 545
                   NSW/ACT          QLD            SA       TAS           VIC         WA         NT
Initial Visit        $33.00         $32.00       $35.00     $30.00       $35.00      $35.00     $35.00
Subsequent Visit     $26.00         $26.00       $25.05     $26.00       $25.00      $28.00     $28.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I4 20 Other Therapies
Osteopathy

Benefit

                   NSW/ACT          QLD            SA       TAS           VIC         WA         NT
Initial Visit        $39.90         $35.00       $40.60     $32.90       $36.40      $32.65     $35.00
Subsequent Visit     $37.10         $31.10       $27.65     $26.25       $31.50      $27.45     $31.95

Eye Therapy

Benefit

                   NSW/ACT          QLD            SA       TAS           VIC         WA         NT
Initial Visit        $42.00         $36.80       $27.70     $31.50       $34.55      $27.70     $35.70
Subsequent Visit     $34.45         $27.95       $20.80     $30.25       $31.50      $20.80     $27.70

Ante Natal and Post Natal Classes by a Midwife


From 1 November 2010, the Company will not pay benefits for services which have an MBS item
number and are provided outside a hospital by a participating midwife.


Benefit

                   NSW/ACT          QLD            SA       TAS           VIC         WA         NT
Per Visit            $17.50         $29.55       $28.00     $28.00       $28.00      $31.50     $29.55

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.




I4 21 Non Surgically Implanted Prostheses and Appliances
Benefit


                                                                                    61 of 545
Benefits for non Surgically Implanted Prostheses and Appliances are payable as set out in the
Company’s Benefit Schedule and in accordance with the Rules set out in Section E3 of the
General Conditions.

Annual Limit

$500 per person combined with Orthotics.


I4 22 Hearing Aids
Benefit

Hearing aid – Monaural - $600 in all States.

Annual Limit

$600 per person every five years.


I4 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.


I4 24 Ambulance Transportation
For policy holders who do not belong to an ambulance subscription scheme, the Company will
pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by
    a fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar
    year for policy holders who contribute to a policy that covers only one person (a single cover)
    and two trips per calendar year for policy holders who contribute to either a single parent or
    family cover.




I4 25 Accident Cover
Benefit

The Company will provide payments to persons covered under this Policy for the cost of accident
related health care services, except for services that are covered by Medicare, incurred as a direct
result of an Accident after joining where:

(1) the costs are not paid or payable from any other source;



                                                                                         62 of 545
(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted;
   and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
   Benefit as set out in the Company’s Benefit Schedule for the respective type of services
   involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

(1) $2000 per person up to a maximum of $4000 per Policy.

(2) $2000 per Accident per person up to a maximum of $4000 per Accident per Policy.


I4 26 Accidental Death Funeral Expenses



I4 27 Other Special




I5 SCHEDULE GENERAL TREATMENT TABLES
I5 1 Table Name or Group of Table Names

PREMIUM EXTRAS

I5 2 Eligibility
Product closed to new members from 30th November 2010.


I5 3 General Conditions


I5 4 Loyalty Bonuses



I5 5 Dental
Benefit


                                                                                          63 of 545
Benefits for Dental services are payable as set out in the Company’s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

Annual Limit

Preventive Dental – No limit
General Dental - $400 per person
Major Dental - $1300 per person
Orthodontia – Lifetime limit of $2500 per person


I5 6 Optical
Benefit

                       NSW/ACT          QLD            SA        TAS           VIC          WA         NT
Frames                 $102.40        $111.40      $124.20     $108.80      $121.60      $108.80    $115.20
Single Vision Lenses    $71.20         $71.20       $82.60      $71.20       $71.20       $71.20     $76.80
Multifocal Lenses      $140.80        $154.90      $172.80     $156.20      $156.10      $149.45    $158.10
Contact Lenses-          80%            80%          80%         80%          80%          80%        80%
Disposable

Annual Limit

$250 per person

I5 7 Physiotherapy
Benefit

                    NSW/ACT         QLD            SA         TAS           VIC          WA          NT
Initial Visit       $39.20         $35.65       $36.90       $36.60       $36.45       $37.80      $37.40
Subsequent Visit    $31.05         $29.25       $29.55       $28.80       $29.25       $30.65      $29.90
Group Session        $9.90          $8.85       $10.25       $10.25       $10.20       $10.25      $16.85
Ante/Post Natal     $17.60         $12.00       $11.95       $12.00       $12.80       $11.95      $18.00
Visits

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as
described in Rule B2.2 (“Therapies”) of the General Conditions.


I5 8 Chiropractic
Benefit

                    NSW/ACT          QLD             SA       TAS           VIC          WA          NT
Initial Visit         $50.00         $40.00        $45.00     $40.00       $45.00       $50.00      $50.00
Subsequent Visit      $40.00         $30.00        $35.00     $30.00       $35.00       $35.00      $35.00

Annual Limit


                                                                                       64 of 545
$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.

I5 9 Non PBS Pharmaceuticals
Benefit

Ancillary Pharmaceutical Items

After deducting an amount equal to the current Commonwealth PBS co-payment, the Company
will pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50
per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Medical Assistance Service

The Company will pay a benefit of up to $40 for a Medical Assistance Service with a pharmacist
that is approved by the Company.

Benefits for a Medical Assistance Service is payable in accordance with the rules set out in
Section E3 of the General Conditions.

Annual Limit

(1) Ancillary Pharmaceutical Items - $300 per person.

(2) Medical Assistance Service – One medication Assistance service per person.

I5 10 Podiatry
Benefit

                     NSW/ACT          QLD            SA          TAS           VIC          WA          NT
Initial Visit          $45.00         $42.00       $45.00        $40.00       $40.00       $45.00      $40.00
Subsequent Visit       $35.00         $36.00       $38.00        $35.00       $35.00       $35.00      $36.00

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I5 11 Psychology and Counselling
Benefit

                     NSW/ACT          QLD             SA         TAS           VIC          WA          NT
Initial Visit          $85.00         $85.00       $100.00       $80.00       $80.00      $130.00      $90.00
Subsequent Visit       $75.00         $70.00        $85.00       $75.00       $70.00       $80.00      $75.00



                                                                                          65 of 545
Group Treatment        $40.00       $45.00        $73.00      $68.00     $64.00      $70.00     $40.00

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.

I5 12 Alternative Therapies



I5 13 Natural Therapies
The following Natural (Complimentary) Therapies are covered:-

Remedial massage, aromatherapy, alexander technique, feldenkrais, kinesiology, homoeopathy,
iridology, bowen technique, herbalist, shiatsu, reflexology, exercise physiology:

Benefit

Benefits are payable as set out in the Company’s Benefit Schedule.

Annual Limit

$200 per person per Therapy type up to a maximum of $400 per person for all Complimentary
Therapies (including Acupuncture and Naturopathy).


I5 14 Speech Therapy
Benefit

                    NSW/ACT         QLD             SA        TAS         VIC         WA         NT
Initial Visit         $90.00        $75.00        $90.00      $65.00     $75.00      $98.00     $80.00
Subsequent Visit      $50.00        $45.00        $60.00      $40.00     $46.00      $43.00     $50.00

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.

I5 15 Orthotics
Benefit



Foot Orthotic – custom made               $120.00

Annual Limit




                                                                                    66 of 545
$500 per person combined with Non Surgically Implanted Prostheses and Appliances.

I5 16 Dietetics
Benefit

                   NSW/ACT          QLD             SA      TAS           VIC         WA         NT
Initial Visit        $60.00         $55.00        $60.00    $50.00       $60.00      $55.00     $60.00
Subsequent Visit     $40.00         $30.00        $40.00    $30.00       $35.00      $35.00     $35.00

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I5 17 Occupational Therapy
Benefit

                   NSW/ACT          QLD             SA      TAS           VIC         WA         NT
Initial Visit        $70.00         $65.00        $75.00    $60.00       $58.00      $68.00     $65.00
Subsequent Visit     $45.00         $50.00        $60.00    $40.00       $45.00      $38.00     $45.00

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.

I5 18 Naturopathy
Benefit

                   NSW/ACT          QLD             SA      TAS           VIC         WA         NT
Initial Visit        $35.00         $35.00        $35.00    $30.00       $40.00      $35.00     $35.00
Subsequent Visit     $30.00         $30.00        $30.00    $28.00       $30.00      $30.00     $30.00

Annual Limit

$200 per person per Therapy type up to a maximum of $400 per person for all Complimentary
Therapies (including Acupuncture and all Natural Therapies listed in Rule I5.13).


I5 19 Acupuncture
Benefit

All States
Initial visit                            $40.00
Subsequent visit                         $30.00

Annual Limit


                                                                                    67 of 545
$200 per person per Therapy type up to a maximum of $300 per person for all Complimentary
Therapies (including Naturopathy and all Natural Therapies listed in Rule I5.13).

I5 20 Other Therapies
Osteopathy

Benefit

                    NSW/ACT         QLD             SA        TAS           VIC         WA         NT
Initial Visit         $45.60        $40.00        $46.40      $37.60       $41.60      $37.30     $40.00
Subsequent Visit      $42.40        $35.55        $31.60      $30.00       $36.00      $31.35     $36.50

Eye Therapy

Benefit

                    NSW/ACT         QLD             SA        TAS           VIC         WA         NT
Initial Visit         $50.00        $50.00        $50.00      $50.00       $50.00      $50.00     $50.00
Subsequent Visit      $45.00        $40.00        $40.00      $40.00       $40.00      $40.00     $40.00

Ante Natal and Post Natal Classes by a Midwife


From 1 November 2010, the Company will not pay benefits for services which have an MBS item
number and are provided outside a hospital by a participating midwife.


Benefit

                    NSW/ACT         QLD             SA        TAS           VIC         WA         NT
Per Visit             $20.00        $33.75        $32.00      $32.00       $32.00      $36.00     $33.75

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I5 21 Non Surgically Implanted Prostheses and Appliances
Benefit

Benefits for non Surgically Implanted Prostheses and Appliances are payable as set out in the
Company’s Benefit Schedule and in accordance with the Rules set out in Section E3 of the
General Conditions.

Annual Limit

$500 per person combined with Orthotics.


                                                                                      68 of 545
I5 22 Hearing Aids
Benefit

Hearing aid – Monaural - $1000 in all States.

Annual Limit

$1000 per hearing aid up to a maximum of two hearing aids per person every three years.



I5 23 Prevention Health Management

Living Well Programs

The Company will provide a cover towards selected Company approved health related services
and health management programs that are designed to prevent or relieve a specific health
condition or conditions.

Benefit

50% of the cost

Annual Limit

$100 per person


Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.


I5 24 Ambulance Transportation
For policy holders who do not belong to an ambulance subscription scheme, the Company will
pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by
    a fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar
    year for policy holders who contribute to a policy that covers only one person (a single cover)
    and two trips per calendar year for policy holders who contribute to either a single parent or
    family cover.




                                                                                         69 of 545
I5 25 Accident Cover
Benefit

The Company will provide payments to persons covered under this Policy for the cost of accident
related health care services, except for services that are covered by Medicare, incurred as a direct
result of an Accident after joining where:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted;
   and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
   Benefit as set out in he Company’s Benefit Schedule for the respective type of services
   involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

(1) $2000 per person up to a maximum of $4000 per Policy.

(2) $2000 per Accident per person up to a maximum of $4000 per Accident per Policy.


I5 26 Accidental Death Funeral Expenses



I5 27 Other Special




I6 SCHEDULE GENERAL TREATMENT TABLES
I6 1 Table Name or Group of Table Names

EXTRACOVER

I6 2 Eligibility


I6 3 General Conditions



                                                                                          70 of 545
I6 4 Loyalty Bonuses



I6 5 Dental
Benefit

Benefits for Dental services are payable as set out in the Company‘s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

Annual Limit

Preventive and General Dental – No limit
Major Dental – Limits apply on the following service groups:
(1) Crowns and bridges, and dentures and denture repairs - $1000 per person
(2) Inlays/onlays and posts and veneers - $400 per person
(3) Periodontics
     • $800 per person where provided by a general dental practitioner, or
     • $1000 per person where provided by a specialist periodontist.
Orthodontia
     • $400 per person up to a maximum lifetime limit of $1200 where provided by a general
         dental practitioner, or
     • $550 per person up to a maximum lifetime limit of $1650 where provided by a specialist
         orthodontist.

I6 6 Optical
Benefit

                       NSW/ACT          QLD           SA         TAS           VIC          WA         NT
Frames                  $61.40         $55.65      $74.45       $48.95       $60.80       $65.25     $57.60
Single Vision Lenses    $65.00         $70.00      $75.35       $70.00       $70.00       $65.00     $75.50
Multifocal Lenses      $100.55        $117.50     $114,85      $115.70      $115.40      $108.60    $105.85
Contact Lenses-         $60.00         $60.00      $60.00      $150.00      $150.00       $60.00     $60.00
Disposable

Annual Limit

$200 per person


I6 7 Physiotherapy
Benefit

                    NSW/ACT         QLD            SA         TAS           VIC          WA          NT
Initial Visit       $25.00         $27.00       $25.00       $18.00       $30.00       $25.00      $27.00
Subsequent Visit    $20.00         $21.00       $20.00       $18.00       $22.00       $20.00      $21.00
Group Session       $10.00         $10.00       $10.00        $5.00       $10.00       $10.00      $10.00
Ante/Post Natal     $10.00          $8.00       $10.00       $10.00        $9.00       $10.00       $8.00


                                                                                       71 of 545
Visits

Group Sessions – limit of 10 sessions per course of treatment.
Hydrotherapy for Post Natal Classes – limit of 10 sessions per course of treatment.

Annual Limit

$800 per person up to a maximum of $1250 per person for all Therapies as described in Rule B2
(“Therapies”) of the General Conditions.

I6 8 Chiropractic
Benefit

                     NSW/ACT        QLD           SA          TAS           VIC          WA            NT
Initial Visit         $39.00         $32.00       $35.00       $33.00       $34.00       $35.00        $35.00
Subsequent Visit      $25.00         $23.00       $25.00       $23.00       $24.00       $25.00        $25.00
Annual Limit

$300 per person up to a maximum of $1250 per person for all Therapies as described in Rule B2
(“Therapies”) of the General Conditions.



I6 9 Non PBS Pharmaceuticals
Benefit

Ancillary Pharmaceutical Items

After deducting an amount equal to the current Commonwealth PBS co-payment, the Company
will pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50
per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3of the General Conditions.

Medical Assistance Service

The Company will pay a benefit of up to $40 for a Medical Assistance Service with a pharmacist
that is approved by the Company.

Benefits for a Medical Assistance Service is payable in accordance with the rules set out in
Section E3 of the General Conditions.

Annual Limit

(1) Ancillary Pharmaceutical Items - $500 per person.

(2) Medical Assistance Service – One medication Assistance service per person.




                                                                                          72 of 545
I6 10 Podiatry
Benefit

                   NSW/ACT       QLD           SA         TAS          VIC         WA           NT
Initial Visit       $22.00        $27.00       $22.00      $15.00      $20.00      $22.00       $27.00
Subsequent Visit    $18.00        $19.00       $18.00      $15.00      $15.00      $18.00       $19.00

Annual Limit

$300 per person up to a maximum of $1250 per person for all Therapies as described in Rule B2
(“Therapies”) of the General Conditions.


I6 11 Psychology and Counselling
Benefit

                   NSW/ACT          QLD            SA       TAS           VIC         WA          NT
Initial Visit        $40.00         $42.00       $40.00     $25.00       $24.00      $40.00      $42.00
Subsequent Visit     $30.00         $28.00       $30.00     $25.00       $24.00      $30.00      $28.00
Group Treatment      $10.00         $10.00       $10.00      $8.00        $8.00      $10.00      $10.00

Annual Limit

$300 per person up to a maximum of $1250 per person for all Therapies as described in Rule B2
(“Therapies”) of the General Conditions.


I6 12 Alternative Therapies



I6 13 Natural Therapies



I6 14 Speech Therapy
Benefit

                   NSW/ACT       QLD           SA         TAS          VIC         WA           NT
Initial Visit       $36.00        $27.00       $36.00      $18.00      $22.00      $36.00       $27.00
Subsequent Visit    $23.00        $21.00       $23.00      $18.00      $15.00      $23.00       $21.00

Annual Limit

$300 per person up to a maximum of $1250 per person for all Therapies as described in Rule B2
(“Therapies”) of the General Conditions.




                                                                                    73 of 545
I6 15 Orthotics
Benefit



Foot Orthotic – custom made                $75.00

Annual Limit

$1000 per person combined with Non Surgically Implanted Prostheses and Appliances.

I6 16 Dietetics
Benefit

                   NSW/ACT       QLD           SA         TAS          VIC         WA            NT
Initial Visit       $48.20        $47.20       $49.50      $43.10      $45.30      $49.50        $48.20
Subsequent Visit    $24.65        $22.05       $25.20      $24.00      $23.80      $24.90        $24.65

Annual Limit

$300 per person up to a maximum of $1250 per person for all Therapies as described in Rule B2
(“Therapies”) of the General Conditions.


I6 17 Occupational Therapy
Benefit

                   NSW/ACT       QLD           SA         TAS          VIC         WA            NT
Initial Visit       $35.00        $27.00       $35.00      $18.00      $22.00      $35.00        $27.00
Subsequent Visit    $23.00        $21.00       $23.00      $18.00      $15.00      $23.00        $21.00

Annual Limit

$300 per person up to a maximum of $1250 per person for all Therapies as described in Rule B2
(“Therapies”) of the General Conditions.

I6 18 Naturopathy



I6 19 Acupuncture



I6 20 Other Therapies
Osteopathy

Benefit


                                                                                     74 of 545
                    NSW/ACT          QLD            SA        TAS           VIC         WA         NT
Initial Visit         $25.00         $27.00       $25.00      $15.00       $30.00      $25.00     $27.00
Subsequent Visit      $18.00         $19.00       $18.00      $15.00       $22.00      $18.00     $19.00

Eye Therapy

Benefit

                    NSW/ACT          QLD            SA        TAS           VIC         WA         NT
Initial Visit         $25.00         $27.00       $25.00      $18.00       $22.00      $25.00     $27.00
Subsequent Visit      $20.00         $21.00       $20.00      $18.00       $15.00      $20.00     $21.00


Ante Natal and Post Natal Classes by a Midwife

From 1 November 2010, the Company will not pay benefits for services which have an MBS item
number and are provided outside a hospital by a participating midwife.

Benefit

                    NSW/ACT          QLD            SA        TAS          VIC          WA         NT
Per Visit             $10.00         $10.00       $10.00      $10.00       $8.00       $10.00     $10.00

Annual Limit

$300 per person up to a maximum of $1250 per person for all Therapies as described in Rule
B2.2 (“Therapies”) of the General Conditions.


I6 21 Non Surgically Implanted Prostheses and Appliances
Benefit

Benefits for non Surgically Implanted Prostheses and Appliances are payable as set out in the
Company’s Benefit Schedule and in accordance with the Rules set out in Section E3 of the
General Conditions.

Annual Limit

$1000 per person combined with Orthotics.


I6 22 Hearing Aids
Benefit

Hearing aid – Monaural - $500 in all States.

Annual Limit



                                                                                      75 of 545
$500 per hearing aid up to a maximum of $1000 per person every five years.

I6 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.


I6 24 Ambulance Transportation
For policy holders who do not belong to an ambulance subscription scheme, the Company will
pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by
    a fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar
    year for policy holders who contribute to a policy that covers only one person (a single cover)
    and two trips per calendar year for policy holders who contribute to either a single parent or
    family cover.




I6 25 Accident Cover
School Accident and School Sports Cover

Benefit

The Company will provide payments for the cost of accident related health care services, except
for services that are covered by Medicare, incurred by a Dependant aged 18 years and under as a
result of an Accident at school or in any school activity provided that:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted;
   and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
   Benefit as set out in the Company Benefit Schedule for the respective type of services
   involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

$500 per registered Dependant aged 18 years and under.




                                                                                          76 of 545
I6 26 Funeral Benefit

Benefit

The Company will pay a funeral expense benefit in respect of a deceased person for the cost of
burial and/or cremation not paid or payable from any other source

The benefits shall be determined according to the age at which the deceased person commenced
continuously paying for this Policy.

Benefits are payable as follows:-

 Age                    Policy Holder/Spouse       Other Dependants
 Under 21 years                 $1000                      $500
 21 years to 30 years           $800                       $500
 31 years to 40 years           $600                       $500
 41 years to 50 years           $500                       $500
 51 years to 60 years           $350                       $350
 61 years to 64 years           $150                       $150
 65 years and over               Nil*                      $150

*(1) Policy Holders aged 65 years of age or over who joined this Policy prior to 1 February 1984
     are entitled to a benefit of $150.
 (2) Policy Holders aged 65 years of age or over who joined this Policy after 1 February 1984 are
     not entitled to a funeral benefit.
 (3) Policy Holders who joined this Policy after 31 January 1992 are not entitled to a funeral
     benefit.

Limit

 $1000 per person

I6 27 Other Special
HOME/BUSH NURSING

Benefit

Benefits are payable for the following services:

(1) Home nursing attention by a registered general trained nurse in private practice where in the
opinion of the Medical Referee appointed by the Company the services are for treatment of the
persons ‘illness and result in reduction of avoidance of a Hospital admission.

(2) Bush nursing attention by a registered nurse employed at a public hospital or bush nursing
centre in areas having no resident doctor.

Benefits are payable as set out in the Company’s Benefit Schedule.




                                                                                        77 of 545
Annual Limit
(1) $500 per person for visits less than six hours

(2) $500 per person for visits in excess of six hours

LOCAL AND INTERSTATE TRAVEL

Benefit

The Company will pay the Policyholder a benefit towards local and interstate travelling expenses
for a person covered under this Policy and an attendant subject to the following conditions:

(1) The person must be referred by a Medical Practitioner; and

(2) The travel must be for essential medical treatment not available locally or that the referring
Medical Practitioner could not provide.

Benefits are payable as set out in the Company’s Benefit Schedule.


Annual Limit
$100 combined per person and attendant.

NON-HOSPITAL ACCOMMODATION

Benefit

The Company will pay the Policyholder a benefit towards overnight non-hospital accommodation
expenses for a person covered under this Policy and an attendant subject to the following
conditions:

(1) The person must be referred by a Medical Practitioner;

(2) The travel must be for essential medical treatment not available locally or that the referring
Medical Practitioner could not provide; and

(3) The return distance travelled for treatment must not be less than 200kms from the Policy
Holder’s normal place of residence.

Benefits are payable as set out in the Company’s Benefit Schedule.


Annual Limit
$100 combined per person and attendant.




                                                                                          78 of 545
I7 SCHEDULE GENERAL TREATMENT TABLES
I7 1 Table Name or Group of Table Names

EVERYDAY EXTRAS

I7 2 Eligibility
Unless specified elsewhere in these Rules, new Policyholders are required to purchase Everyday Extras in
combination with an available level of hospital cover and cannot purchase it as a stand-alone product.


Product closed to new members from 30th November 2010.


I7 3 General Conditions


I7 4 Loyalty Bonuses



I7 5 Dental
Benefit

Benefits for Dental services are payable as set out in the Company Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

Annual Limit

Preventive Dental – No limit
General Dental - $300 per person
Major Dental - $300 per person
Orthodontia – No cover

I7 6 Optical
Benefit

                         NSW/ACT           QLD             SA          TAS           VIC           WA         NT
Frames                    $89.60          $97.45       $108.65        $95.20      $106.40        $95.20    $100.80
Single Vision Lenses      $62.30          $62.30        $72.25        $62.30       $62.30        $62.30     $67.20
Multifocal Lenses        $123.20         $135.55       $150.00       $136.65      $136.60       $130.80    $138.35
Contact Lenses-            70%             70%           70%           70%          70%           70%        70%
Disposable

Annual Limit

$185 per person



                                                                                              79 of 545
I7 7 Physiotherapy
Benefit

                     NSW/ACT          QLD            SA         TAS            VIC          WA           NT
Initial Visit        $34.30          $31.20       $32.30       $32.05        $31.90       $33.10       $32.75
Subsequent Visit     $27.15          $25.60       $25.85       $25.20        $25.60       $26.80       $26.15
Group Session         $8.65           $7.75        $8.95        $8.95         $8.95        $8.95        $8.95
Ante/Post Natal      $15.40          $10.50       $10.45       $10.50        $11.20       $10.45       $15.75
Visits

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.

I7 8 Chiropractic
Benefit

                     NSW/ACT        QLD           SA          TAS           VIC          WA            NT
Initial Visit         $39.00         $32.00       $35.00       $33.00       $34.00       $35.00        $35.00
Subsequent Visit      $25.00         $23.00       $25.00       $23.00       $24.00       $25.00        $25.00

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.



I7 9 Non PBS Pharmaceuticals
Benefit

Ancillary Pharmaceutical Items

After deducting an amount equal to the current Commonwealth PBS co-payment, the Company
will pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50
per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Medical Assistance Service

The Company will pay a benefit of up to $40 for a Medical Assistance Service with a pharmacist
that is approved by the Company.

Benefits for a Medical Assistance Service is payable in accordance with the rules set out in
Section E3 of the General Conditions.




                                                                                          80 of 545
Annual Limit

(1) Ancillary Pharmaceutical Items - $150 per person.

(2) Medical Assistance Service – One medication Assistance service per person.

I7 10 Podiatry
Benefit

                    NSW/ACT       QLD           SA         TAS         VIC         WA           NT
Initial Visit        $30.00        $30.00       $35.00      $30.00     $32.00      $35.00       $33.00
Subsequent Visit     $26.00        $25.00       $28.00      $25.00     $26.00      $27.00       $28.00

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.

I7 11 Psychology and Counselling
Benefit

                    NSW/ACT         QLD             SA        TAS         VIC         WA          NT
Initial Visit         $70.00        $65.00        $85.00      $65.00     $70.00     $100.00      $77.00
Subsequent Visit      $62.00        $55.00        $70.00      $60.00     $60.00      $70.00      $60.00
Group Treatment       $32.00        $30.00        $60.00      $56.00     $56.00      $60.00      $30.00

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.

I7 12 Alternative Therapies




I7 13 Natural Therapies
The following Natural (Complimentary) Therapies are covered:-

Remedial massage, aromatherapy, alexander technique, feldenkrais, kinesiology, homoeopathy,
iridology, bowen technique, herbalist, shiatsu, reflexology, exercise physiology:

Benefit

Benefits are payable as set out in the Company’s Benefit Schedule.

Annual Limit




                                                                                    81 of 545
$200 per person for all Complimentary Therapies (including Acupuncture and Naturopathy).




I7 14 Speech Therapy
Benefit

                   NSW/ACT       QLD           SA         TAS          VIC         WA           NT
Initial Visit       $70.00        $60.00       $75.00      $55.00      $60.00      $78.00       $60.00
Subsequent Visit    $32.00        $35.00       $45.00      $30.00      $35.00      $35.00       $35.00

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I7 15 Orthotics



I7 16 Dietetics
Benefit

                   NSW/ACT       QLD           SA         TAS          VIC         WA           NT
Initial Visit       $55.15        $50.40       $56.60      $49.35      $51.85      $52.50       $53.95
Subsequent Visit    $28.20        $24.75       $28.90      $27.50      $27.20      $24.90       $25.20

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.

I7 17 Occupational Therapy
Benefit

                   NSW/ACT       QLD           SA         TAS          VIC         WA           NT
Initial Visit       $65.00        $58.00       $65.00      $50.00      $52.00      $60.00       $55.00
Subsequent Visit    $35.00        $40.00       $50.00      $30.00      $40.00      $32.00       $35.00

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.




                                                                                    82 of 545
I7 18 Naturopathy
Benefit

                   NSW/ACT         QLD            SA        TAS           VIC         WA         NT
Initial Visit        $28.00        $28.00       $28.00      $24.50       $28.00      $24.50     $25.00
Subsequent Visit     $24.50        $21.00       $21.00      $21.00       $24.50      $21.00     $22.00

Annual Limit

$200 per person for all Complementary Therapies (including Acupuncture and all Natural
Therapies listed in Rule I7.13).

I7 19 Acupuncture
Benefit

                   NSW/ACT         QLD            SA        TAS           VIC         WA         NT
Initial Visit        $31.50        $31.50       $35.00      $28.00       $32.40      $35.00     $31.50
Subsequent Visit     $24.50        $24.50       $25.05      $25.40       $24.50      $25.75     $28.00

Annual Limit

$200 per person for all Complementary Therapies (including Naturopathy and all Natural
Therapies listed in Rule I7.13).


I7 20 Other Therapies
Osteopathy

Benefit

                   NSW/ACT         QLD            SA        TAS           VIC         WA         NT
Initial Visit        $39.90        $35.00       $40.60      $32.90       $36.40      $32.65     $35.00
Subsequent Visit     $37.10        $31.10       $27.65      $26.25       $31.50      $27.45     $31.95

Eye Therapy

Benefit

All States

Initial Visit      $42.00
Subsequent Visit   $35.00

Ante Natal and Post Natal Classes by a Midwife

From 1 November 2010, the Company will not pay benefits for services which have an MBS item
number and are provided outside a hospital by a participating midwife.

Benefit



                                                                                    83 of 545
                     NSW/ACT          QLD            SA         TAS           VIC          WA           NT
Per Visit              $17.50         $29.55       $28.00       $28.00       $28.00       $31.50       $29.55

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I7 21 Non Surgically Implanted Prostheses and Appliances




I7 22 Hearing Aids



I7 23 Prevention Health Management
Living Well Programs

The Company will provide a cover towards selected Company approved health related services
and health management programs that are designed to prevent or relieve a specific health
condition or conditions.

Benefit

50% of the cost

Annual Limit

$100 per person


Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.


I7 24 Ambulance Transportation
For policy holders who do not belong to an ambulance subscription scheme, the Company will
pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by
    a fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar
    year for policy holders who contribute to a policy that covers only one person (a single cover)


                                                                                         84 of 545
    and two trips per calendar year for policy holders who contribute to either a single parent or
    family cover.

I7 25 Accident Cover
Benefit

The Company will provide payments to persons covered under this Policy for the cost of accident
related health care services, except for services that are covered by Medicare, incurred as a direct
result of an Accident after joining where:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted;
   and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
   Benefit as set out in the Company’s Benefit Schedule for the respective type of services
   involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

(1) $2000 per person up to a maximum of $4000 per Policy.

(2) $2000 per Accident per person up to a maximum of $4000 per Accident per Policy.


I7 26 Accidental Death Funeral Expenses



I7 27 Other Special




I8 SCHEDULE GENERAL TREATMENT TABLES
I8 1 Table Name or Group of Table Names

ESSENTIAL EXTRAS

I8 2 Eligibility




                                                                                          85 of 545
I8 3 General Conditions


I8 4 Loyalty Bonuses



I8 5 Dental
Benefit

Benefits for Dental services are payable as set out in the Company’s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

Annual Limit

Preventive and General Dental - $250 per person
Major Dental - $1000 per person
Orthodontia – Lifetime Limit of $2500 per person


I8 6 Optical
Benefit

                       NSW/ACT          QLD           SA         TAS           VIC          WA         NT
Frames                  $76.80         $83.55      $93.15       $81.60       $91.20       $81.60     $86.40
Single Vision Lenses    $53.40         $53.40      $61.95       $53.40       $53.40       $53.40     $57.60
Multifocal Lenses      $105.60        $116.20     $129.60      $117.15      $117.10      $112.10    $118.60
Contact Lenses-          60%            60%         60%          60%          60%          60%        60%
Disposable

Annual Limit

$150 per person


I8 7 Physiotherapy
Benefit

                    NSW/ACT         QLD            SA         TAS           VIC          WA          NT
Initial Visit       $29.40         $26.75       $27.70       $27.45       $27.35       $28.35      $28.05
Subsequent Visit    $23.30         $21.95       $22.15       $21.60       $21.95       $23.00      $22.45
Group Session        $7.45          $6.65        $7.70        $7.70        $7.65        $7.70      $12.65
Ante/Post Natal     $13.20          $9.00        $8.95        $9.00        $9.60        $8.95      $13.50
Visits

Annual Limit




                                                                                       86 of 545
$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I8 8 Chiropractic
Benefit

                     NSW/ACT        QLD           SA          TAS           VIC          WA            NT
Initial Visit         $39.00         $32.00       $35.00       $33.00       $34.00       $35.00        $35.00
Subsequent Visit      $25.00         $23.00       $25.00       $23.00       $24.00       $25.00        $25.00
Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.



I8 9 Non PBS Pharmaceuticals
Benefit

Ancillary Pharmaceutical Items

After deducting an amount equal to the current Commonwealth PBS co-payment, the Company
will pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50
per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Medical Assistance Service

The Company will pay a benefit of up to $40 for a Medical Assistance Service with a pharmacist
that is approved by the Company.

Benefits for a Medical Assistance Service is payable in accordance with the rules set out in
Section E3 of the General Conditions.

Annual Limit

(1) Ancillary Pharmaceutical Items - $250 per person.

(2) Medical Assistance Service – One medication Assistance service per person.


I8 10 Podiatry
Benefit

                     NSW/ACT          QLD             SA         TAS           VIC          WA           NT
Initial Visit          $25.00         $23.85        $27.00       $23.10       $27.00       $29.30       $24.15



                                                                                          87 of 545
Subsequent Visit      $22.20        $21.00       $21.60     $19.80       $22.20      $22.75     $21.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.

I8 11 Psychology and Counselling
Benefit

                   NSW/ACT          QLD            SA       TAS           VIC         WA         NT
Initial Visit        $60.00         $54.00       $72.00     $52.35       $60.00      $84.00     $66.00
Subsequent Visit     $52.65         $45.00       $57.00     $48.00       $49.95      $56.75     $48.45
Group Treatment      $27.00         $22.90       $47.70     $47.70       $47.70      $47.70     $22.90

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I8 12 Alternative Therapies



I8 13 Natural Therapies



I8 14 Speech Therapy
Benefit

                   NSW/ACT          QLD            SA       TAS           VIC         WA         NT
Initial Visit        $59.10         $48.00       $62.70     $45.00       $50.10      $66.00     $49.45
Subsequent Visit     $27.00         $24.15       $36.00     $23.80       $26.80      $28.60     $29.55

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I8 15 Orthotics
Benefit



Foot Orthotic – custom made               $90.00


                                                                                    88 of 545
Annual Limit

$500 per person combined with Non Surgically Implanted Prostheses and Appliances.

I8 16 Dietetics
Benefit

                   NSW/ACT          QLD            SA       TAS           VIC         WA         NT
Initial Visit        $48.20         $47.20       $49.50     $43.10       $45.30      $49.50     $48.20
Subsequent Visit     $24.65         $22.05       $25.20     $24.00       $23.80      $24.90     $24.65

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I8 17 Occupational Therapy
Benefit

                   NSW/ACT          QLD            SA       TAS           VIC         WA         NT
Initial Visit        $46.20         $31.35       $43.45     $33.60       $36.00      $42.80     $37.45
Subsequent Visit     $24.80         $27.00       $32.90     $19.55       $27.00      $21.70     $23.35

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.




I8 18 Naturopathy



I8 19 Acupuncture
Benefit

                   NSW/ACT          QLD            SA       TAS           VIC         WA         NT
Initial Visit        $31.50         $31.50       $35.00     $28.00       $32.35      $35.00     $31.50
Subsequent Visit     $24.50         $24.50       $25.00     $25.35       $24.50      $25.75     $28.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.




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I8 20 Other Therapies
Osteopathy

Benefit

                    NSW/ACT         QLD             SA        TAS           VIC         WA         NT
Initial Visit         $34.20        $30.00        $34.80      $28.20       $31.20      $28.00     $30.00
Subsequent Visit      $31.80        $26.65        $23.70      $22.50       $27.00      $23.50     $27.40

Eye Therapy

Benefit

                    NSW/ACT         QLD             SA        TAS           VIC         WA         NT
Initial Visit         $30.00        $26.30        $19.80      $22.50       $24.70      $19.80     $25.50
Subsequent Visit      $24.60        $19.95        $14.85      $21.60       $22.50      $14.85     $19.80


Ante Natal and Post Natal Classes by a Midwife

From 1 November 2010, the Company will not pay benefits for services which have an MBS item
number and are provided outside a hospital by a participating midwife.

Benefit

                    NSW/ACT         QLD             SA        TAS           VIC         WA         NT
Per Visit             $15.00        $25.30        $24.00      $24.00       $24.00      $27.00     $25.30

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


I8 21 Non Surgically Implanted Prostheses and Appliances
Benefit

Benefits for non Surgically Implanted Prostheses and Appliances are payable as set out in the
Company’s Benefit Schedule and in accordance with the Rules set out in Section E3 of the
General Conditions.

Annual Limit

$500 per person combined with Orthotics.


I8 22 Hearing Aids
Benefit



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Hearing aid – Monaural - $600 in all States.

Annual Limit

$600 per person every five years.



I8 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.


I8 24 Ambulance Transportation

For policy holders who do not belong to an ambulance subscription scheme, the Company will
pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by
    a fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar
    year for policy holders who contribute to a policy that covers only one person (a single cover)
    and two trips per calendar year for policy holders who contribute to either a single parent or
    family cover.


I8 25 Accident Cover
Benefit

The Company will provide payments to persons covered under this Policy for the cost of accident
related health care services, except for services that are covered by Medicare, incurred as a direct
result of an Accident after joining where:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted;
   and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
   Benefit as set out in the Company Benefit Schedule for the respective type of services
   involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

(1) $2000 per person up to a maximum of $4000 per Policy.


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(2) $2000 per Accident per person up to a maximum of $4000 per Accident per Policy.


I8 26 Accidental Death Funeral Expenses



I8 27 Other Special




I9 SCHEDULE GENERAL TREATMENT TABLES
I9 1 Table Name or Group of Table Names

Premier Extras (M) and ANZ (#M)

I9 2 Eligibility



I9 3 General Conditions
1. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (a) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (b) for more than one service of general treatment on a given day provided by a recognised
         provider in registered premises in private practice who is recognised by the Company in
         more than one profession.

2. General treatment services must be rendered by or on behalf of a recognised practitioner for
   benefits to be payable.

3. General treatment services must be rendered on premises registered with the Company for
   benefits to be payable.

4.   General treatment benefits are not payable for any of the circumstances outlined in Rule E 4
     of the General Conditions.


I9 4 Loyalty Bonuses




                                                                                       92 of 545
After 12 months continuous membership, a policy holder is entitled to an increased benefit
maximum equal to the first year benefit maximum for the relevant modality plus 20% of the first
year benefit maximum. For each subsequent continuous 12 months membership, the policy holder
is entitled to an increased benefit maximum equal to their previous years benefit maximum for
the relevant modality plus 20% of the first year benefit maximum. No further increased benefit
maximums apply beyond 200% of the first year maximum. Loyalty bonuses do not apply to
optical, massage, hearing aids and non surgically implanted prostheses and appliances.


I9 5 Dental

Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services
and Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-
operative care.


                  Major dental services include crowns, bridgework, partial dentures and repairs,
                  prosthodontic services, periodontics, oral surgery, endodontics and oral
                  appliances for sleep apnoea implant prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every three years.


Maximum per person during first benefit entitlement year

                 General Dental
All States                                        NIL
                 Major Dental
SA, VIC                                          $700
NSW, QLD, TAS, WA                                $600
NT                                               $350
Orthodontia
All States                                       $450
Lifetime Limit                                   $2700


I9 6 Optical

All States

Frames for prescription lenses                 $150.00
Single Vision Lenses                            $57.00
Progressive Lenses                             $125.00
Contact Lenses, disposable
1 month supply                                  $40.00
3 months supply                                 $70.00
Contact Lenses, non-disposable                 $135.00




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The Maximum per person during any one year is $280.00.

I9 7 Physiotherapy

                           NSW           QLD       SA         TAS          VIC           WA         NT
Initial visit               $38.50        $30.00   $31.50      $32.00       $32.00       $35.00     $32.50
Subsequent visit            $31.00        $25.00   $24.50      $24.00       $24.00       $29.00     $25.50
Ante natal visit            $15.00        $11.00   $ 9.50      $13.00       $13.00       $11.00     $ 9.50
Post natal visit            $15.00        $11.00   $ 9.50      $13.00       $13.00       $11.00     $ 9.50
Group therapy visit         $15.00        $11.00   $ 7.50      $13.00       $13.00       $11.00     $ 9.50
                                          Maximum per person during first benefit entitlement year
                           $750.00       $750.00   $650.00     $750.00      $750.00      $750.00   $550.00


I9 8 Chiropractic

                           NSW           QLD           SA          TAS           VIC            WA       NT
Initial visit               $40.00        $30.00       $36.00       $32.00       $32.00         $32.00   $33.00
Subsequent visit            $29.50        $22.00       $23.50       $24.00       $24.00         $25.00   $23.50
X-ray service – per         $42.00        $75.00                    $40.00       $40.00         $75.00
Person per year
                                       Maximum per person during first benefit entitlement year
                           $450.00    $450.00   $450.00   $450.00      $450.00       $450.00    $450.00
                                  Maximum per family membership during first benefit entitlement year
                           $600.00    $600.00   $600.00   $600.00      $600.00       $600.00    $600.00

The above chiropractic benefits apply to the first 10 visits per person in any calendar year.
Benefits for visits after the first 10 are paid at 50% of the above.


I9 9 Non PBS Pharmaceuticals

After payment by the policy holder of an amount equal to the highest prescribed PBS prescription
fee, a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $40 per
script item.

Maximum per person during first benefit entitlement year
NSW           $750
QLD           $650
SA, TAS, VIC  $400
WA            $500
NT            $600




Pharmacy Saver




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Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the
counter cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at
participating pharmacies provided that the item is:


(a) Designed to manage or prevent disease, injuries or a condition; or
(b) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.

I9 10 Podiatry

                              NSW           QLD       SA        TAS           VIC            WA         NT
Initial visit                  $32.00        $30.00  $31.50      $32.00       $32.00         $34.00     $31.50
Subsequent visit               $24.00        $22.00  $26.00      $24.00       $26.00         $24.00     $26.00
Surgical Nail Resection        $80.00        $80.00 $100.00      $80.00       $80.00         $80.00    $100.00
                                             Maximum per person during first benefit entitlement year
                              $400.00       $400.00 $400.00     $400.00      $400.00        $400.00   $400.00


I9 11 Psychology and Counselling

                           NSW              QLD             SA           TAS            VIC                WA        NT
Initial visit               $60.00           $45.00         $83.00        $39.00        $60 00             $80.00    $83.00
Subsequent visit            $40.00           $40.00         $78.00        $39.00        $45.00             $60.00    $78.00
Interview with              $25.00           $25.00         $40.00        $25.00        $25.00             $25.00    $40.00
another person or
Family attendance
Group therapy visit          $11.00          $11.00  $20.00      $13.00       $15.00         $25.00                  $20.00
                                            Maximum per person during first benefit entitlement year
                           $400.00          $400.00 $400.00     $400.00      $400.00        $400.00                 $400.00


I9 12 Alternative Therapies


I9 13 Natural Therapies
                          NSW             QLD        SA        TAS           VIC          WA                        NT
Initial visit              $24.00          $28.00    $32 00     $24.00       $24.00       $24.00                    $32 00
Subsequent visit           $24.00          $24.00    $24.00     $24.00       $24.00       $24.00                    $24.00
Group therapy visit         $8.00           $8.00     $8.00      $8.00        $8.00        $8.00                     $8.00
                                          Maximum per person during first benefit entitlement year
                            $450.00         $450.00 $500.00     $450.00      $450.00      $450.00                   $450.00

For massage and aromatherapy a benefit of $20 per visit is payable in all States.
Massage and aromatherapy benefits are limited to a combined maximum of $150 per person and
$300 per family membership in any one year.




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I9 14 Speech Therapy

                      NSW        QLD       SA        TAS          VIC           WA        NT
Initial visit          $52.00     $50.00   $75.00     $52.00       $60.00       $75.00    $75.00
Subsequent visit       $28.00     $26.00   $46.00     $28.00       $40.00       $40.00    $46.00
Group therapy visit    $10.00     $10.00   $16.00     $13.00       $13.00       $20.00    $16.00
                                 Maximum per person during first benefit entitlement year
                       $400.00    $400.00 $400.00     $400.00      $400.00      $400.00 $400.00


I9 15 Orthotics




I9 16 Dietetics

                      NSW        QLD        SA        TAS          VIC           WA         NT
Initial visit          $40.00     $40.00   $46.50      $40.00       $40.00       $50.00     $46.50
Subsequent visit       $24.00     $22.00   $22.00      $24.00       $24.00       $25.00     $22.00
Group therapy visit    $11.00     $11.00   $10.50      $13.00       $13.00       $11.00     $10.50
                                  Maximum per person during first benefit entitlement year
                      $400.00    $400.00  $400.00     $400.00      $400.00      $400.00    $400.00


I9 17 Occupational Therapy

                      NSW        QLD       SA        TAS          VIC           WA        NT
Initial visit          $35.00     $30.00   $56 00     $32.00       $32.00       $45.00    $56 00
Subsequent visit       $30.00     $22.00   $37.00     $22.00       $22.00       $30.00    $37.00
Group therapy visit    $11.00     $11.00   $13.00     $13.00       $13.00       $12.00    $13.00
                                 Maximum per person during first benefit entitlement year
                       $400.00    $400.00 $400.00     $400.00      $400.00      $400.00 $400.00


I9 18 Naturopathy


I9 19 Acupuncture




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I9 20 Other Therapies

Eye Therapy                NSW          QLD           SA            TAS       VIC           WA       NT
Initial visit               $35.00       $30.00       $24.00         $32.00   $32.00        $60.00   $24.00
Subsequent visit            $30.00       $22.00       $19.50         $22.00   $22.00        $40.00   $19.50
Group therapy visit         $16.00       $16.00       $16.00         $16.00   $16.00        $16.00   $16.00

                                         Maximum per person during first benefit entitlement year
                            $400.00      $400.00 $400.00     $400.00       $400.00       $400.00     $400.00


I9 21 Non Surgically Implanted Prostheses and Appliances

Asthma Pumps
Refund of 80% for the cost of supply.
Limited to one appliance per person every 3 years and $300 per person every 3 years.

Blood Glucose Monitors/INR (International Normalised Ratio) Devices
Refund of 80% for the cost of supply.
Limited to one appliance per person every year and $500 per person every year.

Continuous or Bilevel Positive Airway Pressure Devices
Refund of 80% for the cost of supply.
Limited to one device per person every 2 years and $750 per person every 2 years.

Surgical Stockings
Refund of 80% for the cost of supply.
Limited to $100 per person in any one year.

TENS Machine (Transcutaneous Electronic Nerve Stimulator)
Refund of 80% for the cost of supply.
Limited to one device per person every year and $175 per person every year.

Blood Pressure Monitors
Refund of 80% for the cost of supply.
Limited to one device per person every year and $175 per person every year.

Hire, Repair and Maintenance of a Health Appliance
80% for the cost and $100 per person every year.

Defined Appliances
Refund of 80% for the cost of supply.
Limited to $500 per person in any one year.
Refer to Rule E3.3 (6) for a list of approved defined appliances.


                There is a combined maximum of $1000 per person during any one year for all
                Prostheses and Appliances under 1.21. This maximum also includes any benefits
                paid for hearing aids under 1.22.




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I9 22 Hearing Aids

Refund of 80% for the cost of supply or the cost of repairs.
This benefit is limited to one hearing aid per ear per person every 3 years and $850 per
person every 3 years. This limit also forms part of the overall limit for prostheses and
appliances under 1.21.


I9 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.

I9 24 Ambulance Transportation



I9 25 Accident Cover



I9 26 Accidental Death Funeral Expenses



I9 27 Other Special


Local and Interstate Travelling Expenses
All States
Benefit for the cost of travel.
Limited to $100 per combined patient and attendant during any one year.

Overnight Non-Hospital Accommodation
All States
Benefit of up to $40 per night
Limited to $150 per combined patient and attendant during any one year.




I10 SCHEDULE GENERAL TREATMENT TABLES
I10 1 Table Name or Group of Table Names



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General Extras (E) and ANZ (#E):

I10 2 Eligibility



I10 3 General Conditions
4. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (a) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (b) for more than one service of general treatment on a given day provided by a recognised
         provider in registered premises in private practice who is recognised by the Company in
         more than one profession.

5. General treatment services must be rendered by or on behalf of a recognised practitioner for
   benefits to be payable.

6. General treatment services must be rendered on premises registered with the Company for
   benefits to be payable.

4.   General treatment benefits are not payable for any of the circumstances outlined in Rule E 4
     of the General Conditions.




I10 4 Loyalty Bonuses

After 12 months continuous membership, a policy holder is entitled to an increased benefit
maximum equal to the first year benefit maximum for the relevant modality plus 20% of the first
year benefit maximum. For each subsequent continuous 12 months membership, the policy holder
is entitled to an increased benefit maximum equal to their previous years benefit maximum for
the relevant modality plus 20% of the first year benefit maximum. No further increased benefit
maximums apply beyond 200% of the first year maximum. Loyalty bonuses do not apply to
optical, massage, hearing aids and non surgically implanted prostheses and appliances.


I10 5 Dental

Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services
and Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-
operative care.


                  Major dental services include crowns, bridgework, partial dentures and repairs,
                  prosthodontic services, periodontics, oral surgery, endodontics and oral
                  appliances for sleep apnoea implant prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every three years.


                                                                                                 99 of 545
Maximum per person during first benefit entitlement year

               General Dental

All States                              NIL
               Major Dental
SA, VIC                                $500
NSW, QLD, TAS, WA                      $400
NT                                     $350
Orthodontia
All States                             $400
Lifetime Limit                         $1800


I10 6 Optical

All States

Frames for prescription lenses         $105.00
Single Vision Lenses                    $45.00
Progressive Lenses                      $95.00
Contact Lenses, disposable
1 month supply                          $32.00
3 months supply                         $50.00
Contact Lenses, non-disposable         $100.00

The Maximum per person during any one year is $180.00.


I10 7 Physiotherapy

                         NSW        QLD       SA         TAS          VIC           WA         NT
Initial visit             $30.00     $28.00   $23.00      $25.00       $25.00       $25.00     $24.00
Subsequent visit          $24.00     $22.00   $16.00      $17.00       $17.00       $21.50     $18.00
Ante natal visit          $13.50     $10.00    $7.00      $12.00       $12.00       $10.00      $8.00
Post natal visit          $13.50     $10.00    $8.00       $9.00        $9.00        $8.00      $8.00
Group therapy visit       $13.50     $10.00    $6.50       $9.00        $9.00        $8.00      $8.00
                                     Maximum per person during first benefit entitlement year
                         $600.00    $500.00   $450.00     $450.00      $450.00      $450.00   $500.00


I10 8 Chiropractic

                         NSW        QLD          SA        TAS        VIC         WA          NT
Initial visit             $31.50     $27.00      $24.00     $25.00    $25.00      $24.00      $22.00
Subsequent visit          $21.50     $19.00      $16.50     $17.00    $17.00      $18.00      $17.00
X-ray service – per       $40.00     $75.00                 $25.00    $25.00      $50.00
Person per year



                                                                             100 of 545
                                         Maximum per person during first benefit entitlement year
                              $350.00   $350.00   $350.00    $350.00      $350.00      $350.00     $350.00
                                    Maximum per family membership during first benefit entitlement year
                              $500.00   $500.00   $500.00    $500.00      $500.00      $500.00     $500.00
The above chiropractic benefits apply to the first 10 visits per person in any calendar
year.
Benefits for visits after the first 10 are paid at 50% of the above.


I10 9 Non PBS Pharmaceuticals

After payment by the policy holder of an amount equal to the highest prescribed PBS prescription
fee, a benefit of 100% of the cost of the balance of the prescription.

Benefit is limited to the following amounts per script item.

NSW, SA, NT, VIC                   $40.00
QLD, WA                            $35.00
TAS                                $20.00
Maximum per person during first benefit entitlement year

NSW                $650
QLD                $600
SA                 $300
TAS, VIC           $350
WA                 $400
NT                 $550


Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the
counter cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at
participating pharmacies provided that the item is:


(a) Designed to manage or prevent disease, injuries or a condition; or
(b) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.



I10 10 Podiatry

                              NSW           QLD       SA        TAS           VIC            WA         NT
Initial visit                  $22.00        $27.00  $23.00      $21.00       $23.00         $24.00    $23.00
Subsequent visit               $22.00        $19.00  $17.00      $17.00       $17.00         $20.00    $17.00
Surgical Nail Resection        $60.00        $60.00  $80.00      $60.00       $60.00         $60.00    $80.00
                                             Maximum per person during first benefit entitlement year
                              $300.00       $300.00 $300.00     $300.00      $300.00        $300.00   $300.00


                                                                                                101 of 545
I10 11 Psychology and Counselling

                         NSW          QLD          SA          TAS         VIC          WA       NT
Initial visit             $35.00       $42.00      $52.50       $27.00     $40 00       $60.00   $52.50
Subsequent visit          $30.00       $30.00      $44.00       $27.00     $35.00       $50.00   $44.00
Interview with another    $15.00       $15.00      $25.00       $15.00     $15.00       $15.00   $25.00
person or Family
attendance
Group therapy visit       $10.00       $10.00  $15.00       $9.00       $10.00         $20.00    $15.00
                                       Maximum per person during first benefit entitlement year
                         $300.00      $300.00 $300.00     $300.00      $300.00        $300.00   $300.00


I10 12 Alternative Therapies


I10 13 Natural Therapies
                         NSW      QLD         SA         TAS        VIC          WA             NT
Initial visit             $17.00   $17.00     $17 00      $17.00     $17.00       $17.00        $17 00
Subsequent visit          $17.00   $17.00     $17.00      $17.00     $17.00       $17.00        $17.00
Group therapy visit        $6.00    $6.00       $6.00      $6.00      $6.00        $6.00         $6.00
                            Maximum per person including Massage during first benefit entitlement year
                         $400.00  $400.00    $400.00     $400.00    $400.00      $400.00       $400.00

For massage and aromatherapy, a benefit of $12 per visit is payable in all States.
Massage and aromatherapy benefits are limited to $100 per person and $200 per family
membership in any one year.

The maximum of $400 per person (including Massage and Aromatherapy) during the first benefit
entitlement year is combined with Naturopathy under 2.16 and Acupuncture under 2.19.


I10 14 Speech Therapy

                         NSW          QLD       SA        TAS          VIC           WA        NT
Initial visit             $30.00       $27.00   $50.00     $25.00       $40.00       $55.00    $50.00
Subsequent visit          $25.00       $20.00   $30.00     $17.00       $25.00       $30.00    $30.00
Group therapy visit       $10.00       $10.00   $10.00      $9.00        $9.00       $15.00    $10.00
                                      Maximum per person during first benefit entitlement year
                           $300.00     $300.00 $300.00     $300.00      $300.00      $300.00 $300.00


I10 15 Orthotics




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I10 16 Dietetics

                           NSW           QLD        SA        TAS          VIC           WA         NT
Initial visit               $23.00        $32.00   $33.00      $21.00       $21.00       $35.00     $33.00
Subsequent visit            $18.00        $18.00   $17.00      $13.00       $13.00       $16.00     $17.00
Group therapy visit          $6.00        $10.00    $8.00       $9.00        $9.00        $8.00      $8.00
                                          Maximum per person during first benefit entitlement year
                           $300.00       $300.00  $300.00     $300.00      $300.00      $300.00    $300.00


I10 17 Occupational Therapy

                           NSW           QLD       SA        TAS          VIC           WA        NT
Initial visit               $30.00        $27.00   $42 00     $25.00       $25.00       $30.00    $42 00
Subsequent visit            $25.00        $20.00   $28.00     $17.00       $17.00       $25.00    $28.00
Group therapy visit         $10.00        $10.00    $9.00      $9.00        $9.00       $10.00     $9.00
                                         Maximum per person during first benefit entitlement year
                               $300.00    $300.00 $300.00     $300.00      $300.00      $300.00 $300.00


I10 18 Naturopathy

                      NSW          QLD        SA           TAS          VIC          WA           NT
Initial visit         $16.00       $24.00     $21.00       $17.00       $17.00       $16.00       $20.00
Subsequent visit      $16.00       $18.00     $15.00       $17.00       $17.00       $16.00       $16.50

Combined maximum for Natural Therapies under 2 13, Naturopathy under 2 18 and Acupuncture under
2.19 is $400 per person during the first benefit entitlement year.



I10 19 Acupuncture

                      NSW          QLD        SA           TAS          VIC          WA           NT
Initial visit         $16.00       $24.00     $21.00       $17.00       $17.00       $16.00       $22.00
Subsequent visit      $16.00       $18.00     $15.00       $17.00       $17.00       $16.00       $16.00

Combined maximum for Natural Therapies under 2.13, Naturopathy under 2.18 and Acupuncture under
2.19 is $400 per person during the first benefit entitlement year.
I




                                                                                      103 of 545
I10 20 Other Therapies

Eye Therapy                NSW          QLD       SA        TAS           VIC           WA          NT
Initial visit               $30.00       $27.00   $21.00     $25.00       $25.00         $42.00     $21.00
Subsequent visit            $25.00       $20.00   $17.00     $17.00       $17.00         $30.00     $17.00
Group therapy visit         $10.00       $10.00    $9.00      $9.00        $9.00          $8.00      $8.00
                                         Maximum per person during first benefit entitlement year
                            $300.00      $300.00 $300.00     $300.00       $300.00       $300.00    $300.00




I10 21 Non Surgically Implanted Prostheses and Appliances

Asthma Pumps
Refund of 60% for the cost of supply.
Limited to one appliance per person every 3 years and $200 per person every 3 years.

Blood Glucose Monitors/INR (International Normalised Ratio) Devices
Refund of 60% for the cost of supply.
Limited to one appliance per person every year and $400 per person every year.

Continuous or Bilevel Positive Airway Pressure Devices
Refund of 60% for the cost of supply.
Limited to one device per person every 2 years and $500 per person every 2 years.

Surgical Stockings
Refund of 60% for the cost of supply.
Limited to $100 per person in any one year.

TENS Machine (Transcutaneous Electronic Nerve Stimulator)
Refund of 60% for the cost of supply.
Limited to one device per person every year and $125 per person every year.

Blood Pressure Monitors
Refund of 60% for the cost of supply.
Limited to one device per person every year and $125 per person every year.

Hire, Repair and Maintenance of a Health Appliance
60% for the cost and $100 per person every year.

Defined Appliances
Refund of 60% for the cost of supply.
Limited to $300 per person in any one year.
Refer to Rule E3.3 (6) for a list of approved defined appliances.



                                                                                       104 of 545
                There is a combined maximum of $500 per person during any one year for all
                Prostheses and Appliances under 2.21. This maximum also includes any benefits
                paid for hearing aids under 2.22.



I10 22 Hearing Aids

Refund of 60% for the cost of supply or the cost of repairs.
This benefit is limited to one hearing aid per ear per person every 3 years and $500 per
person every 3 years. This limit also forms part of the overall limit for prostheses and
appliances under 2.21.


I10 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.

I10 24 Ambulance Transportation



I10 25 Accident Cover



I10 26 Accidental Death Funeral Expenses




I10 27 Other Special


Local and Interstate Travelling Expenses
All States
Benefit for the cost of travel.
Limited to $100 per combined patient and attendant during any one year.

Overnight Non-Hospital Accommodation
All States
Benefit of up to $40 per night
Limited to $150 per combined patient and attendant during any one year.




                                                                                        105 of 545
I11 SCHEDULE GENERAL TREATMENT TABLES
I11 1 Table Name or Group of Table Names


Your Choice Extras Plus (A) and ANZ (#A):


I11 2 Eligibility

This table is subject to the provision that benefit eligibility is limited to four general treatment
service items, as selected by the policy holder. After 12 continuous months’ cover, the policy
holder may change all or any of their selection. No further change to any selections may be made
until a further 12 months continuous cover has expired.


I11 3 General Conditions

1. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (a) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (b) for more than one service of general treatment on a given day provided by a recognised
         provider in registered premises in private practice who is recognised by the Company in
         more than one profession.

2. General treatment services must be rendered by or on behalf of a recognised practitioner for
   benefits to be payable.

3. General treatment services must be rendered on premises registered with the Company for
   benefits to be payable.

4.   General treatment benefits are not payable for any of the circumstances outlined in Rule E 4
     of the General Conditions.



I11 4 Loyalty Bonuses

After 12 months continuous membership, a policy holder is entitled to an increased benefit
maximum equal to the first year benefit maximum for the relevant modality plus 20% of the first
year benefit maximum. For each subsequent continuous 12 months membership, the policy holder
is entitled to an increased benefit maximum equal to their previous years benefit maximum for
the relevant modality plus 20% of the first year benefit maximum. No further increased benefit
maximums apply beyond 200% of the first year maximum. Loyalty bonuses do not apply to
optical and massage.




                                                                                        106 of 545
I11 5 Dental

Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services
and Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-
operative care.


                  Major dental services include crowns, bridgework, partial dentures and repairs,
                  prosthodontic services, periodontics, oral surgery, endodontics and oral
                  appliances for sleep apnoea implant prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every three years.


Maximum per person during first benefit entitlement year


General Dental
All States                                           $700



Major Dental
NSW, TAS, VIC, NT                                    $600
QLD, WA                                              $700
SA                                                   $500

Orthodontia
NSW, QLD, TAS, VIC, NT                               $500
SA                                                   $700
WA                                                   $1000

Orthodontia Lifetime Limit
All States                                           $2000




I11 6 Optical

All States

Frames for prescription lenses                 $150.00
Single Vision Lenses                            $57.00
Progressive Lenses                             $125.00
Contact Lenses, disposable
1 month supply                                  $40.00
3 months supply                                 $70.00
Contact Lenses, non-disposable                 $135.00

The Maximum per person during any one year is $200.00.


                                                                                               107 of 545
I11 7 Physiotherapy

                              NSW           QLD       SA         TAS          VIC           WA         NT
Initial visit                  $38.50        $30.00   $31.50      $32.00       $32.00       $35.00     $32.50
Subsequent visit               $31.00        $25.00   $24.50      $24.00       $24.00       $29.00     $25.50
Ante natal visit               $15.00        $11.00   $ 9.50      $13.00       $13.00       $11.00     $ 9.50
Post natal visit               $15.00        $11.00   $ 9.50      $13.00       $13.00       $11.00     $ 9.50
Group therapy visit            $15.00        $11.00   $ 7.50      $13.00       $13.00       $11.00     $ 9.50
                                             Maximum per person during first benefit entitlement year
                              $500.00       $500.00   $500.00     $500.00      $500.00      $500.00   $500.00


I11 8 Chiropractic

                              NSW           QLD            SA            TAS           VIC            WA       NT
Initial visit                  $40.00        $30.00        $36.00         $32.00       $32.00         $32.00   $33.00
Subsequent visit               $29.50        $22.00        $23.50         $24.00       $24.00         $25.00   $23.50
X-ray service – per            $42.00        $75.00                       $50.00       $50.00         $75.00
Person per year
                                         Maximum per person during first benefit entitlement year
                              $350.00   $350.00   $350.00    $350.00      $350.00      $350.00     $350.00
                                    Maximum per family membership during first benefit entitlement year
                              $500.00   $500.00   $500.00    $500.00      $500.00      $500.00     $500.00

The above chiropractic benefits apply to the first 10 visits per person in any calendar year.
Benefits for visits after the first 10 are paid at 50% of the above.

I11 9 Non PBS Pharmaceuticals

After payment by the policy holder of an amount equal to the highest prescribed PBS prescription
fee, a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $40 per
script item.

Maximum per person during first benefit entitlement year
NSW, QLD, NT        $750
SA, TAS, VIC        $350
WA                  $400


Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the
counter cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at
participating pharmacies provided that the item is:


(c) Designed to manage or prevent disease, injuries or a condition; or
(d) Prescribed in connection with an episode of hospital treatment.


                                                                                                108 of 545
Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.



I11 10 Podiatry



I11 11 Psychology and Counselling



I11 12 Alternative Therapies


I11 13 Natural Therapies
All States
Initial and subsequent visits   $24.00
(excluding Massage and Aromatherapy)
Group attendance                $8
The Maximum per person including Massage and Aromatherapy during the first benefit
entitlement year is $500.

For massage and aromatherapy, a benefit of $15 per visit is payable in all States.

Massage and aromatherapy benefits are limited to $100 per person in any one year.




I11 14 Speech Therapy

                              NSW           QLD             SA           TAS            VIC           WA       NT
Initial visit                  $52.00        $50.00         $75.00        $52.00        $60.00        $75.00   $75.00
Subsequent visit               $28.00        $26.00         $46.00        $28.00        $40.00        $40.00   $46.00
Group therapy visit            $10.00        $10.00         $16.00        $13.00        $13.00        $20.00   $16.00

Maximum per person during the first benefit entitlement year is $400. This maximum is
combined with eye therapy under 3.20 and occupational therapy under 3.17.


I11 15 Orthotics


I11 16 Dietetics




                                                                                                109 of 545
I11 17 Occupational Therapy

                           NSW          QLD           SA           TAS          VIC          WA         NT
Initial visit               $35.00       $30.00       $56 00        $32.00      $32.00       $45.00     $56 00
Subsequent visit            $30.00       $22.00       $37.00        $22.00      $22.00       $30.00     $37.00
Group therapy visit         $11.00       $11.00       $13.00        $13.00      $13.00       $12.00     $13.00

Maximum per person during the first benefit entitlement year is $400. This maximum is
combined with eye therapy under 3.20 and speech therapy under 3.14.


I11 18 Naturopathy


I11 19 Acupuncture



I11 20 Other Therapies

Eye Therapy                NSW          QLD           SA           TAS          VIC            WA         NT
Initial visit               $35.00       $30.00       $24.00        $32.00      $32.00         $60.00     $24.00
Subsequent visit            $30.00       $22.00       $19.50        $22.00      $22.00         $40.00     $19.50
Group therapy visit         $16.00       $16.00       $16.00        $16.00      $16.00         $16.00     $16.00

Maximum per person during the first benefit entitlement year is $400. This maximum is
combined with occupational therapy under 3.17 and speech therapy under 3.14.


I11 21 Non Surgically Implanted Prostheses and Appliances


I11 22 Hearing Aids


I11 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.


I11 24 Ambulance Transportation




                                                                                        110 of 545
I11 25 Accident Cover


I11 26 Accidental Death Funeral Expenses


I11 27 Other Special




I12 SCHEDULE GENERAL TREATMENT TABLES
I12 1 Table Name or Group of Table Names


Your Choice Extras (7) and ANZ (#7):


I12 2 Eligibility

This table is subject to the provision that benefit eligibility is limited to four general treatment
service items, as selected by the policy holder. After 12 continuous months’ cover, the policy
holder may change all or any of their selection. No further change to any selections may be made
until a further 12 months continuous cover has expired.


I12 3 General Conditions
4. If a policy holder takes out a general treatment service, the Company will pay benefits:

    (a) for a single service of general treatment provided to a policy holder by a recognised
        practitioner in private practice on a given day; and
    (b) for more than one service of general treatment on a given day provided by a recognised
        provider in registered premises in private practice who is recognised by the Company in
        more than one profession.




                                                                                        111 of 545
5. General treatment services must be rendered by or on behalf of a recognised practitioner for
   benefits to be payable.

6. General treatment services must be rendered on premises registered with the Company for
   benefits to be payable.

4.   General treatment benefits are not payable for any of the circumstances outlined in Rule E 4
     of the General Conditions.




I12 4 Loyalty Bonuses
After 12 months continuous membership, a policy holder is entitled to an increased benefit
maximum equal to the first year benefit maximum for the relevant modality plus 20% of the first
year benefit maximum. For each subsequent continuous 12 months membership, the policy holder
is entitled to an increased benefit maximum equal to their previous years benefit maximum for
the relevant modality plus 20% of the first year benefit maximum. No further increased benefit
maximums apply beyond 200% of the first year maximum. Loyalty bonuses do not apply to
optical and massage.


I12 5 Dental

Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services
and Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-
operative care.


                  Major dental services include crowns, bridgework, partial dentures and repairs,
                  prosthodontic services, periodontics, oral surgery, endodontics and oral
                  appliances for sleep apnoea implant prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every three years.


Maximum per person during first benefit entitlement year


General Dental
All States                                           $700



Major Dental
NSW, QLD, TAS, VIC, WA                               $500
SA, NT                                               $450

Orthodontia
All States                                           $450
Lifetime Limit                                       $1300


                                                                                               112 of 545
I12 6 Optical

All States

Frames for prescription lenses          $105.00
Single Vision Lenses                     $45.00
Progressive Lenses                       $95.00
Contact Lenses, disposable
1 month supply                           $32.00
3 months supply                          $50.00
Contact Lenses, non-disposable          $100.00

The Maximum per person during any one year is $180.00.




I12 7 Physiotherapy

                         NSW         QLD       SA         TAS          VIC           WA         NT
Initial visit             $30.00      $28.00   $23.00      $25.00       $25.00       $25.00     $24.00
Subsequent visit          $24.00      $22.00   $16.00      $17.00       $17.00       $21.50     $18.00
Ante natal visit          $13.50      $10.00    $7.00      $12.00       $12.00       $10.00      $8.00
Post natal visit          $13.50      $10.00    $8.00       $9.00        $9.00        $8.00      $8.00
Group therapy visit       $13.50      $10.00    $6.50       $9.00        $9.00        $8.00      $8.00
                                      Maximum per person during first benefit entitlement year
                         $450.00     $450.00   $450.00     $450.00      $450.00      $450.00   $450.00


I12 8 Chiropractic

                         NSW         QLD          SA         TAS          VIC         WA       NT
Initial visit             $31.50      $27.00      $23.00      $25.00      $25.00      $24.00   $22.00
Subsequent visit          $21.50      $19.00      $16.50      $17.00      $17.00      $18.00   $17.00
X-ray service – per       $40.00      $75.00                  $25.00      $25.00      $50.00
Person per year
                                    Maximum per person during first benefit entitlement year
                         $350.00   $350.00   $350.00    $350.00      $350.00      $350.00     $350.00
                               Maximum per family membership during first benefit entitlement year
                         $500.00   $500.00   $500.00    $500.00      $500.00      $500.00     $500.00

The above chiropractic benefits apply to the first 10 visits per person in any calendar
year.
Benefits for visits after the first 10 are paid at 50% of the above.




                                                                                 113 of 545
I12 9 Non PBS Pharmaceuticals

After payment by the policy holder of an amount equal to the highest prescribed PBS prescription
fee, a benefit of 100% of the cost of the balance of the prescription.

Benefit is limited to the following amounts per script item:

NSW, SA, NT                                  $40.00
QLD, WA                                      $35.00
TAS, VIC                                     $20.00

Maximum per person during first benefit entitlement year is $300 in all States.


Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the
counter cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at
participating pharmacies provided that the item is:


(a) Designed to manage or prevent disease, injuries or a condition; or
(b) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.



I12 10 Podiatry



I12 11 Psychology and Counselling



I12 12 Alternative Therapies


I12 13 Natural Therapies

All States
Initial and subsequent visits   $17.00
(excluding Massage and Aromatherapy)
Group attendance                $6
The Maximum per person including Massage and Aromatherapy during the first benefit
entitlement year is $500.

For massage and aromatherapy, a benefit of $12 per visit is payable in all States.


                                                                                                114 of 545
Massage and aromatherapy benefits are limited to $100 per person in any one year.




I12 14 Speech Therapy

                          NSW         QLD           SA          TAS         VIC         WA       NT
Initial visit              $30.00      $27.00       $50.00       $25.00     $40.00      $55.00   $50.00
Subsequent visit           $25.00      $20.00       $30.00       $17.00     $25.00      $30.00   $30.00
Group therapy visit        $10.00      $10.00       $10.00        $9.00      $9.00      $15.00   $10.00

Maximum per person during the first benefit entitlement year is $400. This maximum is
combined with eye therapy under 4.20 and occupational therapy under 4.17.


I12 15 Orthotics


I12 16 Dietetics




I12 17 Occupational Therapy

                          NSW         QLD           SA          TAS         VIC         WA       NT
Initial visit              $30.00      $27.00       $42 00       $25.00     $25.00      $30.00   $42 00
Subsequent visit           $25.00      $20.00       $28.00       $17.00     $17.00      $25.00   $28.00
Group therapy visit        $10.00      $10.00        $9.00        $9.00      $9.00      $10.00    $9.00

Maximum per person during the first benefit entitlement year is $400. This maximum is
combined with eye therapy under 4.20 and speech therapy under 4.14.


I12 18 Naturopathy


I12 19 Acupuncture



I12 20 Other Therapies



                                                                                    115 of 545
Eye Therapy                NSW          QLD           SA           TAS          VIC            WA       NT
Initial visit               $30.00       $27.00       $21.00        $25.00      $25.00         $42.00   $21.00
Subsequent visit            $25.00       $20.00       $17.00        $17.00      $17.00         $30.00   $17.00
Group therapy visit         $10.00       $10.00        $9.00         $9.00       $9.00          $8.00    $8.00

Maximum per person during the first benefit entitlement year is $400. This maximum is
combined with occupational therapy under 4.17 and speech therapy under 4.14.



I12 21 Non Surgically Implanted Prostheses and Appliances


I12 22 Hearing Aids


I12 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.


I12 24 Ambulance Transportation
For policy holders who do not belong to an ambulance subscription scheme, the Company will
pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by
    a fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar
    year for policy holders who contribute to a policy that covers only one person (a single cover)
    and two trips per calendar year for policy holders who contribute to either a single parent or
    family cover.


I12 25 Accident Cover


I12 26 Accidental Death Funeral Expenses


I12 27 Other Special




                                                                                        116 of 545
I13 SCHEDULE GENERAL TREATMENT TABLES
I13 1 Table Name or Group of Table Names


Basic Extras (H) and ANZ (#H):


I13 2 Eligibility



I13 3 General Conditions

7. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (c) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (d) for more than one service of general treatment on a given day provided by a recognised
         provider in registered premises in private practice who is recognised by the Company in
         more than one profession.

8. General treatment services must be rendered by or on behalf of a recognised practitioner for
   benefits to be payable.

9. General treatment services must be rendered on premises registered with the Company for
   benefits to be payable.

4.   General treatment benefits are not payable for any of the circumstances outlined in Rule E 4
     of the General Conditions.

I13 4 Loyalty Bonuses

After 12 months continuous membership, a policy holder is entitled to an increased benefit
maximum equal to the first year benefit maximum for the relevant modality plus 20% of the first
year benefit maximum. For each subsequent continuous 12 months membership, the policy holder
is entitled to an increased benefit maximum equal to their previous years benefit maximum for
the relevant modality plus 20% of the first year benefit maximum. No further increased benefit



                                                                                      117 of 545
maximums apply beyond 200% of the first year maximum. Loyalty bonuses do not apply to
optical.



I13 5 Dental

Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services
and Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-
operative care.
Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures.
The benefit for complete dentures is limited to one set of complete dentures per person every three years.


Benefits for major dental and orthodontia are only payable on this table if the service was
required as the result of an accident.


Maximum per person during first benefit entitlement
year

General Dental
All States                                           $400
Major Dental and Orthodontia combined
NSW, QLD, TAS, VIC, WA                               $250
SA, NT                                               $600


I13 6 Optical

All States

Frames for prescription lenses                   $75.00
Single Vision Lenses                             $45.00
Progressive Lenses                               $95.00
Contact Lenses, disposable
1 month supply                                  $32.00
3 months supply                                 $50.00
Contact Lenses, non-disposable                 $100.00

The Maximum per person during any one year is $120.00.




                                                                                               118 of 545
I13 7 Physiotherapy

                              NSW           QLD       SA         TAS          VIC           WA         NT
Initial visit                  $30.00        $28.00   $23.00      $25.00       $25.00       $25.00     $24.00
Subsequent visit               $24.00        $22.00   $16.00      $17.00       $17.00       $21.50     $18.00
Ante natal visit               $13.50        $10.00    $7.00      $12.00       $12.00       $10.00      $8.00
Post natal visit               $13.50        $10.00    $8.00       $9.00        $9.00        $8.00      $8.00
Group therapy visit            $13.50        $10.00    $6.50       $9.00        $9.00        $8.00      $8.00
                                             Maximum per person during first benefit entitlement year
                              $450.00       $450.00   $350.00     $450.00      $450.00      $450.00   $350.00


I13 8 Chiropractic


I13 9 Non PBS Pharmaceuticals

Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the
counter cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at
participating pharmacies provided that the item is:


(c) Designed to manage or prevent disease, injuries or a condition; or
(d) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.



I13 10 Podiatry


I13 11 Psychology and Counselling


I13 12 Alternative Therapies


I13 13 Natural Therapies


I13 14 Speech Therapy




                                                                                                119 of 545
I13 15 Orthotics


I13 16 Dietetics


I13 17 Occupational Therapy


I13 18 Naturopathy


I13 19 Acupuncture


I13 20 Other Therapies


I13 21 Non Surgically Implanted Prostheses and Appliances


I13 22 Hearing Aids


I13 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.


I13 24 Ambulance Transportation


I13 25 Accident Cover


I13 26 Accidental Death Funeral Expenses


I13 27 Other Special




                                                                                        120 of 545
I14 SCHEDULE GENERAL TREATMENT TABLES
I14 1 Table Name or Group of Table Names

Standard Extras (X) and ANZ (#X):

I14 2 Eligibility
Product closed to new members from 30th November 2010.


I14 3 General Conditions

10. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (e) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (f) for more than one service of general treatment on a given day provided by a recognised
         provider in registered premises in private practice who is recognised by the Company in
         more than one profession.

11. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

12. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.   General treatment benefits are not payable for any of the circumstances outlined in Rule E 4
     of the General Conditions.




I14 4 Loyalty Bonuses
After 12 months continuous membership, a policy holder is entitled to an increased benefit
maximum equal to the first year benefit maximum for the relevant modality plus 20% of the first
year benefit maximum. For each subsequent continuous 12 months membership, the policy holder
is entitled to an increased benefit maximum equal to their previous years benefit maximum for
the relevant modality plus 20% of the first year benefit maximum. No further increased benefit
maximums apply beyond 200% of the first year maximum. Loyalty bonuses do not apply to
optical.


I14 5 Dental

Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services
and Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-
operative care.




                                                                                      121 of 545
                Major dental services include crowns, bridgework, partial dentures and repairs,
                prosthodontic services, periodontics, oral surgery, endodontics and oral
                appliances for sleep apnoea implant prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every
three years

Benefits for orthodontia are only payable on this table if the service was required as the result of
an accident.

Maximum per person during first benefit entitlement year

All Dental Combined
NSW, QLD, TAS, VIC, WA           $400
SA, NT                           $500




I14 6 Optical

All States

Frames for prescription lenses               $90.00
Single Vision Lenses                         $45.00
Progressive Lenses                           $95.00
Contact Lenses, disposable
1 month supply                               $32.00
3 months supply                              $50.00
Contact Lenses, non-disposable              $100.00

The Maximum per person during any one year is $150.00.




I14 7 Physiotherapy

                            NSW          QLD           SA           TAS           VIC          WA       NT
Initial visit                $30.00       $28.00       $23.00        $25.00       $25.00       $27.00   $24.00
Subsequent visit             $24.00       $22.00       $16.00        $17.00       $17.00       $23.00   $18.00
Ante natal visit             $13.50       $10.00        $7.00        $12.00       $12.00       $10.00    $8.00
Post natal visit             $13.50       $10.00        $8.00         $9.00        $9.00        $8.00    $8.00
Group therapy visit          $13.50       $10.00        $6.50         $9.00        $9.00        $8.00    $8.00

Combined maximum for physiotherapy under 6.7, chiropractic under 6.8, naturopathy under 6.18
and acupuncture under 6.19 during the first benefit entitlement year is $350 for single
memberships and $500 for family memberships.




                                                                                         122 of 545
I14 8 Chiropractic

                              NSW           QLD            SA            TAS            VIC           WA       NT
Initial visit                  $31.50        $24.00        $24.00         $25.00        $25.00        $28.00   $22.00
Subsequent visit               $21.50        $16.00        $16.50         $17.00        $17.00        $20.00   $17.00
X-ray service – per            $40.00        $23.00                       $23.00        $23.00        $23.00
Person per year

The above chiropractic benefits apply to the first 10 visits per person in any calendar year.
Benefits for visits after the first 10 are paid at 50% of the above.

Combined maximum for physiotherapy under 6.7, chiropractic under 6.8, naturopathy under 6.18
and acupuncture under 6.19 during the first benefit entitlement year is $350 for single
memberships and $500 for family memberships.



I14 9 Non PBS Pharmaceuticals

Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the
counter cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at
participating pharmacies provided that the item is:


(e) Designed to manage or prevent disease, injuries or a condition; or
(f) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.



I14 10 Podiatry


I14 11 Psychology and Counselling


I14 12 Alternative Therapies


I14 13 Natural Therapies


I14 14 Speech Therapy



                                                                                                123 of 545
I14 15 Orthotics


I14 16 Dietetics


I14 17 Occupational Therapy



I14 18 Naturopathy

                        NSW            QLD            SA            TAS            VIC           WA       NT
 Initial visit           $16.00         $24.00        $21.00         $17.00        $17.00        $21.00   $20.00
 Subsequent visit        $16.00         $18.00        $15.00         $17.00        $17.00        $21.00   $16.50

Combined maximum for physiotherapy under 6.7, chiropractic under 6.8, naturopathy under 6.18
and acupuncture under 6.19 during the first benefit entitlement year is $350 for single
memberships and $500 for family memberships.


I14 19 Acupuncture

                         NSW           QLD           SA               TAS            VIC       WA         NT
 Initial visit            $16.00        $24.00       $21.00           $17.00        $17.00     $16.00     $22.00
 Subsequent visit         $16.00        $18.00       $15.00           $17.00        $17.00     $16.00     $16.00

Combined maximum for physiotherapy under 6.7, chiropractic under 6.8, naturopathy under 6.18
and acupuncture under 6.19 during the first benefit entitlement year is $350 for single
memberships and $500 for family memberships.


I14 20 Other Therapies


I14 21 Non Surgically Implanted Prostheses and Appliances


I14 22 Hearing Aids


I14 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.


                                                                                        124 of 545
I14 24 Ambulance Transportation


I14 25 Accident Cover


I14 26 Accidental Death Funeral Expenses


I14 27 Other Special




I15 SCHEDULE GENERAL TREATMENT TABLES
I15 1 Table Name or Group of Table Names

Corporate Extras (K):

I15 2 Eligibility

This Table is subject to the provision that it can only be taken out in conjunction with Hospital
Treatment Tables O1, O2, M1 to M3, E1 to E3 and H1 to H3, and Overseas Hospital Treatment
Tables V, W and W2.

I15 3 General Conditions

13. If a policy holder takes out a general treatment service, the Company will pay benefits:




                                                                                       125 of 545
     (g) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (h) for more than one service of general treatment on a given day provided by a recognised
         provider in registered premises in private practice who is recognised by the Company in
         more than one profession.

14. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

15. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.   General treatment benefits are not payable for any of the circumstances outlined in Rule E 4
     of the General Conditions.




I15 4 Loyalty Bonuses
After 12 months continuous membership, a policy holder is entitled to an increased benefit
maximum equal to the first year benefit maximum for the relevant modality plus 20% of the first
year benefit maximum. For each subsequent continuous 12 months membership, the policy holder
is entitled to an increased benefit maximum equal to their previous years benefit maximum for
the relevant modality plus 20% of the first year benefit maximum. No further increased benefit
maximums apply beyond 200% of the first year maximum. Loyalty bonuses do not apply to
optical, massage, hearing aids and non surgically implanted prostheses and appliances.


I15 5 Dental
The Dental Premier Extras benefits in the State of Victoria apply.

Dental benefits are payable in accordance with the schedule of Victorian dental benefits
maintained by the Company. This schedule uses definitions specified in "Australian Schedule of
Dental Services and Glossary - Australian Dental Association Inc". All treatments are inclusive of
routine post-operative care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every
three years.


Maximum per person during first benefit entitlement
year
All States




                                                                                      126 of 545
                                    $1000
General Dental
Major Dental                        $800
Dentures                            $320 per person per year
Orthodontia                         $800 per person per year
Orthodontia Lifetime Limit          $2700


I15 6 Optical

All States

Frames for prescription lenses                $150.00
Single Vision Lenses                           $57.00
Progressive Lenses                            $125.00
Contact Lenses, disposable
1 month supply                                 $40.00
3 months supply                                $70.00
Contact Lenses, non-disposable                $135.00

The Maximum per person during any one year is $200.00.


I15 7 Physiotherapy
All States
Initial visit                           $32.00
Subsequent visit                        $24.00
Ante natal visit                        $13.00
Post natal visit                        $13.00
Group Therapy visit                     $13.00

The Maximum per person during the first benefit entitlement year is $600.


I15 8 Chiropractic


All States
Initial visit                        $32.00
Subsequent visit                     $24.00
X-ray service-                       $40.00
Per person per year

The above chiropractic benefits apply to the first 10 visits per person in any calendar year.
Benefits for visits after the first 10 are paid at 50% of the above.

Combined maximum for chiropractic under 7.8, speech therapy under 7.14, occupational therapy
under 7.17 and eye therapy under 7.20 during the first benefit entitlement year is $600 per person.




                                                                                        127 of 545
I15 9 Non PBS Pharmaceuticals

After payment by the policy holder of an amount equal to the highest prescribed PBS prescription
fee, a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $40 per
script item.

The Maximum per person during the first benefit entitlement year is $300 in all States.


Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the
counter cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at
participating pharmacies provided that the item is:


(g) Designed to manage or prevent disease, injuries or a condition; or
(h) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.



I15 10 Podiatry
All States
Initial visit                           $32.00
Subsequent visit                        $26.00
Surgical Nail Resection                 $80.00

The Maximum per person during the first benefit entitlement year is $300.


I15 11 Psychology and Counselling

Initial visit                                                            $60
Subsequent visit                                                         $45
Interview with another person or Family attendance                       $25
Group therapy visit                                                      $15

The Maximum per person during the first benefit entitlement year is $300.


I15 12 Alternative Therapies


I15 13 Natural Therapies

All States
Initial and subsequent visits           $24.00


                                                                                                128 of 545
(excluding Massage and Aromatherapy)
Group attendance                $10
The Maximum per person including Massage and Aromatherapy during the first benefit
entitlement year is $200.

For massage and aromatherapy, a benefit of $20 per visit is payable in all States.

Massage and aromatherapy benefits are limited to $150 per person in any one year.




I15 14 Speech Therapy
All States
Initial visit                       $60.00
Subsequent visit                    $40.00
Group therapy visit                 $13.00

Combined maximum for chiropractic under 7.8, speech therapy under 7.14, occupational therapy
under 7.17 and eye therapy under 7.20 during the first benefit entitlement year is $600 per
person.


I15 15 Orthotics




I15 16 Dietetics
All States
Initial visit                           $60.00
Subsequent visit                        $40.00
Group therapy visit                     $13.00

Combined maximum for chiropractic under 7.8, speech therapy under 7.14, occupational therapy
under 7.17 and eye therapy under 7.20 during the first benefit entitlement year is $600 per person.


I15 17 Occupational Therapy
All States
Initial visit                       $32.00
Subsequent visit                    $22.00
Group therapy visit                 $13.00

Combined maximum for chiropractic under 7.8, speech therapy under 7.14, occupational therapy
under 7.17 and eye therapy under 7.20 during the first benefit entitlement year is $600 per person.



                                                                                       129 of 545
I15 18 Naturopathy



I15 19 Acupuncture



I15 20 Other Therapies



Eye Therapy
All States
Initial visit                       $32.00
Subsequent visit                    $22.00
Group therapy visit                 $16.00

Combined maximum for chiropractic under 7.8, speech therapy under 7.14, occupational therapy
under 7.17 and eye therapy under 7.20 during the first benefit entitlement year is $600 per person.




I15 21 Non Surgically Implanted Prostheses and Appliances

Asthma Pumps
Refund of 80% for the cost of supply.
Limited to one appliance per person every 3 years and $300 per person every 3 years.

Blood Glucose Monitors/INR (International Normalised Ratio) Devices
Refund of 80% for the cost of supply.
Limited to one appliance per person every year and $500 per person every year.

Continuous or Bilevel Positive Airway Pressure Devices
Refund of 80% for the cost of supply.
Limited to one device per person every 2 years and $750 per person every 2 years.

Surgical Stockings
Refund of 80% for the cost of supply.
Limited to $100 per person in any one year.

TENS Machine (Transcutaneous Electronic Nerve Stimulator)
Refund of 80% for the cost of supply.
Limited to one device per person every year and $175 per person every year.

Blood Pressure Monitors
Refund of 80% for the cost of supply.
Limited to one device per person every year and $175 per person every year.



                                                                                       130 of 545
Hire, Repair and Maintenance of a Health Appliance
80% for the cost and $100 per person every year.

Defined Appliances
Refund of 80% for the cost of supply.
Limited to $500 per person in any one year.
Refer to Rule E3.3 (6) for a list of approved defined appliances.


                 There is a combined maximum of $1000 per person during any one year for all
                 Prostheses and Appliances under 7.21. This maximum also includes any benefits
                 paid for hearing aids under 7.22.



I15 22 Hearing Aids

Refund of 80% for the cost of supply or the cost of repairs.
This benefit is limited to one hearing aid per ear per person every 3 years and $850 per
person every 3 years. This limit also forms part of the overall limit for prostheses and
appliances under 7.21.


I15 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.

I15 24 Ambulance Transportation



I15 25 Accident Cover



I15 26 Accidental Death Funeral Expenses



I15 27 Other Special


Local and Interstate Travelling Expenses
All States
Benefit for the cost of travel.


                                                                                        131 of 545
Limited to $100 per combined patient and attendant during any one year.

Overnight Non-Hospital Accommodation
All States
Benefit of up to $40 per night
Limited to $150 per combined patient and attendant during any one year.


Home Nursing

$35 per day, capped at 10 visits per year up to an annual limit of $350

The modality will include the following coverage:
   • General Care Services: Catheter Care, Continence Care, Medication Administration
      (injections, rectal vaginal suppositories for frail, enemas, dosette education), and wound
      management (post surgery, ulcer, wound drainage).

    •   Stomal Therapy

    •   Palliative Care Services – RN Care, Personal Care Assistance




I16 SCHEDULE GENERAL TREATMENT TABLES
I16 1 Table Name or Group of Table Names


Executive Extras (D):


I16 2 Eligibility

This Table is subject to the provision that it can only be taken out in conjunction with Hospital
Treatment Tables O1, O2, M1 to M3, E1 to E3 and H1 to H3, and Overseas Hospital Treatment
Tables V, W and W2.


I16 3 General Conditions

16. If a policy holder takes out a general treatment service, the Company will pay benefits:




                                                                                       132 of 545
     (i) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (j) for more than one service of general treatment on a given day provided by a recognised
         provider in registered premises in private practice who is recognised by the Company in
         more than one profession.

17. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

18. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.   General treatment benefits are not payable for any of the circumstances outlined in Rule E 4
     of the General Conditions.

I16 4 Loyalty Bonuses



I16 5 Dental
The Dental Premier Extras Provider Agreement benefits that apply in the policy holder’s State of
Residence applies.

Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services
and Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-
operative care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every
three years.


Maximum per person during any one year
All States
General Dental                      NIL
Major Dental                       $800
Inlays/Onlays                      $400
Orthodontia                        $1200
Orthodontia Lifetime Limit         $2400




I16 6 Optical
All States


                                                                                      133 of 545
Frames for prescription lenses                  $192.70
Single Vision Lenses                             $77.20
Progressive Lenses                              $163.20
Contact Lenses, disposable
1 month supply                                   $53.90
3 months supply                                  $96.30
Contact Lenses, non-disposable                  $171.50

The Maximum per person during any one year is $200.00.



I16 7 Physiotherapy
The Physiotherapy Premier Extras Provider Agreement benefits that apply in the policy holder's
State of Residence applies.
The Maximum per person during any one year is $500.


I16 8 Chiropractic

The Chiropractic Premier Extras Provider Agreement benefits that apply in the policy holder's
State of Residence applies.
The Maximum per person during any one year is $500.


I16 9 Non PBS Pharmaceuticals
After payment by the policy holder of an amount equal to the highest prescribed PBS prescription fee, a
benefit of 85% of the cost of the balance of the prescription.


The Maximum per person during any one year is $350 in all States.


Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the
counter cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at
participating pharmacies provided that the item is:


(i) Designed to manage or prevent disease, injuries or a condition; or
(j) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.




                                                                                                134 of 545
I16 10 Podiatry
All States
Initial visit                           $32.00
Subsequent visit                        $26.00
Surgical Nail Resection                 $80.00

The Maximum per person during any one year is $500.


I16 11 Psychology and Counselling
All States
Initial visit                           $60.00
Subsequent visit                        $45.00
Interview with another person or        $25.00
Family attendance
Group therapy visit                     $15.00

The Maximum per person is $500 and the maximum per family is $1000 during any one year.


I16 12 Alternative Therapies


I16 13 Natural Therapies
All States
Initial and subsequent visits   $24.00
(excluding Massage and Aromatherapy)
Group attendance                $8
The Maximum per person including Massage and Aromatherapy during the first benefit
entitlement year is $350.

For massage and aromatherapy, a benefit of $20 per visit is payable in all States.

Massage and aromatherapy benefits are limited to $150 per person and $300 per family
membership in any one year.




I16 14 Speech Therapy
All States
Initial visit                           $60.00
Subsequent visit                        $40.00
Group therapy visit                     $13.00

The Maximum per person during any one year is $500.


I16 15 Orthotics


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I16 16 Dietetics
All States
Initial visit                         $40.00
Subsequent visit                      $24.00
Group therapy visit                   $13.00

The Maximum per person during any one year is $500.


I16 17 Occupational Therapy
All States
Initial visit                         $32.00
Subsequent visit                      $22.00
Group therapy visit                   $13.00


I16 18 Naturopathy



I16 19 Acupuncture



I16 20 Other Therapies


Eye Therapy
All States
Initial visit                      $32.00
Subsequent visit                   $22.00
Group therapy visit                $16.00

The Maximum per person during any one year is $500.


I16 21 Non Surgically Implanted Prostheses and Appliances

Asthma Pumps
Refund of 80% for the cost of supply.
Limited to one appliance per person every 3 years and $300 per person every 3 years.

Blood Glucose Monitors/INR (International Normalised Ratio) Devices
Refund of 80% for the cost of supply.
Limited to one appliance per person every year and $500 per person every year.



                                                                                       136 of 545
Continuous or Bilevel Positive Airway Pressure Devices
Refund of 80% for the cost of supply.
Limited to one device per person every 2 years and $750 per person every 2 years.

Surgical Stockings
Refund of 80% for the cost of supply.
Limited to $100 per person in any one year.

TENS Machine (Transcutaneous Electronic Nerve Stimulator)
Refund of 80% for the cost of supply.
Limited to one device per person every year and $175 per person every year.

Blood Pressure Monitors
Refund of 80% for the cost of supply.
Limited to one device per person every year and $175 per person every year.

Hire, Repair and Maintenance of a Health Appliance
80% for the cost and $100 per person every year.

Defined Appliances
Refund of 80% for the cost of supply.
Limited to $500 per person in any one year.
Refer to Rule E3.3 (6) for a list of approved defined appliances.


                There is a combined maximum of $1000 per person during any one year for all
                Prostheses and Appliances under 8.21. This maximum also includes any benefits
                paid for hearing aids under 8.22.



I16 22 Hearing Aids

Refund of 80% for the cost of supply or the cost of repairs.
This benefit is limited to one hearing aid per ear per person every 3 years and $850 per
person every 3 years. This limit also forms part of the overall limit for prostheses and
appliances under 8.21.


I16 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.

Living Well Programs

The Fund will provide a cover towards selected Fund approved health related services and health
management programs that are designed to prevent or relieve a specific health condition or
conditions.



                                                                                        137 of 545
Benefit

50% of the cost

Annual Limit

$100 per person


I16 24 Ambulance Transportation



I16 25 Accident Cover



I16 26 Accidental Death Funeral Expenses



I16 27 Other Special

Local and Interstate Travelling Expenses
All States
Benefit for the cost of travel.
Limited to $100 per combined patient and attendant during any one year.

Overnight Non-Hospital Accommodation
All States
Benefit of up to $40 per night
Limited to $150 per combined patient and attendant during any one year.


Home Nursing

$35 per day, capped at 10 visits per year up to an annual limit of $350

The modality will include the following coverage:
   • General Care Services: Catheter Care, Continence Care, Medication Administration
      (injections, rectal vaginal suppositories for frail, enemas, dosette education), and wound
      management (post surgery, ulcer, wound drainage).

    •     Stomal Therapy

    •     Palliative Care Services – RN Care, Personal Care Assistance




                                                                                      138 of 545
I17 SCHEDULE GENERAL TREATMENT TABLES
I17 1 Table Name or Group of Table Names
Industry Superannuation Health Benefits Plan Ancillary Table (6):


I17 2 Eligibility

This is a National product covering members of the Industry Superannuation Fund.


I17 3 General Conditions

19. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (k) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (l) for more than one service of general treatment on a given day provided by a recognised
         provider in registered premises in private practice who is recognised by the Company in
         more than one profession.

20. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

21. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.   General treatment benefits are not payable for any of the circumstances outlined in Rule E 4
     of the General Conditions.




I17 4 Loyalty Bonuses



I17 5 Dental

Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services
and Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-
operative care.



                 Major dental services include crowns, bridgework, partial dentures and repairs,
                 prosthodontic services, periodontics, oral surgery, endodontics and oral
                 appliances for sleep apnoea implant prostheses and complete dentures.



                                                                                      139 of 545
The benefit for complete dentures is limited to one set of complete dentures per person every
three years.

No benefits are payable for orthodontia.

Maximum per person during any one year
All States
                         $600
General Dental
                            $300 1st Year, $600 2nd Year, $800 Subsequent Years
Major Dental


I17 6 Optical
All States

Frames for prescription lenses              $75.00
Single Vision Lenses                        $45.00
Progressive Lenses                          $95.00
Contact Lenses, disposable
1 month supply                              $32.00
3 months supply                             $50.00
Contact Lenses, non-disposable             $100.00

The Maximum per person during any one year is $140.00.


I17 7 Physiotherapy
All States
Initial visit                          $25.00
Subsequent visit                       $17.00
Ante natal visit                       $12.00
Post natal visit                        $9.00
Group Therapy visit                     $9.00

Benefits are limited to $350 per person and $700 per family membership.
These limits are combined with the limits under chiropractic, 10.8.


I17 8 Chiropractic
All States
Initial visit                          $25.00
Subsequent visit                       $17.00
X-ray                                  $25.00

Benefits are limited to $350 per person and $700 per family membership.
Benefits for x-Rays are not included in these limits.
These limits are combined with the limits under physiotherapy, 10.7.




                                                                                      140 of 545
I17 9 Non PBS Pharmaceuticals


I17 10 Podiatry


I17 11 Psychology and Counselling


I17 12 Alternative Therapies


I17 13 Natural Therapies


I17 14 Speech Therapy
All States
Initial visit                          $25.00
Subsequent visit                       $17.00
Group Therapy Visit                     $9.00

Combined maximum for speech therapy under 10.14, occupational therapy under 10.17 and eye
therapy under 10.20 during the first benefit entitlement year is $400 for per person during any one
year.


I17 15 Orthotics


I17 16 Dietetics


I17 17 Occupational Therapy

All States
Initial visit                          $25.00
Subsequent visit                       $17.00
Group Therapy Visit                     $9.00

Combined maximum for speech therapy under 10.14, occupational therapy under 10.17 and eye
therapy under 10.20 during the first benefit entitlement year is $400 for per person during any one
year.




                                                                                       141 of 545
I17 18 Naturopathy


I17 19 Acupuncture


I17 20 Other Therapies

Eye Therapy
All States
Initial Visit             $25.00
Subsequent Visit          $17.00
Group Therapy Visit       $9.00

Combined maximum for speech therapy under 10.14, occupational therapy under 10.17 and eye therapy
under 10.20 during the first benefit entitlement year is $400 for per person during any one year.



I17 21 Non Surgically Implanted Prostheses and Appliances


I17 22 Hearing Aids


I17 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.


I17 24 Ambulance Transportation


I17 25 Accident Cover


I17 26 Accidental Death Funeral Expenses


I17 27 Other Special




                                                                                        142 of 545
I18 SCHEDULE GENERAL TREATMENT TABLES
I18 1 Table Name or Group of Table Names
Broken Hill Pasminco Employees’ Sickness Benefit Fund: (9)


I18 2 Eligibility



I18 3 General Conditions

22. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (m) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (n) for more than one service of general treatment on a given day provided by a recognised
         provider in registered premises in private practice who is recognised by the Company in
         more than one profession.

23. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

24. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.   General treatment benefits are not payable for any of the circumstances outlined in Rule E 4
     of the General Conditions.




I18 4 Loyalty Bonuses



I18 5 Dental
Benefit is payable in respect of dental services provided by the Mines Dental Clinic.


                 Major dental services include crowns, bridgework, partial dentures and repairs,
                 prosthodontic services, periodontics, oral surgery, endodontics and oral
                 appliances for sleep apnoea implant prostheses and complete dentures.


General Dental                NIL
Major Dental                 Maximum benefit of $2500. Payment of benefit is limited
                             to once every two calendar years.
Orthodontia                  $2500 per course of treatment.


                                                                                        143 of 545
I18 6 Optical

A benefit to a maximum of $350.00 is payable for prescribed spectacles (including lenses, frames
and repairs) and contact lenses.

Benefit is limited to one pair of spectacles or contact lenses every two calendar years.

Sunglasses are specifically excluded.


I18 7 Physiotherapy

A benefit of 75% of the reasonable, customary and usual fee is payable on an itemised and
receipted account.

No annual maximum applies.

Benefit is not payable in respect of appliances or equipment supplied or referred by a
Physiotherapist.


I18 8 Chiropractic

A benefit of 75% of the reasonable, customary and usual fee is payable on an itemised and
receipted account.

No annual maximum applies.

Benefit is not payable in respect of appliances or equipment supplied or referred by a
Chiropractor, Osteopath.


I18 9 Non PBS Pharmaceuticals
After payment by the policy holder of an amount equal to the highest prescribed PBS prescription fee, a
benefit of 100% of the cost of the balance of the prescription.

Maximum per person during first benefit entitlement year is $750.

I18 10 Podiatry

A benefit of 75% of the reasonable, customary and usual fee is payable on an itemised and
receipted account.

No annual maximum applies.




                                                                                              144 of 545
Benefit is not payable in respect of appliances or equipment supplied or referred by a Podiatrist,
with the exception that the above benefit is payable for custom made orthotics supplied by a
Podiatrist.


I18 11 Psychology and Counselling
Initial visit                           $35.00 once per year
Subsequent visit                        $30.00

The Maximum per person during any one year is $450.


I18 12 Alternative Therapies


I18 13 Natural Therapies


I18 14 Speech Therapy

A benefit of 80% of the reasonable, customary and usual fee is payable on an itemised and
receipted account.

No annual maximum applies.


I18 15 Orthotics


I18 16 Dietetics


I18 17 Occupational Therapy



I18 18 Naturopathy



I18 19 Acupuncture


I18 20 Other Therapies



                                                                                        145 of 545
I18 21 Non Surgically Implanted Prostheses and Appliances
The cost of surgical and medical appliances when ordered by a medical practitioner will be
reimbursed at the following rates:

Blood Glucose Monitor                    $300.00
Nebuliser                                $200.00
Peak Flow Meter                           $40.00

Payment of benefit is limited to one of each appliance every two calendar years.


I18 22 Hearing Aids

A benefit of 75% of the reasonable, customary and usual fee is payable where the patient has been
referred by a specialist in Otorhinolarynogology.

Payment of benefit is limited to once every three calendar years.

This benefit is not payable where the patient is entitled to claim a benefit or payment from
another source including workers’ compensation or entitled to a service under another program
including Australian Hearing Services.


I18 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.

I18 24 Ambulance Transportation


I18 25 Accident Cover


I18 26 Accidental Death Funeral Expenses


I18 27 Other Special
Travel and Accommodation
Benefit is only payable when the approved form has been presented to the Company. Full payment of travel
expenses will be paid for the purpose of visiting a specialist. Special mode of transport (plane travel) in
emergency cases as recommended by referring doctor on approved form and approved by management
committee. All modes of travel must have prior approval from the Company.

An allowance of $35.00 per day for the patient and accompanying escort will be paid for commercial
accommodation.




                                                                                              146 of 545
An allowance of $20.00 per day for the patient and accompanying escort will be paid for private
accommodation.

Patient benefit is payable for a maximum of 30 days.

Accompanying person benefit is payable for a maximum of 7 days, except where the patient is a
child.

This benefit is not payable where the patient is entitled to claim a benefit from another source.

Reimbursement of taxi transport will be made on the recommendation of the referring doctor
where the patient is required to make visits to a specialist or hospital and the doctor certifies
public transport is unsuitable.

Use of own vehicle

When a policy holder or dependent uses their own car to travel from Broken Hill for referred
treatment, the benefit will be 14 cents per kilometre travelled by the car in which the patient is a
passenger.

Adelaide – 1150 km @ 14c up to $160.00
Mildura - 600 km @14c up to $95.00




I19 SCHEDULE GENERAL TREATMENT TABLES
I19 1 Table Name or Group of Table Names

Ambulance Only Cover (8) and ANZ (#8)


I19 2 Eligibility


I19 3 General Conditions



I19 4 Loyalty Bonuses



I19 5 Dental




                                                                                          147 of 545
I19 6 Optical



I19 7 Physiotherapy



I19 8 Chiropractic



I19 9 Non PBS Pharmaceuticals



I19 10 Podiatry



I19 11 Psychology and Counselling



I19 12 Alternative Therapies



I19 13 Natural Therapies



I19 14 Speech Therapy



I19 15 Orthotics



I19 16 Dietetics




                                    148 of 545
I19 17 Occupational Therapy



I19 18 Naturopathy



I19 19 Acupuncture



I19 20 Other Therapies



I19 21 Non Surgically Implanted Prostheses and Appliances



I19 22 Hearing Aids



I19 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.


I19 24 Ambulance Transportation



I19 25 Accident Cover



I19 26 Accidental Death Funeral Expenses




                                                                                        149 of 545
I19 27 Other Special




                       150 of 545
I20 SCHEDULE GENERAL TREATMENT TABLES
I20 1 Table Name or Group of Table Names


Corporate 80 Extras (N)


I20 2 Eligibility

This Table is subject to the provision that it can only be taken out in conjunction with Hospital
Tables O1, O2, W and W2.

I20 3 General Conditions

25. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (o) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (p) for more than one service of general treatment on a given day provided by a recognised
         provider in registered premises in private practice who is recognised by the Company in
         more than one profession.

26. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

27. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.   General treatment benefits are not payable for any of the circumstances outlined in Rule E 4
     of the General Conditions.

I20 4 Loyalty Bonuses

After 12 months continuous membership, a policy holder is entitled to an increased benefit
maximum equal to the first year benefit maximum for the relevant modality plus 10% of the first
year benefit maximum. For each subsequent continuous 12 months membership, the policy holder
is entitled to an increased benefit maximum equal to their previous years benefit maximum for
the relevant modality plus 10% of the first year benefit maximum. No further increased benefit
maximums apply beyond 150% of the first year maximum. Loyalty bonuses do not apply to
optical.




                                                                                        151 of 545
I20 5 Dental

Dental benefits are payable in accordance with the Victorian General Dental Premier Extras
Provider Agreement benefits maintained by the Company. This schedule uses definitions
specified in "Australian Schedule of Dental Services and Glossary - Australian Dental
Association Inc". All treatments are inclusive of routine post-operative care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every
three years.

All States - A benefit of 80% of the reasonable, customary and usual fee.

The Maximum per person for General Dental, Major Dental and Orthodontia during the first
benefit entitlement year is $1100.




I20 6 Optical

All States:-A benefit of 80% for the cost of approved optical items.

The Maximum per person during any one year is $200.


I20 7 Physiotherapy

All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

The Maximum per person during the first benefit entitlement year is $400.


I20 8 Chiropractic

All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

The Maximum per person during the first benefit entitlement year is $400.




I20 9 Non PBS Pharmaceuticals
After payment by the policy holder of an amount equal to the highest prescribed PBS prescription fee, a
benefit of 80% of the cost of the balance of the prescription.


                                                                                              152 of 545
All States - There is a combined maximum of $500 per person during the first benefit entitlement year for
Non PBS Pharmaceuticals under 13.9, Podiatry under 13.10, Psychology and Counselling under 13.11,
Natural Therapies under 13.13, Speech Therapy under 13.14, Dietetics under 13.16, Occupational Therapy
under 13.17, Eye Therapy under 13.20, Non Surgically Implanted Prostheses and Appliances under 13.21
and Hearing Aids under 13.22.



Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the
counter cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at
participating pharmacies provided that the item is:


(k) Designed to manage or prevent disease, injuries or a condition; or
(l) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.



I20 10 Podiatry

All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $500 per person during the first benefit entitlement year for Non PBS
Pharmaceutical’s under 13.9, Podiatry under 13.10, Psychology and Counselling under 13.11, Natural
Therapies under 13.13, Speech Therapy under 13.14, Dietetics under 13.16, Occupational Therapy under
13.17, Eye Therapy under 13.20, Non Surgically Implanted Prostheses and Appliances under 13.21 and
Hearing Aids under 13.22.



I20 11 Psychology and Counselling


All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $500 per person during the first benefit entitlement year for Non PBS
Pharmaceutical’s under 13.9, Podiatry under 13.10, Psychology and Counselling under 13.11, Natural
Therapies under 13.13, Speech Therapy under 13.14, Dietetics under 13.16, Occupational Therapy under
13.17, Eye Therapy under 13.20, Non Surgically Implanted Prostheses and Appliances under 13.21 and
Hearing Aids under 13.22.



I20 12 Alternative Therapies




                                                                                                153 of 545
I20 13 Natural Therapies


All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $500 per person during the first benefit entitlement year for Non PBS
Pharmaceutical’s under 13.9, Podiatry under 13.10, Psychology and Counselling under 13.11, Natural
Therapies under 13.13, Speech Therapy under 13.14, Dietetics under 13.16, Occupational Therapy under
13.17, Eye Therapy under 13.20, Non Surgically Implanted Prostheses and Appliances under 13.21 and
Hearing Aids under 13.22.



I20 14 Speech Therapy
All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $500 per person during the first benefit entitlement year for Non PBS
Pharmaceutical’s under 13.9, Podiatry under 13.10, Psychology and Counselling under 13.11, Natural
Therapies under 13.13, Speech Therapy under 13.14, Dietetics under 13.16, Occupational Therapy under
13.17, Eye Therapy under 13.20, Non Surgically Implanted Prostheses and Appliances under 13.21 and
Hearing Aids under 13.22.



I20 15 Orthotics



I20 16 Dietetics
All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $500 per person during the first benefit entitlement year for Non PBS
Pharmaceutical’s under 13.9, Podiatry under 13.10, Psychology and Counselling under 13.11, Natural
Therapies under 13.13, Speech Therapy under 13.14, Dietetics under 13.16, Occupational Therapy under
13.17, Eye Therapy under 13.20, Non Surgically Implanted Prostheses and Appliances under 13.21 and
Hearing Aids under 13.22.



I20 17 Occupational Therapy
All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $500 per person during the first benefit entitlement year for Non PBS
Pharmaceutical’s under 13.9, Podiatry under 13.10, Psychology and Counselling under 13.11, Natural
Therapies under 13.13, Speech Therapy under 13.14, Dietetics under 13.16, Occupational Therapy under
13.17, Eye Therapy under 13.20, Non Surgically Implanted Prostheses and Appliances under 13.21 and
Hearing Aids under 13.22.




                                                                                          154 of 545
I20 18 Naturopathy




I20 19 Acupuncture




I20 20 Other Therapies

All States      A benefit of 80% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $500 per person during any one year for Non PBS Pharmaceuticals under
13.9, Podiatry under 13.10, Psychology and Counselling under 13.11, Natural Therapies under 13.13,
Speech Therapy under 13.14, Dietetics under 13.16, Occupational Therapy under 13.17, Eye Therapy under
13.20, Non Surgically Implanted Prostheses and Appliances under 13.21 and Hearing Aids under 13.22.



I20 21 Non Surgically Implanted Prostheses and Appliances

Asthma Pumps
Refund of 80% for the cost of supply.

Blood Glucose Monitors/INR (International Normalised Ratio) Devices
Refund of 80% for the cost of supply.

Continuous or Bilevel Positive Airway Pressure Devices
Refund of 80% for the cost of supply.

Surgical Stockings
Refund of 80% for the cost of supply.

TENS Machine (Transcutaneous Electronic Nerve Stimulator)
Refund of 80% for the cost of supply.

Blood Pressure Monitors
Refund of 80% for the cost of supply.

Hire, Repair and Maintenance of a Health Appliance
80% for the cost.

Defined Appliances
Refund of 80% for the cost of supply.
Refer to Rule E3.3 (6) for a list of approved defined appliances.




                                                                                         155 of 545
All States - There is a combined maximum of $500 per person during the first benefit entitlement year for
Non PBS Pharmaceuticals under 13.9, Podiatry under 13.10, Psychology and Counselling under 13.11,
Natural Therapies under 13.13, Speech Therapy under 13.14, Dietetics under 13.16, Occupational Therapy
under 13.17, Eye Therapy under 13.20, Non Surgically Implanted Prostheses and Appliances under 13.21
and Hearing Aids under 13.22.



I20 22 Hearing Aids

All States - Refund of 80% for the cost of supply or the cost of repairs.
Limited to one hearing aid per person every 3 years.

There is a combined maximum of $500 per person during the first benefit entitlement year for Non PBS
Pharmaceutical’s under 13.9, Podiatry under 13.10, Psychology and Counselling under 13.11, Natural
Therapies under 13.13, Speech Therapy under 13.14, Dietetics under 13.16, Occupational Therapy under
13.17, Eye Therapy under 13.20, Non Surgically Implanted Prostheses and Appliances under 13.21 and
Hearing Aids under 13.22.



I20 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.

Living Well Programs

The Fund will provide a cover towards selected Fund approved health related services and health
management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

80% of the cost

Annual Limit

$100 per person



I20 24 Ambulance Transportation




I20 25 Accident Cover




                                                                                             156 of 545
I20 26 Accidental Death Funeral Expenses




I20 27 Other Special


Local and Interstate Travelling Expenses
All States
Benefit for the cost of travel.
Limited to $100 per combined patient and attendant during any one year.

Overnight Non-Hospital Accommodation
All States
Benefit of up to $40 per night
Limited to $150 per combined patient and attendant during any one year.

Home Nursing

80% up to an annual limit of $350

The modality will include the following coverage:
   • General Care Services: Catheter Care, Continence Care, Medication Administration
      (injections, rectal vaginal suppositories for frail, enemas, dosette education), and wound
      management (post surgery, ulcer, wound drainage).

    •   Stomal Therapy

    •   Palliative Care Services – RN Care, Personal Care Assistance




I21 SCHEDULE GENERAL TREATMENT TABLES
I21 1 Table Name or Group of Table Names
Corporate 60 Extras (R)

I21 2 Eligibility


This Table is subject to the provision that it can only be taken out in conjunction with Hospital
Tables O1, O2, W and W2.


                                                                                        157 of 545
I21 3 General Conditions

28. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (q) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (r) for more than one service of general treatment on a given day provided by a recognised
         provider in registered premises in private practice who is recognised by the Company in
         more than one profession.

29. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

30. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.   General treatment benefits are not payable for any of the circumstances outlined in Rule E 4
     of the General Conditions.




I21 4 Loyalty Bonuses

After 12 months continuous membership, a policy holder is entitled to an increased benefit
maximum equal to the first year benefit maximum for the relevant modality plus 10% of the first
year benefit maximum. For each subsequent continuous 12 months membership, the policy holder
is entitled to an increased benefit maximum equal to their previous years benefit maximum for
the relevant modality plus 10% of the first year benefit maximum. No further increased benefit
maximums apply beyond 150% of the first year maximum. Loyalty bonuses do not apply to
optical.




I21 5 Dental

Dental benefits are payable in accordance with the Victorian General Dental Premier Extras
Provider Agreement benefits maintained by the Company. This schedule uses definitions
specified in "Australian Schedule of Dental Services and Glossary - Australian Dental
Association Inc". All treatments are inclusive of routine post-operative care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every
three years.



                                                                                      158 of 545
All States - A benefit of 60% of the reasonable, customary and usual fee.

The Maximum per person for General Dental, Major Dental and Orthodontia during the first
benefit entitlement year is $800.

I21 6 Optical

All States:-A benefit of 60% for the cost of approved optical items.

The Maximum per person during any one year is $180.




I21 7 Physiotherapy

All States - A benefit of 60% of the reasonable, customary and usual fee for each visit.

The Maximum per person during the first benefit entitlement year is $350.




I21 8 Chiropractic

All States - A benefit of 60% of the reasonable, customary and usual fee for each visit.

The Maximum per person during the first benefit entitlement year is $350.




I21 9 Non PBS Pharmaceuticals
After payment by the policy holder of an amount equal to the highest prescribed PBS prescription fee, a
benefit of 60% of the cost of the balance of the prescription.


All States - There is a combined maximum of $400 per person during the first benefit entitlement year for
Non PBS Pharmaceutical’s under 14.9, Podiatry under 14.10, Psychology and Counselling under 14.11,
Natural Therapies under 14.13, Speech Therapy under 14.14, Dietetics under 14.16, Occupational Therapy
under 14.17, Eye Therapy under 14.20, Non Surgically Implanted Prostheses and Appliances under 14.21
and Hearing Aids under 14.22.



Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the
counter cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at
participating pharmacies provided that the item is:




                                                                                                159 of 545
(m) Designed to manage or prevent disease, injuries or a condition; or
(n) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.



I21 10 Podiatry
All States - A benefit of 60% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $400 per person during the first benefit entitlement year for Non PBS
Pharmaceutical’s under 14.9, Podiatry under 14.10, Psychology and Counselling under 14.11, Natural
Therapies under 14.13, Speech Therapy under 14.14, Dietetics under 14.16, Occupational Therapy under
14.17, Eye Therapy under 14.20, Non Surgically Implanted Prostheses and Appliances under 14.21 and
Hearing Aids under 14.22.



I21 11 Psychology and Counselling
All States - A benefit of 60% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $400 per person during the first benefit entitlement year for Non PBS
Pharmaceutical’s under 14.9, Podiatry under 14.10, Psychology and Counselling under 14.11, Natural
Therapies under 14.13, Speech Therapy under 14.14, Dietetics under 14.16, Occupational Therapy under
14.17, Eye Therapy under 14.20, Non Surgically Implanted Prostheses and Appliances under 14.21 and
Hearing Aids under 14.22.




I21 12 Alternative Therapies


I21 13 Natural Therapies

All States - A benefit of 60% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $400 per person during the first benefit entitlement year for Non PBS
Pharmaceutical’s under 14.9, Podiatry under 14.10, Psychology and Counselling under 14.11, Natural
Therapies under 14.13, Speech Therapy under 14.14, Dietetics under 14.16, Occupational Therapy under
14.17, Eye Therapy under 14.20, Non Surgically Implanted Prostheses and Appliances under 14.21 and
Hearing Aids under 14.22.



I21 14 Speech Therapy


All States - A benefit of 60% of the reasonable, customary and usual fee for each visit.



                                                                                                160 of 545
There is a combined maximum of $400 per person during the first benefit entitlement year for Non PBS
Pharmaceutical’s under 14.9, Podiatry under 14.10, Psychology and Counselling under 14.11, Natural
Therapies under 14.13, Speech Therapy under 14.14, Dietetics under 14.16, Occupational Therapy under
14.17, Eye Therapy under 14.20, Non Surgically Implanted Prostheses and Appliances under 14.21 and
Hearing Aids under 14.22.




I21 15 Orthotics




I21 16 Dietetics
All States - A benefit of 60% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $400 per person during the first benefit entitlement year for Non PBS
Pharmaceutical’s under 14.9, Podiatry under 14.10, Psychology and Counselling under 14.11, Natural
Therapies under 14.13, Speech Therapy under 14.14, Dietetics under 14.16, Occupational Therapy under
14.17, Eye Therapy under 14.20, Non Surgically Implanted Prostheses and Appliances under 14.21 and
Hearing Aids under 14.22.



I21 17 Occupational Therapy
All States - A benefit of 60% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $400 per person during the first benefit entitlement year for Non PBS
Pharmaceutical’s under 14.9, Podiatry under 14.10, Psychology and Counselling under 14.11, Natural
Therapies under 14.13, Speech Therapy under 14.14, Dietetics under 14.16, Occupational Therapy under
14.17, Eye Therapy under 14.20, Non Surgically Implanted Prostheses and Appliances under 14.21 and
Hearing Aids under 14.22.




I21 18 Naturopathy




I21 19 Acupuncture




                                                                                          161 of 545
I21 20 Other Therapies

All States       A benefit of 60% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $400 per person during any one year for Non PBS Pharmaceuticals under
14.9, Podiatry under 14.10, Psychology and Counselling under 14.11, Natural Therapies under 14.13,
Speech Therapy under 14.14, Dietetics under 14.16, Occupational Therapy under 14.17, Eye Therapy under
14.20, Non Surgically Implanted Prostheses and Appliances under 14.21 and Hearing Aids under 14.22.




I21 21 Non Surgically Implanted Prostheses and Appliances
Asthma Pumps
Refund of 60% for the cost of supply.

Blood Glucose Monitors/INR (International Normalised Ratio) Devices
Refund of 60% for the cost of supply.

Continuous or Bilevel Positive Airway Pressure Devices
Refund of 60% for the cost of supply.

Surgical Stockings
Refund of 60% for the cost of supply.

TENS Machine (Transcutaneous Electronic Nerve Stimulator)
Refund of 60% for the cost of supply.

Blood Pressure Monitors
Refund of 60% for the cost of supply.

Hire, Repair and Maintenance of a Health Appliance
60% for the cost

Defined Appliances
Refund of 60% for the cost of supply.
Refer to Rule E3.3 (6) for a list of approved defined appliances.

All States -There is a combined maximum of $400 per person during the first benefit entitlement year for
Non PBS Pharmaceutical’s under 14.9, Podiatry under 14.10, Psychology and Counselling under 14.11,
Natural Therapies under 14.13, Speech Therapy under 14.14, Dietetics under 14.16, Occupational Therapy
under 14.17, Eye Therapy under 14.20, Non Surgically Implanted Prostheses and Appliances under 14.21
and Hearing Aids under 14.22.



I21 22 Hearing Aids
All States - A benefit of 60% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $400 per person during the first benefit entitlement year for Non PBS
Pharmaceutical’s under 14.9, Podiatry under 14.10, Psychology and Counselling under 14.11, Natural



                                                                                            162 of 545
Therapies under 14.13, Speech Therapy under 14.14, Dietetics under 14.16, Occupational Therapy under
14.17, Eye Therapy under 14.20, Non Surgically Implanted Prostheses and Appliances under 14.21 and
Hearing Aids under 14.22.



I21 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.

Living Well Programs

The Fund will provide a cover towards selected Fund approved health related services and health
management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

60% of the cost

Annual Limit

$100 per person



I21 24 Ambulance Transportation




I21 25 Accident Cover




I21 26 Accidental Death Funeral Expenses




I21 27 Other Special


Local and Interstate Travelling Expenses
All States
Benefit for the cost of travel.


                                                                                          163 of 545
Limited to $100 per combined patient and attendant during any one year.

Overnight Non-Hospital Accommodation
All States
Benefit of up to $40 per night
Limited to $150 per combined patient and attendant during any one year.

Home Nursing

60% up to an annual limit of $350

The modality will include the following coverage:
   • General Care Services: Catheter Care, Continence Care, Medication Administration
      (injections, rectal vaginal suppositories for frail, enemas, dosette education), and wound
      management (post surgery, ulcer, wound drainage).

    •   Stomal Therapy

    •   Palliative Care Services – RN Care, Personal Care Assistance




I22 SCHEDULE GENERAL TREATMENT TABLES
I22 1 Table Name or Group of Table Names
General Dental Extras (S) and ANZ (#S)


I22 2 Eligibility

This Table is subject to the provision that it can only be taken out in conjunction with a Hospital
Treatment Table, with the exception of any combined Hospital Treatment Table and General
Treatment Table as outlined in Schedule J of these Rules.

Product closed to new members from 30th November 2010.


I22 3 General Conditions

31. If a policy holder takes out a general treatment service, the Company will pay benefits:

    (s) for a single service of general treatment provided to a policy holder by a recognised
        practitioner in private practice on a given day; and
    (t) for more than one service of general treatment on a given day provided by a recognised
        provider in registered premises in private practice who is recognised by the Company in
        more than one profession.




                                                                                        164 of 545
32. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

33. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.   General treatment benefits are not payable for any of the circumstances outlined in Rule E 4
     of the General Conditions.




I22 4 Loyalty Bonuses

After 12 months continuous membership, South Australian and Northern Territory policy holder
are entitled to an increased benefit maximum equal to the first year benefit maximum plus 20% of
the first year benefit maximum. For each subsequent continuous 12 months membership, South
Australian and Northern Territory policy holders are entitled to an increased benefit maximum
equal to their previous years benefit maximum plus 20% of the first year benefit maximum. No
further increased benefit maximums apply beyond 200% of the first year maximum.



I22 5 Dental
Dental benefits are payable in accordance with the Schedule of Dental Benefits maintained by the
Company. This Schedule uses definitions specified in "Australian Schedule of Dental Services
and Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-
operative care.

No benefits are payable for Major Dental services and Orthodontia.

For one oral examination or consultation per policy holder per year, a benefit of 100% of the
reasonable, customary and usual fee applies.

A maximum of $400 per policy holder during any one year applies for policy holders other than
those in South Australia and the Northern Territory.

A maximum of $400 per policy holder during the first benefit entitlement year applies for policy
holders of South Australia and the Northern Territory.


I22 6 Optical




I22 7 Physiotherapy




                                                                                      165 of 545
I22 8 Chiropractic




I22 9 Non PBS Pharmaceuticals

Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the
counter cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at
participating pharmacies provided that the item is:


(o) Designed to manage or prevent disease, injuries or a condition; or
(p) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.




I22 10 Podiatry




I22 11 Psychology and Counselling




I22 12 Alternative Therapies




I22 13 Natural Therapies




I22 14 Speech Therapy




                                                                                                166 of 545
I22 15 Orthotics




I22 16 Dietetics




I22 17 Occupational Therapy




I22 18 Naturopathy




I22 19 Acupuncture




I22 20 Other Therapies




I22 21 Non Surgically Implanted Prostheses and Appliances




                                                      167 of 545
I22 22 Hearing Aids




I22 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any
one year.

I22 24 Ambulance Transportation




I22 25 Accident Cover




I22 26 Accidental Death Funeral Expenses




I22 27 Other Special




                                                                                        168 of 545
I23 SCHEDULE GENERAL TREATMENT TABLES
I23 1 Table Name or Group of Table Names


Corporate 90 Extras (J)


I23 2 Eligibility

This Table is subject to the provision that it can only be taken out in conjunction with Hospital Tables
O1, O2, W and W2.


I23 3 General Conditions


34. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (u) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (v) for more than one service of general treatment on a given day provided by a recognised
         provider in registered premises in private practice who is recognised by the Company in more
         than one profession.

35. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

36. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.    General treatment benefits are not payable for any of the circumstances outlined in Rule E 4 of
     the General Conditions.




I23 4 Loyalty Bonuses

After 12 months continuous membership, a policy holder is entitled to an increased benefit maximum
equal to the first year benefit maximum for the relevant modality plus 10% of the first year benefit
maximum. For each subsequent continuous 12 months membership, the policy holder is entitled to an
increased benefit maximum equal to their previous years benefit maximum for the relevant modality
plus 10% of the first year benefit maximum. No further increased benefit maximums apply beyond
150% of the first year maximum. Loyalty bonuses do not apply to optical.




                                                                                            169 of 545
I23 5 Dental

Dental benefits are payable in accordance with the Victorian General Dental Premier Extras Provider
Agreement benefits maintained by the Company. This schedule uses definitions specified in
"Australian Schedule of Dental Services and Glossary - Australian Dental Association Inc". All
treatments are inclusive of routine post-operative care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic services,
periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant prostheses and complete
dentures.


The benefit for complete dentures is limited to one set of complete dentures per person every three
years.

All States - A benefit of 90% of the reasonable, customary and usual fee.

The Maximum per person for General Dental, Major Dental and Orthodontia during the first benefit
entitlement year is $1100.




I23 6 Optical
All States:-A benefit of 90% for the cost of approved optical items.

The Maximum per person during any one year is $300.


I23 7 Physiotherapy

All States - A benefit of 90% of the reasonable, customary and usual fee for each visit.

The Maximum per person during the first benefit entitlement year is $550.


I23 8 Chiropractic

All States - A benefit of 90% of the reasonable, customary and usual fee for each visit.

The Maximum per person during the first benefit entitlement year is $550.




I23 9 Non PBS Pharmaceuticals
After payment by the policy holder of an amount equal to the highest prescribed PBS prescription fee, a benefit
of 90% of the cost of the balance of the prescription.


All States - There is a combined maximum of $700 per person during the first benefit entitlement year for Non
PBS Pharmaceuticals under 16.9, Podiatry under 16.10, Psychology and Counselling under 16.11, Natural
Therapies under 16.13, Speech Therapy under 16.14, Dietetics under 16.16, Occupational Therapy under 16.17,



                                                                                                   170 of 545
Eye Therapy under 16.20, Non Surgically Implanted Prostheses and Appliances under 16.21 and Hearing Aids
under 16.22.



Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the counter
cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at participating pharmacies
provided that the item is:


(q) Designed to manage or prevent disease, injuries or a condition; or
(r) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.



I23 10 Podiatry

All States - A benefit of 90% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $700 per person during the first benefit entitlement year for Non PBS
Pharmaceuticals under 16.9, Podiatry under 16.10, Psychology and Counselling under 16.11, Natural Therapies
under 16.13, Speech Therapy under 16.14, Dietetics under 16.16, Occupational Therapy under 16.17, Eye
Therapy under 16.20, Non Surgically Implanted Prostheses and Appliances under 16.21 and Hearing Aids under
16.22.



I23 11 Psychology and Counselling



All States - A benefit of 90% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $700 per person during the first benefit entitlement year for Non PBS
Pharmaceuticals under 16.9, Podiatry under 16.10, Psychology and Counselling under 16.11, Natural Therapies
under 16.13, Speech Therapy under 16.14, Dietetics under 16.16, Occupational Therapy under 16.17, Eye
Therapy under 16.20, Non Surgically Implanted Prostheses and Appliances under 16.21 and Hearing Aids under
16.22.




I23 12 Alternative Therapies



I23 13 Natural Therapies

All States - A benefit of 90% of the reasonable, customary and usual fee for each visit.




                                                                                                     171 of 545
There is a combined maximum of $700 per person during the first benefit entitlement year for Non PBS
Pharmaceuticals under 16.9, Podiatry under 16.10, Psychology and Counselling under 16.11, Natural Therapies
under 16.13, Speech Therapy under 16.14, Dietetics under 16.16, Occupational Therapy under 16.17, Eye
Therapy under 16.20, Non Surgically Implanted Prostheses and Appliances under 16.21 and Hearing Aids under
16.22.



I23 14 Speech Therapy

All States - A benefit of 90% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $700 per person during the first benefit entitlement year for Non PBS
Pharmaceuticals under 16.9, Podiatry under 16.10, Psychology and Counselling under 16.11, Natural Therapies
under 16.13, Speech Therapy under 16.14, Dietetics under 16.16, Occupational Therapy under 16.17, Eye
Therapy under 16.20, Non Surgically Implanted Prostheses and Appliances under 16.21 and Hearing Aids under
16.22.



I23 15 Orthotics




I23 16 Dietetics
All States - A benefit of 90% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $700 per person during the first benefit entitlement year for Non PBS
Pharmaceuticals under 16.9, Podiatry under 16.10, Psychology and Counselling under 16.11, Natural Therapies
under 16.13, Speech Therapy under 16.14, Dietetics under 16.16, Occupational Therapy under 16.17, Eye
Therapy under 16.20, Non Surgically Implanted Prostheses and Appliances under 16.21 and Hearing Aids under
16.22.



I23 17 Occupational Therapy

All States - A benefit of 90% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $700 per person during the first benefit entitlement year for Non PBS
Pharmaceuticals under 16.9, Podiatry under 16.10, Psychology and Counselling under 16.11, Natural Therapies
under 16.13, Speech Therapy under 16.14, Dietetics under 16.16, Occupational Therapy under 16.17, Eye
Therapy under 16.20, Non Surgically Implanted Prostheses and Appliances under 16.21 and Hearing Aids under
16.22.



I23 18 Naturopathy




                                                                                              172 of 545
I23 19 Acupuncture




I23 20 Other Therapies

All States - A benefit of 90% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $700 per person during the first benefit entitlement year for Non PBS
Pharmaceuticals under 16.9, Podiatry under 16.10, Psychology and Counselling under 16.11, Natural Therapies
under 16.13, Speech Therapy under 16.14, Dietetics under 16.16, Occupational Therapy under 16.17, Eye
Therapy under 16.20, Non Surgically Implanted Prostheses and Appliances under 16.21 and Hearing Aids under
16.22.



I23 21 Non Surgically Implanted Prostheses and Appliances

Asthma Pumps
Refund of 90% for the cost of supply.

Blood Glucose Monitors/INR (International Normalised Ratio) Devices
Refund of 90% for the cost of supply.

Continuous or Bilevel Positive Airway Pressure Devices
Refund of 90% for the cost of supply.

Surgical Stockings
Refund of 90% for the cost of supply.

TENS Machine (Transcutaneous Electronic Nerve Stimulator)
Refund of 90% for the cost of supply.

Blood Pressure Monitors
Refund of 90% for the cost of supply.

Hire, Repair and Maintenance of a Health Appliance
90% for the cost

Defined Appliances
Refund of 90% for the cost of supply.
Refer to Rule E3.3 (6) for a list of approved defined appliances.

All States - There is a combined maximum of $700 per person during the first benefit entitlement year for Non
PBS Pharmaceuticals under 16.9, Podiatry under 16.10, Psychology and Counselling under 16.11, Natural
Therapies under 16.13, Speech Therapy under 16.14, Dietetics under 16.16, Occupational Therapy under 16.17,
Eye Therapy under 16.20, Non Surgically Implanted Prostheses and Appliances under 16.21 and Hearing Aids
under 16.22.



I23 22 Hearing Aids



                                                                                                 173 of 545
All States - Refund of 90% for the cost of supply or the cost of repairs.
Limited to one hearing aid per person every 3 years.

There is a combined maximum of $700 per person during the first benefit entitlement year for Non PBS
Pharmaceuticals under 16.9, Podiatry under 16.10, Psychology and Counselling under 16.11, Natural Therapies
under 16.13, Speech Therapy under 16.14, Dietetics under 16.16, Occupational Therapy under 16.17, Eye
Therapy under 16.20, Non Surgically Implanted Prostheses and Appliances under 16.21 and Hearing Aids under
16.22.



I23 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

Living Well Programs

The Fund will provide a cover towards selected Fund approved health related services and health
management programs that are designed to prevent or relieve a specific health condition or conditions.

Benefit

90% of the cost

Annual Limit

$100 per person



I23 24 Ambulance Transportation




I23 25 Accident Cover




I23 26 Accidental Death Funeral Expenses




I23 27 Other Special

Local and Interstate Travelling Expenses
All States


                                                                                              174 of 545
Benefit for the cost of travel.
Limited to $100 per combined patient and attendant during any one year.

Overnight Non-Hospital Accommodation
All States
Benefit of up to $40 per night
Limited to $150 per combined patient and attendant during any one year.


Home Nursing

90% up to an annual limit of $350

The modality will include the following coverage:
   • General Care Services: Catheter Care, Continence Care, Medication Administration
      (injections, rectal vaginal suppositories for frail, enemas, dosette education), and wound
      management (post surgery, ulcer, wound drainage).

    •   Stomal Therapy

    •   Palliative Care Services – RN Care, Personal Care Assistance




I24 SCHEDULE GENERAL TREATMENT TABLES
I24 1 Table Name or Group of Table Names


Platinum Extras (0) and ANZ (#0)


I24 2 Eligibility




I24 3 General Conditions
37. If a policy holder takes out a general treatment service, the Company will pay benefits:
    (w) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
    (x) for more than one service of general treatment on a given day provided by a recognised
         provider in registered premises in private practice who is recognised by the Company in more
         than one profession.
38. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.
39. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.
4. General treatment benefits are not payable for any of the circumstances outlined in Rule E 4 of
    the General Conditions.



                                                                                          175 of 545
I24 4 Loyalty Bonuses
After 12 months continuous membership, a policy holder is entitled to an increased benefit equal to
the first year benefit for the relevant modality plus 2% of the first year benefit. For each subsequent
continuous 12 month’s membership, the policy holder is entitled to an increased benefit equal to their
previous year’s benefit for the relevant modality plus 2% of the first year benefit. No further increased
benefits apply beyond 10% of the first year benefit. Loyalty bonuses do not apply to optical, massage,
prostheses and appliances and hearing aids.


I24 5 Dental
Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services and
Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-operative
care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every three
years.

Maximum per person during any one year: -
General Dental
All States                                  NIL
Major Dental
All States                                  $1200
Orthodontia
All States                                  $900
Lifetime Limit                              $2800


I24 6 Optical

All States
Frames for prescription lenses              $173.40
Single Vision Lenses                         $69.50
Progressive Lenses                          $146.90
Contact Lenses, disposable
1 month supply                               $48.50
3 months supply                              $86.60
Contact Lenses, non-disposable              $154.30

The Maximum per person during any one year is $280.00.


I24 7 Physiotherapy
                           NSW          QLD          SA        TAS        VIC         WA                    NT
Initial visit               $50.40       $49.70      $46.50     $36.00     $46.50     $49.70                $48.30
Subsequent visit            $42.50       $40.00      $37.10     $27.00     $37.10     $40.00                $39.30
Ante natal visit            $14.00       $14.10      $10.70     $14.70     $12.80     $14.10                $10.70
Post natal visit            $14.00       $14.10      $10.70     $14.70     $12.80     $14.10                $10.70
Group therapy visit         $15.20       $18.80      $12.30     $14.70     $15.20     $18.80                $14.10
                                                  Maximum per person during any one year


                                                                                             176 of 545
                              $900.00       $900.00       $900.00        $900.00       $900.00        $900.00      $900.00


I24 8 Chiropractic
                            NSW             QLD            SA            TAS            VIC           WA           NT
Initial visit                $50.80          $33.80        $51.20         $36.00        $49.40        $36.00       $37.20
Subsequent visit             $35.00          $24.80        $32.10         $27.00        $32.10        $28.20       $26.50
X-ray service – per          $41.00          $84.40                       $45.00        $42.30        $84.40
Person per year
                                                    Maximum per person during any one year
                            $700.00         $700.00    $700.00   $700.00    $700.00     $700.00                    $700.00
                                             Maximum per family membership during any one year
                            $1400.00        $1400.00 $1400.00 $1400.00 $1400.00 $1400.00                           $1400.00

The above chiropractic benefits apply to the first 10 visits per person in any calendar year.
Benefits for visits after the first 10 are paid at 50% of the above.


I24 9 Non PBS Pharmaceuticals

After payment by the policy holder of an amount equal to the highest prescribed PBS prescription fee,
a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $45.00 per script
item in all States.

The Maximum per person during any one year is $700 in all States.



Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the counter
cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at participating pharmacies
provided that the item is:


(s) Designed to manage or prevent disease, injuries or a condition; or
(t) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.



I24 10 Podiatry

                              NSW           QLD        SA       TAS         VIC          WA                          NT
Initial visit                  $40.00        $38.00   $38.00     $40.00     $38.00       $40.00                      $38.00
Subsequent visit               $30.00        $28.00   $28.00     $30.00     $28.00       $30.00                      $28.00
Surgical Nail Resection        $80.00        $80.00   $80.00     $80.00     $80.00       $80.00                      $80.00
                                                    Maximum per person during any one year
                              $500.00       $500.00  $500.00    $500.00    $500.00      $500.00                     $500.00


I24 11 Psychology and Counselling
                              NSW           QLD             SA           TAS            VIC           WA           NT


                                                                                                     177 of 545
Initial visit               $68.00       $51.00       $83.00       $44.00        $68 00    $80.00      $83.00
Subsequent visit            $45.00       $45.00       $78.00       $44.00        $51.00    $68.00      $78.00
Interview with another      $25.00       $25.00       $40.00       $25.00        $25.00    $25.00      $40.00
person or Family
attendance
Group therapy visit         $12.00       $12.00     $22.00    $15.00     $17.00      $25.00            $22.00
                                                Maximum per person during any one year
                           $500.00      $500.00   $500.00    $500.00    $500.00     $500.00            $500.00


I24 12 Alternative Therapies



I24 13 Natural Therapies
All States

Initial visit            $32.00
Subsequent visit         $24.00
Group attendance         $8.00
The Maximum per person including Massage and Aromatherapy during the first benefit entitlement
year is $500.

For massage and aromatherapy, a benefit of $24 per visit is payable in all States.

Massage and aromatherapy benefits are limited to $200 per person in any one year.




I24 14 Speech Therapy

                           NSW          QLD         SA       TAS        VIC         WA                  NT
Initial visit               $59.00       $56.00    $75.00     $59.00     $68.00     $75.00              $75.00
Subsequent visit            $32.00       $29.00    $46.00     $32.00     $45.00     $45.00              $46.00
Group therapy visit         $11.00       $11.00    $18.00     $20.00     $15.00     $20.00              $18.00
                                                Maximum per person during any one year
                            $500.00      $500.00   $500.00    $500.00    $500.00    $500.00              $500.00


I24 15 Orthotics




                                                                                          178 of 545
I24 16 Dietetics

All States

Initial visit               $50.00
Subsequent visit            $25.00
Group therapy visit         $13.00

The Maximum per person during any one year is $500.


I24 17 Occupational Therapy

                          NSW          QLD         SA       TAS        VIC         WA               NT
Initial visit              $39.00       $34.00    $56 00     $36.00     $36.00     $51.00           $56 00
Subsequent visit           $34.00       $25.00    $37.00     $25.00     $25.00     $34.00           $37.00
Group therapy visit        $12.00       $12.00    $13.00     $13.00     $13.00     $13.00           $13.00
                                               Maximum per person during any one year
                           $500.00      $500.00   $500.00    $500.00    $500.00    $500.00          $500.00


I24 18 Naturopathy



I24 19 Acupuncture




I24 20 Other Therapies

Eye Therapy               NSW          QLD         SA       TAS         VIC          WA               NT
Initial visit              $39.00       $34.00     $32.00    $36.00     $36.00       $46.00           $32.00
Subsequent visit           $28.00       $23.00     $22.00    $24.00     $24.00       $34.00           $22.00
                                                Maximum per person during any one year
                           $500.00      $500.00    $500.00   $500.00     $500.00     $500.00          $500.00


I24 21 Non Surgically Implanted Prostheses and Appliances

Asthma Pumps
Refund of 85% for the cost of supply.
Limited to one appliance per person every 3 years and $400 per person every 3 years.

Blood Glucose Monitors/INR (International Normalised Ratio) Devices
Refund of 85% for the cost of supply.
Limited to one appliance per person every year and $600 per person every year.

Continuous or Bilevel Positive Airway Pressure Devices
Refund of 85% for the cost of supply.
Limited to one device per person every 2 years and $1000 per person every 2 years.


                                                                                       179 of 545
Surgical Stockings
Refund of 90% for the cost of supply.
Limited to $100 per person in any one year.

TENS Machine (Transcutaneous Electronic Nerve Stimulator)
Refund of 85% for the cost of supply.
Limited to one device per person every year and $200 per person every year.

Blood Pressure Monitors
Refund of 85% for the cost of supply.
Limited to one device per person every year and $200 per person every year.

Hire, Repair and Maintenance of a Health Appliance
85% for the cost and $100 per person every year.

Defined Appliances
Refund of 85% for the cost of supply.
Limited to $1000 per person in any one year.
Refer to Rule E3.3 (6) for a list of approved defined appliances.

There is a combined maximum of $1200 per person during any one year for all Prostheses and Appliances under
17.21. This maximum also includes any benefits paid for hearing aids under 17.22.



I24 22 Hearing Aids

Refund of 90% for the cost of supply.
This benefit is limited to one hearing aid per ear per person every 3 years and $850 per person during
any one year.
Benefit for repairs is limited to 85% of the repair cost, up to $100 per person during any one year.
The above limits also form part of the overall limit for non surgically implanted prostheses and
appliances under 17.21.

I24 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

Living Well Programs

The Fund will provide a cover towards selected Fund approved health related services and health
management programs that are designed to prevent or relieve a specific health condition or conditions.

Benefit

50% of the cost

Annual Limit

$100 per person




                                                                                              180 of 545
I24 24 Ambulance Transportation

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.




I24 25 Accident Cover




I24 26 Accidental Death Funeral Expenses




I24 27 Other Special


Local and Interstate Travelling Expenses
All States
Benefit for the cost of travel.
Limited to $100 per combined patient and attendant during any one year.

Overnight Non-Hospital Accommodation
All States
Benefit of up to $40 per night
Limited to $150 per combined patient and attendant during any one year.

Home Nursing

$40 per day, capped at 10 visits per year up to an annual limit of $400

The modality will include the following coverage:
   • General Care Services: Catheter Care, Continence Care, Medication Administration
      (injections, rectal vaginal suppositories for frail, enemas, dosette education), and wound
      management (post surgery, ulcer, wound drainage).

    •   Stomal Therapy

    •   Palliative Care Services – RN Care, Personal Care Assistance




                                                                                            181 of 545
I25 SCHEDULE GENERAL TREATMENT TABLES
I25 1 Table Name or Group of Table Names

Gold Extras (3) and ANZ (#3):


I25 2 Eligibility




I25 3 General Conditions
40. If a policy holder takes out a general treatment service, the Company will pay benefits:
    (y) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
    (z) for more than one service of general treatment on a given day provided by a recognised
         provider in registered premises in private practice who is recognised by the Company in more
         than one profession.
41. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.
42. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.
4. General treatment benefits are not payable for any of the circumstances outlined in Rule E 4 of
    the General Conditions.


I25 4 Loyalty Bonuses
After 12 months continuous membership, a policy holder is entitled to an increased benefit equal to
the first year benefit for the relevant modality plus 2% of the first year benefit. For each subsequent
continuous 12 month’s membership, the policy holder is entitled to an increased benefit equal to their
previous year’s benefit for the relevant modality plus 2% of the first year benefit. No further increased
benefits apply beyond 10% of the first year benefit. Loyalty bonuses do not apply to optical, massage,
prostheses and appliances and hearing aids.


I25 5 Dental
Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services and
Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-operative
care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every three
years.

Maximum per person during any one year: -




                                                                                             182 of 545
General Dental
All States                                   NIL
Major Dental
All States                                  $1100
Orthodontia
All States                                  $800
Lifetime Limit                              $2600



I25 6 Optical
All States
Frames for prescription lenses              $144.60
Single Vision Lenses                         $57.90
Progressive Lenses                          $122.40
Contact Lenses, disposable
1 month supply                               $40.40
3 months supply                              $72.20
Contact Lenses, non-disposable              $128.60

The Maximum per person during any one year is $240.00.


I25 7 Physiotherapy
                           NSW           QLD        SA        TAS        VIC          WA                     NT
Initial visit               $42.00        $41.40    $38.70     $30.00     $38.70      $41.40                 $40.20
Subsequent visit            $35.40        $33.30    $30.90     $22.50     $30.90      $33.30                 $32.70
Ante natal visit            $11.70        $11.80    $ 9.00     $12.20     $10.80      $11.80                 $ 9.00
Post natal visit            $11.70        $11.80    $ 9.00     $12.20     $10.80      $11.80                 $ 9.00
Group therapy visit         $12.70        $15.60    $10.30     $12.20     $12.70      $15.60                 $11.80
                                                 Maximum per person during any one year
                           $800.00       $800.00   $800.00   $800.00     $800.00     $800.00                 $800.00


I25 8 Chiropractic
                          NSW            QLD           SA          TAS           VIC             WA          NT
Initial visit              $42.40         $28.20       $42.70       $30.00       $41.20          $30.00      $31.00
Subsequent visit           $29.20         $20.70       $26.80       $22.50       $26.80          $23.50      $22.10
X-ray service – per        $34.20         $70.40                    $37.50       $35.20          $70.40
Person per year
                                                 Maximum per person during any one year
                          $600.00        $600.00    $600.00   $600.00    $600.00     $600.00                 $600.00
                                          Maximum per family membership during any one year
                          $1200.00       $1200.00 $1200.00 $1200.00 $1200.00 $1200.00                        $1200.00

The above chiropractic benefits apply to the first 10 visits per person in any calendar year.
Benefits for visits after the first 10 are paid at 50% of the above.


I25 9 Non PBS Pharmaceuticals

After payment by the policy holder of an amount equal to the highest prescribed PBS prescription fee,
a benefit of 100% of the cost of the balance of the prescription.




                                                                                                183 of 545
Benefit is limited to the following amounts per script item.

NSW, SA, NT, VIC                             $40.00
QLD, TAS, WA                                 $38.00

The Maximum per person during any one year is $600 in all States.


Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the counter
cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at participating pharmacies
provided that the item is:


(u) Designed to manage or prevent disease, injuries or a condition; or
(v) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.



I25 10 Podiatry

All States

Initial visit                  $35.00
Subsequent visit               $25.00
Surgical Nail Resection        $70.00

The Maximum per person during any one year is $500.


I25 11 Psychology and Counselling

                              NSW           QLD             SA           TAS            VIC                WA        NT
Initial visit                  $56.00        $42.00         $78.00        $37.00        $56 00             $75.00    $78.00
Subsequent visit               $38.00        $38.00         $73.00        $37.00        $42.00             $56.00    $73.00
Interview with another         $20.00        $20.00         $30.00        $20.00        $20.00             $20.00    $30.00
person or Family
attendance
Group therapy visit            $10.00        $10.00   $19.00     $12.00     $14.00       $24.00                      $19.00
                                                    Maximum per person during any one year
                              $500.00       $500.00  $500.00    $500.00    $500.00      $500.00                     $500.00


I25 12 Alternative Therapies



I25 13 Natural Therapies




                                                                                                     184 of 545
All States

Initial visit            $28.00
Subsequent visit         $21.00
Group attendance             $8.00
The Maximum per person including Massage and Aromatherapy during the first benefit entitlement
year is $500.

For massage and aromatherapy, a benefit of $21 per visit is payable in all States.

Massage and aromatherapy benefits are limited to $200 per person and $400 per family membership
in any one year.




I25 14 Speech Therapy

                           NSW          QLD         SA       TAS        VIC         WA             NT
Initial visit               $49.00       $47.00    $70.00     $49.00     $56.00     $70.00         $70.00
Subsequent visit            $26.00       $24.00    $43.00     $26.00     $38.00     $38.00         $43.00
Group therapy visit         $10.00       $10.00    $15.00     $12.00     $12.00     $19.00         $15.00
                                                Maximum per person during any one year
                            $500.00      $500.00   $500.00    $500.00    $500.00    $500.00         $500.00


I25 15 Orthotics




I25 16 Dietetics

Dietetics                  NSW          QLD         SA       TAS        VIC          WA            NT
Initial visit               $45.00       $45.00    $45.00     $45.00     $45.00      $45.00        $45.00
Subsequent visit            $22.00       $22.00    $22.00     $22.00     $22.00      $22.00        $22.00
Group therapy visit         $13.00       $13.00    $12.00     $13.00     $12.00      $13.00        $13.00
                                                Maximum per person during any one year
                           $500.00      $500.00   $500.00   $500.00     $500.00     $500.00        $500.00


I25 17 Occupational Therapy

                           NSW          QLD            SA         TAS           VIC    WA           NT


                                                                                      185 of 545
Initial visit              $33.00       $28.00     $48 00    $30.00      $30.00     $42.00          $48 00
Subsequent visit           $28.00       $21.00     $35.00    $21.00      $21.00     $28.00          $35.00
Group therapy visit        $10.00       $10.00     $12.00    $12.00      $12.00     $12.00          $12.00
                                                Maximum per person during any one year
                           $500.00       $500.00 $500.00     $500.00     $500.00    $500.00         $500.00


I25 18 Naturopathy


I25 19 Acupuncture


I25 20 Other Therapies

Eye Therapy               NSW           QLD         SA       TAS         VIC          WA               NT
Initial visit              $32.00        $31.00    $24.00     $32.00     $32.00       $44.00           $28.00
Subsequent visit           $27.00        $22.00    $21.00     $22.00     $22.00       $32.00           $20.00
                                                 Maximum per person during any one year
                           $500.00       $500.00   $500.00    $500.00     $500.00      $500.00         $500.00




I25 21 Non Surgically Implanted Prostheses and Appliances

Asthma Pumps
Refund of 75% for the cost of supply.
Limited to one appliance per person every 3 years and $300 per person every 3 years.

Blood Glucose Monitors/INR (International Normalised Ratio) Devices
Refund of 75% for the cost of supply.
Limited to one appliance per person every year and $500 per person every year.

Continuous or Bilevel Positive Airway Pressure Devices
Refund of 75% for the cost of supply.
Limited to one device per person every 2 years and $750 per person every 2 years.

Surgical Stockings
Refund of 75% for the cost of supply.
Limited to $100 per person in any one year.

TENS Machine (Transcutaneous Electronic Nerve Stimulator)
Refund of 75% for the cost of supply.
Limited to one device per person every year and $150 per person every year.

Blood Pressure Monitors
Refund of 75% for the cost of supply.



                                                                                       186 of 545
Limited to one device per person every year and $150 per person every year.

Hire, Repair and Maintenance of a Health Appliance
75% for the cost and $100 per person every year.

Defined Appliances
Refund of 75% for the cost of supply.
Limited to $800 per person during any one year.
Refer to Rule E3.3 (6) for a list of approved defined appliances.

There is a combined maximum of $1000 per person during any one year for all Prostheses and Appliances under
18.21. This maximum also includes any benefits paid for hearing aids under 18.22.




I25 22 Hearing Aids

Refund of 75% for the cost of supply.
This benefit is limited to one hearing aid per ear per person every 3 years and $800 per person during
any one year.
Benefit for repairs is limited to 75% of the repair cost, up to $100 per person during any one year.
The above limits also form part of the overall limit for non surgically implanted prostheses and
appliances under 18.21.


I25 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

Living Well Programs

The Fund will provide a cover towards selected Fund approved health related services and health
management programs that are designed to prevent or relieve a specific health condition or conditions.

Benefit

50% of the cost

Annual Limit

$100 per person



I25 24 Ambulance Transportation

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


                                                                                              187 of 545
I25 25 Accident Cover



I25 26 Accidental Death Funeral Expenses




I25 27 Other Special


Local and Interstate Travelling Expenses
All States
Benefit for the cost of travel.
Limited to $100 per combined patient and attendant during any one year.

Overnight Non-Hospital Accommodation
All States
Benefit of up to $40 per night
Limited to $150 per combined patient and attendant during any one year.

Home Nursing

$35 per day, capped at 10 visits per year up to an annual limit of $350

The modality will include the following coverage:
   • General Care Services: Catheter Care, Continence Care, Medication Administration
      (injections, rectal vaginal suppositories for frail, enemas, dosette education), and wound
      management (post surgery, ulcer, wound drainage).

    •   Stomal Therapy

    •   Palliative Care Services – RN Care, Personal Care Assistance




I26 SCHEDULE GENERAL TREATMENT TABLES
I26 1 Table Name or Group of Table Names


Silver Extras (Z) and ANZ (#Z):




                                                                                          188 of 545
I26 2 Eligibility




I26 3 General Conditions
43. If a policy holder takes out a general treatment service, the Company will pay benefits:
    (aa) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
    (bb)          for more than one service of general treatment on a given day provided by a
         recognised provider in registered premises in private practice who is recognised by the
         Company in more than one profession.
44. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.
45. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.
4. General treatment benefits are not payable for any of the circumstances outlined in Rule E 4 of
    the General Conditions.




I26 4 Loyalty Bonuses
After 12 months continuous membership, a policy holder is entitled to an increased benefit equal to
the first year benefit for the relevant modality plus 2% of the first year benefit. For each subsequent
continuous 12 month’s membership, the policy holder is entitled to an increased benefit equal to their
previous year’s benefit for the relevant modality plus 2% of the first year benefit. No further increased
benefits apply beyond 10% of the first year benefit. Loyalty bonuses do not apply to optical, massage,
prostheses and appliances and hearing aids.


I26 5 Dental
Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services and
Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-operative
care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every three
years.

Maximum per person during any one year: -
General Dental
All States                                  NIL
Major Dental
All States                                  $1000
Orthodontia
All States                                  $700
Lifetime Limit                              $2000



                                                                                             189 of 545
I26 6 Optical

All States
Frames for prescription lenses              $115.60
Single Vision Lenses                         $46.30
Progressive Lenses                           $97.90
Contact Lenses, disposable
1 month supply                               $32.30
3 months supply                              $57.80
Contact Lenses, non-disposable              $102.90

The Maximum per person during any one year is $200.00.


I26 7 Physiotherapy
                           NSW           QLD        SA        TAS        VIC          WA                     NT
Initial visit               $33.60        $33.20    $31.00     $24.00     $31.00      $33.20                 $32.20
Subsequent visit            $28.40        $26.70    $24.80     $18.00     $24.80      $26.70                 $26.20
Ante natal visit            $ 9.40        $ 9.40    $ 7.20     $ 9.80     $ 8.60      $ 9.40                 $ 7.20
Post natal visit            $ 9.40        $ 9.40    $ 7.20     $ 9.80     $ 8.60      $ 9.40                 $ 7.20
Group therapy visit         $10.10        $12.50    $ 8.20     $ 9.80     $10.10      $12.50                 $ 9.40
                                                 Maximum per person during any one year
                           $700.00       $700.00   $700.00   $700.00     $700.00     $700.00                 $700.00


I26 8 Chiropractic

                          NSW            QLD           SA          TAS           VIC             WA          NT
Initial visit              $33.90         $22.50       $34.10       $24.00       $32.90          $24.00      $24.80
Subsequent visit           $23.30         $16.50       $21.40       $18.00       $21.40          $18.80      $17.70
X-ray service – per        $27.40         $56.30                    $30.00       $28.20          $56.30
Person per year
                                                 Maximum per person during any one year
                          $500.00        $500.00    $500.00   $500.00    $500.00     $500.00                 $500.00
                                          Maximum per family membership during any one year
                          $1000.00       $1000.00 $1000.00 $1000.00 $1000.00 $1000.00                        $1000.00

The above chiropractic benefits apply to the first 10 visits per person in any calendar year.
Benefits for visits after the first 10 are paid at 50% of the above.




I26 9 Non PBS Pharmaceuticals

After payment by the policy holder of an amount equal to the highest prescribed PBS prescription fee,
a benefit of 100% of the cost of the balance of the prescription.

Benefit is limited to the following amounts per script item.

NSW, SA, NT, VIC                $40
QLD, WA                         $35


                                                                                                190 of 545
TAS                                $20

The Maximum per person during any one year is $500 in all States.


Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the counter
cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at participating pharmacies
provided that the item is:


(w) Designed to manage or prevent disease, injuries or a condition; or
(x) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.



I26 10 Podiatry

All States

Initial visit                  $30.00
Subsequent visit               $22.00
Surgical Nail Resection        $60.00

The Maximum per person during any one year is $400.


I26 11 Psychology and Counselling

                              NSW           QLD             SA           TAS            VIC                WA        NT
Initial visit                  $35.00        $42.00         $52.50        $27.00        $40 00             $60.00    $52.50
Subsequent visit               $30.00        $30.00         $44.00        $27.00        $35.00             $50.00    $44.00
Interview with another         $15.00        $15.00         $25.00        $15.00        $15.00             $15.00    $25.00
person or Family
attendance
Group therapy visit            $10.00        $10.00   $15.00      $9.00     $10.00       $20.00                      $15.00
                                                    Maximum per person during any one year
                              $400.00       $400.00  $400.00    $400.00    $400.00      $400.00                     $400.00


I26 12 Alternative Therapies



I26 13 Natural Therapies


All States

Initial visit                  $24.00



                                                                                                     191 of 545
Subsequent visit         $18.00
Group attendance                $6.00
The Maximum per person including Massage and Aromatherapy during the first benefit entitlement
year is $400.

For massage and aromatherapy, a benefit of $18 per visit is payable in all States.

Massage and aromatherapy benefits are limited to $150 per person and $300 per family membership
in any one year.




I26 14 Speech Therapy

                           NSW          QLD         SA       TAS        VIC         WA            NT
Initial visit               $30.00       $27.00    $50.00     $25.00     $40.00     $55.00        $50.00
Subsequent visit            $25.00       $20.00    $30.00     $17.00     $25.00     $30.00        $30.00
Group therapy visit          $9.00        $9.00    $10.00      $9.00      $9.00     $15.00        $10.00
                                                Maximum per person during any one year
                            $400.00      $400.00   $400.00    $400.00    $400.00    $400.00        $400.00


I26 15 Orthotics




I26 16 Dietetics

                           NSW          QLD         SA       TAS        VIC          WA           NT
Initial visit               $40.00       $40.00    $40.00     $40.00     $40.00      $40.00       $40.00
Subsequent visit            $19.00       $19.00    $19.00     $19.00     $19.00      $19.00       $19.00
Group therapy visit         $13.00       $13.00    $11.00     $13.00     $11.00      $13.00       $13.00
                                                Maximum per person during any one year
                           $400.00      $400.00   $400.00   $400.00     $400.00     $400.00       $400.00


I26 17 Occupational Therapy

                           NSW          QLD         SA       TAS        VIC         WA            NT
Initial visit               $30.00       $27.00    $42 00     $25.00     $25.00     $30.00        $42 00
Subsequent visit            $25.00       $20.00    $28.00     $17.00     $17.00     $25.00        $28.00
Group therapy visit         $10.00       $10.00     $9.00      $9.00      $9.00     $10.00         $9.00
                                                Maximum per person during any one year
                            $400.00      $400.00   $400.00    $400.00    $400.00    $400.00        $400.00


I26 18 Naturopathy



                                                                                     192 of 545
I26 19 Acupuncture


I26 20 Other Therapies

Eye Therapy                 NSW          QLD         SA       TAS         VIC          WA                    NT
Initial visit                $28.00       $28.00    $22.00     $28.00     $28.00       $42.00                $24.00
Subsequent visit             $26.00       $21.00    $19.00     $20.00     $20.00       $30.00                $18.00
                                                  Maximum per person during any one year
                             $400.00      $400.00   $400.00    $400.00     $400.00      $400.00              $400.00




I26 21 Non Surgically Implanted Prostheses and Appliances

Asthma Pumps
Refund of 60% for the cost of supply.
Limited to one appliance per person every 3 years and $200 per person every 3 years.

Blood Glucose Monitors/INR (International Normalised Ratio) Devices
Refund of 60% for the cost of supply.
Limited to one appliance per person every year and $400 per person every year.

Continuous or Bilevel Positive Airway Pressure Devices
Refund of 60% for the cost of supply.
Limited to one device per person every 2 years and $500 per person every 2 years.

Surgical Stockings
Refund of 60% for the cost of supply.
Limited to $100 per person in any one year.

TENS Machine (Transcutaneous Electronic Nerve Stimulator)
Refund of 60% for the cost of supply.
Limited to one device per person every year and $125 per person every year.

Blood Pressure Monitors
Refund of 60% for the cost of supply.
Limited to one device per person every year and $125 per person every year.

Hire, Repair and Maintenance of a Health Appliance
60% for the cost and $100 per person every year.

Defined Appliances
Refund of 60% for the cost of supply.
Limited to $500 per person during any one year.
Refer to Rule E3.3 (6) for a list of approved defined appliances.

There is a combined maximum of $800 per person during any one year for all Prostheses and Appliances under
19.21. This maximum also includes any benefits paid for hearing aids under 19.22.




                                                                                              193 of 545
I26 22 Hearing Aids

Refund of 60% for the cost of supply.
This benefit is limited to one hearing aid per ear per person every 3 years and $500 per person during
any one year.
Benefit for repairs is limited to 60% of the repair cost, up to $100 per person during any one year.
The above limits also form part of the overall limit for non surgically implanted prostheses and
appliances under 19.21.




I26 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

Living Well Programs

The Fund will provide a cover towards selected Fund approved health related services and health
management programs that are designed to prevent or relieve a specific health condition or conditions.

Benefit

50% of the cost

Annual Limit

$100 per person


I26 24 Ambulance Transportation

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.




I26 25 Accident Cover



I26 26 Accidental Death Funeral Expenses




                                                                                            194 of 545
I26 27 Other Special


Local and Interstate Travelling Expenses
All States
Benefit for the cost of travel.
Limited to $100 per combined patient and attendant during any one year.

Overnight Non-Hospital Accommodation
All States
Benefit of up to $40 per night
Limited to $150 per combined patient and attendant during any one year.

Home Nursing

$35 per day, capped at 10 visits per year up to an annual limit of $350

The modality will include the following coverage:
   • General Care Services: Catheter Care, Continence Care, Medication Administration
      (injections, rectal vaginal suppositories for frail, enemas, dosette education), and wound
      management (post surgery, ulcer, wound drainage).

    •     Stomal Therapy

    •     Palliative Care Services – RN Care, Personal Care Assistance




I27 SCHEDULE GENERAL TREATMENT TABLES
I27 1 Table Name or Group of Table Names
Value Extras

I27 2 Eligibility

A Policy Holder may register a Dependant Child as a Dependant Extension under this policy in
accordance with the definition under Rule B2 of the General Conditions.

Product closed to new members from August 17th 2010.

I27 3 General Conditions


I27 4 Loyalty Bonuses



I27 5 Dental
Benefit




                                                                                          195 of 545
Benefits for Dental services are payable as set out in the Company’s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

No benefits are payable for Dentures and Orthodontics.

Annual Limit

Preventive Dental and General Dental – $400 per person

Major Dental (except for Dentures)

    (a) All states except WA - $300 per person increasing by $50 per year for each year of the Policy
        up to a maximum of $350.
    (b) WA - $350 per person increasing by $50 per year for each year of the Policy up to a
        maximum of $700.

Orthodontia – No cover

I27 6 Optical
Benefit

                       NSW/ACT          QLD           SA         TAS           VIC          WA             NT
Frames                  $45.00         $45.00      $45.00       $45.00       $45.00       $45.00         $45.00
Single Vision Lenses    $57.00         $57.00      $57.00       $57.00       $57.00       $50.00         $57.00
Multifocal Lenses      $110.00        $110.00     $110.00      $110.00      $110.00      $110.00        $110.00
Contact Lenses-         $80.00         $65.00      $65.00       $65.00       $80.00       $65.00         $65.00
Disposable

Annual Limit

 (c) All states except WA - $145 per person

 (d) WA - $170 per person

I27 7 Physiotherapy
Benefit

                       NSW/ACT          QLD           SA         TAS           VIC          WA            NT
Initial Visit          $24.00          $24.00      $24.00       $24.00       $24.00       $25.00        $24.00
Subsequent Visit       $16.50          $16.50      $16.50       $16.50       $16.50       $18.00        $16.50
Group Session           $6.00           $6.00       $6.00        $6.00        $6.00        $6.00         $6.00
Ante/Post Natal Visits $11.50          $11.50      $11.50       $11.50       $11.50        $8.00        $11.50

Annual Limit

    (e) All states except WA - $200 per person combined limit with chiropractic, osteopathy,
        naturopathy and acupuncture.

    (f) WA - $450 per person combined limit with chiropractic, osteopathy, naturopathy and
        acupuncture.


I27 8 Chiropractic
Benefit



                                                                                          196 of 545
                   NSW/ACT         QLD           SA         TAS          VIC          WA        NT
Initial Visit        $25.00        $25.00      $25.00       $25.00      $25.00       $25.00    $25.00
Subsequent Visit     $16.00        $16.00      $16.00       $16.00      $16.00       $17.00    $16.00

Annual Limit

   (g) All states except WA - $200 per person combined limit with physiotherapy, osteopathy,
       naturopathy and acupuncture.

   (h) WA - $450 per person combined limit with physiotherapy, osteopathy, naturopathy and
       acupuncture.

I27 9 Non PBS Pharmaceuticals




I27 10 Podiatry



I27 11 Psychology and Counselling




I27 12 Alternative Therapies




I27 13 Natural Therapies



I27 14 Speech Therapy




I27 15 Orthotics




I27 16 Dietetics



                                                                                      197 of 545
I27 17 Occupational Therapy




I27 18 Naturopathy
Benefit

                    NSW/ACT          QLD           SA         TAS           VIC         WA         NT
Initial Visit         $23.00         $23.00      $25.00       $23.00       $23.00      $25.00     $25.00
Subsequent Visit      $16.00         $16.00      $16.00       $16.00       $16.00      $17.00     $16.00

Annual Limit

 (i)   All states except WA - $200 per person combined limit with physiotherapy, chiropractic,
       osteopathy and acupuncture.

 (j)   WA - $450 per person combined limit with physiotherapy, chiropractic, osteopathy and
       acupuncture.

I27 19 Acupuncture

Benefit

                    NSW/ACT          QLD           SA         TAS           VIC         WA         NT
Initial Visit         $25.00         $25.00      $25.00       $25.00       $25.00      $25.00     $25.00
Subsequent Visit      $16.00         $16.00      $16.00       $16.00       $16.00      $17.00     $16.00

Annual Limit

 (k) All states except WA - $200 per person combined limit with physiotherapy, chiropractic,
     osteopathy and naturopathy.

 (l)   WA - $450 per person combined limit with physiotherapy, chiropractic, osteopathy and
       naturopathy.

I27 20 Other Therapies
Osteopathy

Benefit

All States
Initial visit                          $25.00
Subsequent visit                       $16.00

Annual Limit

 (m) All states except WA - $200 per person combined limit with physiotherapy, chiropractic,
     naturopathy and acupuncture.

 (n) WA - $450 per person combined limit with physiotherapy, chiropractic, naturopathy and
     acupuncture.


                                                                                         198 of 545
I27 21 Non Surgically Implanted Prostheses and Appliances



I27 22 Hearing Aids




I27 23 Prevention Health Management
Alliances Living Well Programs

The Company will provide a cover towards selected Company approved health related services and
health management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

$50 per claim

Annual Limit

$100 per person



Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


I27 24 Ambulance Transportation

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


I27 25 Accident Cover



I27 26 Accidental Death Funeral Expenses




                                                                                            199 of 545
I27 27 Other Special



I28 SCHEDULE GENERAL TREATMENT TABLES
I28 1 Table Name or Group of Table Names
All Extras


I28 2 Eligibility
A Policy Holder may register a Dependant Child as a Dependant Extension under this policy in
accordance with the definition under Rule B2 of the General Conditions.

Product closed to new members from August 17th 2010.


I28 3 General Conditions




I28 4 Loyalty Bonuses


I28 5 Dental
Benefit

Benefits for Dental services are payable as set out in the Company Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

Annual Limit

Preventive Dental and General Dental – $600 per person

Major Dental

    (o) All states except WA - $350 per person increasing by $50 per year for each year of the Policy
        up to a maximum of $700.
    (p) WA - 500 per person increasing by $50 per year for each year of the Policy up to a maximum
        of $1300.

Orthodontia – Lifetime Limit of $1500 per person for a course of treatment over a maximum of three
years.

I28 6 Optical
Benefit

                       NSW/ACT         QLD            SA         TAS           VIC             WA         NT
Frames                 $45.00         $45.00       $45.00       $45.00       $45.00          $45.00     $45.00
Single Vision Lenses   $57.00         $57.00       $57.00       $57.00       $57.00          $50.00     $57.00



                                                                                         200 of 545
Multifocal Lenses      $110.00        $110.00      $110.00      $110.00      $110.00      $110.00       $110.00
Contact Lenses-         $80.00         $65.00       $65.00       $65.00       $80.00       $65.00        $65.00
Disposable

Annual Limit

$200 per person

I28 7 Physiotherapy
Benefit

                       NSW/ACT          QLD            SA         TAS           VIC          WA            NT
Initial Visit          $24.00          $24.00       $24.00       $24.00       $24.00       $25.00        $24.00
Subsequent Visit       $16.50          $16.50       $16.50       $16.50       $16.50       $18.00        $16.50
Group Session           $6.00           $6.00        $6.00        $6.00        $6.00        $6.00         $6.00
Ante/Post Natal Visits $11.50          $11.50       $11.50       $11.50       $11.50        $8.00        $11.50

Annual Limit

$500 per person


I28 8 Chiropractic
Benefit

                    NSW/ACT          QLD            SA         TAS           VIC          WA             NT
Initial Visit         $25.00         $25.00       $25.00       $25.00       $25.00       $25.00         $25.00
Subsequent Visit      $16.00         $16.00       $16.00       $16.00       $16.00       $17.00         $16.00

Annual Limit

    (q) All states except WA - $450 per person combined limit with osteopathy, naturopathy and
        acupuncture.

    (r) WA - $350 per person combined limit with osteopathy, naturopathy and acupuncture.


I28 9 Non PBS Pharmaceuticals
Benefit

    (a) All States except WA - after deducting an amount equal to the highest prescribed PBS
        prescription fee, the Company will pay a benefit of 100% of the cost of the balance of the
        prescription. Benefit is limited to $50 per item.

    (b) WA - after deducting an amount equal to the highest prescribed PBS prescription fee, the
        Company will pay a benefit of 100% of the cost of the balance of the prescription. Benefit is
        limited to $40 per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Annual Limit

$500 per person




                                                                                           201 of 545
I28 10 Podiatry
Benefit

                    NSW/ACT        QLD           SA       TAS          VIC           WA        NT
Initial Visit         $25.00       $25.00      $25.00     $25.00      $25.00        $26.00    $25.00
Subsequent Visit      $19.00       $19.00      $19.00     $19.00      $19.00        $20.00    $19.00

Annual Limit

 (s) All states except WA - $250 per person.

 (t)   WA - $300 per person.

I28 11 Psychology and Counselling
Psychology

Benefit

                    NSW/ACT        QLD           SA       TAS          VIC           WA        NT
Initial Visit         $51.00       $51.00      $51.00     $51.00      $51.00        $55.00    $51.00
Subsequent Visit      $37.00       $37.00      $37.00     $37.00      $37.00        $40.00    $37.00
Group Treatment        $8.00        $8.00       $8.00      $8.00       $8.00        $10.00     $8.00

Hypnotherapy

Benefit

                    NSW/ACT        QLD           SA       TAS          VIC           WA        NT
Initial Visit         $37.00       $37.00      $37.00     $37.00      $37.00        $40.00    $37.00
Subsequent Visit      $37.00       $37.00      $37.00     $37.00      $37.00        $40.00    $37.00

Annual Limit

 (u) All states except WA - $350 per person combined psychology and hypnotherapy.

 (v) WA - $500 per person combined psychology and hypnotherapy.

I28 12 Alternative Therapies




I28 13 Natural Therapies



I28 14 Speech Therapy
Benefit

                    NSW/ACT        QLD           SA       TAS          VIC           WA        NT
Initial Visit         $50.00       $50.00      $50.00     $50.00      $50.00        $60.00    $50.00
Subsequent Visit      $30.00       $30.00      $30.00     $30.00      $30.00        $35.00    $30.00



                                                                                     202 of 545
Annual Limit

 (w) All states except WA - $450 per person.

 (x) WA - $500 per person.

I28 15 Orthotics
Benefit



Foot Orthotic – custom made              $500.00

Annual Limit

$500 per person combined with Non Surgically Implanted Prostheses and Appliances.

I28 16 Dietetics
Benefit

All States
Initial visit                        $37.00
Subsequent visit                     $18.00

Annual Limit

$250 per person

I28 17 Occupational Therapy
Benefit

All States
Initial visit                        $35.00
Subsequent visit                     $25.00

Annual Limit

 (y) All states except WA - $250 per person.

 (z) WA - $500 per person.


I28 18 Naturopathy
Benefit

                   NSW/ACT         QLD            SA         TAS          VIC          WA         NT
Initial Visit        $25.00        $25.00       $25.00       $25.00      $25.00       $25.00     $25.00
Subsequent Visit     $16.00        $16.00       $16.00       $16.00      $16.00       $17.00     $16.00

Annual Limit

 (aa) All states except WA - $450 per person combined limit with chiropractic, osteopathy and
      acupuncture.



                                                                                        203 of 545
 (bb) WA - $350 per person combined limit with chiropractic, osteopathy and acupuncture.


I28 19 Acupuncture
Benefit

                    NSW/ACT         QLD            SA        TAS           VIC          WA           NT
Initial Visit         $25.00        $25.00       $25.00      $25.00       $25.00       $25.00       $25.00
Subsequent Visit      $16.00        $16.00       $16.00      $16.00       $16.00       $17.00       $16.00

Annual Limit

 (cc) All states except WA - $450 per person combined limit with chiropractic, osteopathy and
      naturopathy.

 (dd) WA - $350 per person combined limit with chiropractic, osteopathy and naturopathy.

I28 20 Other Therapies
Osteopathy

Benefit

All States
Initial visit                         $25.00
Subsequent visit                      $16.00

Annual Limit

 (ee) All states except WA - $450 per person combined limit with chiropractic, naturopathy and
      acupuncture.

 (ff) WA - $350 per person combined limit with chiropractic, naturopathy and acupuncture.

Eye Therapy

Benefit

                    NSW/ACT         QLD            SA        TAS           VIC          WA           NT
Initial Visit         $30.00        $30.00       $30.00      $30.00       $30.00       $40.00       $30.00
Subsequent Visit      $30.00        $30.00       $30.00      $30.00       $30.00       $40.00       $30.00

Annual Limit

    (a) All states except WA - $250 per person

    (b) WA - $300 per person

I28 21 Non Surgically Implanted Prostheses and Appliances
Benefit

Benefits for non Surgically Implanted Prostheses and Appliances are payable as set out in the the
Company’s Benefit Schedule and in accordance with the Rules set out in Section E3 of the General
Conditions.

Annual Limit



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$500 per person combined with Orthotics.

I28 22 Hearing Aids

Benefit

Hearing Aid - Monaural       $550

Annual Limit

$550 for one hearing aid and $700 for two hearing aids per person every five years.

$50 per person per year for repairs.


I28 23 Prevention Health Management
Living Well Programs

The Company will provide a cover towards selected Company approved health related services and
health management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

$50 per claim

Annual Limit

$100 per person


Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


I28 24 Ambulance Transportation

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


I28 25 Accident Cover




                                                                                            205 of 545
I28 26 Accidental Death Funeral Expenses


I28 27 Other Special
Home Nursing (Royal District Nursing Service)

Benefits are paid for services provided by a registered nurse for an illness, injury or condition that
does not require admission to an approved hospital.

Benefit

All States
Pensioners and other Health Care Card Holders – 4 week period          $20.00
All Others – 4 week period                                             $40.00

Annual Limit

$100 per person

Peak Flow Meter

Benefit

All States
Per Appliance                                                          $25.00

Annual Limit

$25 per person

Blood Glucose Monitor

Benefit

All States
Per Appliance                                                         $200.00

Annual Limit

$200 per person once every three years

TENS Unit

Benefit

All States
Per Appliance                                                         $200.00

Annual Limit

$200 per person once every three years

Nebuliser

Benefit

                     NSW/ACT          QLD             SA         TAS           VIC           WA            NT
Per Appliance         $135.00        $135.00       $135.00      $135.00      $135.00       $140.00       $135.00


                                                                                              206 of 545
Annual Limit

    (c) All states except WA - $135 per person once every three years

    (d) WA - $140 per person once every three years



I29 SCHEDULE GENERAL TREATMENT TABLES
I29 1 Table Name or Group of Table Names
Extras Plus

I29 2 Eligibility
A Policy Holder may register a Dependant Child as a Dependant Extension under this policy in
accordance with the definition under Rule B2 of the General Conditions.

Product closed to new members from August 17th 2010.


I29 3 General Conditions


I29 4 Loyalty Bonuses


I29 5 Dental
Benefit

Benefits for Dental services are payable as set out in the Company’s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

Annual Limit

Preventive Dental and General Dental – $600 per person

Major Dental - $600 per person

Orthodontia – Lifetime Limit of $2000 per person for a course of treatment over a maximum of three
years.

I29 6 Optical
Benefit

                       NSW/ACT          QLD           SA         TAS           VIC          WA            NT
Frames                  $60.00         $60.00      $60.00       $60.00       $60.00       $60.00        $60.00
Single Vision Lenses    $57.00         $57.00      $57.00       $57.00       $57.00       $50.00        $57.00
Multifocal Lenses      $110.00        $110.00     $110.00      $110.00      $110.00      $110.00       $110.00
Contact Lenses-         $80.00         $65.00      $65.00       $65.00       $80.00       $65.00        $65.00
Disposable

Annual Limit


                                                                                          207 of 545
$200 per person

I29 7 Physiotherapy
Benefit

                         NSW/ACT         QLD            SA          TAS           VIC          WA              NT
Initial Visit            $48.00         $44.00       $44.00        $40.00       $43.20       $40.00          $44.00
Subsequent Visit         $44.00         $40.00       $36.00        $36.80       $40.00       $35.20          $32.00
Group Session            $17.60         $20.00       $12.80         $9.60        $9.60       $12.00           $9.60
Ante/Post Natal Visits   $24.00         $20.00       $12.00        $20.00       $20.00       $12.80          $20.00

Annual Limit

$400 per person per Therapy type up to a maximum of $800 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions and alternative therapies under 3.12, naturopathy
under 3.18 and acupuncture under 3.19.


I29 8 Chiropractic
Benefit

                         NSW/ACT         QLD            SA          TAS           VIC          WA              NT
Initial Visit            $56.00         $44.00       $44.00        $48.00       $44.00       $40.00          $40.00
Subsequent Visit         $38.40         $32.00       $28.80        $30.40       $31.20       $30.40          $32.00

Annual Limit

$400 per person per Therapy type up to a maximum of $800 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions and alternative therapies under 3.12, naturopathy
under 3.18 and acupuncture under 3.19.


I29 9 Non PBS Pharmaceuticals
Benefit

After deducting an amount equal to the highest prescribed PBS prescription fee, the Company will
pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $70 per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Annual Limit

$300 per person


I29 10 Podiatry
Benefit

                     NSW/ACT          QLD            SA          TAS           VIC          WA               NT
Initial Visit          $56.00         $40.00       $44.00        $36.00       $44.00       $44.00           $44.00
Subsequent Visit       $41.60         $36.00       $36.00        $22.00       $36.00       $32.00           $32.00



                                                                                             208 of 545
Annual Limit

$400 per person per Therapy type up to a maximum of $800 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions and alternative therapies under 3.12, naturopathy
under 3.18 and acupuncture under 3.19.


I29 11 Psychology and Counselling
Psychology

Benefit

                    NSW/ACT         QLD            SA         TAS          VIC         WA              NT
Initial Visit        $112.00        $96.00      $104.00      $126.00      $96.00     $120.00          $96.00
Subsequent Visit     $100.00        $84.00       $96.00       $88.00     $100.00     $100.00          $96.00
Group Treatment       $32.00        $32.00       $48.00       $32.00      $32.00      $32.00          $32.00

Hypnotherapy

Benefit

                    NSW/ACT         QLD            SA         TAS          VIC         WA           NT
Initial Visit        $120.00        $84.00      $120.00      $110.00     $120.00     $116.00      $110.00
Subsequent Visit     $120.00        $84.00      $120.00      $110.00     $120.00     $116.00      $110.00

Annual Limit

$400 per person per Therapy type up to a maximum of $800 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions and alternative therapies under 3.12, naturopathy
under 3.18 and acupuncture under 3.19.


I29 12 Alternative Therapies
The following Alternative Therapies are covered:-

Alexander technique, bowen therapy, feldenkrais, herbalism including Chinese Traditional Medicine
and Western Herbalism, homoeopathy and remedial massage.

Benefit

Benefits are payable as set out in the Company’s Benefit Schedule.

Annual Limit

$200 per person sub limit for all alternative therapies within the overall combined maximum of $800
per person for all Therapies as described in Rule B2 (“Therapies”) of the General Conditions and
alternative therapies, naturopathy under 3.18 and acupuncture under 3.19.


I29 13 Natural Therapies




                                                                                        209 of 545
I29 14 Speech Therapy
Benefit

                    NSW/ACT         QLD            SA        TAS           VIC         WA             NT
Initial Visit         $88.00        $80.00       $80.00      $80.00       $80.00      $60.00         $80.00
Subsequent Visit      $56.00        $44.00       $56.80      $56.00       $48.00      $35.00         $56.00

Annual Limit

$400 per person per Therapy type up to a maximum of $800 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions and alternative therapies under 3.12, naturopathy
under 3.18 and acupuncture under 3.19.

I29 15 Orthotics
Benefit



Foot Orthotic – custom made               $400.00

Annual Limit

$500 per person combined with Non Surgically Implanted Prostheses and Appliances.


I29 16 Dietetics
Benefit

                    NSW/ACT         QLD            SA        TAS           VIC         WA             NT
Initial Visit         $60.00        $56.00       $56.00      $56.00       $60.00      $56.00         $56.00
Subsequent Visit      $36.00        $36.00       $36.00      $36.00       $36.00      $33.60         $36.00

Annual Limit

$400 per person per Therapy type up to a maximum of $800 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions and alternative therapies under 3.12, naturopathy
under 3.18 and acupuncture under 3.19.

I29 17 Occupational Therapy
Benefit

                    NSW/ACT         QLD            SA         TAS         VIC          WA             NT
Initial Visit         $80.00        $84.00       $64.00       $64.00      $72.00      $60.00         $68.00
Subsequent Visit      $48.00        $44.00       $48.00       $48.00      $48.00      $32.00         $38.40

Annual Limit

$400 per person per Therapy type up to a maximum of $800 per person for all Therapies as described
in Rule B2.2 (“Therapies”) of the General Conditions and alternative therapies under 3.12,
naturopathy under 3.18 and acupuncture under 3.19.

I29 18 Naturopathy
Benefit


                                                                                        210 of 545
                     NSW/ACT        QLD           SA         TAS          VIC          WA             NT
Initial Visit          $60.00       $50.40      $52.00       $48.00      $52.00       $47.20         $48.00
Subsequent Visit       $44.00       $37.60      $36.00       $32.00      $40.00       $36.00         $40.00

Annual Limit

$400 per person per Therapy type up to a maximum of $800 per person for all Therapies as described
in Rule B2.2 (“Therapies”) of the General Conditions and alternative therapies under 3.12 and
acupuncture under 3.19.


I29 19 Acupuncture
Benefit

                     NSW/ACT        QLD           SA         TAS          VIC          WA             NT
Initial Visit          $44.00       $40.00      $40.80       $40.00      $60.00       $40.00         $40.00
Subsequent Visit       $36.00       $31.20      $34.40       $44.00      $33.60       $35.20         $36.00

Annual Limit

$400 per person per Therapy type up to a maximum of $800 per person for all Therapies as described
in Rule B2.2 (“Therapies”) of the General Conditions and alternative therapies under 3.12 and
naturopathy under 3.18.

I29 20 Other Therapies
Osteopathy

Benefit

All States
Initial and Subsequent visits         $80.00

Eye Therapy

Benefit

                     NSW/ACT        QLD           SA         TAS          VIC          WA             NT
Initial Visit          $80.00       $56.00      $40.00       $44.00      $36.00       $48.00         $44.00
Subsequent Visit       $48.00       $48.00      $44.00       $44.00      $32.00       $48.00         $44.00

Annual Limit

$400 per person per Therapy type up to a maximum of $800 per person for all Therapies as described
in Rule B2.2 (“Therapies”) of the General Conditions and alternative therapies under 3.12,
naturopathy under 3.18 and acupuncture under 3.19.


I29 21 Non Surgically Implanted Prostheses and Appliances
Benefit

Benefits for non Surgically Implanted Prostheses and Appliances are payable as set out in the
Company’s Benefit Schedule and in accordance with the Rules set out in Section E3.15 of the General
Conditions.



                                                                                       211 of 545
Annual Limit

$500 per person combined with Orthotics.


I29 22 Hearing Aids
Benefit

Hearing Aid - Monaural       $550

Annual Limit

$500 for one hearing aid and $700 for two hearing aids per person every five years.

$50 per person per year for repairs.

I29 23 Prevention Health Management

Living Well Programs

The Company will provide a cover towards selected Company approved health related services and
health management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

$50 twice per year

Annual Limit

$100 per person, up to a maximum of $200 per Policy


Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


I29 24 Ambulance Transportation



I29 25 Accident Cover



I29 26 Accidental Death Funeral Expenses




                                                                                            212 of 545
I29 27 Other Special
Home Nursing (Royal District Nursing Service)

Benefits are paid for services provided by a registered nurse for an illness, injury or condition that
does not require admission to an approved hospital.

Benefit

All States
Pensioners and other Health Care Card Holders – 4 week period          $20.00
All Others – 4 week period                                             $40.00

Annual Limit

$100 per person

Peak Flow Meter

Benefit

All States

75% of the cost

Annual Limit

$25 per person

Blood Glucose Monitor

Benefit

All States
Per Appliance                                                         $200.00

Annual Limit

$200 per Policy once every three years

TENS Unit

Benefit

All States
Per Appliance                                                         $200.00

Annual Limit

$200 per Policy once every three years

Nebuliser

Benefit

All States
Per Appliance                                                         $140.00

Annual Limit



                                                                                              213 of 545
$200 per Policy once every three years




I30 SCHEDULE GENERAL TREATMENT TABLES
I30 1 Table Name or Group of Table Names
Extras Value

I30 2 Eligibility
A Policy Holder may register a Dependant Child as a Dependant Extension under this policy in
accordance with the definition under Rule B2 of the General Conditions.

Product closed to new members from August 17th 2010.


I30 3 General Conditions


I30 4 Loyalty Bonuses


I30 5 Dental
Benefit

Benefits for Dental services are payable as set out in the Company’s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

No benefits are payable for Major Dental and Orthodontics.

Annual Limit

Preventive Dental and General Dental – $400 per person

Major Dental – No cover

Orthodontia – No cover

I30 6 Optical
Benefit

                       NSW/ACT          QLD           SA         TAS           VIC          WA            NT
Frames                  $45.00         $45.00      $45.00       $45.00       $45.00       $45.00        $45.00
Single Vision Lenses    $57.00         $57.00      $57.00       $57.00       $57.00       $57.00        $57.00
Multifocal Lenses      $110.00        $110.00     $110.00      $110.00      $110.00      $110.00       $110.00
Contact Lenses-         $52.00         $42.25      $42.25       $42.25       $52.00       $42.25        $42.25
Disposable

Annual Limit

$150 per person



                                                                                          214 of 545
I30 7 Physiotherapy
Benefit

                         NSW/ACT         QLD            SA          TAS           VIC          WA             NT
Initial Visit            $48.00         $44.00       $44.00        $40.00       $43.20       $40.00         $44.00
Subsequent Visit         $44.00         $40.00       $36.00        $36.80       $40.00       $35.20         $32.00
Group Session            $17.60         $20.00       $12.80         $9.60        $9.60       $12.00          $9.60
Ante/Post Natal Visits   $24.00         $20.00       $12.00        $20.00       $20.00       $12.80         $20.00

Annual Limit

$300 per person combined limit with - chiropractic, osteopathy, alternative therapies, naturopathy and
acupuncture.


I30 8 Chiropractic
Benefit

                         NSW/ACT         QLD            SA          TAS           VIC          WA             NT
Initial Visit            $56.00         $44.00       $44.00        $48.00       $44.00       $40.00         $40.00
Subsequent Visit         $38.40         $32.00       $28.80        $30.40       $31.20       $30.40         $32.00

Annual Limit

$300 per person combined limit with - physiotherapy, osteopathy, alternative therapies, naturopathy
and acupuncture.

I30 9 Non PBS Pharmaceuticals
Benefit

After deducting an amount equal to the highest prescribed PBS prescription fee, the Company will
pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50 per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Annual Limit

$100 per person

I30 10 Podiatry



I30 11 Psychology and Counselling




I30 12 Alternative Therapies
The following Alternative Therapies are covered:-



                                                                                             215 of 545
Alexander technique, bowen therapy, feldenkrais, herbalism including Chinese Traditional Medicine
and Western Herbalism, homoeopathy and remedial massage.

Benefit

Benefits are payable as set out in the Company’s Benefit Schedule.

Annual Limit

$150 per person sub limit for all alternative therapies within the overall combined maximum of $300
per person for physiotherapy, chiropractic, osteopathy, alternative therapies, naturopathy and
acupuncture.

I30 13 Natural Therapies



I30 14 Speech Therapy




I30 15 Orthotics




I30 16 Dietetics




I30 17 Occupational Therapy




I30 18 Naturopathy
Benefit

                    NSW/ACT          QLD            SA        TAS           VIC          WA             NT
Initial Visit         $60.00         $50.40       $52.00      $48.00       $52.00       $47.20         $48.00
Subsequent Visit      $44.00         $37.60       $36.00      $32.00       $40.00       $36.00         $40.00

Annual Limit

$300 per person combined limit with – physiotherapy, chiropractic, osteopathy, alternative therapies
and acupuncture.




                                                                                          216 of 545
I30 19 Acupuncture
Benefit

                     NSW/ACT         QLD            SA         TAS          VIC          WA              NT
Initial Visit          $44.00        $40.00       $40.80       $40.00      $60.00       $40.00          $40.00
Subsequent Visit       $36.00        $31.20       $34.40       $44.00      $33.60       $35.20          $36.00

Annual Limit

$300 per person combined limit with – physiotherapy, chiropractic, osteopathy, alternative therapies
and naturopathy.


I30 20 Other Therapies
Osteopathy

Benefit

All States
Initial and Subsequent visits          $80.00

Annual Limit

$300 per person combined limit with - physiotherapy, chiropractic, alternative therapies, naturopathy
and acupuncture.


I30 21 Non Surgically Implanted Prostheses and Appliances




I30 22 Hearing Aids




I30 23 Prevention Health Management
Living Well Programs

The Company will provide a cover towards selected Company approved health related services and
health management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

$50 twice per year

Annual Limit

$100 per person, up to a maximum of $200 per Policy




                                                                                          217 of 545
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


I30 24 Ambulance Transportation
For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


I30 25 Accident Cover



I30 26 Accidental Death Funeral Expenses



I30 27 Other Special



I31 SCHEDULE GENERAL TREATMENT TABLES
I31 1 Table Name or Group of Table Names
Extras Super Plus

I31 2 Eligibility
A Policy Holder may register a Dependant Child as a Dependant Extension under this policy in
accordance with the definition under Rule B2 of the General Conditions.

Product closed to new members from August 17th 2010.


I31 3 General Conditions


I31 4 Loyalty Bonuses


I31 5 Dental
Benefit




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Benefits for Dental services are payable as set out in the Company’s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

Annual Limit

General Dental – $700 per person

Major Dental - $800 per person

Orthodontia – Lifetime Limit of $2500 per person for a course of treatment over a maximum of three
years.

I31 6 Optical
Benefit

                         NSW/ACT        QLD           SA         TAS           VIC          WA           NT
Frames                    90%           90%         90%          90%          90%          90%          90%
Single Vision Lenses      90%           90%         90%          90%          90%          90%          90%
Multifocal Lenses         90%           90%         90%          90%          90%          90%          90%
Contact Lenses-          $72.00        $58.50      $58.50       $58.50       $72.00       $58.50       $58.50
Disposable

Annual Limit

$250 per person

I31 7 Physiotherapy
Benefit

                         NSW/ACT        QLD           SA         TAS           VIC          WA           NT
Initial Visit            $54.00        $49.50      $49.50       $45.00       $48.60       $45.00       $49.50
Subsequent Visit         $49.50        $45.00      $40.50       $41.40       $45.00       $39.60       $36.00
Group Session            $19.80        $22.50      $14.40       $10.80       $10.80       $13.50       $10.80
Ante/Post Natal Visits   $27.00        $22.50      $13.50       $22.50       $22.50       $14.40       $22.50

Annual Limit

$500 per person per Therapy type up to a maximum of $1000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions and alternative therapies under 5.12,
naturopathy under 5.18 and acupuncture under 5.19.

I31 8 Chiropractic
Benefit

                         NSW/ACT        QLD           SA         TAS           VIC          WA           NT
Initial Visit            $63.00        $49.50      $49.50       $54.00       $49.50       $45.00       $45.00
Subsequent Visit         $43.20        $36.00      $32.40       $32.40       $35.10       $34.20       $36.00

Annual Limit

$500 per person per Therapy type up to a maximum of $1000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions and alternative therapies under 5.12,
naturopathy under 5.18 and acupuncture under 5.19.




                                                                                          219 of 545
I31 9 Non PBS Pharmaceuticals
Benefit

After deducting an amount equal to the highest prescribed PBS prescription fee, the Company will
pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $70 per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Annual Limit

$500 per person

I31 10 Podiatry
Benefit

                     NSW/ACT          QLD            SA          TAS           VIC          WA               NT
Initial Visit          $63.00         $45.00       $49.50        $40.50       $49.50       $49.50           $49.50
Subsequent Visit       $46.80         $40.50       $40.50        $36.00       $40.50       $36.00           $36.00

Annual Limit

$500 per person per Therapy type up to a maximum of $1000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions and alternative therapies under 5.12,
naturopathy under 5.18 and acupuncture under 5.19.


I31 11 Psychology and Counselling

Psychology

Benefit

                     NSW/ACT          QLD            SA         TAS            VIC          WA           NT
Initial Visit         $126.00        $108.00      $117.00      $126.00       $117.00      $135.00      $108.00
Subsequent Visit      $112.50         $94.50      $108.00       $99.00       $112.50      $112.50      $108.00
Group Treatment        $36.00         $36.00       $54.00       $36.00        $36.00       $36.00       $36.00

Hypnotherapy

Benefit

                     NSW/ACT          QLD            SA          TAS           VIC          WA               NT
Initial Visit         $108.00         $94.50      $108.00        $99.00      $108.00      $104.40           $99.00
Subsequent Visit      $108.00         $94.50      $108.00        $99.00      $108.00      $104.40           $99.00

Annual Limit

$500 per person per Therapy type up to a maximum of $1000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions and alternative therapies under 5.12,
naturopathy under 5.18 and acupuncture under 5.19.




                                                                                             220 of 545
I31 12 Alternative Therapies

The following Alternative Therapies are covered:-

Alexander technique, bowen therapy, feldenkrais, herbalism including Chinese Traditional Medicine
and Western Herbalism, homoeopathy and remedial massage.

Benefit

Benefits are payable as set out in the Company’s Benefit Schedule.

Annual Limit

$300 per person sub limit for all alternative therapies within the overall combined maximum of
$1000 per person for all Therapies as described in Rule B2 (“Therapies”) of the General Conditions
and alternative therapies, naturopathy under 5.18 and acupuncture under 5.19.

I31 13 Natural Therapies



I31 14 Speech Therapy
Benefit

                    NSW/ACT         QLD            SA         TAS          VIC          WA            NT
Initial Visit         $88.00        $80.00       $80.00       $80.00      $80.00       $97.60        $80.00
Subsequent Visit      $56.00        $44.00       $56.80       $56.00      $48.00       $48.00        $56.00

Annual Limit

$500 per person per Therapy type up to a maximum of $1000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions and alternative therapies under 5.12,
naturopathy under 5.18 and acupuncture under 5.19.


I31 15 Orthotics
Benefit




Annual Limit



I31 16 Dietetics
Benefit

                    NSW/ACT         QLD            SA         TAS          VIC          WA            NT
Initial Visit         $67.50        $63.00       $63.00       $63.00      $67.50       $63.00        $63.00



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Subsequent Visit       $40.50       $40.50       $40.50      $40.50       $40.50       $37.80        $40.50

Annual Limit

$500 per person per Therapy type up to a maximum of $1000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions and alternative therapies under 5.12,
naturopathy under 5.18 and acupuncture under 5.19.

I31 17 Occupational Therapy
Benefit

                    NSW/ACT         QLD            SA         TAS          VIC          WA            NT
Initial Visit         $90.00        $94.50       $72.00       $72.00       $81.00      $76.50        $67.50
Subsequent Visit      $54.00        $49.50       $54.00       $54.00       $54.00      $43.20        $58.50

Annual Limit

$500 per person per Therapy type up to a maximum of $1000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions and alternative therapies under 5.12,
naturopathy under 5.18 and acupuncture under 5.19.

I31 18 Naturopathy
Benefit

                    NSW/ACT         QLD            SA        TAS           VIC          WA            NT
Initial Visit         $67.50        $56.70       $58.50      $54.00       $58.50       $53.10        $54.00
Subsequent Visit      $49.50        $42.30       $40.50      $36.00       $45.00       $40.50        $45.00

Annual Limit

$500 per person per Therapy type up to a maximum of $1000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions and alternative therapies under 5.12
and acupuncture under 5.19.

I31 19 Acupuncture
Benefit

                    NSW/ACT         QLD            SA        TAS           VIC          WA            NT
Initial Visit         $49.50        $45.00       $45.90      $45.00       $67.50       $45.00        $45.00
Subsequent Visit      $40.50        $35.10       $38.70      $49.50       $37.80       $39.60        $40.50

Annual Limit

$500 per person per Therapy type up to a maximum of $1000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions and alternative therapies under 5.12
and naturopathy under 5.18.


I31 20 Other Therapies
Osteopathy

Benefit




                                                                                        222 of 545
All States
Initial and Subsequent visits           $90.00

Eye Therapy

Benefit

                     NSW/ACT           QLD         SA         TAS           VIC          WA           NT
Initial Visit          $90.00          $63.00    $45.00       $49.50       $40.50       $54.00       $49.50
Subsequent Visit       $54.00          $54.00    $49.50       $49.50       $36.00       $54.00       $49.50
Annual Limit

$500 per person per Therapy type up to a maximum of $1000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions and alternative therapies under 5.12,
naturopathy under 5.18 and acupuncture under 5.19.

I31 21 Non Surgically Implanted Prostheses and Appliances
Benefit

Benefits for non Surgically Implanted Prostheses and Appliances are payable as set out in the the
Company’s Benefit Schedule and in accordance with the Rules set out in Section E3 of the General
Conditions.

Annual Limit

$500 per person combined

I31 22 Hearing Aids
Benefit

Hearing Aid - Monaural          $495

Annual Limit

$550 for one hearing aid and $700 for two hearing aids per person every five years.

$50 per person per year for repairs.


I31 23 Prevention Health Management
Living Well Programs

The Company will provide a cover towards selected the Company approved health related services
and health management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

$50 twice per year

Annual Limit

$100 per person, up to a maximum of $200 per Policy




                                                                                         223 of 545
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


I31 24 Ambulance Transportation
For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.

.

I31 25 Accident Cover



I31 26 Accidental Death Funeral Expenses



I31 27 Other Special
Home Nursing (Royal District Nursing Service)

Benefits are paid for services provided by a registered nurse for an illness, injury or condition that
does not require admission to an approved hospital.

Benefit

All States
Pensioners and other Health Care Card Holders – 4 week period          $20.00
All Others – 4 week period                                             $40.00

Annual Limit

$100 per person

Peak Flow Meter

Benefit

All States
Per Appliance                                                          $22.50

Annual Limit

$25 per person

Blood Glucose Monitor


                                                                                              224 of 545
Benefit

All States
Per Appliance                                                   $200.00

Annual Limit

$200 per Policy once every three years

TENS Unit

Benefit

All States
Per Appliance                                                   $180.00

Annual Limit

$200 per Policy once every three years

Nebuliser

Benefit

All States
Per Appliance                                                   $180.00

Annual Limit

$200 per Policy once every three years


I32 SCHEDULE GENERAL TREATMENT TABLES
I32 1 Table Name or Group of Table Names
Extras Select

I32 2 Eligibility
A Policy Holder may register a Dependant Child as a Dependant Extension under this policy in
accordance with the definition under Rule B2 of the General Conditions.

Product closed to new members from August 17th 2010.


I32 3 General Conditions


I32 4 Loyalty Bonuses


I32 5 Dental
Benefit




                                                                                       225 of 545
Benefits for Dental services are payable as set out in the Company’sBenefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

No benefits are payable for Orthodontics.

Annual Limit

Preventive Dental, General Dental and Major Dental – $350 per person, up to a maximum of $750
per Policy

Orthodontia – No cover


I32 6 Optical
Benefit

                         NSW/ACT       QLD            SA         TAS           VIC         WA            NT
Frames                    $89.60      $97.45      $108.65       $95.20      $106.40      $95.20       $100.80
Single Vision Lenses      $62.30      $62.30       $72.25       $62.30       $62.30      $62.30        $67.20
Multifocal Lenses        $123.20     $135.55      $151.20      $136.65      $136.60     $130.80       $138.35
Contact Lenses-            70%         70%          70%         $70%          70%         70%           70%
Disposable

Annual Limit

$150 per person, up to a maximum of $300 per Policy.

I32 7 Physiotherapy
Benefit

                         NSW/ACT       QLD            SA         TAS           VIC         WA           NT
Initial Visit            $34.30       $31.20       $32.30       $32.05       $31.90      $33.10       $32.75
Subsequent Visit         $27.15       $25.60       $25.85       $25.20       $25.60      $26.80       $26.15
Group Session            $11.40        $9.50        $9.55       $13.40       $14.00       $7.00       $12.55
Ante/Post Natal Visits   $18.00       $18.00       $18.00       $18.00       $18.00      $18.00       $18.00

Annual Limit

$350 per person, up to a maximum of $700 per Policy combined limit with chiropractic and
osteopathy services and ante and post natal services by a midwife. From 1 November 2010, the
Company will not pay benefits for services which have an MBS item number and are provided
outside a hospital by a participating midwife.


I32 8 Chiropractic
Benefit

                         NSW/ACT       QLD            SA         TAS           VIC         WA           NT
Initial Visit            $39.00       $32.00       $35.00       $33.00       $34.00      $35.00       $35.00
Subsequent Visit         $25.00       $23.00       $25.00       $23.00       $24.00      $25.00       $25.00

Annual Limit

$350 per person, up to a maximum of $700 per Policy combined limit with physiotherapy and
osteopathy services and ante and post natal services by a midwife. From 1 November 2010, the



                                                                                         226 of 545
Company will not pay benefits for services which have an MBS item number and are provided
outside a hospital by a participating midwife.


I32 9 Non PBS Pharmaceuticals
Benefit

After deducting an amount equal to the highest prescribed PBS prescription fee, the Company will
pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50 per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Annual Limit

$100 per person up to a maximum of $200 per Policy.

I32 10 Podiatry




I32 11 Psychology and Counselling




I32 12 Alternative Therapies
The following Alternative Therapies are covered:-

Alexander technique, bowen therapy, feldenkrais, herbalism including Chinese Traditional Medicine
and Western Herbalism, homoeopathy and remedial massage.

Benefit

Benefits are payable as set out in the Company’s Benefit Schedule.

Annual Limit

$100 per person, up to a maximum of $200 per Policy combined limit for all alternative therapies
and naturopathy under 6.18 and acupuncture under 6.19.

I32 13 Natural Therapies


I32 14 Speech Therapy




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I32 15 Orthotics




I32 16 Dietetics




I32 17 Occupational Therapy




I32 18 Naturopathy
Benefit

                   NSW/ACT          QLD           SA        TAS           VIC         WA         NT
Initial Visit        $25.00         $25.00      $25.00      $22.00       $25.00      $22.00     $25.00
Subsequent Visit     $22.00         $20.00      $20.00      $20.00       $21.50      $20.00     $22.00

Annual Limit

$100 per person, up to a maximum of $200 per Policy combined limit for naturopathy and all
alternative therapies under 6.12 and acupuncture under 6.19.


I32 19 Acupuncture
Benefit

                   NSW/ACT          QLD           SA        TAS           VIC         WA         NT
Initial Visit        $28.00         $28.00      $31.00      $25.00       $28.50      $32.00     $30.00
Subsequent Visit     $22.00         $22.00      $23.00      $23.00       $21.50      $25.00     $25.00

Annual Limit

$100 per person, up to a maximum of $200 per Policy combined limit for acupuncture and all
alternative therapies under 6.12 and naturopathy under 6.18.


I32 20 Other Therapies
Osteopathy

Benefit




                                                                                       228 of 545
                     NSW/ACT          QLD            SA         TAS           VIC          WA           NT
Initial Visit          $39.90         $35.00       $40.60       $32.90       $36.40       $32.65       $35.00
Subsequent Visit       $37.10         $31.10       $27.65       $26.25       $31.50       $27.45       $25.00

Ante Natal and Post Natal Classes

From 1 November 2010, the Company will not pay benefits for services which have an MBS item
number and are provided outside a hospital by a participating midwife.

Benefit

All States
Per visit                               $29.55

Annual Limit

$350 per person, up to a maximum of $700 per Policy combined limit with physiotherapy and
chiropractic.


I32 21 Non Surgically Implanted Prostheses and Appliances




I32 22 Hearing Aids




I32 23 Prevention Health Management
Living Well Programs

The Company will provide a cover towards selected Company approved health related services and
health management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

50% of the cost

Annual Limit

$50 per Policy


Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.




                                                                                            229 of 545
I32 24 Ambulance Transportation

. For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


I32 25 Accident Cover
Benefit

The Company will provide payments to the Policy Holder for the cost of accident related health care
services, except for services that are covered by Medicare, incurred as a direct result of an Accident
after joining where:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted; and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
    Benefit as set out in the Company’s Benefit Schedule for the respective type of services involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

(1) $2000 per person up to a maximum of $4000 per Policy.

(2) $2000 per Accident per person up to a maximum of $4000 per Accident per Policy.

I32 26 Accidental Death Funeral Expenses



I32 27 Other Special



I33 SCHEDULE GENERAL TREATMENT TABLES
I33 1 Table Name or Group of Table Names
Extras Select Value

I33 2 Eligibility
1. A Policy Holder can only purchase Extras Select Value in combination with an available level of
hospital cover and cannot be purchased as a stand-alone policy.

2. A Policy Holder may register a Dependant Child as a Dependant Extension under this policy in
accordance with the definition under Rule B2 of the General Conditions.


                                                                                            230 of 545
Product closed to new members from August 17th 2010.


I33 3 General Conditions


I33 4 Loyalty Bonuses


I33 5 Dental
Benefit

Benefits for Dental services are payable as set out in the Company’s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

No benefits are payable for Orthodontics

Annual Limit

Preventive Dental - Nil

General Dental – $300 per person

Major Dental - $300 per person

Orthodontia – No cover


I33 6 Optical
Benefit

                         NSW/ACT        QLD           SA         TAS           VIC          WA            NT
Frames                    $89.60       $97.45     $108.65       $95.20      $106.40       $95.20       $100.80
Single Vision Lenses      $62.30       $62.30      $72.25       $62.30       $62.30       $62.30        $67.20
Multifocal Lenses        $123.20      $135.55     $151.20      $136.65      $136.60      $130.80       $138.35
Contact Lenses-            70%          70%         70%         $70%          70%          70%           70%
Disposable

Annual Limit

$185 per person

I33 7 Physiotherapy
Benefit

                         NSW/ACT        QLD           SA         TAS           VIC          WA           NT
Initial Visit            $34.30        $31.20      $32.30       $32.05       $31.90       $33.10       $32.75
Subsequent Visit         $27.15        $25.60      $25.85       $25.20       $25.60       $26.80       $26.15
Group Session            $11.40         $9.50       $9.55       $13.40       $14.00        $7.00       $12.55
Ante/Post Natal Visits   $18.00        $18.00      $18.00       $18.00       $18.00       $18.00       $18.00

Annual Limit




                                                                                          231 of 545
$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


I33 8 Chiropractic
Benefit

                        NSW/ACT          QLD            SA          TAS           VIC          WA              NT
Initial Visit           $39.00          $32.00       $35.00        $33.00       $34.00       $35.00          $35.00
Subsequent Visit        $25.00          $23.00       $25.00        $23.00       $24.00       $25.00          $25.00

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


I33 9 Non PBS Pharmaceuticals
Benefit

After deducting an amount equal to the highest prescribed PBS prescription fee, the Company’s will
pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50 per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Annual Limit

$150 per person

I33 10 Podiatry
Benefit

                     NSW/ACT          QLD            SA          TAS           VIC          WA               NT
Initial Visit          $30.00         $30.00       $35.00        $30.00       $32.00       $49.50           $35.00
Subsequent Visit       $26.00         $25.00       $28.00        $25.00       $26.00       $36.00           $27.00

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

I33 11 Psychology and Counselling
Benefit

                     NSW/ACT          QLD            SA          TAS           VIC          WA               NT
Initial Visit          $70.00         $65.00       $85.00        $65.00       $70.00      $100.00           $77.00
Subsequent Visit       $62.00         $55.00       $70.00        $60.00       $60.00       $70.00           $60.00
Group Treatment        $32.00         $30.00       $60.00        $56.00       $56.00       $60.00           $30.00

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2.2 (“Therapies”) of the General Conditions.


                                                                                             232 of 545
I33 12 Alternative Therapies

Alexander technique, bowen therapy, feldenkrais, herbalism including Chinese Traditional Medicine
and Western Herbalism, homoeopathy and remedial massage.

Benefit

Benefits are payable as set out in the Company’s Benefit Schedule.

Annual Limit

$200 per person, combined limit with naturopathy under 7.18 and acupuncture under 7.19.


I33 13 Natural Therapies



I33 14 Speech Therapy
Benefit

                    NSW/ACT         QLD            SA         TAS         VIC         WA              NT
Initial Visit         $70.00        $60.00       $75.00       $55.00     $60.00      $78.00          $60.00
Subsequent Visit      $32.00        $35.00       $45.00       $30.00     $35.00      $35.00          $35.00

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


I33 15 Orthotics


I33 16 Dietetics
Benefit

                    NSW/ACT         QLD            SA         TAS         VIC         WA              NT
Initial Visit         $55.15        $50.40       $56.60       $49.35     $51.85      $52.50          $53.95
Subsequent Visit      $28.20        $24.75       $28.90       $27.50     $27.20      $24.90          $25.20

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


I33 17 Occupational Therapy
Benefit

                    NSW/ACT          QLD            SA        TAS         VIC         WA               NT



                                                                                          233 of 545
Initial Visit          $65.00       $58.00        $65.00      $50.00       $52.00      $60.00        $55.00
Subsequent Visit       $35.00       $40.00        $50.00      $30.00       $40.00      $32.00        $35.00

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

I33 18 Naturopathy
Benefit

                    NSW/ACT         QLD            SA         TAS          VIC          WA            NT
Initial Visit         $28.00        $28.00       $28.00       $24.50      $28.00       $24.50        $25.00
Subsequent Visit      $24.50        $21.50       $21.00       $21.00      $24.50       $21.00        $22.00

Annual Limit

$200 per person, combined limit with alternative therapies under 7.12 and acupuncture under 7.19.

I33 19 Acupuncture
Benefit

                    NSW/ACT         QLD            SA         TAS          VIC          WA            NT
Initial Visit         $31.50        $31.50       $35.05       $28.00      $32.00       $35.00        $31.50
Subsequent Visit      $24.50        $24.50       $25.05       $25.40      $24.50       $25.75        $28.00

Annual Limit

$200 per person, combined limit with alternative therapies under 7.12 and naturopathy under 7.18.


I33 20 Other Therapies
Osteopathy

Benefit

                    NSW/ACT         QLD             SA        TAS          VIC          WA            NT
Initial Visit         $39.90        $35.00        $40.60      $32.90      $36.40       $32.65        $35.00
Subsequent Visit      $37.10        $23.00        $25.00      $23.00      $24.00       $25.00        $25.00

Eye Therapy

Benefit

All States
Initial visit                         $42.00
Subsequent visit                      $35.00

Ante Natal and Post Natal Classes

From 1 November 2010, the Company will not pay benefits for services which have an MBS item
number and are provided outside a hospital by a participating midwife.

Benefit


                                                                                         234 of 545
                     NSW/ACT          QLD            SA         TAS           VIC          WA               NT
Per Visit              $17.50         $29.55       $28.00       $28.00       $28.00       $31.50           $29.55

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

I33 21 Non Surgically Implanted Prostheses and Appliances




I33 22 Hearing Aids




I33 23 Prevention Health Management
Living Well Programs

The Company will provide a cover towards selected Company approved health related services and
health management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

50% of the cost

Annual Limit

$100 per person



Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


I33 24 Ambulance Transportation
For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.




                                                                                            235 of 545
I33 25 Accident Cover
Benefit

The Company will provide payments to the Policy Holder for the cost of accident related health care
services, except for services that are covered by Medicare, incurred as a direct result of an Accident
after joining where:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted; and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
    Benefit as set out in the Company’s Benefit Schedule for the respective type of services involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

(1) $2000 per person up to a maximum of $4000 per Policy.

(2) $2000 per Accident per person up to a maximum of $4000 per Accident per Policy.

I33 26 Accidental Death Funeral Expenses



I33 27 Other Special



I34 SCHEDULE GENERAL TREATMENT TABLES
I34 1 Table Name or Group of Table Names
Extras Select Plus

I34 2 Eligibility
1. A Policy Holder can only purchase Extras Select Plus in combination with an available level of
hospital cover and cannot be purchased as a stand-alone policy.

2. A Policy Holder may register a Dependant Child as a Dependant Extension under this policy in
accordance with the definition under Rule B2 of the General Conditions.

Product closed to new members from August 17th 2010.


I34 3 General Conditions




                                                                                            236 of 545
I34 4 Loyalty Bonuses


I34 5 Dental
Benefit

Benefits for Dental services are payable as set out in he Company’s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

Annual Limit

Preventive Dental - Nil

General Dental – $300 per person

Major Dental - $800 per person

Orthodontia – Lifetime Limit of $2000 per person

I34 6 Optical
Benefit

                       NSW/ACT         QLD            SA         TAS           VIC         WA            NT
Frames                  $89.60        $97.45      $108.65       $95.20      $106.40      $95.20       $100.80
Single Vision Lenses    $62.30        $62.30       $72.25       $62.30       $62.30      $62.30        $67.20
Multifocal Lenses      $123.20       $135.55      $151.20      $136.65      $136.60     $130.80       $138.35
Contact Lenses-          70%           70%          70%         $70%          70%         70%           70%
Disposable

Annual Limit

$225 per person

I34 7 Physiotherapy
Benefit

                       NSW/ACT         QLD            SA         TAS           VIC         WA           NT
Initial Visit          $34.30         $31.20       $32.30       $32.05       $31.90      $33.10       $32.75
Subsequent Visit       $27.15         $25.60       $25.85       $25.20       $25.60      $26.80       $26.15
Group Session          $11.40          $9.50        $9.55       $13.40       $14.00       $7.00       $12.55
Ante/Post Natal Visits $18.00         $18.00       $18.00       $18.00       $18.00      $18.00       $18.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

I34 8 Chiropractic
Benefit

                       NSW/ACT         QLD            SA         TAS           VIC         WA           NT
Initial Visit          $40.00         $35.00       $40.00       $35.00       $38.00      $40.00       $40.00
Subsequent Visit       $30.00         $25.00       $28.00       $25.00       $28.00      $30.00       $30.00



                                                                                         237 of 545
Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

I34 9 Non PBS Pharmaceuticals
Benefit

After deducting an amount equal to the highest prescribed PBS prescription fee, the Company will
pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50 per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Annual Limit

$300 per person


I34 10 Podiatry
Benefit

                     NSW/ACT          QLD            SA          TAS           VIC          WA               NT
Initial Visit          $35.00         $35.00       $40.00        $35.00       $35.00       $40.00           $36.00
Subsequent Visit       $30.00         $30.00       $32.00        $30.00       $30.00       $30.00           $32.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


I34 11 Psychology and Counselling
Benefit

                     NSW/ACT          QLD            SA          TAS           VIC          WA               NT
Initial Visit          $75.00         $70.00       $90.00        $70.00       $75.00      $110.00           $85.00
Subsequent Visit       $65.00         $60.00       $75.00        $65.00       $65.00       $75.00           $70.00
Group Treatment        $35.00         $35.00       $68.00        $60.00       $60.00       $65.00           $36.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

I34 12 Alternative Therapies

Alexander technique, bowen therapy, feldenkrais, herbalism including Chinese Traditional Medicine
and Western Herbalism, homoeopathy and remedial massage.

Benefit

Benefits are payable as set out in he Company’s Benefit Schedule.



                                                                                             238 of 545
Annual Limit

$200 per person, combined limit with naturopathy under 8.18 and acupuncture under 8.19.

I34 13 Natural Therapies


I34 14 Speech Therapy
Benefit

                    NSW/ACT         QLD           SA        TAS           VIC         WA              NT
Initial Visit         $75.00        $65.00      $80.00      $60.00       $65.00      $82.00          $70.00
Subsequent Visit      $35.00        $40.00      $50.00      $35.00       $40.00      $37.00          $45.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

I34 15 Orthotics
Benefit



Foot Orthotic – custom made               $105.00

Annual Limit

$500 per person combined with Non Surgically Implanted Prostheses and Appliances.




I34 16 Dietetics

Benefit

                    NSW/ACT         QLD           SA        TAS           VIC         WA              NT
Initial Visit         $55.15        $50.40      $56.60      $49.35       $51.85      $52.50          $55.00
Subsequent Visit      $30.00        $25.00      $30.00      $27.50       $27.20      $30.00          $30.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

I34 17 Occupational Therapy
Benefit

                    NSW/ACT         QLD           SA        TAS           VIC         WA              NT
Initial Visit         $68.00        $60.00      $70.00      $55.00       $55.00      $65.00          $60.00
Subsequent Visit      $38.00        $45.00      $55.00      $35.00       $43.00      $35.00          $40.00



                                                                                          239 of 545
Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

I34 18 Naturopathy
Benefit

                    NSW/ACT         QLD            SA         TAS          VIC          WA            NT
Initial Visit         $30.00        $30.00       $30.00       $25.00      $30.00       $30.00        $30.00
Subsequent Visit      $25.00        $25.00       $25.00       $23.00      $25.00       $25.00        $25.00

Annual Limit

$200 per person, combined limit with alternative therapies under 8.12 and acupuncture under 8.19.


I34 19 Acupuncture
Benefit

                    NSW/ACT         QLD            SA         TAS          VIC          WA            NT
Initial Visit         $33.00        $32.00       $35.00       $30.00      $35.00       $35.00        $35.00
Subsequent Visit      $26.00        $26.00       $25.05       $26.00      $25.00       $28.00        $28.00

Annual Limit

$200 per person, combined limit with alternative therapies under 8.12 and naturopathy under 8.18.




I34 20 Other Therapies
Osteopathy

Benefit

                    NSW/ACT         QLD             SA        TAS          VIC          WA            NT
Initial Visit         $39.90        $35.00        $40.60      $32.90      $36.40       $32.65        $35.00
Subsequent Visit      $37.10        $31.10        $25.00      $26.25      $31.50       $27.45        $31.95

Eye Therapy

Benefit

All States
Initial visit                         $42.00
Subsequent visit                      $38.00

Ante Natal and Post Natal Classes

From 1 November 2010, the Company will not pay benefits for services which have an MBS item
number and are provided outside a hospital by a participating midwife.

Benefit




                                                                                         240 of 545
                     NSW/ACT          QLD            SA         TAS           VIC          WA           NT
Per Visit              $17.50         $29.55       $28.00       $28.00       $28.00       $31.50       $29.55

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


I34 21 Non Surgically Implanted Prostheses and Appliances
Benefit

Benefits for non Surgically Implanted Prostheses and Appliances are payable as set out in the
Company’s Benefit Schedule and in accordance with the Rules set out in Section E3 of the General
Conditions.

Annual Limit

$500 per person combined with Orthotics.

I34 22 Hearing Aids




I34 23 Prevention Health Management
Living Well Programs

The Company will provide a cover towards selected Company approved health related services and
health management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

50% of the cost

Annual Limit

$100 per person



Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.



I34 24 Ambulance Transportation
For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,


                                                                                            241 of 545
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.




I34 25 Accident Cover
Benefit

The Company will provide payments to the Policy Holder for the cost of accident related health care
services, except for services that are covered by Medicare, incurred as a direct result of an Accident
after joining where:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted; and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
    Benefit as set out in the Company‘s Benefit Schedule for the respective type of services involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

(1) $2000 per person up to a maximum of $4000 per Policy.

(2) $2000 per Accident per person up to a maximum of $4000 per Accident per Policy.

I34 26 Accidental Death Funeral Expenses



I34 27 Other Special



I35 SCHEDULE GENERAL TREATMENT TABLES
I35 1 Table Name or Group of Table Names
Extras Select Super Plus


I35 2 Eligibility
A Policy Holder may register a Dependant Child as a Dependant Extension under this policy in
accordance with the definition under Rule B2 of the General Conditions.

Product closed to new members from August 17th 2010.


I35 3 General Conditions



                                                                                            242 of 545
I35 4 Loyalty Bonuses


I35 5 Dental
Benefit

Benefits for Dental services are payable as set out in the Company’s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

Annual Limit

Preventive Dental - Nil

General Dental – $400 per person

Major Dental - $1300 per person

Orthodontia – Lifetime Limit of $2500 per person

I35 6 Optical
Benefit

                         NSW/ACT        QLD           SA         TAS           VIC          WA            NT
Frames                   $102.40      $111.40     $124.20      $108.80      $121.60      $108.80       $115.20
Single Vision Lenses      $71.20       $71.20      $82.60       $71.20       $71.20       $71.20        $76.80
Multifocal Lenses        $140.80      $154.90     $172.80      $156.20      $156.10      $149.45       $158.10
Contact Lenses-            80%          80%         80%          80%          80%          80%           80%
Disposable

Annual Limit

$250 per person

I35 7 Physiotherapy
Benefit

                         NSW/ACT        QLD           SA         TAS           VIC          WA           NT
Initial Visit            $39.20        $35.65      $36.90       $36.60       $36.45       $37.80       $37.40
Subsequent Visit         $31.05        $29.25      $29.55       $28.80       $29.25       $30.65       $29.90
Group Session            $13.00        $10.85      $10.90       $15.30       $16.00        $8.00       $14.35
Ante/Post Natal Visits   $17.60        $12.00      $11.95       $12.00       $12.80       $11.95       $18.00

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


I35 8 Chiropractic
Benefit

                         NSW/ACT        QLD           SA         TAS           VIC          WA           NT
Initial Visit            $50.00        $40.00      $45.00       $40.00       $45.00       $50.00       $50.00
Subsequent Visit         $40.00        $30.00      $35.00       $30.00       $35.00       $35.00       $35.00



                                                                                          243 of 545
Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


I35 9 Non PBS Pharmaceuticals
Benefit

After deducting an amount equal to the highest prescribed PBS prescription fee, the Company will
pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50 per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Annual Limit

$300 per person

I35 10 Podiatry
Benefit

                     NSW/ACT          QLD            SA          TAS           VIC          WA               NT
Initial Visit          $45.00         $42.00       $45.00        $40.00       $40.00       $45.00           $40.00
Subsequent Visit       $35.00         $36.00       $38.00        $35.00       $35.00       $35.00           $36.00

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

I35 11 Psychology and Counselling
Benefit

                     NSW/ACT          QLD            SA          TAS           VIC          WA               NT
Initial Visit          $85.00         $85.00      $100.00        $80.00       $80.00      $130.00           $90.00
Subsequent Visit       $75.00         $70.00       $85.00        $75.00       $70.00       $80.00           $75.00
Group Treatment        $40.00         $45.00       $73.00        $68.00       $64.00       $70.00           $40.00

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

I35 12 Alternative Therapies

Alexander technique, bowen therapy, feldenkrais, herbalism including Chinese Traditional Medicine
and Western Herbalism, homoeopathy and remedial massage.

Benefit

Benefits are payable as set out in the Company’s Benefit Schedule.




                                                                                             244 of 545
Annual Limit

$200 per person per therapy type, up to a combined maximum of $400 for all alternative therapies
and naturopathy under 9.18 and acupuncture under 9.19.

I35 13 Natural Therapies



I35 14 Speech Therapy
Benefit

                    NSW/ACT         QLD            SA        TAS           VIC          WA            NT
Initial Visit         $90.00        $75.00       $90.00      $65.00       $75.00       $98.00        $80.00
Subsequent Visit      $50.00        $45.00       $60.00      $40.00       $46.00       $43.00        $50.00

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


I35 15 Orthotics
Benefit



Foot Orthotic – custom made               $183.50

Annual Limit

$500 per person combined with Non Surgically Implanted Prostheses and Appliances.

I35 16 Dietetics
Benefit

                    NSW/ACT         QLD            SA        TAS           VIC          WA            NT
Initial Visit         $60.00        $55.00       $60.00      $50.00       $60.00       $55.00        $60.00
Subsequent Visit      $40.00        $30.00       $40.00      $30.00       $35.00       $35.00        $35.00

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


I35 17 Occupational Therapy
Benefit

                    NSW/ACT         QLD            SA        TAS           VIC          WA            NT
Initial Visit         $70.00        $65.00       $75.00      $60.00       $58.00       $68.00        $65.00
Subsequent Visit      $45.00        $50.00       $60.00      $40.00       $45.00       $38.00        $45.00




                                                                                        245 of 545
Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


I35 18 Naturopathy
Benefit

                    NSW/ACT         QLD           SA        TAS           VIC         WA              NT
Initial Visit         $35.00        $35.00      $35.00      $30.00       $40.00      $35.00          $35.00
Subsequent Visit      $30.00        $30.00      $30.00      $28.00       $30.00      $30.00          $30.00

Annual Limit

$200 per person per therapy type, up to a combined maximum of $400 for naturopathy, alternative
therapies under 9.12 and acupuncture under 9.19.

I35 19 Acupuncture
Benefit

All States
Initial visit                         $40.00
Subsequent visit                      $30.00

Annual Limit

$150 per person per therapy type, up to a combined maximum of $300 for naturopathy, alternative
therapies under 9.12 and naturopathy under 9.18.`


I35 20 Other Therapies
Osteopathy

Benefit

                    NSW/ACT         QLD            SA       TAS           VIC         WA              NT
Initial Visit         $45.60        $40.00       $46.40     $37.60       $41.60      $37.30          $40.00
Subsequent Visit      $42.40        $35.55       $31.60     $30.00       $36.00      $31.35          $36.50

Eye Therapy

Benefit

                    NSW/ACT         QLD           SA        TAS           VIC         WA              NT
Initial Visit         $50.00        $50.00      $50.00      $50.00       $50.00      $50.00          $50.00
Subsequent Visit      $45.00        $40.00      $40.00      $40.00       $40.00      $40.00          $40.00

Ante Natal and Post Natal Classes

From 1 November 2010, the Company will not pay benefits for services which have an MBS item
number and are provided outside a hospital by a participating midwife.

Benefit


                                                                                       246 of 545
                     NSW/ACT          QLD            SA         TAS           VIC          WA           NT
Per Visit              $20.00         $33.75       $32.00       $32.00       $32.00       $36.00       $33.75

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

I35 21 Non Surgically Implanted Prostheses and Appliances
Benefit

Benefits for non Surgically Implanted Prostheses and Appliances are payable as set out in the
Company’s Benefit Schedule and in accordance with the Rules set out in Section E3 of the General
Conditions.

Annual Limit

$500 per person combined with Orthotics.

I35 22 Hearing Aids
Benefit

Hearing Aid - Monaural       $1000

Annual Limit

$1000 per hearing aid up to a maximum of two hearing aids per person every three years.



I35 23 Prevention Health Management
Living Well Programs

The Company will provide a cover towards selected Company approved health related services and
health management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

50% of the cost

Annual Limit

$100 per person



Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.




                                                                                            247 of 545
I35 24 Ambulance Transportation
For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.




I35 25 Accident Cover
Benefit

The Company will provide payments to the Policy Holder for the cost of accident related health care
services, except for services that are covered by Medicare, incurred as a direct result of an Accident
after joining where:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted; and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
    Benefit as set out in The Company’s Benefit Schedule for the respective type of services involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

(1) $2000 per person up to a maximum of $4000 per Policy.

(2) $2000 per Accident per person up to a maximum of $4000 per Accident per Policy.

I35 26 Accidental Death Funeral Expenses



I35 27 Other Special



I36 SCHEDULE GENERAL TREATMENT TABLES
I36 1 Table Name or Group of Table Names


Signature Extras


I36 2 Eligibility



                                                                                            248 of 545
This Table is subject to the provision that it can only be taken out in conjunction with Hospital Tables
O1 & O2.

I36 3 General Conditions

46. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (cc) for a single service of general treatment provided to a policy holder by a recognised
          practitioner in private practice on a given day; and
     (dd)          for more than one service of general treatment on a given day provided by a
          recognised provider in registered premises in private practice who is recognised by the
          Company in more than one profession.

47. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

48. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.    General treatment benefits are not payable for any of the circumstances outlined in Rule E 4 of
     the General Conditions.

I36 4 Loyalty Bonuses

After 12 months continuous membership, a policy holder is entitled to an increased benefit maximum
equal to the first year benefit maximum for the relevant modality plus 10% of the first year benefit
maximum. For each subsequent continuous 12 months membership, the policy holder is entitled to an
increased benefit maximum equal to their previous years benefit maximum for the relevant modality
plus 10% of the first year benefit maximum. No further increased benefit maximums apply beyond
150% of the first year maximum. Loyalty bonuses do not apply to optical.



I36 5 Dental

Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services and
Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-operative
care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every three
years.

All States - A benefit of 80% of the reasonable, customary and usual fee.

General Dental has no annual Maximum limit per person.

The Maximum per person for Major Dental and Orthodontia combined per calendar year is $2000.




                                                                                            249 of 545
I36 6 Optical

All States:-A benefit of 80% for the cost of approved optical items.

The Maximum per person during any one year is $350.


I36 7 Physiotherapy

All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

The Maximum per person during the first benefit entitlement year is $600.


I36 8 Chiropractic

All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

The Maximum per person per calendar year is $600.

The Maximum per policy per calendar year is $1200.




I36 9 Non PBS Pharmaceuticals
After payment by the policy holder of an amount equal to the highest prescribed PBS prescription fee, a benefit
of 80% of the cost of the balance of the prescription.


All States - There is a maximum of $600 per person during the first benefit entitlement year for Non PBS
Pharmaceuticals.



Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the counter
cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at participating pharmacies
provided that the item is:


(y) Designed to manage or prevent disease, injuries or a condition; or
(z) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.



I36 10 Podiatry


                                                                                                     250 of 545
All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $600 per person during the first benefit entitlement year for Podiatry under
36.10, Psychology and Counselling under 36.11, Natural Therapies under 36.36, Speech Therapy under 36.14,
Dietetics under 36.16, Occupational Therapy under 36.17, Eye Therapy under 36.20, Non Surgically Implanted
Prostheses and Appliances under 36.21, Hearing Aids under 36.22 and Home Nursing under 36.27.



I36 11 Psychology and Counselling
All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $600 per person during the first benefit entitlement year for Podiatry under
36.10, Psychology and Counselling under 36.11, Natural Therapies under 36.36, Speech Therapy under 36.14,
Dietetics under 36.16, Occupational Therapy under 36.17, Eye Therapy under 36.20, Non Surgically Implanted
Prostheses and Appliances under 36.21, Hearing Aids under 36.22 and Home Nursing under 36.27.



I36 12 Alternative Therapies


I36 13 Natural Therapies
All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $600 per person during the first benefit entitlement year for Podiatry under
36.10, Psychology and Counselling under 36.11, Natural Therapies under 36.36, Speech Therapy under 36.14,
Dietetics under 36.16, Occupational Therapy under 36.17, Eye Therapy under 36.20, Non Surgically Implanted
Prostheses and Appliances under 36.21, Hearing Aids under 36.22 and Home Nursing under 36.27.



I36 14 Speech Therapy
All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $600 per person during the first benefit entitlement year for Podiatry under
36.10, Psychology and Counselling under 36.11, Natural Therapies under 36.36, Speech Therapy under 36.14,
Dietetics under 36.16, Occupational Therapy under 36.17, Eye Therapy under 36.20, Non Surgically Implanted
Prostheses and Appliances under 36.21, Hearing Aids under 36.22 and Home Nursing under 36.27.



I36 15 Orthotics



I36 16 Dietetics
All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $600 per person during the first benefit entitlement year for Podiatry under
36.10, Psychology and Counselling under 36.11, Natural Therapies under 36.36, Speech Therapy under 36.14,
Dietetics under 36.16, Occupational Therapy under 36.17, Eye Therapy under 36.20, Non Surgically Implanted
Prostheses and Appliances under 36.21, Hearing Aids under 36.22 and Home Nursing under 36.27.




                                                                                               251 of 545
I36 17 Occupational Therapy
All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $600 per person during the first benefit entitlement year for Podiatry under
36.10, Psychology and Counselling under 36.11, Natural Therapies under 36.36, Speech Therapy under 36.14,
Dietetics under 36.16, Occupational Therapy under 36.17, Eye Therapy under 36.20, Non Surgically Implanted
Prostheses and Appliances under 36.21, Hearing Aids under 36.22 and Home Nursing under 36.27.



I36 18 Naturopathy




I36 19 Acupuncture




I36 20 Other Therapies
All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $600 per person during the first benefit entitlement year for Podiatry under
36.10, Psychology and Counselling under 36.11, Natural Therapies under 36.36, Speech Therapy under 36.14,
Dietetics under 36.16, Occupational Therapy under 36.17, Eye Therapy under 36.20, Non Surgically Implanted
Prostheses and Appliances under 36.21, Hearing Aids under 36.22 and Home Nursing under 36.27.



I36 21 Non Surgically Implanted Prostheses and Appliances

Asthma Pumps
Refund of 80% for the cost of supply.

Blood Glucose Monitors/INR (International Normalised Ratio) Devices
Refund of 80% for the cost of supply.

Continuous or Bilevel Positive Airway Pressure Devices
Refund of 80% for the cost of supply.

Surgical Stockings
Refund of 80% for the cost of supply.

TENS Machine (Transcutaneous Electronic Nerve Stimulator)
Refund of 80% for the cost of supply.

Blood Pressure Monitors
Refund of 80% for the cost of supply.

Hire, Repair and Maintenance of a Health Appliance
80% for the cost.




                                                                                               252 of 545
Defined Appliances
Refund of 80% for the cost of supply.
Refer to Rule E3 for a list of approved defined appliances.

There is a combined maximum of $600 per person during the first benefit entitlement year for Podiatry under
36.10, Psychology and Counselling under 36.11, Natural Therapies under 36.36, Speech Therapy under 36.14,
Dietetics under 36.16, Occupational Therapy under 36.17, Eye Therapy under 36.20, Non Surgically Implanted
Prostheses and Appliances under 36.21, Hearing Aids under 36.22 and Home Nursing under 36.27.



I36 22 Hearing Aids
All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $600 per person during the first benefit entitlement year for Podiatry under
36.10, Psychology and Counselling under 36.11, Natural Therapies under 36.36, Speech Therapy under 36.14,
Dietetics under 36.16, Occupational Therapy under 36.17, Eye Therapy under 36.20, Non Surgically Implanted
Prostheses and Appliances under 36.21, Hearing Aids under 36.22 and Home Nursing under 36.27.



I36 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

Living Well Programs

The Fund will provide a cover towards selected Fund approved health related services and health
management programs that are designed to prevent or relieve a specific health condition or conditions.

Benefit

80% of the cost

Annual Limit

$100 per person



I36 24 Ambulance Transportation




I36 25 Accident Cover




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I36 26 Accidental Death Funeral Expenses




I36 27 Other Special


Local and Interstate Travelling Expenses
All States
Benefit for the cost of travel.
Limited to $100 per combined patient and attendant during any one year.

Overnight Non-Hospital Accommodation
All States
Benefit of up to $40 per night
Limited to $150 per combined patient and attendant during any one year.

Home Nursing

All States - A benefit of 80% of the reasonable, customary and usual fee for each visit.

There is a combined maximum of $600 per person during the first benefit entitlement year for Podiatry under
36.10, Psychology and Counselling under 36.11, Natural Therapies under 36.36, Speech Therapy under 36.14,
Dietetics under 36.16, Occupational Therapy under 36.17, Eye Therapy under 36.20, Non Surgically Implanted
Prostheses and Appliances under 36.21, Hearing Aids under 36.22 and Home Nursing under 36.27.




I37 SCHEDULE GENERAL TREATMENT TABLES
I37 1 Table Name or Group of Table Names
Corporate Advantage


I37 2 Eligibility

This Table is subject to the provision that it can only be taken out in conjunction with Hospital
Treatment Tables O1, O2, M1 to M3, E1 to E3 and H1 to H3.


I37 3 General Conditions

49. If a policy holder takes out a general treatment service, the Company will pay benefits:

    (ee) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and




                                                                                               254 of 545
     (ff) for more than one service of general treatment on a given day provided by a recognised
          provider in registered premises in private practice who is recognised by the Company in more
          than one profession.

50. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

51. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.    General treatment benefits are not payable for any of the circumstances outlined in Rule E 4 of
     the General Conditions.

I37 4 Loyalty Bonuses



I37 5 Dental
A benefit of 9/8 of the Dental Executive Extras Provider Agreement benefits that apply in the policy
holder’s State of Residence applies.

Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services and
Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-operative
care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every three
years.


Maximum per person during any one year
All States
General Dental                     Unlimited
Major Dental                       $800
Orthodontia                        $1200
Orthodontia Lifetime Limit         $2400




I37 6 Optical
A benefit of 9/8 of the Optical Executive Extras Provider Agreement benefits that apply in the policy
holder's State of Residence applies.

The Maximum per person during any one year is $250.




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I37 7 Physiotherapy
A benefit of 9/8 of the Physiotherapy Executive Extras Provider Agreement benefits that apply in the
policy holder's State of Residence applies.

The Maximum per person during the first benefit entitlement year is $300.



I37 8 Chiropractic
A benefit of 9/8 of the Chiropractic Executive Extras Provider Agreement benefits that apply in the
policy holder's State of Residence applies.

The Maximum per person during any one year is $600.

The Maximum per policy during any one year is $1200.




I37 9 Non PBS Pharmaceuticals
After payment by the policy holder of an amount equal to the highest prescribed PBS prescription fee, a benefit
of 90% of the cost of the balance of the prescription.


The Maximum per person during the first benefit entitlement year is $300.


Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the counter
cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at participating pharmacies
provided that the item is:


(aa) Designed to manage or prevent disease, injuries or a condition; or
(bb) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.




I37 10 Podiatry
A benefit of 9/8 of the Podiatry Executive Extras benefits that apply in the policy holder's State of
Residence applies.

There is a combined maximum of $300 per person during the first benefit entitlement year for Podiatry under
37.10, Speech Therapy under 37.14, Dietetics under 37.16, Occupational Therapy under 37.17and Eye Therapy
under 37.20.




                                                                                                     256 of 545
I37 11 Psychology and Counselling
A benefit of 9/8 of the Psychology Executive Extras benefits that apply in the policy holder's State of
Residence applies.

The Maximum per person during any one year is $500.

The Maximum per policy during any one year is $1000.


I37 12 Alternative Therapies


I37 13 Natural Therapies
A benefit of 9/8 of the Natural Therapies Executive Extras benefits that apply in the policy holder's
State of Residence applies.

The Maximum per person during the first benefit entitlement year is $175.




I37 14 Speech Therapy
A benefit of 9/8 of the Speech Therapy Executive Extras benefits that apply in the policy holder's
State of Residence applies.

There is a combined maximum of $300 per person during the first benefit entitlement year for Podiatry under
37.10, Speech Therapy under 37.14, Dietetics under 37.16, Occupational Therapy under 37.17and Eye Therapy
under 37.20.




I37 15 Orthotics



I37 16 Dietetics
A benefit of 9/8 of the Dietetics Executive Extras benefits that apply in the policy holder's State of
Residence applies.

There is a combined maximum of $300 per person during the first benefit entitlement year for Podiatry under
37.10, Speech Therapy under 37.14, Dietetics under 37.16, Occupational Therapy under 37.17and Eye Therapy
under 37.20.




                                                                                               257 of 545
I37 17 Occupational Therapy
A benefit of 9/8 of the Occupational Therapy Executive Extras benefits that apply in the policy
holder's State of Residence applies.

There is a combined maximum of $300 per person during the first benefit entitlement year for Podiatry under
37.10, Speech Therapy under 37.14, Dietetics under 37.16, Occupational Therapy under 37.17and Eye Therapy
under 37.20.




I37 18 Naturopathy



I37 19 Acupuncture



I37 20 Other Therapies


Eye Therapy
All States
Initial visit                         $32.00
Subsequent visit                      $22.00
Group therapy visit                   $16.00

The Maximum per person during any one year is $500.


I37 21 Non Surgically Implanted Prostheses and Appliances

Asthma Pumps
Refund of 90% for the cost of supply.
Limited to one appliance per person every 3 years and $300 per person every 3 years.

Blood Glucose Monitors/INR (International Normalised Ratio) Devices
Refund of 90% for the cost of supply.
Limited to one appliance per person every year and $500 per person every year.

Continuous or Bilevel Positive Airway Pressure Devices
Refund of 90% for the cost of supply.
Limited to one device per person every 2 years and $750 per person every 2 years.

Hearing Aids
Refund of 90% for the cost of supply.
Limited to one appliance per person every 3 years and $850 per person every 3 years.




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Surgical Stockings
Refund of 90% for the cost of supply.
Limited to $100 per person in any one year.

TENS Machine (Transcutaneous Electronic Nerve Stimulator)
Refund of 90% for the cost of supply.
Limited to one device per person every year and $175 per person every year.

Blood Pressure Monitors
Refund of 90% for the cost of supply.
Limited to one device per person every year and $175 per person every year.

Hire, Repair and Maintenance of a Health Appliance
90% for the cost and $100 per person every year.

Defined Appliances
Refund of 90% for the cost of supply.
Limited to $500 per person in any one year.
Refer to Rule E3 for a list of approved defined appliances.


                  There is a combined maximum of $850 per person during any one year for all
                  Prostheses and Appliances under 37.21. This maximum also includes any benefits
                  paid for hearing aids under 37.22.



I37 22 Hearing Aids

Refund of 90% for the cost of supply or the cost of repairs.
This benefit is limited to one hearing aid per ear per person every 3 years and $850 per
person every 3 years. This limit also forms part of the overall limit for prostheses and
appliances under 37.21.


I37 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

Living Well Programs

The Fund will provide a cover towards selected Fund approved health related services and health
management programs that are designed to prevent or relieve a specific health condition or conditions.

Benefit

50% of the cost

Annual Limit

$100 per person




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I37 24 Ambulance Transportation



I37 25 Accident Cover



I37 26 Accidental Death Funeral Expenses



I37 27 Other Special

Local and Interstate Travelling Expenses
All States
Benefit for the cost of travel.
Limited to $100 per combined patient and attendant during any one year.

Overnight Non-Hospital Accommodation
All States
Benefit of up to $40 per night
Limited to $150 per combined patient and attendant during any one year.


Home Nursing

$35 per day, capped at 10 visits per year up to an annual limit of $350

The modality will include the following coverage:
   • General Care Services: Catheter Care, Continence Care, Medication Administration
      (injections, rectal vaginal suppositories for frail, enemas, dosette education), and wound
      management (post surgery, ulcer, wound drainage).

    •   Stomal Therapy

    •   Palliative Care Services – RN Care, Personal Care Assistance




I38 SCHEDULE GENERAL TREATMENT TABLES
I38 1 Table Name or Group of Table Names
Corporate Classic


I38 2 Eligibility

This Table is subject to the provision that it can only be taken out in conjunction with Hospital
Treatment Tables O1, O2, M1 to M3, E1 to E3 and H1 to H3.


                                                                                             260 of 545
I38 3 General Conditions

52. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (gg)         for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (hh)         for more than one service of general treatment on a given day provided by a
         recognised provider in registered premises in private practice who is recognised by the
         Company in more than one profession.

53. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

54. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.    General treatment benefits are not payable for any of the circumstances outlined in Rule E 4 of
     the General Conditions.

I38 4 Loyalty Bonuses



I38 5 Dental
The Dental Executive Extras Provider Agreement benefits apply in the policy holder’s State of
Residence applies.

Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services and
Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-operative
care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every three
years.


Maximum per person during first benefit entitlement year
All States
General Dental                                   $400
Major Dental & Orthodontics Combined             $400

Orthodontia Lifetime Limit                       $1600




                                                                                            261 of 545
I38 6 Optical
The Optical Executive Extras Provider Agreement benefits that apply in the policy holder's State of
Residence applies.

The Maximum per person during any one year is $225.


I38 7 Physiotherapy
The Physiotherapy Executive Extras Provider Agreement benefits that apply in the policy holder's
State of Residence applies.

The Maximum per person during the first benefit entitlement year is $150.



I38 8 Chiropractic
The Chiropractic Executive Extras Provider Agreement benefits that apply in the policy holder's State
of Residence applies.

The Maximum per person during any one year is $500.

The Maximum per policy during any one year is $1000.




I38 9 Non PBS Pharmaceuticals
After payment by the policy holder of an amount equal to the highest prescribed PBS prescription fee, a benefit
of 80% of the cost of the balance of the prescription.


The Maximum per person during the first benefit entitlement year is $150.


Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the counter
cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at participating pharmacies
provided that the item is:


(cc) Designed to manage or prevent disease, injuries or a condition; or
(dd) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.




I38 10 Podiatry
The Podiatry Executive Extras benefits that apply in the policy holder's State of Residence applies.




                                                                                                     262 of 545
There is a combined maximum of $300 per person during the first benefit entitlement year for Podiatry under
38.10, Psychology under 38.11, Natural Therapies under 38.13, Speech Therapy under 38.14, Dietetics under
38.16, Occupational Therapy under 38.17, Eye Therapy under 38.20 and Non Surgically Implanted Prostheses
and Appliances under 38.21




I38 11 Psychology and Counselling
The Psychology Executive Extras benefits that apply in the policy holder's State of Residence applies.

There is a combined maximum of $300 per person during the first benefit entitlement year for Podiatry under
38.10, Psychology under 38.11, Natural Therapies under 38.13, Speech Therapy under 38.14, Dietetics under
38.16, Occupational Therapy under 38.17, Eye Therapy under 38.20 and Non Surgically Implanted Prostheses
and Appliances under 38.21




I38 12 Alternative Therapies


I38 13 Natural Therapies
The Natural Therapies Executive Extras benefits that apply in the policy holder's State of Residence
applies.

There is a combined maximum of $300 per person during the first benefit entitlement year for Podiatry under
38.10, Psychology under 38.11, Natural Therapies under 38.13, Speech Therapy under 38.14, Dietetics under
38.16, Occupational Therapy under 38.17, Eye Therapy under 38.20, Non Surgically Implanted Prostheses and
Appliances under 38.21 and Hearing aids under 38.22.




I38 14 Speech Therapy
The Speech Therapy Executive Extras benefits that apply in the policy holder's State of Residence
applies.

There is a combined maximum of $300 per person during the first benefit entitlement year for Podiatry under
38.10, Psychology under 38.11, Natural Therapies under 38.13, Speech Therapy under 38.14, Dietetics under
38.16, Occupational Therapy under 38.17, Eye Therapy under 38.20, Non Surgically Implanted Prostheses and
Appliances under 38.21 and Hearing aids under 38.22.




I38 15 Orthotics




                                                                                                263 of 545
I38 16 Dietetics
The Dietetics Extras benefits that apply in the policy holder's State of Residence applies.

There is a combined maximum of $300 per person during the first benefit entitlement year for Podiatry under
38.10, Psychology under 38.11, Natural Therapies under 38.13, Speech Therapy under 38.14, Dietetics under
38.16, Occupational Therapy under 38.17, Eye Therapy under 38.20, Non Surgically Implanted Prostheses and
Appliances under 38.21 and Hearing aids under 38.22.




I38 17 Occupational Therapy
The Occupational Therapy Executive Extras benefits that apply in the policy holder's State of
Residence applies.

There is a combined maximum of $300 per person during the first benefit entitlement year for Podiatry under
38.10, Psychology under 38.11, Natural Therapies under 38.13, Speech Therapy under 38.14, Dietetics under
38.16, Occupational Therapy under 38.17, Eye Therapy under 38.20, Non Surgically Implanted Prostheses and
Appliances under 38.21 and Hearing aids under 38.22.




I38 18 Naturopathy



I38 19 Acupuncture



I38 20 Other Therapies


Eye Therapy
All States
Initial visit                         $32.00
Subsequent visit                      $22.00
Group therapy visit                   $16.00

The Maximum per person during any one year is $500.


I38 21 Non Surgically Implanted Prostheses and Appliances

Asthma Pumps
Refund of 90% for the cost of supply.
Limited to one appliance per person every 3 years.


                                                                                                264 of 545
Blood Glucose Monitors/INR (International Normalised Ratio) Devices
Refund of 90% for the cost of supply.
Limited to one appliance per person every year.

Continuous or Bilevel Positive Airway Pressure Devices
Refund of 90% for the cost of supply.
Limited to one device per person every 2 years.

Hearing Aids
Refund of 90% for the cost of supply.
Limited to one appliance per person every 3 years.


Surgical Stockings
Refund of 90% for the cost of supply.
Limited to $100 per person in any one year.

TENS Machine (Transcutaneous Electronic Nerve Stimulator)
Refund of 90% for the cost of supply.
Limited to one device per person every year and $175 per person every year.

Blood Pressure Monitors
Refund of 90% for the cost of supply.
Limited to one device per person every year and $175 per person every year.

Hire, Repair and Maintenance of a Health Appliance
90% for the cost and $100 per person every year.

The Psychology Executive Extras benefits that apply in the policy holder's State of Residence applies.

There is a combined maximum of $300 per person during the first benefit entitlement year for Podiatry under
38.10, Psychology under 38.11, Natural Therapies under 38.13, Speech Therapy under 38.14, Dietetics under
38.16, Occupational Therapy under 38.17, Eye Therapy under 38.20, Non Surgically Implanted Prostheses and
Appliances under 38.21 and Hearing aids under 38.22.



I38 22 Hearing Aids

Refund of 90% for the cost of supply or the cost of repairs.
This benefit is limited to one hearing aid per ear per person every 3 years.
This limit also forms part of the overall limit for prostheses and appliances under 38.21.


I38 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

Living Well Programs

The Fund will provide a cover towards selected Fund approved health related services and health
management programs that are designed to prevent or relieve a specific health condition or conditions.



                                                                                                265 of 545
Benefit

50% of the cost

Annual Limit

$100 per person


I38 24 Ambulance Transportation



I38 25 Accident Cover



I38 26 Accidental Death Funeral Expenses



I38 27 Other Special

Local and Interstate Travelling Expenses
All States
Benefit for the cost of travel.
Limited to $100 per combined patient and attendant during any one year.

Overnight Non-Hospital Accommodation
All States
Benefit of up to $40 per night
Limited to $150 per combined patient and attendant during any one year.


Home Nursing

$35 per day, capped at 10 visits per year up to an annual limit of $350

The modality will include the following coverage:
   • General Care Services: Catheter Care, Continence Care, Medication Administration
      (injections, rectal vaginal suppositories for frail, enemas, dosette education), and wound
      management (post surgery, ulcer, wound drainage).

    •     Stomal Therapy

    •     Palliative Care Services – RN Care, Personal Care Assistance




                                                                                          266 of 545
I39 SCHEDULE GENERAL TREATMENT TABLES
I39 1 Table Name or Group of Table Names
Corporate Essentials


I39 2 Eligibility

This Table is subject to the provision that it can only be taken out in conjunction with Hospital
Treatment Tables O1, O2, M1 to M3, E1 to E3 and H1 to H3.


I39 3 General Conditions

55. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (ii) for a single service of general treatment provided to a policy holder by a recognised
          practitioner in private practice on a given day; and
     (jj) for more than one service of general treatment on a given day provided by a recognised
          provider in registered premises in private practice who is recognised by the Company in more
          than one profession.

56. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

57. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.    General treatment benefits are not payable for any of the circumstances outlined in Rule E 4 of
     the General Conditions.

I39 4 Loyalty Bonuses



I39 5 Dental
A benefit of 7/8 of the Dental Executive Extras Provider Agreement benefits that apply in the policy
holder’s State of Residence applies.

Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services and
Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-operative
care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every three
years.

A combined maximum for General Dental & Major Dental of $350 per year applies.


                                                                                             267 of 545
I39 6 Optical
A benefit of 7/8 of the Optical Executive Extras Provider Agreement benefits that apply in the policy
holder's State of Residence applies.

The Maximum per person during any one year is $175.


I39 7 Physiotherapy
A benefit of 7/8 of the Physiotherapy Executive Extras Provider Agreement benefits that apply in the
policy holder's State of Residence applies.

There is a combined maximum of $150 per person during the first benefit entitlement year for Physiotherapy
under 39.7, Chiropractic under 39.8 and Natural therapies under 39.13.




I39 8 Chiropractic
A benefit of 7/8 of the Chiropractic Executive Extras Provider Agreement benefits that apply in the
policy holder's State of Residence applies.

There is a combined maximum of $150 per person during the first benefit entitlement year for Physiotherapy
under 39.7, Chiropractic under 39.8 and Natural therapies under 39.13.




I39 9 Non PBS Pharmaceuticals
After payment by the policy holder of an amount equal to the highest prescribed PBS prescription fee, a benefit
of 70% of the cost of the balance of the prescription.


The Maximum per person during the first benefit entitlement year is $150.


Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the counter
cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at participating pharmacies
provided that the item is:


(ee) Designed to manage or prevent disease, injuries or a condition; or
(ff) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.




                                                                                                     268 of 545
I39 10 Podiatry



I39 11 Psychology and Counselling


I39 12 Alternative Therapies


I39 13 Natural Therapies
A benefit of 7/8 of the Natural Therapies Executive Extras benefits that apply in the policy holder's
State of Residence applies.

There is a combined maximum of $150 per person during the first benefit entitlement year for Physiotherapy
under 39.7, Chiropractic under 39.8 and Natural therapies under 39.13.




I39 14 Speech Therapy


I39 15 Orthotics



I39 16 Dietetics


I39 17 Occupational Therapy


I39 18 Naturopathy



I39 19 Acupuncture



I39 20 Other Therapies


I39 21 Non Surgically Implanted Prostheses and Appliances




                                                                                                 269 of 545
I39 22 Hearing Aids


I39 23 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

Living Well Programs

The Fund will provide a cover towards selected Fund approved health related services and health
management programs that are designed to prevent or relieve a specific health condition or conditions.

Benefit

50% of the cost

Annual Limit

$100 per person


I39 24 Ambulance Transportation



I39 25 Accident Cover



I39 26 Accidental Death Funeral Expenses



I39 27 Other Special


I40 SCHEDULE GENERAL TREATMENT TABLES
I40 1 Table Name or Group of Table Names

Bronze Extras Cover

I40 2 Eligibility


I40 3 General Conditions




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I40 4 Loyalty Bonuses


I40 5 Dental
Benefit

Benefits for Dental services are payable as set out in the Company’s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

Annual Limit

General Dental and Preventive Dental- $350 per person; $700 per membership.
Major Dental – No coverage for major dental services.
Orthodontia – No coverage for orthodontic services.



I40 6 Optical
Benefit
                        NSW/ACT         QLD            SA          TAS           VIC          WA            NT
Frames                  $105.00       $105.00      $105.00       $105.00      $105.00      $105.00       $105.00
Single Vision Lenses     $45.00        $45.00       $45.00        $45.00       $45.00       $45.00        $45.00
Multifocal Lenses        $95.00        $95.00       $95.00        $95.00       $95.00       $95.00        $95.00


Benefits are limited to one appliance (frames and lenses or contact lenses) per person per year.

Annual Limit

$150 per person up to a maximum of $300 per Policy.

I40 7 Physiotherapy
Benefit

                     NSW/ACT         QLD            SA         TAS           VIC           WA          NT
Initial Visit        $30.00         $28.00       $23.00       $25.00       $25.00        $25.00      $24.00
Subsequent Visit     $24.00         $22.00       $16.00       $17.00       $17.00        $21.50      $18.00
Group Session        $13.50         $10.00        $6.50        $9.00        $9.00         $8.00       $8.00
Ante/Post Natal      $13.4          $10.00        $8.00       $12.00       $12.00        $10.00       $8.00
Visits



Annual Limit

$350 per person up to a maximum of $700 per Policy combined with chiropractic and osteopathy
services and ante and post natal classes by a midwife. The Company will not pay benefits for services
which have an MBS item number and are provided outside a hospital by a participating midwife.




                                                                                            271 of 545
I40 8 Chiropractic
Benefit

                      NSW/ACT         QLD            SA        TAS           VIC          WA            NT
Initial Visit           $31.50        $27.00       $23.00      $25.00       $25.00       $24.00        $22.00
Subsequent Visit        $21.50        $19.00       $16.00      $17.00       $17.00       $18.00        $17.00

Annual Limit

$350 per person up to a maximum of $700 per Policy combined with physiotherapy and osteopathy
services and ante and post natal services by a midwife. The Company will not pay benefits for
services which have an MBS item number and are provided outside a hospital by a participating
midwife.



I40 9 Non PBS Pharmaceuticals
Benefit

Ancillary Pharmaceutical Items

          After deducting an amount equal to the current Commonwealth PBS co-payment, the
          Company will pay a benefit of 100% of the cost of the balance of the prescription.
          Benefit is limited to the following amounts per script item:

          QLD and WA $35.00
          NSW, SA, NT, VIC & TAS $40.00


Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Benefits for a Medical Assistance Service is payable in accordance with the rules set out in Section
E3 of the General Conditions.

Annual Limit

(1) Ancillary Pharmaceutical Items - $100 per person to a maximum of $200 per Policy

(2) Medical Assistance Service – One medication Assistance service per person

I40 10 Podiatry



I40 11 Psychology and Counseling



I40 12 Alternative Therapies




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I40 13 Natural Therapies
The following Natural (Complimentary) Therapies are covered:-
Accupuncture, Alexander Technique, Chinese herbalism, Exercise physiology, Feldenkrais,
Homeopathy, Iridology, Massage, naturopathy and Western herbalism.

Massage includes Aromatherapy, Bowen Technique, Kinesiology, Shiatsu and Remedial
Massage.

Benefit

Benefits are payable as set out in the Company’s Benefit Schedule.

Annual Limit

This limit is combined with the limit for physiotherapy. A sublimit of $100 per person up to a
maximum of $200 per Policy for all Complimentary Therapies (including Acupuncture and
Naturopathy).


I40 14 Speech Therapy



I40 15 Orthotics



I40 16 Dietetics



I40 17 Occupational Therapy



I40 18 Naturopathy
Benefit

                    NSW/ACT          QLD            SA         TAS           VIC          WA        NT
Initial Visit         $17.00         $17.00       $17.00       $17.00       $17.00       $17.00    $17.00
Subsequent Visit      $17.00         $17.00       $17.00       $17.00       $17.00       $17.00    $17.00

Annual Limit

$100 per person up to a maximum of $200 per Policy for all Complimentary Therapies (including
Acupuncture and all Natural Therapies listed in Rule I2.13).


I40 19 Acupuncture
Benefit


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                    NSW/ACT         QLD            SA        TAS           VIC         WA            NT
Initial Visit         $17.00        $17.00       $17.00      $17.00       $17.00      $17.00        $17.00
Subsequent Visit      $17.00        $17.00       $17.00      $17.00       $17.00      $17.00        $17.00

Annual Limit

$100 per person up to a maximum of $200 per Policy for all Complimentary Therapies (including
Naturopathy and all Natural Therapies listed in Rule I2.13).

I40 20 Other Therapies
Osteopathy

Benefit

The Company will not pay benefits for services which have an MBS item number and are provided
outside a hospital by a participating midwife.


                    NSW/ACT         QLD            SA        TAS           VIC         WA            NT
Initial Visit         $31.50        $27.00       $24.00      $25.00       $25.00      $24.00        $26.25
Subsequent Visit      $21.50        $19.00       $16.00      $17.00       $17.00      $18.00        $17.00




I40 21 Non Surgically Implanted Prostheses and Appliances



I40 22 Hearing Aids



I40 23 Prevention Health Management

Living Well Programs

The Company will provide a cover towards selected Company approved health related services and
health management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

50% of the cost

Annual Limit

$50 per person


Bowel Cancer Screening Kits




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All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


I40 24 Ambulance Transportation

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) A refund of 100% of the cost of emergency ambulance transport by a fully equipped
    ambulance where the service is provided by a recognised ambulance service, including on-the-
    spot emergency attendances. This benefit is limited to one trip per calendar year for policy holders
    who contribute to a policy that covers only one person (a single cover) and two trips per calendar
    year for policy holders who contribute to either a single parent or family cover.




I40 25 Accident Cover



I40 26 Accidental Death Funeral Expenses



I40 27 Other Special




J2 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J2 1 Table Name or Group of Table Names

HealthSmart

J2 2 Eligibility

This table is only available as a Single (one person) or Couples(two adults) policy.

Product closed to new members from 30th November 2010.




                                                                                            275 of 545
J2 3 General Conditions


J2 4 Hospital Treatment Payments
Providing a hospital admission is not related to an excluded service described in rule J2.14, The Company will
pay to Hospitals for Hospital Treatment received by a Policy Holder, the following payments:

(1) In Network Hospitals – the Network Hospital Payment;

(2) In Public Hospitals – the Public Hospital Benefit; and

(3) In non-agreement Private Hospitals – the Non-Agreement Hospital Benefit (Private)

J2 5 Medical Services Payments while admitted
Providing a hospital admission is not related to an excluded service described in rule J2.14, where there is an
MPPA, PA or Gap Cover Scheme in place, the Company will pay to Medical Practitioners for medical services
received by the Policy Holder while an admitted patient, the MPPA, PA or Gap Cover Schemes Payment.

Providing a hospital admission is not related to an excluded service described in rule J2.14, where there is no
MPPA, PA or Gap Cover Scheme in place, the Company will pay the Schedule Fee Gap Benefit for medical
services received by the Policy Holder while an admitted patient:

(1) to the Policyholder; or

(2) where the Policyholder assigns the benefit to the Medical Practitioner, to that Medical Practitioner.


J2 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
Providing a hospital admission is not related to an excluded service described in Rule J2.14, benefits
for qualifying PBS Items supplied to an Admitted Patient of a Network Hospital are payable in
accordance with Rule E2 of the General Conditions.



J2 7 Non PBS Pharmaceuticals
Providing a hospital admission is not related to an excluded service described in Rule J2.14, benefits
for non PBS medications supplied to an Admitted Patient of a Network Hospital are payable in
accordance with Rule E2 of the General Conditions.


J2 8 Surgically Implanted Prostheses
Providing a hospital admission is not related to an excluded service described in Rule J2.14, benefits
for qualifying surgically implanted prostheses are payable in accordance with Rule E2 of the General
Conditions, whichever is applicable.



J2 9 Nursing Home Type Patients
Providing a hospital admission is not related to an excluded service described in rule J2.14, benefits
for Hospital Treatment provided to Nursing Home Type Patients are payable in accordance with Rule
E2 of the General Conditions.




                                                                                                  276 of 545
J2 10 Co Payments


J2 11 Excesses
The following annual Excess options apply per person once per Calendar Year to a maximum of twice per
Policy: - $250, $500 or $1,000.

J2 12 Benefit Limitation Periods

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:

J2 13 Restricted Benefits

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J2 14 Exclusions

1. Assisted Reproductive Services: The Company will make no payments for hospital services,
medical services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient
payments where the purpose of the hospital admission is for assisted reproductive services.

2. Pregnancy Related Services: : The Company will make no payments for hospital services, medical
services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments
where the purpose of the hospital admission is for pregnancy and birth related services.




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3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Plastic and Cosmetic Surgery:

6. Hip and Joint Replacements:

7. Other:

J2 15 Loyalty Bonuses



J2 16 Other Special Hospital Treatment
Health Management Programs

The Company offers each person covered under this Policy participation in the Company’s
Preventive Program or other approved health management programs offered by the Company.

J2 17 Dental
Benefit

Benefits for Dental services are payable as set out in the Company’s Schedule and in accordance with
the Rules set out in Section E3 of the General Conditions.

Annual Limit

Preventive Dental – No limit
General Dental - $300 per person
Major Dental - $200 per person base limit
Orthodontia – No cover

Increased Limits

(1) If any person covered under this Policy undergoes and claims a preventive dental check-up each
calendar year, the Major Dental annual limit for that person will increase by:
(a) $100 per year for the first three years; and

(b) $200 in each subsequent year up to a maximum of $1500 per year.

(2) If a person covered under this Policy fails to claim a preventive dental service-in two consecutive
years, the annual limit will automatically revert to the $200 base limit.


J2 18 Optical
Benefit

                         NSW/ACT          QLD           SA         TAS           VIC          WA             NT
Frames                    $89.60         $97.45     $108.65       $95.20      $106.40       $95.20        $100.80
Single Vision Lenses      $62.30         $62.30      $72.25       $62.30       $62.30       $62.30         $67.20
Multifocal Lenses        $123.20        $135.55     $151.20      $136.65      $136.60      $130.80        $138.35



                                                                                            278 of 545
Contact Lenses-           70%            70%          70%          70%       70%         70%           70%
Disposable

Benefits are limited to one set of frames per person every two years.

Annual Limit

$185 per person



J2 19 Physiotherapy
Benefit

                    NSW/ACT          QLD            SA         TAS         VIC         WA             NT
Initial Visit       $34.30          $31.20       $32.30       $32.00     $31.90      $33.05         $32.70
Subsequent Visit    $27.20          $25.60       $25.85       $25.20     $25.60      $26.85         $26.15
Group Session        $8.65           $7.75        $9.00        $9.00      $9.00       $9.00         $14.75

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


J2 20 Chiropractic
Benefit

                    NSW/ACT          QLD             SA        TAS         VIC         WA             NT
Initial Visit         $39.00         $32.00        $35.00      $33.00     $34.00      $35.00         $35.00
Subsequent Visit      $25.00         $23.00        $25.00      $23.00     $24.00      $25.00         $25.00

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


J2 21 Non PBS Pharmaceuticals
Benefit

Travel Related Pharmaceutical Items

The Company will only pay a benefit for preventive travel related pharmaceutical items under this
Policy.

Preventive travel related pharmaceutical items means:

(1) Pharmaceutical items prescribed by a Medical Practitioner; and

(2) Company approved travel-related immunisation prescribed and administered by a Medical
Practitioner.



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After deducting an amount equal to the highest prescribed PBS prescription fee, the Company will
pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50 per item.

Benefits for travel related pharmaceutical items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Medical Assistance Service

The Company will pay a benefit of up to $40 for a Medical Assistance Service with a pharmacist that
is approved by the Company.

Benefits for a Medical Assistance Service is payable in accordance with the rules set out in Section E3
of the General Conditions.

Annual Limit

(1) Travel Related Pharmaceutical Items - $225 per person.

(2) Medical Assistance Service – One medication Assistance service per person.


J2 22 Podiatry
Benefit

                     NSW/ACT          QLD             SA         TAS           VIC          WA               NT
Initial Visit          $30.00         $30.00        $35.00       $30.00       $32.00       $35.00           $33.00
Subsequent Visit       $26.00         $25.00        $28.00       $25.00       $26.00       $27.00           $28.00

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


J2 23 Psychology and Counselling
Benefit

                     NSW/ACT          QLD             SA         TAS           VIC          WA               NT
Initial Visit          $70.00         $65.00        $85.00       $65.00       $70.00      $100.00           $77.00
Subsequent Visit       $62.00         $55.00        $70.00       $60.00       $60.00       $70.00           $60.00
Group Treatment        $32.00         $30.00        $60.00       $56.00       $56.00       $60.00           $30.00

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


J2 24 Alternative Therapies




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J2 25 Natural Therapies
The following Natural (Complimentary) Therapies are covered:-

Remedial massage, aromatherapy, alexander technique, feldenkrais, kinesiology, homoeopathy,
iridology, bowen technique, herbalist, shiatsu, reflexology, exercise physiology:

Benefit

Benefits are payable as set out in the Company’s Benefit Schedule.

Annual Limit

$150 per person per Therapy type up to a maximum of $450 per person for all Complimentary
Therapies (including Acupuncture and Naturopathy).


J2 26 Speech Therapy



J2 27 Orthotics



J2 28 Dietetics
Benefit

                    NSW/ACT         QLD            SA       TAS           VIC         WA              NT
Initial Visit         $48.20        $47.20       $49.50     $43.10       $45.30      $49.50          $48.20
Subsequent Visit      $24.65        $22.05       $25.20     $24.00       $23.80      $25.20          $24.65

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


J2 29 Occupational Therapy
Benefit

                    NSW/ACT         QLD            SA       TAS           VIC         WA              NT
Initial Visit         $65.00        $58.00       $65.00     $50.00       $52.00      $60.00          $55.00
Subsequent Visit      $35.00        $40.00       $50.00     $30.00       $40.00      $32.00          $35.00

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.




                                                                                       281 of 545
J2 30 Naturopathy
Benefit

                    NSW/ACT         QLD            SA          TAS           VIC         WA           NT
Initial Visit         $30.00        $30.00       $30.00        $26.25       $30.00      $26.25       $26.25
Subsequent Visit      $26.25        $22.50       $22.50        $22.50       $26.25      $22.50       $22.50

Annual Limit

$150 per person per Therapy type up to a maximum of $450 per person for all Complimentary
Therapies (including Acupuncture and all Natural Therapies listed in Rule J2.25).


J2 31 Acupuncture

Benefit

                     ACT        NSW          QLD        SA         TAS          VIC       WA        NT
Initial Visit        $31.50     $33.75       $31.50   $35.00       $28.00      $32.35    $35.00   $31.50
Subsequent Visit     $26.25     $26.25       $26.25   $26.75       $27.15      $26.25    $27.55   $30.00

Annual Limit

$150 per person per Therapy type up to a maximum of $450 per person for all Complimentary
Therapies (including Naturopathy and all Natural Therapies listed in Rule J2.25).



J2 32 Other Therapies
Osteopathy

Benefit

                    NSW/ACT         QLD            SA          TAS           VIC         WA           NT
Initial Visit         $39.90        $35.00       $40.60        $32.90       $36.40      $32.65       $35.00
Subsequent Visit      $37.10        $31.10       $27.65        $26.25       $31.50      $27.45       $31.95

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


J2 33 Non Surgically Implanted Prostheses and Appliances
Benefit

Benefits for non Surgically Implanted Prostheses and Appliances are payable as set out in the
Company’s Schedule and in accordance with the Rules set out in Section E3.15 of the General
Conditions.

Annual Limit



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$750 per person.


J2 34 Hearing Aids



J2 35 Prevention Health Management
Living Well Programs

The Company will provide a cover towards selected Company approved health related services and
health management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

50% of the cost

Annual Limit

$100 per person


Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


J2 36 Ambulance Transportation
.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.



J2 37 Accident Cover
Benefit

The Company will provide payments to persons covered under this Policy for the cost of accident
related health care services, except for services that are covered by Medicare, incurred as a direct
result of an Accident after joining where:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted; and




                                                                                             283 of 545
(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
    Benefit as set out in the Company’s Schedule for the respective type of services involved.

Benefits are payable in accordance with the rules set out in Section E3.16 of the General Conditions.

Annual Limit

(1) $2000 per person up to a maximum of $4000 per Policy.

(2) $2000 per Accident per person up to a maximum of $4000 per Accident per Policy.

J2 38 Accidental Death Funeral Expenses



J2 39 Other Special General Treatment


J2 40 Hospital-Substitute Treatment



J3 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J3 1 Table Name or Group of Table Names

FamilyFirst

J3 2 Eligibility


J3 3 General Conditions


J3 4 Hospital Treatment Payments
The Company will pay to Hospitals for Hospital Treatment received by Policy Holder, the following payments:

(1) In Network Hospitals – the Network Hospital Payment;

(2) In Public Hospitals – the Public Hospital Benefit; and

(3) In non-agreement Private Hospitals – the Non-Agreement Hospital Benefit (Private).


J3 5 Medical Services Payments while admitted
Where there is an MPPA, PA or Gap Cover Scheme in place, the Company will pay to Medical Practitioners for
medical services received by a Policy Holder while an Admitted Patient, the MPPA, PA or Gap Cover Schemes
Payment.




                                                                                               284 of 545
Where there is no MPPA, PA or Gap Cover Scheme in place, the Company will pay the Schedule Fee Gap
Benefit for medical services received by a Policy Holder while an Admitted Patient:

(1) to the Policyholder; or

(2) where the Policyholder assigns the benefit to the Medical Practitioner, to that Medical Practitioner.


J3 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
Benefits for qualifying PBS Items supplied to an admitted patient of a Network Hospital are payable
in accordance with Rule E2 the General Conditions.


J3 7 Non PBS Pharmaceuticals
Benefits for non PBS medications supplied to an admitted patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.


J3 8 Surgically Implanted Prostheses
Benefits for qualifying surgically implanted prostheses are payable in accordance with Rule E2 of the
General Conditions, whichever is applicable.



J3 9 Nursing Home Type Patients
Benefits for Hospital Treatment provided to Nursing Home Type Patients are payable in accordance
with Rule E2 of the General Conditions.



J3 10 Co Payments
A $50 Co-Payment applies to each person covered under this Policy for any same day or overnight 
admissions and at any private or public hospital to a maximum of $250 per admission.



J3 11 Excesses

1) No excess applies for policy holders on Table OK1.

2) An excess of $250 per hospital stay including Ambulatory Programs applies for policy holders on
    Table OK2. This is limited to $250 per year for policy holders who contribute to a policy that
    covers only one person (a single cover) and $500 per year for policy holders who contribute to
    either a single parent or family cover.


J3 12 Benefit Limitation Periods

1. Assisted Reproductive Services:

2. Pregnancy Related Services



                                                                                            285 of 545
3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J3 13 Restricted Benefits

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J3 14 Exclusions
1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J3 15 Loyalty Bonuses



J3 16 Other Special Hospital Treatment
Health Management Programs




                                                  286 of 545
The Company offers each person covered under this Policy participation in the Company’s Preventive
Program or other approved health management programs offered by the Company


J3 17 Dental
Benefit

Benefits for Dental services are payable as set out in the Company’s Schedule and in accordance with
the Rules set out in Section E3 of the General Conditions.

Orthodontic benefits are only payable for Dependant Children who are under 18 years of age covered
on this Policy.

Annual Limit

Preventive Dental – No limit
General Dental - $300 per person up to a maximum of $600 per Policy
Major Dental - $200 per person base limit
Orthodontia – $750 per person with a lifetime limit of $2000 per person

Increased Limits

(1) If any person covered under this Policy undergoes and claims a preventive dental check-up each
calendar year, the Major Dental annual limit for that person will increase by:
(a) $100 per year for the first three years; and

(b) $200 in each subsequent year up to a maximum of $1500 per year.

(2) If a person covered under this Policy fails to claim a preventive dental service-in two consecutive
years, the annual limit will automatically revert to the $200 base limit.


J3 18 Optical
Benefit

                         NSW/ACT          QLD           SA         TAS           VIC          WA             NT
Frames                    $76.80         $83.55      $93.15       $81.60       $91.20       $81.60         $86.40
Single Vision Lenses      $53.40         $53.40      $61.95       $53.40       $53.40       $53.40         $57.60
Multifocal Lenses        $105.60        $116.20     $129.60      $117.50      $117.10      $112.10        $118.60
Contact Lenses-            60%            60%         60%          60%          60%          60%            60%
Disposable

Benefits are limited to one set of frames every two years for adult Policy Holders and Dependants
who are 19 years of age or over covered by this Policy.

Annual Limit

$150 per person


J3 19 Physiotherapy
Benefit


                                                                                            287 of 545
                     NSW/ACT          QLD            SA         TAS            VIC          WA           NT
Initial Visit        $29.40          $26.70       $27.70       $27.40        $27.30       $28.30       $28.00
Subsequent Visit     $23.30          $21.90       $22.10       $21.60        $21.90       $23.00       $22.40
Group Session         $7.40           $6.60        $7.70        $7.70         $7.65        $7.70       $12.60

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.



J3 20 Chiropractic
Benefit

                     NSW/ACT          QLD             SA         TAS           VIC          WA               NT
Initial Visit          $39.00         $32.00        $35.00       $33.00       $34.00       $35.00           $35.00
Subsequent Visit       $25.00         $23.00        $25.00       $23.00       $24.00       $25.00           $25.00

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.



J3 21 Non PBS Pharmaceuticals
Benefit

Ancillary Pharmaceutical Items

After deducting an amount equal to the highest prescribed PBS prescription fee, the Company will
pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50 per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Medical Assistance Service

The Company will pay a benefit of up to $40 for a Medical Assistance Service with a pharmacist that
is approved by the Company.

Benefits for a Medical Assistance Service is payable in accordance with the rules set out in Section E3
of the General Conditions.

Annual Limit

(1) Ancillary Pharmaceutical Items - $525 per person

(2) Medical Assistance Service – One medication Assistance service per person




                                                                                             288 of 545
J3 22 Podiatry
Benefit

                    NSW/ACT         QLD            SA         TAS         VIC         WA              NT
Initial Visit         $25.00        $23.80       $27.00       $23.10     $27.00      $29.30          $24.10
Subsequent Visit      $22.20        $21.00       $21.60       $19.80     $22.20      $22.70          $21.00

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


J3 23 Psychology and Counselling
Benefit

                    NSW/ACT         QLD            SA         TAS         VIC         WA              NT
Initial Visit         $60.00        $54.00       $72.00       $52.35     $60.00      $84.00          $66.00
Subsequent Visit      $52.65        $45.00       $57.00       $48.00     $49.90      $56.70          $48.45
Group Treatment       $27.00        $22.90       $47.70       $47.70     $47.70      $47.70          $22.90

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


J3 24 Alternative Therapies



J3 25 Natural Therapies
The following Natural (Complimentary) Therapies are covered:-

Remedial massage, aromatherapy, alexander technique, feldenkrais, kinesiology, homoeopathy,
iridology, bowen technique, herbalist, shiatsu, reflexology, exercise physiology:

Benefit

Benefits are payable as set out in the Company Benefit Schedule.

Annual Limit

$150 per person per Therapy type up to a maximum of $450 per person for all Complimentary
Therapies (including Acupuncture and Naturopathy).



J3 26 Speech Therapy
Benefit




                                                                                       289 of 545
                    NSW/ACT         QLD            SA        TAS           VIC          WA            NT
Initial Visit         $59.10        $48.00       $62.70      $45.00       $50.10       $66.00        $49.40
Subsequent Visit      $27.00        $24.10       $36.00      $23.80       $26.80       $28.60        $29.55

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


J3 27 Orthotics
Benefit

Benefits are only payable for Dependant Children aged 18 years or under covered on this Policy.



Foot Orthotic – custom made                $90.00

Annual Limit

$750 per person combined with Non Surgically Implanted Prostheses and Appliances.




J3 28 Dietetics
Benefit

                    NSW/ACT         QLD            SA        TAS           VIC          WA            NT
Initial Visit         $48.20        $47.20       $49.50      $43.10       $45.30       $45.90        $43.10
Subsequent Visit      $24.65        $22.05       $25.20      $24.00       $23.80       $24.90        $24.65

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.



J3 29 Occupational Therapy
Benefit

                    NSW/ACT         QLD            SA        TAS           VIC          WA            NT
Initial Visit         $56.55        $38.40       $53.20      $41.20       $44.10       $52.40        $45.90
Subsequent Visit      $30.35        $33.10       $40.30      $23.90       $33.10       $26.60        $28.60

Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.




                                                                                         290 of 545
J3 30 Naturopathy
Benefit

                   NSW/ACT         QLD           SA        TAS          VIC         WA         NT
Initial Visit        $30.00        $30.00      $30.00      $26.25      $30.00      $26.25     $26.25
Subsequent Visit     $26.25        $22.50      $22.50      $22.50      $26.25      $22.50     $22.50

Annual Limit

$150 per person per Therapy type up to a maximum of $450 per person for all Complimentary
Therapies (including Acupuncture and all Natural Therapies listed in Rule J3.25).



J3 31 Acupuncture
Benefit

                   NSW/ACT         QLD           SA        TAS          VIC         WA         NT
Initial Visit        $33.75        $33.75      $37.50      $30.00      $34.60      $37.50     $33.75
Subsequent Visit     $26.25        $26.25      $26.75      $27.15      $26.25      $27.55     $30.00
Annual Limit

$150 per person per Therapy type up to a maximum of $450 per person for all Complimentary
Therapies (including Naturopathy and all Natural Therapies listed in Rule J3.25).


J3 32 Other Therapies
Osteopathy

Benefit

                   NSW/ACT         QLD           SA        TAS          VIC         WA         NT
Initial Visit        $34.20        $30.00      $34.80      $28.20      $31.20      $28.00     $30.00
Subsequent Visit     $31.80        $26.60      $23.70      $22.50      $27.00      $23.50     $27.40

Eye Therapy

Benefit

                   NSW/ACT         QLD           SA        TAS          VIC         WA         NT
Initial Visit        $36.75        $32.20      $24.25      $27.50      $30.25      $24.25     $31.20
Subsequent Visit     $30.10        $24.40      $18.20      $26.50      $27.60      $18.20     $24.25

Ante Natal and Post Natal Classes by a Midwife

Benefit

From 1 November 2010, the Company will not pay benefits for services which have an MBS item
number and are provided outside a hospital by a participating midwife.

                   NSW/ACT         QLD           SA        TAS          VIC         WA         NT
Per Visit            $15.00        $23.00      $24.00      $24.00      $24.00      $27.00     $25.30



                                                                                     291 of 545
Annual Limit

$200 per person per Therapy type up to a maximum of $350 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


J3 33 Non Surgically Implanted Prostheses and Appliances
Benefit

Benefits for non Surgically Implanted Prostheses and Appliances are payable as set out in the
Company Benefit Schedule and in accordance with the Rules set out in Section E3 of the General
Conditions.

Annual Limit

$750 per person combined with Orthotics.


J3 34 Hearing Aids
Benefit

Hearing aid – Monaural - $600 in all States.

Annual Limit

$600 per person every five years.

J3 35 Prevention Health Management
Living Well Programs

The Company will provide a cover towards selected Company approved health related services and
health management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

50% of the cost

Annual Limit

$100 per Policy


Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


J3 36 Ambulance Transportation

. A benefit of 100% of the cost of an ambulance subscription applies.



                                                                                            292 of 545
For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.



J3 37 Accident Cover
ACCIDENT COVER

Benefit

The Company will provide payments to persons covered under this Policy for the cost of accident
related health care services, except for services that are covered by Medicare, incurred as a direct
result of an Accident after joining where:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted; and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
    Benefit as set out in the Company Schedule for the respective type of services involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

(1) $2000 per person up to a maximum of $4000 per Policy.

(2) $2000 per Accident per person up to a maximum of $4000 per Accident per Policy.

SCHOOL ACCIDENT AND SCHOOL SPORTS COVER

Benefit

The Company will provide payments to persons covered under this Policy for the cost of accident
related health care services, except for services that are covered by Medicare, incurred by a
Dependant aged 18 years and under as a result of an Accident at school or in any school activity
provided that:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted; and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
    Benefit as set out in the Company’s Benefit Schedule for the respective type of services involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

$1000 per registered Dependant aged 18 years and under.


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J3 38 Accidental Death Funeral Expenses



J3 39 Other Special General Treatment


J3 40 Hospital-Substitute Treatment



J6 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J6 1 Table Name or Group of Table Names
HealthSmart Gold

J6 2 Eligibility
Product closed to new members from 30th November 2010.


J6 3 General Conditions


J6 4 Hospital Treatment Payments
The Company will pay to Hospitals for Hospital Treatment received by Policy Holder, the following payments:

(1) In Network Hospitals – the Network Hospital Payment;

(2) In Public Hospitals – the Public Hospital Benefit; and

(3) In non-agreement Private Hospitals – the Non-Agreement Hospital Benefit (Private).


J6 5 Medical Services Payments while admitted
Where there is an MPPA, PA or Gap Cover Scheme in place, the Company will pay to Medical Practitioners for
medical services received by a Policy Holder while an Admitted Patient, the MPPA, PA or Gap Cover Schemes
Payment.

Where there is no MPPA, PA or Gap Cover Scheme in place, the Company will pay the Schedule Fee Gap
Benefit for medical services received by a Policy Holder while an Admitted Patient:

(1) to the Policyholder; or

(2) where the Policyholder assigns the benefit to the Medical Practitioner, to that Medical Practitioner.


J6 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
Benefits for qualifying PBS Items supplied to an admitted patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.


                                                                                               294 of 545
J6 7 Non PBS Pharmaceuticals
Benefits for non PBS medications supplied to an admitted patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.


J6 8 Surgically Implanted Prostheses
Benefits for qualifying surgically implanted prostheses are payable in accordance with Rule E2 of the
General Conditions, whichever is applicable.



J6 9 Nursing Home Type Patients
Benefits for Hospital Treatment provided to Nursing Home Type Patients are payable in accordance
with Rule E2 of the General Conditions.



J6 10 Co Payments


J6 11 Excesses
The following annual Excess options apply per person once per Calendar Year to a maximum of twice per
Policy: - $250, $500 or $1,000.

J6 12 Benefit Limitation Periods

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J6 13 Restricted Benefits

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:




                                                                                         295 of 545
4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J6 14 Exclusions

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J6 15 Loyalty Bonuses



J6 16 Other Special Hospital Treatment
Health Management Programs
The Company offers each person covered under this Policy participation in the Company’s Preventive
Program or other approved health management programs offered by the Company.

J6 17 Dental
Benefit

Benefits for Dental services are payable as set out in the Company’s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

Annual Limit

Preventive Dental – No limit
General Dental - $500 per person
Major Dental - $300 per person
Orthodontia – Lifetime limit of $2000 per person


J6 18 Optical
Benefit



                                                                                          296 of 545
                        NSW/ACT          QLD            SA          TAS           VIC          WA              NT
Frames                   $77.10         $83.80       $93.45        $81.90       $91.50       $81.90          $86.70
Single Vision Lenses     $53.60         $53.60       $62.15        $53.60       $53.60       $53.60          $57.80
Multifocal Lenses       $106.00        $116.60      $130.10       $117.55      $117.50      $112.50         $119.00
Contact Lenses-           60%            60%          60%           60%          60%          60%             60%
Disposable

Annual Limit

$200 per person


J6 19 Physiotherapy
Benefit

                     NSW/ACT          QLD            SA         TAS            VIC          WA           NT
Initial Visit        $31.60          $28.75       $29.75       $29.50        $29.40       $30.45       $30.15
Subsequent Visit     $25.05          $23.60       $23.80       $23.20        $23.60       $24.75       $24.10
Group Session         $7.45           $6.65        $7.75        $7.75         $7.70        $7.75       $12.70

Annual Limit

$300 per person for all Therapies as described in Rule B2 (“Therapies”) of the General Conditions.


J6 20 Chiropractic
Benefit

                     NSW/ACT          QLD             SA         TAS           VIC          WA               NT
Initial Visit          $39.00         $32.00        $35.00       $33.00       $34.00       $35.00           $35.00
Subsequent Visit       $25.00         $23.00        $25.00       $23.00       $24.00       $25.00           $25.00

Annual Limit

$300 per person for all Therapies as described in Rule B2 (“Therapies”) of the General Conditions.




J6 21 Non PBS Pharmaceuticals
Benefit

Ancillary Pharmaceutical Items

After deducting an amount equal to the highest prescribed PBS prescription fee, the Company will
pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50 per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Medical Assistance Service




                                                                                             297 of 545
The Company will pay a benefit of up to $40 for a Medical Assistance Service with a pharmacist that
is approved by the Company.

Benefits for a Medical Assistance Service is payable in accordance with the rules set out in Section E3
of the General Conditions.

Annual Limit

(1) Ancillary Pharmaceutical Items - $300 per person

(2) Medical Assistance Service – One medication Assistance service per person


J6 22 Podiatry
Benefit

                    NSW/ACT          QLD             SA        TAS           VIC          WA           NT
Initial Visit         $25.05         $23.90        $27.10      $23.20       $27.10       $29.40       $24.20
Subsequent Visit      $22.25         $21.05        $21.65      $19.85       $22.25       $22.85       $21.05

Annual Limit

$300 per person for all Therapies as described in Rule B2 (“Therapies”) of the General Conditions.



J6 23 Psychology and Counselling
Benefit

                    NSW/ACT          QLD             SA        TAS           VIC          WA           NT
Initial Visit         $60.20         $54.20        $72.25      $52.55       $60.20       $84.30       $66.20
Subsequent Visit      $52.85         $45.15        $57.20      $48.15       $50.10       $56.95       $48.65
Group Treatment       $27.10         $22.95        $47.85      $47.85       $47.85       $47.85       $22.95

Annual Limit

$300 per person for all Therapies as described in Rule B2 (“Therapies”) of the General Conditions.


J6 24 Alternative Therapies



J6 25 Natural Therapies
The following Natural (Complimentary) Therapies are covered:-

Remedial massage, aromatherapy, alexander technique, feldenkrais, kinesiology, homoeopathy,
iridology, bowen technique, herbalist, shiatsu, reflexology, exercise physiology:

Benefit

Benefits are payable as set out in the Company’s Benefit Schedule.



                                                                                           298 of 545
Annual Limit

$300 per person for all Complimentary Therapies (including Acupuncture and Naturopathy).


J6 26 Speech Therapy
Benefit

                    NSW/ACT         QLD            SA        TAS           VIC         WA             NT
Initial Visit         $59.30        $48.15       $62.90      $45.15       $50.25      $66.20         $49.60
Subsequent Visit      $27.10        $24.20       $36.10      $23.85       $26.90      $28.70         $29.65

Annual Limit

$300 per person for all Therapies as described in Rule B2 (“Therapies”) of the General Conditions.

J6 27 Orthotics
Benefit



Foot Orthotic – custom made                $90.30

Annual Limit

$300 per person combined with Non Surgically Implanted Prostheses and Appliances.


J6 28 Dietetics
Benefit

                    NSW/ACT         QLD            SA        TAS           VIC         WA             NT
Initial Visit         $48.25        $47.20       $49.50      $43.15       $45.35      $49.50         $48.20
Subsequent Visit      $24.70        $22.05       $25.25      $24.05       $23.80      $24.90         $24.65

Annual Limit

$300 per person for all Therapies as described in Rule B2 (“Therapies”) of the General Conditions.



J6 29 Occupational Therapy
Benefit

                    NSW/ACT         QLD            SA        TAS           VIC         WA             NT
Initial Visit         $56.60        $38.45       $53.25      $41.15       $44.10      $52.45         $45.90
Subsequent Visit      $30.40        $33.10       $40.30      $23.95       $33.10      $26.55         $28.60

Annual Limit

$300 per person for all Therapies as described in Rule B2 (“Therapies”) of the General Conditions.



                                                                                        299 of 545
J6 30 Naturopathy
Benefit

                    NSW/ACT         QLD           SA        TAS           VIC         WA            NT
Initial Visit         $28.00        $28.00      $28.00      $24.50       $28.00      $24.50        $25.00
Subsequent Visit      $24.50        $21.00      $21.00      $21.00       $24.50      $21.00        $22.00

Annual Limit

$300 per person for all Complimentary Therapies (including Acupuncture and all Natural Therapies
listed in Rule J6.25).


J6 31 Acupuncture
Benefit

                    NSW/ACT         QLD           SA        TAS           VIC         WA            NT
Initial Visit         $31.50        $31.50      $35.00      $28.00       $32.35      $35.00        $31.50
Subsequent Visit      $24.50        $24.50      $25.00      $25.35       $24.50      $25.75        $28.00

Annual Limit

$300 per person for all Complimentary Therapies (including Naturopathy and all Natural Therapies
listed in Rule J6.25).


J6 32 Other Therapies
Osteopathy

Benefit

                    NSW/ACT         QLD            SA       TAS           VIC         WA            NT
Initial Visit         $34.30        $30.10       $34.90     $28.30       $31.30      $28.10        $30.10
Subsequent Visit      $31.90        $26.75       $23.80     $22.60       $27.10      $23.55        $27.50

Eye Therapy

Benefit

                    NSW/ACT         QLD            SA       TAS           VIC         WA            NT
Initial Visit         $36.75        $32.25       $24.25     $27.55       $30.25      $24.25        $31.25
Subsequent Visit      $30.15        $24.40       $18.20     $26.45       $27.55      $18.20        $24.25

Ante Natal and Post Natal Classes by a Midwife

Benefit

From 1 November 2010, the Company will not pay benefits for services which have an MBS item
number and are provided outside a hospital by a participating midwife.

                    NSW/ACT         QLD            SA        TAS          VIC         WA            NT


                                                                                       300 of 545
Per Visit               $15.05        $25.35       $24.10       $24.10       $24.10       $31.50       $29.55

Annual Limit

$300 per person for all Therapies as described in Rule B2 (“Therapies”) of the General Conditions.



J6 33 Non Surgically Implanted Prostheses and Appliances
Benefit

Benefits for non Surgically Implanted Prostheses and Appliances are payable as set out in the
Company’s Benefit Schedule and in accordance with the Rules set out in Section E3 of the General
Conditions.

Annual Limit

$300 per person combined with Orthotics.


J6 34 Hearing Aids
Benefit

Hearing Aid - Monaural       $300

Annual Limit

$300 per hearing aid up to a maximum of two hearing aids per person every three years.


J6 35 Prevention Health Management
Living Well Programs

The Company will provide a cover towards selected Company approved health related services and
health management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

50% of the cost

Annual Limit

$100 per Policy


Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.




                                                                                            301 of 545
J6 36 Ambulance Transportation

A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J6 37 Accident Cover

ACCIDENT COVER

Benefit

The Company will provide payments to persons covered under this Policy for the cost of accident
related health care services, except for services that are covered by Medicare, incurred as a direct
result of an Accident after joining where:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted; and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
    Benefit as set out in the Company’s Benefit Schedule for the respective type of services involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

(1) $2000 per person up to a maximum of $4000 per Policy.

(2) $2000 per Accident per person up to a maximum of $4000 per Accident per Policy.

SCHOOL ACCIDENT AND SCHOOL SPORTS COVER

Benefit

The Company will provide payments to persons covered under this Policy for the cost of accident
related health care services, except for services that are covered by Medicare, incurred by a
Dependant aged 18 years and under as a result of an Accident at school or in any school activity
provided that:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted; and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
    Benefit as set out in the Company’s Benefit Schedule for the respective type of services involved.




                                                                                             302 of 545
Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

$1000 per registered Dependant aged 18 years and under.


J6 38 Accidental Death Funeral Expenses



J6 39 Other Special General Treatment


J6 40 Hospital-Substitute Treatment



J9 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J9 1 Table Name or Group of Table Names

HealthSmart Diamond

J9 2 Eligibility
Product closed to new members from 30th November 2010.


J9 3 General Conditions


J9 4 Hospital Treatment Payments
The Company will pay to Hospitals for Hospital Treatment received by Policy Holder, the following payments:

(1) In Network Hospitals – the Network Hospital Payment;

(2) In Public Hospitals – the Public Hospital Benefit; and

(3) In non-agreement Private Hospitals – the Non-Agreement Hospital Benefit (Private).


J9 5 Medical Services Payments while admitted
Where there is an MPPA, PA or Gap Cover Scheme in place, the Company will pay to Medical Practitioners for
medical services received by a Policy Holder while an Admitted Patient, the MPPA, PA or Gap Cover Schemes
Payment.

Where there is no MPPA, PA or Gap Cover Scheme in place, the Company will pay the Schedule Fee Gap
Benefit for medical services received by a Policy Holder while an Admitted Patient:




                                                                                               303 of 545
(1) to the Policyholder; or

(2) where the Policyholder assigns the benefit to the Medical Practitioner, to that Medical Practitioner.


J9 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
Benefits for qualifying PBS Items supplied to an admitted patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.


J9 7 Non PBS Pharmaceuticals
Benefits for non PBS medications supplied to an admitted patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.

J9 8 Surgically Implanted Prostheses
Benefits for qualifying surgically implanted prostheses are payable in accordance with Rule E2 of the
General Conditions, whichever is applicable.



J9 9 Nursing Home Type Patients
Benefits for Hospital Treatment provided to Nursing Home Type Patients are payable in accordance
with Rule E2 of the General Conditions.

J9 10 Co Payments
A $50 Co-Payment applies to each person covered under this Policy for any same day or overnight
admissions and at any private or public hospital to a maximum of $250 per admission.

J9 11 Excesses
The following annual Excess options apply per person once per Calendar Year to a maximum of twice
per Policy : - $250, $500 or $1,000.

J9 12 Benefit Limitation Periods

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:




                                                                                            304 of 545
J9 13 Restricted Benefits

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:




J9 14 Exclusions

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:




J9 15 Loyalty Bonuses



J9 16 Other Special Hospital Treatment
Health Management Programs
The Company offers each person covered under this Policy participation in the Company’s Preventive
Program or other approved health management programs offered by the Company.

J9 17 Dental
Benefit

Benefits for Dental services are payable as set out in the Company’s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.



                                                                                          305 of 545
Annual Limit

Preventive Dental – No limit
General Dental - $1000 per person
Major Dental - $2000 per person, with an $800 sub-limit for each of the following service groups:-

(a)   Orthodontics
(b)   Endodontics
(c)   Crowns and Bridgework
(d)   Other Major Dental services

Orthodontia – Lifetime limit of $2500 per person


J9 18 Optical
Benefit

                       NSW/ACT         QLD             SA       TAS           VIC         WA             NT
Frames                  $77.10        $83.80        $93.45     $81.90       $91.50      $81.90         $86.70
Single Vision Lenses    $53.60        $53.60        $62.15     $53.60       $53.60      $53.60         $57.80
Multifocal Lenses      $106.00       $116.60       $130.10    $117.55      $117.50     $112.50        $119.00
Contact Lenses-          60%           60%           60%        60%          60%         60%            60%
Disposable

Annual Limit

$250 per person


J9 19 Physiotherapy
Benefit

                    NSW/ACT          QLD           SA         TAS          VIC         WA              NT
Initial Visit       $31.60          $28.75      $29.75       $29.50      $31.90      $30.45          $30.15
Subsequent Visit    $25.05          $23.60      $23.80       $23.20      $23.60      $24.75          $24.10
Group Session        $7.45           $6.65       $7.75        $7.75       $7.70       $7.75          $12.70

Annual Limit

$500 per person per Therapy type up to a maximum of $2000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


J9 20 Chiropractic
Benefit

                    NSW/ACT          QLD             SA       TAS          VIC          WA             NT
Initial Visit         $40.00         $35.00        $40.00     $35.00      $38.00       $40.00         $40.00
Subsequent Visit      $30.00         $25.00        $28.00     $25.00      $28.00       $30.00         $30.00

Annual Limit




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$500 per person per Therapy type up to a maximum of $2000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


J9 21 Non PBS Pharmaceuticals
Benefit

Ancillary Pharmaceutical Items

After deducting an amount equal to the highest prescribed PBS prescription fee, the Company will
pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50 per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Medical Assistance Service

The Company will pay a benefit of up to $40 for a Medical Assistance Service with a pharmacist that
is approved by the Company.

Benefits for a Medical Assistance Service is payable in accordance with the rules set out in Section E3
of the General Conditions.

Annual Limit

(1) Ancillary Pharmaceutical Items - $600 per person

(2) Medical Assistance Service – One medication Assistance service per person



J9 22 Podiatry

Benefit

                     NSW/ACT          QLD             SA         TAS           VIC          WA               NT
Initial Visit          $25.05         $23.90        $27.10       $23.20       $27.10       $29.40           $24.20
Subsequent Visit       $22.25         $21.05        $21.65       $19.85       $22.25       $22.85           $21.05

Annual Limit

$500 per person per Therapy type up to a maximum of $2000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


J9 23 Psychology and Counselling
Benefit

                     NSW/ACT          QLD             SA         TAS           VIC          WA               NT
Initial Visit          $60.20         $54.20        $72.25       $52.55       $60.20       $84.30           $66.20
Subsequent Visit       $52.85         $45.15        $57.20       $48.15       $50.10       $56.95           $48.65
Group Treatment        $27.10         $22.95        $47.85       $47.85       $47.85       $47.85           $22.95




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Annual Limit

$500 per person per Therapy type up to a maximum of $2000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.

J9 24 Alternative Therapies



J9 25 Natural Therapies
The following Natural (Complimentary) Therapies are covered:-

Remedial massage, aromatherapy, alexander technique, feldenkrais, kinesiology, homoeopathy,
iridology, bowen technique, herbalist, shiatsu, reflexology, exercise physiology:

Benefit

Benefits are payable as set out in the Company’s Benefit Schedule.

Annual Limit

$300 per person per Therapy type up to a maximum of $500 per person for all Complimentary
Therapies (including Acupuncture and Naturopathy).



J9 26 Speech Therapy
Benefit

                    NSW/ACT         QLD             SA        TAS         VIC         WA         NT
Initial Visit         $59.30        $48.15        $62.90      $45.15     $50.25      $66.20     $49.60
Subsequent Visit      $27.10        $24.20        $36.10      $23.85     $26.90      $28.70     $29.65

Annual Limit

$500 per person per Therapy type up to a maximum of $2000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.



J9 27 Orthotics
Benefit



Foot Orthotic – custom made                $90.30

Annual Limit

$1000 per person combined with Non Surgically Implanted Prostheses and Appliances.




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J9 28 Dietetics
Benefit

                   NSW/ACT         QLD            SA        TAS           VIC         WA         NT
Initial Visit        $55.15        $50.40       $56.60      $49.35       $51.85      $52.50     $55.00
Subsequent Visit     $30.00        $25.00       $30.00      $27.50       $27.20      $30.00     $30.00

Annual Limit

$500 per person per Therapy type up to a maximum of $2000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


J9 29 Occupational Therapy
Benefit

                   NSW/ACT         QLD            SA        TAS           VIC         WA         NT
Initial Visit        $56.60        $38.45       $53.25      $41.15       $44.10      $52.45     $45.90
Subsequent Visit     $30.40        $33.10       $40.30      $23.95       $33.10      $26.55     $28.60

Annual Limit

$500 per person per Therapy type up to a maximum of $2000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


J9 30 Naturopathy
Benefit

                   NSW/ACT         QLD            SA        TAS           VIC         WA         NT
Initial Visit        $30.00        $30.00       $30.00      $25.00       $30.00      $30.00     $30.00
Subsequent Visit     $25.00        $25.00       $25.00      $23.00       $25.00      $25.00     $25.00

Annual Limit

$300 per person per Therapy type up to a maximum of $500 per person for all Complimentary
Therapies (including Acupuncture and all Natural Therapies listed in Rule J9.25).


J9 31 Acupuncture
Benefit

                   NSW/ACT         QLD            SA        TAS           VIC         WA         NT
Initial Visit        $33.00        $32.00       $35.00      $30.00       $35.00      $35.00     $35.00
Subsequent Visit     $26.00        $26.00       $25.05      $26.00       $25.00      $28.00     $28.00

Annual Limit

$300 per person per Therapy type up to a maximum of $500 per person for all Complimentary
Therapies (including Naturopathy and all Natural Therapies listed in Rule J9.25).




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J9 32 Other Therapies
Osteopathy

Benefit

                    NSW/ACT         QLD            SA        TAS           VIC         WA           NT
Initial Visit         $34.30        $30.10       $34.90      $28.30       $31.30      $28.10       $30.10
Subsequent Visit      $31.90        $26.75       $23.80      $22.60       $27.10      $23.55       $27.50

Eye Therapy

Benefit

                    NSW/ACT         QLD            SA        TAS           VIC         WA           NT
Initial Visit         $36.75        $32.25       $24.25      $27.55       $30.25      $24.25       $31.25
Subsequent Visit      $30.15        $24.40       $18.20      $26.45       $27.55      $18.20       $24.25

Ante Natal and Post Natal Classes

Benefit

From 1 November 2010, the Company will not pay benefits for services which have an MBS item
number and are provided outside a hospital by a participating midwife.

                    NSW/ACT         QLD            SA        TAS           VIC         WA           NT
Per Visit             $15.05        $25.35       $24.10      $24.10       $24.10      $27.10       $25.35

Annual Limit

$500 per person per Therapy type up to a maximum of $2000 per person for all Therapies as
described in Rule B2 (“Therapies”) of the General Conditions.


J9 33 Non Surgically Implanted Prostheses and Appliances
Benefit

Benefits for non Surgically Implanted Prostheses and Appliances are payable as set out in the
Company’s Benefit Schedule and in accordance with the Rules set out in Section E3 of the General
Conditions.

Annual Limit

$1000 per person combined with Orthotics.


J9 34 Hearing Aids
Benefit

Hearing Aid - Monaural     $1000

Annual Limit

$1000 per hearing aid up to a maximum of two hearing aids per person every three years.


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J9 35 Prevention Health Management
Living Well Programs

The Company will provide a cover towards selected Company approved health related services and
health management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

50% of the cost

Annual Limit

$100 per Policy


Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.



J9 36 Ambulance Transportation

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.



J9 37 Accident Cover

ACCIDENT COVER

Benefit

The Company will provide payments to persons covered under this Policy for the cost of accident
related health care services, except for services that are covered by Medicare, incurred as a direct
result of an Accident after joining where:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted; and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
    Benefit as set out in the Company’s Benefit Schedule for the respective type of services involved.




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Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

(1) $2000 per person up to a maximum of $4000 per Policy.

(2) $2000 per Accident per person up to a maximum of $4000 per Accident per Policy.

SCHOOL ACCIDENT AND SCHOOL SPORTS COVER

Benefit

The Company will provide payments to persons covered under this Policy for the cost of accident
related health care services, except for services that are covered by Medicare, incurred by a
Dependant aged 18 years and under as a result of an Accident at school or in any school activity
provided that:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted; and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
    Benefit as set out in the Company’s Benefit Schedule for the respective type of services involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

$1000 per registered Dependant aged 18 years and under.



J9 38 Accidental Death Funeral Expenses



J9 39 Other Special General Treatment


J9 40 Hospital-Substitute Treatment



J11 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J11 1 Table Name or Group of Table Names

HEALTHLINK PACKAGES

HealthLink Essentials Plus
HealthLink Classic


                                                                                           312 of 545
HealthLink Advantage


J11 2 Eligibility
Policy Holders may register Dependant Children as Dependant Extensions under any of these policies
in accordance with the definition under Rule B2 of the General Conditions.


J11 3 General Conditions


J11 4 Hospital Treatment Payments
The Company will pay to Hospitals for Hospital Treatment received by Policy Holder, the following payments:

(1) In Network Hospitals – the Network Hospital Payment;

(2) In Public Hospitals – the Public Hospital Benefit; and

(3) In non-agreement Private Hospitals – the Non-Agreement Hospital Benefit (Private).


J11 5 Medical Services Payments while admitted
Where there is an MPPA, PA or Gap Cover Scheme in place, the Company will pay to Medical Practitioners for
medical services received by a Policy Holder while an Admitted Patient, the MPPA, PA or Gap Cover Schemes
Payment.

Where there is no MPPA, PA or Gap Cover Scheme in place, the Company will pay the Schedule Fee Gap
Benefit for medical services received by a Policy Holder while an Admitted Patient:

(1) to the Policyholder; or

(2) where the Policyholder assigns the benefit to the Medical Practitioner, to that Medical Practitioner.


J11 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
The Company offers each person covered under this Policy participation in the Company’s Preventive
Program or other approved health management programs offered by the Company.


J11 7 Non PBS Pharmaceuticals
Benefits for non PBS medications supplied to an admitted patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.


J11 8 Surgically Implanted Prostheses
Benefits for qualifying surgically implanted prostheses are payable in accordance with Rule E2 of the
General Conditions, whichever is applicable.




                                                                                               313 of 545
J11 9 Nursing Home Type Patients
Benefits for Hospital Treatment provided to Nursing Home Type Patients are payable in accordance
with Rule E2 of the General Conditions.



J11 10 Co Payments


J11 11 Excesses
The following annual Excess options apply per person once per Calendar Year to a maximum of twice per
Policy: - No Excess, $250, $500 or $1,000.

No excesses apply for any admissions to hospital of a dependent child or dependent child non-student
covered under the policy.

J11 12 Benefit Limitation Periods

1. Assisted Reproductive Services: After the relevant waiting periods, for the following 24 months of
the Policy, daily benefits are limited to the Minister’s default benefits for admissions to Private
Hospitals.

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric: After the relevant waiting periods, for the following 24 months of the Policy, daily
benefits are limited to the Minister’s default benefits for admissions to Private Hospitals.

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:

8. Hip and Knee Joint Replacements: After the relevant waiting periods, for the following 24 months
of the Policy, daily benefits are limited to the Minister’s default benefits for admissions to Private
Hospitals except where they are required as the result of an accident that occurs after the Policy
commences.

9. Other: Cataract eye surgery, Dialysis for chronic renal failure and Bone Marrow Transplants: After
the relevant Waiting Periods, for the following 24 months of the Policy daily benefits are limited to
the Minister’s default benefits for admissions to Private Hospitals.


J11 13 Restricted Benefits


J11 14 Exclusions




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J11 15 Loyalty Bonuses



J11 16 Other Special Hospital Treatment
                 Health Management Programs
The Company offers each person covered under this Policy participation in the Company’s Preventive
Program or other approved health management programs offered by the Company.

J11 17 Dental
HEALTHLINK ESSENTIALS PLUS

Benefit

Benefits for Dental services are payable as set out in the Company’s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

General Dental

Benefits are only payable for following General Dental services under this Policy:-
   • Two general consultation attendances billed as separate items , with a limit of one general
        attendance every six months;
   • Scaling and cleaning;
   • Fluoride applications;
   • Extractions (other than surgical extractions);
   • Simple fillings; and
   • One sports mouthguard per person

Major Dental

Benefits are only payable for surgical extractions under this Policy.

Annual Limit

Combined General and Major Dental - $350 per person up to a maximum of $700 per Policy.

HEALTHLINK CLASSIC

Benefit

Benefits for Dental services are payable as set out in the Company’s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

Annual Limit

Preventive Dental – No limit
General Dental - $300 per person
Major Dental - $800 per person
Orthodontia – Lifetime limit of $2000 per person

HEALTHLINK ADVANTAGE

Benefit



                                                                                          315 of 545
Benefits for Dental services are payable as set out in the Company’s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

Annual Limit

Preventive Dental – No limit
General Dental - $400 per person
Major Dental - $1300 per person
Orthodontia – Lifetime limit of $2500 per person


J11 18 Optical
HEALTHLINK ESSENTIALS PLUS

Benefit

                        NSW/ACT         QLD            SA          TAS           VIC          WA            NT
Frames                   $89.60        $97.45      $100.00        $95.20      $100.00       $95.20       $100.00
Single Vision Lenses     $62.30        $62.30       $72.25        $62.30       $62.30       $62.30        $67.20
Multifocal Lenses       $100.00       $100.00      $100.00       $100.00      $100.00      $100.00       $100.00
Contact Lenses-           70%           70%          70%           70%          70%          70%           70%
Disposable

Benefits are limited to one appliance (frames and lenses or contact lenses) per person per year.

Annual Limit

$150 per person up to a maximum of $300 per Policy.

HEALTHLINK CLASSIC

Benefit

                        NSW/ACT         QLD            SA          TAS           VIC          WA            NT
Frames                   $89.60        $97.45      $108.65        $95.20      $106.40       $95.20       $100.80
Single Vision Lenses     $62.30        $62.30       $72.25        $62.30       $62.30       $62.30        $67.20
Multifocal Lenses       $123.20       $135.55      $151.20       $136.65      $136.60      $130.80       $138.35
Contact Lenses-           70%           70%          70%           70%          70%          70%           70%
Disposable

Annual Limit

$225 per person

HEALTHLINK ADVANTAGE

Benefit

                        NSW/ACT         QLD            SA          TAS           VIC          WA            NT
Frames                   $89.60        $97.45      $108.65        $95.20      $106.40       $95.20       $100.80
Single Vision Lenses     $62.30        $62.30       $72.25        $62.30       $62.30       $62.30        $67.20
Multifocal Lenses       $123.20       $135.55      $151.20       $136.65      $136.60      $130.80       $138.35
Contact Lenses-           70%           70%          70%           70%          70%          70%           70%
Disposable


                                                                                            316 of 545
Annual Limit

$250 per person


J11 19 Physiotherapy
HEALTHLINK ESSENTIALS PLUS

Benefit

                    NSW/ACT        QLD            SA        TAS           VIC         WA           NT
Initial Visit       $34.30        $31.20       $32.30      $32.05       $31.90      $33.10       $32.75
Subsequent Visit    $27.15        $25.60       $25.85      $25.20       $25.60      $26.80       $26.15
Group Session        $8.65         $7.75        $8.95       $8.95        $8.95       $8.40       $14.75
Ante/Post Natal     $15.40        $10.50       $10.45      $10.50       $11.20      $10.45       $15.75
Visits

Annual Limit

$350 per person up to a maximum of $700 per Policy combined with chiropractic and osteopathy
services and ante and post natal classes by a midwife. From 1 November 2010, the Company will not
pay benefits for services which have an MBS item number and are provided outside a hospital by a
participating midwife.

HEALTHLINK CLASSIC

Benefit

                    NSW/ACT        QLD            SA        TAS           VIC         WA           NT
Initial Visit       $34.30        $31.20       $32.30      $32.05       $31.90      $33.10       $32.75
Subsequent Visit    $27.15        $25.60       $25.85      $25.20       $25.60      $26.80       $26.15
Group Session        $8.65         $7.75        $8.95       $8.95        $8.95       $8.95       $14.75
Ante/Post Natal     $15.40        $10.50       $10.45      $10.50       $11.20      $10.45       $15.75
Visit

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

HEALTHLINK ADVANTAGE

Benefit

                    NSW/ACT        QLD            SA        TAS           VIC         WA           NT
Initial Visit       $34.30        $31.20       $32.30      $32.05       $31.90      $33.10       $32.75
Subsequent Visit    $27.15        $25.60       $25.85      $25.20       $25.60      $26.80       $26.15
Group Session        $8.65         $7.75        $8.95       $8.95        $8.95       $8.95       $14.75
Ante/Post Natal     $15.40        $10.50       $10.45      $10.50       $11.20      $10.45       $15.75
Visit

Annual Limit



                                                                                       317 of 545
$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

J11 20 Chiropractic
HEALTHLINK ESSENTIALS PLUS

Benefit

                    NSW/ACT         QLD            SA        TAS          VIC          WA             NT
Initial Visit         $39.00        $32.00       $35.00      $33.00      $34.00       $35.00         $35.00
Subsequent Visit      $25.00        $23.00       $25.00      $23.00      $24.00       $25.00         $25.00

Annual Limit

$350 per person up to a maximum of $700 per Policy combined with physiotherapy and osteopathy
services and ante and post natal services by a midwife. From 1 November 2010, the Company will
not pay benefits for services which have an MBS item number and are provided outside a hospital by
a participating midwife.

HEALTHLINK CLASSIC

Benefit

                    NSW/ACT         QLD            SA        TAS          VIC          WA             NT
Initial Visit         $40.00        $35.00       $40.00      $35.00      $38.00       $40.00         $40.00
Subsequent Visit      $30.00        $25.00       $28.00      $25.00      $28.00       $30.00         $30.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

HEALTHLINK ADVANTAGE

Benefit

                    NSW/ACT         QLD            SA        TAS          VIC          WA             NT
Initial Visit         $50.00        $40.00       $45.00      $40.00      $45.00       $50.00         $50.00
Subsequent Visit      $40.00        $30.00       $35.00      $30.00      $35.00       $35.00         $35.00

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


J11 21 Non PBS Pharmaceuticals
HEALTHLINK ESSENTIALS PLUS

Benefit

Ancillary Pharmaceutical Items




                                                                                       318 of 545
After deducting an amount equal to the highest prescribed PBS prescription fee, the Company will
pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50 per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Medical Assistance Service

The Company will pay a benefit of up to $40 for a Medical Assistance Service with a pharmacist that
is approved by the Company.

Benefits for a Medical Assistance Service is payable in accordance with the rules set out in Section
E3 of the General Conditions.

Annual Limit

(1) Ancillary Pharmaceutical Items - $100 per person up to a maximum of $200 per Policy.

(2) Medical Assistance Service – One medication Assistance service per person

HEALTHLINK CLASSIC

Benefit

Ancillary Pharmaceutical Items

After deducting an amount equal to the highest prescribed PBS prescription fee, the Company will
pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50 per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Medical Assistance Service

The Company will pay a benefit of up to $40 for a Medical Assistance Service with a pharmacist that
is approved by the Company.

Benefits for a Medical Assistance Service is payable in accordance with the rules set out in Section
E3 of the General Conditions.

Annual Limit

(1) Ancillary Pharmaceutical Items - $300 per person.

(2) Medical Assistance Service – One medication Assistance service per person.

HEALTHLINK ADVANTAGE

Benefit

Ancillary Pharmaceutical Items

After deducting an amount equal to the highest prescribed PBS prescription fee, the Company will
pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50 per item.




                                                                                             319 of 545
Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Medical Assistance Service

The Company will pay a benefit of up to $40 for a Medical Assistance Service with a pharmacist that
is approved by the Company.

Benefits for a Medical Assistance Service is payable in accordance with the rules set out in Section E3
of the General Conditions.

Annual Limit

(1) Ancillary Pharmaceutical Items - $300 per person.

(2) Medical Assistance Service – One medication Assistance service per person.




J11 22 Podiatry
HEALTHLINK ESSENTIALS PLUS

Podiatry benefits are not payable under this Policy.

HEALTHLINK CLASSIC

Benefit

                     NSW/ACT          QLD            SA        TAS           VIC          WA           NT
Initial Visit          $35.00         $35.00       $40.00      $35.00       $35.00       $40.00       $36.00
Subsequent Visit       $30.00         $30.00       $32.00      $30.00       $30.00       $30.00       $32.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

HEALTHLINK ADVANTAGE

Benefit

                     NSW/ACT          QLD            SA        TAS           VIC          WA           NT
Initial Visit          $45.00         $42.00       $45.00      $40.00       $40.00       $40.00       $40.00
Subsequent Visit       $35.00         $36.00       $38.00      $35.00       $35.00       $35.00       $36.00

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


J11 23 Psychology and Counselling
HEALTHLINK ESSENTIALS PLUS


                                                                                           320 of 545
Psychology and Counselling benefits are not payable under this Policy.

HEALTHLINK CLASSIC

Benefit

                    NSW/ACT         QLD             SA        TAS         VIC         WA              NT
Initial Visit         $75.00        $70.00        $90.00      $70.00     $75.00     $110.00          $85.00
Subsequent Visit      $65.00        $60.00        $75.00      $65.00     $65.00      $75.00          $70.00
Group Treatment       $35.00        $35.00        $68.00      $60.00     $60.00      $65.00          $36.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

HEALTHLINK ADVANTAGE

Benefit

                    NSW/ACT         QLD            SA         TAS         VIC         WA              NT
Initial Visit         $85.00        $85.00      $100.00       $80.00     $80.00     $130.00          $90.00
Subsequent Visit      $70.00        $70.00       $85.00       $75.00     $70.00      $80.00          $75.00
Group Treatment       $40.00        $45.00       $73.00       $68.00     $64.00      $70.00          $40.00

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


J11 24 Alternative Therapies



J11 25 Natural Therapies

HEALTHLINK ESSENTIALS PLUS

The following Natural (Complimentary) Therapies are covered:-

Remedial massage, aromatherapy, alexander technique, feldenkrais, kinesiology, homoeopathy,
iridology, bowen technique, herbalist, shiatsu, reflexology, exercise physiology:

Benefit

Benefits are payable as set out in the Company’s Benefit Schedule.

Annual Limit




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$100 per person up to a maximum of $200 per Policy for all Complimentary Therapies (including
Acupuncture and Naturopathy).

HEALTHLINK CLASSIC

The following Natural (Complimentary) Therapies are covered:-

Remedial massage, aromatherapy, alexander technique, feldenkrais, kinesiology, homoeopathy,
iridology, bowen technique, herbalist, shiatsu, reflexology, exercise physiology:

Benefit

Benefits are payable as set out in the Company’s Benefit Schedule.

Annual Limit

$200 per person for all Complimentary Therapies (including Acupuncture and Naturopathy).

HEALTHLINK ADVANTAGE

The following Natural (Complimentary) Therapies are covered:-

Remedial massage, aromatherapy, alexander technique, feldenkrais, kinesiology, homoeopathy,
iridology, bowen technique, herbalist, shiatsu, reflexology, exercise physiology:

Benefit

Benefits are payable as set out in the Company’s Benefit Schedule.

Annual Limit

$200 per person per Therapy type up to a maximum of $400 per person for all Complimentary
Therapies (including Acupuncture and Naturopathy).


J11 26 Speech Therapy
HEALTHLINK ESSENTIALS PLUS

Speech Therapy benefits are not payable under this Policy.

HEALTHLINK CLASSIC

Benefit

                    NSW/ACT         QLD             SA        TAS         VIC         WA              NT
Initial Visit         $75.00        $65.00        $80.00      $60.00     $65.00      $82.00          $70.00
Subsequent Visit      $35.00        $40.00        $50.00      $35.00     $40.00      $37.00          $45.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.



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HEALTHLINK ADVANTAGE

Benefit

                     NSW/ACT          QLD             SA     TAS          VIC         WA              NT
Initial Visit          $90.00         $75.00        $90.00   $65.00      $75.00      $98.00          $80.00
Subsequent Visit       $50.00         $45.00        $60.00   $40.00      $46.00      $43.00          $50.00

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


J11 27 Orthotics
HEALTHLINK ESSENTIALS PLUS

Orthotics benefits are not payable under this Policy.

HEALTHLINK CLASSIC

Benefit



Foot Orthotic – custom made                 $105.00

Annual Limit

$500 per person combined with Non Surgically Implanted Prostheses and Appliances.

HEALTHLINK ADVANTAGE


Foot Orthotic - off the shelf                $35.70

Foot Orthotic – custom made                 $105.00

Annual Limit

$500 per person combined with Non Surgically Implanted Prostheses and Appliances.


J11 28 Dietetics
HEALTHLINK ESSENTIALS PLUS

Dietetics benefits are not payable under this Policy.

HEALTHLINK CLASSIC

Benefit

                     NSW/ACT          QLD             SA     TAS          VIC         WA              NT
Initial Visit          $55.15         $50.40        $56.60   $49.35      $51.85      $52.50          $55.00



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Subsequent Visit       $30.00       $25.00        $30.00      $27.50     $27.20      $30.00          $30.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

HEALTHLINK ADVANTAGE

Benefit

                    NSW/ACT         QLD             SA        TAS         VIC         WA              NT
Initial Visit         $60.00        $55.00        $60.00      $50.00     $60.00      $55.00          $60.00
Subsequent Visit      $40.00        $30.00        $40.00      $30.00     $35.00      $35.00          $35.00

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


J11 29 Occupational Therapy
HEALTHLINK ESSENTIALS PLUS

Occupational Therapy benefits are not payable under this Policy.

HEALTHLINK CLASSIC

Benefit

                    NSW/ACT         QLD             SA        TAS         VIC         WA              NT
Initial Visit         $68.00        $60.00        $70.00      $55.00     $55.00      $65.00          $60.00
Subsequent Visit      $38.00        $45.00        $55.00      $35.00     $43.00      $35.00          $40.00

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

HEALTHLINK ADVANTAGE

Benefit

                    NSW/ACT         QLD             SA        TAS         VIC         WA              NT
Initial Visit         $70.00        $65.00        $75.00      $60.00     $58.00      $68.00          $65.00
Subsequent Visit      $45.00        $50.00        $60.00      $45.00     $45.00      $38.00          $45.00

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.




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J11 30 Naturopathy

HEALTHLINK ESSENTIALS PLUS

Benefit

                   NSW/ACT         QLD            SA        TAS           VIC         WA            NT
Initial Visit        $25.00        $25.00       $25.00      $22.00       $25.00      $22.00        $25.00
Subsequent Visit     $22.00        $20.00       $20.00      $20.00       $21.50      $20.00        $22.00

Annual Limit

$100 per person up to a maximum of $200 per Policy for all Complimentary Therapies (including
Acupuncture and all Natural Therapies listed in Rule J11.25).

HEALTHLINK CLASSIC

Benefit

                   NSW/ACT         QLD            SA        TAS           VIC         WA            NT
Initial Visit        $30.00        $30.00       $30.00      $25.00       $30.00      $30.00        $30.00
Subsequent Visit     $25.00        $25.00       $25.00      $23.00       $25.00      $25.00        $25.00

Annual Limit

$200 per person for all Complimentary Therapies (including Acupuncture and all Natural Therapies
listed in Rule J11.25).

HEALTHLINK ADVANTAGE

Benefit

                   NSW/ACT         QLD            SA        TAS           VIC         WA            NT
Initial Visit        $35.00        $35.00       $35.00      $30.00       $40.00      $35.00        $35.00
Subsequent Visit     $30.00        $30.00       $30.00      $28.00       $30.00      $30.00        $30.00

Annual Limit

$200 per person per Therapy type up to a maximum of $400 per person for all Complimentary
Therapies (including Acupuncture and all Natural Therapies listed in Rule J11.25).


J11 31 Acupuncture

HEALTHLINK ESSENTIALS PLUS

Benefit

                   NSW/ACT         QLD            SA        TAS           VIC         WA            NT
Initial Visit        $28.00        $28.00       $31.00      $25.00       $28.50      $32.00        $30.00
Subsequent Visit     $22.00        $22.00       $23.00      $23.00       $21.50      $25.00        $25.00




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Annual Limit

$100 per person up to a maximum of $200 per Policy for all Complimentary Therapies (including
Naturopathy and all Natural Therapies listed in Rule J11.25).

HEALTHLINK CLASSIC

Benefit

                    NSW/ACT         QLD            SA       TAS           VIC         WA            NT
Initial Visit         $33.00        $32.00       $35.00     $30.00       $35.00      $35.00        $35.00
Subsequent Visit      $26.00        $26.00       $25.05     $26.00       $25.00      $28.00        $28.00

Annual Limit

$200 per person for all Complimentary Therapies (including Naturopathy and all Natural Therapies
listed in Rule J11.25).

HEALTHLINK ADVANTAGE

Benefit
All States
Initial visit                    $40.00
Subsequent visit                 $30.00

Annual Limit

$200 per person per Therapy type up to a maximum of $400 per person for all Complimentary
Therapies (including Naturopathy and all Natural Therapies listed in Rule J11.25).




J11 32 Other Therapies
HEALTHLINK ESSENTIALS PLUS

Osteopathy

Benefit

                    NSW/ACT         QLD            SA       TAS           VIC         WA            NT
Initial Visit         $39.90        $35.00       $40.60     $32.90       $36.40      $32.65        $35.00
Subsequent Visit      $37.10        $31.10       $27.65     $26.25       $31.50      $27.45        $31.95

Ante Natal and Post Natal Classes by a Midwife

Benefit

From 1 November 2010, the Company will not pay benefits for services which have an MBS item
number and are provided outside a hospital by a participating midwife.

                    NSW/ACT         QLD            SA       TAS           VIC         WA            NT
Per Visit             $17.50        $29.55       $28.00     $28.00       $28.00      $31.50        $29.55




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Annual Limit

$350 per person up to a maximum of $700 per Policy combined with physiotherapy and chiropractic.

HEALTHLINK CLASSIC

Osteopathy

Benefit

                    NSW/ACT         QLD            SA       TAS           VIC         WA              NT
Initial Visit         $39.90        $35.00       $40.60     $32.90       $36.40      $32.65          $35.00
Subsequent Visit      $37.10        $31.10       $27.65     $26.25       $31.50      $27.45          $31.95

Eye Therapy

Benefit

All States

Initial Visit      $45.00
Subsequent Visit   $38.00

Ante Natal and Post Natal Classes by a Midwife

Benefit

From 1 November 2010, the Company will not pay benefits for services which have an MBS item
number and are provided outside a hospital by a participating midwife.

                    NSW/ACT         QLD            SA       TAS           VIC         WA              NT
Per Visit             $17.50        $29.55       $28.00     $28.00       $28.00      $31.50          $29.55

Annual Limit

$375 per person per Therapy type up to a maximum of $750 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.

HEALTHLINK ADVANTAGE

Osteopathy

Benefit

                    NSW/ACT         QLD            SA       TAS           VIC         WA              NT
Initial Visit         $39.90        $35.00       $40.60     $32.90       $36.40      $32.65          $35.00
Subsequent Visit      $37.10        $31.10       $27.65     $26.25       $31.50      $27.45          $31.95

Eye Therapy

Benefit

                    NSW/ACT         QLD            SA       TAS           VIC         WA              NT
Initial Visit         $42.00        $36.80       $27.70     $31.50       $34.55      $27.70          $35.70
Subsequent Visit      $34.45        $27.95       $20.80     $30.25       $31.50      $20.80          $27.70


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Ante Natal and Post Natal Classes by a Midwife

Benefit

From 1 November 2010, the Company will not pay benefits for services which have an MBS item
number and are provided outside a hospital by a participating midwife.

                    NSW/ACT          QLD            SA       TAS           VIC          WA            NT
Per Visit             $17.50         $29.55       $28.00     $28.00       $28.00       $31.50        $29.55

Annual Limit

$500 per person per Therapy type up to a maximum of $900 per person for all Therapies as described
in Rule B2 (“Therapies”) of the General Conditions.


J11 33 Non Surgically Implanted Prostheses and Appliances
HEALTHLINK ESSENTIALS PLUS

Non Surgically Implanted Prostheses and Appliances benefits are not payable under this Policy.

HEALTHLINK CLASSIC

Benefit

Benefits for non Surgically Implanted Prostheses and Appliances are payable as set out in the
Company’s Benefit Schedule and in accordance with the Rules set out in Section E3 of the General
Conditions.

Annual Limit

$500 per person combined with Orthotics.

HEALTHLINK ADVANTAGE

Benefit

Benefits for non Surgically Implanted Prostheses and Appliances are payable as set out in the
Company’s Benefit Schedule and in accordance with the Rules set out in Section E3 of the General
Conditions.

Annual Limit

$500 per person combined with Orthotics.


J11 34 Hearing Aids
HEALTHLINK ESSENTIALS PLUS

Hearing Aids benefits are not payable under this Policy.

HEALTHLINK CLASSIC



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Hearing Aids benefits are not payable under this Policy.

HEALTHLINK ADVANTAGE

Benefit

Hearing aid – Monaural - $600 in all States.

Annual Limit

$600 per person every five years.


J11 35 Prevention Health Management
HEALTHLINK ESSENTIALS PLUS

Living Well Programs

The Company will provide a cover towards selected Company approved health related services and
health management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

50% of the cost

Annual Limit

$50 per person


Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


HEALTHLINK CLASSIC

Living Well Programs

The Company will provide a cover towards selected Company approved health related services and
health management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

50% of the cost

Annual Limit

$100 per person


Bowel Cancer Screening Kits


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All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


HEALTHLINK ADVANTAGE

Living Well Programs

The Company will provide a cover towards selected Company approved health related services and
health management programs that are designed to prevent or relieve a specific health condition or
conditions.

Benefit

50% of the cost

Annual Limit

$100 per person

Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.



J11 36 Ambulance Transportation
HEALTHLINK ESSENTIALS PLUS

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


HEALTHLINK CLASSIC

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.

HEALTHLINK ADVANTAGE


For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -




                                                                                            330 of 545
    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J11 37 Accident Cover
HEALTHLINK ESSENTIALS PLUS

Benefit

The Company will provide payments to persons covered under this Policy for the cost of accident
related health care services, except for services that are covered by Medicare, incurred as a direct
result of an Accident after joining where:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted; and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
    Benefit as set out in the Company’s Benefit Schedule for the respective type of services involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

(1) $2000 per person up to a maximum of $4000 per Policy.

(2) $2000 per Accident per person up to a maximum of $4000 per Accident per Policy.


HEALTHLINK CLASSIC

Benefit

The Company will provide payments to persons covered under this Policy for the cost of accident
related health care services, except for services that are covered by Medicare, incurred as a direct
result of an Accident after joining where:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted; and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
    Benefit as set out in the Company’s Benefit Schedule for the respective type of services involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

(1) $2000 per person up to a maximum of $4000 per Policy.

(2) $2000 per Accident per person up to a maximum of $4000 per Accident per Policy.



                                                                                             331 of 545
HEALTHLINK ADVANTAGE

Benefit

The Company will provide payments to persons covered under this Policy for the cost of accident
related health care services, except for services that are covered by Medicare, incurred as a direct
result of an Accident after joining where:

(1) the costs are not paid or payable from any other source;

(2) the limits for the relevant benefits in the Policy Holder’s Level of Cover have been exhausted; and

(3) the costs of such services for the purpose of determining benefits shall be limited to the Set
    Benefit as set out in the Company’s Benefit Schedule for the respective type of services involved.

Benefits are payable in accordance with the rules set out in Section E3 of the General Conditions.

Annual Limit

(1) $2000 per person up to a maximum of $4000 per Policy.

(2) $2000 per Accident per person up to a maximum of $4000 per Accident per Policy.


J11 38 Accidental Death Funeral Expenses



J11 39 Other Special General Treatment


J11 40 Hospital-Substitute Treatment



J13 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J13 1 Table Name or Group of Table Names
Choices with 70% back
Choices with 80% back
Choices with 90% back


J13 2 Eligibility
These tables are only available as Singles (one person) or Couples (two adults) policies.

J13 3 General Conditions
Where the Company an agreement in place with Company Recognised Providers of general treatment
, the benefits that apply for services rendered by Company Recognised Providers shall be:-



                                                                                             332 of 545
(a) 70% of the fee charged for Policy Holders covered on Choices with 70% back;

(b) 80% of the fee charged for Policy Holders covered on Choices with 80% back; or

(c) 90% of the fee charged for Policy Holders covered on Choices with 90% back.

Where the services are provided by Company Recognised Providers with which the Company does
not have an agreement, the benefits that apply shall be those set out in the Company’s Benefit
Schedule.


J13 4 Hospital Treatment Payments

                Providing a hospital admission is not related to an excluded service described in rule
                J13.14, the Company will pay to Hospitals for Hospital Treatment received by a Policy
                Holder, the following payments:

                (A) For the services listed below:-

    •   Shoulder arthroscopy and reconstructions

    •   Knee arthroscopy and reconstructions

    •   Ankle arthroscopy and reconstructions

    •   Removal of tonsils

    •   Removal of adenoids

    •   Removal of wisdom teeth

    •   Appendicitis (including removal):

                (1) In Network Hospitals – the Network Hospital Payment;

                (2) In Public Hospitals – the Public Hospital Benefit; and
(3) In non-agreement Private Hospitals – the Non-Agreement Hospital Benefit (Private); or

(B) For any other services :-

The Minister’s Default Benefit



J13 5 Medical Services Payments while admitted
                Providing a hospital admission is not related to an excluded service described in rule
                J13.14, where there is an MPPA, PA or Gap Cover Scheme in place, the Company
                will pay to Medical Practitioners for medical services received by the Policy Holder
                while an admitted patient, the MPPA, PA or Gap Cover Schemes Payment.

                Providing a hospital admission is not related to an excluded service described in rule
                J13.14, where there is no MPPA, PA or Gap Cover Scheme in place, the Company
                will pay the Schedule Fee Gap Benefit for medical services received by the Policy
                Holder while an admitted patient:



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(1) to the Policyholder; or

(2) where the Policyholder assigns the benefit to the Medical Practitioner, to that Medical Practitioner.


J13 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
Providing a hospital admission is not related to an excluded service described in Rule J13.14, benefits
for qualifying PBS Items supplied to an Admitted Patient of a Network Hospital are payable in
accordance with Rule E2 of the General Conditions.



J13 7 Non PBS Pharmaceuticals
Providing a hospital admission is not related to an excluded service described in Rule J13.14,
benefits for non PBS medications supplied to an Admitted Patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.


J13 8 Surgically Implanted Prostheses
Providing a hospital admission is not related to an excluded service described in Rule J13.14, benefits
for qualifying surgically implanted prostheses are payable in accordance with Rule E2 of the General
Conditions, whichever is applicable.

J13 9 Nursing Home Type Patients
Providing a hospital admission is not related to an excluded service described in rule J13.14, benefits
for Hospital Treatment provided to Nursing Home Type Patients are payable in accordance with Rule
E2 of the General Conditions.

J13 10 Co Payments


J13 11 Excesses
The following annual Excess applies per person once per Calendar Year to a maximum of
twice per Policy: $250


J13 12 Benefit Limitation Periods

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:



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7. Plastic and Cosmetic Surgery:


J13 13 Restricted Benefits
    1. Assisted Reproductive Services:

    2. Pregnancy Related Services:

    3. Sterilisation and Reversal of Sterilisation:

    4. Cardiothoracic:

    5. Psychiatric:

    6. Rehabilitation:

    7. Plastic and Cosmetic Surgery:



J13 14 Exclusions
1. Assisted Reproductive Services: The Company will make no payments for hospital services,
medical services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient
payments where the purpose of the hospital admission is for assisted reproductive services.

2. Pregnancy Related Services: : The Company will make no payments for hospital services, medical
services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments
where the purpose of the hospital admission is for pregnancy and birth related services.

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic: The Company will make no payments for hospital services, medical services,
pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments where the
purpose of the hospital admission is for cardiac and cardiac related services being any services
relating to the heart and surrounding arteries including but not limited to diagnostic cardiac
investigations, invasive cardiac procedures, surgical pacemakers, defibrillators, open heart and by-
pass surgery and cardiac valve surgery.

5. Plastic and Cosmetic Surgery:

6. Hip and Joint Replacements: The Company will make no payments for hospital services, medical
services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments
where the purpose of the hospital admission is for any hip or joint replacement (including revisions).

7. Other:
(a) Cataract and Eye Lens Procedures- The Company will make no payments for hospital services,
medical services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient
payments where the purpose of the hospital admission is for cataract or eye lens procedures.

(b) Renal Dialysis for chronic renal failure – The Company will make no payments for hospital
services, medical services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type
Patient payments where the purpose of the hospital admission is for renal dialysis for chronic renal
failure.



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J13 15 Loyalty Bonuses


J13 16 Other Special Hospital Treatment
                 Health Management Programs

The Company offers each person covered under this Policy participation in the Company’s Preventive
Program or other approved health management programs offered by the Company.


J13 17 Dental
Benefit

Benefits for Dental services are payable as set out in the Company’s Benefit Schedule and in
accordance with the Rules set out in Section E3 of the General Conditions.

Annual Limit

Combined General Dental and Major Dental - $300 per person base limit
Orthodontia – No cover

Increased Limits

If any persons covered under these Policies undergo and claim a preventive dental check-up each
calendar year, the combined General Dental Major Dental annual limits will increase in the following
year to:-

      •   Year 1 - $300
      •   Year 2 - $400
      •   Year 3 - $500
      •   Year 4 - $600
      •   Year5+ - $800

      A 12 month waiting period applies from the date of joining the cover with the 2nd year of
      loyalty commencing on the first anniversary of the joining date and ending on December
      31st.


J13 18 Optical
11.
Benefit
                          NSW/ACT       QLD           SA         TAS           VIC          WA            NT
Frames                     $89.60      $97.45     $100.00       $95.20      $100.00       $95.20       $100.00
Single Vision Lenses       $62.30      $62.30      $72.25       $62.30       $62.30       $62.30        $67.20
Multifocal Lenses         $100.00     $100.00     $100.00      $100.00      $100.00      $100.00       $100.00
Contact Lenses-             70%         70%         70%          70%          70%          70%           70%
Disposable

Annual Limit




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$300 per person up to a maximum of $500 per person combined limit with - physiotherapy,
chiropractic, osteopathy, non-PBS pharmaceuticals, psychology and counselling, natural therapies,
naturopathy, acupuncture and travel well benefits.

Increased Flexi-Limits

Increasing flexible limits (Flexi-Limits) apply to all listed general treatment services other than Dental
under rule J13.17.

   •      Year 1 - $300
   •      Year 2 - $350
   •      Year 3 - $400
   •      Year 4 - $450
   •      Year5+ - $500

A 12 month waiting period applies from the date of joining the cover with the 2nd year of
loyalty commencing on the first anniversary of the joining date and ending on December 31st.


J13 19 Physiotherapy
Benefit

                     NSW/ACT          QLD            SA          TAS           VIC          WA            NT
Initial Visit        $33.60          $31.20       $32.30        $32.05       $31.90       $33.10        $32.75
Subsequent Visit     $27.15          $25.60       $25.85        $25.20       $25.60       $26.80        $26.15
Group Session         $8.65           $7.75        $8.95         $8.95        $8.95        $8.40        $14.75

Annual Limit

$300 per person up to a maximum of $500 per person combined limit with - optical, chiropractic,
osteopathy, non-PBS pharmaceuticals, psychology and counselling, natural therapies, naturopathy,
acupuncture and travel well benefits.

Increased Flexi-Limits

Increasing flexible limits (Flexi-Limits) apply to all listed general treatment services other than Dental
under rule J13.17 .

   •      Year 1 - $300
   •      Year 2 - $350
   •      Year 3 - $400
   •      Year 4 - $450
   •      Year5+ - $500

A 12 month waiting period applies from the date of joining the cover with the 2nd year of
loyalty commencing on the first anniversary of the joining date and ending on December 31st.


J13 20 Chiropractic
Benefit

                     NSW/ACT          QLD             SA         TAS           VIC           WA           NT
Initial Visit          $39.00         $32.00        $35.00       $33.00       $34.00        $35.00       $35.00
Subsequent Visit       $25.00         $23.00        $25.00       $23.00       $24.00        $25.00       $25.00


                                                                                             337 of 545
Annual Limit

$300 per person up to a maximum of $500 per person combined limit with - optical, physiotherapy,
osteopathy, non-PBS pharmaceuticals, psychology and counselling, natural therapies, naturopathy,
acupuncture and travel well benefits.

Increased Flexi-Limits

Increasing flexible limits (Flexi-Limits) apply to all listed general treatment services other than Dental
under rule J13.17 under rule J13.36.

   •      Year 1 - $300
   •      Year 2 - $350
   •      Year 3 - $400
   •      Year 4 - $450
   •      Year5+ - $500

A 12 month waiting period applies from the date of joining the cover with the 2nd year of
loyalty commencing on the first anniversary of the joining date and ending on December 31st.


J13 21 Non PBS Pharmaceuticals
Benefit

Ancillary Pharmaceutical Items

After deducting an amount equal to the current Commonwealth PBS co-payment, the Company will
pay a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $50 per item.

Benefits for Ancillary Pharmaceutical Items are payable in accordance with the rules set out in
Section E3 of the General Conditions.

Medical Assistance Service

The Company will pay a benefit of up to $40 for a Medical Assistance Service with a pharmacist that
is approved by the Company.

Benefits for a Medical Assistance Service is payable in accordance with the rules set out in Section
E3 of the General Conditions.

Annual Limit

(1) Ancillary Pharmaceutical Items - $300 per person up to a maximum of $500 per person combined
limit with - optical, physiotherapy, chiropractic, osteopathy, psychology and counselling, natural
therapies, naturopathy, acupuncture and travel well benefits.

(2) Medical Assistance Service – One medication Assistance service per person

Increased Flexi-Limits

Increasing flexible limits (Flexi-Limits) apply to all listed general treatment services other than Dental
under rule J13.17.

    •     Year 1 - $300


                                                                                             338 of 545
    •     Year 2 - $350
    •     Year 3 - $400
    •     Year 4 - $450
    •     Year5+ - $500

A 12 month waiting period applies from the date of joining the cover with the 2nd year of
loyalty commencing on the first anniversary of the joining date and ending on December 31st.


J13 22 Podiatry


J13 23 Psychology and Counselling
Benefit

                     NSW/ACT          QLD             SA         TAS           VIC          WA            NT
Initial Visit          $70.00         $65.00        $85.00       $65.00       $70.00      $100.00        $77.00
Subsequent Visit       $62.00         $55.00        $70.00       $60.00       $60.00       $70.00        $60.00
Group Treatment        $32.00         $30.00        $60.00       $56.00       $56.00       $60.00        $30.00

Annual Limit

$300 per person up to a maximum of $500 per person combined limit with - optical, physiotherapy,
chiropractic, osteopathy, non-PBS pharmaceuticals, natural therapies, naturopathy, acupuncture and
travel well benefits.

Increased Flexi-Limits

Increasing flexible limits (Flexi-Limits) apply to all listed general treatment services other than Dental
under rule J13.17 under rule J13.36.

   •      Year 1 - $300
   •      Year 2 - $350
   •      Year 3 - $400
   •      Year 4 - $450
   •      Year5+ - $500

A 12 month waiting period applies from the date of joining the cover with the 2nd year of
loyalty commencing on the first anniversary of the joining date and ending on December 31st.


J13 24 Alternative Therapies


J13 25 Natural Therapies

The following Natural (Complementary) Therapies are covered:-

Remedial massage, aromatherapy, alexander technique, feldenkrais, kinesiology, homoeopathy,
iridology, bowen technique, herbalist, shiatsu, reflexology, exercise physiology:

Benefit


                                                                                             339 of 545
Benefits are payable as set out in the Company’s Benefit Schedule.

Annual Limit

$300 per person up to a maximum of $500 per person combined limit with - optical, physiotherapy,
chiropractic, osteopathy, non-PBS pharmaceuticals, psychology and counselling, naturopathy,
acupuncture and travel well benefits.

Increased Flexi-Limits

Increasing flexible limits (Flexi-Limits) apply to all listed general treatment services other than Dental
under rule J13.17 under rule J13.36.

    •     Year 1 - $300
    •     Year 2 - $350
    •     Year 3 - $400
    •     Year 4 - $450
    •     Year5+ - $500

A 12 month waiting period applies from the date of joining the cover with the 2nd year of
loyalty commencing on the first anniversary of the joining date and ending on December 31st.


J13 26 Speech Therapy


J13 27 Orthotics


J13 28 Dietetics


J13 29 Occupational Therapy


J13 30 Naturopathy
Benefit

                     NSW/ACT          QLD             SA         TAS           VIC           WA           NT
Initial Visit          $25.00         $25.00        $25.00       $22.00       $25.00        $22.00       $25.00
Subsequent Visit       $22.00         $20.00        $20.00       $20.00       $21.50        $20.00       $22.00

Annual Limit

$300 per person up to a maximum of $500 per person combined limit with - optical, physiotherapy,
chiropractic, osteopathy, non-PBS pharmaceuticals, psychology and counselling, natural therapies,
acupuncture and travel well benefits.

Increased Flexi-Limits




                                                                                             340 of 545
Increasing flexible limits (Flexi-Limits) apply to all listed general treatment services other than Dental
under rule J13.17 under rule J13.36.

   •      Year 1 - $300
   •      Year 2 - $350
   •      Year 3 - $400
   •      Year 4 - $450
   •      Year5+ - $500

A 12 month waiting period applies from the date of joining the cover with the 2nd year of
loyalty commencing on the first anniversary of the joining date and ending on December 31st.


J13 31 Acupuncture
Benefit

                     NSW/ACT          QLD             SA         TAS           VIC           WA           NT
Initial Visit          $28.00         $28.00        $31.00       $25.00       $28.50        $32.00       $30.00
Subsequent Visit       $22.00         $22.00        $23.00       $23.00       $21.50        $25.00       $25.00

Annual Limit

$300 per person up to a maximum of $500 per person combined limit with - optical, physiotherapy,
chiropractic, osteopathy, non-PBS pharmaceuticals, psychology and counselling, natural therapies,
naturopathy and travel well benefits.

Increased Flexi-Limits

Increasing flexible limits (Flexi-Limits) apply to all listed general treatment services other than Dental
under rule J13.17 under rule J13.36.

   •      Year 1 - $300
   •      Year 2 - $350
   •      Year 3 - $400
   •      Year 4 - $450
   •      Year5+ - $500

A 12 month waiting period applies from the date of joining the cover with the 2nd year of
loyalty commencing on the first anniversary of the joining date and ending on December 31st.


J13 32 Other Therapies
Osteopathy

Benefit

                     NSW/ACT          QLD             SA         TAS           VIC           WA           NT
Initial Visit          $39.90         $35.00        $40.60       $32.90       $36.40        $32.65       $35.00
Subsequent Visit       $37.10         $31.10        $27.65       $26.25       $31.50        $27.45       $31.95

Annual Limit




                                                                                             341 of 545
$300 per person up to a maximum of $500 per person combined limit with - optical, physiotherapy,
chiropractic, non-PBS pharmaceuticals, psychology and counselling, natural therapies, naturopathy,
acupuncture and travel well benefits.

Increased Flexi-Limits

Increasing flexible limits (Flexi-Limits) apply to all listed general treatment services other than Dental
under rule J13.17.

   •    Year 1 - $300
   •    Year 2 - $350
   •    Year 3 - $400
   •    Year 4 - $450
   •    Year5+ - $500

A 12 month waiting period applies from the date of joining the cover with the 2nd year of
loyalty commencing on the first anniversary of the joining date and ending on December 31st.



J13 33 Non Surgically Implanted Prostheses and Appliances


J13 34 Hearing Aids


J13 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


J13 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.




J13 37 Accident Cover


J13 38 Accidental Death Funeral Expenses



                                                                                             342 of 545
J13 39 Other Special General Treatment
Travel Well Benefit

All States – 100% of the cost towards travel vaccinations approved by the Company.

Annual Limit

$300 per person up to a maximum of $500 per person combined limit with - optical, physiotherapy,
chiropractic, osteopathy, non-PBS pharmaceuticals, psychology and counselling, natural therapies,
naturopathy and acupuncture.

Increased Flexi-Limits

Increasing flexible limits (Flexi-Limits) apply to all listed general treatment services other than Dental
under rule J13.17.

    •   Year 1 - $300
    •   Year 2 - $350
    •   Year 3 - $400
    •   Year 4 - $450
    •   Year5+ - $500

A 12 month waiting period applies from the date of joining the cover with the 2nd year of
loyalty commencing on the first anniversary of the joining date and ending on December 31st.



J13 40 Hospital-Substitute Treatment




J15 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J15 1 Table Name or Group of Table Names
HealthLink Hospital

J15 2 Eligibility
A Policy Holder may register a Dependant Child as a Dependant Extension under this policy in
accordance with the definition under Rule B2 of the General Conditions.


J15 3 General Conditions


J15 4 Hospital Treatment Payments
The Company will pay to Hospitals for Hospital Treatment received by a Policy Holder, the following
payments:

(1) In Network Hospitals – the Network Hospital Payment;



                                                                                             343 of 545
(2) In Public Hospitals – the Public Hospital Benefit; and

(3) In non-agreement Private Hospitals – the Non-Agreement Hospital Benefit (Private).


J15 5 Medical Services Payments while admitted
Where there is an MPPA, PA or Gap Cover Scheme in place, the Company will pay to Medical Practitioners for
medical services received by a Policy Holder while an Admitted Patient, the MPPA, PA or Gap Cover Schemes
Payment.

Where there is no MPPA, PA or Gap Cover Scheme in place, the Company will pay the Schedule Fee Gap
Benefit for medical services received by a Policy Holder while an Admitted Patient:

(1) to the Policy Holder; or

(2) where the Policy Holder assigns the benefit to the Medical Practitioner, to that Medical
Practitioner.


J15 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
Benefits for qualifying PBS Items supplied to an Admitted Patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions..



J15 7 Non PBS Pharmaceuticals
Benefits for non PBS medications supplied to an Admitted Patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.


J15 8 Surgically Implanted Prostheses
Benefits for qualifying surgically implanted prostheses are payable in accordance with Rule E2 of the
General Conditions, whichever is applicable.



J15 9 Nursing Home Type Patients
Benefits for Hospital Treatment provided to Nursing Home Type Patients are payable in accordance
with Rule E2 of the General Conditions.



J15 10 Co Payments


J15 11 Excesses
The following annual Excess options apply per person once per Calendar Year to a maximum of twice per
Policy: - $250, $500 or $1,000.

J15 12 Benefit Limitation Periods


                                                                                               344 of 545
1. Assisted Reproductive Services: After the relevant waiting periods, for the following 24 months of
the Policy, daily benefits are limited to the Minister’s default benefits for admissions to Private
Hospitals.

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric: After the relevant waiting periods, for the following 24 months of the Policy, daily
benefits are limited to the Minister’s default benefits for admissions to Private Hospitals. Excludes
eating disorders and post-natal depression.

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:

8. Hip and Knee Joint Replacements: After the relevant waiting periods, for the following 24 months
of the Policy, daily benefits are limited to the Minister’s default benefits for admissions to Private
Hospitals except where they are required as the result of an accident that occurs after the Policy
commences.

9. Other: Cataract eye surgery, Dialysis for chronic renal failure and Bone Marrow Transplants: After
the relevant Waiting Periods, for the following 24 months of the Policy daily benefits are limited to
the Minister’s default benefits for admissions to Private Hospitals.


J15 13 Restricted Benefits

1. Assisted Reproductive Services:

2. Pregnancy Related Services:

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J15 14 Exclusions

1. Assisted Reproductive Services:

2. Pregnancy Related Services:

3. Sterilisation and Reversal of Sterilisation:


                                                                                            345 of 545
4. Cardiothoracic:

5. Plastic and Cosmetic Surgery:

6. Hip Replacements:

7. Other:


J15 15 Loyalty Bonuses


J15 16 Other Special Hospital Treatment
Health Management Programs

The Company offers each person covered under this Policy participation in the Company’s Preventive
Program or other approved health management programs offered by the Company.


J15 17 Dental


J15 18 Optical


J15 19 Physiotherapy


J15 20 Chiropractic


J15 21 Non PBS Pharmaceuticals


J15 22 Podiatry


J15 23 Psychology and Counselling


J15 24 Alternative Therapies


J15 25 Natural Therapies




                                                                                       346 of 545
J15 26 Speech Therapy


J15 27 Orthotics


J15 28 Dietetics


J15 29 Occupational Therapy


J15 30 Naturopathy


J15 31 Acupuncture


J15 32 Other Therapies


J15 33 Non Surgically Implanted Prostheses and Appliances


J15 34 Hearing Aids


J15 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


J15 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J15 37 Accident Cover



                                                                                            347 of 545
J15 38 Accidental Death Funeral Expenses


J15 39 Other Special General Treatment


J15 40 Hospital-Substitute Treatment



J16 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J16 1 Table Name or Group of Table Names
Premium Hospital

J16 2 Eligibility
A Policy Holder may register a Dependant Child as a Dependant Extension under this policy in
accordance with the definition under Rule B2 of the General Conditions.

Product closed to new members from 30th November 2010.


J16 3 General Conditions


J16 4 Hospital Treatment Payments
The Company will pay to Hospitals for Hospital Treatment received by Policy Holder, the following payments:

(1) In Network Hospitals – the Network Hospital Payment;

(2) In Public Hospitals – the Public Hospital Benefit; and

(3) In non-agreement Private Hospitals – the Non-Agreement Hospital Benefit (Private).


J16 5 Medical Services Payments while admitted
Where there is an MPPA, PA or Gap Cover Scheme in place, the Company will pay to Medical Practitioners for
medical services received by a Policy Holder while an Admitted Patient, the MPPA, PA or Gap Cover Schemes
Payment.

Where there is no MPPA, PA or Gap Cover Scheme in place, the Company will pay the Schedule Fee Gap
Benefit for medical services received by a Policy Holder while an Admitted Patient:

(1) to the Policyholder; or

(2) where the Policyholder assigns the benefit to the Medical Practitioner, to that Medical Practitioner.




                                                                                               348 of 545
J16 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
Benefits for qualifying PBS Items supplied to an admitted patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.

J16 7 Non PBS Pharmaceuticals
Benefits for non PBS medications supplied to an admitted patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.


J16 8 Surgically Implanted Prostheses
Benefits for qualifying surgically implanted prostheses are payable in accordance with Rule E2 of the
General Conditions, whichever is applicable.



J16 9 Nursing Home Type Patients
Benefits for hospital treatment provided to nursing home type patients are payable in accordance with
Rule E2 of the General Conditions.



J16 10 Co Payments


J16 11 Excesses


J16 12 Benefit Limitation Periods

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J16 13 Restricted Benefits

1. Assisted Reproductive Services:

2. Pregnancy Related Services:



                                                                                          349 of 545
3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J16 14 Exclusions

1. Assisted Reproductive Services:

2. Pregnancy Related Services:

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Plastic and Cosmetic Surgery:

6. Hip Replacements:

7. Other:


J16 15 Loyalty Bonuses


J16 16 Other Special Hospital Treatment
Health Management Programs


The Company offers each person covered under this Policy participation in the Company’s Preventive
Program or other approved health management programs offered by the Company.


Premium Hospital Special Benefits

The Company will also pay additional daily benefits for the following services where charged in a Network
Hospital:-

(1) accommodation in hospital for parent/s, spouse or next of kin – maximum $60 a night.

(2) meals in hospital for parent/s, spouse, or next of kin – maximum $30 per day.

(3) home services directly relating to and following the admission, including post natal care, lactation nursing,
    physiotherapy, occupational therapy or speech pathology – maximum $60 per visit.




                                                                                                   350 of 545
In Non-Agreement Hospitals (Private), the Company will also pay an additional daily benefit, capped
at 80% of the charge, for hospital provided and invoiced items, per Insured Person:

(1) for shared ward or single accommodation

(2) intensive care

(3) theatre charges

    An annual limit of $1000 will apply


J16 17 Dental


J16 18 Optical


J16 19 Physiotherapy


J16 20 Chiropractic


J16 21 Non PBS Pharmaceuticals


J16 22 Podiatry


J16 23 Psychology and Counselling


J16 24 Alternative Therapies


J16 25 Natural Therapies


J16 26 Speech Therapy


J16 27 Orthotics


J16 28 Dietetics




                                                                                        351 of 545
J16 29 Occupational Therapy


J16 30 Naturopathy


J16 31 Acupuncture


J16 32 Other Therapies


J16 33 Non Surgically Implanted Prostheses and Appliances


J16 34 Hearing Aids


J16 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


J16 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J16 37 Accident Cover


J16 38 Accidental Death Funeral Expenses


J16 39 Other Special General Treatment


J16 40 Hospital-Substitute Treatment



                                                                                            352 of 545
J17 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J17 1 Table Name or Group of Table Names
Budget Hospital Cover

J17 2 Eligibility


J17 3 General Conditions


J17 4 Hospital Treatment Payments
Providing a hospital admission is not related to an excluded service described in rule J17.14, the Company will
pay to Hospitals for Hospital Treatment received by a Policy Holder, the following payments:

(1) In Network Hospitals – the Network Hospital Payment;

(2) In Public Hospitals – the Public Hospital Benefit; and

(3) In non-agreement Private Hospitals – the Non-Agreement Hospital Benefit (Private).


J17 5 Medical Services Payments while admitted
Providing a hospital admission is not related to an excluded service described in rule J17.14, where there is an
MPPA, PA or Gap Cover Scheme in place, the Company will pay to Medical Practitioners for medical services
received by the Policy Holder while an admitted patient, the MPPA, PA or Gap Cover Schemes Payment.

Providing a hospital admission is not related to an excluded service described in rule J17.14, where there is no
MPPA, PA or Gap Cover Scheme in place, the Company will pay the Schedule Fee Gap Benefit for medical
services received by the Policy Holder while an admitted patient:

(1) to the Policyholder; or

(2) where the Policyholder assigns the benefit to the Medical Practitioner, to that Medical Practitioner.


J17 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
Providing a hospital admission is not related to an excluded service described in Rule J17.14, benefits
for qualifying PBS Items supplied to an Admitted Patient of a Network Hospital are payable in
accordance with Rule E2 of the General Conditions.



J17 7 Non PBS Pharmaceuticals
Providing a hospital admission is not related to an excluded service described in Rule J17.14,
benefits for non PBS medications supplied to an Admitted Patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.



                                                                                                   353 of 545
J17 8 Surgically Implanted Prostheses
Providing a hospital admission is not related to an excluded service described in Rule J17.14, benefits
for qualifying surgically implanted prostheses are payable in accordance with Rule E2 of the General
Conditions, whichever is applicable.



J17 9 Nursing Home Type Patients
Providing a hospital admission is not related to an excluded service described in rule J17.14, benefits
for Hospital Treatment provided to Nursing Home Type Patients are payable in accordance with Rule
E2 of the General Conditions.



J17 10 Co Payments


J17 11 Excesses
The following annual Excess options apply per person once per Calendar Year to a maximum of twice per
Policy: - $250, $500 or $1,000 (Not available to new members from 30th of November 2010).

J17 12 Benefit Limitation Periods

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:

J17 13 Restricted Benefits

1. Assisted Reproductive Services:

2. Pregnancy Related Services:

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:



                                                                                           354 of 545
6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J17 14 Exclusions
1. Assisted Reproductive Services: The Company will make no payments for hospital services,
medical services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient
payments where the purpose of the hospital admission is for assisted reproductive services.

2. Pregnancy Related Services: : The Company will make no payments for hospital services, medical
services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments
where the purpose of the hospital admission is for pregnancy and birth related services.

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic: The Company will make no payments for hospital services, medical services,
pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments where the
purpose of the hospital admission is for cardiac and cardiac related services being any services
relating to the heart and surrounding arteries including but not limited to diagnostic cardiac
investigations, invasive cardiac procedures, surgical pacemakers, defibrillators, open heart and by-
pass surgery and cardiac valve surgery.

5. Plastic and Cosmetic Surgery:

6. Hip and Joint Replacements: The Company will make no payments for hospital services, medical
services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments
where the purpose of the hospital admission is for any hip or joint replacement (including revisions).

7. Other:
(a) Cataract and Eye Lens Procedures- The Company will make no payments for hospital services,
medical services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient
payments where the purpose of the hospital admission is for cataract or eye lens procedures.

(b) Renal Dialysis for chronic renal failure – For Policy Holders who enrolled on this cover on or after
1 April 2006, the Company will make no payments for hospital services, medical services,
pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments where the
purpose of the hospital admission is for renal dialysis for chronic renal failure.

(c) Surgical Podiatry - The Company will make no payments for hospital services, medical services,
pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments where the
purpose of the hospital admission is for surgical podiatry by an accredited podiatrist.


J17 15 Loyalty Bonuses


J17 16 Other Special Hospital Treatment
Health Management Programs

The Company offers each person covered under this Policy participation in the Company’s Preventive
Program or other approved health management programs offered by the Company.



                                                                                            355 of 545
J17 17 Dental


J17 18 Optical


J17 19 Physiotherapy


J17 20 Chiropractic


J17 21 Non PBS Pharmaceuticals


J17 22 Podiatry


J17 23 Psychology and Counselling


J17 24 Alternative Therapies


J17 25 Natural Therapies


J17 26 Speech Therapy


J17 27 Orthotics


J17 28 Dietetics


J17 29 Occupational Therapy


J17 30 Naturopathy


J17 31 Acupuncture




                                    356 of 545
J17 32 Other Therapies


J17 33 Non Surgically Implanted Prostheses and Appliances


J17 34 Hearing Aids


J17 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


J17 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J17 37 Accident Cover


J17 38 Accidental Death Funeral Expenses


J17 39 Other Special General Treatment


J17 40 Hospital-Substitute Treatment



J18 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J18 1 Table Name or Group of Table Names
Standard Hospital Cover




                                                                                            357 of 545
J18 2 Eligibility


J18 3 General Conditions


J18 4 Hospital Treatment Payments
Providing a hospital admission is not related to an excluded service described in rule J18.14, the Company will
pay to Hospitals for Hospital Treatment received by a Policy Holder, the following payments:

(1) In Network Hospitals – the Network Hospital Payment;

(2) In Public Hospitals – the Public Hospital Benefit; and

(3) In non-agreement Private Hospitals – the Non-Agreement Hospital Benefit (Private).


J18 5 Medical Services Payments while admitted
Providing a hospital admission is not related to an excluded service described in rule J18.14, where there is an
MPPA, PA or Gap Cover Scheme in place, the Company will pay to Medical Practitioners for medical services
received by the Policy Holder while an admitted patient, the MPPA, PA or Gap Cover Schemes Payment.

Providing a hospital admission is not related to an excluded service described in rule J18.14, where there is no
MPPA, PA or Gap Cover Scheme in place, the Company will pay the Schedule Fee Gap Benefit for medical
services received by the Policy Holder while an admitted patient:

(1) to the Policy Holder; or

(2) where the Policy Holder assigns the benefit to the Medical Practitioner, to that Medical
Practitioner.


J18 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
Providing a hospital admission is not related to an excluded service described in Rule J18.14, benefits
for qualifying PBS Items supplied to an Admitted Patient of a Network Hospital are payable in
accordance with Rule E2 of the General Conditions.



J18 7 Non PBS Pharmaceuticals
Providing a hospital admission is not related to an excluded service described in Rule J18.14,
benefits for non PBS medications supplied to an Admitted Patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.


J18 8 Surgically Implanted Prostheses
Providing a hospital admission is not related to an excluded service described in Rule J18.14, benefits
for qualifying surgically implanted prostheses are payable in accordance with Rule E2 of the General
Conditions, whichever is applicable.




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J18 9 Nursing Home Type Patients
Providing a hospital admission is not related to an excluded service described in rule J18.14, benefits
for Hospital Treatment provided to Nursing Home Type Patients are payable in accordance with Rule
E2 of the General Conditions.



J18 10 Co Payments


J18 11 Excesses
The following annual Excess options apply per person once per Calendar Year to a maximum of twice per
Policy: - $250, $500 or $1,000 (Not available to new members from 30th of November 2010).

J18 12 Benefit Limitation Periods

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:

J18 13 Restricted Benefits

1. Assisted Reproductive Services:

2. Pregnancy Related Services:

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J18 14 Exclusions
1. Assisted Reproductive Services:

2. Pregnancy Related Services:


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3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Plastic and Cosmetic Surgery:

6. Hip and Joint Replacements: The Company will make no payments for hospital services, medical
services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments
where the purpose of the hospital admission is for any hip or joint replacement (including revisions).

7. Other:
(a) Cataract and Eye Lens Procedures- The Company will make no payments for hospital services,
medical services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient
payments where the purpose of the hospital admission is for cataract or eye lens procedures.

(b) Renal Dialysis for Chronic Renal Failure – For Policy Holders who enrolled on this cover on or
after 1 April 2006, the Company will make no payments for hospital services, medical services,
pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments where the
purpose of the hospital admission is for renal dialysis for chronic renal failure.

(c) Surgical Podiatry - The Company will make no payments for hospital services, medical services,
pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments where the
purpose of the hospital admission is for surgical podiatry by an accredited podiatrist.


J18 15 Loyalty Bonuses


J18 16 Other Special Hospital Treatment
Health Management Programs

The Company offers each person covered under this Policy participation in the Company’s Preventive
Program or other approved health management programs offered by the Company.


J18 17 Dental


J18 18 Optical


J18 19 Physiotherapy


J18 20 Chiropractic


J18 21 Non PBS Pharmaceuticals




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J18 22 Podiatry


J18 23 Psychology and Counselling


J18 24 Alternative Therapies


J18 25 Natural Therapies


J18 26 Speech Therapy


J18 27 Orthotics


J18 28 Dietetics


J18 29 Occupational Therapy


J18 30 Naturopathy


J18 31 Acupuncture


J18 32 Other Therapies


J18 33 Non Surgically Implanted Prostheses and Appliances


J18 34 Hearing Aids


J18 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.




                                                                                            361 of 545
J18 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.




J18 37 Accident Cover


J18 38 Accidental Death Funeral Expenses


J18 39 Other Special General Treatment


J18 40 Hospital-Substitute Treatment



J19 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J19 1 Table Name or Group of Table Names
Advantage Hospital Cover

J19 2 Eligibility
A Policy Holder may register a Dependant Child as a Dependant Extension under this policy in
accordance with the definition under Rule B2 of the General Conditions.

J19 3 General Conditions


J19 4 Hospital Treatment Payments
The Company will pay to Hospitals for Hospital Treatment received by Policy Holder, the following payments:

(1) In Network Hospitals – the Network Hospital Payment;

(2) In Public Hospitals – the Public Hospital Benefit; and

(3) In non-agreement Private Hospitals – the Non-Agreement Hospital Benefit (Private).




                                                                                               362 of 545
J19 5 Medical Services Payments while admitted
Where there is an MPPA, PA or Gap Cover Scheme in place, the Company will pay to Medical Practitioners for
medical services received by a Policy Holder while an Admitted Patient, the MPPA, PA or Gap Cover Schemes
Payment.

Where there is no MPPA, PA or Gap Cover Scheme in place, the Company will pay the Schedule Fee Gap
Benefit for medical services received by a Policy Holder while an Admitted Patient:

(1) to the Policyholder; or

(2) where the Policyholder assigns the benefit to the Medical Practitioner, to that Medical Practitioner.


J19 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
Benefits for qualifying PBS Items supplied to an admitted patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.

J19 7 Non PBS Pharmaceuticals
Benefits for non PBS medications supplied to an admitted patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.


J19 8 Surgically Implanted Prostheses
Benefits for qualifying surgically implanted prostheses are payable in accordance with Rule E2 of the
General Conditions, whichever is applicable.



J19 9 Nursing Home Type Patients
Benefits for Hospital Treatment provided to Nursing Home Type Patients are payable in accordance
with Rule E2 of the General Conditions.



J19 10 Co Payments
When taken with a no Excess Policy option, a $50 Co-Payment applies for each Policy Holder for any
same day or overnight admissions and at any private or public hospital to a maximum of $250 per
admission.

No Co-Payment applies for any admissions to hospital of a Child Dependent, Student Dependant or
Dependant Extension covered under the Policy.



J19 11 Excesses
The following annual Excess options apply per person per Calendar Year to a maximum of twice per Policy -
No Excess, $250, $500 or $1,000 (Not available to new members from 30th of November 2010).

of a dependent child or dependent child non-student




                                                                                             363 of 545
J19 12 Benefit Limitation Periods

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J19 13 Restricted Benefits

1. Assisted Reproductive Services:

2. Pregnancy Related Services:

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J19 14 Exclusions

1. Assisted Reproductive Services:

2. Pregnancy Related Services:

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Plastic and Cosmetic Surgery:

6. Hip Replacements:

7. Other:




                                                  364 of 545
J19 15 Loyalty Bonuses


J19 16 Other Special Hospital Treatment
Health Management Programs
The Company offers each person covered under this Policy participation in the Company’s Preventive
Program or other approved health management programs offered by the Company.
.

J19 17 Dental


J19 18 Optical


J19 19 Physiotherapy


J19 20 Chiropractic


J19 21 Non PBS Pharmaceuticals


J19 22 Podiatry


J19 23 Psychology and Counselling


J19 24 Alternative Therapies


J19 25 Natural Therapies


J19 26 Speech Therapy


J19 27 Orthotics


J19 28 Dietetics




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J19 29 Occupational Therapy


J19 30 Naturopathy


J19 31 Acupuncture


J19 32 Other Therapies


J19 33 Non Surgically Implanted Prostheses and Appliances


J19 34 Hearing Aids


J19 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


J19 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.




J19 37 Accident Cover


J19 38 Accidental Death Funeral Expenses


J19 39 Other Special General Treatment




                                                                                            366 of 545
J19 40 Hospital-Substitute Treatment



J20 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J20 1 Table Name or Group of Table Names

Ultimate Health Hospital and Extras Cover (Z4) and ANZ (#Z4):


J20 2 Eligibility



J20 3 General Conditions
58. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (kk)          for a single service of general treatment provided to a policy holder by a recognised
          practitioner in private practice on a given day; and
     (ll) for more than one service of general treatment on a given day provided by a recognised
          provider in registered premises in private practice who is recognised by the Company in more
          than one profession.

59. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

60. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.    General treatment benefits are not payable for any of the circumstances outlined in Rule E 4 of
     the General Conditions.


J20 4 Hospital Treatment Payments


Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals with
which the Company has an agreement. For private hospitals with which the Company does not have
an agreement benefits are paid according to the schedule of benefits maintained by the Company.
Policy holders may not be fully covered in private hospitals with which the Company does not have
an agreement.


J20 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner


                                                                                             367 of 545
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J20 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.


J20 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J20 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.


J20 9 Nursing Home Type Patients

Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J20 10 Co Payments



J20 11 Excesses



J20 12 Benefit Limitation Periods

    1. Assisted Reproductive Services:




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    2. Pregnancy Related Services


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Psychiatric:


    6. Rehabilitation:


    7. Plastic and Cosmetic Surgery:


    8. Hip Replacements:


    9. Other:


J20 13 Restricted Benefits

12. Assisted Reproductive Services:


13. Pregnancy Related Services:


14. Sterilisation and Reversal of Sterilisation:


15. Cardiothoracic:


16. Psychiatric:


17. Rehabilitation:


18. Plastic and Cosmetic Surgery:


19. Hip Replacements:




                                                      369 of 545
20. Other:



J20 14 Exclusions
    1. Assisted Reproductive Services:


    2. Pregnancy Related Services:


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
       clinically necessary


    6. Hip Replacements:


    7. Other:



J20 15 Loyalty Bonuses

1) After 12 months continuous membership, a policy holder is entitled to an increased benefit
   maximum equal to the first year benefit maximum for the relevant modality plus 20% of the first
   year benefit maximum. For each subsequent continuos 12 months membership, the policy holder
   is entitled to an increased benefit maximum equal to their previous years benefit maximum for the
   relevant modality plus 20% of the first year benefit maximum. No further increased benefit
   maximums apply beyond 200% of the first year maximum. Loyalty bonuses do not apply to
   optical, massage, hearing aids and non surgically implanted prostheses and appliances.

2) After 3 years membership on this Table, a policy holder is eligible for a benefit of 100% towards
   the cost of Laser Correction Eye Surgery where performed by a recognised health care provider.

3) After 1 year’s membership on this Table, a policy holder is eligible for a benefit of 85% of the
   cost of a Cochlear Implant Processor.

4) After 6 months membership on this Table, a policy holder is eligible to a refund of 100% of the
   cost of a subscription to the Arthritis Foundation, Asthma Foundation, Diabetes Australia and
   Parkinson’s in Western Australia.



J20 16 Other Special Hospital Treatment
1. The Company will establish a pool to which it will credit, in respect of each policy holder:


                                                                                            370 of 545
    at the time the policy holder joins - $200
    on December 31 each year - $200

      Amounts credited to the pool will accrue.

      The policy holder may draw from the pool, accrued credits in respect of;

      (i)        Any Co-payment that may result from services rendered to the policy holder, his
                 spouse or dependants by a medical practitioner with which the Company has a
                 Medical Purchaser Provider Agreement; or
      (ii)       Any amount exceeding 100% of the Government Schedule Fee for services rendered
                 to the policy holder, his spouse or dependants by a medical practitioner, where the
                 services were as a result of an emergency hospital admission

2. Special Benefits

      Benefits will be offered to a partner, immediate family member, carer/parent, next of kin who is
      required to stay at the hospital with the patient. The benefit is payable on the admitted person’s
      policy.

      The Benefits payable are:

    Accommodation in hospital for up to $60 per night whilst a boarder in hospital
    Benefit towards meals whilst in hospital for up to $30 per day for any hospital meals provided
    An annual limit of $1000 will apply


J20 17 Dental
Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services and
Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-operative
care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every three
years.

Maximum per person during first benefit entitlement year

                 General Dental

All States                                  NIL
                 Major Dental

All States                                  $800
Orthodontia
All States                                  $500
Lifetime Limit                              $3000


J20 18 Optical


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All States

Frames for prescription lenses                 $190.75
Single Vision Lenses                            $76.45
Progressive Lenses                             $161.60
Contact Lenses, disposable
1 month supply                                  $53.35
3 months supply                                 $95.30
Contact Lenses, non-disposable                 $169.75

The Maximum per person during any one year is $280.00.


J20 19 Physiotherapy

                            NSW           QLD       SA         TAS           VIC          WA                      NT
Initial visit             $50.00        $50.00   $51.15     $50.00        $51.15       $50.00                  $50.00
Subsequent visit          $40.00        $40.00   $40.85     $40.00        $40.85       $40.00                  $40.00
Ante natal visit          $15.00        $15.00   $ 11.80    $15.00        $14.10       $15.00                  $15.00
Post natal visit          $15.00        $15.00   $ 11.80    $15.00        $14.10       $15.00                  $15.00
Group therapy visit       $17.40        $17.40   $ 13.55    $17.40        $16.75       $17.40                  $17.40
                                        Maximum per person during first benefit entitlement year
                          $750.00       $750.00   $750.00    $750.00       $750.00      $750.00                $750.00


J20 20 Chiropractic

                             NSW           QLD            SA            TAS           VIC            WA            NT
Initial visit                 $52.80        $52.80        $56.35         $52.80       $54.35         $52.80        $52.80
Subsequent visit              $34.40        $34.40        $35.35         $34.40       $35.35         $34.40        $34.40
X-ray service – per           $43.70        $75.00                       $43.70       $46.55         $75.00
Person per year
                                        Maximum per person during first benefit entitlement year
                             $500.00   $500.00   $500.00    $500.00      $500.00      $500.00     $500.00
                                   Maximum per family membership during first benefit entitlement year
                             $800.00   $800.00   $800.00    $800.00      $800.00      $800.00     $800.00


J20 21 Non PBS Pharmaceuticals

After payment by the policy holder of an amount equal to the highest prescribed PBS prescription fee,
a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $75 per script
item.

The Maximum per person during first benefit entitlement year is $750 in all States.


Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the counter
cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at participating pharmacies
provided that the item is:




                                                                                                   372 of 545
(gg) Designed to manage or prevent disease, injuries or a condition; or
(hh) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.



J20 22 Podiatry

                              NSW           QLD            SA             TAS          VIC             WA          NT
Initial visit                  $45.00        $41.80        $48.00          $44.00       $45.00         $44.00      $44.00
Subsequent visit               $35.00        $35.00        $38.00          $33.00       $35.00         $34.00      $36.00
Surgical Nail Resection       $100.00       $100.00       $100.00         $100.00      $100.00        $100.00     $100.00

                                             Maximum per person during first benefit entitlement year
                              $500.00       $500.00  $500.00     $500.00      $500.00      $500.00    $500.00




J20 23 Psychology and Counselling
                              NSW           QLD            SA             TAS           VIC           WA          NT
Initial visit                  $83.00        $83.00        $91.30          $83.00       $83.00        $88.00      $91.30
Subsequent visit               $78.00        $78.00        $85.80          $78.00       $78.00        $78.00      $85.80
Interview with another         $40.00        $40.00        $40.00          $40.00       $40.00        $40.00      $40.00
person or Family
attendance
Group therapy visit            $25.00        $25.00   $44.00      $25.00       $25.00       $25.00     $44.00
                                             Maximum per person during first benefit entitlement year
                              $500.00       $500.00  $500.00     $500.00      $500.00      $500.00    $500.00




J20 24 Alternative Therapies


J20 25 Natural Therapies

All States
Initial visit                   $35.20
Subsequent visit                $26.40
Group attendance                $10.00
The Maximum per person including Massage and Aromatherapy during the first benefit entitlement
year is $500.

For massage and aromatherapy:
                        NSW                 QLD            SA             TAS           VIC           WA          NT
Per Visit                $40.00              $35.00        $36.00          $28.00       $41.00        $35.00      $36.00




                                                                                                     373 of 545
Massage and aromatherapy benefits are limited to $250 per person and $500 per family membership
in any one year.




J20 26 Speech Therapy
                          NSW          QLD       SA         TAS          VIC           WA         NT
Initial visit              $75.00       $75.00   $82.50      $75.00       $75.00       $82.50     $82.50
Subsequent visit           $46.00       $46.00   $50.60      $46.00       $46.00       $49.50     $50.60
Group therapy visit        $20.00       $20.00   $20.00      $22.00       $20.00       $22.00     $20.00
                                        Maximum per person during first benefit entitlement year
                          $500.00      $500.00  $500.00     $500.00      $500.00      $500.00    $500.00




J20 27 Orthotics



J20 28 Dietetics

All States

Initial visit               $55.00
Subsequent visit            $30.00
Group therapy visit         $14.30

The Maximum per person during the first benefit entitlement year is $500.


J20 29 Occupational Therapy
                          NSW          QLD       SA         TAS          VIC           WA         NT
Initial visit              $56.00       $56.00   $61.60      $56.00       $56.00       $56.10     $61.60
Subsequent visit           $37.40       $37.00   $40.70      $37.00       $40.70       $37.40     $37.00
Group therapy visit        $13.20       $13.20   $14.30      $14.30       $14.30       $14.30     $14.30
                                        Maximum per person during first benefit entitlement year
                          $500.00      $500.00  $500.00     $500.00      $500.00      $500.00    $500.00




J20 30 Naturopathy


J20 31 Acupuncture



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J20 32 Other Therapies
Eye Therapy
All States
Initial Visit              $60
Subsequent Visit           $40
Group Therapy Visit        $16

Maximum per person during first benefit entitlement year is $500.


J20 33 Non Surgically Implanted Prostheses and Appliances
Asthma Pumps
Refund of 85% for the cost of supply.
Limited to one appliance per person every 3 years.

Blood Glucose Monitors/INR (International Normalised Ratio) Devices
Refund of 85% for the cost of supply.
Limited to one appliance per person every year.

Continuous or Bilevel Positive Airway Pressure Devices
Refund of 85% for the cost of supply.
Limited to one device per person every 2 years and $1500 per person every 2 years.

Insoles
Refund of 100% for the cost of supply.
Combined limit of $1000 applies. Refer below.

Wigs
Refund of 85% for the cost of supply.
Combined limit of $1000 applies. Refer below.

Surgical Stockings
Refund of 100% for the cost of supply up to $100.
Combined limit of $1000 applies. Refer below.

TENS Machine (Transcutaneous Electronic Nerve Stimulator)
Refund of 85% for the cost of supply.
Combined limit of $1000 applies. Refer below.

Blood Pressure Monitors
Refund of 85% for the cost of supply.
Combined limit of $1000 applies. Refer below.

Hire, Repair and Maintenance of a Health Appliance
85% for the cost and $100 per person every year.


Defined Appliances
Refund of 85% for the cost of supply.
Combined limit of $1000 applies.
Refer to Rule E3.3 (6) for a list of approved defined appliances.



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There is a combined maximum of $1000 per person during any one year insoles, wigs, surgical stockings and
defined appliances.

J20 34 Hearing Aids

Refund of 100% for the cost of supply of hearing aids or the cost of repairs.
This benefit is limited to one hearing aid per ear per person every 3 years and $850 per
person during any one year. Benefit for repairs is limited to $100 per person during any one
year.

J20 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

Living Well Programs

The Fund will provide a cover towards selected Fund approved health related services and health
management programs that are designed to prevent or relieve a specific health condition or conditions.

Benefit

50% of the cost

Annual Limit

$100 per person


J20 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.




J20 37 Accident Cover



J20 38 Accidental Death Funeral Expenses




                                                                                               376 of 545
J20 39 Other Special General Treatment


Local and Interstate Travelling Expenses
All States
Benefit for the cost of travel.
Limited to $200 per combined patient and attendant during any one year.

Overnight Non-Hospital Accommodation
All States
Benefit of up to $75 per night
Limited to $300 per combined patient and attendant during any one year.


J20 40 Hospital-Substitute Treatment
Home Nursing

$40 per day, capped at 10 visits per year up to an annual limit of $400

The modality will include the following coverage:
   • General Care Services: Catheter Care, Continence Care, Medication Administration
      (injections, rectal vaginal suppositories for frail, enemas, dosette education), and wound
      management (post surgery, ulcer, wound drainage).

    •   Stomal Therapy

    •   Palliative Care Services – RN Care, Personal Care Assistance




J21 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J21 1 Table Name or Group of Table Names


Singles Choice Hospital and Extras Cover (YX) and ANZ (#YX):


J21 2 Eligibility



J21 3 General Conditions

61. If a policy holder takes out a general treatment service, the Company will pay benefits:



                                                                                           377 of 545
     (mm)         for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (nn)         for more than one service of general treatment on a given day provided by a
         recognised provider in registered premises in private practice who is recognised by the
         Company in more than one profession.

62. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

63. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.    General treatment benefits are not payable for any of the circumstances outlined in Rule E 4 of
     the General Conditions.


J21 4 Hospital Treatment Payments

Benefits fully cover the cost of shared ward hospital charges raised by public hospitals and private
hospitals with which the Company has an agreement in the following circumstances:

     1) Hospital treatment where resulting from an accident: and


     2) Hospital treatment for the following Medicare Benefits Schedule (MBS) items where
        performed singularly on the patient:



         Appendicitis                 30394, 30571-30574 and ICD Codes K35-K37.
         Knee Surgery                 49500-49509, 49536-49542, 49548-49551, 49557-79566
         Tonsils and Adenoids         41788-41801
         Minor Gynaecological         35500-35527, 35542-35545, 35545-35557, 35572, 35587,
         Surgery                      35608-35615, 35639-35648
         Dental Surgery               Any surgical item as described in the Australian Dental
                                      Associations’ Schedule of Dental Items
For any other circumstances benefits are paid according to the minimum default benefits prescribed
by the Minister.


J21 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J21 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals




                                                                                            378 of 545
The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.




J21 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J21 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.


J21 9 Nursing Home Type Patients

Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J21 10 Co Payments



J21 11 Excesses



J21 12 Benefit Limitation Periods

21. Assisted Reproductive Services:


22. Pregnancy Related Services


23. Sterilisation and Reversal of Sterilisation:




                                                                                         379 of 545
24. Cardiothoracic:


25. Psychiatric:


26. Rehabilitation:


27. Plastic and Cosmetic Surgery:


28. Hip Replacements:


29. Other:



J21 13 Restricted Benefits

30. Assisted Reproductive Services:


31. Pregnancy Related Services:


32. Sterilisation and Reversal of Sterilisation:


33. Cardiothoracic:


34. Psychiatric:


35. Rehabilitation:


36. Plastic and Cosmetic Surgery:


37. Hip Replacements:


38. Other:
Restricted Benefits apply for all services except the following:

    -   Accidentally sustained injuries needing urgent medical attention
    -   Knee operations (arthroscopy or meniscectomy)
    -   Appendicitis



                                                                           380 of 545
    -   Removal of tonsils and adenoids
    -   Dental surgery
    -   Minor gynaecological surgery (not including laparoscopy surgery)


J21 14 Exclusions

    1. Assisted Reproductive Services:


    2. Pregnancy Related Services:


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
       clinically necessary


    6. Hip Replacements:


    7. Other:



J21 15 Loyalty Bonuses

After 12 months continuous membership, a policy holder is entitled to an increased benefit maximum
equal to the first year benefit maximum for the relevant modality plus 20% of the first year benefit
maximum. For each subsequent continuos 12 months membership, the policy holder is entitled to an
increased benefit maximum equal to their previous years benefit maximum for the relevant modality
plus 20% of the first year benefit maximum. No further increased benefit maximums apply beyond
200% of the first year maximum. Loyalty bonuses do not apply to optical.



J21 16 Other Special Hospital Treatment


J21 17 Dental

Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services and
Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-operative
care.




                                                                                           381 of 545
Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every three
years.

Benefits for orthodontia are only payable on this table if the service was required as the result of an
accident.

Maximum per person during first benefit entitlement year

All Dental Combined
NSW, QLD, TAS, VIC, WA           $400
SA, NT                           $500




J21 18 Optical

All States

Frames for prescription lenses               $90.00
Single Vision Lenses                         $45.00
Progressive Lenses                           $95.00
Contact Lenses, disposable
1 month supply                               $32.00
3 months supply                              $50.00
Contact Lenses, non-disposable              $100.00

The Maximum per person during any one year is $150.00.




J21 19 Physiotherapy

                           NSW           QLD           SA           TAS          VIC           WA          NT
Initial visit               $30.00        $28.00       $23.00        $25.00      $25.00        $27.00      $24.00
Subsequent visit            $24.00        $22.00       $16.00        $17.00      $17.00        $23.00      $18.00
Ante natal visit            $13.50        $10.00        $7.00        $12.00      $12.00        $10.00       $8.00
Post natal visit            $13.50        $10.00        $8.00         $9.00       $9.00         $8.00       $8.00
Group therapy visit         $13.50        $10.00        $6.50         $9.00       $9.00         $8.00       $8.00

Combined maximum for physiotherapy under 2.19, chiropractic under 2.20, naturopathy under 2.30
and acupuncture under 2.31 during the first benefit entitlement year is $350 for single memberships
and $500 for family memberships.




                                                                                              382 of 545
J21 20 Chiropractic

                              NSW           QLD            SA             TAS           VIC           WA           NT
Initial visit                  $31.50        $24.00        $24.00          $25.00       $25.00        $28.00       $22.00
Subsequent visit               $21.50        $16.00        $16.50          $17.00       $17.00        $20.00       $17.00
X-ray service – per            $40.00        $23.00                        $23.00       $23.00        $23.00
Person per year

The above chiropractic benefits apply to the first 10 visits per person in any calendar year.
Benefits for visits after the first 10 are paid at 50% of the above.

Combined maximum for physiotherapy under 2.19, chiropractic under 2.20, naturopathy
under 2.30 and acupuncture under 2.31 during the first benefit entitlement year is $350 for
single memberships and $500 for family memberships.


J21 21 Non PBS Pharmaceuticals

Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the counter
cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at participating pharmacies
provided that the item is:


(ii) Designed to manage or prevent disease, injuries or a condition; or
(jj) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.




J21 22 Podiatry



J21 23 Psychology and Counselling



J21 24 Alternative Therapies



J21 25 Natural Therapies



                                                                                                     383 of 545
J21 26 Speech Therapy



J21 27 Orthotics



J21 28 Dietetics



J21 29 Occupational Therapy




J21 30 Naturopathy

 Naturopathy           NSW            QLD            SA           TAS            VIC          WA       NT
 Initial visit          $16.00         $24.00        $21.00        $17.00        $17.00       $21.00   $20.00
 Subsequent visit       $16.00         $18.00        $15.00        $17.00        $17.00       $21.00   $16.50

Combined maximum for physiotherapy under 2.19 chiropractic under 2.20, naturopathy under 2.30
and acupuncture under 2.31 during the first benefit entitlement year is $350 for single memberships
and $500 for family memberships.


J21 31 Acupuncture

                         NSW          QLD          SA               TAS           VIC        WA        NT
 Initial visit            $16.00       $24.00      $21.00           $17.00       $17.00      $16.00    $22.00
 Subsequent visit         $16.00       $18.00      $15.00           $17.00       $17.00      $16.00    $16.00

Combined maximum for physiotherapy under 2.19, chiropractic under 2.20, naturopathy under 2.30
and acupuncture under 2.31 during the first benefit entitlement year is $350 for single memberships
and $500 for family memberships.


J21 32 Other Therapies




                                                                                          384 of 545
J21 33 Non Surgically Implanted Prostheses and Appliances



J21 34 Hearing Aids



J21 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit in any one year.


J21 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.



J21 37 Accident Cover



J21 38 Accidental Death Funeral Expenses



J21 39 Other Special General Treatment




J21 40 Hospital-Substitute Treatment




                                                                                            385 of 545
J22 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J22 1 Table Name or Group of Table Names


Corporate Hospital and Extras Cover
      Without Excess (OK1), With Excess (OK2):


J22 2 Eligibility



J22 3 General Conditions

64. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (oo)         for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (pp)         for more than one service of general treatment on a given day provided by a
         recognised provider in registered premises in private practice who is recognised by the
         Company in more than one profession.

65. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

66. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.    General treatment benefits are not payable for any of the circumstances outlined in Rule E 4 of
     the General Conditions.


J22 4 Hospital Treatment Payments


Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals with
which the Company has an agreement. For private hospitals with which the Company does not have
an agreement benefits are paid according to the schedule of benefits maintained by the Company.
Policy holders may not be fully covered in private hospitals with which the Company does not have
an agreement.


J22 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner




                                                                                             386 of 545
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J22 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals


The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.




J22 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J22 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.


J22 9 Nursing Home Type Patients

Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J22 10 Co Payments



J22 11 Excesses

1) No excess applies for policy holders on Table OK1.

2) An excess of $250 per hospital stay applies for policy holders on Table OK2. This is limited to
   $250 per year for policy holders who contribute to a policy that covers only one person (a single
   cover) and $500 per year for policy holders who contribute to either a single parent or family
   cover.



                                                                                          387 of 545
J22 12 Benefit Limitation Periods
39. Assisted Reproductive Services:


40. Pregnancy Related Services:


41. Sterilisation and Reversal of Sterilisation:


42. Cardiothoracic:


43. Psychiatric:


44. Rehabilitation:


45. Plastic and Cosmetic Surgery:


46. Hip Replacements:


47. Other:


J22 13 Restricted Benefits

    1. Assisted Reproductive Services:


    2. Pregnancy Related Services:


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Psychiatric:


    6. Rehabilitation:




                                                      388 of 545
    7. Plastic and Cosmetic Surgery:


    8. Hip Replacements:


    9. Other:


J22 14 Exclusions
    1. Assisted Reproductive Services:


    2. Pregnancy Related Services:


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
       clinically necessary.


    6. Hip Replacements:


    7. Other:


J22 15 Loyalty Bonuses
After 12 months continuous membership, a policy holder is entitled to an increased benefit maximum
equal to the first year benefit maximum for the relevant modality plus 20% of the first year benefit
maximum. For each subsequent continuos 12 months membership, the policy holder is entitled to an
increased benefit maximum equal to their previous years benefit maximum for the relevant modality
plus 20% of the first year benefit maximum. No further increased benefit maximums apply beyond
200% of the first year maximum. Loyalty bonuses do not apply to optical, massage, hearing aids and
non surgically implanted prostheses and appliances.


J22 16 Other Special Hospital Treatment
3. Special Benefits

      Benefits will be offered to a partner, immediate family member, carer/parent, next of kin who is
      required to stay at the hospital with the patient. The benefit is payable on the admitted person’s
      policy.

      The Benefits payable are:



                                                                                           389 of 545
    Accommodation in hospital for up to $60 per night whilst a boarder in hospital
    Benefit towards meals whilst in hospital for up to $30 per day for any hospital meals provided
    An annual limit of $1000 will apply


J22 17 Dental
The Dental Premier Extras benefits in the State of Victoria apply.

Dental benefits are payable in accordance with the schedule of Victorian dental benefits maintained
by the Company. This schedule uses definitions specified in "Australian Schedule of Dental Services
and Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-
operative care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic services,
periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant prostheses and complete
dentures.


The benefit for complete dentures is limited to one set of complete dentures per person every three
years.


Maximum per person during first benefit entitlement year
All States
                                      $1000
General Dental
Major Dental                          $800
Dentures                              $320 per person per year
Orthodontia                           $800 per person per year
Orthodontia Lifetime Limit            $2700


J22 18 Optical

All States

Frames for prescription lenses                $150.00
Single Vision Lenses                           $57.00
Progressive Lenses                            $125.00
Contact Lenses, disposable
1 month supply                                 $40.00
3 months supply                                $70.00
Contact Lenses, non-disposable                $135.00

The Maximum per person during any one year is $200.00.




J22 19 Physiotherapy
All States
Initial visit                             $32.00
Subsequent visit                          $24.00



                                                                                                  390 of 545
Ante natal visit                           $13.00
Post natal visit                           $13.00
Group Therapy visit                        $13.00

The Maximum per person during the first benefit entitlement year is $600.


J22 20 Chiropractic

All States
Initial visit                           $32.00
Subsequent visit                        $24.00
X-ray service-                          $40.00
Per person per year

The above chiropractic benefits apply to the first 10 visits per person in any calendar year.
Benefits for visits after the first 10 are paid at 50% of the above.

Combined maximum for chiropractic under 3.20, speech therapy under 3.26, occupational therapy
under 3.29 and eye therapy under 3.32 during the first benefit entitlement year is $600 for per person
during any one year.


J22 21 Non PBS Pharmaceuticals

After payment by the policy holder of an amount equal to the highest prescribed PBS prescription fee,
a benefit of 100% of the cost of the balance of the prescription. Benefit is limited to $40 per script
item.

The Maximum per person during the first benefit entitlement year is $300 in all States.


Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the counter
cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at participating pharmacies
provided that the item is:


(kk) Designed to manage or prevent disease, injuries or a condition; or
(ll) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.



J22 22 Podiatry

All States
Initial visit                           $32.00
Subsequent visit                        $26.00
Surgical Nail Resection                 $80.00

The Maximum per person during the first benefit entitlement year is $300.


                                                                                                     391 of 545
J22 23 Psychology and Counselling
All States
Initial visit                           $60.00
Subsequent visit                        $45.00
Interview with another person           $25.00
or Family attendance
Group therapy visit                     $15.00

The Maximum per person during the first benefit entitlement year is $300.


J22 24 Alternative Therapies


J22 25 Natural Therapies
All States
Initial and subsequent visits   $24.00
(excluding Massage)
Group attendance                $8
The Maximum per person including Massage and Aromatherapy during the first benefit entitlement
year is $200.

For massage and aromatherapy, a benefit of $20 per visit is payable in all States.

Massage and aromatherapy benefits are limited to $150 per person and $300 per family membership
in any one year.




J22 26 Speech Therapy
All States
Initial visit                           $60.00
Subsequent visit                        $40.00
Group therapy visit                     $13.00

Combined maximum for chiropractic under 3.20, speech therapy under 3.26, occupational therapy under 3.29
and eye therapy under 3.32 during the first benefit entitlement year is $600 for per person during any one year.



J22 27 Orthotics




                                                                                                    392 of 545
J22 28 Dietetics

All States
Initial visit                       $40.00
Subsequent visit                    $24.00
Group therapy visit                 $13.00

The Maximum per person during the first benefit entitlement year is $400.




J22 29 Occupational Therapy

All States
Initial visit                       $32.00
Subsequent visit                    $22.00
Group therapy visit                 $13.00

Combined maximum for chiropractic under 3.20, speech therapy under 3.26, occupational therapy
under 3.29 and eye therapy under 3.32 during the first benefit entitlement year is $600 for per person
during any one year.


J22 30 Naturopathy


J22 31 Acupuncture



J22 32 Other Therapies


Eye Therapy
All States
Initial visit                       $32.00
Subsequent visit                    $22.00
Group therapy visit                 $16.00

Combined maximum for chiropractic under 3.20, speech therapy under 3.26, occupational therapy
under 3.29 and eye therapy under 3.32 during the first benefit entitlement year is $600 for per person
during any one year.


J22 33 Non Surgically Implanted Prostheses and Appliances
Asthma Pumps
Refund of 80% for the cost of supply.
Limited to one appliance per person every 3 years and $300 per person every 3 years.



                                                                                           393 of 545
Blood Glucose Monitors/INR (International Normalised Ratio) Devices
Refund of 80% for the cost of supply.
Limited to one appliance per person every year and $500 per person every year.

Continuous or Bilevel Positive Airway Pressure Devices
Refund of 80% for the cost of supply.
Limited to one device per person every 2 years and $750 per person every 2 years.

Surgical Stockings
Refund of 80% for the cost of supply.
Limited to $100 per person in any one year.

TENS Machine (Transcutaneous Electronic Nerve Stimulator)
Refund of 80% for the cost of supply.
Limited to one device per person every year and $175 per person every year.

Blood Pressure Monitors
Refund of 80% for the cost of supply.
Limited to one device per person every year and $175 per person every year.

Hire, Repair and Maintenance of a Health Appliance
80% for the cost and $100 per person every year.


Defined Appliances
Refund of 80% for the cost of supply.
Limited to $500 per person in any one year.
Refer to Rule E3.3 (6) for a list of approved defined appliances.


                There is a combined maximum of $1000 per person during any one year for all
                Prostheses and Appliances under 3.33. This maximum also includes any benefits
                paid for hearing aids under 3.34.



J22 34 Hearing Aids

Refund of 80% for the cost of supply or the cost of repairs.
This benefit is limited to one hearing aid per ear per person every 3 years and $850 per
person every 3 years. This limit also forms part of the overall limit for prostheses and
appliances under 3.33.


J22 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

J22 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -



                                                                                            394 of 545
    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.




J22 37 Accident Cover



J22 38 Accidental Death Funeral Expenses



J22 39 Other Special General Treatment
Local and Interstate Travelling Expenses
All States
Benefit for the cost of travel.
Limited to $100 per combined patient and attendant during any one year.

Overnight Non-Hospital Accommodation
All States
Benefit of up to $40 per night
Limited to $150 per combined patient and attendant during any one year.


J22 40 Hospital-Substitute Treatment
Home Nursing

$35 per day, capped at 10 visits per year up to an annual limit of $350.

The modality will include the following coverage:
   • General Care Services: Catheter Care, Continence Care, Medication Administration
      (injections, rectal vaginal suppositories for frail, enemas, dosette education), and wound
      management (post surgery, ulcer, wound drainage).

    •   Stomal Therapy

    •   Palliative Care Services – RN Care, Personal Care Assistance




J23 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J23 1 Table Name or Group of Table Names




                                                                                            395 of 545
Corporate Hospital and Executive Extras Cover                                               Without
Excess (OD1), With Excess (OD2):


J23 2 Eligibility



J23 3 General Conditions

67. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (qq)          for a single service of general treatment provided to a policy holder by a recognised
          practitioner in private practice on a given day; and
     (rr) for more than one service of general treatment on a given day provided by a recognised
          provider in registered premises in private practice who is recognised by the Company in more
          than one profession.

68. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

69. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.    General treatment benefits are not payable for any of the circumstances outlined in Rule E 4 of
     the General Conditions.


J23 4 Hospital Treatment Payments

Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals with
which the Company has an agreement. For private hospitals with which the Company does not have
an agreement benefits are paid according to the schedule of benefits maintained by the Company.
Policy holders may not be fully covered in private hospitals with which the Company does not have
an agreement.


J23 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J23 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.



                                                                                             396 of 545
J23 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J23 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.


J23 9 Nursing Home Type Patients
Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J23 10 Co Payments



J23 11 Excesses

1) No excess applies for policy holders on Table OD1.

2) An excess of $250 per hospital stay applies for policy holders on Table OD2. This is limited to
   $250 per year for policy holders who contribute to a policy that covers only one person (a single
   cover) and $500 per year for policy holders who contribute to either a single parent or family
   cover.




J23 12 Benefit Limitation Periods
48. Assisted Reproductive Services:


49. Pregnancy Related Services:


50. Sterilisation and Reversal of Sterilisation:




                                                                                          397 of 545
51. Cardiothoracic:


52. Psychiatric:


53. Rehabilitation:


54. Plastic and Cosmetic Surgery:


55. Hip Replacements:


56. Other:



J23 13 Restricted Benefits

    1. Assisted Reproductive Services:


    2. Pregnancy Related Services:


    3. Sterilisation and Reversal of Sterilisation: Restricted benefits apply.


    4. Cardiothoracic:


    5. Psychiatric:


    6. Rehabilitation:


    7. Plastic and Cosmetic Surgery:


    8. Hip Replacements:


    9. Other:




                                                                                 398 of 545
J23 14 Exclusions
    1. Assisted Reproductive Services:


    2. Pregnancy Related Services:


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
       clinically necessary.


    6. Hip Replacements:


    7. Other:



J23 15 Loyalty Bonuses


J23 16 Other Special Hospital Treatment


J23 17 Dental
The Dental Premier Extras Provider Agreement benefits in the State of Victoria apply.

Dental benefits are payable in accordance with the schedule of Victorian dental benefits maintained
by the Company. This schedule uses definitions specified in "Australian Schedule of Dental Services
and Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-
operative care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic services,
periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant prostheses and complete
dentures.


The benefit for complete dentures is limited to one set of complete dentures per person every three
years.


Maximum per person during any one year
All States
General Dental                        NIL



                                                                                                  399 of 545
Major Dental                          $800
Inlays/Onlays                         $400
Orthodontia                           $1200
Orthodontia Lifetime Limit            $2400




J23 18 Optical
All States

Frames for prescription lenses                 $192.70
Single Vision Lenses                            $77.20
Progressive Lenses                             $163.20
Contact Lenses, disposable
1 month supply                                  $53.90
3 months supply                                 $96.30
Contact Lenses, non-disposable                 $171.50

The Maximum per person during any one year is $200.00.




J23 19 Physiotherapy

The Physiotherapy Premier Extras Provider Agreement benefits in the State of Victoria
apply.
The Maximum per person during any one year is $500.


J23 20 Chiropractic

The Chiropractic Premier Extras Provider Agreement benefits in the State of Victoria apply.
The Maximum per person is $500 and the maximum per family is $1000 during any one year.


J23 21 Non PBS Pharmaceuticals
After payment by the policy holder of an amount equal to the highest prescribed PBS prescription fee, a benefit
of 85% of the cost of the balance of the prescription.


The Maximum per person during any one year is $350 in all States.


Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the counter
cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at participating pharmacies
provided that the item is:


(mm)    Designed to manage or prevent disease, injuries or a condition; or


                                                                                                   400 of 545
(nn) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.




J23 22 Podiatry


All States
Initial visit                           $32.00
Subsequent visit                        $26.00
Surgical Nail Resection                 $80.00

The Maximum per person during any one year is $500.


J23 23 Psychology and Counselling
All States
Initial visit                           $60.00
Subsequent visit                        $45.00
Interview with another person           $25.00
or Family attendance
Group therapy visit                     $15.00

The Maximum per person is $500 and the maximum per family is $1000 during any one year.




J23 24 Alternative Therapies


J23 25 Natural Therapies
All States
Initial and subsequent visits   $24.00
(excluding Massage)
Group attendance                $8
The Maximum per person including Massage and Aromatherapy during the first benefit entitlement
year is $350.

For massage and aromatherapy, a benefit of $20 per visit is payable in all States.

Massage and aromatherapy benefits are limited to $150 per person and $300 per family membership
in any one year.



                                                                                                     401 of 545
J23 26 Speech Therapy
All States
Initial visit                      $60.00
Subsequent visit                   $40.00
Group therapy visit                $13.00

The Maximum per person during any one year is $500.


J23 27 Orthotics



J23 28 Dietetics


All States
Initial visit                      $40.00
Subsequent visit                   $24.00
Group therapy visit                $13.00

The Maximum per person during the first benefit entitlement year is $500.


J23 29 Occupational Therapy


All States
Initial visit                      $32.00
Subsequent visit                   $22.00
Group therapy visit                $13.00

The Maximum per person during any one year is $500.


J23 30 Naturopathy


J23 31 Acupuncture




                                                                            402 of 545
J23 32 Other Therapies

Eye Therapy
All States
Initial visit                       $32.00
Subsequent visit                    $22.00
Group therapy visit                 $16.00

The Maximum per person during any one year is $500.


J23 33 Non Surgically Implanted Prostheses and Appliances


Asthma Pumps
Refund of 80% for the cost of supply.
Limited to one appliance per person every 3 years and $300 per person every 3 years.

Blood Glucose Monitors/INR (International Normalised Ratio) Devices
Refund of 80% for the cost of supply.
Limited to one appliance per person every year and $500 per person every year.

Continuous or Bilevel Positive Airway Pressure Devices
Refund of 80% for the cost of supply.
Limited to one device per person every 2 years and $750 per person every 2 years.

Surgical Stockings
Refund of 80% for the cost of supply.
Limited to $100 per person in any one year.

TENS Machine (Transcutaneous Electronic Nerve Stimulator)
Refund of 80% for the cost of supply.
Limited to one device per person every year and $175 per person every year.

Blood Pressure Monitors
Refund of 80% for the cost of supply.
Limited to one device per person every year and $175 per person every year.

Hire, Repair and Maintenance of a Health Appliance
80% for the cost and $100 per person every year.

Defined Appliances
Refund of 80% for the cost of supply.
Limited to $500 per person in any one year.
Refer to Rule E3.3 (6) for a list of approved defined appliances.


                There is a combined maximum of $1000 per person during any one year for all
                Prostheses and Appliances under 4.33. This maximum also includes any benefits
                paid for hearing aids under 4.34.



J23 34 Hearing Aids



                                                                                       403 of 545
Refund of 80% for the cost of supply or the cost of repairs.
This benefit is limited to one hearing aid per ear per person every 3 years and $850 per
person every 3 years. This limit also forms part of the overall limit for prostheses and
appliances under 4.33.


J23 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

Living Well Programs

The Fund will provide a cover towards selected Fund approved health related services and health
management programs that are designed to prevent or relieve a specific health condition or conditions.

Benefit

50% of the cost

Annual Limit

$100 per person


J23 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.




J23 37 Accident Cover



J23 38 Accidental Death Funeral Expenses



J23 39 Other Special General Treatment




                                                                                            404 of 545
Local and Interstate Travelling Expenses
All States
Benefit for the cost of travel.
Limited to $100 per combined patient and attendant during any one year.

Overnight Non-Hospital Accommodation
All States
Benefit of up to $40 per night
Limited to $150 per combined patient and attendant during any one year.



J23 40 Hospital-Substitute Treatment
Home Nursing

$35 per day, capped at 10 visits per year up to an annual limit of $350

The modality will include the following coverage:
   • General Care Services: Catheter Care, Continence Care, Medication Administration
      (injections, rectal vaginal suppositories for frail, enemas, dosette education), and wound
      management (post surgery, ulcer, wound drainage).

    •   Stomal Therapy

    •   Palliative Care Services – RN Care, Personal Care Assistance




J24 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J24 1 Table Name or Group of Table Names


Young Singles Saver Cover (3Y) and ANZ (#3YX):


J24 2 Eligibility
This table is only available as a Single (one person) policy.


J24 3 General Conditions

70. If a policy holder takes out a general treatment service, the Company will pay benefits:

    (ss) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
    (tt) for more than one service of general treatment on a given day provided by a recognised
         provider in registered premises in private practice who is recognised by the Company in more
         than one profession.



                                                                                           405 of 545
71. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

72. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.    General treatment benefits are not payable for any of the circumstances outlined in Rule E 4 of
     the General Conditions.




J24 4 Hospital Treatment Payments


Benefits fully cover the cost of shared ward hospital charges raised by public hospitals and private
hospitals with which the Company has an agreement in the following circumstances:

     3) Hospital treatment where resulting from an accident: and


     4) Hospital treatment for the following Medicare Benefits Schedule (MBS) items where
        performed singularly on the patient:



         Appendicitis                 30394, 30571-30574 and ICD Codes K35-K37.
         Knee Surgery                 49500-49509, 49536-49542, 49548-49551, 49557-79566
         Tonsils and Adenoids         41788-41801
         Minor Gynaecological         35500-35527, 35542-35545, 35545-35557, 35572, 35587,
         Surgery                      35608-35615, 35639-35648
         Dental Surgery               Any surgical item as described in the Australian Dental
                                      Associations’ Schedule of Dental Items
For any other circumstances benefits are paid according to the minimum default benefits prescribed
by the Minister.


J24 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J24 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals


The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received




                                                                                            406 of 545
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.


J24 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J24 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.


J24 9 Nursing Home Type Patients

Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J24 10 Co Payments


A co-payment of $50 is payable by the policy holder for each day in hospital and is deducted from the
benefits that would otherwise be payable. This is limited to $250 per hospital stay.


J24 11 Excesses



J24 12 Benefit Limitation Periods

57. Assisted Reproductive Services:


58. Pregnancy Related Services


59. Sterilisation and Reversal of Sterilisation:




                                                                                         407 of 545
60. Cardiothoracic:


61. Psychiatric:


62. Rehabilitation:


63. Plastic and Cosmetic Surgery:


64. Hip Replacements:


65. Other:


J24 13 Restricted Benefits

66. Assisted Reproductive Services:


67. Pregnancy Related Services:


68. Sterilisation and Reversal of Sterilisation:


69. Cardiothoracic:


70. Psychiatric:


71. Rehabilitation:


72. Plastic and Cosmetic Surgery:


73. Hip Replacements:


74. Other:

Restricted Benefits apply for all services except the following:

    -   Accidentally sustained injuries needing urgent medical attention
    -   Knee operations (arthroscopy or meniscectomy)



                                                                           408 of 545
    -   Appendicitis
    -   Removal of tonsils and adenoids
    -   Dental surgery
    -   Minor gynaecological surgery (not including laparoscopy surgery)


J24 14 Exclusions
    1. Assisted Reproductive Services:


    2. Pregnancy Related Services:


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
       clinically necessary.


    6. Hip Replacements:


    7. Other:



J24 15 Loyalty Bonuses
After 12 months continuous membership, a policy holder is entitled to an increased benefit maximum
equal to the first year benefit maximum for the relevant modality plus 20% of the first year benefit
maximum. For each subsequent continuos 12 months membership, the policy holder is entitled to an
increased benefit maximum equal to their previous years benefit maximum for the relevant modality
plus 20% of the first year benefit maximum. No further increased benefit maximums apply beyond
200% of the first year maximum. Loyalty bonuses do not apply to optical.


J24 16 Other Special Hospital Treatment


J24 17 Dental

Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services and
Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-operative
care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures.


                                                                                           409 of 545
The benefit for complete dentures is limited to one set of complete dentures per person every three
years.

Benefits for orthodontia are only payable on this table if the service was required as the result of an
accident.

Maximum per person during first benefit entitlement year

All Dental Combined
All States                       $500


J24 18 Optical
All States

Frames for prescription lenses               $90.00
Single Vision Lenses                         $45.00
Progressive Lenses                           $95.00
Contact Lenses, disposable
1 month supply                               $32.00
3 months supply                              $50.00
Contact Lenses, non-disposable              $100.00

The Maximum per person during any one year is $150.00.




J24 19 Physiotherapy

                           NSW           QLD           SA           TAS          VIC           WA          NT
Initial visit               $30.00        $28.00       $23.00        $25.00      $25.00        $25.00      $24.00
Subsequent visit            $24.00        $22.00       $16.00        $17.00      $17.00        $21.50      $18.00
Ante natal visit            $13.50        $10.00        $7.00        $12.00      $12.00        $10.00       $8.00
Post natal visit            $13.50        $10.00        $8.00         $9.00       $9.00         $8.00       $8.00
Group therapy visit         $13.50        $10.00        $6.50         $9.00       $9.00         $8.00       $8.00

Combined maximum for physiotherapy under 5.19, chiropractic under 5.20, naturopathy under 5.30
and acupuncture under 5.31 during the first benefit entitlement year is $350.




J24 20 Chiropractic

                           NSW           QLD           SA           TAS          VIC           WA          NT
Initial visit               $31.50        $24.00       $24.00        $25.00      $25.00        $30.00      $22.00
Subsequent visit            $21.50        $16.00       $16.50        $17.00      $17.00        $20.00      $17.00



                                                                                              410 of 545
X-ray service – per            $40.00        $23.00                       $23.00       $23.00        $23.00
Person per year

The above chiropractic benefits apply to the first 10 visits per person in any calendar year.
Benefits for visits after the first 10 are paid at 50% of the above.

Combined maximum for physiotherapy under 5.19, chiropractic under 5.20, naturopathy under 5.30
and acupuncture under 5.31 during the first benefit entitlement year is $350.


J24 21 Non PBS Pharmaceuticals

Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the counter
cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at participating pharmacies
provided that the item is:


(oo) Designed to manage or prevent disease, injuries or a condition; or
(pp) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in
Schedule K


J24 22 Podiatry



J24 23 Psychology and Counselling



J24 24 Alternative Therapies



J24 25 Natural Therapies



J24 26 Speech Therapy



J24 27 Orthotics




                                                                                                   411 of 545
J24 28 Dietetics



J24 29 Occupational Therapy




J24 30 Naturopathy

 Naturopathy            NSW            QLD             SA            TAS             VIC             WA       NT
 Initial visit           $16.00         $24.00         $21.00         $17.00         $17.00          $25.00   $20.00
 Subsequent visit        $16.00         $18.00         $15.00         $17.00         $17.00          $25.00   $16.50

Combined maximum for physiotherapy under 5.19 chiropractic under 5.20, naturopathy under 5.30 and
acupuncture under 5.31 during the first benefit entitlement year is $350.



J24 31 Acupuncture

 Acupuncture              NSW          QLD            SA               TAS            VIC        WA           NT
 Initial visit             $22.00       $22.00        $22.00           $22.00        $22.00      $25.00       $22.00
 Subsequent visit          $16.00       $16.00        $16.00           $16.00        $16.00      $25.00       $16.00

Combined maximum for physiotherapy under 5.19, chiropractic under 5.20, naturopathy under 5.30 and
acupuncture under 5.31 during the first benefit entitlement year is $350.



J24 32 Other Therapies



J24 33 Non Surgically Implanted Prostheses and Appliances



J24 34 Hearing Aids




                                                                                              412 of 545
J24 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit in any one year.

J24 36 Ambulance Transportation

A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J24 37 Accident Cover



J24 38 Accidental Death Funeral Expenses



J24 39 Other Special General Treatment


Travel Vaccines

All States      100% of cost for the vaccines.

The maximum during the first benefit entitlement year is $50 per person.

Top Up Bonus

Each policy holder is eligible for a top up bonus of $50 during the first benefit entitlement year that
may be used to cover out of pocket expenses for general treatment services that are eligible for
benefits. Unused bonuses do not accumulate from year to year.




J24 40 Hospital-Substitute Treatment




                                                                                              413 of 545
J25 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J25 1 Table Name or Group of Table Names


Young Singles Choice and Young Couples Choice (93) and ANZ (#93):


J25 2 Eligibility

This table is only available as a Single (one person) policy or a Couples (two adults) policy.


J25 3 General Conditions

73. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (uu)         for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (vv)         for more than one service of general treatment on a given day provided by a
         recognised provider in registered premises in private practice who is recognised by the
         Company in more than one profession.

74. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

75. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.    General treatment benefits are not payable for any of the circumstances outlined in Rule E 4 of
     the General Conditions.




J25 4 Hospital Treatment Payments

Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals (with
the exception of co-payments described in J6.10, restrictions described in J6.13 and exclusions
described J6.14) with which the Company has an agreement. For private hospitals with which the
Company does not have an agreement benefits are paid according to the schedule of benefits
maintained by the Company. Policy holders may not be fully covered in private hospitals with which
the Company does not have an agreement.




                                                                                             414 of 545
J25 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J25 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.




J25 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J25 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.


J25 9 Nursing Home Type Patients
Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J25 10 Co Payments


A co-payment of $50 is payable by the policy holder for each day in hospital and is deducted from the
benefits that would otherwise be payable. This is limited to $250 per hospital stay.




                                                                                         415 of 545
J25 11 Excesses



J25 12 Benefit Limitation Periods

    1. Assisted Reproductive Services:


    2. Pregnancy Related Services


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Psychiatric:


    6. Rehabilitation:


    7. Plastic and Cosmetic Surgery:


    8. Hip Replacements:


    9. Other:


J25 13 Restricted Benefits

75. Assisted Reproductive Services:


76. Pregnancy Related Services:


77. Sterilisation and Reversal of Sterilisation:


78. Cardiothoracic:




                                                      416 of 545
79. Psychiatric: Restricted benefits apply


80. Rehabilitation: Restricted benefits apply


81. Plastic and Cosmetic Surgery:


82. Hip Replacements:


83. Other:




J25 14 Exclusions

    1. Assisted Reproductive Services: No benefits payable


    2. Pregnancy Related Services: No benefits payable


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic: No benefits payable


    5. Plastic and Cosmetic Surgery: No benefits payable for Cosmetic Surgery unless deemed
       clinically necessary


    6. Hip Replacements: No benefits payable

    7. Other: Knee Replacements, Cataract Surgery: No benefits payable



J25 15 Loyalty Bonuses
After 12 months continuous membership, a policy holder is entitled to an increased benefit maximum
equal to the first year benefit maximum for the relevant modality plus 20% of the first year benefit
maximum. For each subsequent continuos 12 months membership, the policy holder is entitled to an
increased benefit maximum equal to their previous years benefit maximum for the relevant modality
plus 20% of the first year benefit maximum. No further increased benefit maximums apply beyond
200% of the first year maximum. Loyalty bonuses do not apply to optical.




                                                                                         417 of 545
J25 16 Other Special Hospital Treatment


J25 17 Dental

Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services and
Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-operative
care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every three
years.

Benefits for orthodontia are only payable on this table if the service was required as the result of an
accident.

Maximum per person during first benefit entitlement year

All Dental Combined
All States                       $500




J25 18 Optical
All States

Frames for prescription lenses               $90.00
Single Vision Lenses                         $45.00
Progressive Lenses                           $95.00
Contact Lenses, disposable
1 month supply                               $32.00
3 months supply                              $50.00
Contact Lenses, non-disposable              $100.00

The Maximum per person during any one year is $150.00.




J25 19 Physiotherapy

                           NSW           QLD           SA           TAS          VIC           WA          NT
Initial visit               $30.00        $28.00       $23.00        $25.00      $25.00        $25.00      $24.00
Subsequent visit            $24.00        $22.00       $16.00        $17.00      $17.00        $21.50      $18.00
Group therapy visit         $13.50        $10.00        $6.50         $9.00       $9.00         $8.00       $8.00

Combined maximum for physiotherapy under 6.19 and chiropractic under 6.20 during the first benefit
entitlement year is $350 per person.




                                                                                              418 of 545
J25 20 Chiropractic
J6 20 Chiropractic:
                             NSW            QLD            SA             TAS         VIC            WA            NT
Initial visit                 $31.50         $24.00        $24.00          $25.00     $25.00         $24.00        $22.00
Subsequent visit              $21.50         $16.00        $16.50          $17.00     $17.00         $18.00        $17.00
X-ray service – per           $40.00         $23.00                        $23.00     $23.00         $23.00
Person per year

The above chiropractic benefits apply to the first 10 visits per person in any calendar year.
Benefits for visits after the first 10 are paid at 50% of the above.

Combined maximum for physiotherapy under 6.19 and chiropractic under 6.20 during the first benefit
entitlement year is $350.



J25 21 Non PBS Pharmaceuticals

Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the counter
cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at participating pharmacies
provided that the item is:


(qq) Designed to manage or prevent disease, injuries or a condition; or
(rr) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K




J25 22 Podiatry



J25 23 Psychology and Counselling



J25 24 Alternative Therapies



J25 25 Natural Therapies


All States
Initial visit                                $17.00
Subsequent visit                             $17.00



                                                                                                   419 of 545
Group attendance                   $6.00
The Maximum per person including Massage and Aromatherapy during the first benefit entitlement
year is $350.

For massage and aromatherapy, a benefit of $12 per visit is payable in all States.

Massage and aromatherapy benefits are limited to $100 per person in any one year.




J25 26 Speech Therapy



J25 27 Orthotics



J25 28 Dietetics



J25 29 Occupational Therapy




J25 30 Naturopathy



J25 31 Acupuncture



J25 32 Other Therapies



                                                                                     420 of 545
J25 33 Non Surgically Implanted Prostheses and Appliances



J25 34 Hearing Aids



J25 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

J25 36 Ambulance Transportation

A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J25 37 Accident Cover



J25 38 Accidental Death Funeral Expenses



J25 39 Other Special General Treatment
Travel Vaccines

All States      100% of cost for the vaccines.

The maximum per policy holder during the first benefit entitlement year is $50.

Top Up Bonus

Each policy is eligible for a top up bonus of $75 for policy holders who contribute to a policy that
covers only one person (a single cover) and $150 for policy holders who contribute to a couples cover
during the first benefit entitlement year that may be used to cover out of pocket expenses for general
treatment services that are eligible for benefits. Unused bonuses do not accumulate from year to year.
The maximum per policy holder during the first benefit entitlement year is $75.




                                                                                            421 of 545
J25 40 Hospital-Substitute Treatment



J26 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J26 1 Table Name or Group of Table Names


Active Sports Cover (SP) and ANZ (#SP)


J26 2 Eligibility
This table is only available as a Single (one person) policy.


J26 3 General Conditions

76. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (ww)         for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (xx)         for more than one service of general treatment on a given day provided by a
         recognised provider in registered premises in private practice who is recognised by the
         Company in more than one profession.

77. General treatment services must be rendered by or on behalf of a recognised practitioner for
    benefits to be payable.

78. General treatment services must be rendered on premises registered with the Company for
    benefits to be payable.

4.    General treatment benefits are not payable for any of the circumstances outlined in Rule E 4 of
     the General Conditions.




J26 4 Hospital Treatment Payments
Benefits fully cover the cost of shared ward hospital charges raised by public hospitals and private
hospitals with which the Company has an agreement in the following circumstances:

     5) Hospital treatment where resulting from an accident: and




                                                                                            422 of 545
    6) Hospital treatment for the following Medicare Benefits Schedule (MBS) items where
       performed singularly on the patient:



        Appendicitis                30394, 30571-30574 and ICD Codes K35-K37.
        Knee Surgery                49500-49509, 49536-49542, 49548-49551, 49557-79566
        Tonsils and Adenoids        41788-41801
        Minor Gynaecological        35500-35527, 35542-35545, 35545-35557, 35572, 35587,
        Surgery                     35608-35615, 35639-35648
        Dental Surgery              Any surgical item as described in the Australian Dental
                                    Associations’ Schedule of Dental Items
For any other circumstances benefits are paid according to the minimum default benefits prescribed
by the Minister from time to time.




J26 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.




J26 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals

The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.


J26 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.




                                                                                         423 of 545
J26 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.


J26 9 Nursing Home Type Patients
Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J26 10 Co Payments


A co-payment of $100 is payable by the policy holder for each day in hospital and is deducted from
the benefits that would otherwise be payable. This is limited to $500 per hospital stay.




J26 11 Excesses




J26 12 Benefit Limitation Periods

84. Assisted Reproductive Services:


85. Pregnancy Related Services


86. Sterilisation and Reversal of Sterilisation:


87. Cardiothoracic:


88. Psychiatric:


89. Rehabilitation:


90. Plastic and Cosmetic Surgery:




                                                                                         424 of 545
91. Hip Replacements:


92. Other:



J26 13 Restricted Benefits

93. Assisted Reproductive Services:


94. Pregnancy Related Services:


95. Sterilisation and Reversal of Sterilisation:


96. Cardiothoracic:


97. Psychiatric:


98. Rehabilitation:


99. Plastic and Cosmetic Surgery:


100.    Hip Replacements:


101.    Other:

Restricted Benefits apply for all services except the following:

    -   Accidentally sustained injuries needing urgent medical attention
    -   Knee operations (arthroscopy or meniscectomy)
    -   Appendicitis
    -   Removal of tonsils and adenoids
    -   Dental surgery
    -   Minor gynaecological surgery (not including laparoscopy surgery)



J26 14 Exclusions

    1. Assisted Reproductive Services:




                                                                           425 of 545
    2. Pregnancy Related Services:


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
       clinically necessary.


    6. Hip Replacements:


    7. Other:



J26 15 Loyalty Bonuses



J26 16 Other Special Hospital Treatment


J26 17 Dental

Dental benefits are payable in accordance with the Schedule of Dental Benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services and
Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-operative
care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures

Benefits for major dental and orthodontia are only payable on this table if the service was required as
the result of an accident.

A benefit of up to $50 per person is payable for the cost of a mouthguard. This benefit is separate
from the combined dental maximums below.

All States Limited to $300 per person in any one year.

There is a combined maximum of $1000 per person during any one year for General Dental under
7.17, Physiotherapy under 7.19, Chiropractic under 7.20, Podiatry under 7.22, Natural Therapies
under 7.25, Dietetics under 7.28, Naturopathy under 7.30, Acupuncture under 7.31 and Mouthguards
under 7.39.




                                                                                            426 of 545
J26 18 Optical


J26 19 Physiotherapy

                           NSW           QLD           SA          TAS           VIC             WA          NT
Initial visit               $30.00        $28.00       $23.00       $25.00       $25.00          $25.00      $24.00
Subsequent visit            $24.00        $22.00       $16.00       $17.00       $17.00          $21.50      $18.00
Ante natal visit            $13.50        $10.00        $7.00       $12.00       $12.00          $10.00       $8.00
Post natal visit            $13.50        $10.00        $8.00        $9.00        $9.00           $8.00       $8.00
Group therapy visit         $13.50        $10.00        $6.50        $9.00        $9.00           $8.00       $8.00

All States - Limited to $300 per person in any one year.

There is a combined maximum of $1000 per person during any one year for General Dental under
7.17, Physiotherapy under 7.19, Chiropractic under 7.20, Podiatry under 7.22, Natural Therapies
under 7.25, Dietetics under 7.28, Naturopathy under 7.30, Acupuncture under 7.31 and Mouthguards
under 7.39.




J26 20 Chiropractic

                           NSW           QLD           SA          TAS           VIC             WA          NT
Initial visit               $31.50        $27.00       $24.00       $25.00       $25.00          $30.00      $22.00
Subsequent visit            $21.50        $19.00       $16.50       $17.00       $17.00          $20.00      $17.00
X-ray service – per         $40.00        $75.00                    $25.00       $25.00          $50.00
Person per year

The above chiropractic benefits apply to the first 10 visits per person in any calendar year.
Benefits for visits after the first 10 are paid at 50% of the above.

All States Limited to $300 per person in any one year.

There is a combined maximum of $1000 per person during any one year for General Dental under
7.17, Physiotherapy under 7.19, Chiropractic under 7.20, Podiatry under 7.22, Natural Therapies
under 7.25, Dietetics under 7.28, Naturopathy under 7.30, Acupuncture under 7.31 and Mouthguards
under 7.39.




                                                                                                427 of 545
J26 21 Non PBS Pharmaceuticals

Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the counter
cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at participating pharmacies
provided that the item is:


(ss) Designed to manage or prevent disease, injuries or a condition; or
(tt) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K




J26 22 Podiatry
                             NSW            QLD            SA             TAS         VIC              WA          NT
Initial visit                 $22.00         $27.00        $23.00          $21.00     $23.00           $24.00      $23.00
Subsequent visit              $22.00         $19.00        $17.00          $17.00     $17.00           $20.00      $17.00
Surgical Nail Resection       $60.00         $60.00        $80.00          $60.00     $60.00           $60.00      $80.00

All States - Limited to $300 per person in any one year.

There is a combined maximum of $1000 per person during any one year for General Dental under
7.17, Physiotherapy under 7.19, Chiropractic under 7.20, Podiatry under 7.22, Natural Therapies
under 7.25, Dietetics under 7.28, Naturopathy under 7.30, Acupuncture under 7.31 and Mouthguards
under 7.39.




J26 23 Psychology and Counselling




J26 24 Alternative Therapies




J26 25 Natural Therapies
All States
Initial visit                                              $17.00
Subsequent visit                                           $17.00
Massage and aromatherapy - WA                              $15.00
Massage and aromatherapy – NSW, QLD, SA,                   $12.00
TAS, VIC, NT



                                                                                                   428 of 545
Group attendance                                    $6.00

There is a combined maximum of $1000 per person during any one year for General Dental under
7.17, Physiotherapy under 7.19, Chiropractic under 7.20, Podiatry under 7.22, Natural Therapies
under 7.25, Dietetics under 7.28, Naturopathy under 7.30, Acupuncture under 7.31 and Mouthguards
under 7.39.




J26 26 Speech Therapy




J26 27 Orthotics




J26 28 Dietetics
                          NSW          QLD          SA          TAS          VIC          WA          NT
Initial visit              $23.00       $32.00      $33.00       $21.00      $21.00       $35.00      $33.00
Subsequent visit           $18.00       $18.00      $17.00       $13.00      $13.00       $16.00      $17.00
Group therapy visit        $ 6.00       $10.00      $ 8.00       $ 9.00      $ 9.00       $ 8.00      $ 8.00

All States Limited to $300 per person in any one year.

There is a combined maximum of $1000 per person during any one year for General Dental under
7.17, Physiotherapy under 7.19, Chiropractic under 7.20, Podiatry under 7.22, Natural Therapies
under 7.25, Dietetics under 7.28, Naturopathy under 7.30, Acupuncture under 7.31 and Mouthguards
under 7.39.




J26 29 Occupational Therapy




J26 30 Naturopathy
                      NSW            QLD            SA            TAS           VIC          WA         NT
 Initial visit         $16.00         $24.00        $21.00         $17.00       $17.00       $25.00     $20.00
 Subsequent visit      $16.00         $18.00        $15.00         $17.00       $17.00       $25.00     $16.50

All States - Combined with Natural Therapies sub-limit of $300 per person in any one year. Refer
Rule J7.25.

There is a combined maximum of $1000 per person during any one year for General Dental under
7.17, Physiotherapy under 7.19, Chiropractic under 7.20, Podiatry under 7.22, Natural Therapies



                                                                                         429 of 545
under 7.25, Dietetics under 7.28, Naturopathy under 7.30, Acupuncture under 7.31 and Mouthguards
under 7.39.




J26 31 Acupuncture

                         NSW           QLD           SA               TAS            VIC       WA         NT
 Initial visit            $16.00        $24.00       $21.00           $17.00        $17.00     $25.00     $22.00
 Subsequent visit         $16.00        $18.00       $15.00           $17.00        $17.00     $25.00     $16.00

All States Combined with Natural Therapies sub-limit of $300 per person in any one year. Refer
Rule J7.25.

There is a combined maximum of $1000 per person during any one year for General Dental under
7.17, Physiotherapy under 7.19, Chiropractic under 7.20, Podiatry under 7.22, Natural Therapies
under 7.25, Dietetics under 7.28, Naturopathy under 7.30, Acupuncture under 7.31 and Mouthguards
under 7.39.




J26 32 Other Therapies




J26 33 Non Surgically Implanted Prostheses and Appliances




J26 34 Hearing Aids




J26 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit in any one year.

J26 36 Ambulance Transportation

A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,


                                                                                             430 of 545
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J26 37 Accident Cover




J26 38 Accidental Death Funeral Expenses




J26 39 Other Special General Treatment
Mouthguards

All States - Up to $50 per mouthguard limited to 10 mouthguards per year. A limit of $300 per person
in any one year applies.

There is a combined maximum of $1000 per person during any one year for General Dental under 7.17,
Physiotherapy under 7.19, Chiropractic under 7.20, Podiatry under 7.22, Natural Therapies under 7.25, Dietetics
under 7.28, Naturopathy under 7.30, Acupuncture under 7.31 and Mouthguards under 7.39



J26 40 Hospital-Substitute Treatment



J27 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J27 1 Table Name or Group of Table Names


Under 50’s (T) and Over 50’s (P) and ANZ (#T) Top Hospital Cover


J27 2 Eligibility



J27 3 General Conditions


J27 4 Hospital Treatment Payments
Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals with
which the Company has an agreement. For private hospitals with which the Company does not have


                                                                                                  431 of 545
an agreement, benefits are paid according to the schedule of benefits maintained by the Company.
Policy holders may not be fully covered in private hospitals with which the Company does not have
an agreement.


J27 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J27 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals

The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.




J27 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J27 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.


J27 9 Nursing Home Type Patients

Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J27 10 Co Payments



                                                                                         432 of 545
J27 11 Excesses



J27 12 Benefit Limitation Periods


  1. Assisted Reproductive Services:


  2. Pregnancy Related Services


  3. Sterilisation and Reversal of Sterilisation:


  4. Cardiothoracic:


  5. Psychiatric:


  6. Rehabilitation:


  7. Plastic and Cosmetic Surgery:


  8. Hip Replacements:


  9. Other:


J27 13 Restricted Benefits

  1. Assisted Reproductive Services:


  2. Pregnancy Related Services:


  3. Sterilisation and Reversal of Sterilisation:


  4. Cardiothoracic:




                                                    433 of 545
    5. Psychiatric:


    6. Rehabilitation:


    7. Plastic and Cosmetic Surgery:


    8. Hip Replacements:


    9. Other:




J27 14 Exclusions
    1. Assisted Reproductive Services:


    2. Pregnancy Related Services:


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
       clinically necessary.


    6. Hip Replacements:


    7. Other:



J27 15 Loyalty Bonuses
The Company will pay a refund of 50% of the cost of a subscription to the Arthritis Foundation,
Asthma Foundation, Diabetes Australia, and Parkinson’s in Western Australia. This benefit is limited
to one subscription per year.
South Australian policy holders on tables T and P will receive full cover for the Arthritis Foundation’s
Moving Towards Wellness Program.
Victorian policy holders on tables T and P will receive full cover for Disease Management Programs
that are approved by the Company.



                                                                                            434 of 545
J27 16 Other Special Hospital Treatment
4. Special Benefits

      Benefits will be offered to a partner, immediate family member, carer/parent, next of kin who is
      required to stay at the hospital with the patient. The benefit is payable on the admitted person’s
      policy.

      The Benefits payable are:

    Accommodation in hospital for up to $60 per night whilst a boarder in hospital
    Benefit towards meals whilst in hospital for up to $30 per day for any hospital meals provided
    An annual limit of $1000 will apply


J27 17 Dental


J27 18 Optical


J27 19 Physiotherapy


J27 20 Chiropractic


J27 21 Non PBS Pharmaceuticals


J27 22 Podiatry



J27 23 Psychology and Counselling



J27 24 Alternative Therapies



J27 25 Natural Therapies



J27 26 Speech Therapy



                                                                                           435 of 545
J27 27 Orthotics



J27 28 Dietetics



J27 29 Occupational Therapy


J27 30 Naturopathy


J27 31 Acupuncture


J27 32 Other Therapies



J27 33 Non Surgically Implanted Prostheses and Appliances



J27 34 Hearing Aids



J27 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

J27 36 Ambulance Transportation

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.




                                                                                            436 of 545
J27 37 Accident Cover



J27 38 Accidental Death Funeral Expenses



J27 39 Other Special General Treatment




J27 40 Hospital-Substitute Treatment



J28 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J28 1 Table Name or Group of Table Names


Under 50’s (B) and Over 50’s (N) and ANZ (#B) Hospital Cover with Excess Bonus


J28 2 Eligibility
Product closed to new members from 30th November 2010.




J28 3 General Conditions


J28 4 Hospital Treatment Payments
Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals (with
the exception of excesses described in J9.11) with which the Company has an agreement. For private
hospitals with which the Company does not have an agreement benefits are paid according to the
schedule of benefits maintained by the Company. Policy holders may not be fully covered in private
hospitals with which the Company does not have an agreement.


J28 5 Medical Services Payments while admitted



                                                                                             437 of 545
A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J28 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals

The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.




J28 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J28 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.


J28 9 Nursing Home Type Patients

Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J28 10 Co Payments



J28 11 Excesses
An excess of $300 per hospital stay applies.
This is limited to $500 per year for policy holders who contribute to a policy that covers only one
person (a single cover) and $1000 per year for policy holders who contribute to either a single parent
or family cover.



                                                                                           438 of 545
                The Company will allow one excess free same day or overnight hospital
                admission per calendar year for policy holders who contribute to either a
                single or single parent cover and two excess free same day or overnight
                hospital admissions per calendar year for policy holders who contribute to a
                family cover.

The above excesses will not apply for the first three years for any dependent child who was born on or
after 1 April 2006 and who is covered under a single parent or family table as outlined in Rule J9.1.
This is providing that the policy holder has had continuous cover under any one of the Company’s
tables as outlined in Schedule K for at least 6 months prior to the birth of the child.




J28 12 Benefit Limitation Periods


    1. Assisted Reproductive Services:


    2. Pregnancy Related Services


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Psychiatric:


    6. Rehabilitation:


    7. Plastic and Cosmetic Surgery:


    8. Hip Replacements:


    9. Other:


J28 13 Restricted Benefits

    1. Assisted Reproductive Services:




                                                                                          439 of 545
  2. Pregnancy Related Services:


  3. Sterilisation and Reversal of Sterilisation: restricted benefits apply.


  4. Cardiothoracic:


  5. Psychiatric:


  6. Rehabilitation:


  7. Plastic and Cosmetic Surgery:


  8. Hip Replacements:


  9. Other:




J28 14 Exclusions
  1. Assisted Reproductive Services:


  2. Pregnancy Related Services:


  3. Sterilisation and Reversal of Sterilisation:


  4. Cardiothoracic:


  5. Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
     clinically necessary.


  6. Hip Replacements:


  7. Other:




                                                                                    440 of 545
J28 15 Loyalty Bonuses
The Company will pay a refund of 50% of the cost of a subscription to the Arthritis Foundation,
Asthma Foundation, Diabetes Australia and Parkinson’s in Western Australia. This benefit is limited
to one subscription per year.
South Australian policy holders on tables B and N will receive full cover for the Arthritis
Foundation’s Moving Towards Wellness Program.
Victorian policy holders on tables B and N will receive full cover for Disease Management Programs
that are approved by the Company.


J28 16 Other Special Hospital Treatment


J28 17 Dental


J28 18 Optical


J28 19 Physiotherapy


J28 20 Chiropractic


J28 21 Non PBS Pharmaceuticals


J28 22 Podiatry



J28 23 Psychology and Counselling



J28 24 Alternative Therapies



J28 25 Natural Therapies



J28 26 Speech Therapy



                                                                                              441 of 545
J28 27 Orthotics



J28 28 Dietetics



J28 29 Occupational Therapy


J28 30 Naturopathy


J28 31 Acupuncture


J28 32 Other Therapies



J28 33 Non Surgically Implanted Prostheses and Appliances



J28 34 Hearing Aids



J28 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

J28 36 Ambulance Transportation

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.




                                                                                            442 of 545
J28 37 Accident Cover



J28 38 Accidental Death Funeral Expenses



J28 39 Other Special General Treatment



J28 40 Hospital-Substitute Treatment



J29 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J29 1 Table Name or Group of Table Names

Under 50’s (G) and Over 50’s (J) and ANZ (#G) Hospital Cover with Excess; and
Hospital Cover with Excess Level 5 (D5) and ANZ (#D5)


J29 2 Eligibility
Product closed to new members from 30th November 2010.




J29 3 General Conditions


J29 4 Hospital Treatment Payments
Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals (with
the exception of excesses described in J10.11) with which the Company has an agreement. For private
hospitals with which the Company does not have an agreement benefits are paid according to the
schedule of benefits maintained by the Company. Policy holders may not be fully covered in private
hospitals with which the Company does not have an agreement.


J29 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner



                                                                                            443 of 545
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J29 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals

The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.




J29 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J29 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.


J29 9 Nursing Home Type Patients

Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J29 10 Co Payments



J29 11 Excesses
    1. An excess of $400 per hospital stay applies for policy holders on Tables G, J and #G. This is
       limited to $500 per year for policy holders who contribute to a policy that covers only one
       person (a single cover) and $1000 per year for policy holders who contribute to either a single
       parent or family cover.

    2. An excess of $500 per hospital stay applies for policy holders on Tables D5 and #D5. This is
       limited to $500 per year for policy holders who contribute to a policy that covers only one
       person (a single cover) and $1000 per year for policy holders who contribute to either a single
       parent or family cover.


                                                                                          444 of 545
       The above excesses will not apply for the first three years for any dependent child who was
       born on or after 1 April 2006 and who is covered under a single parent or family table as
       outlined in Rule J10.1. This is providing that the policy holder has had continuous cover
       under any one of the Company’s tables as outlined in Schedule K for at least 6 months prior
       to the birth of the child.




J29 12 Benefit Limitation Periods

102.   Assisted Reproductive Services:


103.   Pregnancy Related Services


104.   Sterilisation and Reversal of Sterilisation:


105.   Cardiothoracic:


106.   Psychiatric:


107.   Rehabilitation:


108.   Plastic and Cosmetic Surgery:


109.   Hip Replacements:


110.   Other:


J29 13 Restricted Benefits

111.   Assisted Reproductive Services:


112.   Pregnancy Related Services:


113.   Sterilisation and Reversal of Sterilisation:




                                                                                        445 of 545
114.    Cardiothoracic:


115.    Psychiatric:


116.    Rehabilitation:


117.    Plastic and Cosmetic Surgery:


118.    Hip Replacements:


119.    Other:




J29 14 Exclusions
120.    Assisted Reproductive Services:


121.    Pregnancy Related Services:


122.    Sterilisation and Reversal of Sterilisation:


123.    Cardiothoracic:


124.    Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
   clinically necessary.


125.    Hip Replacements:


126.    Other:



J29 15 Loyalty Bonuses
South Australian policy holders on tables G, J and D5 will receive full cover for the Arthritis
Foundation’s Moving Towards Wellness Program.
Victorian policy holders on tables G, J and D5 will receive full cover for Disease Management
Programs that are approved by the Company.




                                                                                            446 of 545
J29 16 Other Special Hospital Treatment


J29 17 Dental


J29 18 Optical


J29 19 Physiotherapy


J29 20 Chiropractic


J29 21 Non PBS Pharmaceuticals


J29 22 Podiatry



J29 23 Psychology and Counselling



J29 24 Alternative Therapies



J29 25 Natural Therapies



J29 26 Speech Therapy



J29 27 Orthotics



J29 28 Dietetics




                                          447 of 545
J29 29 Occupational Therapy




J29 30 Naturopathy


J29 31 Acupuncture


J29 32 Other Therapies



J29 33 Non Surgically Implanted Prostheses and Appliances



J29 34 Hearing Aids



J29 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

J29 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.




                                                                                            448 of 545
J29 37 Accident Cover



J29 38 Accidental Death Funeral Expenses



J29 39 Other Special General Treatment




J29 40 Hospital-Substitute Treatment



J30 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J30 1 Table Name or Group of Table Names

Hospital Cover with Excess Bonus Plus (I) and ANZ (#I)


J30 2 Eligibility

Product closed to new members from 30th November 2010.


J30 3 General Conditions


J30 4 Hospital Treatment Payments
Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals (with
the exception of excesses described in J11.11) with which the Company has an agreement. For private
hospitals with which the Company does not have an agreement benefits are paid according to the
schedule of benefits maintained by the Company. Policy holders may not be fully covered in private
hospitals with which the Company does not have an agreement.


J30 5 Medical Services Payments while admitted




                                                                                            449 of 545
A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J30 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals

The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.




J30 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J30 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.


J30 9 Nursing Home Type Patients

Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J30 10 Co Payments



J30 11 Excesses
An excess of $200 per hospital stay applies.
This is limited to $500 per year for policy holders who contribute to a policy that covers only one
person (a single cover) and $1000 per year for policy holders who contribute to either a single parent
or family cover.



                                                                                           450 of 545
                The Company will allow one excess free same day or overnight hospital
                admission per calendar year for policy holders who contribute to either a
                single or single parent cover and two excess free same day or overnight
                hospital admissions per calendar year for policy holders who contribute to a
                family cover.


The above excesses will not apply for the first three years for any dependent child who was born on or
after 1 April 2006 and who is covered under a single parent or family table as outlined in Rule J11.1.
This is providing that the policy holder has had continuous cover under any one of the Company’s
tables as outlined in Schedule K for at least 6 months prior to the birth of the child.


J30 12 Benefit Limitation Periods

    1. Assisted Reproductive Services:


    2. Pregnancy Related Services


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Psychiatric:


    6. Rehabilitation:


    7. Plastic and Cosmetic Surgery:


    8. Hip Replacements:


    9. Other:



J30 13 Restricted Benefits

    1. Assisted Reproductive Services:


    2. Pregnancy Related Services:




                                                                                          451 of 545
    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Psychiatric:


    6. Rehabilitation:


    7. Plastic and Cosmetic Surgery:


    8. Hip Replacements:


    9. Other:




J30 14 Exclusions
    1. Assisted Reproductive Services:


    2. Pregnancy Related Services:


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
       clinically necessary.


    6. Hip Replacements:


    7. Other:



J30 15 Loyalty Bonuses
The Company will pay a refund of 50% of the cost of a subscription to the Arthritis Foundation,
Asthma Foundation, Diabetes Australia and Parkinson’s in Western Australia. This benefit is limited
to one subscription per year.


                                                                                         452 of 545
South Australian policy holders on table I will receive full cover for the Arthritis Foundation’s
Moving Towards Wellness Program.

Victorian policy holders on table I will receive full cover for Disease Management Programs that are
approved by the Company.


J30 16 Other Special Hospital Treatment


J30 17 Dental


J30 18 Optical


J30 19 Physiotherapy


J30 20 Chiropractic


J30 21 Non PBS Pharmaceuticals


J30 22 Podiatry



J30 23 Psychology and Counselling



J30 24 Alternative Therapies



J30 25 Natural Therapies



J30 26 Speech Therapy



J30 27 Orthotics



                                                                                             453 of 545
J30 28 Dietetics



J30 29 Occupational Therapy



J30 30 Naturopathy


J30 31 Acupuncture


J30 32 Other Therapies



J30 33 Non Surgically Implanted Prostheses and Appliances



J30 34 Hearing Aids



J30 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

J30 36 Ambulance Transportation

A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J30 37 Accident Cover



                                                                                            454 of 545
J30 38 Accidental Death Funeral Expenses



J30 39 Other Special General Treatment




J30 40 Hospital-Substitute Treatment



J31 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J31 1 Table Name or Group of Table Names


                Hospital Saver Plus Cover with or without Excess Levels – (K0, K2, K3, 1, K5),
                and ANZ (#K0, #K2, #K3, #1, #K5)


J31 2 Eligibility
Product closed to new members from 30th November 2010.




J31 3 General Conditions


J31 4 Hospital Treatment Payments
Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals (with
the exception of excesses described in J12.11) with which the Company has an agreement. For private
hospitals with which the Company does not have an agreement benefits are paid according to the
schedule of benefits maintained by the Company. Policy holders may not be fully covered in private
hospitals with which the Company does not have an agreement.


J31 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner



                                                                                            455 of 545
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J31 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals

The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.




J31 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J31 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.


J31 9 Nursing Home Type Patients

Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J31 10 Co Payments


J31 11 Excesses
1. No excess applies for policy holders on Tables K0 and #K0.
2. An excess of $200 per hospital stay applies for policy holders on Tables K2 and #K2. This is
   limited to $500 per year for policy holders who contribute to a policy that covers only one person
   (a single cover) and $1000 per year for policy holders who contribute to either a single parent or
   family cover.
3. An excess of $300 per hospital stay applies for policy holders on Tables K3 and #K3. This is
   limited to $500 per year for policy holders who contribute to a policy that covers only one person




                                                                                           456 of 545
   (a single cover) and $1000 per year for policy holders who contribute to either a single parent or
   family cover.
4. An excess of $400 per hospital stay applies for policy holders on Tables 1 and #1. This is limited to
   $500 per year for policy holders who contribute to a policy that covers only one person (a single
   cover) and $1000 per year for policy holders who contribute to either a single parent or family
   cover.
5. An excess of $500 per hospital stay applies for policy holders on Tables K5 and #K5. This is
   limited to $500 per year for policy holders who contribute to a policy that covers only one person
   (a single cover) and $1000 per year for policy holders who contribute to either a single parent or
   family cover.




J31 12 Benefit Limitation Periods

    1. Assisted Reproductive Services:


    2. Pregnancy Related Services


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Psychiatric:


    6. Rehabilitation:


    7. Plastic and Cosmetic Surgery:


    8. Hip Replacements:


    9. Other:


J31 13 Restricted Benefits

    1. Assisted Reproductive Services:




                                                                                            457 of 545
    2. Pregnancy Related Services:


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Psychiatric:


    6. Rehabilitation:


    7. Plastic and Cosmetic Surgery:


    8. Hip Replacements: Restricted benefits apply.


    9. Other: Knee Replacements and Cataract Surgery: Restricted benefits apply.



J31 14 Exclusions
    1. Assisted Reproductive Services:


    2. Pregnancy Related Services:


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
       clinically necessary.


    6. Hip Replacements:


    7. Other:



J31 15 Loyalty Bonuses
South Australian policy holders on tables K0, K2, K3, 1 and K5 will receive full cover for the
Arthritis Foundation’s Moving Towards Wellness Program.


                                                                                          458 of 545
Victorian policy holders on tables K0, K2, K3, 1 and K5 will receive full cover for Disease
Management Programs that are approved by the Company.


J31 16 Other Special Hospital Treatment


J31 17 Dental


J31 18 Optical


J31 19 Physiotherapy


J31 20 Chiropractic


J31 21 Non PBS Pharmaceuticals


J31 22 Podiatry



J31 23 Psychology and Counselling



J31 24 Alternative Therapies



J31 25 Natural Therapies



J31 26 Speech Therapy



J31 27 Orthotics




                                                                                          459 of 545
J31 28 Dietetics



J31 29 Occupational Therapy




J31 30 Naturopathy


J31 31 Acupuncture


J31 32 Other Therapies



J31 33 Non Surgically Implanted Prostheses and Appliances



J31 34 Hearing Aids



J31 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

J31 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J31 37 Accident Cover




                                                                                            460 of 545
J31 38 Accidental Death Funeral Expenses



J31 39 Other Special General Treatment




J31 40 Hospital-Substitute Treatment



J32 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J32 1 Table Name or Group of Table Names

Hospital Saver Cover (2) and ANZ (#2)


J32 2 Eligibility

Product closed to new members from 30th November 2010.


J32 3 General Conditions


J32 4 Hospital Treatment Payments
Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals (with
the exception of excesses described in J13.11) with which the Company has an agreement. For private
hospitals with which the Company does not have an agreement benefits are paid according to the
schedule of benefits maintained by the Company. Policy holders may not be fully covered in private
hospitals with which the Company does not have an agreement.


J32 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


                                                                                            461 of 545
J32 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals

The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.




J32 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J32 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.


J32 9 Nursing Home Type Patients

Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J32 10 Co Payments



J32 11 Excesses
An excess of $500 per hospital stay applies.
This is limited to $500 per year for policy holders who contribute to a policy that covers only one
person (a single cover) and $1000 per year for policy holders who contribute to either a single parent
or family cover.


J32 12 Benefit Limitation Periods




                                                                                           462 of 545
  1. Assisted Reproductive Services:


  2. Pregnancy Related Services


  3. Sterilisation and Reversal of Sterilisation:


  4. Cardiothoracic:


  5. Psychiatric:


  6. Rehabilitation:


  7. Plastic and Cosmetic Surgery:


  8. Hip Replacements:


  9. Other:



J32 13 Restricted Benefits
  1. Assisted Reproductive Services: Restricted benefits apply

  2. Pregnancy Related Services: Restricted benefits apply

  3. Sterilisation and Reversal of Sterilisation:

  4. Cardiothoracic: Restricted benefits apply

  5. Psychiatric: Restricted benefits apply

  6. Rehabilitation: Restricted benefits apply

  7. Plastic and Cosmetic Surgery: Restricted benefits apply for Plastic Surgery only

  8. Hip Replacements: Restricted benefits apply

  9. Other: Knee Replacements and Cataract Surgery: Restricted benefits apply



J32 14 Exclusions
  1. Assisted Reproductive Services:




                                                                                        463 of 545
    2. Pregnancy Related Services:


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
       clinically necessary.


    6. Hip Replacements:


    7. Other:



J32 15 Loyalty Bonuses
South Australian policy holders on table 2 will receive full cover for the Arthritis Foundation’s
Moving Towards Wellness Program.

Victorian policy holders on table 2 will receive full cover for Disease Management Programs that are
approved by the Company.


J32 16 Other Special Hospital Treatment


J32 17 Dental


J32 18 Optical


J32 19 Physiotherapy


J32 20 Chiropractic


J32 21 Non PBS Pharmaceuticals


J32 22 Podiatry




                                                                                            464 of 545
J32 23 Psychology and Counselling



J32 24 Alternative Therapies



J32 25 Natural Therapies



J32 26 Speech Therapy



J32 27 Orthotics



J32 28 Dietetics



J32 29 Occupational Therapy


J32 30 Naturopathy


J32 31 Acupuncture


J32 32 Other Therapies



J32 33 Non Surgically Implanted Prostheses and Appliances



J32 34 Hearing Aids



J32 35 Prevention Health Management
Bowel Cancer Screening Kits


                                                        465 of 545
All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

J32 36 Ambulance Transportation

A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J32 37 Accident Cover



J32 38 Accidental Death Funeral Expenses



J32 39 Other Special General Treatment



J32 40 Hospital-Substitute Treatment



J33 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J33 1 Table Name or Group of Table Names

Family Essentials Hospital Cover (U) and ANZ (#U)


J33 2 Eligibility



J33 3 General Conditions




                                                                                            466 of 545
J33 4 Hospital Treatment Payments
Benefits fully cover the cost of shared ward hospital charges raised by public hospitals and private
hospitals with which the Company has an agreement in the following circumstances:-


    a) Where the hospital treatment was a result of an accident; or
    b) Where the hospital treatment is for any dependent child of a policy holder who is covered
       under either a single parent or family cover.


For any other circumstances, benefits are paid according to the minimum default benefits that are
prescribed by the Minister.


J33 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J33 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals

The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.




J33 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J33 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.




                                                                                            467 of 545
J33 9 Nursing Home Type Patients

Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J33 10 Co Payments



J33 11 Excesses


J33 12 Benefit Limitation Periods

127.    Assisted Reproductive Services:


128.    Pregnancy Related Services


129.    Sterilisation and Reversal of Sterilisation:


130.    Cardiothoracic:


131.    Psychiatric:


132.    Rehabilitation:


133.    Plastic and Cosmetic Surgery:


134.    Hip Replacements:


135.    Other:



J33 13 Restricted Benefits

136.    Assisted Reproductive Services:




                                                                                        468 of 545
137.   Pregnancy Related Services:


138.   Sterilisation and Reversal of Sterilisation:


139.   Cardiothoracic:


140.   Psychiatric:


141.   Rehabilitation:


142.   Plastic and Cosmetic Surgery:


143.   Hip Replacements:


144.   Other:




J33 14 Exclusions
145.   Assisted Reproductive Services:


146.   Pregnancy Related Services:


147.   Sterilisation and Reversal of Sterilisation:


148.   Cardiothoracic:


149.    Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
   clinically necessary.


150.   Hip Replacements:


151.   Other:




                                                                                       469 of 545
J33 15 Loyalty Bonuses


J33 16 Other Special Hospital Treatment


J33 17 Dental


J33 18 Optical


J33 19 Physiotherapy


J33 20 Chiropractic


J33 21 Non PBS Pharmaceuticals


J33 22 Podiatry



J33 23 Psychology and Counselling



J33 24 Alternative Therapies



J33 25 Natural Therapies



J33 26 Speech Therapy



J33 27 Orthotics




                                          470 of 545
J33 28 Dietetics



J33 29 Occupational Therapy



J33 30 Naturopathy


J33 31 Acupuncture


J33 32 Other Therapies



J33 33 Non Surgically Implanted Prostheses and Appliances



J33 34 Hearing Aids



J33 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

J33 36 Ambulance Transportation

A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J33 37 Accident Cover




                                                                                            471 of 545
J33 38 Accidental Death Funeral Expenses



J33 39 Other Special General Treatment



J33 40 Hospital-Substitute Treatment



J34 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J34 1 Table Name or Group of Table Names

Corporate Hospital Cover Level 1 (O1) and Level 2 (O2)


J34 2 Eligibility

This Table can only be taken out in conjunction with a general treatment Table as set out in Schedule
I of these Rules.

J34 3 General Conditions


J34 4 Hospital Treatment Payments
Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals (with
the exception of excesses described in J15.11) with which the Company has an agreement. For private
hospitals with which the Company does not have an agreement benefits are paid according to the
schedule of benefits maintained by the Company. Policy holders may not be fully covered in private
hospitals with which the Company does not have an agreement.


J34 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J34 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals



                                                                                            472 of 545
The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.




J34 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J34 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.


J34 9 Nursing Home Type Patients

Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J34 10 Co Payments



J34 11 Excesses
1) No excess applies for policy holders on Table O1.
2) An excess of $250 per hospital stay applies for policy holders on Table O2. This is limited to
   $250 per year for policy holders who contribute to a policy that covers only one person (a single
   cover) and $500 per year for policy holders who contribute to either a single parent or family
   cover.


J34 12 Benefit Limitation Periods

152.    Assisted Reproductive Services:




                                                                                          473 of 545
153.   Pregnancy Related Services


154.   Sterilisation and Reversal of Sterilisation:


155.   Cardiothoracic:


156.   Psychiatric:


157.   Rehabilitation:


158.   Plastic and Cosmetic Surgery:


159.   Hip Replacements:


160.   Other:



J34 13 Restricted Benefits

161.   Assisted Reproductive Services:


162.   Pregnancy Related Services:


163.   Sterilisation and Reversal of Sterilisation:


164.   Cardiothoracic:


165.   Psychiatric:


166.   Rehabilitation:


167.   Plastic and Cosmetic Surgery:


168.   Hip Replacements:




                                                      474 of 545
169.    Other:




J34 14 Exclusions
170.    Assisted Reproductive Services:


171.    Pregnancy Related Services:


172.    Sterilisation and Reversal of Sterilisation:


173.    Cardiothoracic:


174.    Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
   clinically necessary.


175.    Hip Replacements:


176.    Other:




J34 15 Loyalty Bonuses


J34 16 Other Special Hospital Treatment
5. Special Benefits

       Benefits will be offered to a partner, immediate family member, carer/parent, next of kin who is
       required to stay at the hospital with the patient. The benefit is payable on the admitted person’s
       policy.

       The Benefits payable are:

    Accommodation in hospital for up to $60 per night whilst a boarder in hospital
    Benefit towards meals whilst in hospital for up to $30 per day for any hospital meals provided
    An annual limit of $1000 will apply


J34 17 Dental




                                                                                            475 of 545
J34 18 Optical


J34 19 Physiotherapy


J34 20 Chiropractic


J34 21 Non PBS Pharmaceuticals


J34 22 Podiatry



J34 23 Psychology and Counselling



J34 24 Alternative Therapies



J34 25 Natural Therapies



J34 26 Speech Therapy



J34 27 Orthotics



J34 28 Dietetics



J34 29 Occupational Therapy



J34 30 Naturopathy



                                    476 of 545
J34 31 Acupuncture


J34 32 Other Therapies



J34 33 Non Surgically Implanted Prostheses and Appliances



J34 34 Hearing Aids



J34 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

J34 36 Ambulance Transportation

A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J34 37 Accident Cover



J34 38 Accidental Death Funeral Expenses



J34 39 Other Special General Treatment




                                                                                            477 of 545
J34 40 Hospital-Substitute Treatment



J35 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J35 1 Table Name or Group of Table Names

Corporate Hospital Top Cover With or Without Excess Levels (M1, M2, M3)


J35 2 Eligibility



J35 3 General Conditions


J35 4 Hospital Treatment Payments
Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals (with
the exception of excesses described in J16.11) with which the Company has an agreement. For private
hospitals with which the Company does not have an agreement benefits are paid according to the
schedule of benefits maintained by the Company. Policy holders may not be fully covered in private
hospitals with which the Company does not have an agreement.


J35 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J35 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals

The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.




                                                                                            478 of 545
J35 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J35 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis

J35 9 Nursing Home Type Patients

Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J35 10 Co Payments


J35 11 Excesses
1. No excess applies for policy holders on Table M1.
2. An excess of $250 per hospital stay applies for policy holders on Table M2. This is limited to $500
   per year for policy holders who contribute to a policy that covers only one person (a single cover)
   and $1000 per year for policy holders who contribute to either a single parent or family cover.
3. An excess of $500 per hospital stay applies for policy holders on Table M3. This is limited to $500
   per year for policy holders who contribute to a policy that covers only one person (a single cover)
   and $1000 per year for policy holders who contribute to either a single parent or family cover.
For Table M2 policy holders, the Company will allow one excess free same day or overnight hospital
admission per calendar year for policy holders who contribute to either a single or single parent cover
and two excess free same day or overnight hospital admissions per calendar year for policy holders
who contribute to a family cover.


J35 12 Benefit Limitation Periods

    1. Assisted Reproductive Services:


    2. Pregnancy Related Services




                                                                                           479 of 545
  3. Sterilisation and Reversal of Sterilisation:


  4. Cardiothoracic:


  5. Psychiatric:


  6. Rehabilitation:


  7. Plastic and Cosmetic Surgery:


  8. Hip Replacements:


  9. Other:


J35 13 Restricted Benefits

  1. Assisted Reproductive Services:


  2. Pregnancy Related Services:


  3. Sterilisation and Reversal of Sterilisation:


  4. Cardiothoracic:


  5. Psychiatric:


  6. Rehabilitation:


  7. Plastic and Cosmetic Surgery:


  8. Hip Replacements:


  9. Other:




                                                    480 of 545
J35 14 Exclusions
    1. Assisted Reproductive Services:


    2. Pregnancy Related Services:


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
       clinically necessary.


    6. Hip Replacements:


    7. Other:




J35 15 Loyalty Bonuses
For policy holders on Tables M1 and M2, the Company will pay a refund of 50% of the cost of a
subscription to the Arthritis Foundation, Asthma Foundation, Diabetes Australia, and Parkinson’s in
Western Australia. This benefit is limited to one subscription per year.


J35 16 Other Special Hospital Treatment
6. Special Benefits

      Benefits will be offered to a partner, immediate family member, carer/parent, next of kin who is
      required to stay at the hospital with the patient. The benefit is payable on the admitted person’s
      policy.

      The Benefits payable are:

    Accommodation in hospital for up to $60 per night whilst a boarder in hospital
    Benefit towards meals whilst in hospital for up to $30 per day for any hospital meals provided
    An annual limit of $1000 will apply


J35 17 Dental


J35 18 Optical




                                                                                           481 of 545
J35 19 Physiotherapy


J35 20 Chiropractic


J35 21 Non PBS Pharmaceuticals


J35 22 Podiatry



J35 23 Psychology and Counselling



J35 24 Alternative Therapies



J35 25 Natural Therapies



J35 26 Speech Therapy



J35 27 Orthotics



J35 28 Dietetics



J35 29 Occupational Therapy




J35 30 Naturopathy


J35 31 Acupuncture


                                    482 of 545
J35 32 Other Therapies



J35 33 Non Surgically Implanted Prostheses and Appliances



J35 34 Hearing Aids



J35 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

J35 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.




J35 37 Accident Cover



J35 38 Accidental Death Funeral Expenses



J35 39 Other Special General Treatment



J35 40 Hospital-Substitute Treatment




                                                                                            483 of 545
J36 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J36 1 Table Name or Group of Table Names

Corporate Hospital Intermediate Cover With or Without Excess Levels (E1, E2, E3)


J36 2 Eligibility



J36 3 General Conditions


J36 4 Hospital Treatment Payments
Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals (with
the exception of excesses described in J17.11) with which the Company has an agreement. For private
hospitals with which the Company does not have an agreement benefits are paid according to the
schedule of benefits maintained by the Company. Policy holders may not be fully covered in private
hospitals with which the Company does not have an agreement.


J36 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J36 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals

The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.




J36 7 Non PBS Pharmaceuticals




                                                                                            484 of 545
The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J36 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis

J36 9 Nursing Home Type Patients

Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J36 10 Co Payments


J36 11 Excesses
1. No excess applies for policy holders on Table E1.
2. An excess of $250 per hospital stay applies for policy holders on Table E2. This is limited to $500
   per year for policy holders who contribute to a policy that covers only one person (a single cover)
   and $1000 per year for policy holders who contribute to either a single parent or family cover.
3. An excess of $500 per hospital stay applies for policy holders on Table E3. This is limited to $500
   per year for policy holders who contribute to a policy that covers only one person (a single cover)
   and $1000 per year for policy holders who contribute to either a single parent or family cover.
For Table E2 policy holders, the Company will allow one excess free same day or overnight hospital
admission per calendar year for policy holders who contribute to either a single or single parent cover
and two excess free same day or overnight hospital admissions per calendar year for policy holders
who contribute to a family cover.


J36 12 Benefit Limitation Periods

    1. Assisted Reproductive Services:


    2. Pregnancy Related Services


    3. Sterilisation and Reversal of Sterilisation:




                                                                                           485 of 545
  4. Cardiothoracic:


  5. Psychiatric:


  6. Rehabilitation:


  7. Plastic and Cosmetic Surgery:


  8. Hip Replacements:


  9. Other:


J36 13 Restricted Benefits

  1. Assisted Reproductive Services:


  2. Pregnancy Related Services:


  3. Sterilisation and Reversal of Sterilisation:


  4. Cardiothoracic:


  5. Psychiatric:


  6. Rehabilitation:


  7. Plastic and Cosmetic Surgery:


  8. Hip Replacements: Restricted benefits apply.


  9. Other: Knee Replacements and Cataract Surgery: Restricted benefits apply.




                                                                                 486 of 545
J36 14 Exclusions
  1. Assisted Reproductive Services:


  2. Pregnancy Related Services:


  3. Sterilisation and Reversal of Sterilisation:


  4. Cardiothoracic:


  5. Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
     clinically necessary.


  6. Hip Replacements:


  7. Other:




J36 15 Loyalty Bonuses


J36 16 Other Special Hospital Treatment


J36 17 Dental


J36 18 Optical


J36 19 Physiotherapy


J36 20 Chiropractic


J36 21 Non PBS Pharmaceuticals


J36 22 Podiatry



                                                                                    487 of 545
J36 23 Psychology and Counselling



J36 24 Alternative Therapies



J36 25 Natural Therapies



J36 26 Speech Therapy



J36 27 Orthotics



J36 28 Dietetics



J36 29 Occupational Therapy


J36 30 Naturopathy


J36 31 Acupuncture


J36 32 Other Therapies



J36 33 Non Surgically Implanted Prostheses and Appliances



J36 34 Hearing Aids



J36 35 Prevention Health Management
Bowel Cancer Screening Kits


                                                        488 of 545
All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

J36 36 Ambulance Transportation

A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J36 37 Accident Cover



J36 38 Accidental Death Funeral Expenses



J36 39 Other Special General Treatment



J36 40 Hospital-Substitute Treatment



J37 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J37 1 Table Name or Group of Table Names

Corporate Hospital Saver Cover with or without Excess Levels (H1, H2, H3)


J37 2 Eligibility



J37 3 General Conditions




                                                                                            489 of 545
J37 4 Hospital Treatment Payments
Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals (with
the exception of excesses described in J18.11) with which the Company has an agreement. For private
hospitals with which the Company does not have an agreement benefits are paid according to the
schedule of benefits maintained by the Company. Policy holders may not be fully covered in private
hospitals with which the Company does not have an agreement.


J37 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J37 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals

The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.




J37 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J37 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis

J37 9 Nursing Home Type Patients

Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




                                                                                            490 of 545
J37 10 Co Payments


J37 11 Excesses
1. No excess applies for policy holders on Table H1.
2. An excess of $250 per hospital stay applies for policy holders on Table H2. This is limited to $500
   per year for policy holders who contribute to a policy that covers only one person (a single cover)
   and $1000 per year for policy holders who contribute to either a single parent or family cover.
3. An excess of $500 per hospital stay applies for policy holders on Table H3. This is limited to $500
   per year for policy holders who contribute to a policy that covers only one person (a single cover)
   and $1000 per year for policy holders who contribute to either a single parent or family cover.
For Table H2 policy holders, the Company will allow one excess free same day or overnight hospital
admission per calendar year for policy holders who contribute to either a single or single parent cover
and two excess free same day or overnight hospital admissions per calendar year for policy holders
who contribute to a family cover.




J37 12 Benefit Limitation Periods

    1. Assisted Reproductive Services:


    2. Pregnancy Related Services


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Psychiatric:


    6. Rehabilitation:


    7. Plastic and Cosmetic Surgery:


    8. Hip Replacements:


    9. Other:




                                                                                           491 of 545
J37 13 Restricted Benefits
  1. Assisted Reproductive Services:

  2. Pregnancy Related Services:

  3. Sterilisation and Reversal of Sterilisation:

  4. Cardiothoracic:

  5. Psychiatric: Restricted benefits apply

  6. Rehabilitation: Restricted benefits apply

  7. Plastic and Cosmetic Surgery:

  8. Hip Replacements:

  9. Other:



J37 14 Exclusions
  1. Assisted Reproductive Services: No benefits payable

  2. Pregnancy Related Services: No benefits payable

  3. Sterilisation and Reversal of Sterilisation:

  4. Cardiothoracic: No benefits payable

  5. Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic surgery unless deemed
     clinically necessary.

  6. Hip Replacements: No benefits payable

  7. Other: Knee Replacements, Cataract Surgery - No benefits payable



J37 15 Loyalty Bonuses


J37 16 Other Special Hospital Treatment


J37 17 Dental


J37 18 Optical




                                                                                    492 of 545
J37 19 Physiotherapy


J37 20 Chiropractic


J37 21 Non PBS Pharmaceuticals


J37 22 Podiatry



J37 23 Psychology and Counselling



J37 24 Alternative Therapies



J37 25 Natural Therapies



J37 26 Speech Therapy



J37 27 Orthotics



J37 28 Dietetics



J37 29 Occupational Therapy




                                    493 of 545
J37 30 Naturopathy


J37 31 Acupuncture


J37 32 Other Therapies



J37 33 Non Surgically Implanted Prostheses and Appliances



J37 34 Hearing Aids



J37 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

J37 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.



J37 37 Accident Cover



J37 38 Accidental Death Funeral Expenses



J37 39 Other Special General Treatment




                                                                                            494 of 545
J37 40 Hospital-Substitute Treatment



J38 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J38 1 Table Name or Group of Table Names
Hospital Economy Cover (R) and ANZ (#R)
Hospital Economy Cover with Excess Bonus (Q) and ANZ (#Q):


J38 2 Eligibility


J38 3 General Conditions


J38 4 Hospital Treatment Payments
Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals (with
the exception of co-payments described in J19.10 and excesses described in J19.11) with which the
Company has an agreement. For private hospitals with which the Company does not have an
agreement benefits are paid according to the schedule of benefits maintained by the Company. Policy
holders may not be fully covered in private hospitals with which the Company does not have an
agreement.


J38 5 Medical Services Payments while admitted
A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J38 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.


J38 7 Non PBS Pharmaceuticals
The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with



                                                                                             495 of 545
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.


J38 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.


J38 9 Nursing Home Type Patients
Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.


J38 10 Co Payments
In addition to the excess, a co-payment of $40 is payable by the policy holder for each day in hospital
and is deducted from the benefits that would otherwise be payable. This is limited to $200 per
hospital stay. This does not apply for policy holders on Tables Q or #Q.


J38 11 Excesses
An excess of $400 per hospital stay applies. This is limited to $500 per year for policy holders who
contribute to a policy that covers only one person (a single cover) and $1000 per year for policy
holders who contribute to a family cover.

For policy holders of tables Q and #Q, the Company will establish a pool to which it will credit $100
on the 31st of December each year. Amounts credited to the pool will accrue. However, this credit is
not available to policy holders whose cover is suspended as at the 31st of December or policy holders
who are covered on tables R and #R.

From 1 January 2010, excess credits will no longer apply.

When an excess is incurred in respect of a hospital stay, the policy holder may draw from the pool a
maximum of $400 or part thereof to offset the excess.

Excess credits are only transferable to tables B, #B, I, #I, Q, #Q, R or #R.


J38 12 Benefit Limitation Periods

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:



                                                                                           496 of 545
6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J38 13 Restricted Benefits
   1. Assisted Reproductive Services:

   2. Pregnancy Related Services:

   3. Sterilisation and Reversal of Sterilisation:

   4. Cardiothoracic:

   5. Psychiatric:

   6. Rehabilitation:

   7. Plastic and Cosmetic Surgery:

   8. Hip Replacements:

   9. Other:



J38 14 Exclusions
   1. Assisted Reproductive Services:


   2. Pregnancy Related Services:


   3. Sterilisation and Reversal of Sterilisation:


   4. Cardiothoracic:


   5. Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
      clinically necessary.


   6. Hip Replacements:


   7. Other:




                                                                                     497 of 545
J38 15 Loyalty Bonuses
South Australian policy holders on tables R and Q will receive full cover for the Arthritis
Foundation’s Moving Towards Wellness Program.

Victorian policy holders on tables R and Q will receive full cover for Disease Management Programs
that are approved by the Company.


J38 16 Other Special Hospital Treatment


J38 17 Dental


J38 18 Optical


J38 19 Physiotherapy


J38 20 Chiropractic



J38 21 Non PBS Pharmaceuticals


J38 22 Podiatry


J38 23 Psychology and Counselling


J38 24 Alternative Therapies


J38 25 Natural Therapies


J38 26 Speech Therapy


J38 27 Orthotics


J38 28 Dietetics



                                                                                              498 of 545
J38 29 Occupational Therapy


J38 30 Naturopathy


J38 31 Acupuncture


J38 32 Other Therapies


J38 33 Non Surgically Implanted Prostheses and Appliances


J38 34 Hearing Aids


J38 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

J38 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.



J38 37 Accident Cover


J38 38 Accidental Death Funeral Expenses


J38 39 Other Special General Treatment


J38 40 Hospital-Substitute Treatment



                                                                                            499 of 545
J39 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J39 1 Table Name or Group of Table Names
Start ‘N’ Save Hospital Cover (C) and ANZ (#C):


J39 2 Eligibility


J39 3 General Conditions


J39 4 Hospital Treatment Payments
Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals (with
the exception of co-payments described in J20.10 and excesses described in J20.11) with which the
Company has an agreement. For private hospitals with which the Company does not have an
agreement benefits are paid according to the schedule of benefits maintained by the Company. Policy
holders may not be fully covered in private hospitals with which the Company does not have an
agreement.


J39 5 Medical Services Payments while admitted
A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.




J39 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.




J39 7 Non PBS Pharmaceuticals
The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.




                                                                                             500 of 545
J39 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.




J39 9 Nursing Home Type Patients
Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J39 10 Co Payments
In addition to the excess, a co-payment of $50 is payable by the policy holder for each day in hospital
and is deducted from the benefits that would otherwise be payable. This is limited to $250 per
hospital stay.


J39 11 Excesses
An excess of $500 per hospital stay applies. This is limited to $500 per year for policy holders who
contribute to a policy that covers only one person (a single cover) and $1000 per year for policy
holders who contribute to a family cover.

The Company will establish a pool to which it will credit $100 on the 31st of December each year to a
maximum of five years ($500) in respect of each policy holder. Amounts credited to the pool will
accrue. However, this credit is not available to policy holders whose cover is suspended as at the 31st
of December.

From 1 January 2010, excess credits will no longer apply.

When an excess is incurred in respect of a hospital stay, the policy holder may draw from the pool to
offset the excess.

Excess credits are only transferable to Tables B, #B, N, Q or #Q.




                                                                                            501 of 545
J39 12 Benefit Limitation Periods
   1. Assisted Reproductive Services:

   2. Pregnancy Related Services:

   3. Sterilisation and Reversal of Sterilisation:

   4. Cardiothoracic:

   5. Psychiatric:

   6. Rehabilitation:

   7. Plastic and Cosmetic Surgery:

   8. Hip Replacements:

   9. Other:



J39 13 Restricted Benefits
   1. Assisted Reproductive Services:

   2. Pregnancy Related Services:

   3. Sterilisation and Reversal of Sterilisation:

   4. Cardiothoracic:

   5. Psychiatric:

   6. Rehabilitation:

   7. Plastic and Cosmetic Surgery:

   8. Hip Replacements:

   9. Other:



J39 14 Exclusions
177.   Assisted Reproductive Services:


178.   Pregnancy Related Services:


179.   Sterilisation and Reversal of Sterilisation:




                                                      502 of 545
180.    Cardiothoracic:


181.    Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
   clinically necessary.


182.    Hip Replacements:


183.    Other:



J39 15 Loyalty Bonuses
South Australian policy holders on table C will receive full cover for the Arthritis Foundation’s
Moving Towards Wellness Program.

Victorian policy holders on table C will receive full cover for Disease Management Programs that are
approved by the Company.


J39 16 Other Special Hospital Treatment


J39 17 Dental


J39 18 Optical


J39 19 Physiotherapy


J39 20 Chiropractic


J39 21 Non PBS Pharmaceuticals


J39 22 Podiatry


J39 23 Psychology and Counselling


J39 24 Alternative Therapies




                                                                                            503 of 545
J39 25 Natural Therapies


J39 26 Speech Therapy


J39 27 Orthotics


J39 28 Dietetics


J39 29 Occupational Therapy


J39 30 Naturopathy


J39 31 Acupuncture


J39 32 Other Therapies


J39 33 Non Surgically Implanted Prostheses and Appliances


J39 34 Hearing Aids


J39 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

J39 36 Ambulance Transportation


A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.



                                                                                            504 of 545
J39 37 Accident Cover


J39 38 Accidental Death Funeral Expenses


J39 39 Other Special General Treatment


J39 40 Hospital-Substitute Treatment



J40 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J40 1 Table Name or Group of Table Names
Industry Superannuation Health Benefits Plan (F)
Industry Superannuation Health Benefits Plan with Excess Bonus Plus (F1):


J40 2 Eligibility


J40 3 General Conditions


J40 4 Hospital Treatment Payments
Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals (with
the exception of co-payments described in J21.10 and excesses described in J21.11) with which the
Company has an agreement. For private hospitals with which the Company does not have an
agreement benefits are paid according to the schedule of benefits maintained by the Company. Policy
holders may not be fully covered in private hospitals with which the Company does not have an
agreement.


J40 5 Medical Services Payments while admitted
A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.




                                                                                             505 of 545
J40 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.


J40 7 Non PBS Pharmaceuticals
The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.


J40 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.


J40 9 Nursing Home Type Patients
Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.


J40 10 Co Payments
In addition to the excess, a co-payment of $40 is payable by the policy holder for each day in hospital
and is deducted from the benefits that would otherwise be payable. This is limited to $200 per
hospital stay. This does not apply for policy holders on Table F1.


J40 11 Excesses
An excess of $400 per hospital stay applies. This is limited to $500 per year for policy holders who
contribute to a policy that covers only one person (a single cover) and $1000 per year for policy
holders who contribute to a family cover.

The Company will establish a pool to which it will credit $100 on the 31st of December each year.
Amounts credited to the pool will accrue. However, this credit is not available to policy holders
whose cover is suspended as at the 31st of December or policy holders who are covered on table F.

From 1 January 2010, excess credits will no longer apply.

When an excess is incurred in respect of a hospital stay, the policy holder may draw from the pool a
maximum of $400 or part thereof to offset the excess.

Excess credits are only transferable to tables B, #B, I, #I, Q, #Q, R or #R.




                                                                                           506 of 545
J40 12 Benefit Limitation Periods
   1. Assisted Reproductive Services:

   2. Pregnancy Related Services:

   3. Sterilisation and Reversal of Sterilisation:

   4. Cardiothoracic:

   5. Psychiatric:

   6. Rehabilitation:

   7. Plastic and Cosmetic Surgery:

   8. Hip Replacements:

   9. Other:



J40 13 Restricted Benefits
   1. Assisted Reproductive Services:

   2. Pregnancy Related Services:

   3. Sterilisation and Reversal of Sterilisation:

   4. Cardiothoracic:

   5. Psychiatric:

   6. Rehabilitation:

   7. Plastic and Cosmetic Surgery:

   8. Hip Replacements:

   9. Other:



J40 14 Exclusions
184.   Assisted Reproductive Services:


185.   Pregnancy Related Services:


186.   Sterilisation and Reversal of Sterilisation:




                                                      507 of 545
187.   Cardiothoracic:


188.    Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
   clinically necessary.


189.   Hip Replacements:


190.   Other:



J40 15 Loyalty Bonuses


J40 16 Other Special Hospital Treatment



J40 17 Dental


J40 18 Optical


J40 19 Physiotherapy


J40 20 Chiropractic


J40 21 Non PBS Pharmaceuticals


J40 22 Podiatry


J40 23 Psychology and Counselling


J40 24 Alternative Therapies


J40 25 Natural Therapies




                                                                                       508 of 545
J40 26 Speech Therapy


J40 27 Orthotics


J40 28 Dietetics


J40 29 Occupational Therapy


J40 30 Naturopathy


J40 31 Acupuncture


J40 32 Other Therapies


J40 33 Non Surgically Implanted Prostheses and Appliances


J40 34 Hearing Aids


J40 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

J40 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.



J40 37 Accident Cover



                                                                                            509 of 545
J40 38 Accidental Death Funeral Expenses


J40 39 Other Special General Treatment


J40 40 Hospital-Substitute Treatment



J41 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J41 1 Table Name or Group of Table Names
Hospital Plus

J41 2 Eligibility
A Policy Holder may register a Dependant Child as a Dependant Extension under this policy in
accordance with the definition under Rule B2 of the General Conditions.

Product closed to new members from August 17th 2010.


J41 3 General Conditions


J41 4 Hospital Treatment Payments
The Company will pay to Hospitals for Hospital Treatment received by a Policy Holder, the following
payments:

(1) In Network Hospitals – the Network Hospital Payment;

(2) In Public Hospitals – the Public Hospital Benefit; and

(3) In non-agreement Private Hospitals – the Non-Agreement Hospital Benefit (Private).


J41 5 Medical Services Payments while admitted
Where there is an MPPA, PA or Gap Cover Scheme in place, the Company will pay to Medical Practitioners for
medical services received by a Policy Holder while an Admitted Patient, the MPPA, PA or Gap Cover Schemes
Payment.

Where there is no MPPA, PA or Gap Cover Scheme in place, the Company will pay the Schedule Fee Gap
Benefit for medical services received by a Policy Holder while an Admitted Patient:

(1) to the Policy Holder; or

(2) where the Policy Holder assigns the benefit to the Medical Practitioner, to that Medical
Practitioner.




                                                                                               510 of 545
J41 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
Benefits for qualifying PBS Items supplied to an Admitted Patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.

J41 7 Non PBS Pharmaceuticals
Benefits for non PBS medications supplied to an Admitted Patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.

Policy Holders covered on a Family Extension policy receive an increased limit of $30 per person per
Calendar Year for non-PBS medications.

J41 8 Surgically Implanted Prostheses
Benefits for qualifying surgically implanted prostheses are payable in accordance with Rule E2 of the
General Conditions, whichever is applicable.



J41 9 Nursing Home Type Patients
Benefits for Hospital Treatment provided to Nursing Home Type Patients are payable in accordance
with Rule E2 of the General Conditions.

J41 10 Co Payments
A $50 Co-Payment applies for any same day or overnight admissions and at any private or public
hospital to a maximum of $250 per admission.

No Co-Payment applies for admissions to hospital of a Child Dependent, Student Dependant or
Dependant Extension covered under the Policy.

J41 11 Excesses


J41 12 Benefit Limitation Periods

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:




                                                                                         511 of 545
J41 13 Restricted Benefits

1. Assisted Reproductive Services:

2. Pregnancy Related Services:

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J41 14 Exclusions

1. Assisted Reproductive Services:

2. Pregnancy Related Services:

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Plastic and Cosmetic Surgery:

6. Hip Replacements:

7. Other:


J41 15 Loyalty Bonuses


J41 16 Other Special Hospital Treatment
Lithotripsy

The Company will pay a benefit of $1000 for treatment involving the operation of a Lithotripter
where the treatment has been carried out in an approved Hospital.

Home Nursing

The Company will pay benefits towards services provided by a registered nurse for an illness, injury
or condition that would otherwise require admission and treatment of the kind provided in an
approved Hospital.

Benefits are payable as follows:-



                                                                                          512 of 545
Attendance for a period of not more than 1 hour             $15.00
Attendance for more than 1 hour but less than 2 hours       $30.00
Attendance for more than 2 hours but less than 3 hours      $45.00
Attendance for more than 3 hours but less than 4 hours      $60.00
Attendance in excess of 4 hours                             $75.00

Maximum daily benefit of $75 with a limit of 65 days per person per Calendar Year.



J41 17 Dental


J41 18 Optical


J41 19 Physiotherapy


J41 20 Chiropractic


J41 21 Non PBS Pharmaceuticals


J41 22 Podiatry


J41 23 Psychology and Counselling


J41 24 Alternative Therapies


J41 25 Natural Therapies


J41 26 Speech Therapy


J41 27 Orthotics


J41 28 Dietetics


J41 29 Occupational Therapy



                                                                                     513 of 545
J41 30 Naturopathy


J41 31 Acupuncture


J41 32 Other Therapies


J41 33 Non Surgically Implanted Prostheses and Appliances


J41 34 Hearing Aids


J41 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


J41 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J41 37 Accident Cover


J41 38 Accidental Death Funeral Expenses


J41 39 Other Special General Treatment


J41 40 Hospital-Substitute Treatment




                                                                                            514 of 545
J42 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J42 1 Table Name or Group of Table Names
Hospital Super Plus

J42 2 Eligibility
A Policy Holder may register a Dependant Child as a Dependant Extension under this policy in
accordance with the definition under Rule B2 of the General Conditions.

Product closed to new members from August 17th 2010.


J42 3 General Conditions


J42 4 Hospital Treatment Payments
The Company will pay to Hospitals for Hospital Treatment received by a Policy Holder, the following
payments:

(1) In Network Hospitals – the Network Hospital Payment;

(2) In Public Hospitals – the Public Hospital Benefit; and

(3) In non-agreement Private Hospitals – the Non-Agreement Hospital Benefit (Private).


J42 5 Medical Services Payments while admitted
Where there is an MPPA, PA or Gap Cover Scheme in place, the Company will pay to Medical Practitioners for
medical services received by a Policy Holder while an Admitted Patient, the MPPA, PA or Gap Cover Schemes
Payment.

Where there is no MPPA, PA or Gap Cover Scheme in place, the Company will pay the Schedule Fee Gap
Benefit for medical services received by a Policy Holder while an Admitted Patient:

(1) to the Policy Holder; or

(2) where the Policy Holder assigns the benefit to the Medical Practitioner, to that Medical
Practitioner.


J42 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
Benefits for qualifying PBS Items supplied to an Admitted Patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.

J42 7 Non PBS Pharmaceuticals
Benefits for non PBS medications supplied to an Admitted Patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.

Policy Holders covered on a Family Extension policy receive an increased limit of $30 per person per
Calendar Year for non-PBS medications.


                                                                                               515 of 545
J42 8 Surgically Implanted Prostheses
Benefits for qualifying surgically implanted prostheses are payable in accordance with Rule E2 of the
General Conditions, whichever is applicable.

J42 9 Nursing Home Type Patients
Benefits for Hospital Treatment provided to Nursing Home Type Patients are payable in accordance
with Rule E2 of the General Conditions.

J42 10 Co Payments


J42 11 Excesses


J42 12 Benefit Limitation Periods

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J42 13 Restricted Benefits

1. Assisted Reproductive Services:

2. Pregnancy Related Services:

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:




                                                                                         516 of 545
J42 14 Exclusions

1. Assisted Reproductive Services:

2. Pregnancy Related Services:

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Plastic and Cosmetic Surgery:

6. Hip Replacements:

7. Other:


J42 15 Loyalty Bonuses


J42 16 Other Special Hospital Treatment
Lithotripsy

The Company will pay a benefit of $1000 for treatment involving the operation of a Lithotripter
where the treatment has been carried out in an approved Hospital.

Home Nursing

The Company will pay benefits towards services provided by a registered nurse for an illness, injury
or condition that would otherwise require admission and treatment of the kind provided in an
approved Hospital.

Benefits are payable as follows:-

Attendance for a period of not more than 1 hour                     $15.00
Attendance for more than 1 hour but less than 2 hours               $30.00
Attendance for more than 2 hours but less than 3 hours              $45.00
Attendance for more than 3 hours but less than 4 hours              $60.00
Attendance in excess of 4 hours                                     $75.00

Maximum daily benefit of $75 with a limit of 65 days per person per Calendar Year.

Special Benefits

Benefits will be offered to a partner, immediate family member, carer/parent, next of kin who is
required to stay at the hospital with the patient. The benefit is payable on the admitted person’s policy.

The Benefits payable are:

- Accommodation in hospital for up to $60 per night whilst a boarder in hospital
- Benefit towards meals whilst in hospital for up to $30 per day for any hospital meals provided
- An annual limit of $1000 will apply
F


                                                                                             517 of 545
J42 17 Dental


J42 18 Optical


J42 19 Physiotherapy


J42 20 Chiropractic


J42 21 Non PBS Pharmaceuticals


J42 22 Podiatry


J42 23 Psychology and Counselling


J42 24 Alternative Therapies


J42 25 Natural Therapies


J42 26 Speech Therapy


J42 27 Orthotics


J42 28 Dietetics


J42 29 Occupational Therapy


J42 30 Naturopathy


J42 31 Acupuncture




                                    518 of 545
J42 32 Other Therapies


J42 33 Non Surgically Implanted Prostheses and Appliances


J42 34 Hearing Aids


J42 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


J42 36 Ambulance Transportation

A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.




J42 37 Accident Cover


J42 38 Accidental Death Funeral Expenses


J42 39 Other Special General Treatment


J42 40 Hospital-Substitute Treatment



J43 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J43 1 Table Name or Group of Table Names
Hospital Value



                                                                                            519 of 545
J43 2 Eligibility
A Policy Holder may register a Dependant Child as a Dependant Extension under this policy in
accordance with the definition under Rule B2 of the General Conditions.

Product closed to new members from August 17th 2010.


J43 3 General Conditions


J43 4 Hospital Treatment Payments
The Company will pay to Hospitals for Hospital Treatment received by a Policy Holder, the following
payments:

(1) In Network Hospitals – the Network Hospital Payment;

(2) In Public Hospitals – the Public Hospital Benefit; and

(3) In non-agreement Private Hospitals – the Non-Agreement Hospital Benefit (Private).


J43 5 Medical Services Payments while admitted
Where there is an MPPA, PA or Gap Cover Scheme in place, The Company will pay to Medical Practitioners
for medical services received by a Policy Holder while an Admitted Patient, the MPPA, PA or Gap Cover
Schemes Payment.

Where there is no MPPA, PA or Gap Cover Scheme in place, The Company will pay the Schedule Fee Gap
Benefit for medical services received by a Policy Holder while an Admitted Patient:

(1) to the Policy Holder; or

(2) where the Policy Holder assigns the benefit to the Medical Practitioner, to that Medical
Practitioner.


J43 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
Benefits for qualifying PBS Items supplied to an Admitted Patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.

J43 7 Non PBS Pharmaceuticals
Benefits for non PBS medications supplied to an Admitted Patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.

Policy Holders covered on a Family Extension policy receive an increased limit of $30 per person per
Calendar Year for non-PBS medications.

J43 8 Surgically Implanted Prostheses
Benefits for qualifying surgically implanted prostheses are payable in accordance with Rule E2 of the
General Conditions, whichever is applicable.




                                                                                               520 of 545
J43 9 Nursing Home Type Patients
Benefits for Hospital Treatment provided to Nursing Home Type Patients are payable in accordance
with Rule E2 of the General Conditions.

J43 10 Co Payments


J43 11 Excesses
The following annual Excess options apply per person once per Calendar Year to a maximum of twice per
Policy: - $250, $500 or $1,000.

J43 12 Benefit Limitation Periods

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J43 13 Restricted Benefits

1. Assisted Reproductive Services:

2. Pregnancy Related Services:

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J43 14 Exclusions

1. Assisted Reproductive Services:



                                                                                         521 of 545
2. Pregnancy Related Services:

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Plastic and Cosmetic Surgery:

6. Hip Replacements:

7. Other:


J43 15 Loyalty Bonuses


J43 16 Other Special Hospital Treatment
Lithotripsy

The Company will pay a benefit of $1000 for treatment involving the operation of a Lithotripter
where the treatment has been carried out in an approved Hospital.

Home Nursing

The Company will pay benefits towards services provided by a registered nurse for an illness, injury
or condition that would otherwise require admission and treatment of the kind provided in an
approved Hospital.

Benefits are payable as follows:-

Attendance for a period of not more than 1 hour                   $15.00
Attendance for more than 1 hour but less than 2 hours             $30.00
Attendance for more than 2 hours but less than 3 hours            $45.00
Attendance for more than 3 hours but less than 4 hours            $60.00
Attendance in excess of 4 hours                                   $75.00

Maximum daily benefit of $75 with a limit of 65 days per person per Calendar Year.



J43 17 Dental


J43 18 Optical


J43 19 Physiotherapy


J43 20 Chiropractic




                                                                                          522 of 545
J43 21 Non PBS Pharmaceuticals


J43 22 Podiatry


J43 23 Psychology and Counselling


J43 24 Alternative Therapies


J43 25 Natural Therapies


J43 26 Speech Therapy


J43 27 Orthotics


J43 28 Dietetics


J43 29 Occupational Therapy


J43 30 Naturopathy


J43 31 Acupuncture


J43 32 Other Therapies


J43 33 Non Surgically Implanted Prostheses and Appliances


J43 34 Hearing Aids


J43 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


                                                                                            523 of 545
J43 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J43 37 Accident Cover


J43 38 Accidental Death Funeral Expenses


J43 39 Other Special General Treatment


J43 40 Hospital-Substitute Treatment



J44 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J44 1 Table Name or Group of Table Names
Hospital Select Value

J44 2 Eligibility
A Policy Holder may register a Dependant Child as a Dependant Extension under this policy in
accordance with the definition under Rule B2 of the General Conditions.

Product closed to new members from August 17th 2010.


J44 3 General Conditions


J44 4 Hospital Treatment Payments
The Company will pay to Hospitals for Hospital Treatment received by a Policy Holder, the following
payments:

(1) In Network Hospitals – the Network Hospital Payment;




                                                                                            524 of 545
(2) In Public Hospitals – the Public Hospital Benefit; and

(3) In non-agreement Private Hospitals – the Non-Agreement Hospital Benefit (Private).


J44 5 Medical Services Payments while admitted
Where there is an MPPA, PA or Gap Cover Scheme in place, The Company will pay to Medical Practitioners
for medical services received by a Policy Holder while an Admitted Patient, the MPPA, PA or Gap Cover
Schemes Payment.

Where there is no MPPA, PA or Gap Cover Scheme in place, The Company will pay the Schedule Fee Gap
Benefit for medical services received by a Policy Holder while an Admitted Patient:

(1) to the Policy Holder; or

(2) where the Policy Holder assigns the benefit to the Medical Practitioner, to that Medical
Practitioner.


J44 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
Benefits for qualifying PBS Items supplied to an Admitted Patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.

J44 7 Non PBS Pharmaceuticals
Benefits for non PBS medications supplied to an Admitted Patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.

Policy Holders covered on a Family Extension policy receive an increased limit of $30 per person per
Calendar Year for non-PBS medications.

J44 8 Surgically Implanted Prostheses
Benefits for qualifying surgically implanted prostheses are payable in accordance with Rule E2 of the
General Conditions, whichever is applicable.

J44 9 Nursing Home Type Patients
Benefits for Hospital Treatment provided to Nursing Home Type Patients are payable in accordance
with Rule E2 of the General Conditions.

J44 10 Co Payments


J44 11 Excesses
The following annual Excess options apply per person once per Calendar Year to a maximum of twice per
Policy: - $250, $500 or $1,000.

J44 12 Benefit Limitation Periods

1. Assisted Reproductive Services:

2. Pregnancy Related Services



                                                                                               525 of 545
3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J44 13 Restricted Benefits

1. Assisted Reproductive Services:

2. Pregnancy Related Services:

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J44 14 Exclusions
1. Assisted Reproductive Services: The Company will make no payments for hospital services,
medical services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient
payments where the purpose of the hospital admission is for assisted reproductive services.

2. Pregnancy Related Services: : The Company will make no payments for hospital services, medical
services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments
where the purpose of the hospital admission is for pregnancy and birth related services.

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic: The Company will make no payments for hospital services, medical services,
pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments where the
purpose of the hospital admission is for cardiac and cardiac related services being any services
relating to the heart and surrounding arteries including but not limited to diagnostic cardiac
investigations, invasive cardiac procedures, surgical pacemakers, defibrillators, open heart and by-
pass surgery and cardiac valve surgery.

5. Plastic and Cosmetic Surgery:

6. Hip and Joint Replacements: The Company will make no payments for hospital services, medical
services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments
where the purpose of the hospital admission is for any hip or joint replacement (including revisions).



                                                                                           526 of 545
7. Other:
(a) Cataract and Eye Lens Procedures- The Company will make no payments for hospital services,
medical services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient
payments where the purpose of the hospital admission is for cataract or eye lens procedures.

(b) Renal Dialysis for chronic renal failure – The Company will make no payments for hospital
services, medical services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type
Patient payments where the purpose of the hospital admission is for renal dialysis for chronic renal
failure.

(c) Surgical Podiatry - The Company will make no payments for hospital services, medical services,
pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments where the
purpose of the hospital admission is for surgical podiatry by an accredited podiatrist.


J44 15 Loyalty Bonuses


J44 16 Other Special Hospital Treatment


J44 17 Dental


J44 18 Optical


J44 19 Physiotherapy


J44 20 Chiropractic


J44 21 Non PBS Pharmaceuticals


J44 22 Podiatry


J44 23 Psychology and Counselling


J44 24 Alternative Therapies


J44 25 Natural Therapies



                                                                                          527 of 545
J44 26 Speech Therapy


J44 27 Orthotics


J44 28 Dietetics


J44 29 Occupational Therapy


J44 30 Naturopathy


J44 31 Acupuncture


J44 32 Other Therapies


J44 33 Non Surgically Implanted Prostheses and Appliances


J44 34 Hearing Aids


J44 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


J44 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J44 37 Accident Cover



                                                                                            528 of 545
J44 38 Accidental Death Funeral Expenses


J44 39 Other Special General Treatment


J44 40 Hospital-Substitute Treatment



J45 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J45 1 Table Name or Group of Table Names
Hospital Select Plus

J45 2 Eligibility
A Policy Holder may register a Dependant Child as a Dependant Extension under this policy in
accordance with the definition under Rule B2 of the General Conditions.

Product closed to new members from August 17th 2010.


J45 3 General Conditions


J45 4 Hospital Treatment Payments
The Company will pay to Hospitals for Hospital Treatment received by a Policy Holder, the following
payments:

(1) In Network Hospitals – the Network Hospital Payment;

(2) In Public Hospitals – the Public Hospital Benefit; and

(3) In non-agreement Private Hospitals – the Non-Agreement Hospital Benefit (Private).


J45 5 Medical Services Payments while admitted
Where there is an MPPA, PA or Gap Cover Scheme in place, The Company will pay to Medical Practitioners
for medical services received by a Policy Holder while an Admitted Patient, the MPPA, PA or Gap Cover
Schemes Payment.

Where there is no MPPA, PA or Gap Cover Scheme in place, The Company will pay the Schedule Fee Gap
Benefit for medical services received by a Policy Holder while an Admitted Patient:

(1) to the Policy Holder; or

(2) where the Policy Holder assigns the benefit to the Medical Practitioner, to that Medical
Practitioner.




                                                                                               529 of 545
J45 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
Benefits for qualifying PBS Items supplied to an Admitted Patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.

J45 7 Non PBS Pharmaceuticals
Benefits for non PBS medications supplied to an Admitted Patient of a Network Hospital are payable
in accordance with Rule E2 of the General Conditions.

Policy Holders covered on a Family Extension policy receive an increased limit of $30 per person per
Calendar Year for non-PBS medications.

J45 8 Surgically Implanted Prostheses
Benefits for qualifying surgically implanted prostheses are payable in accordance with Rule E2 of the
General Conditions, whichever is applicable.

J45 9 Nursing Home Type Patients
Benefits for Hospital Treatment provided to Nursing Home Type Patients are payable in accordance
with Rule E2 of the General Conditions.

J45 10 Co Payments


J45 11 Excesses
The following annual Excess options apply per person once per Calendar Year to a maximum of twice per
Policy: - $250, $500 or $1,000.

J45 12 Benefit Limitation Periods

1. Assisted Reproductive Services:

2. Pregnancy Related Services

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J45 13 Restricted Benefits

1. Assisted Reproductive Services:

2. Pregnancy Related Services:




                                                                                         530 of 545
3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Psychiatric:

6. Rehabilitation:

7. Plastic and Cosmetic Surgery:


J45 14 Exclusions
1. Assisted Reproductive Services:

2. Pregnancy Related Services:

3. Sterilisation and Reversal of Sterilisation:

4. Cardiothoracic:

5. Plastic and Cosmetic Surgery:

6. Hip and Joint Replacements: The Company will make no payments for hospital services, medical
services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments
where the purpose of the hospital admission is for any hip or joint replacement (including revisions).

7. Other:
(a) Cataract and Eye Lens Procedures- The Company will make no payments for hospital services,
medical services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient
payments where the purpose of the hospital admission is for cataract or eye lens procedures.

(b) Renal Dialysis for chronic renal failure – The Company will make no payments for hospital
services, medical services, pharmaceuticals, surgically implanted prostheses, or Nursing Home Type
Patient payments where the purpose of the hospital admission is for renal dialysis for chronic renal
failure.

(c) Surgical Podiatry - The Company will make no payments for hospital services, medical services,
pharmaceuticals, surgically implanted prostheses, or Nursing Home Type Patient payments where the
purpose of the hospital admission is for surgical podiatry by an accredited podiatrist.

J45 15 Loyalty Bonuses


J45 16 Other Special Hospital Treatment


J45 17 Dental




                                                                                           531 of 545
J45 18 Optical


J45 19 Physiotherapy


J45 20 Chiropractic


J45 21 Non PBS Pharmaceuticals


J45 22 Podiatry


J45 23 Psychology and Counselling


J45 24 Alternative Therapies


J45 25 Natural Therapies


J45 26 Speech Therapy


J45 27 Orthotics


J45 28 Dietetics


J45 29 Occupational Therapy


J45 30 Naturopathy


J45 31 Acupuncture


J45 32 Other Therapies




                                    532 of 545
J45 33 Non Surgically Implanted Prostheses and Appliances


J45 34 Hearing Aids


J45 35 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.


J45 36 Ambulance Transportation
A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

    1) The Company will pay a refund of 100% of the cost of emergency ambulance transport by a
    fully equipped ambulance where the service is provided by a recognised ambulance service,
    including on-the-spot emergency attendances. This benefit is limited to one trip per calendar year
    for policy holders who contribute to a policy that covers only one person (a single cover) and two
    trips per calendar year for policy holders who contribute to either a single parent or family cover.


J45 37 Accident Cover


J45 38 Accidental Death Funeral Expenses


J45 39 Other Special General Treatment


J45 40 Hospital-Substitute Treatment


J46 SCHEDULE COMBINED HOSPITAL TREATMENT and
GENERAL TREATMENT TABLES
J46 1 Table Name or Group of Table Names

Ultimate Corporate Health Cover


J46 2 Eligibility




                                                                                            533 of 545
J46 3 General Conditions
7. If a policy holder takes out a general treatment service, the Company will pay benefits:

     (c) for a single service of general treatment provided to a policy holder by a recognised
         practitioner in private practice on a given day; and
     (d) for more than one service of general treatment on a given day provided by a recognised
         provider in registered premises in private practice who is recognised by the Company in more
         than one profession.

8. General treatment services must be rendered by or on behalf of a recognised practitioner for
   benefits to be payable.F

9. General treatment services must be rendered on premises registered with the Company for
   benefits to be payable.

4.    General treatment benefits are not payable for any of the circumstances outlined in Rule E 4 of
     the General Conditions.


J46 4 Hospital Treatment Payments


Benefits fully cover the cost of hospital charges raised by public hospitals and private hospitals with
which the Company has an agreement. For private hospitals with which the Company does not have
an agreement benefits are paid according to the schedule of benefits maintained by the Company.
Policy holders may not be fully covered in private hospitals with which the Company does not have
an agreement.


J46 5 Medical Services Payments while admitted

A benefit of 25% of the Government schedule fee described in the Medicare Benefits Schedule is
payable for medical services provided whilst an in-patient in a hospital or day hospital facility.
Medicare pays a benefit of 75% of the Government schedule fee for these services. Benefits are also
payable for the fee that is above the Government schedule fee in cases where the medical practitioner
either has a medical purchaser provider agreement with the Company or uses the Company's Ezyclaim
system.


J46 6 Pharmaceutical Benefits Scheme PBS Pharmaceuticals
The Company will pay the costs that a policy holder incurs for a PBS item received while admitted to
a hospital with which the Company has an agreement. No benefits are payable for PBS items received
while admitted to a hospital with which the Company does not have an agreement, or for
pharmaceuticals supplied on discharge from hospital.


J46 7 Non PBS Pharmaceuticals

The Company will pay up to $500 for the costs that a policy holder incurs for each pharmaceutical
item not covered by the PBS received while admitted to a hospital with which the Company has an
agreement. No benefits are payable for non-PBS items received while admitted to a hospital with



                                                                                             534 of 545
which the Company does not have an agreement, or for pharmaceuticals supplied on discharge from
hospital.



J46 8 Surgically Implanted Prostheses
Surgically implanted prostheses are defined by the Government as no-gap prostheses. The Company
will pay benefits that fully cover the costs of a no gap prosthesis where the prosthesis item is
implanted as part of the hospital treatment. The Company will pay the minimum benefits determined
by the Minister for a gap permitted prosthesis.


J46 9 Nursing Home Type Patients

Nursing Home Type Patients receive benefits and must make a contribution to their care as
determined by the Minister.




J46 10 Co Payments



J46 11 Excesses



J46 12 Benefit Limitation Periods

    1. Assisted Reproductive Services:


    2. Pregnancy Related Services


    3. Sterilisation and Reversal of Sterilisation:


    4. Cardiothoracic:


    5. Psychiatric:


    6. Rehabilitation:


    7. Plastic and Cosmetic Surgery:




                                                                                        535 of 545
   8. Hip Replacements:


   9. Other:


J46 13 Restricted Benefits

191.   Assisted Reproductive Services:


192.   Pregnancy Related Services:


193.   Sterilisation and Reversal of Sterilisation:


194.   Cardiothoracic:


195.   Psychiatric:


196.   Rehabilitation:


197.   Plastic and Cosmetic Surgery:


198.   Hip Replacements:


199.   Other:



J46 14 Exclusions
   1. Assisted Reproductive Services:


   2. Pregnancy Related Services:


   3. Sterilisation and Reversal of Sterilisation:


   4. Cardiothoracic:




                                                      536 of 545
    5. Plastic and Cosmetic Surgery: No benefits are payable for Cosmetic Surgery unless deemed
       clinically necessary


    6. Hip Replacements:


    7. Other:



J46 15 Loyalty Bonuses

1) After 12 months continuous membership, a policy holder is entitled to an increased benefit
   maximum equal to the first year benefit maximum for the relevant modality plus 20% of the first
   year benefit maximum. A 12 month waiting period applies from the date of joining the
    cover with the 2nd year of loyalty commencing on the first anniversary of the joining date
    and ending on December 31st.

2) For each subsequent continuous 12 months membership, the policy holder is entitled to an
   increased benefit maximum equal to their previous years benefit maximum for the relevant
   modality plus 20% of the first year benefit maximum. No further increased benefit maximums
   apply beyond 200% of the first year maximum. Loyalty bonuses do not apply to optical, massage,
   hearing aids and non surgically implanted prostheses and appliances.

3) After 3 years membership on this Table, a policy holder is eligible for a benefit of 100% towards
   the cost of Laser Correction Eye Surgery where performed by a recognised health care provider.

4) After 1 year’s membership on this Table, a policy holder is eligible for a benefit of 85% of the
   cost of a Cochlear Implant Processor.

5) After 6 months membership on this Table, a policy holder is eligible to a refund of 100% of the
   cost of a subscription to the Arthritis Foundation, Asthma Foundation, Diabetes Australia and
   Parkinson’s in Western Australia.




J46 16 Other Special Hospital Treatment
7. The Company will establish a pool to which it will credit, in respect of each policy holder:

    at the time the policy holder joins - $200
    on December 31 each year - $200

       Amounts credited to the pool will accrue.

       The policy holder may draw from the pool, accrued credits in respect of;

       (iii)     Any Co-payment that may result from services rendered to the policy holder, his
                 spouse or dependants by a medical practitioner with which the Company has a
                 Medical Purchaser Provider Agreement; or




                                                                                            537 of 545
      (iv)       Any amount exceeding 100% of the Government Schedule Fee for services rendered
                 to the policy holder, his spouse or dependants by a medical practitioner, where the
                 services were as a result of an emergency hospital admission

8. Special Benefits

      Benefits will be offered to a partner, immediate family member, carer/parent, next of kin who is
      required to stay at the hospital with the patient. The benefit is payable on the admitted person’s
      policy.

      The Benefits payable are:

    Accommodation in hospital for up to $60 per night whilst a boarder in hospital
    Benefit towards meals whilst in hospital for up to $30 per day for any hospital meals provided
    An annual limit of $1000 will apply



J46 17 Dental
Dental benefits are payable in accordance with the schedule of dental benefits maintained by the
Company. This schedule uses definitions specified in "Australian Schedule of Dental Services and
Glossary - Australian Dental Association Inc". All treatments are inclusive of routine post-operative
care.

Major dental services include crowns, bridgework, partial dentures and repairs, prosthodontic
services, periodontics, oral surgery, endodontics and oral appliances for sleep apnoea implant
prostheses and complete dentures.

The benefit for complete dentures is limited to one set of complete dentures per person every three
years.

Maximum per person during first benefit entitlement year

                 General Dental

All States                                  NIL
                 Major Dental
All States                                 Yr 1 N/A
                                           Yr 2 $800

Orthodontia
All States                                 $1400
Lifetime Limit                             $3200


J46 18 Optical

All States

Frames for prescription lenses             $216.80
Single Vision Lenses                       $103.50
Progressive Lenses                         $190.80




                                                                                           538 of 545
The Maximum per person during any one year is $300.00.


J46 19 Physiotherapy
A benefit of 100% of the cost applies for the first $350 worth of benefits claimed per person,
in a calendar year and once this sub-limit has been reached, set benefits apply.


                            NSW           QLD       SA         TAS           VIC          WA        NT
Initial visit             $65.25        $64.35   $61.20     $58.95        $64.35       $67.05    $63.45
Subsequent visit          $40.00        $52.20   $49.50     $52.20        $51.30       $55.80    $51.75
                                        Maximum per person during first benefit entitlement year
                          $750.00       $750.00   $750.00    $750.00       $750.00      $750.00 $750.00


J46 20 Chiropractic
A benefit of 100% of the cost applies for the first $350 worth of benefits claimed per person,
in a calendar year and once this sub-limit has been reached, set benefits apply.



                            NSW       QLD         SA       TAS           VIC          WA         NT
Initial visit             $69.75    $67.95    $67.50    $64.80        $68.40       $64.80     $69.75
Subsequent visit          $48.15    $48.15    $42.75    $44.55        $44.10       $44.55     $48.15
                                    Maximum per person during first benefit entitlement year
                          $500.00   $500.00    $500.00   $500.00       $500.00      $500.00 $500.00
                               Maximum per family membership during first benefit entitlement year
                          $800.00   $800.00    $800.00   $800.00       $800.00      $800.00 $800.00




J46 21 Non PBS Pharmaceuticals

After payment by the policy holder of an amount equal to the highest prescribed PBS prescription fee,
a benefit of 90% of the cost of the balance of the prescription.

The Maximum per person during first benefit entitlement year is $750 in all States.


Pharmacy Saver
Policy holders may elect to receive an additional benefit in the form of a 20% discount off the over the counter
cost of pharmaceutical items not supplied to the policy holder on the PBS purchased at participating pharmacies
provided that the item is:


(c) Designed to manage or prevent disease, injuries or a condition; or
(d) Prescribed in connection with an episode of hospital treatment.

Policy holders electing to receive this benefit will pay an additional premium as set out in Schedule K.


                                                                                                     539 of 545
J46 22 Podiatry


                         NSW         QLD       SA         TAS           VIC          WA        NT
Initial visit          $45.00      $41.80   $48.00     $44.00        $45.00       $44.00    $44.00
Subsequent visit       $35.00      $35.00   $35.00     $33.00        $35.00       $34.00    $36.00
                                   Maximum per person during first benefit entitlement year
                       $500.00     $500.00   $500.00    $500.00       $500.00      $500.00 $500.00




J46 23 Psychology

                         NSW         QLD       SA         TAS           VIC          WA        NT
Initial visit          $83.00      $83.00   $91.30     $83.00        $83.00       $88.00    $91.30
Subsequent visit       $78.00      $78.00   $85.80     $78.00        $78.00       $78.00    $85.80
                                   Maximum per person during first benefit entitlement year
                       $500.00     $500.00   $500.00    $500.00       $500.00      $500.00 $500.00




J46 24 Alternative Therapies
The following Natural (Complimentary) Therapies are covered:- Acupuncture, Alexander Technique,
Chinese herbalism, Exercise Physiology, Feldenkrais, Homeopathy, Iridology Massage, Naturopathy
and Western Herbalism.

Massage includes Aromatherapy, Bowen Technique, Kinesiology, Reflexology, Shiatsu and remedial
massage.

Year 1 benefit maximum is $500 per person.

Includes sub-limits for massage of up to $250 per person, $500 per family membership.


Benefit

Benefits are payable as set out in the Company’s Benefit Schedule.




J46 25 Speech Therapy



                                                                                        540 of 545
                         NSW           QLD       SA         TAS           VIC          WA        NT
Initial visit          $82.50        $75.00   $82.50     $75.00        $75.00       $82.50    $82.50
Subsequent visit       $50.60        $46.00   $50.60     $46.00        $49.50       $49.50    $50.60
                                     Maximum per person during first benefit entitlement year
                       $500.00       $500.00   $500.00    $500.00       $500.00      $500.00 $500.00




J46 26 Orthotics



J46 27 Dietetics

All States

Initial visit               $55.00
Subsequent visit            $30.00

The Maximum per person during the first benefit entitlement year is $500.


J46 28 Occupational Therapy

                         NSW           QLD       SA         TAS           VIC          WA        NT
Initial visit          $56.00        $56.00   $61.60     $56.00        $56.00       $56.10    $61.60
Subsequent visit       $37.40        $37.00   $40.70     $37.00        $37.00       $37.40    $40.70
                                     Maximum per person during first benefit entitlement year
                       $500.00       $500.00   $500.00    $500.00       $500.00      $500.00 $500.00




J46 39 Naturopathy

Maximum per person during first benefit entitlement year is $500 (Combined limit for acupuncture,
naturopathy, remedial massage and other therapies).


                         NSW           QLD         SA          TAS            VIC       WA             NT
Initial visit          $35.20        $35.20     $35.20       $35.20         $35.20   $35.20         $35.20
Subsequent visit       $26.40        $26.40     $26.40       $26.40         $26.40   $26.40         $26.40




J46 30 Acupuncture
Maximum per person during first benefit entitlement year is $500 (Combined limit for acupuncture,
remedial massage and other therapies).




                                                                                        541 of 545
                         NSW          QLD            SA       TAS          VIC          WA             NT
Initial visit          $35.20       $35.20        $35.20    $35.20       $35.20      $35.20         $35.20
Subsequent visit       $26.40       $26.40        $26.40    $26.40       $26.40      $26.40         $26.40




J46 31 Other Therapies
Eye Therapy
All States
Initial Visit             $60
Subsequent Visit          $40


Maximum per person during first benefit entitlement year is $500 (Combined limit for acupuncture,
naturopathy, remedial massage and other therapies).


Ante Natal and Post Natal Classes by a Midwife

Note: The Company will not pay benefits for services which have an MBS item number and are
provided outside a hospital by a participating midwife.



Annual Limit

$500 per person.


J46 32 Non Surgically Implanted Prostheses and Appliances

Benefits paid 100% of charge to annual maximums. Sub Limits apply.
Asthma Pumps

Refund of 100% of cost up to $500 sub-limit.
Limited to one appliance per person every 2 years.

Blood Glucose Monitors/INR (International Normalised Ratio) Devices

Refund of 100% of cost up to $600 sub-limit.

Limited to one appliance per person every year.

Continuous or Bilevel Positive Airway Pressure Devices
Refund of 100% up to $1000
Limited to one device per person every 2 years

Insoles
Refund of 100% for the cost of supply.
Combined limit of $1000 applies. Refer below.




                                                                                        542 of 545
Wigs
Refund of 85% for the cost of supply.
Combined limit of $1000 applies. Refer below.

Surgical Stockings
Refund of 100% for the cost of supply up to $100.
Combined limit of $1000 applies. Refer below.

TENS Machine (Transcutaneous Electronic Nerve Stimulator)
Refund of 100% for the cost of purchase..
Combined limit of $1000 applies under Defined Appliances annual maximum.. Refer below.

Blood Pressure Monitors
Refund of 85% for the cost of supply.
Combined limit of $1000 applies. Refer below.

Hire, Repair and Maintenance of a Health Appliance
$100 per person every year.

Defined Appliances
Combined limit of $1000 applies.
Refer to Rule E3.3 (6) for a list of approved defined appliances.

There is a combined maximum of $1000 per person during any one year insoles, wigs, surgical stockings and
defined appliances.

J46 33 Hearing Aids

Refund of 100% for the cost of supply of hearing aids or the cost of repairs.
This benefit is limited to one hearing aid per ear per person every 3 years and $850 per
person during any one year. Benefit for repairs is limited to $100 per person during any one
year.

J46 34 Prevention Health Management
Bowel Cancer Screening Kits

All States – a benefit of $22.00 per bowel cancer screening kit limited to one kit per person in any one
year.

Living Well Programs

The Fund will provide a cover towards selected Fund approved health related services and health
management programs that are designed to prevent or relieve a specific health condition or conditions.

Benefit

50% of the cost

Annual Limit

$100 per person




                                                                                               543 of 545
J46 35 Ambulance Transportation

A benefit of 100% of the cost of an ambulance subscription applies.

For policy holders who do not belong to an ambulance subscription scheme, the Company will pay: -

1) A refund of 100% of the cost of emergency ambulance transport by a fully equipped ambulance
   where the service is provided by a recognised ambulance service, including on-the-spot
   emergency attendances. This benefit is limited to one trip per year for policy holders who
   contribute to a policy that covers only one person (a single cover) and two trips per year for policy
   holders who contribute to either a single parent or family cover.




J46 36 Accident Cover



J46 37 Accidental Death Funeral Expenses


J46 38 Other Special General Treatment


Local and Interstate Travelling Expenses
All States
Benefit for the cost of travel.
Limited to $200 per combined patient and attendant during any one year.

Overnight Non-Hospital Accommodation
All States
Benefit of up to $75 per night
Limited to $300 per combined patient and attendant during any one year.


J46 39 Hospital-Substitute Treatment
Home Nursing

$40 per day, capped at 10 visits per year up to an annual limit of $400

The modality will include the following coverage:
   • General Care Services: Catheter Care, Continence Care, Medication Administration
      (injections, rectal vaginal suppositories for frail, enemas, dosette education), and wound
      management (post surgery, ulcer, wound drainage).

    •   Stomal Therapy

    •   Palliative Care Services – RN Care, Personal Care Assistance




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