cover comparison TUH it s my health fund! Your Queensland health fund Effective 2 April 2014

Transcription

1 Effective 2 Apil 2014 You Queensland health fund cove compaison TUH it s my health fund! PLEASE CAREFULLY READ AND RETAIN THIS BROCHURE. PLEASE READ IN CONJUNCTION WITH THE Fine Points BROCHURE.

2 waiting peiods Immediate cove 2 months Accidents All othe hospital and geneal sevices (unless specified othewise) Palliative cae Psychiatic sevices Rehabilitation Home Cae Pogams 6 months Health Bonus Midwife sevices (outpatient not coveed by Medicae) Disease Management Pogams Optical (, and Mid Range Geneal) Obstetic elated conditions Pe-existing conditions Majo dental Othodontia 12 months Postheses (non implanted) Mechanical/health appliances Plastic/econstuctive sugey (only if medically necessay) Heaing aids Midwife sevices (inpatient) 2 yeas Refactive/lase eye sugey The table on page 3 shows the hospital benefits that ae available unde ou coves. Fo a moe detailed desciption visit ou website The TUH Home Cae Pogams ae available fo all eligible membes with hospital cove. Some conditions apply fo,, Intemediate and Budget. Access Gap Cove closes the gap on out-of-pocket in-hospital medical expenses fo all membes. Paticipation is the pesonal choice of you medical pactitione, so check this befoe you commence teatment. Also ask you specialist to ecommend that any assisting specialist/s use Access Gap Cove fo the billing of sevices. Contact us on fo infomation elating to podiatic sugey pefomed by an accedited podiatic sugeon. extended dependant cove TUH offes single paents and families with nonstudent childen the oppotunity to puchase extended dependant cove. adults, who ae single, not coveed as a student dependant and eaning less than $50,000 a yea, can emain on thei paents policy until the age of 25. Extended dependant cove is available on Ultimate fo a pemium loading of appoximately 25%, fo a pemium loading of appoximately 30% and Total Cae with excess + Compehensive Geneal (HXAN) fo a pemium loading of appoximately 30%. Extended dependant cove is not available fo any othe cove. 2

3 cove compaison Benefits Ultimate Total Cae HP Total Cae (excess) HX, HE Intemediate IP Intemediate (excess) IX, IE Budget BX You choice of docto o hospital No exclusions on eligible Medicae conditions Same day accommodation Pivate oom when available Opeating theate fees 1 1 Labou wad Resticted 2 Intensive cae x x x x 1 Coonay cae when eligible fo Medicae benefits Cadiac and cadiac elated sevices Steility evesals Infetility investigations, assisted epoductive sevices Pegnancy and pegnancy elated sevices Resticted 2 x x x Hip, knee and joint investigations and econstuctions Hip, knee and joint eplacements Resticted 2 Cosmetic sugey 3 Gastic banding, obesity sugey 3 Resticted 2 Plastic and econstuctive sugey 3 Resticted 2 Podiatic sugey Resticted 2 Resticted 2 Eye sugey e.g. cataacts Psychiatic sevices Resticted 2 x x x Resticted 2 Resticted 2 x x Resticted 2 x x x Resticted 2 Rehabilitation Resticted 2 Dialysis Palliative cae Resticted 2 x x x medication chages as pe hospital contact (some limits may apply) PBS co-payment whee a hospital medication is elated to you hospital teatment Sugically implanted postheses 1 Home Cae Pogams 4 Access Gap Cove with paticipating doctos Excess 5 $300/600 $250/500 $250/500 HX $300/ 600 HE $500/ 1000 IX $300/ 600 IE $500/ 1000 $250/ Conditions apply - efe to the elevant poduct bochue. 2 Fo the sevices listed as esticted we will pay the default benefit fo accommodation as detemined by the Govenment. Any excess applicable to you cove will be chaged even whee a default benefit only is paid. The default benefit coves the cost of: shaed accommodation at a public hospital; o a educed level of accommodation benefits and no theate fee benefits in a pivate hospital; plus medical gap access gap cove with paticipating doctos sugically implanted postheses we will cove the full cost of any No Gap postheses and the minimum benefit fo Gap Pemitted postheses. 3 No benefit is payable fo hospital pocedues that ae not listed in the Medicae Benefit Schedule and/o do not meet the eligibility citeia fo the benefit of Medicae Benefits. Any excess applicable to you cove will be chaged even whee a default benefit only is paid. Only payable fo medically necessay pocedues. 4 Refe to the Fine Points bochue. 5 The hospital excess is not payable fo dependent childen, including full-time students and extended dependants. 3

4 Geneal teatments compaison Benefits Ultimate Compehensive Geneal AN Mid Range Geneal MR Basic Geneal Y Dental Peventive dental Geneal dental 1 Sugical extaction of teeth (wisdom teeth only) Majo Dental Dentues Cowns and bidges Inlays, onlays, facings Dental implants Endodontia Peiodontia Othodontia Anti snoe device Optical Glasses and contact lenses Refactive/lase eye sugey Physiotheapy Physiotheapy Hydotheapy Goup physiotheapy 2 /execise physiology 2 (including Pilates) Execise physiology Ante/post natal physiotheapy Othe theapies Psychology/hypnotheapy Dietetics/nutitionists Speech theapy Occupational theapy Podiaty Othoptics/eye theapy Othotics (custom made/customised/moulded) Audiology This table shows sevices that ae available unde ou coves. Fo full details about benefits, entitlements, yealy limits and waiting peiods visit ou website Please contact us on o enquiies@tuh.com.au to check if you geneal (extas) teatment povide is ecognised. The Ultimate,, and geneal teatments cannot be puchased alone, as these geneal teatments ae pat of a packaged poduct. 4

5 Benefits Ultimate Compehensive Geneal AN Mid Range Geneal MR Basic Geneal Y Altenative theapies Chiopactic Osteopathy Acupunctue Massage theapy Natuopathy Homeopathy Bowen theapy Aomatheapy Myotheapy Mechanical/health appliances Blood glucose/blood pessue monitos Nebulise Mechanical health appliances Health aids CPAP/APAP/BiPAP machine CPAP accessoies (eg. mask/tubing/chin stap/epais) Othe Heaing aids Health and Wellness Postheses (custom made) Phamaceutical Remote tavel and accomodation Midwife sevices (outpatient not coveed by Medicae) Home nusing and lactation nuse Health Bonus 3 School accident cove 4 Ambulance tanspot 1 Geneal dental includes the sugical emoval of teeth (including wisdom teeth). Majo dental includes all dental sevices elating to dentues, cowns, bidges, endodontia, anti snoe devices and othodontia. 2 Povided by egisteed physiotheapist/execise physiologist as pat of a teatment plan. 3 This benefit is accessible fo Compehensive Geneal in combination with any Total Cae cove (HP, HX, HE). 4 Refe to the table on page 7. 5

6 Geneal teatment limits compaison Ultimate Compehensive Geneal AN Mid Range Geneal MR Basic Geneal Y Benefits Calenda yea limits Calenda yea limits Calenda yea limits Calenda yea limits Calenda yea limits Calenda yea limits Calenda yea limits Dental Peventive dental Geneal dental 1 No limits apply No limits apply Majo dental $ * No limits apply $ oveall $600 oveall dental/majo dental $600 $600 $1000 oveall Dentues $ * $ * $ * Cowns and bidges $ * $ * $550 Inlays, onlays, facings $ * $ * Dental implants $ * $ * Endodontia $ * $ * $300 $300 Peiodontia $ * $ * Othodontia Up to $1000 $ * Othodontia (lifetime limit) * $ * $ * Anti snoe device 2 $300 $300 $300 No limits apply $600 No limits apply $ * $1000 oveall $ * $ * $ * $ * $ * -560* $ * Up to $ * * $ * $300 $300 Optical Glasses & contact lenses $ * $230 $190 Refactive/lase eye sugey $1600 ($800 pe eye) Physiotheapy Physiotheapy Hydotheapy Goup physiotheapy 3 / execise physiology 3 (including Pilates) $ * oveall $ * $700 oveall $600 oveall Included in the alt. theapies oveall limit $700 $600 $300** $190** $150** Execise physiology $250** $140** $100** $80** $ * $160 $ * oveall $ * $600 oveall oveall fo all item limits below $600 $250** $150** $150** ** $100** $100** Ante/post natal physiotheapy Othe theapies $ * (additional to the oveall physiotheapy limit) Psychology/hypnotheapy $ * Dietetics/nutitionist $ * $125 $110 $1000 oveall (additional to the oveall othe theapies limit) $350 oveall $250 $ * (additional to the oveall physiotheapy limit) $110 $85 $350 oveall $250 Speech theapy $ * $150 each $150 each Occupational theapy $ * each Podiaty $ * $250 $250 Othoptics/eye theapy $ * -240* Othotics (custom made) 4 $ * Othotics 4 (customised/moulded) $360 (included in the othotics limit above) $250 (included in the podiaty limit of ) (included in the othotics limit above) $ * $240 (included in the othotics limit above) Audiology -240* -240* 6

7 Ultimate Compehensive Geneal AN Mid Range Geneal MR Basic Geneal Y Benefits Calenda yea limits Calenda yea limits Calenda yea limits Calenda yea limits Calenda yea limits Calenda yea limits Calenda yea limits Altenative theapies Chiopactic $ * $500 oveall (not included in the oveall limit) oveall $300 (not included in the oveall limit) $450 oveall Osteopathy $300 Acupunctue $ * $350 oveall $300 (not included in the oveall limit) $300 $350 (a) with (b) Massage theapy Natuopathy Homeopathy Bowen theapy Aomatheapy Myotheapy $ * limit pe peson $ * limit pe single paent/ family membeship 5 limit pe peson $800 limit pe single paent/family membeship 5 $350 pe peson $700 pe single paent/family membeship 5 pe peson pe single paent/family membeship 5 pe peson $ * limit pe single paent / family membeship 5 $350 pe peson $700 limit pe single paent/family membeship 5 (b) with (a) above Mechanical/health appliances $ * $620 oveall $ * Blood glucose monitos Nebulise $ * $ * Mechnical health appliances Health aids $120 $120 (included in above limit) CPAP/APAP/BiPAP machine $ * $620 $120 $ * CPAP accessoies (e.g. mak/ tubing/chin stap/epais) Othe $100 $100 $100 Health and Wellness $300 $240 $150 $270 Heaing aids 2 $1000 pe ea $800 pe ea $900 pe ea Postheses (custom made) 6 $ * $500 (included in the oveall mechanical/health appliances limit) Phamaceutical $ * $500 Remote tavel and accommodation $110 $100 Midwife sevices (outpatient not coveed by Medicae) $600 Home nusing and lactation nuse $ * $ * $ * $250 $100 $600 $ * Health Bonus 7 School accident cove 8 Ambulance tanspot $125 pe single membeship $250 pe single paent/family membeship $800 pe peson $1600 pe single paent/family membeship $75 pe single membeship $150 pe single paent/family membeship pe peson $800 pe single paent/ family membeship Refe to Fine Points bochue fo details. $75 pe single membeship $150 pe single paent/family membeship * Limit inceases with yeas of membeship. ** Sublimits apply. 1 Geneal dental includes the sugical extaction of teeth (including wisdom teeth). Majo dental includes all dental sevices elating to dentues, cowns, bidges, inlays, onlays, facings, dental implants, peiodontia, endodontia, anti snoe devices and othodontia. 2 Replacement evey 3 yeas fom date of pevious supply. Lette fom medical pactitione (not a dentist) is equied fo anti-snoing device. Docto/audiologist lette must be submitted with claim fo left and ight eas fo heaing aids. 3 Povided by an appoved health pofessional. 4 When ecommended by an appoved health pofessional. 5 An individual within the family cove can claim up to the pe peson limit, povided the family as a whole has not exceeded its family membeship limit. This also applies to a single paent cove. 6 Custom made 1 pe yea. Fo non-implanted TUH appoved posthetic appliances when odeed by a medical pactitione. 7 Health-e-Pofile paticipation equied. Conditions apply. 8 Conditions apply. Fo details on limits and sub limits efe to ou website 7

8 website: phone: St Pauls Teace Fotitude Valley Queensland 4006 PO Box 265 Fotitude Valley Queensland 4006 ABN Fo moe infomation on all ou poducts, govenment initiatives and TUH membeship ules visit