Only the best of care, since 1977

Transcription

1 Only the best of care, since 1977 Effective date: 1 April 2015

2 CONTENTS Welcome to Doctors Health Fund Things you need to know Who can be a member of Doctors Health Fund? It s so easy to join Continuity when transferring from another fund Australian Government private health insurance initiatives Changing your insurance Financial things you need to know The Private Health Insurance Code of Conduct How we manage your privacy How we handle problems and complaints About hospital insurance Top Cover Prime Choice Smart Starter About extras insurance Total Extras Essential Extras Direct Debit Service Agreement For more information visit

3 Welcome to Doctors Health Fund Doctors Health Fund has been providing private health insurance to the medical community since Our health insurance products provide protection from the impact of healthcare incidents in your life. As a restricted health fund, we strive to ensure our products meet your requirements. How we are different With Top Cover for hospital you will receive benefits up to the AMA list of services and fees and have complete freedom in your choice of doctor. Your doctor does not have to agree to participate in any medical scheme for you to receive this benefit. We don t have preferred provider arrangements, so our members have their own choice of providers for all extras benefits. Use the dentist of your choice and get 100% cover on general dental check up items up to two times a year. A high level of optical cover is offered in both of our extras insurance products. Choose any hospital insurance product and any extras insurance product from our range to create a combination to suit your needs. We encourage you to actively consider the level of cover you want and expect from your health insurance. We are happy to answer any questions you may have and discuss the things you should consider when selecting your private health insurance. While price and taxation considerations are important, so is having the cover which will work for you. For any assistance please contact our Customer Service team on or info@doctorshealthfund.com.au The information in this brochure was correct at the time of publication in May Any changes to the information in the brochure will be published on our website at doctorshealthfund.com.au Call our Customer Service team on

4 THINGS YOU NEED TO KNOW A range of topics relevant to choosing and applying for health insurance are on the following pages and further information is available on our website in a section called Understanding Health Cover. Information about hospital insurance and the product descriptions starts on page 7. Information about extras insurance and the product descriptions starts on page 16. We write our product descriptions as clearly as possible and try to provide all the information you need to choose private health insurance which will suit your needs. However, if you have any questions please contact our Customer Service team on or info@doctorshealthfund.com.au Who can be a member of Doctors Health Fund? Eligibility for Membership of Doctors Health Fund To be eligible to be a member of Doctors Health Fund you must be or have been: 1. A registered Medical Practitioner* 2. A registered Health Practitioner** in one of the following categories: medical medical radiation*** optometry dental**** occupational therapy physiotherapy psychology 3. A person studying to become a practitioner in the first 2 points above, at an Australian educational institution. 4. An overseas qualified doctor who is registered for the AMC exams. 5. An employee of a Medical Practitioner or a Health Practitioner or an officer or employee of an incorporated practice of a Medical Practitioner or a Health Practitioner. 6. Employed in any role by a federal or state Australian Medical Association (AMA), or an associated or subsidiary organisation of an AMA. 7. Employed in any role by an association whose members are Medical Practitioners or Health Practitioners. 8. An officer or employee (including contractors) of Avant Insurance Limited (ABN ) or Avant Law Pty Ltd (ACN ). 9. The partner, child, grandchild, parent, sibling, former partner, or the partner of an adult child of any person qualified in points 1-8. Once you have been eligible to be a member of the Fund you retain the right to remain a member, even if you change employment or cease to fulfill the criteria above. Please contact us on if you would like help in determining your eligibility. 2 For more information visit

5 Definitions: * Medical Practitioner means a person who is, or was at any time, registered or licensed as a medical practitioner under a law of a State or Territory that provides for the registration or licensing of medical practitioners. ** Health Practitioner means a person who is, or was at any time, in one of the above categories of health practitioner, as listed in the Health Practitioner Regulation National Law Act 2009 (QLD) (whether or not registered or practising in Queensland or any other Australian State or Territory). *** Medical radiation means a person working as a medical radiation practitioner, diagnostic radiographer, medical imaging technologist, radiographer, nuclear medicine scientist, nuclear medicine technologist or radiation therapist. **** Dental means a person working as a dentist, dental therapist, dental hygienist, dental prosthetist or oral health therapist. It s so easy to join After you have read the product descriptions and chosen your health insurance, simply apply online and let us do the work for you. With your authorisation we can organise the following things for you: your transfer from another health insurer set up automatic payments set up faster payment of claims, direct to your account register you for the government rebate Retain a copy of this brochure in your records so you know the details of the hospital and extras health insurance products you have chosen. Once your membership starts, a 30 day cooling off period commences. During this time you can choose to cease your membership, or if you have increased your cover you can revert to your previous level of cover, and we will refund the contributions you paid. Of course, if any claims have been paid they will be deducted from the contributions before they are refunded. Continuity when transferring from another fund Any waiting periods that you have served with another fund are recognised by Doctors Health Fund, when your new insurance has equal levels of benefits and you join us within two months of leaving your former fund. If your new cover with Doctors Health Fund has greater benefits on any service, you will need to serve the waiting period for that service, as shown on the product descriptions in this brochure. Benefits that you have been paid by your previous fund, on any services that have benefit limits, will be reported on the transfer certificate and you will only be able to claim the remaining amount of your benefit limit for those services on your new insurance policy. Some accumulated benefits do not carry over from another fund. Benefits that increase due to length of membership, such as orthodontic benefits, will generally carry over. Call our Customer Service team on

6 THINGS YOU NEED TO KNOW The Doctors Health Fund will handle the transfer process for you. Legislation requires your previous health fund to send us your transfer certificate within 14 days of your termination date. Australian Government private health insurance incentives To encourage Australians to protect themselves with private health insurance, the Commonwealth Government has introduced the following programs. Australian Government Rebate on private health insurance The Australian Government has introduced legislation to means test the rebate effective 1 July 2012, based on your income level. The table below details the different rebate amounts and Medicare Levy Surcharge levels as at 1 April Singles $90,000 $90, ,000 $105, ,000 Families $180,000 $180, ,000 $210, ,000 Rebate Under age % % 9.273% Age % % % Age % % % Medicare Levy Surcharge All ages 0.0% 1.0% 1.25% *If you re a family with children, the income threshold for each tier is increased by $1,500 for every child after your first. Family includes couples and single parent families. For further information as to how this change may affect you, please visit our website at doctorshealthfund.com.au Lifetime Health Cover Lifetime Health Cover (LHC) is another Government initiative, which is designed to encourage people to take out and maintain hospital insurance earlier in life. To avoid paying a LHC loading, you need to take out a private health insurance hospital policy by the 1st of July following your 31st birthday. For each year you delay, you will pay 2% more for your premium, up to a maximum of 70%, as stipulated by the Government LHC guidelines. If you were born before 1 July 1934, you are exempt from LHC. Once you have paid a LHC loading on your private health insurance for 10 continuous years, the loading is removed as long as you retain your hospital cover. Some other special circumstances apply, which are described below. To cover small gaps, such as switching from one insurer to another, you are able to be without private health insurance for periods totaling 1,094 days (i.e. three years less one day) during your lifetime, without affecting your loading. As a new migrant to Australia, if you are aged 31 or over, you will not have to 4 For more information visit

7 pay a LHC loading if you take out private health insurance within 12 months of being registered for Medicare. After this time you will have to pay 2% more for each year you are aged over 30 when you take out private health insurance. What happens to the Australian Government Rebate on private health insurance under Lifetime Health Cover? From 1 July 2013, if you are eligible for the Australian Government Rebate on private health insurance, this will apply to your base hospital premium only and will not apply to the portion of your hospital premium that has the Lifetime Health Cover loading. Your LHC base day is the deadline by which you must have taken out private hospital insurance to avoid incurring a LHC loading. For most people this will be 1 July following their 31st birthday, although there are exceptions to this. If you are a new migrant to Australia, your LHC base day is the later of 1 July following your 31st birthday and the anniversary of when you register for full Medicare benefits. A Lifetime Health Cover calculator and further information can be found at Changing your insurance You can make changes to your insurance at any time. Either use our online member services to make the updates or fill out an application and membership changes form which is available on the website. Your username on our online member services portal is your membership number. Financial things you need to know Selecting direct credit for your claim payments reduces the time it takes to pay your claims and for you to receive the payment. For contribution premiums, you can pay by direct bank debit, Mastercard or Visa. Selecting a direct debit option is a convenient and flexible way to pay your premiums. If your contributions are not up to date claims cannot be paid. Once a year the Australian Government considers private health insurers submissions for a price rise on their products. We send a submission and pricing request for approval by the Minister for Health. We notify you of price increases in March. The Private Health Insurance Code of Conduct Doctors Health Fund has adopted this code of conduct which aims to improve the standards of practice and service in the private health insurance industry. The code sets standards for providing information to customers, staff training and dispute resolution. The Code of Conduct can be found at and a link is on our website. Call our Customer Service team on

8 THINGS YOU NEED TO KNOW How we manage your privacy To provide health insurance services to you as a member, Doctors Health Fund collects information that includes your personal details, financial information and medical information. We treat personal information with respect and care, to protect it from misuse, loss, unauthorised access, modification or disclosure. Our privacy policy can be found at doctorshealthfund.com.au How we handle problems and complaints Doctors Health Fund is always happy to receive feedback, and wants to solve problems and resolve complaints. To reduce the likelihood of potential problems arising, we encourage members to familiarise themselves with the health insurance products they have purchased, to make informed decisions for when they need healthcare services. In the Member Zone on the Fund website you will find sections on managing and using your health cover. Making a complaint We handle complaints following our Complaints Resolution Policy and Australian Government requirements of private health insurance funds. There are three stages to the process: 1. Contact the Head of Operations by phone, fax, or post to PO Box Q1749 Queen Victoria Building Sydney NSW If you are not satisfied you can then raise your complaint with The CEO, Doctors Health Fund. 3. If we cannot resolve the complaint to your satisfaction you can contact the Private Health Insurance Ombudsman. The Private Health Insurance Ombudsman is a Commonwealth Government agency charged with providing an independent service to help consumers with health insurance problems and enquiries. The Private Health Insurance Ombudsman Freecall Complaints Hotline: info@phio.org.au Web: Mail: Suite 2, Level 22, 580 George St, Sydney NSW 2000 Telephone: (02) Facsimile: (02) For more information visit

9 HOSPITAL INSURANCE PRODUCTS About hospital insurance The basics Hospital insurance covers you while you are an admitted patient in a hospital or day-only facility. Only Medicare recognised treatment is covered by hospital insurance. Benefits for a consultation with a doctor prior to being admitted or after you have been discharged from hospital can only be claimed from Medicare. Hospital insurance - our gap cover is different We offer two medical services gap cover schemes so you can choose a level of financial protection which suits you for those times when you are an admitted patient. AMA Gap cover Our Top Cover for hospital is unique. It offers premium medical gap cover. This means that on any Medicare eligible service you will receive a benefit up to that listed on the AMA List of services and fees. You will only have outof-pocket expenses for Medicare recognised services, when your doctor charges above the AMA List of services and fees. As your doctor doesn t have to agree to participate in this gap scheme you have complete freedom to choose your doctor. Access gap cover scheme Our Prime Choice and Smart Starter hospital products, use the Access Gap Cover scheme which can reduce or eliminate your medical services outof-pocket expenses. This scheme has a record of covering 90% of services with no patient out-of-pocket expense. Ask your doctor if they and any other doctors involved in your treatment will treat you under the gap scheme. The accounts they provide need to be marked as Access Gap Cover scheme accounts. When your doctors choose not to participate in the Access Gap Cover scheme you will be covered to the Medicare schedule fee. See the example in the table on the next page to compare the different medical benefit outcomes. Contracted gap cover Our contractual arrangements with most pathology and radiology providers apply to all our hospital insurance products. The delivery of services by these contracted providers will have no out-of-pocket expense. Claims for services from providers who do not have contracts with the Fund can be handled under the medical services gap cover in the hospital products. Call our Customer Service team on

10 HOSPITAL INSURANCE PRODUCTS Medical services benefits for a knee reconstruction, item no $3, $2, $1, Top Cover maximum benefit for a knee reconstruction. Includes Medicare benefit plus the AMA gap benefit. Prime Choice & Smart Starter maximum benefit for a knee reconstruction in VIC, the benefit varies by State. Includes Medicare benefit plus the Access gap benefit. Medicare Schedule fee payable for a knee reconstruction. Includes the 75% paid by Medicare and 25% paid by the Fund. Contracts and cover which protect you By negotiating contracts with hospitals we are able to establish conditions which help keep the cost of your health insurance down. Using a contracted hospital will provide you with the maximum cover for the hospital service components of your treatment, including accommodation, theatre and pharmaceuticals. We have contracts in place with the majority of Australian private hospitals. Access to the search facility for contract hospitals can be found on our website at doctorshealthfund.com.au When you need a prosthesis, maximise your cover by checking with your doctor that a government approved prosthesis will be used. Our ambulance cover protects you in the event of an emergency or medical necessity for this service, anywhere in Australia. Keeping everyone covered when you re having a baby If you are planning to have children check that your hospital cover includes obstetrics. These are the services associated with pregnancy and birth of a baby. Hospital cover has a 12 month waiting period for making claims for all in-patient services related to an obstetrics admission. After the birth, all you need to do for your baby to be covered is to contact the fund to add them to your membership within two months from the date of their birth. This means moving to a family membership if you are not already on that level of cover. This will ensure your child does not serve any additional waiting periods. Pre-existing medical conditions A pre-existing ailment, illness or condition is one where there were signs or symptoms present that a doctor would have detected during the six months before you took your hospital insurance or upgraded your hospital insurance. There is a 12 month waiting period before benefits will be paid 8 For more information visit

11 for treatment of pre-existing conditions. The Fund s medical advisor makes the decision about whether your condition is pre-existing and if the waiting period will apply. The waiting period for treatment that is psychiatric care, rehabilitation or palliative, whether or not for a pre-existing condition, is two months. Full descriptions of the hospital insurance products are on pages Claiming your benefits for hospital treatment Hospitals will deal directly with the Fund to claim payment. Direct billing for medical services claims The most efficient way to make medical services claims is called direct billing. You don t have to go to Medicare. The Fund processes the entire claim for you including the claim to Medicare. Whether you are covered by Top Cover, Prime Choice or Smart Starter your doctors should always submit the bills for your treatment in hospital directly to Doctors Health Fund. If you are covered by Prime Choice or Smart Starter and your doctors have agreed to treat you under the Access Gap Cover scheme, but they send their bills to you, check they have been marked as Access Gap Cover accounts before submitting them to the Fund with a claim form. Send your claim to: Mail: The Doctors Health Fund Pty Ltd PO Box Q1749 Queen Victoria Building Sydney NSW 1230 A claim form can be obtained from our website at doctorshealthfund.com.au Call our Customer Service team on

12 HOSPITAL INSURANCE PRODUCTS Top Cover - unique cover with AMA gap Excess Waiting periods Exclusions Benefit restrictions Ambulance Accommodation Hospital services None None for accidents 12 months for pre-existing conditions 12 months for obstetrics 2 months for palliative care, rehabilitation and psychiatric treatment 2 months for everything else None Plastic and reconstructive surgery, and other service benefits for hospital and medical costs, are restricted to services eligible for Medicare benefits. When chosen for cosmetic reasons only default hospital accommodation benefits apply and no medical benefits are paid. National cover for emergency and medically necessary ambulance services when: an ambulance is called to attend you but you are not subsequently taken to hospital it is medically necessary for you to be transported by an ambulance to be admitted to hospital you need immediate medical attention at a hospital or other approved facility you are an admitted patient and need to be transferred to another hospital In a contracted private hospital or dayonly facility, or a public hospital as a private patient, all costs of accommodation are covered. In non-contract hospitals or day-only facilities the lowest contracted benefit is paid and you can expect to have out-of-pocket expenses. Search contracted hospitals on our website at doctorshealthfund.com.au All costs are covered for theatre and labour ward services while you are an admitted patient in a contract hospital. 10 For more information visit

13 AMA gap cover Pharmaceuticals Prostheses Other Examples of what you can expect to pay if you go to hospital The cost of doctors services delivered while an admitted patient is covered by our premium gap cover. Medicare pays 75% of the Medicare Schedule fee and your Fund benefits pay the remainder up to a total equal to the AMA List of services and fees. You pay any amount charged above the AMA List of services and fees. Most pathology and radiology providers have contracts with us, so while you are an admitted patient most of these services will have no out-of-pocket expense. Medical service claims should always be submitted directly to the Fund by your doctor or you. In a contracted private hospital or dayonly facility, or a public hospital as a private patient all costs of PBS pharmaceuticals related to the condition being treated are covered, and the cost of non-pbs items related to the condition being treated are covered as per the contract with the hospital. In non-contract hospitals or dayonly facilities the lowest contracted benefit is paid and you can expect to have out-ofpocket expenses. Covers 100% of the minimum cost specified for government approved prostheses. Up to $100 per day for travel and accommodation where a doctor certifies the need for a parent, spouse or child to be with a member in hospital more than 200 kms from home. An annual limit of $1,000 applies. Prostheses cost if charged above the minimum cost Personal items such as newspapers and television hire Call our Customer Service team on

14 HOSPITAL INSURANCE PRODUCTS Prime Choice - comparable to most other funds premium cover Excess Waiting periods Exclusions Benefit restrictions Ambulance Accommodation Prime choice can be taken with or without an excess. If you choose to take an excess: Singles - up to $500 per calendar year. Couple, single parent and family memberships - up to $1000 per calendar year. An excess of up to $500 is paid per admission until the full amount of excess is paid for the year. The total excess amount applies to the entire membership not each person covered by the membership. None for accidents 12 months for pre-existing conditions 12 months for obstetrics 2 months for palliative care, rehabilitation and psychiatric treatment 2 months for everything else None Plastic and reconstructive surgery, and other service benefits for hospital and medical costs are restricted to services eligible for Medicare benefits. When chosen for cosmetic reasons only default hospital accommodation benefits apply and no medical benefits are paid. National cover for emergency and medically necessary ambulance services when: an ambulance is called to attend you but you are not subsequently taken to hospital it is medically necessary for you to be transported by an ambulance to be admitted to hospital you need immediate medical attention at a hospital or other approved facility you are an admitted patient and need to be transferred to another hospital In a contracted private hospital or day-only facility, or a public hospital as a private patient all costs of accommodation are covered after any excess is paid. In non-contract hospitals and day-only facilities the lowest contracted benefit is paid and you can expect to have out-of-pocket expenses. Search contracted hospitals on our website at doctorshealthfund.com.au 12 For more information visit

15 Hospital services Access gap cover scheme After the excess is paid all costs are covered for theatre and labour ward services while you are an admitted patient in a contracted hospital for included services. The cost of doctors services delivered while you are an admitted patient can be covered by the Access Gap Cover scheme which reduces or eliminates your medical services out-of-pocket expenses. When your doctor agrees to participate in the Access Gap Cover scheme the Fund covers the scheme s scheduled amount for your treatment. The doctor may choose to charge you a payment above the scheme s scheduled amount. This may be no more than $400 per service or for the birth of a child no more than $800 for the confinement. Most pathology and radiology providers have contracts with us, so while you are an admitted patient most of these services will have no out-of-pocket expense. Claims using this gap scheme should be submitted directly to the Fund. Check that your doctors have marked any bills sent to you as Access Gap Cover accounts. To find doctors who participate in this gap scheme use the Doctor Search facility on our website. Pharmaceuticals In a contracted private hospital or day-only facility, or a public hospital as a private patient all costs of PBS pharmaceuticals related to the condition being treated are covered, and the cost of non-pbs items related to the condition being treated are covered as per the contract with the hospital. In non-contracted hospitals and day-only facilities the lowest contracted benefit is paid and you can expect to have out-of-pocket expenses. Prostheses Covers 100% of the minimum cost specified for government approved prostheses. Other Up to $70 per day for travel and accommodation where a doctor certifies the need for a parent, spouse or child to be with a member in hospital more than 200 kms from home. An annual limit of $800 applies. Examples of what you can expect to pay if you go to hospital Your excess Prostheses cost if charged above the minimum cost Personal items such as newspapers and television hire If your doctor does not wish to participate in the Access Gap Scheme, the Fund will only pay benefits up to the Medicare Schedule Fee Call our Customer Service team on

16 HOSPITAL INSURANCE PRODUCTS Smart Starter - basic cover, available to singles and couples only Excess Waiting periods Exclusions Benefit restrictions Ambulance Accommodation Singles - up to $500 per calendar year. Couple memberships - up to $1,000 per calendar year. An excess of up to $500 is paid per admission until the full amount of excess is paid for the year. The total excess amount applies to the entire membership not each person covered by the membership. None for accidents 12 months for pre-existing conditions 2 months for palliative care, rehabilitation and psychiatric treatment 2 months for everything else covered No benefits are paid for: Pregnancy related services Assisted reproductive services Sterilisation and reversal of sterilisation Hip and knee replacements and revisions Cataract and glaucoma treatment Gastric banding and obesity surgery Plastic surgery and other services which are excluded from Medicare coverage The below services are limited to delivery as a private patient in a public hospital: Cardio-thoracic surgery, Psychiatric services are limited to an initial 10 days per annum in a private hospital, Dialysis for chronic renal failure Rehab services following cardio- thoracic, psychiatric, hip and knee replacement and revisions. National cover for emergency and medically necessary ambulance services when: an ambulance is called to attend you but you are not subsequently taken to hospital it is medically necessary for you to be transported by an ambulance to be admitted to hospital you need immediate medical attention at a hospital or other approved facility you are an admitted patient and need to be transferred to another hospital. In a contracted private hospital or day-only facility, or a public hospital as a private patient all costs of accommodation are covered after the excess is paid, for included services 14 For more information visit

17 Hospital services Access gap cover scheme Pharmaceuticals Prostheses Other Examples of what you can expect to pay if you go to hospital In non-contracted hospitals or day-only facilities the lowest contracted benefit is paid and you can expect to have out-of-pocket expenses. Search contracted hospitals on our website at doctorshealthfund.com.au After the excess is paid all costs are covered for theatre services while you are an admitted patient in a contract hospital. The cost of doctors services delivered while you are an admitted patient can be covered by the Access Gap Cover scheme which reduces or eliminates your medical services out-of-pocket expenses. When your doctor agrees to participate in the Access Gap Cover scheme the Fund covers the scheme s scheduled amount for your treatment. The doctor may choose to charge you a payment above the scheme s scheduled amount. This may be no more than $400 per service. Most pathology and radiology providers have contracts with us, so while you are an admitted patient most of these services will have no out-of-pocket expense. Claims using this gap scheme should be submitted directly to the Fund. Check that your doctors have marked any bills sent to you as Access Gap Cover accounts. To find doctors who participate in this gap scheme use the Doctor Search facility on our website. In a contracted private hospital or day-only facility, or a public hospital as a private patient, all costs of PBS pharmaceuticals related to the condition being treated are covered, and the cost of non-pbs items related to the condition being treated are covered as per the contract with the hospital. In non-contracted hospitals and day-only facilities the lowest contracted benefit is paid and you can expect to have out-of-pocket expenses. Covers 100% of the minimum cost specified for government approved prostheses. Up to $70 per day for travel and accommodation where a doctor certifies the need for a parent, spouse or child to be with a member in hospital more than 200 kms from home. An annual limit of $500 applies. Your excess Prostheses cost if charged above the minimum cost Personal items such as newspapers and television hire If your doctor does not wish to participate in the Access Gap Scheme, the Fund will only pay benefits up to the Medicare Schedule fee Call our Customer Service team on

18 EXTRAS INSURANCE PRODUCTS About extras insurance Extras services cover certain healthcare services such as dental, optical and physiotherapy, which are not covered by Medicare. Our extras insurance difference Our extras products offer great benefits across a number of areas including: Optical cover up to $500 over any two consecutive calendar years. When making a claim, the previous and current year claims cannot exceed $500. You can logon to online member services to check your optical benefits balance before making a claim. The non-pbs pharmaceuticals cover pays 85% of the cost of the prescription after you have paid the current PBS prescription cost. For a non-pbs prescription which costs $150, our cover would pay $ Full descriptions of the extras insurance products are on pages Service providers and benefit payments Many services included in extras insurance are delivered by registered practitioners who are governed by systems which register and recognise them as providers. The Fund pays benefits on services delivered by a wide range of these allied health practitioners including dentists, orthodontists, endodontists, periodontists, oral surgeons, prosthodontists, pedodontists, ophthalmologists, optometrists, registered nurses and midwifes, practitioners of orthoptics, occupational therapy, speech therapy, dietetics, podiatry, physiotherapy and psychology. If you are unsure whether your provider is covered, please give us a call. Remedial massage and Myotherapy Remedial massage does not operate under a standard system of registration control. For the Fund to pay benefits for remedial massage and myotherapy services the provider must either be a registered physiotherapist or have accreditation in remedial massage therapy or myotherapy with an organisation that adheres to the Department of Health and Ageing governed systems for registration and recognition of them as providers. Claiming your benefits for extras services Extras or ancillary service claims can often be made at the provider s office via the electronic HICAPS system, with no need to submit a claim to the Fund. The provider simply swipes your membership card and you pay any difference between the service charge and the benefit paid and there s no paperwork to do. If electronic claiming isn t available, Doctors Health Fund offers a mobile claiming app. You simply take a picture of your receipt and submit through the app, and we will reimburse your expense, according to cover limits, to your nominated account. Alternatively, you can also scan and your receipt and claim form to info@doctorshealthfund.com.au or submit to: Mail: The Doctors Health Fund Pty Ltd PO Box Q1749, Queen Victoria Building Sydney NSW 1230 Fax: A claim form can be obtained from our website at doctorshealthfund.com.au 16 For more information visit

19 Call our Customer Service team on

20 EXTRAS INSURANCE PRODUCTS Total Extras - premium cover with better benefits Waiting periods Limits 12 months for major dental services, aids and appliances 24 months for hearing aids 2 months for all other services Limits per person per calendar year, except where otherwise indicated ITEM LIMITS BENEFITS PAID General dental services No annual limits 100% paid for specified examinations and scale and clean, up to two times per year, as long as the fees are within the range of usual, customary and reasonable charges. Fixed benefits paid for all other items. Major dental services Major dental restorations $1,000 Endodontic/periodontic $1,000 Crowns & bridges $1,200 Dentures and prosthodontics $1,000 Orthodontics $600 per year of membership accumulating to a lifetime limit of $3,000 Optical category limit $500 limit over any 2 consecutive calendar years. Claims made in the current and prior year cannot exceed $500. Fixed benefits paid per item 18 For more information visit