THE HEALTH BENEFITS GUIDE FOR EVERYONE

Transcription

1 Healthy you! THE HEALTH BENEFITS GUIDE FOR EVERYONE EFFECTIVE 1 APRIL 2014 EHWĦHU KHDOŦ FRYHU VKRXOGQÚW KXUW

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3 Welcome TO QUEENSLAND COUNTRY OUR PURPOSE OUR HISTORY Queensland Country Health Fund ( Queensland Country ) is a Member focused Health Fund. WE EXIST: TO PROVIDE INDUSTRY LEADING BENEFITS THAT SUIT BOTH THE MARKET AND THE NEEDS OF OUR MEMBERS AND; TO PROMOTE GOOD HEALTH AND WELLBEING OF THE PEOPLE IN OUR COMMUNITIES. Queensland Country Health Fund has been in the business of providing private health insurance cover to Queenslanders for over 30 years. Established in 1977 as the MIM Employees Health Society, the fund was developed to assist Members to protect themselves against the financial burden of rising hospital and ancillary health care costs. In January 1999 we began trading as Queensland Country Health Fund continuing the traditions of affordable and comprehensive health cover backed by superior, personalised and genuine service. Whether you re new to health insurance or just thinking about making a move from another insurer, give us a call to find out how exceptional benefits and genuine service makes a refreshing change! CONTENTS» Why private health insurance? 2» Why us? 4» Which cover is right for you? 6» Hospital cover 8» Extras cover 16» On-the-spot claiming 22» How to join 24» How to pay contributions 25» In more detail 26» Government initiatives 31» Private Health Insurance Complaints 33 1

4 Got the itch to switch?? WHY PRIVATE HEALTH INSURANCE? HAVE EXISTING HEALTH INSURANCE? WHETHER YOU RE LOOKING FOR YOURSELF OR YOUR FAMILY, QUEENSLAND COUNTRY HAS YOU COVERED. IT S TOO EASY TO TRANSFER - HOW IT ALL WORKS!! At Queensland Country we believe Private Health Insurance should be easy to understand, easy to claim on but, most of all, it should be easy to join or transfer to us in the first place! WILL I NEED TO SERVE ANY WAITING PERIODS WHEN I SWITCH TO QUEENSLAND COUNTRY? No Queues! Avoid waiting times in the Public system TOTAL KNEE REPLACEMENT DAYS REMOVAL OF TONSILS DAYS CATARACT SURGERY DAYS HEART SURGERY - 75 DAYS 10% OF PEOPLE ON THE LIST WAITED LONGER THAN THESE TIMES. Queensland waiting times at 90th percentile as reported by the Australian Institute of Health and Welfare, Australian Hospital Statistics Having private health insurance definitely has it s rewards. It affords you the peace of mind and the security of health care options and benefits simply not available today through the public health care system. Following is an example of some of these costs: ø Child birth $8,243 ø Hip replacement $25,565 ø Knee replacement $18,326 PRIVATE HEALTH COVER ENABLES YOU TO: Choose your doctor - Receive continuity of care by the specialist who knows you best! Choose your hospital - Have more control over where you are treated! Choose when you are treated - Get back on your feet sooner with shorter waiting times for elective surgery! Lock in your Lifetime Health cover age - Take out hospital cover early in life to guarantee lower premiums! Pay less tax - Take out hospital cover and avoid having to pay the Medicare Levy Surcharge! If you switch from another Australian registered health fund, you are guaranteed portability of cover by law. What this means is that you can transfer from one health fund to another without having to re-serve waiting periods you ve already served with your current fund. We ll recognise any waiting periods (or portions of waiting periods) you ve already served if you join us within 63 days of leaving your previous health fund. The only time waiting periods apply when you transfer to us from another fund is when your Queensland Country cover offers a higher level of benefits than your previous cover. In this case, you ll be entitled to the same level of benefits as you had under your previous cover until you ve served the waiting period for the higher level of benefits. If you transfer from a cover with a higher excess to one with a lower excess (for example, from a $500 excess to a $250 excess), that counts as an upgrade in your cover. In this case you may have to pay your previous higher excess until you ve served the waiting period for the new, higher level of cover. WHAT WE NEED! To complete the transfer to Queensland Country, you will be provided with a Transfer Certificate from your previous health insurance fund. This important document confirms your health cover history, your Lifetime Health Cover status, and ensures you receive continuity of cover by ensuring that we apply all appropriate waiting period waivers. If your existing health fund sends your Interfund Transfer/Clearance Certificate to you, and not us, you ll need to forward the certificate to us. Your transfer certificate is required before any benefits can be paid. Image + graphics here Join or Switch to Queensland Country today! 2 3

5 Why us? MEMBER FOCUSED At Queensland Country our primary focus is on continually exploring ways to satisfy the needs of our policy holders. Not having shareholders to satisfy, allows us to invest heavily in making our policy holders experience unique and refreshing. We are driven to design and deliver exceptional value private health insurance products, whilst maintaining a simpler and more satisfying experience for our growing, loyal Member base! ADULT CHILDREN ARE ALSO COVERED Your adult children can remain on your family cover until the age of 21 at no extra cost, and can continue to stay on the family policy if they are studying full-time or an apprentice earning up to $30,000 p.a. and are not married or in a defacto relationship. If they are not studying full-time or an apprentice we have our Family Plus option. A higher premium is payable but it can be more cost effective than if they were to take out their own cover at the same level. For more information please see page 27. HAPPY MEMBERS To ensure we maintain our high service standards, and to ensure our products continually meet our policy holders needs, every year Queensland Country conduct a survey of its Members to ensure we keep touch with what our Members really think! The good news is that from our last Member survey in 2014 we were pleased to hear that 98% of respondents voiced that they were satisfied with Queensland Country. We will always strive to improve our already highly regarded reputation for exceptional Member service, to ensure our policy holders always have a smile on their face! r AUSTRALIA-WIDE COVER Being the only regionally based health insurer in Queensland enables us to understand the health care needs of people in this state better than anyone. However, policy holders who move, work or play interstate can also rest easy. Queensland Country in conjunction with the Australian Health Service Alliance (AHSA) have entered into an agreement with most private hospitals and medical practitioners throughout Australia. This ensures peace of mind and ensures that our policy holders receive maximum cover for in-hospital services within Australia, where ever they may go! HOME AWAY FROM HOME! As the majority of our policy holders live in regional and remote areas of Queensland, it is often necessary for people to travel to Townsville or Brisbane for essential medical treatment. This can mean high accommodation expenses for family accompanying the patient. Queensland Country has addressed this issue for policy holders with the purchase of a number of two bedroom furnished apartments. McIlwraith on the Park in the Brisbane suburb of Auchenflower, close to the Wesley Hospital and Roy Harris Place in Townsville, near the Mater Hospital in Pimlico, provide our Members with a home away from home. These units are available at concessional rates for our policy holders exclusively for use associated with a medical need. MANAGING YOUR MEMBERSHIP ONLINE Not only can you get product information from our website, but once you are a Member you can securely access and even update a range of details concerning your cover. You can do a lot of things that you may normally expect to have to call us for; this gives you greater control over your cover and gives you the ability to update your details whenever you need to. All you need to do is visit our website com.au and register with our online services on the homepage. This will give you access to our system and you ll be able to update a variety of details. It will take just a minute to register. For more information please see page 23. SPONSORSHIPS AND COMMUNITY SUPPORT Queensland Country is committed to supporting its local communities, and in doing so is proud to be a major sponsor of the National Rugby League team the North Queensland Cowboys, as well as the Women s National Basketball League team - Townsville Fire. Backing our commitment to healthier communities we also sponsor the Townsville Running Festival and Bowen Triathlon events. We are the only health fund in Australia to provide this benefit! Queensland Country also supports local community groups through sponsorship of events and also donations. An example of this includes the Mount Isa Emergency Helicopter. 4 5

6 Which cover is right for you? STEP ONE Choose your level of hospital cover based on your needs and budget. Private Hospital cover Description Excess options Top hospital Top hospital 250 Provides a comprehensive private hospital cover Provides a comprehensive hospital cover where you pay the first $250 towards any inpatient hospitalisation in return for a lower premium. No excess payable $250 excess per person per membership year up to a maximum of $500 for a family policy. Top hospital 500 Provides a comprehensive hospital cover where you pay the first $500 towards any inpatient hospitalisation in return for the lowest premium in our Top hospital cover range. $500 excess per person per membership year up to a maximum of $1,000 for a family policy. HOSPITAL COVER If you are concerned about public hospital waiting times and want to ensure that quality timely care is available for yourself or your family by a doctor of your choice then one of our private hospital cover range may suit you! Intermediate hospital 250 If you are young and healthy and are not planning a family, this cover may be for you. Benefits for some hospital services are restricted or excluded to keep the premium more affordable. $250 excess per person per membership year up to a maximum of $500 for a family policy. EXTRAS COVER If you need assistance with the cost of visits to the dentist, optometrist, physio and other health services that Medicare does not normally provide a benefit for, then Extras cover is for you! Intermediate hospital 500 If you are young and healthy and are not planning a family, this cover may be for you. Benefits for some hospital services are restricted or excluded to keep the premium more affordable. $500 excess per person per membership year up to a maximum of $1,000 for a family policy. A + Extras Public Hospital Cover Description Excess options Public hospital Public Hospital cover is exactly as the name suggests - cover in a public hospital. Limited benefits are paid for inpatient treatment in a private hospital No excess payable. Top hospital Top hospital 250 Premium Extras STEP TWO Choose your level of Extras cover based on your expected frequency of use and budget. Top hospital 500 Intermediate hospital 250 Essential Extras Young Extras* cover Description Provides benefits for a comprehensive range of therapies Premium Extras and offers high benefits per service and generous annual limits. Intermediate hospital 500 Public hospital *Young Extras is the only Extras cover option that can be taken as a stand alone Extras product. All other Extras products need to be packaged with any of our Hospital cover options. Essential Extras Young Extras Provides benefits for a comprehensive range of therapies with lower benefits per service and lower annual limits but offers a lower premium. Provides benefits for a broad range of therapies most likely to be used by young people while keeping the cover affordable with sensible claim limits for those who may not regularly use Extras services. 6 7

7 Hospital Cover NO HOSPITAL EXCESS FOR YOUNG CHILDREN* With our Top hospital covers, you will not be charged an excess if your child up to and including the age of 10 is admitted to hospital for medical treatment. *This excess exemption does not apply to our Intermediate and Smart Start Singles and Couples cover Hospital covers.^ TOP HOSPITAL COVER INTERMEDIATE HOSPITAL COVER Excluded Benefits PUBLIC HOSPITAL COVER What we will pay: For the services included* under our Top hospital covers, we will pay benefits (less any applicable excess) towards: ø Private hospital accommodation shared or private room (if available) ø overnight stay ø same day admissions ø theatre fees ø intensive care ø labour ward ø prostheses ø Public hospital accommodation as a private patient ø overnight stay in a private room (if available) or shared room ø same day admissions (shared room only) ø Doctors fees for in-hospital medical services when you are treated as a private patient ø Please note that there is a Benefit Limitation Period (BLP) for certain hospital treatments that only applies to new members to private health insurance cover or to members rejoining after a lapse in health cover in excess of 63 days. For further information on Benefit Limitation Periods and how this may affect you please refer to the Benefit Limitation Periods information in this brochure or refer to our Membership Guide. Intermediate hospital cover as the name suggests is for that in between period in your life where you may not yet have started planning for a family and still feel fit and healthy, and are looking for a lower cost private hospital cover to get you through to the next stage in your life. Intermediate hospital provides cover for treatment in both a private hospital or day surgery and a public hospital at an affordable price. There are benefit restrictions on some hospital services including, but not limited to, pregnancy, IVF, Heart Surgery, major eye surgery and other services (see hospital cover table on pages for further information) to keep the policy premiums down. This cover also excludes benefits for hip and knee replacements which are generally not required until later in life. An excluded service means you will not be covered in a public or private hospital and will not receive a payment from Queensland Country for that service. If you think you may require treatment for any excluded services you may like to consider taking one of our Top Hospital cover products. However, to understand that should you wish to have full benefit entitlement for any of the restricted or excluded services under our Intermediate Hospital cover, you will need to upgrade your policy to one of our Top Hospital cover options at least 1 in advance to provide cover for hospital services that are listed as Restricted or Excluded services. Public Hospital cover is exactly as the name suggests - cover for treatment in a public hospital. Public Hospital cover is a basic level of hospital cover designed for those who want to be treated as a private patient in a public hospital. This cover option will allow you or your family to choose your own doctor (if he/she is willing, or able to treat you in a public facility) and receive treatment as a private patient in a public hospital. This means we will pay for the cost of shared ward accommodation only up to the level prescribed by the Federal Minister for Health, if admitted as a private patient. So if you choose to be admitted in a private room in a public hospital, you will incur further out of pocket expenses. However public hospital cover will not assist in avoiding waiting times in the public hospital system, and would also mean that if you require to be treated in a private hospital or day surgery you will face high out of pocket expenses, which wouldn t be the case if you were to choose one of our Private Hospital cover options.* We will pay benefits for inpatient services* in a private or public hospital where a Medicare benefit is payable, providing waiting periods have been served, except for restricted or excluded services where a lower or nil benefit entitlement exists. (see hospital cover table on pages for further information). Restricted Benefits If a service is covered as a Restricted Benefit, this means you will be covered with your choice of doctor for shared ward accommodation in a public hospital only. If you go to a private hospital for a specific service which has Restricted Benefits, it is likely to result in large out-of-pocket expenses. * Some hospital services under our Intermediate Hospital cover have restricted or excluded benefit entitlement however. Please see Hospital Cover table for details of these restrictions and exclusions * Irrespective of which hospital cover you have chosen, any ancillary service provided during your hospital stay will not be able to be claimed against the fund unless you have cover for these services under an ancillary (Extras) product eg. physiotherapy, dieticians, exercise physiologists etc. Restricted Benefits are amounts set by the Government and are generally not enough to cover accommodation costs in a private hospital. No benefit is paid towards the cost of theatre charges raised for services in a private hospital. Not every hospital cover product has benefit restrictions, please refer to hospital cover tables on pages to determine benefit entitlement conditions for individual hospital products. Whilst cover with Restricted Benefits entitles you to your choice of Doctor in a public hospital, your Doctor may not be willing, or able, to treat you in a public facility. Waiting periods may also apply to all restricted services. 8 9

8 BENEFIT LIMITATION PERIODS Our Top Hospital cover requires a policy holder (who is new to private health insurance hospital cover) to be with Queensland Country for a period of 24 months before certain hospital services are fully benefited as part of their cover. A Benefit Limitation Periods will apply to the following services: Bariatric Surgery (weight loss surgery): including but not limited to gastric banding, gastric sleeving/diversion; and gastric bypass surgery; including replacement, repair or adjustments Hip or Knee Joint Replacements During the first 24 months of cover (but after the standard hospital waiting periods have been served), benefits payable for these services will be limited to restricted benefits. Restricted benefits will only cover you for a stay in a shared ward of a public hospital. But it will not cover the cost for a stay in a private room in a public hospital or a stay in a private hospital, you will incur large out of pocket expenses to cover the difference in costs. Benefit Limitation Periods will not apply if you are transferring from another health fund s hospital cover providing you are transferring within 63 days of ceasing the previous cover. REDUCE YOUR MEDICAL COSTS Your doctor, surgeon and anesthetist, will all charge for their services separately to your hospital accommodation costs. Their fees are known as medical expenses. These medical expenses are assessed against the Medicare Benefits Schedule (MBS) fees, which are set down by the government. If you are admitted to hospital as a private patient. Medicare will pay 75% of the MBS fee for your medical expenses. Queensland Country will pay the remaining 25% of the MBS fee. However, some doctors charge more than the MBS fee. This can result in significant out-of- pocket expenses. Queensland Country s private hospital cover can help reduce or avoid these extra expenses through our Access Gap agreement. ACCESS GAP - MINIMISE OUT OF POCKET EXPENSES Access Gap is a major feature of our hospital cover. Participation by your doctor in Access Gap could significantly reduce medical costs for inpatient hospital services, or in some cases, may eliminate them completely. By making arrangements with your doctor before going into hospital you will have an understanding of the costs for the medical procedure based on how the doctor will charge for their services. Under this direct billing arrangement Queensland Country will pay a higher amount to your doctor if he or she agrees to participate and charge you fees in accordance with the agreement. If your doctor agrees, it means that they are willing to accept a set fee for their services that is more than the MBS fee, and means you are likely to have lower out of pocket costs, and in some cases, none at all! Participation by your doctor in Access Gap is voluntary. There is no obligation to do so. Your doctor must inform you of the total of any out-of-pocket expenses you will have to meet before you go to hospital. You can search for doctors who may participate in the Access Gap Scheme by referring to the AHSA website ahsa.com.au/web/gapcoversearch We also recommend that you contact us before going into hospital or day surgery so that we can discuss the level of benefit your policy provides you. HOSPITAL COVER - WHAT YOU ARE COVERED FOR This provides a summary of cover and isn t intended to be a comprehensive list of all the services covered Choice of Doctor/Hospital Public Hospital Accommodation as a Private Patient (Shared room, please refer to page 9) Private Hospital Accommodation * Theatre Fees* Surgically Implanted Prosthesis Benefits Approved minimum prosthesis benefits (artificial hips, knees, etc) as per the approved Government listing. Intensive Care* Medical Gap Cover for the 25% gap between the 75% Medicare Benefit and the Medicare Benefits Schedule fee for inpatient services. Tonsils and Adenoids Removal* Appendix Removal* Colonoscopies* Gastroscopies* Grommetts in Ears* Gynaecological Services* Hernia Repair* Joint Reconstructions* Back Surgery* Brain Surgery* Plastic and Reconstructive Surgery* In-hospital Rehabilitation Treatment* Obstetric Related Services* e.g. birth and pregnancy Assisted Reproductive Services* e.g. IVF In-Hospital Psychiatric Treatment* Access Gap Cover The Access Gap benefit, for inpatient services, is a benefit over and above the Medicare Benefits Schedule for participating Doctors. Nursing Home Type Patients* We pay a benefit toward a nursing home type patient This amount is determined by the Federal Government. Certification is required Cardio-Thoracic Procedures* eg. open heart surgery Major Eye Surgery* cataracts and eye lenses procedures NIL EXCESS TOP HOSPITAL COVER INTERMEDIATE HOSPITAL COVER PUBLIC HOSPITAL COVER Gastric banding, sleeving/diversions or bypass (weight loss surgery)* including replacements, repairs and adjustments R Renal Dialysis* Hip and Knee Joint Replacement Surgery* Mechanical Appliances and Artificial Aids # Benefit up to 85% of the cost or hire of mechanical appliances and artificial aids approved by Queensland Country Health with an annual limit of $2000 per person covered. Mammograms and Bone Density Test Benefit up to $50 limited to 2 services for each of the above tests, only if not claimable from another source. The membership year limit is $200 per person covered. Hearing Aids Benefit of 85% of cost of hearing aid/s up to $1000, limited to once every three years. Australian Hearing Services Benefit of $25 per membership year per eligible person for the cost of a Hearing Services Card Nursing Special Benefit of up to $150 per day $750 per person covered. Home Benefit up to $15 per visit or $60 per day limited to $600 per person covered. Bush Benefit up to $15 towards the cost of treatment with an annual limit of $300 per person. $500 EXCESS $250 EXCESS $250 EXCESS $500 EXCESS NIL EXCESS R R R R R R Hospital Boarder Benefits up to $35 per day to a maximum of four days per person listed on the membership. Cosmetic Surgery (hospital treatment for which Medicare pays no benefit) 10 For hospital services or treatments that have Restricted benefit availability under Intermediate Hospital cover, no benefit is paid towards the cost of theatre charges raised for inpatient services in a private hospital or day surgery. If you have chosen Public Hospital cover and are an inpatient at a private hospital or day surgery, you will have a benefit entitlement to the default rate benefit for shared ward accommodation in a public hospital only. Benefits are not available on second hand equipment or on consumables. A benefit is payable for short term hiring (up to 3 months) of some mechanical aids. The purchase of some machines and monitors are limited to once every three membership years. Waiting periods will apply to all benefits outlined. Please refer to page 37 for further details. Services we don t pay benefits towards Stands for BLP - Benefit Limitation Period. Hospital benefits payable on these hospital services during the designated benefit limitation period will be the minimum benefit declared by the Minister for Health and Ageing, except when a waiting period is being served, in which case no benefit applies. See Benefit Limitation Period information in this brochure. Stands for Restricted Benefit. Covered for shared ward accommodation in a public hospital only. If you go to private hospital or day surgery for these services it is likely to result in large out of pocket expenses

9 PROSTHESIS BENEFIT We provide a benefit towards surgically implanted prostheses and other items on the Federal Government prostheses list. MECHANICAL APPLIANCES AND AIDS To help you maintain your health we provide an excellent benefit on our Top Hospital cover of up to 85% of the cost of mechanical appliances and artificial aids approved by Queensland Country within a membership year limit of $2,000 per person covered. For some mechanical aids the benefit is for hire only. Products covered include: Blood Pressure Monitor, Glucometer, Tens Machine, crutches, walking frame, wigs etc. Benefits are not available on second hand equipment or on consumables. A benefit is payable for short term hiring (up to 3 months) of some mechanical aids. The purchase of some machines & monitors are limited to once every three years from the date of purchase. A letter of referral from your doctor or other practitioner may be required. Please contact us regarding benefit availability prior to purchasing an aid or appliance. HOSPITAL NETWORK Queensland Country has negotiated Purchaser Provider Agreements with most of the participating private hospitals and day hospital facilities Australia-wide. In most instances, the approved hospital charges for policy holders of a Top Hospital policy will be covered in full once the agreed excess has been deducted. This means that you will benefit from capped fees we ve negotiated and convenient billing as your invoice will be sent directly to Queensland Country. Private hospitals and day hospital facilities that have not signed an agreement attract reduced benefits which will mean you may incur out-of-pocket medical expenses for in-hospital treatment. Go to our website to find a hospital most convenient to you. Lower your premiums with an Excess! AN EXCESS IS THE AMOUNT YOU AGREE TO CONTRIBUTE TOWARDS ACCOMMODATION COSTS IF YOU ARE ADMITTED TO A PUBLIC OR PRIVATE HOSPITAL OR A DAY SURGERY. THE MORE EXCESS YOU AGREE TO PAY, THE LOWER YOUR HEALTH MEMBERSHIP CONTRIBUTIONS WILL BE. g Mechanical Appliances and Aids coverage is not available on our Intermediate Hospital or Public Hospital cover products Our private hospital cover range has flexible excess options to ensure there is an affordable cover for everyone! Our Top Hospital cover has a choice of a nil, $250 or $500 hospital excess, whilst our Intermediate Hospital cover has only two hospital excess options of $250 or $500. The excess is only payable if you, or someone on your policy, is admitted as an inpatient to a public hospital (as a private patient), or private hospital or a day surgery. It does not apply to Extras cover. The excess calculation is membership year based.* If you have a singles cover with us the excess only applies on your first admission to hospital or day surgery in any one membership year, and is only required to be paid up to twice in a membership year on the entire policy for those who have a couples or family policy. No individual person on any policy with a hospital excess will pay this excess more than once in any one membership year. KEY FEATURES Ø WE HAVE AGREEMENTS WITH OVER 500 PRIVATE HOSPITALS ACROSS AUSTRALIA Ø OUR TOP HOSPITAL COVERS DON T HAVE LOTS OF EXCLUSIONS, PROVIDING CONFIDENCE YOU ARE COVERED Ø OUR ACCESS GAP COVER KEEPS OUT-OF-POCKET MEDICAL EXPENSES DOWN If you have a dependant child up to and including the age of 10 years, who needs to be admitted to hospital, there will be no excess payable for that child. This excess exemption for children 10 years and under is NOT applicable under our Intermediate Hospital cover, and Smart Start Singles and Couples cover. It is exclusive to our range of Top hospital covers ONLY. * Membership Year is defined on page

10 Extras As well as Hospital cover, we also provide Ancillary cover better known as Extras cover which can be bundled together with your Hospital Cover. We have three levels of Extras cover here at Queensland Country and this provides benefits for a range of general private health services that are not covered by Medicare. This includes Dental, Optical and Physiotherapy, Podiatry etc. As well as looking after you if you are unwell, we also want you and your family to stay well. With our Extras cover you ll get great benefits on a whole range of healthcare treatments and services and it s a great incentive to keep that six-monthly dental checkup, new pair of glasses or even a therapeutic massage. With our three Extras Covers - Premium Extras, Essential Extras and Young Extras, you can be confident that you ll be covered from head to toe. HEALTHY LIVING BENEFITS As well as helping you to get well we want to help you to stay well. Therefore we have introduced benefits to encourage you to live a healthy lifestyle. We will pay up to $150* per person per membership year to assist you to: ø participate in your choice of weight management programs (excludes gym memberships, personal training and other physical activity programs). REWARDING LIMITS Once you have held cover under either our Premium or Essential Extras products for a year, we automatically increase your annual claim limits for Dental (excluding Orthodontic) and our full range of Therapies by $50 per year. We provide this loyalty incentive for the first 5 years of cover, and continue to honour this for as long as you hold cover under the above eligible products. ø participate in quit smoking programs ø have your skin checked for skin cancers through e.g. after 5 years continuous cover on our Premium Extras product, the annual limit per person for Dental would have mole mapping increased to $1650 per person per membership year. PREMIUM EXTRAS provides you and your family with a comprehensive range of therapies and benefits with generous limits to ensure out-of-pocket expenses are kept to a minimum and can only be purchased in conjunction with a hospital cover. ø Consultation fees for Diabetes Educator ø Consultation fees for Metabolic dieticians and nutritionists when providing assistance with weight management Loyalty limit increases do not apply to sub-limits or individual service/item benefits. ESSENTIAL EXTRAS provides a comprehensive range of therapies and benefits with lower limits and premiums and can only be purchased in conjunction with a hospital cover. ø Bowel Screening tests and Bone Density tests (no doctors referral will be required) ø PSA Test (one per year). We will cover a second yearly YOUNG EXTRAS provides a broad range of therapies and a good level of benefits with limits on a per person per policy basis, and can be purchased on its own or in conjunction with a hospital cover. Young Extras is designed as an entry level extras cover and is best suited for young people under the test not covered by Medicare * benefit payable under Premium Extras age of 30. OPTICAL DISCOUNTS Queensland Country has negotiated agreements with a large number of optical providers across Australia. When you visit one of our preferred optical providers you will receive great discounts on frames, lenses and contact lenses. Further details of these providers can be seen at under Your cover explained/understanding health insurance/preferred provider network. The benefits outlined in the Health Benefits Guide are a summary of benefits payable and do not provide comprehensive details of all benefits. To confirm the details or any conditions that may apply, please contact us on extra! extra! 16 17

11 LIMITS PER MEMBERSHIP YEAR AND WHAT WE LL PAY TYPE OF SERVICE WAITING PERIODS PREMIUM EXTRAS ESSENTIAL EXTRAS YOUNG EXTRAS DENTAL Diagnostic This includes examinations, consultations and Xrays etc. $600^ Preventative This includes cleaning and scaling, flouride treatment and mouth guards $800^ eg. Periodic Oral Exam - $42 X-rays - $30 eg. Scale & Clean - $70 Flouride Treatment - $20 Mouth guard - $150 $1400 overall benefit limit per person per membership year for all Dental services (excluding Orthodontics which has separate claim limits) Sub limits apply^ $400^ $500^ eg. Periodic Oral Ex am - $27 X-rays - $19 eg. Scale & Clean - $45 Flouride Treatment - $13 Mouth guard - $96 Periodontics eg. Specialised Gum Treatments 1 $500^ $300^ X Simple Extraction Surgical Extractions Wisdom teeth extraction, removal of impacted teeth 1 Endodontic eg. Root canal therapy and root fillings 1 $600^ Restorative Composite fillings and amalgam fillings $800^ Crowns/Bridges 1 $800^ Prosthodontics Dentures etc. 1 $850^ $700^ eg. Simple Extractions - $100 Surgical Extraction - $175 eg. Root Canal obturation- one canal - $170 eg. One surface composite filling - $85 (accumulating to $1500 per year after 2 years of membership) eg. Full Veneered Crown - $800 eg. Full upper and lower denture - $850 $400^ eg. Simple Extractions - $64 Surgical Extraction - $112 $350^ eg. Root Canal obturation - one canal - $109 eg. One surface composite filling $500^ - $54 (accumulating to $1000 $550^ per year after 2 years of membership) eg. Full Veneered Crown - $512 $900 overall benefit limit per person per membership year for all Dental services (excluding Orthodontics which has separate claim limits) Sub limits apply^ eg. Periodic Oral Exam - $32 X-rays - $23 eg. Scale & Clean - $53 Flouride Treatment - $15 Mouth guards - $113 eg. Simple Extractions - $75 Surgical Extraction# - $131 X eg. One surface composite filling - $64 eg. Full Veneered Crown - $500 $500^ eg. Full lower denture - $320 X General Services $500^ eg. Occlusal splints - $300 $300^ eg. Occlusal splints - $192 eg. Occlusal splints - $225 Orthodontics Braces etc. OPTICAL Single Vision Spectacles Bifocal Spectacles Mulitfocal Spectacles Contact Lenses (hard or soft) Repairs to frames/spectacle frames only/replacement lenses 1 $1000 (increasing to $2000 after completion of 2 years membership* $3000 available after completion of 3 years membership*) $3000 Lifetime limit. All limits per person. Benefits are paid at 85% of cost *Years of membership refers to the actual period of cover on Premium Extras products only. Total benefit for optical items or services is limited to a maximum of $275 per person, per membership year $500 (increasing to $1000 after completion of 2 years membership* $1500 available after completion of 3 years membership*) $1500 Lifetime limit. All limits per person. Benefits are paid at 85% of cost *Years of membership refers to the actual period of cover on Essential Extras products only. Total benefit for optical items or services is limited to a maximum of $185 per person, per membership year THERAPIES Acupuncture* CONSULTATION TYPE OR SERVICE Initial and subsequent - $35 CONSULTATION TYPE OR SERVICE Initial and subsequent - $22 CONSULTATION TYPE OR SERVICE Initial and Subsequent - $30 Audiology Initial and subsequent - $50 Report - $60 Initial and subsequent - $32 Report - $38 X Initial and subsequent - $35 Initial and subsequent - $22 Initial and subsequent - $30 Chiropractic X-rays - $60 (not reading of x-rays) X-rays - $50 (not reading of x-rays) X-rays (not reading of X-rays) - $50 $600 combined $400 combined Remedial Massage/Bowen Therapy/Myotherapy* Initial and subsequent - $35 Initial and subsequent - $22 Initial and Subsequent - $30 sub limit # sub limit # Osteopathy Initial - $35 Subsequent - $35 Initial - $28 Subsequent - $24 Initial - $30 Subsequent - $30 Naturopathy/Homeopathy* Initial and subsequent - $35 Initial and subsequent - $22 Initial and Subsequent - $30 Dietitian Initial - $75 Subsequent - $40 Initial - $48 Subsequent - $26 Initial - $55 Subsequent - $35 Occupational Therapy Initial - $80 Subsequent - $40 Initial - $51 Subsequent- $26 X $1400 overall benefit $900 overall benefit Orthoptic Therapy Initial and subsequent - $60 Initial and subsequent - $38 X limit per person per limit per person per Foot Orthoses and Orthopaedic Shoes (orthoses and custom made footwear) 85% of cost Initial and subsequent - $35 $150 sub limit membership year for all Therapy services Sub limits may apply 85% of cost Initial and subsequent - $22 $100 sub limit membership year for all Therapy services Sub limits may apply X Initial and subsequent - $30 Approved appliances (orthotics) - Podiatry Approved appliances (orthotics) - 85% of cost $550 sub limit ## Approved appliances (orthotics) - 85% of cost $350 sub limit ## 85% of cost up to available policy limits Minor Procedures - 75% of cost Minor Procedures - 75% of cost Minor Procedures - 75% of cost up to available policy limits Physiotherapy Exercise Physiology Psychology Initial - $55 Subsequent - $40 Group Therapy - $10 (sub limit of $100 applies) Initial - $50 Subsequent - $35 Monthly Program fee - $35 Group Therapy - $10 (sub limit of $100 applies) Initial and subsequent consultations - $80 Report - $80 Group Therapy - $80 $600 combined sub limit ### Initial - $36 Subsequent - $26 Group Therapy - $7 (sub limit of $70 applies) Initial - $32 Subsequent - $22 Monthly Program fee - $22 Group Therapy - $7 (sub limit of $70 applies) Initial and subsequent - $51 Report - $51 Group Therapy - $51 $400 combined sub limit ### Initial - $42 Subsequent - $32 Group Therapy - $8 (sub limit of $80 applies) Speech Therapy Initial - $70 Subsequent - $35 Initial - $45 Subsequent - $22 X OTHER EXTRAS Childbirth Education $60 $38 X Pharmaceutical^^ School Accidents SUB LIMIT EXAMPLE OF BENEFITS SUB LIMIT EXAMPLE OF BENEFITS EXAMPLE OF BENEFITS BENEFIT LIMITS Up to $50 Limit of $500 p/p per membership year 100% - Limit of $750 per dependent child per membership year Up to $30 Limit of $300 per person per membership year 100%- Limit of $450 per dependent child per membership year X X Up to $30 Limit of $150 per person up to $300 per policy per membership year Healthy Living (see Healthy Living benefits information on previous page) $150 p/p per membership year $125 p/p per membership year $125 p/p up to $250 per policy per membership year X No cover for Orthodontics Total benefit for optical items or services is limited to a maximum of $200 per person up to $400 per policy per membership year $500 per person up to $1,000 per policy per membership year. Combined limit claimable for General and Major Dental (Surgical Extractions and Crowns and Bridges only) $250 per therapy $450 per person up to $900 per policy $350 per person up to $700 per policy ^ Dental Sub Limits: the maximum benefit amount claimable per person for treatment/ service in a specific area of dentistry per membership year. This is providing an individual person s overall dental benefit limit for the membership year has not already been reached. If this was the case no further dental benefits can be claimed by this individual on any area of dentistry until new Membership year commences. Individual dental item benefits apply. ^^ Prescriptions not covered by the PBS, excluding contraceptives and items normally available without prescription and drugs not approved for sale in Australia. A co-payment applies to each prescription item equal to the current PBS General Patient Contribution. Please refer to page 30 for more information. # Combined Sub limit: the maximum benefit amount claimable per person per membership year for a combination of Chiropractic, Remedial Massage/ Bowen Therapy/ Myotherapy and Osteopathic services. This is providing an individual person s overall Therapies benefit limit for the membership year has not already been reached. If this was the case no further therapy benefits can be claimed by this individual on any therapy until new Membership year commences. Individual visit benefits apply. ## Sub limits: the maximum benefit amount claimable per person per membership year for Podiatry services. This is providing an individual person s overall therapies benefit limit for the membership year has not already been reached. If this was the case no further benefits can be claimed on this,or any therapy until new Membership year commences. Individual dental item benefits apply. ### Combined Sub limit: the maximum benefit amount claimable per person per membership year for a combination of Physiotherapy and Exercise Physiology services. This is providing an individual person s overall Therapies benefit limit for the membership year has not already been reached. If this was the case no further therapy benefits can be claimed by this individual on any therapy until new Membership year commences. Individual visit benefits apply. There are specific requirements to claim for Exercise Physiology. Contact the Fund for details. * Benefits are payable for services rendered by Australian Regional Health Group approved providers registered with Queensland Country as well as Bowen Therapists that are registered with the Bowen Association of Australia (BAA) or Bowen Therapists Foundation of Australia (BT FA). Membership Year limits are calculated from the anniversary date of the establishment of the policy. X Service we don t pay a benefit towards

12 On-the-spot claiming for extras Manage your cover online To make it even easier to claim Depending on your level of cover, and Online Member Services (OMS) Below is a list of all the different your benefit, participating health if your provider has the appropriate gives you the ability to update your services you can access by registering: 21 t To 22 professionals have electronic claiming facilities available. HICAPS/IBA allows you to simply swipe your Queensland Country Membership Card at the end of your consultation or treatment, automatically deducting your benefit entitlement from the amount you ve been charged. Then, all you have to pay is the difference. By using electronic claiming you don t have to lodge a manual claim, so no need to fill out a claim form and no waiting for the claim to be processed. find out if your health service provider has HICAPS visit them online at facility, you can claim these services through HICAPS: ø Dentists, Endodontists, Periodontists, Dental Prosthetist/ Advanced Dental Technicians, Prosthodontists, Paediatric Dentists ø Dispensing Optometrists, Optical Dispensers ø Physiotherapists ø Chiropractors ø Osteopaths ø Podiatrists ø Occupational Therapists ø Psychologists ø Massage Therapy membership details whenever you want, giving you greater control and easy access. You can log on at any time of the day and check your cover; update address details, change your level of cover and even add a new addition to the family. To access OMS, all you need to do is register on the homepage of our website The register icon is located at the top right hand corner of the screen. Once you have registered using your membership number and your choice of password, click on the Login tab and enter your membership number and password. Now you re ready to go! Access to some functions may be limited for your spouse/partner and dependants. ø Claims history ø View/print tax statement ø Update Membership details ø Change contact details ø Add new person ø Change personal details ø Add student dependant or apprentice ø Add Medicare card details ø Add previous cover details ø Make a contribution payment by credit card ø Update your method of payment ø Change level of cover ø Update the way we pay benefits eg. direct credit ø Contribution changes ø View benefit limits 22 23

13 How to join It s super easy to join Queensland Country Health Fund. YOU CAN How to pay contributions Queensland Country offers you a variety of payment options so you can choose the best method for you. You can choose to pay weekly, fortnightly, monthly, quarterly, 6 monthly or yearly, whichever suits you. If you choose to pay by a method other than direct debit from a bank account or credit card, and your payment frequency is quarterly or greater, we will send you a reminder notice as a courtesy. As a policy holder it is your responsibility to ensure that the payment amounts are correct and made in advance, this avoids claims being rejected due to an un-financial status. Call us on freecall and complete an application over the phone Visit a retail service centre and let one of our friendly staff assist you Go to our website and apply online through our online application process. The web address is Drop in to one of Queensland Country Credit Union s 23 branches throughout Queensland Your policy will commence from a future date that you nominate or simply the date that your application is received by us or Queensland Country Credit Union. We will then forward a membership card to your address. Direct Debit Direct Debit facilities are available for policy holders who prefer to pay through automatic deductions from their Bank, Building Society, Credit Union accounts and Credit Cards. If this is your preferred method of payment, simply nominate this on the application form, and complete your details or visit our website. A reminder notice is not issued if you pay by direct debit. Credit Card Credit Card* facilities are available to all policy holders who prefer to pay via this option. If this is your preferred method of payment, simply visit our website and make the payment online through Online Member Services (OMS^). Alternatively, visit one of our Service Centres located in Townsville, Mount Isa, Ayr Mackay and Gladstone. Details appear at the back of this brochure, or phone us on * We do not accept American Express or Diners Club BPAY BPAY facilities are available to all policy holders who prefer to pay via this option. BPAY allows you to pay your health insurance premium via internet or phone banking, or at your financial institution. The BPAY biller code and your reference number appear on all statements. If you don t receive regular statements please contact us and we ll be happy to supply you with your BPAY biller code and reference number. (This option is not available to eligible participants in a Corporate Health Plan) BillPaying BillPaying Service Queensland Country Credit Union offers a BillPaying service through all their branch offices. BillPaying is a comprehensive budgeting and bill paying service that provides a fast and simple way to pay all your bills. If you would like more information on this service, please feel free to contact Queensland Country Credit Union on ^ Please see page 33 for details on how to register for OMS Note: Deadlines may exist for one or more of these payment options. Please consult our Membership Guide for further details You can choose to pay weekly, fortnightly, monthly, quarterly, 6 monthly or yearly, whichever suits you. ( 25

14 In more detail... Membership guide We have prepared a Membership Guide to outline a summary of the rules that apply to your membership. Please ask for a Membership Guide or access it by visiting us at It should be read in conjunction with this Health Benefits Guide. ^& PRE-EXISTING CONDITIONS A pre-existing ailment, illness or condition is one where, after examining evidence, a medical adviser, or other relevant health care practitioner appointed by Queensland Country would consider that signs or symptoms would have been in existence at any time during the six months preceding the application for membership or upgrade of cover. You may have a pre-existing condition, ailment or illness without being aware of it. In these cases, there is a 12 month waiting period before you are entitled to claim benefits for treatment. It is not necessary for the signs or symptoms to have been diagnosed by a doctor when a member joined or upgraded their level of cover. Surgery for assisted fertility programs such as IVF or GIFT, Sterilisation or Vasectomy are elective and attract a 12 month waiting period as does obstetrics-related services. The 12 month pre-existing condition waiting period can be applied to all hospital or hospital substitute treatment for which we pay benefits. However, a two month waiting period applies to the following services: ø approved psychiatric treatment ø approved rehabilitation treatment, or ø palliative care. The 12 month waiting period for the treatment of a pre-existing Condition can also apply to ancillary (Extras) services. BENEFIT CONDITIONS Queensland Country will only pay benefits when: ø Goods and Services are provided in Australia ø The Member has been charged for the treatment or service ø A service or treatment is medically necessary and clinically relevant ø Services are part of a course of treatment recognised by Queensland Country ø The service is provided in person ø The service is provided to a person on the membership ø The service or treatment has been provided by a practitioner or therapist recognised by Queensland Country ø The treatment or service is covered under the Member s level of cover ø No benefits are payable from another source (e.g. compensation payment or Government benefit) ø The conditions of the level of cover have been met ø A claim for a service rendered is submitted for payment within 24 months of the date of service ø The waiting period for that service has been served ø The benefit limitation period for that service has been served (where applicable) The amount of benefit is calculated on the cost of the treatment or aid to the Member, taking into account any allowances or discounts given by the provider. No benefit paid by Queensland Country can exceed the actual charge of the service or appliance. MEMBERSHIP YEAR All yearly limits and excesses are calculated from the anniversary date of the establishment of the membership. k TYPES OF MEMBERSHIPS: SINGLES, COUPLES & FAMILIES Single: a single policy covers only one person. Couple: a couple policy covers the person who establishes the policy as well as that person s partner. The policy can be extended to cover dependant children at no additional cost. Family: a family policy covers the person who establishes the policy as well as that person s partner and all dependant children (up to 21 years). Student and apprentice dependants can be covered up to age 25*. Single Parent Family: a single parent family policy covers the person who establishes the policy as well as that person s dependant children (up to 21 years). Student and apprentice dependants can be covered up to age 25*. Family Plus ^^: a family plus policy covers the person who establishes the policy as well as that person s partner and all dependant children up to the age of 25* years. In the case of a single parent family, the family plus policy will cover the person who establishes the policy as well as that person s dependant children up to the age of 25* years. * As long as the dependant child is not married or living in a de facto relationship ^^ Only Top Hospital and Premium/Essential Extras Packaged covers are available for Family Plus policies. Not available for any Hospital only cover, Extras only covers, packaged Top Hospital and Young Extras; or Public Hospital and Extras covers. DEPENDANTS Dependants include a policy holders children and stepchildren, legally adopted children or foster children under the age of 21. Dependants turning 21 who are not eligible for cover under a family policy as a student or apprenticeship dependant are required to commence their own policy if they wish to continue private health cover. The good news is that they can move straight across to their own single membership without having to serve any waiting periods. Alternatively, dependants between 21 & 25 years who do not qualify as a student or apprentice dependant may stay on your family policy for an additional premium. Please refer to the section Covering Adult Children Dependants will be covered as student dependants under their parent s membership from 21 years of age up to 25 years of age, provided the following conditions are satisfied: ø Is a full time student at a school, college or university who is not aged 25 years or over; or ø Is an apprentice who is not aged 25 years or over and does not earn more than $30,000 p.a; ø Is not married or living in a de facto relationship If, at any time, your student dependant s situation changes and they no longer meet all the above conditions then please contact us for further information. COVERING ADULT CHILDREN Family Plus* will allow all adult children between 21 & 25 years to remain on their family or single parent policy (as long as they are not married or in a de facto relationship) The Family Plus policy premium will of course be higher than our standard family or single parent family policy, but will prove to be a financially more economical option for eligible dependant children, in comparison to having them take out their own cover at an equivalent level. *Family Plus cover option will be restricted to Top Hospital and Premium Extras or Essential Extras packaged covers only. It will not be available to family or single parent policies with any Hospital Only Product, Intermediate Hospital, or Intermediate Hospital and Extras package, Private Hospital and Young Extras Product, Smart Start Products or Public Hospital and Extras packaged covers

15 WAITING PERIODS So when will I be fully covered you ask? Waiting periods apply when you join any health fund for the very first time or when you upgrade to a higher level of cover. But you won t have to wait if you re transferring to Queensland Country from an equivalent or higher level of cover with another health fund, or if you ve been covered by your parents membership and you re just starting out on your own. For full details, please refer to our Membership Guide under the heading Transferring from another Fund. Waiting periods are necessary to keep health cover fair and aim to protect our existing policy holders who contribute to a fund over a period of time for when they may need cover. If we didn t have these waiting periods people may join, claim for something planned and then leave. Always make sure you have waited the sufficient period before claiming, otherwise you may not be covered! For those of you who are thinking of starting a family, if you have a single policy, to be sure your baby has cover, it is necessary to add a newborn baby to your policy within two months after their date of birth. The baby will not have to serve any waiting periods* that have already been fully served by the policy holder providing that the change is made to the policy within this time frame. *For policy holders with no previous cover, the preexisting condition waiting periods may apply to the baby within the first 1. If you want to change your existing level of Extras cover for one that is more extensive you will be required to serve waits on the increased benefits only. Two month waiting periods apply for most other items or services. The 2 month Waiting Period is waived for treatment arising from an accident (excluding a school and sporting accident) that occurred after joining. Waiting period Dental: 1 Diagnostic includes examinations & consultations Preventative includes cleaning and scaling, fluoride treatment, mouth guards etc. Simple extraction Restorative composite and amalgam fillings General services includes occlusal splints Optical Acupuncture Audiology Chiropractor Massage Therapy Osteopathy Naturopath Dietician Foot Orthoses & Orthopedic Shoes Occupational Therapy Orthoptic Therapy Physiotherapy Exercise Physiology Podiatry Psychology Speech Therapy Pharmaceutical School Accidents Healthy Living Benefits Pre-existing Conditions Obstetrics-related Services Child birth education Major Dental services: Periodontics specialised gum treatment Surgical Extraction includes wisdom tooth extraction Endodontic Services includes root canal therapy Crowns and Bridges Prosthodontics Dentures Mechanical Aids & Appliances Surgery for assisted fertility programs such as IVF or GIFT, sterilization or vasectomy, elective surgery Mammograms & Bone Density Tests Hearing Aids Australian Hearing Services Nursing Home Type Patients Nursing Hospital Boarder o CONTRIBUTIONS IN ARREARS A policy holder who fails to pay contributions within 63 days of the day of which contributions were due and payable shall be deemed to be unfinancial. No benefits are payable for services rendered whilst a membership remains in arrears. However, provided contributions are paid within 63 days of the due date, the membership will be re-instated. Membership of Queensland Country Health shall automatically cease for any policy holder whose contributions are more than 63 days in arrears. LENGTH OF STAY Full hospital benefits are not available after 35 days of continuous hospitalisation unless your doctor certifies the need for continued hospital-level care. OVERSEAS SUSPENSION OF MEMBERSHIP If you re lucky enough to travel overseas, and you re going to be absent from Australia for more than 4 weeks and less than 24 months, and provided you ve fulfilled all other criteria, you may apply for a suspension on your membership. (For further information, please call us when you re making your travel plans.) If you develop a condition or ailment during the suspension, you won t be covered by your policy. Once you re-activate your policy pre-existing condition waiting periods for that condition will apply. For information on pre-existing conditions, please see page 35. RECOGNISED PROVIDERS Queensland Country will only pay benefits for ancillary, dental and nursing services where the services are provided by practitioners recognised by Queensland Country. Recognition is subject to change without notice. There are no benefits payable for overseas hospitalisation or ancillary care. Recognition of providers is for the purpose of determining the payment of benefits and should not be taken or considered in any way as approval of, or any recommendation as to the qualifications and skills of, or services provided by, a practitioner or therapist. Members should check with Queensland Country that their practitioner is recognised before commencing treatment. COOLING OFF PERIOD Queensland Country will allow any Member who has not yet made a claim to cancel their policy and receive a full refund of any premiums paid within a period of 30 days from the commencement of their policy or upgraded policy. INFORMATION BENEFIT REPLACEMENT PERIOD A Benefit Replacement Period applies to certain mechanical appliances and hearing aids. This means that, once you have been paid a benefit for a particular aid, you must wait for a certain period of time from the date of purchase of the item before you are entitled to a benefit for the replacement of that item. These Benefit Replacement Periods apply per Member. BENEFIT REPLACEMENT PERIOD 3 years ITEMS Blood glucose monitors (Glucometer) Blood Pressure Monitor C-pap Machine and Humidifier and initial mask and tubing Tens Machine (not circulation booster) Please ensure that you read all Hearing Aids documentation provided to you before any decision is made to purchase a health insurance product and ensure you retain a copy of the documentation for future reference. $ 28 29

16 PHARMACEUTICAL The Pharmaceutical Benefits Scheme (PBS) is a national pharmaceutical scheme funded by the Federal Government where patients contribute to the cost of prescribed drugs. Queensland Country doesn t cover pharmaceutical prescriptions covered by the Pharmaceutical Benefits Scheme or for contraceptives and items normally available without prescriptions. We ll pay benefits as outlined in the Extras table up to the claim limit for this category, with consideration to the maximum individual script benefit limit. The benefit amount per script is calculated by deducting the PBS General Patient Contribution amount from the purchase price (up to script benefit limit). This is conditional on the pharmaceutical prescription being listed in the MIMs Schedule as S4 or S8 and being dispensed in quantities in accordance with this schedule. We also pay for compound pharmacy scripts, as long as one of the ingredients meets this criteria. The PBS General Patient Contribution amount is reviewed annually by the Government and changes every year on 1 January. As at 1 January 2014, the PBS contribution is set at $ It s important to note that a doctor s letter may be required for some Pharmacy items. PRIVATE HEALTH INSURANCE CODE OF CONDUCT Queensland Country Health is a signatory to the Private Health Insurance Code of Conduct. The code was developed by the health insurance industry and aims to promote the standards of service to be applied throughout the industry. A full copy of the Code is available at SUMMARY OF RULES The In more detail pages contain only a summary of the fund rules. The complete rules of the health benefits fund set out in full the terms and conditions of membership and liability under the fund. These rules are available for inspection at Queensland Country, Level 1, 296 Ross River Rd, Aitkenvale QLD Government Initiatives MEDICARE LEVY SURCHARGE The Medicare Levy Surcharge (MLS) is levied on payers of Australian tax who do not have hospital cover under a private health insurance policy and who earn above a certain income. The surcharge aims to encourage individuals to take out private hospital cover, and where possible, to use the private hospital system to reduce the demand on the public health care system. People who don t have private health insurance hospital cover, and who have an assessable income^ in excess of the thresholds set down by the Australian Taxation Office (ATO) pay a surcharge of between 1.0% to 1.5% of assessable income^. This surcharge is in addition to the standard Medicare Levy of 1.5% of taxable income. The Medicare Levy Surcharge will not apply to any Queensland Country policy holder who has a hospital cover. The Medicare Levy Surcharge is applied on a pro-rata basis. If you take out hospital cover part-way through the financial year you ll still avoid the surcharge but only for the period you held hospital cover. For current assessable income thresholds refer to our website or visit the ATO website ^There is a different income test for the application of MLS, which is known as income for Medicare levy surcharge purposes. For more information about what is included as income for Medicare levy surcharge purposes, please seek the advice of your tax agent or Accountant or contact the Australian Taxation Office (ATO) Help Line on or visit the ATO website AUSTRALIAN GOVERNMENT REBATE ON PRIVATE HEALTH INSURANCE The Federal Government rebate scheme was introduced in January The basis for the initiative was to provide a financial incentive to assist Australians in affording private health insurance cover. Initially the scheme provided for a rebate of 30, 35 or 40% on private health insurance premiums, with entitlement based on the age of the oldest person on the policy. The scheme, now known as the Australian Government Rebate on private health insurance introduced means testing of the rebate in 2012, which resulted in the rebate entitlement being determined by both assessable income* and age. This change resulted in person/s on higher incomes having their rebate entitlement either reduced, or depending on their assessable income*, have no entitlement to receive any rebate assistance at all. It is the responsibility of a Member to nominate an appropriate rebate tier (based on age and assessable income*). Refer to Premium tables for assessable income thresholds for the current financial year. The Australian Government Rebate on private health insurance will apply to the base hospital premium only and will not apply to the portion of hospital premium that has any Lifetime Health Cover Loading applied. (See Lifetime Health Cover section for further information) A Member can choose to claim the appropriate rebate up front as a lower premium; however can also nominate to claim a lower rebate than their entitlement, or in fact no rebate at all, and reconcile this when lodging their annual tax return. The Australian Government Rebate on private health insurance is undergoing further changes. From 1 April 2014 rebate eligibility will still be based on a Member s age and assessable income* but will be indexed by CPI (Consumer Price Index) each year. Essentially this will mean that the standard rebate amounts that have historically applied will be indexed each year using a ratio of the average industry premium increases and CPI. Premiums quoted by the Fund will take into consideration these latest changes and will not require additional input or calculation by our Members apart from the standard age and assessable income* information. * For information in regards to the assessable income thresholds applicable for current financial year, please refer to or our website under your cover explained/government initiatives. For calculation method for this income known as income for Medicare Levy Surcharge purposes, please seek the advice of your tax agent, financial advisor or contact the Australian Taxation Office (ATO) Help Line on or visit their website at

17 LIFETIME HEALTH COVER Lifetime Health cover (LHC) is a Federal Government initiative that came into effect on 1 July It is designed to reward people who join a private health fund earlier in life by securing lower premium payments. Under Lifetime Health cover, if you don t have hospital cover on the 1 st of July following your 31 st birthday, then for each year you delay joining, your membership fees will increase. In fact you will pay a loading of 2% on top of the base rate on your premium (or on your share of a couple or family premium) up to a maximum loading of 70%. Once you have stayed with private hospital cover for 10 continuous years and keep it, you stop paying that loading as a reward for commitment to the private health system. Be aware that the loading may be reapplied if you then cease to hold a hospital cover and subsequently take it up again. By joining hospital cover as soon as possible, you can stop this continuous increase and your loading will be frozen at the rate that matched your age when you joined (known as your Certified Age at Entry or CAE). As long as you maintain your hospital cover, your loading percentage will continue to be set according to your CAE, and will not increase each year. People who took out and maintained a hospital cover dated prior to 1 July 2000 will pay a base rate premium regardless of their age. People born before 1 July 1934 can take out hospital cover at any time and pay only the base rate. When transferring hospital cover from another registered fund, make sure you use your CAE (the age at which you joined), rather than the age you are now, to calculate the correct fee. Under the Federal Government s Lifetime Health Cover legislation the loading of 2% does not apply to Extras cover. Note: Due to the Australian Government s rounding rules for the rebate, actual premiums for hospital and/or extras coverage can vary from this calculation by up to 10 cents. S PRIVATE HEALTH INSURANCE COMPLAINTS If, for any reason, you re not happy with something then please let us know. We will do whatever we can to fix it. While we are absolutely committed to providing you with the best possible service, we are only human and sometimes we may make mistakes or see things differently from our policy holders, so we have processes in place to make sure you re absolutely satisfied. If you have any complaints, and we hope you don t, then please contact us immediately - Toll free hotline: Website: info@qchfund.com.au Address: Level 1, 296 Ross River Road Aitkenvale, QLD 4814 We take all complaints very seriously and our understanding staff are here to answer any questions and allay any fears you may have. Your health and wellbeing is our number one priority and if you re not completely happy with our service we would like to know about it. If, after we ve done all we can to rectify the situation, and you re not satisfied with the outcome, you have every right to contact the Private Health Insurance Ombudsman. The Ombudsman is an independent body formed to help resolve complaints and to provide advice and information to members of private health funds. You can contact the Ombudsman directly at: Telephone: info@phio.org.au Website: Address: Suite 2, Level 22, 580 George Street Sydney NSW 2000 PRIVACY POLICY We at Queensland Country are committed to managing personal information in accordance with our Privacy Policy. Our Privacy Policy is available for your information on our website at or from any of our Service Centres or Queensland Country Credit Union branches. 32

18 qldcountryhealth.com.au TOWNSVILLE CALL CENTRE Freecall: REGISTERED OFFICE 85 Patrick St, Townsville Qld 4814 TOWNSVILLE ADMINISTRATION Level Ross River Rd Aitkenvale Qld 4814 Phone: [07] Fax: [07] Post: PO Box 42 Aitkenvale Qld 4814 TOWNSVILLE SERVICE CENTRE Willows Shopping Centre Cnr Thuringowa Dr & Hervey Range Rd Kirwan Qld 4817 MOUNT ISA SERVICE CENTRE 70 Camooweal St Mount Isa Qld 4825 Phone: [07] BURDEKIN SERVICE CENTRE 186 Queen St Ayr Qld 4807 MACKAY SERVICE CENTRE Caneland Central Shopping Centre Cnr Victoria St & Mangrove Rd Mackay Qld 4740 GLADSTONE SERVICE CENTRE Shop 39, Gladstone Shopping Centre For everyone!

19 CREDIT UNION BRANCHES BEAUDESERT 8 William St Telephone: BOULIA Shire Council Office, Herbert St Telephone: BOWEN 37 Williams St Telephone: BRISBANE Koala House Cnr Creek & Adelaide St Telephone: BURDEKIN Ayr 186 Queen St Telephone: Home Hill 6 Eighth Ave Telephone: CAIRNS Smithfield Shopping Centre Cnr Cook & Kennedy Hwy Telephone: Earlville Mulgrave Road CHARTERS TOWERS Town Plaza Shopping Centre Gill St Telephone: COLLINSVILLE 13 Stanley St Telephone: GLENDEN Glenden Shopping Centre Telephone: GLADSTONE Shop 39, Gladstone Shopping Centre Telephone: JIMBOOMBA Jimboomba Shopping Centre Mt Lindesay Hwy Telephone: MACKAY Mackay Caneland Central Shopping Centre Cnr Victoria St & Mangrove Rd Telephone: Mount Pleasant Mount Pleasant Shopping Centre Cnr Phillip St & Bucasia Rd Telephone: MOUNT ISA 70 Camooweal St Telephone: STANTHORPE 3 Maryland St Telephone: TIERI Tieri Shopping Centre Telephone: TOWNSVILLE Aitkenvale 296 Ross River Rd Telephone: Deeragun Woodlands Shopping Centre Telephone: The Townsville Hospital Main Foyer, Douglas Telephone: Quick contact If you have any questions or need more information, please contact us by: Branch Visit our website for a listing of all our branches Magnetic Island Nelly Bay Telephone: Website info@qchfund.com.au Kirwan Willows Shopping Centre Telephone: Call WEIPA Cnr Kerr Point Dr & Commercial Ave Telephone: Queensland Country Health Fund Ltd ABN is a Registered Private Health Insurer.