SA Ambulance Service ACE. Ambulance Cover Extras non emergency

Transcription

1 SA Ambulance Service ACE Ambulance Cover Extras non emergency

2 I have private health insurance. Why do I need ACE? Most private health insurance policies cover you for the cost of the emergency attendance,treatment and/or transport by SA Ambulance Service. But what about non-emergency transport by ambulance? Whilst it s difficult to pre-determine each set of circumstances, many cases of illness or injury require additional patient transportation, for tests, on-going treatment or transference to another hospital. This ambulance transport is generally classed as non-emergency transport. In fact, non-emergency transportation makes up around one third of SA Ambulance Service s workload. Non-emergency fees start at around $205.

3 It always pays to keep an ACE up your sleeve. Ambulance Cover Extras (ACE), provides you with all the cover and peace of mind you need. Annual Membership Fees. Family $41.00 Single $20.30 When do benefits commence? Benefits for Ambulance Cover Extras (ACE) commences two months after the date of joining. STOP. Check first if you are assured emergency cover with your private health fund and only require cover for non-emergency transport: > Post the attached application form with your cheque or completed payment details to; SA Ambulance Service GPO Box 3, Adelaide 5001 > Present the attached application form with your payment to an Australia Post Bill Pay Centre. > Call our Customer Service Centre on and pay by credit card over the phone during business hours. (Please have your credit card details ready).

4 SA Ambulance Service Ambulance Cover Extras (ACE) Terms and Conditions The following Rules are current as at 1 August While these Rules apply to a subscriber during the period of a particular subscription, SA Ambulance Service (SAAS) reserves the right to make any changes it considers necessary to these Rules from time to time, without notice, in relation to a subscriber s subsequent subscription period. A current set of Rules including all modifications are available for inspection by any subscriber during normal business hours at SAAS s head office, or on SAAS s website at Definitions The following definitions apply to all Ambulance Cover products unless specified otherwise: Ambulance transport/service is defined as any service (either interstate or domestic) provided by SAAS or a person whom it directs, or agrees to allow, to provide the service, or any transport by a recognised Interstate Ambulance Service. Ambulance transport will be by Road Ambulance or, where impractical, patients may be transported by Air Ambulance if approved by SAAS. Recognised interstate ambulance services: Queensland Ambulance Service, St John Ambulance NT, St John Ambulance Western Australia, Ambulance Victoria, Ambulance Service of NSW, ACT Ambulance Service, Tasmanian Ambulance Service, Royal Flying Doctor Service. Medical need Where a medical practitioner is authorising non-emergency ambulance transport, medical need means that the primary reason for the transport is medical, and that the subscriber is being transported to, or from, a facility where they are to receive, or have received, medical treatment and transport by ambulance is the only medically suitable form of transport. Non-emergency ambulance transport (or elective ambulance transport) is where: > a pre-arranged booking for an ambulance transfer between a hospital, nursing home, residence, or other place providing medical treatment is authorised by the treating medical practitioner, and the authorisation is based on medical need. The subscriber will not have to pay for the cost of non-emergency ambulance transport if: > the service is provided by SAAS, or > the ambulance transport originates in another State or Territory and is provided by a recognised Interstate ambulance service; or > For a transport service originating in South Australia, if: > SAAS directs or requests another person to provide non-emergency ambulance transport > after a request by the subscriber, SAAS, at its sole discretion, agrees in writing prior to the transport date that another person may provide the service, and that person is recognised under Part 6 of the Health Care Act 2008 (SA). Where can I purchase Ambulance Cover Extras? Ambulance Cover Extras can be purchased by contacting the Customer Service Centre on , by visiting National Pharmacy or Australia Post bill pay outlets or other recognised payment outlets including online if available. Who is covered? ACE Family Cover entitles benefits to the primary member named on the ACE Membership Card and, subject to the conditions set out below, to their spouse

5 or co-habiting partner, their children or legal dependants under the age of 18, and any children or legal dependants they may have between the ages of 18 and 25 who are full-time students and residing at home. ACE Family Cover is provided on the following basis: > A non-student dependant who turns 18, or a student dependant who turns 25, during a membership year is still covered for the remainder of that membership year. To continue cover, a new single membership must be taken out at the end of the relevant membership year. > In relation to student dependants, a current student ID card must be provided at the time of applying for membership or post transport for confirmation of student status. > It is the responsibility of the primary member to ensure up-to-date membership details are maintained for all members who are included in their Family Cover Policy. > If a person other than the primary member wishes to change the membership details of a member of a Family Cover Policy (other than themselves), they must provide written proof that they are the legal guardian or otherwise have authority to change the membership details of that person. > The primary member may notify SAAS of the death of a member included in their Family Cover Policy by contacting the Customer Service Centre. A person other than the primary member may only notify SA Ambulance Service of the death of a member in writing. > The primary member has one month to notify SAAS of the birth of a child to be included in their Family Cover Policy (at this point their membership will be updated to include the child or singles must upgrade to Family Cover). The baby will be covered for one month to allow time to advise the Customer Service Centre via , fax or in writing. > All members must reside with the primary member to be covered under a Family Cover Policy. > Where a country student has a city semester address for the purpose of attending study, they will be deemed to reside with the primary member for the purpose of their Family Cover Policy. > Students residing interstate for the purpose of study will not be covered by the Family Cover Policy. It is recommended that cover is sought in the state of residence. > If a legal dependant or child of the primary member has their own dependants, those dependants will not be covered under the primary member s Family Cover Policy, regardless of their residence. In these circumstances, the legal dependant or child must have their own Ambulance Cover Policy for their dependants to be covered. ACE Single Cover entitles benefits to the person whose name appears on the Ambulance Cover membership card. Note: Ambulance Cover is intended for permanent residents of South Australia. Non-South Australian residents may join ACE cover at the discretion of SAAS. When do benefits commence? ACE commences two months after the date of joining. What are the benefits? Once you are covered, you will not have to pay the cost of non-emergency ambulance transport if: > the service is provided by SAAS, or > the ambulance transport originates in another State or Territory and is provided by a recognised interstate ambulance service, or

6 > for a transport service originating in South Australia, if: > SAAS directs or requests another person to provide non-emergency ambulance services, or > after a request by the subscriber, SAAS, at its sole discretion, agrees in writing prior to the transport date that another person may provide the service, and that person is recognised under Part 6 of the Health Care Act 2008 (SA). ACE Members may change back to Ambulance Cover at any time without penalty, by advising SAAS and paying the difference between the two membership rates pro-rata, until the date of the next renewal. Will I be covered for interstate ambulance transport? If you are a subscriber to ACE with SAAS and require ambulance transport while visiting interstate, you will be fully covered for all medically justified nonemergency ambulance transports (subject to the conditions and exclusions set out in these rules) Note: cover can not be maintained with Ambulance Cover if you are no longer resident in South Australia. If you have knowingly renewed your membership and a transport occurs you may be liable for the cost. Conditions ACE is subject to the following conditions: If the ambulance service is provided by another provider (other than SAAS), the non-emergency service will only be covered if: > SAAS directs or requests another person to provide non-emergency ambulance services, or > after a request by the subscriber, SAAS, at its sole discretion, agrees in writing prior to the transport date that another person may provide the service, and that person is recognised under Part 6 of the Health Care Act 2008 (SA). > all services must be medically justified > for non-emergency ambulance transports, the patient s treating medical practitioner must specify that an ambulance is the most medically appropriate means of transport and provide written authorisation, a copy of which shall be supplied to SAAS if requested; > transport between an interstate location and South Australia must be arranged by, and have the approval of, SAAS > when on-going non-emergency ambulance transport is required, the treating medical practitioner s written authorisation must be provided to SAAS. Such authorisation is valid for a maximum period of one month, after which it must be renewed. What isn t covered? ACE does not cover: > emergency ambulance transports > the cost of ambulance transport that is not, either transport to a place where the subscriber is to receive medical treatment, or transport from a place where the subscriber has received medical treatment, except where the transport has been authorised by a medical practitioner and where SAAS has given its prior written agreement > the cost of ambulance transport that is not provided by SAAS (unless directed or requested by SAAS, or where SAAS has given the subscriber its prior written agreement to use another provider), or provided by a recognised interstate ambulance service, or does not meet the conditions above > the cost of ambulance transport to the extent that you have insurance from a third party that would cover the cost if you did not have Ambulance Cover with SAAS, or where a third party would be responsible for the cost if you did not have Ambulance Cover, including without limitation:

7 - registered Private Health Funds - Motor Accident Commission - any other insurance company pursuant to an insurance policy that you hold - WorkCover - any third party who caused the injury or illness for which the ambulance transport was provided > patient movements between two recognised hospitals where one of the hospitals is responsible for the cost > public hospitals, or other places such as day care centres, for outpatient treatment where a hospital is responsible for the cost > Any government agencies or organisations. > SAAS reserves the right to recover the cost of an ambulance transport from you if you receive compensation, damages or any other payment from a third party covering the cost of the transport. How could I lose my Cover? You could lose your ACE: > by not renewing your subscription by the due date. Note: You are not covered for the cost of ambulance transport whilst your subscription is overdue and unpaid;or > by SAAS cancelling your subscription, without refund, if you or anyone under your Cover: - provide false or misleading information on your application, or on renewal - engage in activity with the purpose or effect of defrauding SAAS - initiate nuisance call-outs or in any other way misuse the ambulance transport service; or - act in a violent or threatening way to SAAS staff, SAAS s agents, or any other person in the course of an ambulance transport. When should I pay? ACE is payable in advance and is not refundable in part or in full. When changing from Single to Family status, or from ACE to Ambulance Cover, you are only required to meet the difference between the two rates pro-rata, until the date of the next renewal. It is the responsibility of the primary subscriber to ensure renewal of the subscription by the expiry date, whether a reminder notice is received or not. What s in the fine print? SAAS reserves the right to: > vary ACE fees and the terms and conditions of subscription, at any time, without prior notice, in relation to subsequent subscription periods > seek written advice that any spouse, partner, child or dependants for whom benefits are sought, qualify under the terms and conditions of this cover > invoice the member for ambulance transport charges where the conditions of the subscription have been breached > not provide a service during riots, or civil commotion > prohibit/cancel cover for any subscriber who is not normally a resident of South Australia, or who abuses their ACE through misuse of the services, or who fails to renew their subscription by the due date, or who breaches the conditions of the subscription > prioritise services in accordance with demand and available resources > not provide, or cancel, a service to a subscriber who is violent or otherwise poses a risk to other persons including SAAS officers.

8 Service responses and transport classifications will be determined by SAAS in its discretion in accordance with SAAS operating criteria. Your Privacy SAAS collects and holds personal information that is provided by you on your application form when you join as a subscriber. We need this information to make sure that your subscription details are correct and to contact you when necessary. Without this information, we may not be able to process (and therefore may reject) your application to be a subscriber. You may seek access to the personal information held about you by SAAS at any time (although some requests may be denied in certain circumstances). You may advise us if you believe this information is inaccurate or incomplete, and we will make any amendments we consider necessary. We may from time to time send you information about SAAS and our services. Unless you request otherwise, you authorise us to send you this information. If you do not want to receive this information, or if you wish to change any of your personal information, you may instruct us by contacting our Customer Service Centre on SAAS will only disclose your personal information to a third party where such disclosure is permitted in accordance with the Privacy Act 1988 (Cth) (Privacy Act) and our Privacy Policy, including where: a) you have expressly or impliedly consented to the disclosure b) staff disclosing the information believe on reasonable grounds that the disclosure is necessary to prevent or lessen a serious and imminent threat to life or health to you or to some other person; or c) the disclosure is authorised by or under law d) the disclosure is to agents or contractors that provide contracted services to SAAS (subject to privacy obligations) e) the disclosure is reasonably necessary for the enforcement of the criminal law or of a law imposing a pecuniary penalty or for the protection of the public revenue or for the interests of the government, statutory authority or statutory office holder as an employer. Before providing us with any details about another individual, you must ensure that the individual is aware of: a) the proposed disclosure of their information to us and the purposes for which the information is collected and used by us b) the individual s ability to request access to the information that we hold about them under the Privacy Act and to advise us if they think the information is inaccurate, incomplete or out of date. Full details of SAAS s privacy practices regarding personal information are set out in its Privacy Policy. To request a copy of the Privacy Policy, please contact our Customer Service Centre. For more information SA Ambulance Service GPO Box 3 Adelaide SA 5001 Telephone: Non-English speaking: for information in languages other than English, call the interpreting and translating centre and ask them to call SA Ambulance Service. This service is available at no cost to you, contact (08) SA Ambulance Service. All rights reserved. ISBN Printed July 2015.