How To Get A Free Health Insurance At Qld Country Health And Safety

Transcription

1 Healthy You Healthy You THE HEALTH BENEFITS GUIDE FOR EVERYONE 1 JULY 2015 Laura Geitz, Australian Netball Captain

2 Welcome TO QUEENSLAND COUNTRY OUR PURPOSE OUR HISTORY Queensland Country Health Fund Ltd (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 WELL-BEING OF THE PEOPLE IN OUR COMMUNITIES. Queensland Country has been in the business of providing private health insurance cover to Queenslanders for over 35 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! Head office [ 2 ]

3 CONTENTS Why private health insurance? 4 Have existing health insurance? 6 Why us? 8 Which cover is right for you? 10 Hospital cover 12 Lower your premiums with an excess! 14 Extras cover 18 Cover Packages 23 On-the-spot claiming 29 Easy online claiming 30 Manage your cover online 31 How to pay contributions 33 In more detail 34 Government initiatives 40 Private Health Insurance Complaints 45 [ 3 ]

4 WHY IS PRIVATE HEALTH INSURANCE for me? Doctor With private hospital cover you can choose your own doctor, and decide whether you will go to a public or private hospital that your doctor attends. Whether you re looking for yourself or your family, Queensland Country has you covered. Hospital Private hospital cover gives you the choice of being treated in either a public or private hospital with more choice over the hospital you stay in! have long Public System DAYS WAITING Days Total Knee Replacement Removal of Tonsils 309 Days Cataract Surgery 292 Days Heart Surgery 90 Days With private health insurance you avoid public hospital waiting times! Queensland hospital waiting times at 90th percentile as reported by the Australian Institute of Health and Welfare, Australian Hospital Statistics Queensland Country Health Fund [ 4 ]

5 as to when Lifetime Health Cover Take out hospital cover early in life to guarantee lower premiums. Higher income earners who take out hospital cover will avoid paying the Medicare Levy Surcharge. Having private health insurance definitely has its 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. Private 8,932 * 29,091 * 21,921 * HAVE TO PAY Some of the most common hospital procedures, if provided in a public hospital can have lengthy waiting lists. Alternatively if the medical treatment is provided in a private hospital the cost could easily be thousands of dollars if you don t have private hospital cover. * Source Queensland Country Health Fund claims records [ 5 ]

6 HAVE EXISTING HEALTH INSURANCE? It s too easy to transfer! 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! [ 6 ]

7 Will I need to serve any waiting periods when I switch to Queensland Country? What we need! 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. 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. Join or Switch to Queensland Country today! [ 7 ]

8 Why Us? 98% OF RESPONDENTS VOICED THAT THEY WERE SATISFIED WITH QUEENSLAND COUNTRY Source: Member Satisfaction Survey 2014 Member focused At Queensland Country our primary focus is on continually exploring ways to satisfy the needs of our policy holders. As part of a Member owned group, we 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! Happy members To ensure we maintain our high service standards, and to ensure our products continually meet our policy holder s 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! 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, wherever they may go! Adult children are also covered Your adult children can remain on your family cover up to the age of 21 years at no extra cost, and can continue to stay on their family policy up to the age of 25 years if they are studying full-time or an apprentice earning up to $30,000 p.a. and are not married or in a de-facto relationship. If they are not studying full-time or an apprentice we are able to offer our Extended Family cover option, a cost effective alternative for those families with adult dependants ensuring peace of mind for everyone. For more information please see page 37. 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 in McIlwraith on the Park in the Brisbane suburb of Auchenflower, close to the Wesley Hospital together with Roy Harris Place in Townsville, near the Mater Hospital in Pimlico, providing 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. We are the only health fund in Australia to provide this benefit! [ 8 ]

9 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 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 see page 31. Our own Dental Practice! Sponsorships and community support Queensland Country is committed to supporting local communities, and in doing so is proud to be an official partner of the Women s National Basketball League (WNBL) team - Townsville Fire, as well as Bronze sponsors of the Intrust Super Cup Rugby League team - Northern Pride. Backing our commitment to healthier communities we also sponsor the Townsville Running Festival, and Mackay and Bowen Triathlon events. Queensland Country also supports local community groups through sponsorship of events and also donations. An example of this includes the RACQ NQ Rescue Helicopter. Queensland Country Dental is Queensland Country Health Fund s Member only dental practice located in the Queensland Country Centre in Aitkenvale, Townsville. The practice offers a full range of dental services and focuses on improving the oral health of Members. All Health Fund Members can access high quality dental care. Members with Premium Extras will have low or no out of pocket expenses on diagnostic and preventive treatments, including check-ups, scale and clean and mouthguards. Members with Essential Extras, Young Extras or any of our Hospital cover products are also eligible for treatment at Queensland Country Dental at concessional prices. For further information on the dental practice go to [ 9 ]

10 Hospital cover Extras 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! 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! Top hospital Top hospital 250 Premium Extras Top hospital 500 Essential Extras Intermediate hospital 250 Young Extras* 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. [ 10 ]

11 Choose your level of hospital cover based on your needs and budget. Private Hospital cover Description Excess options Top hospital Top hospital 250 Top hospital 500 Our most comprehensive Hospital product and popular with those looking for complete peace of mind. Provides a comprehensive hospital cover where you pay the first $250 towards any inpatient hospitalisation in return for a lower premium. 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. No excess payable. $250 excess per person per membership year up to a maximum of $500 for a family policy. $500 excess per person per membership year up to a maximum of $1,000 for a family policy. Intermediate hospital 250 Provides a great value mid level hospital cover ideal for a young or healthy person who doesn t want to pay for hospital services they feel less inclined to need. $250 excess per person per membership year up to a maximum of $500 for a family policy. Intermediate hospital 500 Provides a great value mid level hospital cover ideal for a young or healthy person who doesn t want to pay for hospital services they feel less inclined to need. $500 excess per person per membership year up to a maximum of $1,000 for a family policy. 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 towards inpatient treatment in a private hospital. No excess payable. Choose your level of Extras cover based on your expected frequency of use and budget. Extras cover Premium Extras Essential Extras Young Extras Description Provides superior visit benefits for an extensive range of dental, optical and therapy services with generous annual limits. Provides benefits for the same comprehensive range of services as our Premium Extras just with slightly lower benefits and annual limits, keeping the policy cost down. Provides generous benefits for all the services that younger people generally use. Its tailor made to keep premiums low but the benefits high. [ 11 ]

12 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 35.) Private Hospital Accommodation * Theatre Fees* Surgically Implanted Prosthesis Benefits Prosthesis benefits (artificial hips, knees, etc) as per the 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* Grommets in Ears* Gynaecological Services* Hernia Repair* Joint Reconstructions* Back Surgery* Brain Surgery* Plastic and Reconstructive Surgery* In-hospital Rehabilitation Treatment* Rehabilitation for hospital services with restricted or excluded benefit entitlement will have reduced or nil benefit eligibility. 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. Gastric banding, sleeving/diversions or bypass (weight loss surgery)* including replacements, repairs and adjustments. 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 a limit of $2000 per person, per membership year. 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 limit is provided every three (3) years with the limit amount applied based on your length of Membership with Queensland Country Health: Up to 10 years $1000, years $1500 and 15 years+ $2000. Benefits are calculated at 85% of purchase cost up to the appropriate limit of benefit. Any hearing aid cannot be replaced within three (3) years from its original purchase date. Australian Hearing Services Benefit of $25 per membership year per eligible person for the cost of a Hearing Services Card. Nursing Home and Bush Benefit up to $60 per visit or $150 per day limited to $1000 per person, per membership year. Special Benefit of up to $150 per day $750 per person, per membership year. 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.) 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 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 38 for further details. * 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. [ 12 ]

13 TOP HOSPITAL COVER INTERMEDIATE HOSPITAL COVER PUBLIC HOSPITAL COVER NIL EXCESS $250 EXCESS $500 EXCESS $250 EXCESS $500 EXCESS NIL EXCESS R R R R R R R 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, 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. For more information on our hospital cover go to page 34 'In more detail'. [ 13 ]

14 [ 14 ] LOWER YOUR PREMIUMS with an Excess!

15 AN EXCESS IS THE AMOUNT YOU AGREE TO CONTRIBUTE TOWARDS HOSPITAL 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. 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.* The most you ll have to pay each membership year if you choose a cover with a hospital excess is outlined below: EXCESS TYPE SINGLES COVER COUPLES/FAMILY/SINGLE PARENT COVER MAXIMUM PER MEMBERSHIP YEAR MAXIMUM PER PERSON PER MEMBERSHIP YEAR MAXIMUM PER POLICY PER MEMBERSHIP YEAR $250 EXCESS $250 $250 $500 $500 EXCESS $500 $500 $1000 With our Top hospital cover, you will not be charged an excess if your child up to and including the age of 10 years is admitted to hospital for medical treatment. This excess exemption for children 10 years and under is NOT applicable under our Intermediate Hospital cover and Singles and Couples combined cover. It is exclusive to our range of Top Hospital covers ONLY. * Membership Year is defined on page 37. [ 15 ]

16 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 check-up, 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. Premium Extras Essential Extras Young 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. provides a comprehensive range of therapies and benefits with lower limits and premiums and can only be purchased in conjunction with a hospital cover. 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 age of 30. Dental and Optical Premier Providers Queensland Country has negotiated agreements with a large number of Dental and Optical providers. Services at one of our preferred providers are well priced and are likely to reduce out of pocket expenses for Members. Further details of these providers can be seen at Preferredprovidernetwork [ 16 ]

17 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: Participate in your choice of weight management programs Participate in quit smoking programs Participate in other approved health management programs ** including: - Gym Membership - Personal Training programs Have your skin checked for skin cancers through mole mapping Consultation fees for Diabetes Educator Consultation fees for Metabolic dieticians and nutritionists when providing assistance with weight management Bowel Screening tests and Bone Density tests (no doctors referral will be required) PSA Test (one per year). We will cover a second yearly test not covered by Medicare. 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. For example, after 5 years continuous cover on our Premium Extras product, the annual limit per person for Dental would have increased to $1650 per person per membership year. Loyalty limit increases do not apply to sub limits or individual service/item benefits. 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 * Benefit payable under Premium Extras ** To comply with private health insurance legislation you must have been referred by your health care professional to participate in a health management program to address, improve or prevent a specific health or medical condition. A Health Management Program Benefit Approval Form available on our website must accompany claim for these benefits. [ 17 ]

18 EXTRAS LIMITS PER MEMBERSHIP YEAR AND WHAT WE LL PAY TYPE OF SERVICE PREMIUM EXTRAS WAITING PERIODS DENTAL EXAMPLE OF BENEFITS OVERALL LIMIT Diagnostic This includes examinations, consultations and Xrays etc. 2 months eg. Periodic Oral Exam - $45 X-rays - $30 $600 sub limit^ Preventative This includes cleaning and scaling, fluoride treatment and mouth guards 2 months eg. Scale & Clean - $75 Fluoride Treatment - $22 Mouth guard - $150 $800 sub limit^ Periodontics eg. Specialised Gum Treatments Simple Extraction Surgical Extractions Wisdom teeth extraction, removal of impacted teeth *Benefits paid on dental item numbers only, unless hospital cover is held and all waits have been served for any in-patient services. Endodontic eg. Root canal therapy and root fillings Restorative Composite fillings and amalgam fillings 12 months 2 months 12 months eg. Simple Extractions - $105 Surgical Extraction - $ months 2 months eg. Root Canal obturation - one canal - $170 eg. One surface composite filling - $90 $500 sub limit^ $700 sub limit^ $600 sub limit^ $800 sub limit^ $1400 overall benefit limit per person per membership year for all Dental services (excluding Orthodontics which has separate claim limits) Sub limits apply^ Crowns/Bridges 12 months (accumulating to $1500 per year after 2 years of membership) eg. Full Veneered Crown - $800 $800 sub limit^ Prosthodontics Dentures etc. 12 months eg. Full upper and lower denture - $850 $850 sub limit^ General Services 2 months eg. Occlusal splints - $300 $500 sub limit^ Orthodontics Braces etc. 12 months $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. OPTICAL Single Vision Spectacles Bifocal Spectacles Multifocal Spectacles Contact Lenses (hard or soft) 2 months Total benefit for optical items or services is limited to a maximum of $275 per person, per membership year Repairs to frames/spectacle frames only/ replacement lenses ^ 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. X Service we don t pay a benefit towards [ 18 ]

19 ESSENTIAL EXTRAS YOUNG EXTRAS EXAMPLE OF BENEFITS OVERALL LIMIT EXAMPLE OF BENEFITS OVERALL LIMIT e g. Pe r i o d i c O r a l E x a m - $ 2 9 X-rays - $19 $400 sub limit^ eg. Periodic Oral Exam - $34 X-rays - $23 eg. Scale & Clean - $48 Fluoride Treatment - $14 Mouth guard - $96 $500 sub limit^ eg. Scale & Clean - $56 Fluoride Treatment - $17 Mouth guards - $113 eg. Simple Extractions - $67 Surgical Extraction - $115 eg. Root Canal obturation - one canal - $109 eg. One surface composite filling - $58 (accumulating to $1000 per year after 2 years of membership) eg. Full Veneered Crown - $512 eg. Full lower denture - $320 eg. Occlusal splints - $192 $300 sub limit^ $400 sub limit^ $350 sub limit^ $500 sub limit^ $550 sub limit^ $500 sub limit^ $300 sub limit^ $900 overall benefit limit per person per membership year for all Dental services (excluding Orthodontics which has separate claim limits) Sub limits apply^ $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 50% of cost. *Years of membership refers to the actual period of cover on Essential Extras products only. X eg. Simple Extractions - $79 Surgical Extraction# - $135 X eg. One surface composite filling - $68 eg. Full Veneered Crown - $500 X eg. Occlusal splints - $225 No cover for Orthodontics $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) Total benefit for optical items or services is limited to a maximum of $185 per person, per membership year Total benefit for optical items or services is limited to a maximum of $200 per person up to $400 per policy per membership year [ 19 ]

20 LIMITS PER MEMBERSHIP YEAR AND WHAT WE LL PAY TYPE OF SERVICE WAITING PERIODS PREMIUM EXTRAS THERAPIES CONSULTATION TYPE OR SERVICE OVERALL LIMIT Acupuncture* 2 months Initial and Subsequent - $35 Audiology 2 months Initial and Subsequent - $50 Report - $60 Chiropractic Remedial Massage/Bowen Therapy/ Myotherapy* 2 months Initial and Subsequent - $35 X-rays - $60 (not reading of x-rays) 2 months Initial and Subsequent - $35 $700 combined sub limit # Osteopathy 2 months Initial - $35 Subsequent - $35 Naturopathy/Homeopathy* 2 months Initial and Subsequent - $35 Dietitian 2 months Initial - $75 Subsequent - $40 Occupational Therapy 2 months Initial - $80 Subsequent - $40 Orthoptic Therapy 2 months Initial and Subsequent - $60 Foot Orthoses and Orthopaedic Shoes (orthoses and custom made footwear) Podiatry Physiotherapy Exercise Physiology 2 months 85% of cost 2 months 2 months 2 months Initial and Subsequent - $40 Approved appliances (orthotics) - 85% of cost Minor Procedures - 75% of cost Initial - $55 Subsequent - $40 Group Therapy - $10 ($100 combined sub limit applies for Group therapy services provided under Physiotherapy and/or Exercise Physiology) Initial - $50 Subsequent - $35 Monthly Program fee - $35 Group Therapy - $10 ($100 combined sub limit applies for Group therapy services provided under Physiotherapy and/or Exercise Physiology) $150 sub limit $600 sub limit ## $700 combined sub limit ### $1400 overall benefit limit per person per membership year for all Therapy services Sub limits may apply Psychology 2 months Initial and Subsequent - $80 Report - $80 Group Therapy - $80 Speech Therapy 2 months Initial - $70 Subsequent - $35 OTHER EXTRAS Childbirth Education 12 months $60 Pharmaceutical^^ School Accidents Healthy Living (see Healthy Living benefits information on previous page 17) 2 months 2 months 2 months Up to $50 Limit of $500 per person per membership year 100% - Limit of $750 per dependent child per membership year $150 per person per membership year ^^ 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 42 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. Group Therapy has a combined sub limit for services provided under Physiotherapy and Exercise Physiology. 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. [ 20 ]

21 ESSENTIAL EXTRAS YOUNG EXTRAS CONSULTATION TYPE OR SERVICE OVERALL LIMIT CONSULTATION TYPE OR SERVICE OVERALL LIMIT Initial and Subsequent - $22 Initial and Subsequent - $30 Initial and Subsequent - $32 Report - $38 X Initial and Subsequent - $22 X-rays - $50 (not reading of x-rays) $500 Initial and Subsequent - $30 X-rays - $50 (not reading of x-rays) Initial and Subsequent - $22 combined sub limit # Initial and Subsequent - $30 Initial - $28 Subsequent - $24 Initial and Subsequent - $30 Initial and Subsequent - $22 Initial and Subsequent - $30 Initial - $48 Subsequent - $26 Initial - $55 Subsequent - $35 $300 per therapy $500 per person up to $1000 per policy Initial - $51 Subsequent- $26 X Initial and Subsequent - $38 X 85% of cost Initial and Subsequent - $26 Approved appliances (orthotics) - 85% of cost Minor Procedures - 75% of cost $100 sub limit $400 sub limit ## $900 overall benefit limit per person per membership year for all Therapy services Sub limits may apply X Initial and subsequent - $30 Approved appliances (orthotics) - 85% of cost up to available policy limits Minor Procedures - 75% of cost up to available policy limits Initial - $36 Subsequent - $26 Group Therapy - $7 ($70 combined sub limit applies for Group therapy services provided under Physiotherapy and/or Exercise Physiology) Initial - $32 Subsequent - $22 Monthly Program fee - $22 Group Therapy - $7 ($70 combined sub limit applies for Group therapy services provided under Physiotherapy and/or Exercise Physiology) $500 combined sub limit ### Initial - $42 Subsequent - $32 Group Therapy - $8 (sub limit of $80 applies) X $400 per person up to $800 per policy Initial and Subsequent - $51 Report - $51 Group Therapy - $51 X Initial - $45 Subsequent - $22 X $38 X Up to $30 Limit of $300 per person per membership year 100%- Limit of $450 per dependent child per membership year $125 per person per membership year Up to $30 Limit of $150 per person up to $300 per policy per membership year X $125 per person up to $250 per policy per membership year ### 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 [ 21 ]

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23 COVER PACKAGES We provide our policyholders with a simple, but flexible product range, allowing a choice of health cover to meet any budget or need To keep it simple and easy to understand you can choose one of our three broad hospital cover options Top, Intermediate or Public. You then select an eligible excess option that you are comfortable with, and that s your hospital cover locked in! Then if you wish you can add an Extras cover that best suits you or your family s needs! Choose between our Premium, Essential or Young Extras covers. You can even take Young Extras as a stand-alone product. It s that simple! [ 23 ]

24 Singles cover SINGLE HOSPITAL PREMIUMS WITH BASE TIER REBATE NO REBATE DEDUCTED PRODUCT WEEKLY MONTHLY YEARLY WEEKLY MONTHLY YEARLY TOP HOSPITAL $ $ $ $ $ $ 1, $ $ $ $ $ $ 2, TOP HOSPITAL 250 $ $ $ $ $ $ 1, $ $ $ $ $ $ 2, TOP HOSPITAL 500 $ $ $ $ $ $ 1, $ $ $ $ $ $ 1, INTERMEDIATE HOSPITAL 250 $ $ $ $ $ $ 1, $ $ $ $ $ $ 1, INTERMEDIATE HOSPITAL 500 $ $ $ $ $ $ $ $ $ $ $ $ 1, PUBLIC HOSPITAL $ $ $ $ $ $ $ $ $ $ $ $ 1, SINGLE HOSPITAL + EXTRAS PREMIUMS WITH BASE TIER REBATE NO REBATE DEDUCTED PRODUCT WEEKLY MONTHLY YEARLY WEEKLY MONTHLY YEARLY TOP HOSPITAL + PREMIUM EXTRAS $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, TOP HOSPITAL + ESSENTIAL EXTRAS $ $ $ $ $ $ 2, $ $ $ $ $ $ 2, TOP HOSPITAL + YOUNG EXTRAS $ $ $ $ $ $ 1, $ $ $ $ $ $ 2, TOP HOSPITAL PREMIUM EXTRAS $ $ $ $ $ $ 2, $ $ $ $ $ $ 2, TOP HOSPITAL ESSENTIAL EXTRAS $ $ $ $ $ $ 1, $ $ $ $ $ $ 2, TOP HOSPITAL YOUNG EXTRAS $ $ $ $ $ $ 1, $ $ $ $ $ $ 2, TOP HOSPITAL PREMIUM EXTRAS $ $ $ $ $ $ 1, $ $ $ $ $ $ 2, TOP HOSPITAL ESSENTIAL EXTRAS $ $ $ $ $ $ 1, $ $ $ $ $ $ 2, TOP HOSPITAL YOUNG EXTRAS $ $ $ $ $ $ 1, $ $ $ $ $ $ 2, INTERMEDIATE HOSPITAL PREMIUM EXTRAS INTERMEDIATE HOSPITAL ESSENTIAL EXTRAS INTERMEDIATE HOSPITAL YOUNG EXTRAS INTERMEDIATE HOSPITAL PREMIUM EXTRAS INTERMEDIATE HOSPITAL ESSENTIAL EXTRAS INTERMEDIATE HOSPITAL YOUNG EXTRAS $ $ $ $ $ $ 1, $ $ $ $ $ $ 2, $ $ $ $ $ $ 1, $ $ $ $ $ $ 1, $ $ $ $ $ $ 1, $ $ $ $ $ $ 1, $ $ $ $ $ $ 1, $ $ $ $ $ $ 2, $ $ $ $ $ $ 1, $ $ $ $ $ $ 1, $ $ $ $ $ $ 1, $ $ $ $ $ $ 1, PUBLIC HOSPITAL + PREMIUM EXTRAS $ $ $ $ $ $ 1, $ $ $ $ $ $ 2, PUBLIC HOSPITAL + ESSENTIAL EXTRAS $ $ $ $ $ $ 1, $ $ $ $ $ $ 1, PUBLIC HOSPITAL + YOUNG EXTRAS $ $ $ $ $ $ 1, $ $ $ $ $ $ 1, YOUNG EXTRAS $ $ 4.95 $ $ $ $ $ $ 6.85 $ $ $ $ [ 24 ]

25 Couple/Family cover COUPLE/FAMILY HOSPITAL PREMIUMS WITH BASE TIER REBATE NO REBATE DEDUCTED PRODUCT WEEKLY MONTHLY YEARLY WEEKLY MONTHLY YEARLY TOP HOSPITAL $ $ $ $ $ $ 3, $ $ $ $ $ $ 4, TOP HOSPITAL 250 $ $ $ $ $ $ 3, $ $ $ $ $ $ 4, TOP HOSPITAL 500 $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, INTERMEDIATE HOSPITAL 250 $ $ $ $ $ $ 2, $ $ $ $ $ $ 2, INTERMEDIATE HOSPITAL 500 $ $ $ $ $ $ 1, $ $ $ $ $ $ 2, PUBLIC HOSPITAL $ $ $ $ $ $ 1, $ $ $ $ $ $ 2, COUPLE/FAMILY HOSPITAL + EXTRAS PREMIUMS WITH BASE TIER REBATE NO REBATE DEDUCTED PRODUCT WEEKLY MONTHLY YEARLY WEEKLY MONTHLY YEARLY TOP HOSPITAL + PREMIUM EXTRAS $ $ $ $ $ $ 4, $ $ $ $ $ $ 6, TOP HOSPITAL + ESSENTIAL EXTRAS $ $ $ $ $ $ 4, $ $ $ $ $ $ 5, TOP HOSPITAL + YOUNG EXTRAS $ $ $ $ $ $ 3, $ $ $ $ $ $ 5, TOP HOSPITAL PREMIUM EXTRAS $ $ $ $ $ $ 4, $ $ $ $ $ $ 5, TOP HOSPITAL ESSENTIAL EXTRAS $ $ $ $ $ $ 3, $ $ $ $ $ $ 5, TOP HOSPITAL YOUNG EXTRAS $ $ $ $ $ $ 3, $ $ $ $ $ $ 4, TOP HOSPITAL PREMIUM EXTRAS $ $ $ $ $ $ 3, $ $ $ $ $ $ 5, TOP HOSPITAL ESSENTIAL EXTRAS $ $ $ $ $ $ 3, $ $ $ $ $ $ 4, TOP HOSPITAL YOUNG EXTRAS $ $ $ $ $ $ 3, $ $ $ $ $ $ 4, INTERMEDIATE HOSPITAL PREMIUM EXTRAS INTERMEDIATE HOSPITAL ESSENTIAL EXTRAS INTERMEDIATE HOSPITAL YOUNG EXTRAS INTERMEDIATE HOSPITAL PREMIUM EXTRAS INTERMEDIATE HOSPITAL ESSENTIAL EXTRAS INTERMEDIATE HOSPITAL YOUNG EXTRAS $ $ $ $ $ $ 3, $ $ $ $ $ $ 4, $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, $ $ $ $ $ $ 2, $ $ $ $ $ $ 4, $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, PUBLIC HOSPITAL + PREMIUM EXTRAS $ $ $ $ $ $ 2, $ $ $ $ $ $ 4, PUBLIC HOSPITAL + ESSENTIAL EXTRAS $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, PUBLIC HOSPITAL + YOUNG EXTRAS $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, YOUNG EXTRAS $ $ 9.85 $ $ $ $ $ $ $ $ $ $ [ 25 ]

26 Single Parent cover SINGLE PARENT HOSPITAL PREMIUMS WITH BASE TIER REBATE NO REBATE DEDUCTED PRODUCT WEEKLY MONTHLY YEARLY WEEKLY MONTHLY YEARLY TOP HOSPITAL $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, TOP HOSPITAL 250 $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, TOP HOSPITAL 500 $ $ $ $ $ $ 2, $ $ $ $ $ $ 2, INTERMEDIATE HOSPITAL 250 $ $ $ $ $ $ 2, $ $ $ $ $ $ 2, INTERMEDIATE HOSPITAL 500 $ $ $ $ $ $ 1, $ $ $ $ $ $ 2, PUBLIC HOSPITAL $ $ $ $ $ $ 1, $ $ $ $ $ $ 2, SINGLE PARENT HOSPITAL + EXTRAS PREMIUMS WITH BASE TIER REBATE NO REBATE DEDUCTED PRODUCT WEEKLY MONTHLY YEARLY WEEKLY MONTHLY YEARLY TOP HOSPITAL + PREMIUM EXTRAS $ $ $ $ $ $ 3, $ $ $ $ $ $ 5, TOP HOSPITAL + ESSENTIAL EXTRAS $ $ $ $ $ $ 3, $ $ $ $ $ $ 4, TOP HOSPITAL + YOUNG EXTRAS $ $ $ $ $ $ 3, $ $ $ $ $ $ 4, TOP HOSPITAL PREMIUM EXTRAS $ $ $ $ $ $ 3, $ $ $ $ $ $ 5, TOP HOSPITAL ESSENTIAL EXTRAS $ $ $ $ $ $ 3, $ $ $ $ $ $ 4, TOP HOSPITAL YOUNG EXTRAS $ $ $ $ $ $ 2, $ $ $ $ $ $ 4, TOP HOSPITAL PREMIUM EXTRAS $ $ $ $ $ $ 3, $ $ $ $ $ $ 4, TOP HOSPITAL ESSENTIAL EXTRAS $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, TOP HOSPITAL YOUNG EXTRAS $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, INTERMEDIATE HOSPITAL PREMIUM EXTRAS INTERMEDIATE HOSPITAL ESSENTIAL EXTRAS INTERMEDIATE HOSPITAL YOUNG EXTRAS INTERMEDIATE HOSPITAL PREMIUM EXTRAS INTERMEDIATE HOSPITAL ESSENTIAL EXTRAS INTERMEDIATE HOSPITAL YOUNG EXTRAS $ $ $ $ $ $ 3, $ $ $ $ $ $ 4, $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, $ $ $ $ $ $ 2, $ $ $ $ $ $ 4, $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, PUBLIC HOSPITAL + PREMIUM EXTRAS $ $ $ $ $ $ 2, $ $ $ $ $ $ 4, PUBLIC HOSPITAL + ESSENTIAL EXTRAS $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, PUBLIC HOSPITAL + YOUNG EXTRAS $ $ $ $ $ $ 2, $ $ $ $ $ $ 3, YOUNG EXTRAS $ $ 9.85 $ $ $ $ $ $ $ $ $ $ [ 26 ]

27 Extended Family Cover EXTENDED FAMILY HOSPITAL + EXTRAS PREMIUMS WITH BASE TIER REBATE NO REBATE DEDUCTED PRODUCT WEEKLY MONTHLY YEARLY WEEKLY MONTHLY YEARLY TOP HOSPITAL + PREMIUM EXTRAS $ $ $ $ $ $ 5, $ $ $ $ $ $ 8, TOP HOSPITAL + ESSENTIAL EXTRAS $ $ $ $ $ $ 5, $ $ $ $ $ $ 7, TOP HOSPITAL PREMIUM EXTRAS $ $ $ $ $ $ 5, $ $ $ $ $ $ 7, TOP HOSPITAL ESSENTIAL EXTRAS $ $ $ $ $ $ 4, $ $ $ $ $ $ 6, TOP HOSPITAL PREMIUM EXTRAS $ $ $ $ $ $ 4, $ $ $ $ $ $ 6, TOP HOSPITAL ESSENTIAL EXTRAS $ $ $ $ $ $ 4, $ $ $ $ $ $ 5, SINGLE PARENT EXTENDED FAMILY HOSPITAL + EXTRAS PREMIUMS WITH BASE TIER REBATE NO REBATE DEDUCTED PRODUCT WEEKLY MONTHLY YEARLY WEEKLY MONTHLY YEARLY TOP HOSPITAL + PREMIUM EXTRAS $ $ $ $ $ $ 4, $ $ $ $ $ $ 6, TOP HOSPITAL + ESSENTIAL EXTRAS $ $ $ $ $ $ 4, $ $ $ $ $ $ 5, TOP HOSPITAL PREMIUM EXTRAS $ $ $ $ $ $ 4, $ $ $ $ $ $ 6, TOP HOSPITAL ESSENTIAL EXTRAS $ $ $ $ $ $ 3, $ $ $ $ $ $ 5, TOP HOSPITAL PREMIUM EXTRAS $ $ $ $ $ $ 4, $ $ $ $ $ $ 5, TOP HOSPITAL ESSENTIAL EXTRAS $ $ $ $ $ $ 3, $ $ $ $ $ $ 4, [ 27 ]

28 [ 28 ] WE BELIEVE THAT CLAIMING BENEFITS SHOULD BE QUICK & EASY so you ve got more time to relax and enjoy life!

29 On-the-spot claiming for extras To make it even easier to claim your benefit, participating health 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. To find out if your health service provider has HICAPS visit them online at Depending on your level of cover, and if your provider has the appropriate facility, you can claim these services through HICAPS: Dentists, Endodontists, Periodontists, Dental Prosthetist/ Advanced Dental Technicians, Prosthodontists, Paediatric Dentists Dispensing Optometrists, Optical Dispensers Physiotherapists Chiropractors Osteopaths Podiatrists Occupational Therapists Psychologists Massage Therapy [ 29 ]

30 Easy Online Claiming!! Save time and get your money back even faster - online claiming is now available! We ve now made it even easier to claim for a wide range of services when onthe-spot claiming isn t available through your provider. Simply go online using your PC, tablet or smart phone! Log in to Online Member Services where you will find instructions on how to submit your claim, it s really easy!! You can claim up to $400 per day in benefits for services up to three (3) months from the actual date of the service, treatment or visit*. The following services# can be claimed online, depending on your level of cover Acupuncture Audiology Chiropractor Dental General services only. NO major dental or Orthodontic Dietetics Homeopathy Massage Naturopathy Occupational Therapy Optical Osteopathy Physiotherapy Podiatry consultations only No benefit for Orthotics and/or appliances payable via Online claiming Psychology Speech Therapy * Eligible benefits are only claimable after 3 months of membership with the fund. # Some of these services are not available on Young Extras cover. Receipts are not required to be submitted with your online claim, however we may request them for review and ask that you keep your receipts for twelve (12) months from the date of claiming. Full terms and conditions for online claiming can be found on our website [ 30 ]

31 Manage your cover online Online Member Services (OMS) gives you the ability to update your 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! NB. Access to some functions may be limited for your spouse/partner and dependants. Below is a list of all the different services you can access by registering: Claims history View/print tax statement Update Membership details Change contact details Add new person Change personal details Add student dependant or apprentice Add Medicare card details Add previous cover details Make a contribution payment by credit card Update your method of payment Change level of cover Update the way we pay benefits eg. direct credit Contribution changes View benefit limits [ 31 ]

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33 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. 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 Credit Card BPAY BillPaying 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* 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 Retail 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 ^ Please see page 31 for details on how to register for OMS 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 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 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. [ 33 ]