Health Partners Package Cover Prime Living

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1 This document provides an overview of our package cover. Please read and retain it in conjunction with Health Partners Product Disclosure Statement (PDS) which is available at healthpartners.com.au/pds or by calling us on Our package provides comprehensive cover for both hospital and extras. Designed for singles and couples who want comprehensive cover and but aren t planning to start a family. excludes things you probably won t need like orthodontics and pregnancy and provides benefits for services like laser eye surgery as well as benefits of up to 100% for dental, optical and physiotherapy, plus Australia-wide ambulance cover. You get peace of mind with hospital cover for a broad range of hospital services with some exclusions, like pregnancy, so you re not paying for things you no longer need. Key features Nil excess; nil co-payment Full ambulance cover Up to 100% back for dental, optical Laser eye surgery and physiotherapy Natural therapies included Emergency facility fee Access to member discounts and offers Medicare Levy Surcharge exempt. Never-ending benefits at Health Partners Optical and Dental Hospital cover component What s covered You are covered for all Medicare-recognised procedures when you are admitted to hospital, except those listed under Exclusions and minimum benefits for those services listed under Restrictions. With Health Partners, you are eligible to receive benefits at your choice of participating hospitals (private or public), Australia-wide. We will pay for: Your accommodation in hospital (including registered day facilities) Your theatre and intensive care fees All PBS prescriptions relating to your admission, while you re in hospital An extensive range of government-recognised surgically implanted prostheses Access to a range of health management and support programs. We will pay towards: In-patient medical expenses (refer to the PDS or online for information on how to avoid or reduce your out-of-pocket medical expenses) Emergency department facility fees Podiatric surgery 85% benefit in an accredited day facility. $350 per person, per year. A range of additional services as outlined on page 2. Exclusions Exclusions are the services for which benefits are not available on this level of cover: Pregnancy and birth-related services Assisted reproductive services Sterilisation reversal Surgical weight loss procedures. Restrictions ed benefits are available for the following in a public hospital or accredited surgery: Podiatric surgery. Current as at 1 April Page 1 of 5

2 Additional services Benefit Post Admission Non-PBS prescriptions Up to 100% $1,500 Non-surgically implanted prostheses (e.g. prosthetic bras, wigs) 100% $1,500 Post-surgical recovery aids (e.g. compression garments, braces) 100% $250 Home Sleep Studies Set benefit applies when using a Health Partners participating provider $100 $200 Home Nursing Wound management, IV medication, palliative care 100% $500 Included programs Health Management Programs These include Coronary Artery Disease, Bone Health and Type 2 Diabetes. They are designed to support members who are looking to improve the way they manage their condition(s) and overall health. All applications are individually assessed by Health Partners prior to enrolment. Home Health Partner A unique service designed to make the transition from hospital to home easier for you. If it is appropriate, you can elect to leave hospital early after an operation and continue receiving care in the comfort of your own home. All cases are individually reviewed by the hospital prior to your discharge to the care of your GP, with a care plan developed appropriate to your clinical needs. Extras cover component offers the widest range of extras, from dental to optical, podiatry to massage and a variety in between. You can claim benefits at your own recognised provider or just choose a Health Partners professional where you get 100% back for dental and optical services. Benefits and limits explained A benefit is the amount you can receive back when you make a claim for any of the services or products listed in the tables that follow. For most services, there are limits to the amounts you can claim back or the number of times you can claim a benefit, during the calendar year or specified period. Except where otherwise stated, benefits and limits are per person per calendar year, and waiting periods may apply. Not all benefits are listed for all extras services. To check if a specific item is covered or to obtain a benefit quote, please contact us. Page 2 of 5

3 General Dental At Health Partners Dental and Barossa Dental 100% benefit applies. At other dental providers A schedule of benefits applies; please call us for a quote. No limit Major Dental/Endodontic At Health Partners Dental and Barossa Dental 100% benefit applies. At other dental providers $1,600 A schedule of benefits applies; please call us for a quote. Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa. Optical At Health Partners Optical 100% benefit for prescription glasses/prescription sunglasses/contact lenses. 60% unlimited benefit applies at Health Partners Optical if you reach your limit for the year. $500 50% discount on sunglasses. No limit. ($300 sub-limit At other optical providers for other optical providers) 100% benefit for prescription glasses/prescription sunglasses/contact lenses. Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa. Pharmacy At Health Partners Participating Pharmacies $1,000 PBS prescriptions, not already subsidised by the Government. pay max. of $20 Please ask your Private and compounding prescriptions. pay max. of $37 pharmacist about the benefits that apply to 20% discount on most non-prescription items. No limit. Some conditions apply. your prescription and if you can save more with generic brands. Physiotherapy At Health Partners Participating Physiotherapists 100% benefit for initial, subsequent and long consultations, hydrotherapy and lymphoedema treatment. At other physiotherapy providers 70% benefits apply. Pilates Set benefits apply. Per session $20 $1,500 ($1,000 sub-limit for other physiotherapy providers. $300 sub-limit for Pilates) Page 3 of 5

4 Natural Therapies/Naturopathy/Acupuncture/Hypnotherapy 70% benefit applies. $800 ($200 sub-limit for each modality) Chiropractic/Osteopathic/Exercise Physiology 80% benefit applies. ($1,500 limit per membership) Podiatry/ Orthotics 70% benefit applies. (sub-limit $400 for orthotics) Dietary Set benefits apply. Initial consultation $60 Psychology Set benefits apply, for example: Initial consultations $140 Subsequent consultations $120 Speech Therapy Set benefits apply, for example: Initial consultation $100 Subsequent consultation $70 Eye Therapy Set benefits apply. Initial consultation $60 Occupational Therapy Set benefits apply, for example: Initial consultation $60 Laser Eye Surgery Laser correction eye surgery 100% Lifetime limit $4,000 Full ambulance Emergency and non-emergency services; Australia-wide coverage; road and air services. 100% $20,000 Emergency Department Private hospital emergency facility fee 100% of 1 per year, up to $250 Page 4 of 5

5 Health Management Gym and Fitness* 100% $200 Health Risk Assessment via Members Online 100% No limit Quit Smoking* 100% $100, lifetime limit $400 Weight Management* Upon joining $50 Lifetime limit $250 Upon reaching goal $200 Bowel Cancer Screening Kit* $30 $30 Diabetes Membership 100% $100 per membership Bone density test* 100% $100 Compression garments^* 100% $100 per item Diabetes education* 100% $100 per consultation Hip safety kit* 100% $100 Asthma Foundation membership* 100% $100 per membership * For approved conditions or where medically necessary, subject to eligibility requirements. For full details see Health Partners Product Disclosure Statement. ^ For approved conditions. Apparatus^ Asthmatic Spray Appliances 100% $130 every 3 years Blood Glucose Monitoring Machines 100% $250 every 3 years Blood Pressure Machines 100% $100 every 3 years Hearing Aids 100% based on continuous years of membership: 1-2 years $ years $1,600 Benefit is limited to once every 3 years. Sleep Apnoea Machines (CPAP) 100% $1,500 every 5 years Sleep Apnoea Machines (CPAP) - Support Service 100% $250 every 5 years ^ A letter from your medical practitioner may be required. Additional information Outpatient services and services at unregistered day facilities are not covered under private health insurance. Information on waiting periods, pre-existing conditions, benefits and limits, restricted benefits, medical expenses (and how to reduce them with our Access Gap Scheme), Government surcharges and incentives, and other important information can be found in Health Partners PDS and under Useful Information at healthpartners.com.au. For a quote, please contact Health Partners on or go to healthpartners.com.au. Page 5 of 5