young extras EFFECTIVE 1 APRIL 2014 better health cover shouldn t hurt

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1 young extras EFFECTIVE 1 APRIL 2014 better health cover shouldn t hurt

2 welcome to Queensland Country In short, Queensland Country Health has been at it for over 30 years, and takes pride in offering you a flexible, affordable and comprehensive health cover. Your health is our number one priority. This brochure provides an overview of the features and benefits of Young Extras cover to enable a good understanding of the level of cover available. If you wish to package Young Extras with a hospital cover, please refer to our Health Benefits Guide. For more information regarding health insurance please refer to our Membership Guide or visit us at

3 Young Extras Cover Page 2 About Young Extras Cover Page 3 Extras Cover benefits Page 4 How much are the premiums? Page 6 Managing your health insurance online Page 8 How to pay contributions Page 9 In more detail Page 10 Privacy policy & Private Health Insurance complaints Page 15 Contact details Page 16 WE OFFER YOU FLEXIBLE, COMPREHENSIVE AND AFFORDABLE HEALTH COVER. HOW TO JOIN call

4 Young Extras Cover Getting started with health insurance has never been easier. Queensland Country offers Young Extras designed as an entry level extras cover and is best suited for young people under the age of 30. Young Extras will provide you with: Cover for a number of commonly used Extras such as a trip to the dentist, including examinations, scale and cleans, simple fillings, extractions and even crowns and bridges. As well as cover for other services such as physiotherapy, massage and even a new set of glasses or contact lenses. Competitive pricing to make health insurance affordable. Young Extras can be purchased on its own or as a package with one of our hospital covers. If you would like to take a hospital cover with Young Extras please review all other options in our Health Benefits Guide. Australian Government Rebate on private health insurance The Australian Government Rebate on Private Health Insurance was introduced as a financial incentive to assist Australians afford Private Health Cover, and to recognise the contribution that people with private health insurance are making to their own health care costs. Rebate entitlement depends on your age, and assessable income*. From 1 April 2014, the rebate is indexed each year by the difference between CPI and the industry average increase in premiums using a Government-calculated formula. It s up to you to nominate a rebate tier (based on your age and assessable income*). Some people choose to take their rebate up front as a lower premium, but if you d prefer to claim the rebate as a lump sum through your tax at the end of the financial year, you can simply choose to pay the full premium with no rebate deducted. * For information in regards to the assessable income thresholds please refer to our website com.au 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 Income-for-Medicare-levy-surcharge/ QUEENSLAND COUNTRY OFFERS: VALUE FOR MONEY ACCESS TO YOUR HEALTH VERY HIGH LEVELS OF HEALTH INSURANCE INSURANCE POLICY MEMBER SATISFACTION PRODUCTS WITH INFORMATION WHICH IS CONFIRMED 2 COMPREHENSIVE BENEFITS VIA OUR ONLINE MEMBER SERVICES WITH MEMBER SURVEYS

5 About Young Extras Cover Young Extras offers benefits towards the cost of some health care services that are not covered under our hospital cover or by Medicare. Young Extras has been designed to provide good benefits for a broad range of therapies most likely to be used by young people while keeping the cover affordable. Whether you need a massage or a new pair of glasses, Queensland Country can help. ON-THE-SPOT CLAIMING To make it even easier to claim your benefit, participating health professionals have electronic claiming facilities available. HICAPS/IBA is an electronic health claiming and payments system that will process your claim for treatment, on the spot, without leaving the surgery or practice. You simply swipe your Queensland Country Membership Card and just pay the gap, it s that easy. You don t need to fill in claim forms, wait for benefits to be paid or wait in line. KEY FEATURES Generous annual limits for general dental and optical services Cover for a wide range of alternative therapies including remedial massage, naturopathy and podiatry Easy claiming with HICAPS/IBA on the spot claiming Competitive premiums 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. 3

6 Extras Cover benefits Services Waiting Period Benefit Limits per membership year Examples of maximum benefits Dental Benefits General Dental 2 months $500 per person up to $1000 per policy Periodic oral examination $32 Scale & Clean $53 Fluoride treatment $15 Mouth Guard - $113 Major Dental Surgical Extractions* Crowns & Bridges 12 months Surgical tooth extraction $131 Full crown veneered $500 Optical Benefits Single & Multi-focal lenses & frames 2 months $200 per person up to $400 per policy Single vision lenses & frames $200 Repair to frames $200 Contact lenses $200 Physiotherapy Physiotherapy 2 months $350 per person up to $700 per policy Initial visit $42 Subsequent visit $32 Group Therapy - $8 (sub limit of $80 applies) Alternative Therapies Chiropractic Osteopathy 2 months $250 per therapy $450 per person up to $900 per policy Remedial Massage Therapy # Bowen Therapy # Myotherapy # Initial visit $30 Subsequent visit $30 Podiatry Initial visit $30 Subsequent visit $30 Orthotics 85% of cost up to available policy limits Minor procedures 75% of cost up to available policy limits Acupuncture # Initial visit $30 Subsequent visit $30 Naturopathy # Homeopathy # Initial visit $30 Subsequent visit $30 Dietician Initial visit $55 Subsequent visit $35 4 * Benefits paid on dental item numbers only, unless hospital cover is held and all waits have been served for any in-patient services. # Benefits are only 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 (BTFA).

7 Services Waiting Period Benefit Limits per membership year Examples of maximum benefits Other Services Pharmaceutical^ 2 months $150 per person up to $300 per policy $30 per script Healthy Living Benefit 2 months $125 per person up to $250 per policy Benefits up to the policy limit are available for: Your choice of quit smoking programs Your choice of weight management programs (Excludes gym memberships, personal training and other physical activity programs) Skin checks through mole mapping Consultation fees for metabolic dieticians and nutritionists when providing assistance with weight management ^ 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 13 for more information. 5

8 How much are the premiums? WHAT YOU LL PAY WITH BASE TIER REBATE NO REBATE DEDUCTED WEEKLY MONTHLY YEARLY WEEKLY MONTHLY YEARLY SINGLE $4.70 $20.40 $ $6.65 $28.75 $ WITH BASE TIER REBATE NO REBATE DEDUCTED WEEKLY MONTHLY YEARLY WEEKLY MONTHLY YEARLY COUPLE $9.40 $40.85 $ $13.30 $57.60 $ Normal 2 and 12 month waiting periods apply with this product. Premiums are quoted with both base tier rebate and with no Australian Government Rebate on private health insurance. Your eligibility to this rebate will depend on the age of the oldest person on the policy and assessable income levels. More information and resources in regards to the Australian Government Rebate on private health insurance is available on page 2. Join Queensland Country today Joining our fund is simple. Choose one of the following options that suit you: 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 4 Switch to Queensland Country Health Fund If you are a member of another health fund, it s quick and simple to transfer to us. Simply complete our membership application and cancel any direct debits you may have with your old fund. We will contact your old fund and arrange for the transfer of cover. Money back guarantee If you are not completely satisfied with your new health insurance policy we will provide a refund of any premium paid (if a claim hasn t been made) if you write to us advising that you are not satisfied with your policy within 30 days of the commencement date of your policy. 6

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10 Managing your health insurance 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! 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: 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 Change level of cover ø Update your method of payment ø Update the way we pay benefits eg. direct credit ø Contribution changes ø View benefit limits 8

11 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 do choose one of the latter options, we ll 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 unfinancial status. 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, phone us on * We do not accept American Express or Diners Club. ^ Please see page 8 for details on how to register for OMS. 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 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. ( 9

12 In more detail We have included some important information you may need to enable you to better understand your cover entitlements and conditions. Additional information is available in the Membership 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. 10

13 Benefit Conditions Queensland Country will only pay benefits when: All applicable waiting periods have been served Benefits are not payable for claims for goods purchased or rendered outside of Australia or, for items purchased or hired from overseas suppliers (including internet purchases) Goods or services are provided in Australia (not including items imported by the user via an internet purchase) The Member has been charged for the treatment or service A service or treatment is medically necessary and clinically relevant Services are part of a course of treatment recognised by Queensland Country The service is provided in person The service is provided to a person on the membership The service or treatment has been provided by a practitioner or therapist recognised by Queensland Country The treatment or service is covered under the Member s level of cover No benefits are payable from another source (e.g. compensation payment or Government benefit) The conditions of the level of cover have been met A claim for a service rendered is submitted for payment within 24 months of the date of service The waiting period for that service has been served 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. 11

14 12 Membership Year All yearly limits are calculated from the anniversary date of the establishment of the membership. Singles & Couples Single: a single policy covers only one person. Couple: a couple policy covers the person who establishes the policy as well as one other partner/spouse. 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. 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! Contribution 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 reinstated. Membership of Queensland Country shall automatically cease for any policy holder whose contributions are more than 63 days in arrears. 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. ALWAYS MAKE SURE YOU HAVE WAITED THE APPLICABLE PERIOD BEFORE CLAIMING OTHERWISE YOU MAY a NOT BE COVERED

15 Waiting Period 2 Months 12 Months Item / Service Dental 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 Chiropractor Osteopathy Remedial Massage Therapy/ Bowen Therapy/Myotherapy Naturopathy Physiotherapy Podiatry Dietitian Pharmaceutical Healthy Living Benefits Pre-existing Conditions Major Dental services Surgical Extraction* includes Wisdom tooth extraction Crowns and Bridges Recognised Providers Queensland Country will only pay benefits for ancillary or dental 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. Pharmaceutical The Pharmaceutical Benefits Scheme (PBS) is a national pharmaceutical scheme funded by the Federal Government where patients make a contribution to the cost of prescribed drugs. We do not pay for any pharmaceutical prescriptions covered by the Pharmaceutical Benefits Scheme or for contraceptives and items normally available without prescriptions. If the claim is for a PBS Pharmaceutical prescription, Queensland Country cannot pay a benefit. The 2 month Waiting Period is waived for treatment arising from an accident (excluding a school and sporting accident) that occurred after joining. *Surgical Extraction benefits are paid on dental item numbers only, unless hospital cover is held and all waits have been served for any in-patient services. 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. Benefit amount per script is calculated by deducting the PBS general patient contribution amount from the 13

16 14 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. 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 General Patient contribution is set at $ A Doctor s letter may be required for some pharmacy items. 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. To get the full picture, please call us when you re making your travel plans. Private Health Insurance Code of Conduct Queensland Country 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 Information Please ensure that all documentation is read carefully before any decision is made to purchase a health insurance product and the information is retained for future reference. 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 Road, Aitkenvale QLD

17 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: S Website: 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: Website: Address: 2201/580 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. 15

18 Contact Details Registered Office 85 Patrick Street, Townsville QLD 4814 Mount Isa Service Centre 70 Camooweal Street Mount Isa QLD 4825 Telephone: (07) Townsville Administration Level Ross River Road Aitkenvale QLD 4814 Telephone: (07) Facsimile: (07) Postal Address: PO Box 42 Aitkenvale QLD 4814 Willows Service Centre Shop 38 Willows Shoppingtown Kirwan QLD 4817 Burdekin Service Centre 186 Queen St Ayr QLD 4807 Mackay Service Centre Caneland Central Shopping Centre 2 Mangrove Road Mackay QLD 4740 Freecall: Web: Gladstone Service Centre Shop 39 Gladstone Central Shopping Centre Gladstone QLD

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20 How to contact us If you have any questions or need more information, please contact us by: Branch Visit our website for a listing of all our branches Website Call Queensland Country Ltd ABN is a Registered Private Health Insurer.

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