How To Get Health Insurance On A Health Fund

Transcription

1 Providing health insurance to the medical community since 1977 Effective date: 1 April 2012 to 30 June 2012

2 contents Welcome to The Doctors Health Fund 1 Things you need to know 2 Who can be a member of The Doctors Health Fund? 2 It s so easy to join 2 Continuity when transferring from another fund 3 Commonwealth government private health insurance initiatives 3 Changing your insurance 4 Financial things you need to know 4 The Private Health Insurance Code of Conduct 5 How we manage your privacy 5 How we handle problems and complaints 5 About hospital insurance 6 Top Cover 10 Prime Choice 12 Smart Starter 14 About extras insurance 16 Total Extras 18 Essential Extras 20 Direct Debit Service Agreement 22 For more information visit

3 Welcome to The Doctors Health Fund The Doctors Health Fund has been providing private health insurance to the medical community since Our health insurance products provide protection from the impact of healthcare incidents in your life. As a restricted health fund, we strive to insure our products meet your requirements. How we are different Choose any hospital insurance product and any extras insurance product from our range to create a combination to suit your needs. With Top Cover for hospital you will receive benefits up to the AMA list of services and fees and have complete freedom in your choice of doctor. Your doctor does not have to agree to participate in any medical scheme for you to receive this benefit. Under extras, use the dentist of your choice and get 100% cover on general dental check up items up to two times a year. A high level of optical cover is offered in both of our extras insurance products. We encourage you to actively consider the amount of cover you want and expect from your health insurance. We are happy to answer any questions you may have and discuss the things you should consider when selecting your private health insurance. While price and taxation considerations are important, so is having insurance which will work for you. For any assistance please contact our Customer Service team on or info@doctorshealthfund.com.au. The information in this brochure was correct at the time of publication in March Any changes to the information in the brochure will be published on our website at Call our Customer Service team on

4 THINGS YOU NEED TO KNOW A range of topics relevant to choosing and applying for health insurance are on the following pages and further information is available on our website in a section called Understanding Health Cover. Information about hospital insurance and the product descriptions starts on page 6. Information about extras insurance and the product descriptions starts on page 16. We write our product descriptions as clearly as possible and try to provide all the information you need to choose private health insurance which will suit your needs. However, if you have any questions please contact our Customer Service team on or info@doctorshealthfund.com.au Who can be a member of The Doctors Health Fund? The Doctors Health Fund is a restricted access private health insurer. Please contact our office on or visit our website for eligibility criteria. Information is also provided on our website for people who do not have full Medicare cover. Membership is open to those who are or have been: 1. A registered medical practitioner in Australia 2. A medical student at an Australian university 3. An overseas qualified doctor who is registered for the AMC exams 4. Employed in any role by a medical practice 5. Employed in any role by a federal or state Australian Medical Association (AMA), or subsidiary organisation of an AMA 6. Employed in any role by an association whose members are medical practitioners, 7.The partner, child, grandchild, parent, sibling, former partner, or the partner of an adult child of any person qualified in points 1-6. Please contact us on if you would like help in determining your eligibility. It s so easy to join After you have read the product descriptions and chosen your health insurance, simply apply online or fill out the Membership Application Form to start your membership and hand the rest of the work over to us. With your authorisation we can organise the following things for you: your transfer from another health insurer set up automatic payments, if you wish set up faster payment of claims, direct to your account register you for the 30% government rebate, and set up your membership so you pay only the contributions excluding the applicable rebate. Retain a copy of this brochure in your records so you know the details of the hospital and extras health insurance products you have chosen. Once your membership starts, a 30 day cooling off period commences. During this time you can choose to cease your membership, or if you have increased your cover you can revert to your previous level of cover, and we will refund the contributions 2 For more information visit

5 you paid. Of course, if any claims have been paid they will be deducted from the contributions before they are refunded. Continuity when transferring from another fund Any waiting periods that you have served with another fund are recognised by The Doctors Health Fund, when your new insurance has equal levels of benefits. If your new insurance has greater benefits on any service within the cover you will need to serve the waiting period for that service. Benefits that you have been paid by your previous fund, on any services that have benefit limits, will be reported on the transfer certificate and you will only be able to claim the remaining amount of your benefit limit for those services on your new insurance policy. Some accumulated benefits do not carry over from another fund. Benefits that increase due to length of membership, such as orthodontic benefits, will generally carry over. If you have not been contributing to another fund for more than 2 months you will need to serve the waiting periods on your new cover. During the first few months after you transfer it is wise to check with us that your previous fund has supplied the transfer certificate to us before using your insurance. We can follow them up if they have not provided it. Commonwealth government private health insurance initiatives To encourage Australians to protect themselves with private health insurance the Commonwealth government has introduced the following three programs. 30% rebate on private health insurance contributions When you buy private health insurance, the government will pay 30% of the cost of your contributions for both hospital and extras insurance. You can authorise The Doctors Health Fund on the application form to deduct your rebate so you pay only 70% of your contributions. If you are aged from 65 years to 69 years you are eligible for a 35% rebate and for those over 70 years of age the rebate available is 40%. Changes to the Federal Government 30% rebate on private health insurance The federal government has introduced legislation to means test the rebate effective 1 July This legislation will progressively reduce the rebate, based on your income. Those on incomes of up to $84,000 (singles) and $168,000 (families/couples) will not be affected. For further information as to how this change may affect you, please visit our website at as we will posting updates as they become available. Medicare Levy surcharge Are you single and earning more than $80,000 taxable income per year or a Call our Customer Service team on

6 THINGS YOU NEED TO KNOW couple or family earning over $160,000 combined taxable income per year? These thresholds apply to the 2012 tax year and are indexed each year. The family threshold is increased by $1,500 for each dependant child after the first child. If your income is above these thresholds, and you don t have hospital insurance you will pay an extra 1% Medicare levy surcharge at tax time. The levy is charged on a pro-rata basis, for every day you do not have hospital insurance during the tax year. The Medicare levy surcharge will increase from 1st July 2012 for higher income earners, based on the means test for rebate purposes. Information is included on our website at Lifetime Health Cover Lifetime Health Cover (LHC) is another Government initiative, which is designed to encourage people to take out hospital insurance earlier in life and in order to maintain their cover at lower premiums. To avoid paying a LHC loading, you need to take out a private health insurance hospital policy by the 1st of July following your 31st birthday. For each year you delay, you will pay 2% more for your premium, up to a maximum of 70%. If you were born before 1 July 1934, you are exempt from LHC. Once you have paid a LHC loading on your private health insurance for 10 continuous years, the loading is removed as long as you retain your hospital cover. Some other special circumstances apply, which are described below. To cover small gaps, such as switching from one insurer to another, you are able to be without private cover for periods totaling 1,094 days (ie three years less one day) during your lifetime, without affecting your loading. As a new migrant to Australia, if you are aged 31 or over, you will not have to pay a LHC loading if you take out private health insurance within 12 months of being registered for Medicare. After this time you will have to pay 2% more for each year you are aged over 30 when you take out private health insurance. A Lifetime Health Cover calculator and a link to further information can be found at Changing your insurance You can make changes to your insurance at any time. Either use our online member services to make the updates or fill out an application and membership changes form which is available on the website. Financial things you need to know Selecting direct credit for your claim payments reduces the time it takes to pay your claims and for you to receive the payment. For contribution premiums, you can pay by direct bank debit or Mastercard and Visa. Selecting a direct debit option greatly assists with our administration costs. If your contributions are not up to date claims cannot be paid. Once a year the Commonwealth government considers whether private health insurers will be allowed a price rise on their products. We send a submission and pricing request for approval by the Minister for Health & Ageing. We notify you of price increases in March. 4 For more information visit

7 The Private Health Insurance Code of Conduct The Doctors Health Fund has adopted this code of conduct which aims to improve the standards of practice and service in the private health insurance industry. The code sets standards for providing information to customers, staff training and dispute resolution. The code of conduct can be found at and a link is on our website. How we manage your privacy To provide health insurance services to you as a member, The Doctors Health Fund collects information that includes your personal details, financial information and medical information. We treat personal information with respect and care, to protect it from misuse, loss, unauthorised access, modification or disclosure. Our full privacy policy can be found at How we handle problems and complaints The Doctors Health Fund is always happy to receive feedback, and wants to solve problems and resolve complaints. To prevent problems we encourage members to understand the health insurance products they buy and to make informed decisions when they need healthcare services. In the Members Zone on the Fund website you will find sections on managing and using your health cover. Making a complaint We handle complaints following our Complaints Resolution Policy and Commonwealth government requirements of private health insurance funds. There are three stages to the process: 1. Contact the Operations Manager by phone, fax, or post to The Doctors Health Fund PO Box 482 St Leonards NSW If you are not satisfied you can then raise your complaint with The CEO, The Doctors Health Fund. 3. If we cannot resolve the complaint to your satisfaction you can contact the Private Health Insurance Ombudsman. The Private Health Insurance Ombudsman is a Commonwealth government agency charged with providing an independent service to help consumers with health insurance problems and enquiries. The Private Health Insurance Ombudsman Freecall Complaints Hotline: info@phio.org.au Web: Mail: Suite 2, Level 22, 580 George St, Sydney NSW 2000 Telephone: (02) Facsimile: (02) Call our Customer Service team on

8 Hospital insurance products About hospital insurance The basics Hospital insurance covers you while you are an admitted patient. Only Medicare recognised treatment is covered by hospital insurance. Benefits for a consultation with a doctor prior to being admitted or after you have been discharged from hospital can only be claimed from Medicare. Hospital insurance - our gap cover is different We offer two medical services gap cover schemes so you can choose a level of financial protection which suits you for those times when you are an admitted patient. Maximising your cover Top Cover for hospital is unique. It offers premium medical gap cover. This means that on any Medicare eligible service you will get a benefit, and that benefit could be as much as the AMA List of services and fees. You will only have out-of-pocket expenses when your doctor charges above the AMA List of services and fees. As your doctor doesn t have to agree to participate in this gap scheme you have complete freedom to choose your doctor. Comprehensive cover at a lower price Our more economical hospital insurance products, Prime Choice and Smart Starter, use the Access Gap Cover scheme which can reduce or eliminate your medical services out-of-pocket expenses. This scheme has a record of covering almost 90% of services with no patient out-of-pocket expense. Ask your doctor if they and any other doctors involved in your treatment will treat you under the gap scheme. The accounts they submit to us for your treatment, or the accounts which they give you to submit, need to be marked as Access Gap Cover scheme accounts. When your doctors choose not to participate in the Access Gap Cover scheme you will be covered to the Medicare schedule fee. See the example in the table below to compare the different medical benefit outcomes. Pathology and Radiology cover Our contractual arrangements with most pathology and radiology providers apply to all our hospital insurance products. The delivery of services by these contracted providers will have no out-of-pocket expense. Claims for services from providers who do not have contracts with the Fund can be handled under the medical services gap cover in the hospital products. Medical services benefits for a knee reconstruction, item no $3, $1, $1, Top Cover maximum benefit for a knee reconstruction. Includes Medicare benefit plus the Fund gap benefit. Prime Choice & Smart Starter maximum benefit for a knee reconstruction in VIC, the benefit varies by State. Includes Medicare benefit plus the Fund gap benefit. Medicare benefit for a knee reconstruction. Includes the 75% paid by Medicare and 25% paid by the Fund. 6 For more information visit

9 Contracts and cover which protect you By negotiating contracts with hospitals we are able to establish conditions which help keep the cost of your health insurance down. Using a contracted hospital will provide you with the maximum cover for the hospital service components of your treatment, including accommodation, theatre and pharmaceuticals. We have contracts in place with the majority of Australian private hospitals. In fact we have arrangements with more hospitals than some of the larger funds. Access to the search facility for contract hospitals can be found at contractedhospitals.aspx When you need a prosthesis, maximise your cover by checking with your doctor that a government approved prosthesis will be used. Our ambulance cover protects you in the event of an emergency or medical necessity for this service, anywhere in Australia. Keeping everyone covered when you re having a baby If you are planning to have children check that your hospital cover includes Obstetrics, these are the services associated with pregnancy and birth of a baby. Hospital cover has a 12 month waiting period for making claims for all in-patient services related to an obstetrics admission. For a woman with a single membership covering obstetrics, the benefits will cover the birth but not cover the costs incurred by the baby. For a baby to be eligible for benefits at birth the mother must contribute to a family membership for at least 2 months prior to the baby s birth. Babies incur costs when they are admitted. Some circumstances where this happens include when they need neo-natal intensive care, are in hospital for more than nine days, or they are the second or subsequent babies of a multiple birth. Pre-existing or existing medical conditions A pre-existing ailment, illness or condition is one where there were signs or symptoms present that a doctor would have detected during the six months before you took your hospital insurance or upgraded your hospital insurance. There is a 12 month waiting period before benefits will be paid for treatment of pre-existing conditions. The Fund s medical advisor makes the decision about whether your condition is pre-existing and if the waiting period will apply. The waiting period for treatment that is psychiatric care, rehabilitation or palliative, whether or not for a pre-existing condition, is 2 months. Full descriptions of the hospital insurance products are on pages Call our Customer Service team on

10 Hospital INSURANCE Products Claiming your benefits for hospital treatment Hospitals will deal directly with the Fund to claim payment. Direct billing for medical services claims The most efficient way to make medical services claims is called direct billing. You don t have to go to Medicare. The Fund processes the entire claim for you including the claim to Medicare. Wether you are covered by Top Cover, Prime Choice or Smart Starter your doctors should always submit the bills, for your treatment in hospital, directly to The Doctors Health Fund. If you are covered by Prime Choice or Smart Starter and your doctors have agreed to treat you under the Access Gap Cover scheme, but they send their bills to you, check they have been marked as Access Gap Cover accounts before submitting them to the Fund with a claim form. Send your claim to: Fax: (02) OR Mail: The Doctors Health Fund PO Box 482 St Leonards NSW 1590 A claim form can be obtained from forms.aspx 8 For more information visit

11 Call our Customer Service team on

12 Hospital INSURANCE Products Top Cover - unique cover up to AMA list of services and fees Excess None Waiting periods None for accidents 12 months for pre-existing conditions 12 months for obstetrics 2 months for palliative care, rehabilitation and psychiatric treatment 2 months for everything else Exclusions None Benefit restrictions Plastic and reconstructive surgery benefits for hospital and medical costs are restricted to services eligible for Medicare benefits. When chosen for cosmetic reasons only default hospital accommodation benefits apply and no medical benefits are paid. Ambulance National cover for emergency and medically necessary ambulance services when an ambulance is called to attend you but you are not subsequently taken to hospital it is medically necessary for you to be transported by an ambulance to be admitted to hospital you need immediate medical attention at a hospital or other approved facility you are an admitted patient and need to be transferred to another hospital. Accommodation In a contracted private hospital or day-only facility, or a public hospital as a private patient, all costs of accommodation are covered. In non-contract hospitals or day-only facilities the lowest contracted benefit is paid and you can expect to have out-ofpocket expenses. Search contracted hospitals at contractedhospitals.aspx Hospital services All costs are covered for theatre and labour ward services while you are an admitted patient in a contract hospital. Medical services gap cover The cost of doctors services delivered while an admitted patient are covered by our premium gap cover. Medicare pays 75% of the Medicare Schedule fee and your Fund benefits pay the remainder up to a total equal to the AMA List of services and fees. You pay any amount charged above the AMA List of services and fees. Most pathology and radiology providers have contracts with us, so while you are an admitted patient most of these services will have no out-of-pocket expense. Medical service claims should 10 For more information visit

13 Pharmaceuticals Prostheses Other Examples of what you can expect to pay if you go to hospital always be submitted directly to the Fund by your doctor or you. In a contracted private hospital or day-only facility, or a public hospital as a private patient all costs of PBS pharmaceuticals related to the condition being treated are covered, and the cost of non-pbs items related to the condition being treated are covered as per the contract with the hospital. In non-contract hospitals or day-only facilities the lowest contracted benefit is paid and you can expect to have out-ofpocket expenses. Covers 100% of the minimum cost specified for government approved prostheses. Up to $100 per day for travel and accommodation where a doctor certifies the need for a parent, spouse or child to be with a member in hospital more than 200 kms from home. An annual limit of $1,000 applies. Personal items such as newspapers and television hire. Prostheses cost if charged above the minimum cost. Call our Customer Service team on

14 Hospital INSURANCE Products Prime Choice - comparable to some other funds top cover Excess Single membership has two options: no excess, or $500 excess per calendar year. Couple, single parent family and family memberships have two options: no excess, or $1,000 excess per calendar year. Only $250 of excess is paid per hospital admission until the full amount of the excess is paid for the year. If there is only one hospital admittance in the year, then you only pay $250. The total excess amount applies to the entire membership not each person covered by the membership. Waiting periods None for accidents 12 months for pre-existing conditions 12 months for obstetrics 2 months for palliative care, rehabilitation and psychiatric treatment 2 months for everything else Exclusions None Benefit restrictions Plastic and reconstructive surgery benefits for hospital and medical costs are restricted to services eligible for Medicare benefits. When chosen for cosmetic reasons only default hospital accommodation benefits apply and no medical benefits are paid. Ambulance National cover for emergency and medically necessary ambulance services when an ambulance is called to attend you but you are not subsequently taken to hospital it is medically necessary for you to be transported by an ambulance to be admitted to hospital you need immediate medical attention at a hospital or other approved facility you are an admitted patient and need to be transferred to another hospital. Accommodation In a contracted private hospital or day-only facility, or a public hospital as a private patient all costs of accommodation are covered after any excess is paid. In non-contract hospitals and day-only facilities the lowest contracted benefit is paid and you can expect to have out-of-pocket expenses. Search contracted hospitals at memberszone/contractedhospitals.aspx Hospital services After the excess is paid all costs are covered for theatre and labour ward services while you are an admitted patient in a contracted hospital. 12 For more information visit

15 Medical services gap cover The cost of doctors services delivered while you are an admitted patient can be covered by the Access Gap Cover scheme which reduces or eliminates your medical services out-of-pocket expenses. When your doctor agrees to participate in the Access Gap Cover scheme the Fund covers the scheme s scheduled amount for your treatment. The doctor may choose to charge you a payment above the scheme s scheduled amount. This may be no more than $400 per service, or for the birth of a child no more than $800 for the confinement. Most pathology and radiology providers have contracts with us, so while you are an admitted patient most of these services will have no out-of-pocket expense. Claims using this gap scheme should be submitted directly to the Fund. Check that your doctors have marked any bills sent to you as Access Gap Cover accounts. To find doctors who participate in this gap scheme use the Doctor Search facility on our website. Pharmaceuticals In a contracted private hospital or day-only facility, or a public hospital as a private patient all costs of PBS pharmaceuticals related to the condition being treated are covered, and the cost of non-pbs items related to the condition being treated are covered as per the contract with the hospital. In non-contracted hospitals and day-only facilities the lowest contracted benefit is paid and you can expect to have out-ofpocket expenses. Prostheses Covers 100% of the minimum cost specified for government approved prostheses. Other Up to $70 per day for travel and accommodation where a doctor certifies the need for a parent, spouse or child to be with a member in hospital more than 200 kms from home. An annual limit of $800 applies. Examples of what you can expect to pay if you go to hospital Your excess Personal items such as newspapers and television hire. If your doctor does not wish to participate in the Access Gap Scheme, the Fund will only pay benefits up to the Medicare Schedule Fee. Prostheses cost if charged above the minimum cost. Call our Customer Service team on

16 Hospital INSURANCE Products Smart Starter - budget cover, only available to singles and couples Excess Waiting periods Exclusions Benefit restrictions Ambulance Singles $500 per calendar year. Couple memberships $1,000 per calendar year. $500 of excess is paid per admission until the full amount of excess is paid for the year. The total excess amount applies to the entire membership not each person covered by the membership. None for accidents 12 months for pre-existing conditions 2 months for palliative care, rehabilitation and psychiatric treatment 2 months for everything else covered No benefits are paid for: Pregnancy related services Assisted reproductive services Sterilisation and reversal of sterilisation Hip and knee replacements and revisions Cataract and glaucoma treatment Gastric banding and obesity surgery Plastic surgery, which is excluded from Medicare coverage Cardio-thoracic surgery limited to delivery as a private patient in a public hospital. Psychiatric services are limited to 10 days per annum in a private hospital, with benefits for any further days limited to delivery as a private patient in a public hospital shared ward.dialysis for chronic renal failure is limited to delivery as a private patient in a public hospital shared ward.rehabilitation services following cardio thoracic, psychiatric, hip and knee replacement and revisions is limited to delivery as a private patient in a public hospital shared ward. National cover for emergency and medically necessary ambulance services when an ambulance is called to attend you but you are not subsequently taken to hospital it is medically necessary for you to be transported by an ambulance to be admitted to hospital you need immediate medical attention at a hospital or other approved facility you are an admitted patient and need to be transferred to another hospital. Accommodation In a contracted private hospital or day-only facility, or a public hospital as a private patient all costs of accommodation are covered after the excess is paid. In non-contracted hospitals or day-only facilities the lowest contracted benefit is paid and you can expect 14 For more information visit

17 to have out-of-pocket expenses. Search contracted hospitals at memberszone/contractedhospitals.aspx Hospital services After the excess is paid all costs are covered for theatre services while you are an admitted patient in a contract hospital. Medical services gap cover The cost of doctors services delivered while you are an admitted patient can be covered by the Access Gap Cover scheme which reduces or eliminates your medical services out-of-pocket expenses. When your doctor agrees to participate in the Access Gap Cover scheme the Fund covers the scheme s scheduled amount for your treatment. The doctor may choose to charge you a payment above the scheme s scheduled amount. This may be no more than $400 per service. Most pathology and radiology providers have contracts with us, so while you are an admitted patient most of these services will have no out-of-pocket expense. Claims using this gap scheme should be submitted directly to the Fund. Check that your doctors have marked any bills sent to you as Access Gap Cover accounts. To find doctors who participate in this gap scheme use the Doctor Search facility on our website. Pharmaceuticals In a contracted private hospital or day-only facility, or a public hospital as a private patient, all costs of PBS pharmaceuticals related to the condition being treated are covered, and the cost of non-pbs items related to the condition being treated are covered as per the contract with the hospital. In non-contracted hospitals and day-only facilities the lowest contracted benefit is paid and you can expect to have out-ofpocket expenses. Prostheses Covers 100% of the minimum cost specified for government approved prostheses. Other Up to $70 per day for travel and accommodation where a doctor certifies the need for a parent, spouse or child to be with a member in hospital more than 200 kms from home. An annual limit of $500 applies. Examples of what you can expect to pay if you go to hospital Your excess Personal items such as newspapers and television hire. If your doctor does not wish to participate in the Access Gap Scheme, the Fund will only pay benefits up to the Medicare Schedule fee. Prostheses cost if charged above the minimum cost. Call our Customer Service team on

18 EXTRAS INSURANCE products About extras insurance Extras services which are covered by a Medicare benefit are not allowed to receive a benefit payment from a health insurer. Our extras insurance difference Our extras products offer great benefits across a number of areas including: Optical cover is up to $500 over any 2 consecutive calendar years. When making a claim, the previous and current year claims cannot exceed $500. The non-pbs pharmaceuticals cover pays 85% of the cost of the prescription after you have paid the current PBS prescription cost. For a non-pbs prescription which costs $150, our cover would pay $ Full descriptions of the extras insurance products are on pages Service providers and benefit payments Many services included in extras insurance are delivered by registered practitioners who are governed by systems which register and recognise them as providers. The Fund pays benefits on services delivered by a wide range of these allied health practitioners including dentists, orthodontists, endodontists, periodontists, oral surgeons, prosthodontists, pedodontists, ophthalmologists, optometrists, registered nurses and midwifes, and practitioners of orthoptics, occupational therapy, speech therapy, dietetics, podiatry, physiotherapy, and psychology. Remedial massage and Myotherapy Remedial massage does not operate under a standard system of registration control. For the Fund to pay benefits for remedial massage and myotherapy services the provider must either be a registered physiotherapist or have accreditation in remedial massage therapy or myotherapy with an organisation that adheres to the Department of Health s governed systems for registration and recognition of them as providers. Claiming your benefits for extras services Extras or ancillary service claims can often be made at the provider s office via the electronic HICAPS system, with no need to submit a claim to the Fund. The provider simply swipes your membership card and you pay any difference between the service charge and the benefit paid and there s no paperwork to do. If electronic claiming isn t available, you can scan and your receipt and claim form to info@ doctorshealthfund.com.au, or submit to: Fax: (02) OR Mail: The Doctors Health Fund PO Box 482 St Leonards NSW 1590 A claim form can be obtained from forms.aspx 16 For more information visit

19 Call our Customer Service team on

20 EXTRAS INSURANCE Products Total Extras - premium cover with better benefits Waiting periods Limits 12 months for major dental services, aids and appliances 24 months for hearing aids 2 months for all other services Limits per person per calendar year, except where otherwise indicated ITEM LIMITS Benefits Paid General dental services No annual limits 100% paid for check-up and, scale and clean up to two times per year, so long as the fees are within the range of usual, customary and reasonable charges. Fixed benefits paid for all other items. Major dental services Inlays, onlays, facings $700 Endodontic/periodontic $800 Crowns & bridges $1,000 Dentures and $800 prosthodontics Orthodontics Up to $500 per year of membership with a lifetime limit of $2,500 Optical category limit $500 limit over any 2 consecutive calendar years. Claims made in the current and prior year cannot exceed $500. Frames $220 Single vision lenses $200 Bi-focal lenses $250 Multi-focal lenses $320 Contact lenses $500 Repairs $50 Non-PBS pharmaceuticals, mammograms, ThinPrep tests, bone density tests $600 Tests, one each per year Fixed benefits paid per item After the current PBS cost, benefits paid are 85% of the remaining cost of a non-pbs script. $60 per test. more over 8 18 For more information visit

21 Total Extras continued ITEM LIMITS Benefits Paid One hearing aid One set of hearing aids $800 Two hearing aids every 5 calendar years $1,600 Hearing aid repairs $50 Audiology test One visit per year $60 Physiotherapy, Myotherapy and remedial massage, see p.18 $600 $35 per visit Psychology $600 $100 per visit Occupational therapy, Speech therapy, Orthoptics, Podiatry, Dietetics, Midwifery services, see p.18 $1,000 $35 per visit with calendar year sub limits per therapy type of $600 Home nursing $600 $30 per visit of up to 6 hrs $60 per visit exceeding 6 hrs Aids & appliances $1,000 For Fund approved consumable items, benefit paid twice per calendar year. For Fund approved non-consumable items benefits paid 2 years after the first supply. 75% of the cost of the item where use of the item was ordered by a registered practitioner. Call our Customer Service team on

22 EXTRAS INSURANCE Products Essential Extras - better mid-range cover Waiting periods Limits 12 months for major dental services, aids and appliances 24 months for hearing aids 2 months for all other services Limits per person per calendar year, except where otherwise indicated ITEM LIMITS Benefits Paid General dental services $ % paid for check up, scale and clean up to two times per year, so long as the fees are within the range of usual, customary and reasonable charges. Fixed benefits paid for all other items. Major dental services Periodontic Periodontic services are included in the general dental limit. Orthodontics Orthodontic services are included in the general Fixed benefits paid per item dental limit, up to $250 per year of membership with a lifetime limit of $1,250. Optical category limit $500 limit over any 2 consecutive calendar years. Claims made in the current and prior year cannot exceed $500 Frames $220 Single vision lenses $200 Bi-focal lenses $250 Multi-focal lenses $320 Contact lenses $500 Repairs $50 Non-PBS pharmaceuticals, mammograms, ThinPrep tests, bone density tests $300 Tests, one each per year After the current PBS cost, benefits paid are 85% of the remaining cost of a non-pbs script. $60 per test. 20 For more information visit

23 Essential Extras continued ITEM LIMITS Benefits Paid Physiotherapy, Psychology, Occupational therapy, Speech therapy, Orthoptics, Podiatry, Dietetics, Midwifery services, Myotherapy and remedial massage,see p.19 Aids & appliances including hearing aids $900 $100 per visit for psychology, all other therapies $30 per visit with calendar year sub limits per therapy type of $500. $500 For Fund approved consumable items, benefit paid twice per calendar year. For Fund approved non-consumable items benefits paid 2 years after the first supply. 75% of the cost of the item (except hearing aids) where use of the item was ordered by a registered practitioner. Single hearing aid $200 Two hearing aids $400 Hearing aid repairs $50 Call our Customer Service team on

24 EXTRAS INSURANCE Products Direct Debit Service Agreement The following is your Direct Debit Service Agreement with The Doctors Health Fund Limited ABN The agreement is designed to explain what your obligations are when undertaking a Direct Debit arrangement with us. It also details what our obligations are to you as your Direct Debit Provider. We recommend you keep this agreement in a safe place for future reference. It forms part of the terms and conditions of your Direct Debit Request (DDR) and should be read in conjunction with your DDR form. Definitions Account means the account held at your financial institution from which we are authorised to arrange for funds to be debited. Agreement means this Direct Debit Request Service Agreement between you and us. Banking day means a day other than a Saturday or a Sunday or a public holiday listed throughout Australia. Debit day means the day that payment by you to us is due. Debit payment means a particular transaction where a debit is made. Direct Debit Request means the Direct Debit Request between us and you. Us or we means The Doctors Health Fund Limited, (the Debit User) you have authorised by signing a Direct Debit Request. You means the customer who has signed or authorised by other means the Direct Debit Request. Your financial institution means the financial institution nominated by you on the DDR at which the account is maintained. 1. Debiting your account 1.1 By signing a Direct Debit Request or by providing us with a valid instruction, you have authorised us to arrange for funds to be debited from your account. You should refer to the Direct Debit Request and this agreement for the terms of the arrangement between us and you. 1.2 We will only arrange for funds to be debited from your account as authorised as in the Direct Debit Request. 1.3 If the debit day falls on a day that is not a banking day, we may direct your financial institution to debit your account on the following banking day. If you are unsure about which day your account has or will be debited you should ask your financial institution. 2. Amendments by us 2.1 We may vary any details of this agreement or a Direct Debit Request at any time by giving you at least fourteen (14) days written notice. 3. amendments by you 3.1 You may change, stop or defer a debit payment, or terminate this agreement by providing us with at least fourteen (14 days) notification by writing to: The Doctors Health Fund Limited PO Box 482 St Leonards NSW 1590 or by telephoning us on or during business hours; or by arranging it through your own financial institution. 22 For more information visit

25 4. Your obligations 4.1 It is your responsibility to ensure that there are sufficient clear funds available in your account to allow a debit payment to be made in accordance with the Direct Debit Request. 4.2 If there are insufficient clear funds in your account to meet a debit payment: (a) you may be charged a fee and/or interest by your financial institution; (b) you may also incur fees or charges imposed or incurred by us; and (c) you must arrange for the debit payment to be made by another method or arrange for sufficient clear funds to be in your account by an agreed time so that we can process the debit payment. 4.3 You should check your account statement to verify that the amounts debited from your account are correct. 4.4 If The Doctors Health Fund Limited is liable to pay goods and services tax ( GST ) on a supply made in connection with this agreement, then you agree to pay The Doctors Health Fund Limited on demand an amount equal to the consideration payable for the supply multiplied by the prevailing GST rate. 5. Dispute 5.1 If you believe that there has been an error in debiting your account, you should notify us directly on or and confirm that notice in writing with us as soon as possible so that we can resolve your query more quickly. Alternatively you can take it up with your financial institution direct. 5.2 If we conclude, as a result of our investigations, that your account has been incorrectly debited we will respond to your query by arranging for your financial institution to adjust your account (including interest and charges) accordingly. We will also notify you in writing of the amount by which your account has been adjusted. 5.3 If we conclude, as a result of our investigations, that your account has not been incorrectly debited we will respond to your query by providing you with reasons and any evidence for this finding in writing. 6. Accounts 6.1 You should check: (a) with your financial institution whether direct debiting is available from your account as direct debiting is not available on all accounts offered by financial institutions. (b) your account details which you have provided to us are correct by checking them against a recent account statement; and (c) with your financial institution before completing the Direct Debit Request if you have any queries about how to complete the Direct Debit Request. 7. Confidentiality 7.1 We will keep any information (including your account details) in your Direct Debit Request confidential. We will make reasonable efforts to keep any such information that we have about you secure and to ensure that any of our employees or agents who have access to information about you do not make any unauthorised use, modification, reproduction or disclosure of that information. 7.2 We will only disclose information that we have about you: (a) to the extent specifically required by law; or (b) for the purposes of this agreement (including disclosing information in connection with any query or claim). Call our Customer Service team on

26 8. Notice 8.1 If you wish to notify us in writing about anything relating to this agreement, you should write to The Doctors Health Fund Limited PO Box 482 St Leonards NSW We will notify you by sending a notice in the ordinary post to the address you have given us in the Direct Debit Request. 8.3 Any notice will be deemed to have been received on the third banking day after posting. The Doctors Health Fund is a signatory to the Private Health Insurance Code of Conduct. 24 For more information visit

27 Call our Customer Service team on

28 The Doctors Health Fund is a signatory to the Private Health Insurance Code of Conduct. THE DOCTORS HEALTH FUND LIMITED A private health insurer ABN Street address: Ground Floor, 69 Christie Street St Leonards NSW 2065 Postal address: PO Box 482, St Leonards NSW 1590 Freecall: Phone: Facsimile: Web: info@doctorshealthfund.com.au W5205 BRO-04/10