Wesley LifeShape Clinic Services Rebate Guide

Transcription

1 Wesley LifeShape Clinic Services Rebate Guide This document is to be used as a guide only. Clients must speak to: Their private health insurance company Medicare Their GP Their income tax accountant and/or The ATO directly to determine exact rebates on Wesley LifeShape Clinic services. wesleylifeshape.com.au 2013 Wesley Health

2 Private Health Insurance* PH: Level of Dietetics / Annual Limits Ex. Physiology Healthy Lifestyle Bonus Benefits Individuals Mid Plus $200 $350 $200 $150 Rebate 65% Families Top $250 $550 $300 $250 Rebate 75% of the cost Dental Plus $200 $350 Nil $150 Rebate 50% Top Extras $600 $300 $500 $400 Rebate 65% Family Basic Saver $200 $300 Nil Nil Rebate 50% Family Plus $300 $350 $200 $150 Rebate 65% Mid Plus $200 $350 $200 $150 Rebate 65% Top $250 $550 $300 $250 Rebate 70% Dental Plus $200 $350 Nil $150 Rebate 50% Top Extras $600 $300 $500 $400 Rebate 65% * This table is to be used as a guide only. Clients must speak to their insurance company directly to determine exact rebates on services.

3 Private Health Insurance* PH: Please note annual changes occur in April* Level of Dietetics / Annual Limits Ex. Physiology Living Well Program Benefits Individuals Standard Hospital with Silver Extras $400 $400 (Classed as Natural Therapies) $400 $50 Dietitian $40 initial and $19 $27 initial and $27 Families Standard Hospital with Silver Extras $400 $400 (Classed as Natural Therapies) $400 $50 Dietitian $40 initial and $19 $27 initial and $27 * This table is to be used as a guide only. Clients must speak to their insurance company directly to determine exact rebates on services.

4 Private Health Insurance* PH: Level of Dietetics / Ex. Physiology Healthy Lifestyle Bonus Individuals Top Extras 55 $200 Nil $200 Nil Top Extras 70 $400 Nil $400 Nil Top Extras 85 $500 Nil $500 Nil Families Ultra Health Ultra Health $600 Nil $600 Nil $600 Nil $600 Nil For members who joined Medibank Private prior to January 1, 2011, Health Insurance Products were previously known as Healthy Plus, Smart Plus, Advantage Plus and Premier Plus. Members with these products may also be eligible to claim for Healthy LifeStyle Bonuses. * This table is to be used as a guide only. Clients must speak to their insurance company directly to determine exact rebates on services.

5 Private Health Insurance* PH: Level of Dietetics / Annual Limits Ex. Physiology Healthy Lifestyle Bonus Benefits Individuals Top Plus & Super Multi $300 $375 $300 $150 Dietitian $45 initial and $35 General Extras Plus NIL $250 NIL NIL $25 initially, $20 Families Top Plus & Super Multi $350 $250 $600 $200 Dietitian $55 initial and $40 Exercise physiology $40 initial and $33 Fit and Free Extras $300 $600 $300 NIL $30 / 28 Ex Phys $45 / 30 Dietetic $75 Psych * This table is to be used as a guide only. Clients must speak to their insurance company directly to determine exact rebates on services.

6 Private Health Insurance* PH: HBF clients receive different rebates depending on how long they have had their cover* Level of Dietetics / Annual Limits Ex. Physiology Weight Management Individuals Ultimate Combined max for Dietetics & $500 under 3 years $ years $ years & over $400 under 3 years of membership $600 over 3 years of membership $600 $200 Premium Essentials Sub limits apply for ist $300 under 3 years $400 over 3 years Families Ultimate Combined max for Dietetics & $500 under 3 years $ years $ years & over Additional Premium Essentials $400 Nil Nil $50 Sub limits apply for ist $300 under 3 years $400 over 3 years $400 under 3 years of membership $600 over 3years of membership $600 $200 $400 Nil Nil $100 Invidual and Families Wellness $200 $300 $450 $200 * This table is to be used as a guide only. Clients must speak to their insurance company directly to determine exact rebates on services.

7 Enhanced Primary Care (EPC)* Enhanced Primary Care Referrals: Wesley Lifeshape Clinic accepts EPC Referrals An EPC Referral enables a client to see an Allied Health Professional (Dietitian, Exercise Physiologist, Psychologist) for a maximum of 5 times per year. Portions of these consultations are then claimable through Medicare. EPC and the Chronic Disease Management (CDM) Medicare items on the Medicare Benefits Schedule (MBS) enable GPs to plan and coordinate the health care of patients with chronic or terminal medical conditions, including patients with these conditions who require multidisciplinary, team-based care from a GP and at least two other health or care providers. The items are designed for patients who require a structured approach to their care. A chronic medical condition is one that has been or is likely to be present for at least six months, including but not limited to asthma, cancer, cardiovascular disease, diabetes mellitus, musculoskeletal conditions and stroke. Whether a patient is eligible for CDM services is a clinical judgement for the GP, taking into account the patient s medical condition and care needs, as well as the general guidance set out in the MBS. Maximum No. of Rebate Given for Total Rebates^ Consultations WLSC Services^ 5 $52.95 $ ^ Medicare rebates are subject to change, rebate figures correct as at 04/04/2013 * This information is to be used as a guide only. Clients must speak to their GP directly to determine if they are eligible for an EPC Referral

8 Thresholds as at 1 January 2011: Medicare Safety Net* Threshold amount Who it is for How it is calculated What the benefit is Original $ All Medicare cardholders Extended concession and FTB(A) $ Concession cardholders and families eligible for FTB(A) Extended general $ All Medicare cardholders Based on gap amount Out-of-pocket costs 100% of schedule fee for out-of-hospital services 80% of out-of-pocket costs or the EMSN benefit cap for out-ofhospital services What out-of-hospital services are covered? Some examples of services where costs count towards the Medicare Safety Net are: GP and specialist consultations blood tests CT scans pap smears psychiatry radiotherapy tissue biopsies ultrasound x-rays. * This information is to be used as a guide only. Clients must speak to Medicare directly to determine if they are eligible for the Medicare Safety Net What are the benefits? Once you reach a Medicare Safety Net threshold, visiting a doctor or having tests may cost you less. For example: if you reach a threshold and then visit your doctor who charges you $65.00 for a standard consultation, you will receive your Medicare benefit of $ You will also receive 80 per cent of your out-of-pocket costs (($ $34.30) x 80 per cent), giving you an extra $ So in this example it will only cost you $6.10 to visit your doctor. An out-of-pocket cost is the difference between the Medicare benefit and what your doctor charges you.

9 Summary: Net Medical Expenses Tax Offset* If an individual and their dependants collectively spend more than $2,120 (indexed annually) on eligable medical expenses (after rebates) in a financial year, they may be able to claim a tax offset. The offset is 20% of whatever is left (or the excess ) of net medical expenses over $2,120 that were paid in a financial year. Net medical expenses are the total amount spent on medical expenses minus any reimbursements paid by private health insurance or Medicare. From 1 July 2012, the medical expenses tax offset is means tested and those people earning more than a certain amount may be subject to a higher threshold and lower rebate. Example: Nicola s total medical expenses for herself and her dependants for the financial year came to $4,500. Nicola has private health cover, so she subtracts the refund she received from her private cover as well as Medicare, from her total expenses, to find out her net medical expenses. $4,500 - $1,700 = $2800 Because Nicola s net medical expenses are more than $2,120, she is able to claim the medical expenses tax offset. She takes $2,120 from her net amount. $2,800 - $2,120 = $680 Nicola takes the remaining net medical expenses amount, and multiplies it by 20%. $800 x 20% = $136 Nicola is able to claim $136 back as her Medical Expenses Tax offset. * This information is to be used as a guide only. Clients must speak to the income tax accountatnt and/or Australian Taxation Office directly to determine exact medical tax offset rebates.

10 Better Access Program* If you feel that psychological factors may be contributing to your weight gain; you may be eligible for additional appointments through the Better Access Program. Generally speaking, people whose lives are impacted by the following list of conditions may qualify for the Better Access Program: Generalised Anxiety Disorder Bereavement Disorders Alcohol Use Disorders Mixed Anxiety and Depression Adjustment Disorder Depression Eating Disorders Drug Use Disorders Sleep Problems Body Image Disorders The above list is not exhaustive: eligibility for the Program is determined by a Doctor. To ascertain your eligibility, please make a 30 minute appointment with your GP or with our Clinic Doctor. Our Clinic Doctor s consultation fee is $163.35, which must be paid for in full on the day. This fee is fully refundable through Medicare* and must be claimed from Medicare prior to attending any consultations. The Better Access Program entitles you to five one hour consultations. These consultations cost $170 each and must be paid for on the day. Medicare will rebate $ $ of each consultation fee*. After attending the initial five consultations, you will need to arrange a 30 minute review appointment with your Doctor. During this time, the Doctor will review your progress and decide if a further five consultations are warranted. If you have any questions regarding the Better Access Program, please ask your GP, Dietitian or Psychologist; or you can talk to our Client Services Staff. Please take careful note of the following cancellation policy as it will be enforced: Appointments cancelled within 24 hours of the consultation, or appointments not attended on the day of the consultation, will incur a cancellation fee of $85. * All prices are subject to change per the Medicare Benefits Schedule. * This information is to be used as a guide only. Clients must speak to their GP directly to determine if they are eligible for the Better Access.