active choice TUH it s my health fund! comprehensive, efficient and friendly service right from the word go TUH offers

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1 Effective 2 April 2014 Queensland s health fund of choice active choice TUH offers comprehensive, efficient and friendly service right from the word go TUH it s my health fund! Far West Outback PLEASE CAREFULLY READ AND RETAIN THIS BROCHURE. PLEASE READ IN CONJUNCTION WITH THE Finer Points BROCHURE.

2 Prepare for whatever life throws at you with Active Choice. With intermediate hospital cover, you ll pay a lower premium with exclusions and restrictions on treatments you choose not to be covered for. You ll also have access to a selected range of general treatments to keep you on top of your game. Hospital cover Restrictions Pregnancy and pregnancy related services Hip, knee and joint replacements Surgery by podiatrist Exclusions Infertility investigations and assisted reproductive services Sterility reversals Includes For all other services in a private hospital, except restricted or excluded services (see table on left) where a Medicare benefit is payable, we will pay benefits in accordance with each individual hospital contract for: Private room (when available) or shared overnight accommodation Intensive care Theatre fees Same day accommodation Surgically implanted prostheses (industry approved) Hospital medication charges as per the hospital contract PBS co-payment where a hospital medication is related to your hospital treatment Medical Gap Cover (for inpatient medical services) Your choice of doctor or specialist Non-contracted hospitals (reduced benefits will apply) Restrictions For the services listed as restricted we will pay the default benefit for accommodation as determined by the Government. The default benefit covers the cost of: a reduced level of accommodation benefits (no theatre or labour ward fee benefits in a private hospital) medical gap access gap cover with participating doctors surgically implanted prostheses we will cover the full cost of any no gap prostheses and the minimum benefit for gap permitted prostheses. Waiting periods No benefit is payable for hospital procedures that are not listed in the Medicare Benefit Schedule and/or do not meet the eligibility criteria for the payment of Medicare benefits. Any excess applicable to your cover will be charged even where a default benefit only is paid. Exclusions For services listed as exclusions, no benefit is payable. Excess An excess is an amount you elect to contribute towards the cost of your hospital treatment (including same day surgery and procedures). Agreeing to pay an excess if you need hospitalisation reduces the amount of annual premium you pay. The excess is paid on admission into hospital no matter how long you stay. Single/Single parent cover $250 Family cover $500 The excess applies to all inpatient services that attract a hospital benefit (excluding prostheses). The excess is paid only once per adult on the policy in any calendar year, regardless of how many times you are admitted into hospital or a day facility. Hospital excess is not charged for dependent children, including full-time students. Immediate cover Accidents 2 months All other hospital and general services (unless specified otherwise) Palliative care Psychiatric services Rehabilitation Home Care Programs* 6 months Optical Disease Management Programs 2 12 months Obstetric related conditions Pre-existing conditions Major dental Orthodontia *Please refer to the Finer Points brochure. Plastic/ reconstructive surgery (only if medically necessary)

3 General (extras) cover Limits are per person per calendar year (1 January to 31 December) unless otherwise stated. Service Benefit up to Annual limit Waiting periods Alternative therapies $400 overall Acupuncture $350 2 mths Initial consultation - 1 per year $31 Subsequent consultations $26 Osteopathy $300 2 mths Initial consultation 1 per year $31 Subsequent consultations $26 Natural therapies 1 Aromatherapy, Bowen therapy 2, homeopathy, massage therapy, myotherapy, naturopathy $27 $350 combined limit per person $700 combined limit per family membership 2 2 mths Chiropractic $300 2 mths Initial consultation - 1 per year $30 Subsequent consultations $25 X-rays - 1 per year $50 Dental 3 Must be provided by registered dentists or dental prosthetists in private practice $600 overall 2 mths Preventive dental, eg. examinations, x-rays, scale/cleaning General dental 4 Set dental benefits depend on item number 5 Major dental 3 $1000 overall 12 mths Dentures $ * Crowns and bridges Set dental benefits depend $550 on item number 5 Endodontia $300 Orthodontia lifetime limits apply (refer to table on page 5) $400 $400-$550 Anti snore device 6 (replacement every 3 years from date of previous supply) $300 Health and Wellness (refer to page 6) $200 2 mths Optical - overall annual limit $200 6 mths Frames only $80.50 Single vision lenses 7 $84.50 Bi-focal lenses 7 $98 Tri-focal lenses 7 $90 Graduated/progressive lenses 7 $ Contact lenses hard/soft toric $140 Contact lenses hard/soft spherical $100 Repairs to frames $50 Disposable contact lenses included in annual optical limit $45 (3 mth. supply) 3

4 Service Benefit up to Annual limit Waiting periods Other therapies $350 overall Dietetics/nutritionists $150 2 mths Initial consultation (dietetics) 1 per year $30 Subsequent consultations (dietetics) $16 Initial consultation (nutritionist) 1 per year $27 Subsequent consultations (nutritionist) $14 Occupational therapy $150 2 mths Initial consultation - 1 per year $32 Subsequent consultations $25 Podiatry - no benefits for orthotics $250 2 mths Initial consultation - 1 per year $31 Subsequent consultations $26 Speech therapy $150 2 mths Initial consultation - 1 per year $45 Subsequent consultations $20 Group consultation $12 Psychology/hypnotherapy 8 $250 2 mths Initial consultation - 1 per year $61 Subsequent consultations $55 Pharmaceutical For prescriptions minus the current PBS fee. Benefit excludes medicines or medication which are: Prescriptions listed in the PBS Scheme. Available without a medical practitioner s prescription. Not approved by the Therapeutic Goods Act. Prescribed for contraceptive purposes. Physiotherapy Initial consultation - 1 per year $35 Subsequent consultations $32 $50 $400 2 mths $600 overall Exercise physiology $22 $100 Group physiotherapy 9 /exercise physiology 9 (includes Pilates) $17 $150 Antenatal/postnatal $17 $110 Ambulance transport Refer to Finer Points brochure for details. Increases with years of membership. * 1 Provider must be a registered natural therapist approved by TUH. 2 An individual within the family cover can claim up to the per person limit, provided the family as a whole has not exceeded its applicable family membership limit. This also applies to a single parent cover. 3 Dental items as defined by the ADA schedule. 4 General dental includes the surgical removal of teeth (including wisdom teeth). Major dental includes all dental services relating to dentures, crowns, bridges, endodontia, anti snore devices and orthodontia. 5 Contact TUH when you have obtained an itemised treatment plan from your dentist for information on actual benefits payable. 6 Letter from medical practitioner (not a dentist). 7 No benefit for additional lens treatments eg. tinting/hardcoating/transitional. 8 No benefit paid for counsellors. Benefit only paid for registered psychologists. Hypnotherapy benefit only payable when performed by registered psychologist. 9 Provided by a physiotherapist/exercise physiologist as part of a treatment plan. 4

5 Conditions and limits Replacement and other assessment rules can apply to some services. Benefits are paid for treatment by registered practitioners or recognised natural therapists/nutritionists approved by TUH. An individual within the family cover can claim up to the per person limit, provided the family as a whole has not exceeded its applicable family membership limit. This also applies to a single parent cover. Active Choice orthodontic benefit table Years of treatment Total benefit Waiting periods Members transferring from another fund - with no previous orthodontic claims and waiting periods served. $400 $400 $500 $1300 New members Years of TUH membership 1 nil $400 $500 $ mths 2 $400 $500 $550 $ $500 $550 $550 $1600 These figures are based on a maximum of 3 years continuous orthodontic treatment where benefits have not been claimed for previous orthodontic treatment during the patient s lifetime.the maximum lifetime benefit is $1600. You must submit an orthodontic treatment plan from your orthodontist at the commencement of treatment. TUH will advise the benefits available in writing, taking into account length of membership and previous orthodontic benefits paid by TUH or any previous fund. Value-added services Strive for Health programs Health-e-Profile - online health assessment SupportLine Home Care Programs Disease Management Programstelephone counselling TUH Website Online claiming Cover calculator Health articles Much more Health Care Centre Dental Eyecare Physiotherapy Massage Podiatry Acupuncture Dietetics Exercise physiology Health check TUH - It s my health fund Jody Henry Swimmer & triple Olympic Gold Medallist For more information on our value-added services please visit our website 5

6 Health and Wellness Benefit category Benefits are only payable if not claimable through Medicare Benefit Overall annual limit $200 single membership $400 single parent/family membership Health screenings mammogram, pap smear thin prep, ambulatory blood pressure monitoring, bone density screening, coronary CT, MRI, health checks - heart health checks and medical tests prior to fitness training programs Up to 80% Sublimit $90 per person Wellbeing Quit smoking programs, nicotine replacement products 1, illness related association memberships, health education classes 2, lithotripsy, medical bracelets 2, stress management 2, yoga 2 Up to 80% Sublimit $110 per person Weight loss and fitness 2 Gym membership, weight management, exercise classes, (NIDDM) resistance training, personal health coaching, swimming classes Up to 80% Sublimit $120 per person Other Childbirth education classes Up to 80% Sublimit $160 per person 1. Where not covered under PBS. 2. All services are to assist people in the management of their chronic disease. Due to Government legislation TUH can only pay a benefit for these items when there is a health management plan recommended by your medical practitioner. Benefits are paid when TUH receives Form A (completed by your medical practitioner), along with valid receipts. Please visit our website or contact TUH on for the Health Management Program Form A. 6

7 PAYMENT options debit Paying by direct debit from your bank or financial institution will save you 2.5%, while paying with your credit card will save you 1.5%. s can be made fortnightly*, monthly, quarterly, half yearly and yearly directly from your bank/financial institution or credit card account. P AYMENT by account Accounts are sent out monthly, quarterly, half yearly or yearly. options include: - BPAY - Member Services Online (credit card only) - In person (at our Health Care Centre) - By telephone - By mail The premiums are applicable for members who have a certified age of entry (CAE) of 30 or less, or for anyone born on or before 1 July A signed rebate application form must be submitted to receive a reduced premium. This is included with your new member pack. *Not available for credit card deductions. Active Choice without Australian Government Rebate on Private Health Insurance deducted Fortnightly Monthly Quarterly Half yearly Yearly Single Single parent Family Active Choice with maximum Australian Government Rebate on Private Health Insurance available for people under 65* Fortnightly Monthly Quarterly Half yearly Yearly Single Single parent Family *depending on your individual circumstances different rebates may apply. 7

8 website: phone: St Pauls Terrace Fortitude Valley Queensland 4006 PO Box 265 Fortitude Valley Queensland 4006 ABN For more information on all our products, government initiatives and TUH membership rules visit