Overseas Visitors Health Cover

Transcription

1 Overseas Visitors Health Cover Valid until Reg. No Health Insurance Australia February 2015

2 Overseas Visitors Health Cover Welcome to Australia Like most countries, healthcare in Australia can be expensive. It pays to make sure you re covered in case of illness, an accident or even for general health issues. Australia s public healthcare system is called Medicare. As a visitor, you may not have access to the Medicare system, which means you must pay for all of your medical bills. Visitors from certain countries may receive Medicare benefits for some treatments under what are called Reciprocal Health Care Agreements (RHCAs). These agreements also provide some subsidised health services to visitors from these countries when they are in Australia. At the time of printing, the Australian Government has signed agreements with: Belgium Finland Italy Malta New Zealand Norway Slovenia Sweden The Netherlands The Republic of Ireland The United Kingdom. You can check if your home country has an agreement with Medicare by visiting hcf.com.au/overseas or humanservices.gov.au To help out with the costs of hospitalisation and doctors fees in and outside hospital, such as doctors consultations, you will need private health insurance. Private health insurance not only protects you from unwanted health care bills, it gives you more control over your options if you require medical or health related treatment. HCF s Overseas Visitors Health Cover is designed for this purpose. It provides broad level, private patient hospital cover for overseas visitors and exceeds the minimum requirements for health insurance for 457 visa applicants - as set by the Department of Immigration. Who can be covered? You can be covered if you are: On visas: 405 Investor retirement visa 419 Visiting academic 422 Medical practitioner 456 Short stay business visas 457 Long stay business visas On any other visa that gives you the right to work in Australia A consulate member here for diplomatic purposes. You cannot get this cover holding a: Student visa Tourist visa Working holiday visa or Retiree visa not listed above. What is covered? To be covered for treatment in a private or public hospital, with your choice of doctor or specialist and greater access to elective surgery, we offer a broad level of hospital cover on our Overseas Visitors Health Cover. To be covered for services like dental, optical and therapies (e.g. physiotherapy, chiropractic), we offer the following levels of extras cover which can be taken with Overseas Visitors Health Cover: Basic Extras Lifestyle Essentials Active Lifestyle Lifestyle Plus Ultimate Extras. To help you choose, the following pages outline the types of treatments that are covered. 2 3

3 Hospital benefits summary Treatment in hospital You will be covered for hospital and medical services including: Accommodation in a public or HCF participating private hospital (excludes private room accommodation for same day procedures and private hospital emergency room and out-patient fees) Theatre fees Special care unit (e.g. intensive care, coronary care, neo-natal intensive care) 100% cover for Government approved no-gap prostheses Physiotherapy and pharmaceuticals related to your admission (excludes experimental, IVF and high cost non-pbs drugs) Doctors charges for in-hospital treatment - up to 100% of the Medicare Benefits Schedule (MBS) fee State Government emergency ambulance. Excess Also called a front-end deductible in some countries, an excess is an amount that you agree to pay towards the cost of hospital treatment, in exchange for lower premium costs. You can choose a hospital excess of $0, $500 or $1,000. Choosing a higher excess will reduce your premium. See Glossary for more information on excesses. Waiting period Waiting periods apply for certain procedures. See Glossary for more information on waiting periods and procedures. A twelve month waiting period applies for pre-existing conditions and pregnancy and birth related services. Treatment by a doctor You can claim towards the costs of doctors charges in-hospital and out-of-hospital. For services billed by doctors who treat you in hospital, we will pay 100% of the equivalent Medicare Benefit Schedule (MBS) fee. Most doctors charge above this rate, leaving members with a gap. If your treating doctor participates in our nogap arrangement (Medicover) and charges you at the Medicover rate, then you will not need to pay this gap. See Glossary for more information on Medicover. For doctors services provided out-of-hospital, we will pay up to 85% of the MBS fee. Bonus Excess Waiver You won t pay an excess for same day hospital treatment, after serving the relevant waiting periods. See page 10 for more details. Overseas Visitors Health Cover Excess options $0, $500 or $1,000 Available as hospital cover only (without extras) Yes Example hospital procedures at HCF participating private and public hospitals - accommodation, operating theatre, intensive care Accommodation, operating theatre, intensive care Accident related treatment after joining Physiotherapy & pharmaceuticals # related to admission Removal of tonsils Removal of adenoids Removal of appendix Hernia treatment Removal of kidney stones & gall stones Digestive disorder procedures (e.g. bowel surgery) Government approved prostheses for covered services Heart surgery (including diagnostic and therapeutic cardiac procedures) Spinal surgery Rehabilitation services Pregnancy & birth related services Hip & knee joint replacement surgery Cataract & other lens related surgery Emergency ambulance (State Government provided only) Non-emergency State Government provided ambulance (up to $5,000) Covered # Excluding experimental, IVF and high cost non-pbs drugs 4 5

4 Extras benefits & limits If you choose to take out extras cover as well, you can claim towards a range of services, outlined in the table below. The amounts shown are annual limits and not indicative of the individual benefits you will receive. Basic Lifestyle Essentials Active Lifestyle Lifestyle Plus Ultimate No gap dental check through HCF s More for Teeth provider network (not available in NT & Tas) 2 check-ups per year 2 check-ups per year 2 check-ups per year At participating providers, subject to your cover and annual limits To find out more, visit hcf.com.au/100back LIMIT BOOST No gap eyewear and free digital retinal imaging eye check through HCF's More for Eyes provider network No gap for your initial physiotherapy, podiatry, chiropractic and osteopathy consultation through HCF s More for Muscles, More for Feet and More for Backs provider network Use your Limit Boost to top up your optical and/or dental annual limit each year. See hcf.com.au/limitboost for details. Services Details Waiting Periods Annual limits, per person per calender year, unless otherwise specified (set benefits apply per service or item) Diagnostic & preventative dental (service limits apply e.g. maximum 1 or 2 scale & clean per person per year) No annual limit (service limits apply) No annual limit (service limits apply) General Dental Simple fillings (1-2 surfaces) Extractions $450 Year 1 $700 Oral surgery (including wisdom tooth removal) $500 Year 2 $750 Complex fillings (3 or more surfaces) Year 3 $800 $950 $1,150 Periodontics, Endodontics Major Dental Implants, Veneers, Crowns, Bridges 1 Dentures $600/$300 max. per year $800/$400 max. per year $800/$400 max. per year Orthodontics - Specialist dentist / General dentist $1,800/$900 lifetime limit $2,400/$1,200 lifetime limit $2,400/$1,200 lifetime limit Optical Optical $150 $180 $200 $210 $250 Physiotherapy $200 (group & classes covered under Health Management) $250 Exercise physiology Year 1 $400 (group & classes covered under Health Management) Year 2 $450 $550 $750 Occupational therapy Year 3 $500 Psychology (after Medicare entitlement exhausted) Chiropractic Osteopathy Therapies Remedial massage (1 for foot $300 $350 $450 Myotherapy orthotics) $120 $150 ($200 max. per therapy ($250 max. per therapy ($250 max. per therapy Acupuncture, Chinese herbal medicine except for Chiro & Osteo) except for Chiro & Osteo) except for Chiro & Osteo) Naturopathy / Nutrition consultation Alexander technique Podiatry services (including foot orthotics) Dietetics Year 1 $200 Audiology Year 2 $225 $300 $450 Year 3 $250 Speech pathology Travel & accommodation (200km round trip) $200 $250 $250 HCF approved pharmacy after PBS equivalent co-pay Vaccines & immunisations $100 $180 $280 $280 Artificial aids 1 $150 $200 $250 Other Hearing aids 24 months $600 up to $1,600 $800 up to $1,800 $800 up to $1,800 Health Management Programs (e.g. exercise classes, weight management) Emergency ambulance (see page 9 for details and limits) 6 months $50 per person $100 per policy $50 per person $100 per policy $75 per person $150 per policy $100 per person $200 per policy $150 per person $300 per policy NSW/ACT 1 day No annual limit No annual limit No annual limit No annual limit No annual limit VIC/NT/WA/SA 1 day

5 Waiting Periods Glossary of terms Hospital waiting periods Palliative care Psychiatric services Rehabilitation services Pre-existing ailments or conditions Pregnancy & birth related services All other hospital services Extras waiting periods Health Management Programs Artificial appliances (e.g. low vision aids, blood glucose monitors) Foot orthotics Pre-existing ailments & conditions Dental bleaching Bridges Crowns Dentures Endodontics Occlusal therapy Oral surgery Orthodontics Periodontics Prosthodontics Veneers Hearing aids All other extras services Ambulance waiting periods Emergency ambulance (where not for pre-existing ailments) Pre-existing ailments 1 6 months 1 24 months 1 day 1 Ambulance Transportation HCF pays benefits towards eligible State Government provided Emergency and Nonemergency ambulance services depending on your level of cover and up to your annual limit. The ambulance service provider must be recognised by HCF and the transportation must be to the nearest appropriate Australian hospital able to provide the level of care required. Emergency Ambulance Transportation: Benefits are payable for Emergency ambulance services where transport to the nearest hospital or on-the-spot treatment is required. Emergency means an immediate and serious threat to person s health or life. Benefits are not payable: Where the ambulance service is not requested because of an Emergency; For transport on discharge from hospital to your home or nursing home; Where you are covered by another funding arrangement such as a State Government scheme; Where you are covered by another third party (such as a state ambulance subscription or the ambulance charges are the subject of a compensation claim); For transfers between hospitals; For charges raised for a medical retrieval team escort; For ambulance transport providers not recognised by HCF. Non-Emergency Ambulance Transportation: A limited number of HCF products include a non-emergency ambulance benefit and eligible members can claim up to a maximum of $5000 in a calendar year for non-emergency ambulance transport. Non-emergency ambulance transport means transport by a State Government provided ambulance that is requested because your medical condition requires a level of support and medical monitoring in transit that only an ambulance service can provide. Non-emergency ambulance transport must be requested by your treating doctor to be considered for an HCF benefit. Benefits are not payable for Non-Emergency Ambulance transport: Where the transport does not meet the definition above (such as for general patient transport); Where the transport has been elected by the patient or family for reasons such as choice of doctor or hospital or closer to family; Where you are covered by another funding arrangement such as a State Government scheme; Where you are covered by another third party (such as a state ambulance subscription or the ambulance charges are the subject of a compensation claim); For transfers between hospitals; For charges made for a medical retrieval team escort; For ambulance providers not recognised by HCF. Ambulance service providers recognised by HCF HCF recognises the following ambulance service providers for the purposes of paying benefits: - ACT Ambulance Service - Ambulance Service of NSW - Ambulance Victoria - Queensland Ambulance Service - South Australia Ambulance Service - St John Ambulance Service NT - St John Ambulance Service WA - Tasmanian Ambulance Service. 8 9

6 Excess An excess is the amount you nominate to pay if you are admitted to hospital. You can reduce your health cover premium by opting for a higher excess, or pay a bit more to get a lower excess. Whatever excess level you choose: You won t pay a hospital excess for accident-related treatment You won t pay a hospital excess for dependent children You won t pay a hospital excess for same day treatment. Note: to access the waiver, a 12 month waiting period applies for pre-existing conditions and a 2 month waiting period applies for all other procedures You pay only one hospital excess amount per person per calendar year, if an excess is applicable. Hospital cover in-patient services Hospital benefits are payable when you re admitted to hospital for treatment. These are called in-patient services and only in-patient services are covered by your hospital cover. Medicare Benefits Schedule (MBS) Medicare has a list of medical services for which benefits can be paid. These are listed in the Medicare Benefits Schedule (MBS). The list covers most medical procedures and treatments provided by a doctor, for both in-hospital and out-of-hospital treatment. You are not covered for medical services without an MBS item number. This means services like: MRI services that are not registered with Medicare Elective cosmetic surgery Surgery by a podiatrist. Overseas Visitors Hospital Cover does not cover ancillary type services outside of hospital (e.g. podiatry, psychology and physiotherapy), even if they have an MBS number. You can get cover for these services by taking out extras cover. We have many levels of extras cover, which can be taken with Overseas Visitors Health Cover, including Basic Extras, Lifestyle Essentials, Active Lifestyle, Lifestyle Plus and Ultimate Extras. Medicover Medicover is a no gap arrangement we have with certain doctors to help eliminate personal medical expenses for members. If a doctor chooses to participate in this arrangement, we will pay all of their fees for in-hospital medical services which means there will be no out-ofpocket expense for you. Please ask your doctor if they participate. Minimum Benefits Some procedures are paid at Minimum Benefits, depending on the hospital cover you select. Minimum Benefits is the rate set out by the Commonwealth Minister for Health as the minimum benefit for a shared room and benefits for Government approved Prostheses List items. In a private hospital: These benefits would not be adequate to cover all hospital costs and are likely to result in significant out-of-pocket expenses. In a public hospital: As a private patient in a public hospital, in the event these benefits are less than what your chosen public hospital charges, you may have out-of-pocket expenses to pay. What happens if I choose to be a private patient in a public hospital? We pay Commonwealth Minimum Benefit for a shared room and a higher rate for a single, private room. You will need to confirm with the hospital if they will be charging you any out-of-pocket expenses. The hospital has the responsibility to explain to you any out-of-pocket expenses and obtain written informed financial consent (IFC), prior to admission. What happens if I choose to go to a Non-participating private hospital? We pay Commonwealth Minimum Benefit towards accommodation and prostheses. Out-of-pocket expenses may apply to accommodation, theatre, labour ward fees and prostheses. You need to obtain a quote from the hospital. The hospital has the responsibility to explain to you any out-of-pocket expenses and obtain written informed financial consent (IFC), prior to admission. What is informed financial consent (IFC)? IFC is the provision of cost information to patients, including notification of likely out-ofpocket expenses (gaps), by all relevant service providers, in writing, prior to admission to hospital or treatment. Participating hospital This is a private hospital or day hospital facility which has a hospital purchaser-provider agreement with us. You can search for participating hospitals at hcf.com.au/participatinghospitals Pharmaceutical Benefits Scheme (PBS) The PBS Schedule lists all of the medicines available to be dispensed to patients at a Government-subsidised price. The Scheme is available to all Australian residents who hold a current Medicare card. Overseas visitors from countries with which Australia has an RHCA are also eligible to access the Scheme. For more information, visit: pbs.gov.au/info/about-the-pbs Pharmaceutical item Means an item which is ordinarily claimable under an eligible Extras product which meets the following criteria: a) It is prescribed by a Medical Practitioner or dental practitioner on prescription in accordance with relevant state legislation; and b) It is supplied by a pharmacist or Medical Practitioner in private practice under relevant state legislation; and c) It is registered (labelled with an AUST R number) on the Australian Register of Therapeutic Goods (ARTG) and is prescribed for treatment of the approved specific indications as detailed in the ARTG; or d) It complies with HCF s Clinical Pharmaceutical Procedure for Ancillary Benefits as approved by the Medical Director or equivalent, provided that none of the following apply: i) The item is listed or was listed under the Pharmaceutical Benefits Scheme (PBS) in any brand, formulation, strength or pack size and regardless of whether PBS availability is subject to any specified purpose or patient type; or ii) The Minimum Standard Supply for the item is customarily charged at an amount that is less than, equal to, or within $3 of the current PBS co-payment for general patients; or iii) The item is generally prescribed for purposes outside of illness or disease or for reproductive medicine including contraception or for the enhancement of sporting, sexual or work performance; or iv) The item is generally prescribed for weight loss (some weight loss medications can be claimed under Health Management Programs); v) The item is excluded under the HCF Clinical Pharmaceutical Procedure for Ancillary Benefits; or vi) The item is available without a prescription. PBS equivalent co-payment The PBS requires that a co-payment be paid towards each pharmacy item. Under our extras covers, we require an equivalent copayment for each pharmaceutical item before a pharmacy claim is paid. The amount of co-payment is adjusted on or around 1 January each year, in line with the Consumer Price Index (CPI). Pre-existing ailments or condition A pre-existing ailment, illness or condition is one where the signs or symptoms existed during the six months before joining HCF or upgrading to a higher level of cover, even though a diagnosis may not have been made. If there s any doubt that an ailment or condition is pre-existing, a medical practitioner, appointed by HCF will examine information provided by your doctor, together with other relevant claim details

7 Prostheses list This is a list of surgically implanted prostheses, human tissue items and other medical devices, and the benefit to be paid by the private health insurers, as determined by the Minister for Health. Waiting periods This is the time period that must be served before you are covered for treatment. Waiting periods vary, depending on the type of service. If you were previously covered for a service by another private health insurance fund in Australia, you How to apply will not need to serve these waiting periods again if you transfer within 30 days. If you were covered by a private health insurer overseas, you will need to speak to us to confirm whether you are exempt from these waiting periods. Most services have a 2 month waiting period. 12 month waiting periods apply for some treatments, including pregnancy and birth related services, pre-existing ailments or conditions, major dental and orthodontics. See the tables on the previous pages for more on waiting periods. Get more benefits, more cover and more savings at an affordable price. To apply: Call (within Australia) Call (for international callers) Visit us in person, find your nearest branch at hcf.com.au/branches Go to hcf.com.au/overseas overseasvisitors@hcf.com.au Our privacy statement HCF is committed to best practice privacy protection We collect your personal information, including sensitive information such as health information from you and/or the Policyholder who is responsible for your policy and/or from other third parties detailed in our Privacy Policy, so we can: Comply with applicable laws Manage our relationship with you Record your treatment Provide health or other insurance, related products and services to you (including through third parties) Manage and pay claims and benefits Assess your insurance, health and related lifestyle needs Investigate fraudulent or improper claims and assess risks Research and develop products, services and benefits that may better serve your needs Assess your possible interest in and tell you about such products and services Administer our business and deal with complaints. The types of organisations and individuals we disclose personal information to include: Third party organisations who deliver services on our behalf or to us, some of whom may be located overseas Health service providers to improve their ability to provide you with health services Research companies contracted to us to ask your opinion on improving our service, benefits or product offerings Other insurers or reinsurers, including other health insurers if you have moved your insurance to or from HCF Government, including law enforcement agencies Related HCF companies The named Policyholder who has your authority Any other authorised individual. If you do not provide the personal information we request, we may not be able to provide you with our products or services, including health insurance. You can ask us at any time to stop direct marketing to you by ing service@hcf.com.au or calling For more information about the personal information we collect and how we handle it, how to access and correct your information or to make a complaint and how we will respond to complaints, please read our Privacy Policy. To view the HCF Privacy Policy: Visit hcf.com.au/privacy Visit your local branch. All new Policyholders should ensure that all members on the policy are made aware of the HCF Privacy Policy. 13

8 Get the most from your health cover. Join HCF today Go to the HCF website hcf.com.au Visit one of our many branches. Find your closest branch at hcf.com.au/branches Call We re open 8am - 8pm, Monday to Friday, 9am - 5pm weekends (AEST) Mail the attached application form Claim using our app. Take a photo of your extras claim receipt on your phone and submit. Available for iphone and Android Corporate Sales Ask one of our corporate sales representatives to visit your workplace by ing corporatesales@ hcf.com.au Start enjoying benefits only HCF can offer. Become a member today! The Hospitals Contribution Fund of Australia Limited. ABN Head Office: 403 George Street,Sydney NSW 2000