DID YOU KNOW? IMPORTANT INFORMATION

Transcription

1 i DID YOU KNOW? IMPORTANT INFORMATION

2 Why Medibank? Medibank is more than just about insuring your health. We have the people, services and resources to be your personal health partner, helping you to be your best at every stage in life. We re committed to making health insurance as straightforward as possible. For a start, we make it easier for you to choose cover that s right for you. We have an extensive network of stores across Australia where you can drop in for advice and assistance. And when it comes to claiming, we do everything we can to make the process how it should be clear, simple, and certain. We ll help you be your best at every stage in life.

3 It pays to understand your Medibank health insurance. The more you understand about your Medibank cover the easier it is to make the most of it. From rebates and levies to pre-existing conditions and cooling off periods, you ll find it explained simply within these few pages. We know reading about the ins and outs of private health insurance isn t everyone s idea of a good time, but it s certainly time well spent. For more information on Medibank s policies and Fund rules, read our Membership Guide at medibank.com.au Rebates, Levies and Loadings The Medicare Levy Surcharge The Australian Government encourages all adults to take out private health insurance, with the aim of easing the strain on the public hospital system. The Medicare Levy Surcharge (MLS) is an additional tax ranging from 1% to 1.5%, depending on your annual income, on top of the existing Medicare Levy. If applicable, it is deducted from your earnings when you lodge your tax return. You can avoid or minimise the MLS by having a Medibank hospital cover. To learn more about the MLS, go to ato.gov.au Australian Government Rebate The Australian Government Rebate (AGR) on private health insurance helps make health insurance more affordable by giving you a rebate on your premiums. The AGR is applied to the base premium rate only, not to any Lifetime Health Cover loading that may be applicable. The level of rebate percentage you re entitled to is determined by the age of the oldest person covered under the membership and your income. From 1 April 2014, the Federal Government will reduce the rebate percentages annually for all health insurers, based on a calculation that takes in to account the annual industry average rate increase on health insurance premiums and the cost of living. If you re a Medibank member you should nominate your rebate tier by logging into Online Member Services at medibank.com.au or by visiting a Medibank store. Lifetime Health Cover loading The Australian Government is incentivising people to take out private health cover through taxes and rebates. Because they want us to do it sooner rather than later, a Lifetime Health Cover loading (LHC) applies to people who haven t taken out hospital cover by 1 July following their 31st birthday. For every year you don t have hospital cover after your 31st birthday, you ll pay a 2% loading on top of the base rate of your hospital cover premium up to a maximum of 70%. The loading will be removed once you ve held hospital cover continuously for 10 years.

4 Who s exempt? People born before 1 July 1934 don t have to pay a LHC loading. You can learn more about other exemption categories at What if you drop your hospital cover? Life s unpredictable and you may be forced to cancel or suspend your hospital cover for a period of time. The good news is you can drop your hospital cover for up to three years (1,094 permitted days) during your lifetime without impacting your LHC loading status. Any longer than this and you ll have to pay the loading once you take out hospital cover again. There are some circumstances when your days without hospital cover won t count towards your 1,094 permitted days without hospital cover, such as: if you ve been overseas continuously for more than one year (this includes visits back to Australia of less than 90 days at a time), and/or if your health insurer has agreed to a period of suspension of your cover. Switching from another health insurer? If you switch to us from another health insurer it s best to keep your existing cover until the day you become a Medibank member. This way you can avoid using up any of the 1,094 permitted days you can be without hospital cover during your lifetime. Any period of time you ve had the loading applied by another health insurer will be transferred to your Medibank cover and counted towards the 10 year loading period. Remember the loading will be removed after having 10 years of continuous hospital cover. Joining Medibank Cooling off period It s okay to change your mind. You can cancel your membership within 30 days of joining as long as you haven t made a claim, and your premium will be fully refunded. Transfers Coming to us from another health insurer? We ll make the transition as smooth and painless as possible, and you ll be covered from the date you join if: those services are also included on the Medibank cover we consider to be most similar to the cover you had with your former health insurer, and you join us within two months of leaving that former insurer, and you ve served applicable waiting periods. We ll credit you with waiting periods you ve already served, so you ll only need to serve the balance with us before you can claim. Also, benefits that have been paid under your previous cover will be taken into account in determining the benefits payable under your Medibank cover. Any loyalty bonus or similar entitlements built up with your former health insurer won t transfer to Medibank. Waiting periods All health insurers have waiting periods that everyone serves before they can receive benefits. If you haven t had health insurance before or it s been over two months since you had health insurance, you ll need to serve waiting periods. What if you re changing to a higher level? Whether you re upgrading within Medibank or from another health insurer, additional waiting periods may apply. In the meantime you can still receive a benefit for services that are covered in both your old and new cover and where you ve already served relevant waiting periods. In this case the benefit you receive will be that of your previous cover. Waiting periods vary for different services and items. The following table is a guide.

5 Period No waiting period Item/Service Mi Health support services (available with hospital covers only) 2 months* All services (including ambulance services) except those set out below 6 months Optical items Ultra bonus Membership Bonus 12 months Pre-existing conditions Obstetrics-related services Major dental services Orthodontics Surgical dental procedures and extractions Breathing appliances, including nebulisers, peak flow meters and spacing devices^ betterhealth programs Oral appliances for sleep apnoea^ 24 months Blood glucose monitors^ Blood pressure monitors^ 36 months Hearing aids^ Laser eye surgery * If you have an accident after joining us or changing cover and require treatment, we ll waive the 2 month waiting period. Please note that if you have our stand-alone Ambulance cover, the 7 day waiting period for accidents still applies. The 12 month pre-existing condition waiting period does not apply to hospital or hospital substitute treatment for psychiatric treatment, rehabilitation treatment or palliative care, but a 2 month waiting period still applies. ^ Benefit replacement periods apply. Please refer to the Membership Guide at medibank.com.au Pre-existing conditions All private health insurers have a waiting period of 12 months before you can claim for a pre-existing condition. This is an ailment, illness or condition with signs or symptoms that existed as determined by one of our doctors in the six months before starting your membership or changing cover and applies only to hospital cover. If you go to hospital within the first 12 months of joining, we may check whether you re being treated for a pre-existing condition. What if you have a pre-existing condition? If you ve never had private hospital cover or if your cover has lapsed, you ll need to wait 12 months before you can claim for treatment of a pre-existing condition. If you have upgraded to one of our higher levels of hospital covers (either from Medibank or from another health insurer), you ll need to wait 12 months to receive the higher benefits. For more information about pre-existing conditions please refer to the Membership Guide at medibank.com.au Added benefits of some packaged covers With some of our packaged covers you ll benefit from an annual Membership Bonus (per membership) as well as increasing annual limits on selected extras services. These benefits are exclusive to the covers below and aren t available on other Medibank covers: For New Families Essentials For New Families Comprehensive For Settled Families Essentials For Settled Families Comprehensive For Everyday Comprehensive For Security Comprehensive. With For Everyday Essentials and For Security Essentials cover, you receive increasing annual limits on selected extras services. Membership Bonus A separate amount that you can put towards the cost of approved membership and health related expenses. This annual bonus is in addition to benefits you receive towards the hospital and extras services of this product. Any unused Membership Bonus will be added to the following year s entitlement which can accrue up to the maximum limit. * There s a 6 month waiting period before you can use your Membership Bonus. Then on 1 January every year you will receive your Membership Bonus entitlement until you reach your limit.

6 The bonus can be used for a range of things like topping up your benefits to reduce your out-ofpocket expenses, like those you may experience on an extras claim or a hospital excess. You can also use this bonus for other health related expenses. To find out more call us on There are some things you can t use your Membership Bonus towards which include your premium, any contributions towards Pharmaceutical Benefits Scheme (PBS) prescriptions, out-of-hospital medical expenses covered by Medicare, other non-approved expenses, or expenses and costs precluded by law from being paid. The expenses you can use your Membership Bonus towards are subject to change. For more information, call us on Increasing annual limits on selected extras services For a range of extras services *, your annual limits increase by $50 per member, per calendar year (up to the maximum amount * ), starting from 1 January only after a full calendar year of membership has been completed. The following table is an example of a member who takes out For New Families Essentials cover on 30 June 2013 and how their annual limit will increase for major dental. Date 30 June 2013 $400 Annual Limit 1 January 2014 $400 (no increase as membership still within 1st calendar year) 1 January 2015 $450 (annual limit increases as full calendar year of membership has been completed). 1 January 2016 $500 1 January 2017 $550 1 January 2018 $600 1 January 2019 $650 (maximum) *Refer to Extras product tables in the Family packages and Singles and Couples packages brochures for more details, or visit medibank.com.au Ambulance services What s covered? Where you need an ambulance and your medical condition is such that you can t be transported any other way, you ll be covered for services provided by a Medibank approved ambulance provider: When ambulance transportation to a hospital or other approved facility is required to receive immediate professional attention When an ambulance is called to provide immediate professional attention but transport by ambulance is not needed When, as an admitted patient, the hospital requires you to be transferred from one hospital to another (excluding transfers between public hospitals) For transport by air ambulance, where pre-approval has been obtained from Medibank by the air ambulance provider. What s not covered? Medibank does not pay benefits for any ambulance service that has not been defined under What s covered (above). This includes: Ambulance services where immediate professional attention is not required (e.g. general patient transportation) Any ambulance transport required after discharge from hospital (e.g. transport from hospital to home) Inter-hospital transfers when, as an admitted patient, you re transferred from one public hospital to another public hospital Any ambulance costs that are fully covered by a third party arrangement, such as an ambulance subscription or federal/state/territory ambulance transportation scheme, WorkCover or the Transport Accident Commission Any air ambulance services that are fully subsidised, such as South Care or NRMA Care Flight.

7 Are you already covered for ambulance transport? State Government ambulance transport schemes operate in NSW, ACT, Qld and Tas. You can find out more at medibank.com.au/ambulance Do you live in Western Australia? All Western Australian aged pensioners are eligible for free ambulance services. All other senior citizens aged 65 and over are entitled to receive a 50% subsidy on the cost of ambulance transport. The remaining 50% of the cost may be claimable from Medibank. On Standalone Ambulance Cover a $100 co-payment applies to non-emergency transport as classified by the ambulance service. Out-of-pocket expenses The difference between the cost of a hospital or extras service and any benefit received from us or Medicare is an out-of-pocket expense. Here s some info that may help reduce some of those expenses. How much do you pay for extras? While you may have to pay an out-of-pocket expense on extras, you may save money by visiting a Members Choice extras provider. You benefit from capped charges and/or discounts, which means you ll generally have lower out-of-pocket expenses than you would at a non Members Choice provider. How much do you pay if you go to hospital? Hospital cover helps pay for your hospital visit but doesn t always cover all the costs. You may be able to reduce your out-of-pocket hospital expenses by choosing a Members Choice hospital and by asking your doctor or specialist to participate in Medibank s GapCover. For more information about GapCover, please refer to the Membership Guide at medibank.com.au However, you may still have some out-of-pocket hospital expenses, such as the difference between the hospital s charges and the benefit we pay and an excess (if you choose to have one). But remember, by choosing a hospital cover that has an excess, you ll pay a lower premium. Before your admission you should confirm all likely out-of-pocket expenses with your doctor and/or hospital. Other things you should know If there s anything else you want to know that s not covered here such as benefit replacement periods or our rules on paying benefits, you should be able to find what you re looking for by reading our Membership Guide at medibank.com.au Understanding our terms Not familiar with some words or phrases or want to know the definition of specific terms? Find a list of frequently used words, terms and phrases at medibank.com.au/healthcover/glossary.aspx What is an accident? We define an accident as an unforeseen event occurring by chance and caused by an external force or object resulting in involuntary injuries to the body which requires immediate treatment. This doesn t include conditions brought on by medical causes such as asthma attacks and appendicitis. Unhappy? What if you have a complaint? We try to resolve all enquiries and concerns the first time you contact us. If you still need help with your concern or any aspect of your membership, our Customer Resolutions team will provide courteous and respectful service. You ll just need to provide sufficient information regarding your enquiry so we can investigate it for you. You can do this by: calling ing the secure form available in Online Member Services at medibank.com.au writing to Medibank Private Customer Resolutions, GPO Box 9999, Melbourne, VIC If for some reason we are not able to satisfy your enquiry, you can also get free, independent advice from the Private Health Insurance Ombudsman by: calling visiting phio.org.au

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