YOUNG EXTRAS 1 APRIL 2016

Transcription

1 YOUNG EXTRAS 1 APRIL 2016

2 Welcome TO QUEENSLAND COUNTRY In short, Queensland Country Health has been at it for nearly 40 years, and takes pride in offering you a flexible, affordable and comprehensive health cover. Your health is our number one priority. This brochure provides an overview of the features and benefits of Young Extras cover to enable a good understanding of the level of cover available. If you wish to package Young Extras with a hospital cover, please refer to our Health Benefits Guide. For more information regarding health insurance please refer to our Membership Guide or visit us at [ 2 ]

3 CONTENTS Young Extras Cover 4 About Young Extras Cover 5 Extras Cover benefits 6 How much are the premiums? 8 How to pay contributions 11 In more detail 12 Private health Insurance complaints 17 Contact details 18 Managing your health insurance cover online 10 we offer you flexible, comprehensive and affordable health cover. HOW TO JOIN call [ 3 ]

4 YOUNG EXTRAS COVER Getting started with health insurance has never been easier. Queensland Country offers Young Extras designed as an entry level extras cover and is best suited for young people under the age of 30. Young Extras will provide you with: Cover for a number of commonly used Extras such as a trip to the dentist, including examinations, scale and cleans, simple fillings, extractions and even crowns and bridges. As well as cover for other services such as physiotherapy, massage and even a new set of glasses or contact lenses. Competitive pricing to make health insurance affordable. Young Extras can be purchased on its own or as a package with one of our hospital covers. If you would like to take a hospital cover with Young Extras please review all other options in our Health Benefits Guide. Australian Government Rebate on private health insurance The Australian Government Rebate on Private Health Insurance was introduced as a financial incentive to assist Australians afford Private Health Cover, and to recognise the contribution that people with private health insurance are making to their own health care costs. Rebate entitlement depends on your age and income*. The rebate is indexed each year by the difference between CPI and the industry average increase in premiums using a Government-calculated formula. It s up to you to nominate a rebate tier (based on your age and income*). Some people choose to take their rebate up front as a lower premium, but if you d prefer to claim the rebate as a lump sum through your tax at the end of the financial year, you can simply choose to pay the full premium with no rebate deducted. Queensland Country offers: Value for money health insurance products with comprehensive benefits Access to your health insurance policy information via our online member services Very high levels of Member satisfaction which is confirmed with Member surveys * This information is intended as a guide only and does not take into account your personal circumstances. For information in regards to the income thresholds please refer to our website under your cover explained/ government initiatives. For calculation method for this income known as income for Medicare Levy Surcharge purposes, please seek the advice of your tax agent, financial advisor or contact the Australian Taxation Office (ATO) Help Line on or visit their website at [ 4 ]

5 ABOUT YOUNG EXTRAS COVER Young Extras offers benefits towards the cost of some health care services that are not covered under our hospital cover or by Medicare. Young Extras has been designed to provide good benefits for a broad range of therapies most likely to be used by young people while keeping the cover affordable. Whether you need a massage or a new pair of glasses, Queensland Country can help. Online or On-the-spot Claiming To make it even easier to claim your benefit, participating health professionals have electronic claiming facilities available. HICAPS/IBA is an electronic health claiming and payments system that will process your claim for treatment, on the spot, without leaving the surgery or practice of your provider. Alternatively with Online Claiming we ve now made it easier than ever to claim for a wide range of services when on-the-spot claiming isn t available through your provider. After you have been with us for 3 months, simply go online using your PC, tablet or smart phone! You can claim up to $400 per day in benefits for services up to 3 months from the actual date of service, treatment or visit. For full terms and conditions visit our website Optical Discounts Queensland Country has negotiated agreements with a large number of optical providers across Australia. When you visit one of our preferred optical providers you will receive discounts on frames, lenses and contact lenses. Further details of these providers can be seen at under Your cover explained/understanding health insurance/preferred provider network. GENEROUS ANNUAL LIMITS FOR GENERAL DENTAL AND OPTICAL SERVICES COVER FOR A WIDE RANGE OF ALTERNATIVE THERAPIES INCLUDING REMEDIAL MASSAGE, NATUROPATHY AND PODIATRY EASY CLAIMING WITH HICAPS/IBA ON THE SPOT CLAIMING COMPETITIVE PREMIUMS [ 5 ]

6 EXTRAS COVER BENEFITS Services Waiting Period Benefit Limits per membership year Examples of maximum benefits DENTAL BENEFITS General Dental 2 months $500 per person up to $1000 per policy Periodic oral examination $34 Scale & Clean $56 Fluoride treatment $17 Mouth Guard $113 Major Dental Surgical Extractions* Crowns & Bridges 12 months Surgical tooth extraction $135 Full crown veneered $500 OPTICAL BENEFITS Single & Multi-focal lenses & frames PHYSIOTHERAPY 2 months $210 per person up to $420 per policy Single vision lenses & frames $210 Repair to frames $210 Contact lenses $210 Physiotherapy 2 months $400 per person up to $800 per policy Initial visit $42 Subsequent visit $32 Group Therapy $8 (sub limit of $80 applies) ALTERNATIVE THERAPIES Chiropractic Osteopathy 2 months $300 per therapy $500 per person up to $1000 per policy Remedial Massage Therapy # Bowen Therapy # Myotherapy # Initial visit $30 Subsequent visit $30 Podiatry Initial visit $30 Subsequent visit $30 Orthotics 85% of cost up to available policy limits Minor procedures 75% of cost up to available policy limits Acupuncture # Initial visit $30 Subsequent visit $30 Naturopathy # Homeopathy # Initial visit $30 Subsequent visit $30 Dietician Initial visit $55 Subsequent visit $35 * Benefits paid on dental item numbers only, unless hospital cover is held and all waits have been served for any in-patient services. # Benefits are only payable for services rendered by Australian Regional Health Group approved providers registered with Queensland Country as well as Bowen Therapists that are registered with the Bowen Association of Australia (BAA) or Bowen Therapists Federation of Australia (BTFA). [ 6 ]

7 Services Waiting Period Benefit Limits per membership year Examples of maximum benefits OTHER SERVICES Pharmaceutical^ 2 months $150 per person up to $300 per policy $30 per script Healthy Living Benefit 2 months $125 per person up to $250 per policy Benefits up to the policy limit are available for: Your choice of quit smoking programs Your choice of weight management programs Participate in other approved health management programs** including: - Gym Membership - Personal Training programs Skin checks through mole mapping Consultation fees for metabolic dieticians and nutritionists when providing assistance with weight management ^ Prescriptions not covered by the PBS, excluding contraceptives and items normally available without prescription and drugs not approved for sale in Australia. A co-payment applies to each prescription item equal to the current PBS general patient contribution. Please refer to page 13 for more information. ** To comply with private health insurance legislation you must have been referred by your health care professional to participate in a health management program to address, improve or prevent a specific health or medical condition. A Health Management Program Benefit Approval Form available on our website, must accompany a claim for these benefits. [ 7 ]

8 HOW MUCH ARE THE PREMIUMS? What you ll pay WITH BASE TIER REBATE NO REBATE DEDUCTED WEEKLY MONTHLY YEARLY WEEKLY MONTHLY YEARLY SINGLE $5.15 $22.35 $ $7.05 $30.55 $ WITH BASE TIER REBATE NO REBATE DEDUCTED WEEKLY MONTHLY YEARLY WEEKLY MONTHLY YEARLY COUPLE $10.30 $44.70 $ $14.10 $61.10 $ Normal 2 and 12 month waiting periods apply with this product. Premiums are quoted with both base tier rebate and with no Australian Government Rebate on private health insurance. Your eligibility to this rebate will depend on the age of the oldest person on the policy and assessable income levels. More information and resources in regards to the Australian Government Rebate on private health insurance is available on page 4. Join Queensland Country today Joining our fund is simple. Choose one of the following options that suit you: Call us on and complete an application over the phone Visit a retail centre and let one of our friendly staff assist you Go to our website and apply online through our online application process. The web address is Drop in to one of Queensland Country Credit Union s 21 branches throughout Queensland Switch to Queensland Country Health Fund If you are a member of another health fund, it s quick and simple to transfer to us. Simply complete our membership application and cancel any direct debits you may have with your old fund. We will contact your old fund and arrange for the transfer of cover. [ 8 ]

9 Money back guarantee If you are not completely satisfied with your new health insurance policy we will provide a refund of any premium paid (if a claim hasn t been made) if you write to us advising that you are not satisfied with your policy within 30 days. [ 9 ]

10 MANAGING YOUR HEALTH INSURANCE COVER ONLINE Online Member Services (OMS) gives you the ability to update your membership details whenever you want, giving you greater control and easy access. You can log on at any time of the day and check your cover; update address details, change your level of cover and even add a new addition to the family. To access OMS, all you need to do is register on the homepage of our website The register icon is located at the top right hand corner of the screen. Once you have registered using your membership number and your choice of password, click on the Login tab and enter your membership number and password. Now you re ready to go! Below is a list of all the different services you can access by registering: Claims history View/print tax statement Update Membership details Change contact details Add new person Change personal details Add student dependant or apprentice Add Medicare card details Add previous cover details Make a contribution payment by credit card Change level of cover Update your method of payment Update the way we pay benefits eg. direct credit Contribution changes View benefit limits Access to some functions may be limited for your spouse/ partner and dependants. [ 10 ]

11 HOW TO PAY CONTRIBUTIONS Queensland Country offers you a variety of payment options so you can choose the best method for you. You can choose to pay weekly, fortnightly, monthly, quarterly, 6 monthly or yearly, whichever suits you. If you do choose one of the latter options, we ll send you a reminder notice as a courtesy. As a policyholder it is your responsibility to ensure that the payment amounts are correct and made in advance, this avoids claims being rejected due to an unfinancial status. Direct Debit Credit Card BPAY SmartBudget Direct Debit facilities are Credit Card* facilities are BPAY facilities are available SmartBudget Service available for policyholders available to all policyholders to all policyholders who prefer Queensland Country Credit who prefer to pay through who prefer to pay via this to pay via this option. BPAY Union offers a SmartBudget automatic deductions from option. If this is your preferred allows you to pay your health service through all their branch their Bank, Building Society, method of payment, simply insurance premium via internet offices. SmartBudget is a Credit Union accounts and visit our website and make the or phone banking, or at your comprehensive budgeting and Credit Cards. If this is your payment online through Online financial institution. The bill paying service that provides preferred method of payment, Member Services (OMS^). BPAY biller code and your a fast and simple way to pay simply nominate this on Alternatively, phone us on reference number appear on all your bills. If you would application. A reminder notice all statements. If you don t like more information on this is not issued if you pay by direct debit. * We do not accept American Express or Diners Club. ^ Please see page 10 for details on how to register for OMS. receive regular statements please contact us and we ll be happy to supply you with your BPAY biller code and reference number. (This option is not available to eligible service, please feel free to contact Queensland Country Credit Union on participants in a Corporate Health Plan) Note: Deadlines may exist for one or more of these payment options. Please consult our Membership Guide for further details. You can choose to pay weekly, fortnightly, monthly, quarterly, 6 monthly or yearly, whichever suits you. [ 11 ]

12 In more detail We have included some important information you may need to enable you to better understand your cover entitlements and conditions. Additional information is available in the Membership Guide. Pre-Existing Conditions A pre-existing ailment, illness or condition is one where, after examining evidence, a medical adviser, or other relevant health care practitioner appointed by Queensland Country would consider that signs or symptoms would have been in existence at any time during the six months preceding the application for membership or upgrade of cover. You may have a Pre-existing Condition, ailment or illness without being aware of it. In these cases, there is a 12 month waiting period before you are entitled to claim benefits for treatment. It is not necessary for the signs or symptoms to have been diagnosed by a doctor when a Member joined or upgraded their level of cover. [ 12 ]

13 Benefit Conditions Queensland Country will only pay benefits when: All applicable waiting periods have been served Goods or services are provided in Australia (not including items imported by the user via an internet purchase) The Member has been charged for the treatment or service A service or treatment is medically necessary and clinically relevant Services are part of a course of treatment recognised by Queensland Country The service is provided in person The service is provided to a person on the membership The service or treatment has been provided by a practitioner or therapist recognised by Queensland Country No benefits are payable from another source (e.g. compensation payment or Government benefit) The conditions of the level of cover have been met A claim for a service rendered is submitted for payment within 24 months of the date of service The waiting period for that service has been served The amount of benefit is calculated on the cost of the treatment or aid to the Member, taking into account any allowances or discounts given by the provider. No benefit paid by Queensland Country can exceed the actual charge of the service or appliance. Benefits are not payable for claims for goods purchased or rendered outside of Australia or, for items purchased or hired from overseas suppliers (including internet purchases). The treatment or service is covered under the Member s level of cover [ 13 ]

14 Membership Year All yearly limits are calculated from the anniversary date of the establishment of the membership. Singles & Couples Single: a single policy covers only one person. Couple: a couple policy covers the person who establishes the policy as well as one other partner/spouse. Waiting Periods So when will I be fully covered you ask? Waiting periods apply when you join any health fund for the very first time or when you upgrade to a higher level of cover. But you won t have to wait if you re transferring to Queensland Country from an equivalent or higher level of cover with another health fund, or if you ve been covered by your parents membership and you re just starting out on your own. Waiting periods are necessary to keep health cover fair and aim to protect our existing policyholders who contribute to a fund over a period of time for when they may need cover. If we didn t have these waiting periods people may join, claim for something planned and then leave. Always make sure you have waited the sufficient period before claiming, otherwise you may not be covered! Waiting Period 2 months 12 months Item / Service Dental Diagnostic includes examinations & consultations Preventive includes cleaning and scaling, fluoride treatment, mouth guards etc. Simple extraction Restorative composite and amalgam fillings General services includes Occlusal splints Optical Therapies Acupuncture Chiropractor Osteopathy Remedial Massage Therapy/ Bowen Therapy/Myotherapy Naturopathy Physiotherapy Podiatry Dietitian Pharmaceutical Healthy Living Benefits Pre-existing Conditions Major Dental services Surgical Extraction* includes Wisdom tooth extraction Crowns and Bridges * Surgical Extraction benefits are paid on dental item numbers only, unless hospital cover is held and all waits have been served for any inpatient services. [ 14 ]

15 Contribution in arrears A policyholder who fails to pay contributions within 63 days of the day of which contributions were due and payable shall be deemed to be unfinancial. No benefits are payable for services rendered whilst a membership remains in arrears. However, provided all outstanding contributions are paid within 63 days of the due date, the membership will be reinstated. Membership of Queensland Country shall automatically cease for any policyholder whose contributions are more than 63 days in arrears. Cooling off period Queensland Country will allow any Member who has not yet made a claim to cancel their policy and receive a full refund of any premiums paid within a period of 30 days from the commencement of their policy or upgraded policy. Always make sure you have waited the sufficient period before claiming, otherwise you may not be covered Recognised providers Queensland Country will only pay benefits for ancillary or dental services, where the services are provided by practitioners recognised by Queensland Country. Recognition is subject to change without notice. There are no benefits payable for overseas hospitalisation or ancillary care. Recognition of providers is for the purpose of determining the payment of benefits and should not be taken or considered in any way as approval of, or any recommendation as to the qualifications and skills of, or services provided by, a practitioner or therapist. Members should check with Queensland Country that their practitioner is recognised before commencing treatment. Pharmaceutical The Pharmaceutical Benefits Scheme (PBS) is a national pharmaceutical scheme funded by the Federal Government where patients make a contribution to the cost of prescribed drugs. We do not pay for any pharmaceutical prescriptions covered by the Pharmaceutical Benefits Scheme or for contraceptives and items normally available without prescriptions. If the claim is for a PBS Pharmaceutical prescription, Queensland Country cannot pay a benefit. We ll pay benefits as outlined in the Extras table up to the claim limit for this category with consideration to the maximum individual script benefit limit. Benefit amount per script is calculated by deducting the PBS general patient contribution amount from the purchase [ 15 ]

16 price (up to script benefit limit) This is conditional on the pharmaceutical prescription being listed in the MIMs Schedule as S4 or S8 and being dispensed in quantities in accordance with this schedule. The PBS general patient contribution amount is reviewed annually by the Government and changes every year on 1 January. As at 1 January 2016 the PBS General Patient contribution is set at $ A Doctor s letter may be required for some pharmacy items. Overseas suspension of membership If you re lucky enough to travel overseas, and you re going to be absent from Australia for more than 4 weeks and less than 24 months, and provided you ve fulfilled all other criteria, you may apply for a suspension of your membership. To get the full picture, please call us when you re making your travel plans. Private Health Insurance Code of Conduct Queensland Country is a signatory to the Private Health Insurance Code of Conduct ( the Code ). The Code was developed by the health insurance industry and aims to promote the standards of service to be applied throughout the industry. A full copy of the Code is available at Information Please ensure that all documentation is read carefully before any decision is made to purchase a health insurance product and the information is retained for future reference. Summary of rules The In more detail pages contain only a summary of the fund rules. The complete rules of the health benefits fund set out in full the terms and conditions of membership and liability under the fund. These rules are available for inspection at Queensland Country Centre, Level 1, 333 Ross River Road, Aitkenvale, QLD [ 16 ]

17 PRIVATE HEALTH INSURANCE COMPLAINTS While we are absolutely committed to providing you with the best possible service, we are only human and sometimes we may make mistakes or see things differently from our policyholders, so we have processes in place to make sure you re absolutely satisfied. If you have any complaints, and we hope you don t, then please contact us immediately - Call: info@qchfund.com.au for any reason, you re not happy with something then please let us know. We will do whatever we can to fix it. Website: Address: Queensland Country Centre, Level 1, 333 Ross River Road Aitkenvale, QLD 4814 We take all complaints very seriously and our understanding staff are here to answer any questions and allay any fears you may have. Your health and wellbeing is our number one priority and if you re not completely happy with our service we would like to know about it. If, after we ve done all we can to rectify the situation, and you re not satisfied with the outcome, you have every right to contact the Private Health Insurance Ombudsman. The Ombudsman is an independent body formed to help resolve complaints and to provide advice and information to members of private health funds. You can contact the Ombudsman directly at: Telephone: Select option 4 for Private Health Insurance Website: Address: phio.info@ombudsman.gov.au Private Health Insurance Ombudsman Commonwealth Ombudsman GPO Box 442 Canberra, ACT 2601 Australia PRIVACY POLICY We at Queensland Country are committed to managing personal information in accordance with our Privacy Policy. Our Privacy Policy is available for your information on our website at or from any of our Service Centres or Queensland Country Credit Union branches. [ 17 ]

18 CONTACT DETAILS Head Office Queensland Country Centre Level 1, 333 Ross River Road Aitkenvale QLD 4814 Phone: Facsimile: Postal Address: PO Box 42 Aitkenvale QLD 4814 Aitkenvale Retail Centre Mount Isa Retail Centre 70 Camooweal Street Mount Isa Burdekin Retail Centre 186 Queen Street Ayr Mackay Retail Centre Caneland Central Shopping Centre Queensland Country Centre 333 Ross River Road Willows Retail Centre Call: Web: Willows Shopping Centre Kirwan [ 18 ]

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20 HOW TO JOIN It s super easy to join Queensland Country Health Fund. Call us on and complete an application over the phone Visit a retail centre and let one of our friendly staff assist you Go to our website and apply online through our online application process. The web address is Drop in to one of Queensland Country Credit Union s 21 branches throughout Queensland Queensland Country Health Fund Ltd ABN is a Registered Private Health Insurer.