Prime Health Package. Premium cover to help keep you in prime health

Transcription

1 Prime Health Package Premium cover to help keep you in prime health

2 Contents 4 Everything you need to know about your Essentials cover 4 Dental 4 Clinical psychology 6 Optical 6 Pharmacy 6 Podiatry surgery 6 Podiatry foot orthoses 6 Aids to recovery equipment hire or purchase 10 Everything you need to know about your Hospital cover 11 What s covered? 12 Here s a guide to the hospital costs you can receive a benefit towards 12 How soon can you claim? 13 A special service while you re in hospital 13 Support for a healthier life 13 HBF Member Plus hospitals 14 Accommodation 14 Theatre 14 Pharmacy 14 Prostheses 14 Psychiatric treatment 14 Excess Thank you for choosing HBF to look after the one thing important to us all our health. What is an HBF Package? An HBF Package is a cost-effective combination of both Hospital and Essentials cover. This means you re not only covered for a stay in a private hospital, but also for a range of everyday health services such as dental, optical, physio and chiro. Why you should read this brochure It is important to fully understand the details of your health cover. This brochure contains a detailed explanation of our Prime Health Package. We recommend you read it carefully and keep it handy for future reference. 3

3 Everything you need to know about your Essentials cover Services Standard waiting periods Benefits Maximums pp per calendar year General dental Visit a Member Plus dental provider and receive a 70% benefit of the provider s agreed fee and one fully covered scale and clean each calendar year. Consultation/examinations Mouthguard* $44 $24 $52 Scale and clean Up to $55 Extractions $132 Combined $3500 maximum for general dental, major dental, implants and orthodontics Dental You can claim for medically necessary dental services provided by an HBF approved dentist or dental prosthetist. This includes the cost of your consultations and cleans, plus any simple fillings you may need (up to your annual maximum). HBF Member Plus dentists We have agreements with dental providers aimed to keep your out-of-pocket expenses as low as possible we call them HBF Member Plus providers. On Prime Health Package, you ll receive 70% back on dental (up to your combined annual maximum), plus a fully covered scale and clean each calendar year when you visit an HBF Member Plus dentist. And for any children covered on your policy, you ll get 100% back (up to your annual maximum) on general dental at any Member Plus dentist. If you visit any other dental provider, you ll receive the dollar amount benefits detailed in the table, not the percentage benefits. HBF members can choose from more Member Plus dental providers in WA than any other health fund there s bound to be a few near you. To find your nearest Member Plus provider, visit hbf.com.au/memberplus or get the HBF Health app from the App Store or Google Play. What s the difference between general dental and major dental? General dental includes routine dental care such as regular check-ups, consultations, extractions, simple fillings, x-rays and mouthguards. Major dental includes more extensive treatments such as dentures, crowns and bridges. The benefit we pay on some dental items may be restricted if performed in conjunction with other specific dental services, or if a service is received more than once in a specified period of time. Benefits are only paid for medically necessary bleaching and procedures undertaken in the surgery we don t pay a benefit for home bleaching. Clinical psychology We ll pay benefits for treatment by clinical psychologists who are approved by HBF. Fillings direct $45 Major dental Visit a Member Plus dental provider and receive a 70% benefit of the provider s agreed fee. Veneer indirect (2 bondings ) $256 Veneer direct (2 bondings ) $69 Tooth coloured fillings indirect (3 services ) From $202 1 Crowns (3 units of crowns per yr ) $481 Bridges (3 units of bridges per yr ) $404 Full dentures Up to $620 Dental implants and orthodontics Visit a Member Plus dental provider and receive a 70% benefit of the provider s agreed fee. Orthodontics 1 Implants Up to $687 Clinical psychology Individual assessment 1 pp per calendar yr 6 months Up to $2500 $79 Individual treatment/management $44 Couple or family treatment Group treatment $22 $22 to a maximum of $44 per session You may have already completed some or all of these waiting periods. Combined $3500 maximum for general dental, major dental, implants and orthodontics Combined $3500 maximum for general dental, major dental, implants and orthodontics $2500 sub-limit applies $720 4 pp = per person. *A standard mouthguard provided by a dentist. Sub-limits included in overall maximums. Crowns associated with implants limited to 2 per 2 years. 5

4 Optical For more value when choosing your glasses, visit an HBF Member Plus optical store where you ll be able to choose from hundreds of frames that are fully covered (a minimum of 30% of the store s range), and receive at least 20% discount on most designer glasses outside the fully covered range, in addition to your HBF benefit. This includes frames, all lens types (such as single vision, bi-focal, multifocal and progressive lenses) and extras like tinting. To find your nearest Member Plus store, visit hbf.com.au/memberplus or get the HBF Health app from the App Store or Google Play. When purchasing glasses or contacts, your HBF benefit applies to the calendar year when you order them, not when you collect them. For example, if you order your glasses in December 2013 but don t receive them until January 2014, your benefit will be calculated from your 2013 annual maximum so you ll be able to claim again for glasses in Pharmacy The government subsidises the cost of some pharmaceuticals under the Pharmaceutical Benefits Scheme (PBS). You can claim benefits for prescriptions and repeats for non-pbs medications listed on the HBF Pharmacy Schedule, but you may need to pay a co-payment equivalent to that specified by the National Health Act. Podiatry surgery You can receive benefits for podiatry surgery listed on our Podiatry Surgery Schedule. If multiple podiatry procedures are required on the same occasion, benefits are reduced for the subsequent procedures. Podiatry foot orthoses We will pay a benefit for the supply of foot orthoses custom-made by a podiatrist, orthotist, pedorthist, surgical bootmaker or other medical practitioner approved by HBF. Aids to recovery equipment hire or purchase We ll pay a benefit of up to $50 per person per calendar year for the hire or purchase of aids to recovery equipment such as bath boards, shower chairs, bed rails, blood pressure monitors and crutches. Services Standard waiting periods Benefits Maximums pp per calendar year Optical Fully covered frames - a minimum 30% of all frames at a Member Plus optical store are fully covered. º Partially covered frames - choose a frame that is not fully covered and receive a minimum 20% discount from the Member Plus optical store plus your benefit from HBF as listed below. < Use your frame and lens benefit on lenses only if you don t need to purchase new frames. Frames & single vision lenses (or frames only) $120 Frames & bi-focal or multi-focal lenses $160 Contact lenses or frequently replaced lenses $140 Orthoptics (eye therapy) Individual consultations less than 30 mins $23 Individual consultations more than 30 mins $45 Visual field test (2 pp per calendar yr) $36 Colour vision test (1 pp per calendar yr) $36 Pharmacy * For pharmaceuticals listed on the HBF Pharmacy Schedule Podiatry Initial consultation (clinic based) Cost of medicine less member co-payment $26 Brief consultations (clinic based) $14 Intermediate consultations (clinic based) $20 Comprehensive consultations (clinic based) $24 Foot orthoses Foot orthoses (including casting) Diagnostic testing & biomechanical evaluation Aid recovery equipment 1 Up to $240 Up to $60 Hire/purchase 100% $50 1 pair of glasses or 1 set of contact lenses (or up to $140 for frequent replacement/ disposable lenses per year) Maximum for occupational therapy, orthoptics and speech therapy combined $600 under 3yrs $900 over 3yrs $200 under 3yrs $300 over 3yrs 12 consultations $240 per yr $60 per yr You may have already completed some or all of these waiting periods. 6 ºWill be fully covered when the glasses are purchased from any HBF Member Plus optical store and the frames are fitted with hard coated or uncoated standard single vision, bi-focal or multi-focal/progressive lenses. <A minimum 20% discount also applies to all other non-standard lenses, plus any add-ons. Not all lens prescriptions and supplementary services may be eligible to be charged at no cost. *This may vary depending on the medication. 7

5 Services Physiotherapy (1 pp per calendar yr) Standard waiting periods Benefits $37 Subsequent individual consultations $30 Group consultations $8 Individual consultations by a specialised physiotherapist for continence and women s health > (3 pp per calendar yr^) Individual consultations by a specialised physiotherapist for lymphoedema management > (3 pp per calendar yr^) Chiropractic Chiropractic x-ray (1 pp per calendar yr) (1 pp per calendar yr) $56 $56 $80 $37 Subsequent individual consultations $30 Osteopathy (1 pp per calendar yr) $37 Subsequent individual consultations $30 Dietetics Subsequent individual consultations $17 Group consultations $8 $33 Maximums pp per calendar year Combined $1000 maximum for chiropractic, osteopathy and physiotherapy Combined $1000 maximum for chiropractic, osteopathy and physiotherapy Maximum includes x-ray Combined $1000 maximum for chiropractic, osteopathy and physiotherapy $240 Services Occupational therapy Other individual consultations less than 30 mins Other individual consultations more than 30 mins Standard waiting periods Benefits $45 $25 $40 Group consultations $10 Speech therapy less than 45 mins more than 45 mins Subsequent individual consultations less than 45 mins Subsequent individual consultations more than 45 mins $75 $100 $40 $50 Group consultations $10 Appliances Maximums pp per calendar year Maximum for occupational therapy, orthoptics and speech therapy combined $600 under 3yrs $900 over 3yrs Maximum for occupational therapy, orthoptics and speech therapy combined $600 under 3yrs $900 over 3yrs The cost for most appliances must be over $100 to be eligible for a benefit Varies depending on appliance Contact us for more information 1 2yrs depending Blood glucose monitor on appliance $200 One appliance per 3yrs Nebuliser $108 One appliance per 3yrs Hearing aid Hearing aid Urgent ambulance + Urgent ambulance 36 months 7 days $550 over 3 & up to 5yrs $600 over 5 & up to 10yrs $650 over 10yrs Cover for urgent ambulance transport One pp per 5yrs under 15yrs One pp per 3yrs over 15yrs No limit You may have already completed some or all of these waiting periods. >Benefits only payable for services delivered by providers that are approved by HBF as a specialised physiotherapist. ^Forms part of the overall combined physiotherapy, chiropractic and osteopathy maximum. 8 + Urgent ambulance transport covers circumstances classified by St John Ambulance as requiring urgent attention. HBF does not pay any benefit for air ambulance services. 9

6 Everything you need to know about your Hospital cover What s covered? Prime Health Package gives you comprehensive Hospital cover for more than 5000 medical procedures, including common procedures such as removal of tonsils and wisdom teeth, knee and shoulder reconstructions, cancer treatment, cataract and eye lens procedures, heart treatment, joint replacement surgery and psychiatric care. You re not covered for maternity or assisted reproductive services (such as IVF), and we don t cover hospital treatment that s not eligible for a Medicare benefit, such as cosmetic surgery. As an HBF member, you can choose your doctor and hospital. Importantly, you can avoid public hospital waiting lists by choosing to be treated in a private hospital. Which means you ll get the best available treatment as soon as possible

7 Here s a guide to the hospital costs you can receive a benefit towards Accommodation Theatre Pharmacy Prostheses Medical Includes the fees charged for your room in a private or public hospital. Includes the fees charged for the theatre in which your procedure is performed. Includes the cost of some of the medication administered during your hospital stay. Includes the costs of any prostheses (surgically implanted devices you may need if you have a procedure such as joint replacement or cataract surgery) used during your procedure. Includes the fees charged by your surgeon, anaesthetist and pathologist. You re also covered for urgent ambulance transport, which means ambulance trips that St John Ambulance classifies as requiring urgent attention. While you re staying in hospital as a private patient, you re also covered for all medically necessary inter-hospital ambulance transfers, to or from a private hospital. How soon can you claim? As with most health insurance, waiting periods apply before you can receive benefits. Waiting periods protect our members by ensuring a new member can t make a large claim shortly after joining or upgrading their cover and then drop their membership, which would result in increased premiums for all members. The table below is a brief overview of the standard waiting periods that may apply to your cover. If you haven t completed the necessary waiting period, we may not be able to pay a benefit. Pre-existing ailments or conditions Defined as an illness or condition which, in the opinion of a medical practitioner (appointed by HBF), was known to exist, or where signs or symptoms were evident during the six-month period before you became an HBF member, including on the day you joined or transferred to a higher level of cover. 12-month waiting period (does not apply for psychiatric, rehabilitation, or palliative care) A special service while you re in hospital When you re in hospital, you shouldn t have to worry about anything other than getting better. So as an HBF member you can get support from an HBF Hospital Liaison Officer at most WA overnight private hospitals. Hospital Liaison Officers are there to answer any questions you may have about your HBF cover, explain complicated bills or help you to claim benefits. Support for a healthier life If you have a long-term health condition such as diabetes, osteoarthritis or a heart condition, HBF can find and deliver the support you may need to help access practical health programs, take control of your condition and stay well outside of hospital. This support is available to members on Prime Health Package with specified long-term health conditions. Find out more at hbf.com.au/getsupport. HBF Member Plus hospitals HBF Member Plus hospitals provide greater value for our members you ll be covered for accommodation and theatre fees for all agreed services included on your policy (less any agreed excess). Our members can choose from more Member Plus hospitals in WA than any other major health fund and most Australian hospitals outside of WA. Visit hbf.com.au/memberplus to find out which hospitals are included. Non-agreed services in HBF Member Plus hospitals While most services in Member Plus hospitals are covered, some services may not be. It s important to check that your treatment is covered by HBF before going to hospital to avoid any significant out-of-pocket expenses. HBF non-member Plus hospitals It s important you choose to stay at an HBF Member Plus hospital to minimise any out-of-pocket expenses. A stay at any other hospital may result in significant out-of-pocket expenses. Other hospital treatments including surgery Urgent ambulance transport 2-month waiting period 7-day waiting period You may have already completed some or all of these waiting periods

8 Accommodation In most cases, when you go into hospital, regardless of whether you have a procedure or not, you ll be charged for a hospital room. As an HBF member, you ll receive a benefit towards this cost. Prime Health Package provides full cover for your private or shared room in HBF Member Plus hospitals. Hospital boarders If you need someone to stay with you while you re in hospital, we will fully cover the charge for a hospital boarder whose presence is necessary to the management of your condition. Long-stay patients After 35 days of continuous hospitalisation (and if you no longer need acute care) by law the hospital must classify you as a nursing home type patient. If this happens, we can only pay a small portion of the benefit per day and you ll need to contribute towards the cost of your care, which can be substantial if you re in a private hospital. Theatre You re 100% covered for theatre charges, except for maternity and assisted reproductive services (such as IVF), where no theatre benefit is payable. Pharmacy When you are admitted into hospital for a procedure, it s likely you ll be given medication. The government subsidises the cost of some medications under the Pharmaceutical Benefits Scheme (PBS), and we will pay a benefit towards the cost of non-pbs prescription pharmaceuticals administered during a hospital stay. This benefit is limited to $1400 per hospital episode, with a co-payment of $100 (an episode means any period of hospital care or stay). There s no limit on the number of patient episodes per year, however re-admissions within seven days may be considered continuous and therefore one limit and copayment applies. Prostheses Prostheses are surgically implanted devices you may need if you have a procedure such as a joint replacement, cataract surgery or heart treatment. You re covered for items listed on the government s Prostheses List that are implanted while you re in hospital. Psychiatric treatment We will pay you benefits for psychiatric treatment in hospitals with approved programs. HBF members are covered for more of the total bill in WA hospitals than with any other major fund. Excess Great news! You can reduce your premium by adding a $250 or $500 excess. An excess is only paid when you need to stay in hospital overnight and is only paid once per adult member, per calendar year (to a maximum of twice per family policy). This means if you don t have an overnight hospital stay, you don t have to pay the excess. If you re admitted to hospital several times in one year, you only pay the excess once. You don t need to pay an excess for any dependant children on your policy

9 Ni hao! Go to hbf.com.au Visit a branch Mon to Fri: 9am to 5pm Sat: 9am to 12.30pm* Call us Mon to Fri: 8am to 6pm Sat: 8am to 1pm Postal address GPO Box C101 Perth 6839 Stay in touch Find us at HBF Health Metropolitan branches Perth 96 William St Belmont Belmont Forum Booragoon * Garden City Cannington * Carousel Fremantle Corner Market St and High St Mall Hillarys Whitford City Innaloo Innaloo Joondalup * Lakeside Joondalup Shopping City Karrinyup * Karrinyup Mandurah 32 Pinjarra Rd Midland * Midland Gate Morley * Galleria Rockingham * Rockingham Subiaco 513 Hay St Success Cockburn Gateway Regional branches Albany 21 Albany Hwy Bunbury 12 Arthur St Busselton 2/90-92 Queen St Geraldton Northgate We speak your language If English is not your first language, our multilingual team is fluent in many languages including Mandarin, Cantonese and Hindi. Call us on Even the healthiest bodies need looking after. HBF is the Official Health Partner of WA s favourite teams, the Fremantle Dockers and the West Coast Eagles. HBF Health Limited ABN The information in this brochure is correct at time of print. Minor changes may have occurred since that date. If major changes occur, the brochure will be replaced. Details of any minor changes can be obtained from HBF on request. HI /05/14 C105418