Simply better health cover.

Transcription

1 Simply better health cover.

2 Welcome to Health Partners Congratulations on taking an important step towards investing in your most important asset your health. We understand that deciding on a health fund is just as important as the decision to take out private health insurance. At Health Partners, we ve earned a reputation for offering quality, value-for-money health insurance, but we offer more than that. Achieving your optimum health means getting the support you need, when you need it. When you join Health Partners you can expect we ll be there for you with friendly, caring service and fast and simple claiming no matter where in the country you find yourself so you can get on with living your life, sooner. Health Partners is South Australia s oldest and largest private health insurer and we re proudly not-for-profit. That means we re able to invest in member benefits and services at a level well above the industry average. Without the pressure of dividends for shareholders, we can focus on what really matters our members. Health Partners also offers strong expertise in both dental and optical care. We own and operate Health Partners Dental, SA s largest private dental practice, and Health Partners Optical offering the best in eye care, alongside exceptional benefits and discounts. Our members also have access to a growing network of quality health care professionals, including partner pharmacies and physiotherapists. In this brochure you ll discover what Health Partners can offer you and why we re simply better. We look forward to discussing the best cover to meet your health care and budget needs. Byron Gregory Chief Executive Health Partners is a signatory to the Private Health Insurance Code of Conduct. Go to ahia.org.au/codeofconduct.

3 Let us guide you Simply better health cover 2 Finding the perfect cover 4 Hospital cover explained 6 Extras cover explained 8 Package cover Package cover options 10 Platinum 14 Everyday Value Plus 20 Everyday Value 24 Bronze Plus 27 Hospital cover Comparing hospital cover options 30 Gold Hospital 32 Silver Hospital 34 Bronze Hospital 35 Extras cover Comparing extras cover options 36 Gold Extras 38 Silver Extras 42 Bronze Extras 45 Natural Plus 47 Health management and support programs 48 Government surcharges and incentives 49 Things you should know 50 Claiming your way 52 Where to find us 53 Joining is simple 54 The information in this brochure should be read in conjunction with Health Partners Product Disclosure Statement (PDS). The PDS contains additional important information on the general terms of membership and cover with Health Partners, including our Privacy Policy, Resolution Process and health insurance initiatives from the Australian Government. This is available at healthpartners.com.au/pds or by calling us on

4 Simply better health cover With over 75 years of experience, we ve been around long enough to understand what Australians expect from their health fund. Simply better service We re here to help when members have questions or need assistance. When you call, you ll speak with a friendly and knowledgeable team member not a machine right here in Adelaide, who will happily assist you. Simply better dental We ve been providing members with direct access to quality dental care and generous dental benefits for more than 25 years. With over 30 surgeries across three locations, Health Partners Dental is the largest privately owned dental practice in South Australia where members always save more. We offer a full range of general and major dental services, including everything from routine check-ups to mouthguards and nightguards, right through to extractions, crowns, bridges and implants. With additional expertise in special needs dentistry and dental services for children, we cater to people of all ages and needs. Simply better optical Health Partners Optical stores have been combining quality eye care with exceptional value and service for more than 20 years. We operate from four locations all of which provide the latest in equipment technology and diagnostic treatment to ensure we deliver the highest standard of eye care. We value choice as much as you do. Our extensive range of prescription frames and sunglasses includes over 100 brands and a selection of gap-free options. Our focus on value for money means that in addition to exceptional benefits, members receive free digital retinal photography during consultation, free servicing, a minimum 30% off sunglasses and a minimum 40% unlimited benefit when you reach your annual limits. 2

5 Unbeatable pharmacy benefits With our state-wide pharmacy network you can get unique benefits and discounts at 50 pharmacies, at no extra cost. And because most of us regularly depend on our local pharmacy, all of our extras covers include pharmacy benefits. Plus, extras members save 20% on most non-prescription items, every day of the year! That includes vitamins, beauty products, pain relief, gifts, quit smoking products and much more. (Conditions apply; see page 51) Participating physiotherapists We have a network of 45 participating physiotherapists where members pay a low set gap. When you visit, you ll also know upfront what your out-ofpocket expense will be in most instances. Making it simple is what we re all about. Each practice is specifically chosen to ensure access and quality services at locations to suit you. Visit Partner search at healthpartners.com.au itsmygoal.com.au and other programs itsmygoal.com.au is a free online health tool designed to help you get fitter and healthier, and stay that way. Plus, on eligible covers we have a range of health management and support programs to help you reach your optimum health. (See page 48) goal Its my $.com.au More for members As the largest South Australian-based not-for-profit health fund, we re constantly reinvesting in member benefits at a level above the industry average. That means our members receive more not shareholders. Member discounts Members enjoy various special offers like $11 Wallis movie tickets, discounted sports gear, plus special member pricing for travel insurance. (See For members at healthpartners.com.au) 3

6 Finding the perfect cover We ve taken a simple approach to private health insurance which allows you to pick and choose from our range of covers. You can combine your own hospital and extras; select a package cover which combines the two for you; or if you prefer, choose hospital or extras on its own. 4

7 Pages Package cover combines hospital and extras in the one package for you we have four to choose from to suit different life stages and budgets. Or design your own package by selecting one of our hospital covers and adding one of our extras covers. Pages Hospital cover helps cover your costs when you are treated as a private patient in hospital. It also gives you options like being treated by your own doctor, shorter waiting times for elective surgery and the timing of your treatment. Pages Extras cover gives you affordable access to services generally not covered by Medicare such as dental, optical, physiotherapy, chiropractic, pharmacy and much more. With Health Partners own dental and optical centres, and extensive physiotherapy and pharmacy networks, members receive exclusive benefits and discounts at no extra cost. 5

8 Hospital cover explained The following information applies to all Health Partners hospital covers purchased individually or in a package so it s worth taking some time to read through it. We ve kept the details simple, so when you ve read this, simply review the comparison tables to determine the level of cover you need. If you re after hospital cover in a package with extras, see the table on page 11. For hospital cover on its own see the table on page 31. What s covered? Hospital cover helps pay for Medicare-recognised procedures when you are admitted to hospital. With all hospital cover options, you are eligible to receive benefits at your choice of participating hospitals (private or public), Australia-wide. If the procedure or service you require is included in your cover, Health Partners will: Pay for: Your accommodation in hospital (including registered day facilities) Your theatre, labour ward and intensive care fees All PBS prescriptions relating to your admission, while you re in hospital An extensive range of government-recognised surgically implanted prostheses Access to a range of health management and support programs. Pay towards: In-patient medical fees. (See page 7 for information on medical fees and how to avoid or reduce out-of-pocket expenses) A range of additional services depending on your level of cover. What s not covered There are some situations where your Health Partners hospital cover will not cover you: Outpatient services Services at unregistered day facilities Emergency department facility fees (unless otherwise specified). Restricted benefits Restricted benefits apply for admissions where a Medicare rebate does not apply to the treatment procedures. Benefits paid are in accordance with the Federal Government default payment schedule. This may result in large out-of-pocket expenses. Excess and co-payment With Health Partners you can select from various excess and co-payment options when deciding on your hospital cover. An excess is the amount you agree to pay towards your hospital accommodation, should you need to go to hospital. This is payable on admission, once only per person, to a maximum of twice per membership per floating year (that is, 12 months from the date of the first admission). The co-payment is the daily amount you agree to pay (in addition to any applicable excess) towards your hospital accommodation. Maximum co-payment amounts apply per person and per membership per floating year (that is, 12 months from the date of the first admission). 6

9 Excess and co-payments are only payable if you are admitted to hospital and are in addition to any out-of-pocket expenses (also known as gaps ) incurred for in-hospital medical treatment. How to reduce your medical expenses The benefits you are entitled to for in-patient medical services are based on the Commonwealth Medicare Benefits Schedule. When you are admitted to hospital, Medicare pays 75% of the Medicare Schedule Fee and Health Partners covers the remaining 25%. The gap is the amount charged above the Medicare Scheduled Fee, which you pay. Should you need hospital care, you can eliminate or reduce the gap with Health Partners Access Gap Scheme. When your doctor uses Access Gap you will either: have no gap to pay, or know your exact gap before treatment. Your doctor can bill Health Partners direct, to make claiming even simpler for you. To determine if your doctor participates in Access Gap contact us or visit Doctor Search at healthpartners.com.au. It is your doctor s choice to use Access Gap on a patient-by-patient basis. It is important to ask your doctor if they, or any other assisting doctor, will participate in Health Partners Access Gap Scheme. Ask if you will have a gap to pay and if so, how much it will be. This will encourage your doctor to participate in Access Gap. Any excess or co-payment applicable to your level of cover will still apply. Waiting periods Waiting periods are the initial periods after joining or upgrading your private hospital cover during which you cannot claim hospital benefits. Generally, after two months you can claim benefits for hospital services available on your level of cover, except for the following where 12-month waiting periods apply: Pregnancy and birth-related services, including IVF Pre-existing conditions Home nursing Home sleep studies. Waiting periods do not apply for: Newborn babies added to a family hospital cover within 60 days after their birth Treatment required immediately following an accidental injury sustained after you ve joined. Pre-existing conditions A pre-existing condition is one where signs or symptoms of an ailment, illness or condition, in the opinion of a medical practitioner appointed by the Fund, existed at any time during the six months preceding the date on which you purchased or upgraded your hospital cover. A 12-month waiting period applies for all pre-existing conditions. This does not apply to psychiatric conditions, palliative care and rehabilitation. For more information see the Product Disclosure Statement at healthpartners.com.au/pds or contact us. 7

10 Extras cover explained With extras cover, you can claim for a range of services that generally aren t covered by Medicare and that aren t covered by your hospital cover. The following information applies to all Health Partners extras covers purchased individually or in a package so it s worth taking some time to read through this. We ve kept the details simple, so when you ve read this, simply review the comparison tables to determine the level of cover you need. If you re looking for extras cover in a package with hospital, see the table on page 12. For extras cover on its own see the table on page 37. Save with Health Partners professionals You can claim benefits for extras services at your own recognised provider or, to receive the highest possible benefits, just choose a Health Partners professional. To find your nearest Health Partners professional, visit healthpartners.com.au/partnersearch Health Partners Dental When you visit one of our dental centres, you can get back as much as 100% and no less than 60% on general dental treatment. Major dental treatment is also available on most covers, with benefits ranging from 60% to 100%. Health Partners Optical You can expect unbeatable benefits and discounts when you visit any of our optical centres. You get back as much as 100% and no less than 60% for optical prescription items (including contact lenses and sunglasses). Plus, our unique unlimited benefit means that if you reach your annual limits, you can keep on saving on prescription items at a minimum of 40%. Health Partners Participating Pharmacies We have a state-wide network of participating pharmacies where you receive onthe-spot benefits and discounts. Pharmacy benefits are included on all levels of extras covers and are exclusively available at participating pharmacies. Health Partners Participating Physiotherapists When you visit any one of our participating physiotherapists you will pay a low, set gap for most treatments, allowing you to save more. Physiotherapy benefits are included on all levels of extras covers. Benefits A benefit is the amount you receive back when you make a claim. If the service you require is included in your cover, Health Partners will help you cover the costs by paying the benefit specific to your cover. Benefits are listed for each level of cover on pages The examples listed for dental benefits are subject to change annually. You may contact us at any time for a benefit quote. Except where otherwise stated, benefits and limits are per person, per calendar year. There are instances when extras benefits are not payable, such as when a provider is not recognised by us or when your health cover payments are not up to date. If you re unsure, it s always best to contact us. Not all benefits are listed for all extras services. To check if a specific item is covered, please contact us. 8

11 Recognised providers We will pay benefits when the service provider is recognised by us for benefit purposes. Contact us to determine if your provider is a Health Partners recognised provider. Limits For most extras services, there are limits to the amounts that you can claim back or the number of times you can claim a benefit, during the calendar year or the specified period. Health Partners offers some unlimited benefits and discounts allowing you to save more. Refer to the benefits listed on pages for details. Lifetime limits Some extras have lifetime limits which indicate the total amount you can claim in your lifetime. Once you reach the limit, no further benefits will apply. Waiting periods Waiting periods are the initial periods after joining or upgrading your extras cover during which you cannot claim extras benefits. After two months you can claim benefits for all extras services available on your level of cover, except for the following, where the respective waiting periods apply: Major Dental Orthodontic Apparatus Laser Eye Surgery 12 months 12 months 12 months 3 years For more information see the Product Disclosure Statement at healthpartners.com.au/pds or contact us. 9

12 Package cover options Package cover combines hospital and extras in the one package for you we have four to choose from to suit different life stages and budgets. Using the tables alongside, simply short-list your preferences based on how much cover you need. Then consider your hospital excess and co-payment options to determine the best fit for your budget. Hospital cover component For details relating to the hospital component of our package covers, including what s covered, what s not covered, excess and co-payment, restricted benefits, waiting periods, pre-existing conditions and how to reduce your medical expenses, see pages 6-7. Extras cover component For details relating to the extras component of our package covers, including benefits, limits, lifetime limits, Health Partners professionals and waiting periods, see page 8-9. Hospital and extras cover can be purchased individually. (See pages and to compare your options) 10

13 Platinum Everyday Everyday Bronze Value Plus Value Plus Page 14 Page 20 Page 24 Page 27 In-patient procedures and services Cardiac procedures Psychiatric services Rehabilitation services Accident-related treatment after joining Pharmaceuticals related to admission (PBS approved) No exclusions on Medicarerecognised procedures Pregnancy and birth-related procedures Assisted reproductive services (e.g. IVF) Sterilisation reversal Joint-replacement procedures Joint-reconstruction procedures Dialysis for chronic kidney failure Surgical weight loss procedures Examples of other procedures Removal of tonsils, adenoids Removal of appendix Removal of wisdom teeth Cataract surgery Additional benefits Home Nursing Discharge prescriptions, prostheses & recovery aids Health Management Programs Home Health Partner Home Sleep Studies Chronic Condition Management Newborn Support Program Unemployment cover Excess & co-payment Excess NIL $250 $250 $500 Co-payment NIL NIL NIL $50 No excess or co-payment for kids N/A Included Not included. *See page 7 for details on waiting periods. 11

14 Platinum Everyday Everyday Bronze Waiting Value Plus Value Plus period * (mths) Page 14 Page 20 Page 24 Page 27 Page 9 General Dental 2 Major Dental 12 Endodontic 2 Optical 2 Pharmacy 2 Physiotherapy 2 Gym & Fitness 2 (under Health Management) Emergency Ambulance 2 Non-emergency Ambulance 2 Chiropractic/Osteopathic 2 Podiatry 2 Speech Therapy 2 Dietary 2 Psychology 2 Orthodontic 12 Orthotics 2 Occupational Therapy 2 Eye Therapy 2 Exercise Physiology 2 Naturopathy 2 Acupuncture 2 Hypnotherapy 2 Natural Therapies 2 (including massage) Laser Eye Surgery Pilates 2 Apparatus 12 Emergency Department 2 Facility Fee 3 years Natural Plus (optional add-on cover; see page 47) 14 Natural Therapies (including massage) Not applicable Available Available Available 2 Included Not included. *See page 9 for details on waiting periods. 12

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16 Platinum Platinum If you re looking for a premium package, look no further than Platinum. This package offers our highest level of hospital and extras without exclusions and without a hospital excess. You get complete peace of mind with all the very best in benefits and services, including a private hospital room, where available. Key features Nil excess; nil co-payment No hospital exclusions Up to 100% back for dental, optical and physiotherapy Up to 100% back for orthodontics Laser eye surgery Full ambulance cover Unemployment cover Emergency facility fee Hospital cover component You will be covered for all Medicare-recognised procedures and the in-patient services listed on the comparison table on page 11. And so that you receive the best from your cover, you get access to a range of health management and support programs (criteria apply) and up to 100% back for a number of additional services. Please refer to Hospital cover explained on page 6 for details on waiting periods and more. Additional services Benefit Limit Post Admission Pharmaceutical prescriptions 100% $1,500 Non-surgically implanted prostheses (e.g. prosthetic bras, wigs) 100% $1,000 Post-surgical recovery aids (e.g. compression garments, braces) 100% $250 Home Sleep Studies Set benefit applies when using a Health Partners participating provider $100 $200 Home Nursing Wound management, IV medication, palliative care 100% $500 Chronic Condition Management* Bone density test 100% $100 Compression garments^ 100% $100 per item Diabetes education 100% $100 per consultation Hip safety kit 100% $100 Asthma Foundation membership 100% $100 Overall limit $500 * Eligibility requirements apply. ^ For approved conditions. Included programs Health Management Programs Newborn Support Program Home Health Partner See page 48 for details. 14 Unemployment Cover If life takes an unexpected turn and you become unemployed, you will continue to be covered with Platinum for up to 12 months. Eligibility criteria and a 12-month waiting period apply. Exclusions There are no exclusions for any medicallynecessary admission (conditions for which a Medicare rebate applies).

17 Platinum Extras cover component You will be covered for our highest level of extras as detailed below. You can claim benefits at your own recognised provider or just choose a Health Partners professional where you get 100% back for dental, optical and most physiotherapy treatments.. Please refer to Extras cover explained on page 8 for details on waiting periods and more. Services and benefits General Dental At Health Partners Dental 100% benefit Plus, receive one free course of tooth whitening treatment ~. At other dental providers Set benefits apply; please call us for a quote. Limit No limit Major Dental and Endodontic At Health Partners Dental 100% benefit At other dental providers $1,750 Set benefits apply; please call us for a quote. Orthodontic 100% benefit for treatment by an orthodontist Lifetime limit of $1,500 after 75% benefit for treatment by a general dentist 12 months increasing by $500 Includes spacers, orthodontic plates, retainers each year to a maximum A treatment plan may be required lifetime limit of $3,500. Optical At Health Partners Optical 100% benefit for prescription glasses/sunglasses/contact lenses. $500 60% unlimited benefit applies at Health Partners Optical if you reach your limit for the year. 50% discount on sunglasses. No limit. At other optical providers 100% benefit for prescription glasses/sunglasses/contact lenses. $300 Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa. 15

18 Platinum Services and benefits Pharmacy Limit At Health Partners Participating Pharmacies $1,000 PBS prescriptions, not already subsidised by the Government pay max. of $20 Please ask your Private and compounding prescriptions pay max. of $36 pharmacist about the benefits that apply to 20% discount on most non-prescription items. No limit. your prescription and Some conditions apply. if you can save more with generic brands (if available). Physiotherapy At Health Partners Participating Physiotherapists 100% benefit for initial, subsequent and long consultations, and hydrotherapy and $1,500 lymphoedema treatment. (sub-limit $1,000 At other physiotherapy providers at other physiotherapy Set benefits apply, for example: Initial consultation $50 providers) Subsequent $40 Note: maximum of $300 Lymphoedema treatment $80 for hydrotherapy and Hydrotherapy $15 group treatment. This is Group treatment $15 a combined limit with Pilates. Pilates Set benefits apply. Per consultation $15 $300 Combined with hydrotherapy and group treatment (covered under Physiotherapy) Naturopathy/Homoeopathy Set benefits apply. Initial & subsequent consultations $40 Acupuncture $400 Set benefits apply. Initial & subsequent consultations $40 16

19 Platinum Services and benefits Chiropractic/Osteopathic Set benefits apply, for example: Initial consultation $75 Subsequent consultation $45 Radiology (in providers rooms) 85% Limit Exercise Physiology $800 Set benefits apply. Initial consultation $75 Subsequent consultation $45 Group consultation $15 Podiatry Set benefits apply. Initial consultation $50 Subsequent consultation $37 Surgery (in providers rooms) 85% $750 Orthotics Set benefits apply; please call us for a quote. Dietary Set benefits apply. Initial consultation $65 Subsequent consultation $40 $750 Group consultation $20 Psychology Set benefits apply, for example: Initial & subsequent consultations $120 Hypnotherapy $750 Set benefit applies. Per consultation $100 (sub-limit of $400 for orthotics) Speech Therapy Set benefits apply, for example: Initial consultation $100 Subsequent consultation $70 Eye Therapy Set benefits apply. Initial consultation $60 Subsequent consultation $40 Occupational Therapy Set benefits apply, for example: Initial consultation $60 Subsequent consultation $40 $750 $750 $750 17

20 Platinum Services and benefits Laser Eye Surgery Limit Laser correction eye surgery 100% Lifetime limit $4,000 Full Ambulance Emergency and non-emergency services; Australia-wide coverage; road and air services 100% $20,000 Emergency Department Private hospital emergency facility fee 100% Limit of 1 per year, up to $250 Natural Therapies Includes all services listed on page 47 Set benefit applies. Per consultation $50 $250 Health Management Gym and Fitness* 100% $200 Health Risk Assessment via Members Online 100% No limit Quit Smoking* $100 $100, lifetime limit $400 Weight Management* Upon joining $50 Lifetime limit $250 Upon reaching goal $200 Bowel Cancer Screening Kit*^ $30 $30 Diabetes Membership 100% $100 CPAP Apparatus Support (when using a Health Partners participating provider) $250 $250 every 5 years Apparatus^ Asthmatic Spray Appliances 100% $200 every 3 years Blood Glucose Monitoring Machines 100% $300 (sub-limit $150 for Blood Pressure Machines 100% blood pressure machine) every 3 years Hearing Aids 100% Limit based on continuous years of Platinum membership: 1-2 years $ years $1,600 Benefit is limited to once every 3 years. Sleep Apnoea Machines 100% $1,500 every 5 years * Subject to eligibility. ^ A letter from your medical practitioner may be required. ~ Tooth whitening course of treatment includes consultation, two custom-fitted mouth trays and kits. 18

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22 Everyday Value Plus Everyday Value Plus This package builds on our Everyday Value package so that you and your family get higher benefits and an extended range of extras. It excludes some hospital admissions like pregnancy and joint replacements so you don t pay for things you probably won t need. Key features $250 excess; nil co-payment No excess for kids Gap-free kids services available Orthodontics included Full ambulance cover Hospital cover component If anyone in your family needs to go to hospital, you re covered Australia-wide for a broad range of hospital procedures and all the in-patient services indicated on the comparison table on page 11. You also get access to the following listed items. Please refer to Hospital cover explained on page 6 for details on waiting periods and more. Additional services Benefit Limit Post Admission Pharmaceutical prescriptions 100% $1,000 Included programs Home Health Partner See page 48 for details. Exclusions Exclusions are the services for which benefits are not available on this level of cover. They are in addition to the items listed under What s not covered on page 6. Excess and co-payment A $250 excess is payable if you are admitted to hospital. This is waived for dependant children. There is no co-payment. Pregnancy and birth-related services Assisted reproductive services Sterilisation reversal Joint-replacement procedures Surgical weight loss procedures Dialysis for chronic kidney failure. 20

23 Everyday Value Plus Extras cover component Your family is covered for an extensive range of useful extras. You can claim benefits at your own recognised provider or, to receive the highest possible benefits, just choose a Health Partners professional. We offer our own dental and optical services and have a state-wide network of participating pharmacies and physiotherapists. Please refer to Extras cover explained on page 8 for details on waiting periods and more. Services and benefits General Dental At Health Partners Dental 70% benefit, for example: Oral exam $37.80 Scale & clean $82.60 Dependant children receive one gap-free check-up per year ~. At other dental providers Set benefits apply; please call us for a quote. Limit No limit Major Dental and Endodontic At Health Partners Dental 70% benefit, for example: Full crown veneered $1,000 Complete preparation $1,000 of root canal (one) $ (sub-limit of $500 at At other dental providers other dental providers) Set benefits apply; please call us for a quote. Benefits claimed at Health Partners Dental will count towards the limits at other optical providers, and vice versa. Orthodontic 70% benefit for treatment by an orthodontist Lifetime limit of $800 after 50% benefit for treatment by a general dentist 12 months, increasing by $200 Includes spacers, orthodontic plates, retainers each year to a maximum A treatment plan may be required lifetime limit of $2,400. Optical At Health Partners Optical 70% benefit for prescription glasses/sunglasses/contact lenses. $300 One pair of gap-free single vision or multifocal prescription glasses per year (selected range, within annual limits). 40% unlimited benefit applies at Health Partners Optical if you reach your limit for the year. 30% discount on sunglasses. No limit. At other optical providers $200 40% benefit for prescription glasses/sunglasses/contact lenses. (sub-limit $55 for frames) Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa. 21

24 Everyday Value Plus Services and benefits Pharmacy Limit At Health Partners Participating Pharmacies $500 PBS prescriptions, not already subsidised by the Government pay max. of $20 Please ask your Private and compounding prescriptions pay max. of $36 pharmacist about the benefits that apply to 20% discount on most non-prescription items. No limit. your prescription and Some conditions apply. Physiotherapy At Health Partners Participating Physiotherapists You pay a set gap for most visits, for example: Initial & subsequent consultations pay only $18 Long consultation pay only $25 Dependant children receive two gap-free consultations. $500 At other physiotherapy providers Set benefits apply, for example: Initial consultation $26 Chiropractic/Osteopathic Subsequent consultation $20 Lymphoedema treatment $40 Hydrotherapy $8 Group Treatment $8 if you can save more with generic brands (if available). (sub-limit $400 at other physiotherapy providers) Note: maximum of $150 for hydrotherapy and group treatment. Set benefits apply for the first 6 consultations: Initial consultation $50 Subsequent consultation $32 Set benefits for additional consultations: Initial consultation $25 Subsequent consultation $16 $500 Podiatry Set benefits apply. Initial consultation $30 Subsequent consultation $25 $400 Orthotics Set benefits apply; please call us for a quote. Dietary (sub-limit $200 for orthotics) Set benefits apply. Initial consultation $50 Subsequent consultation $30 $400 Psychology Set benefits apply. Initial consultation $50 Subsequent consultation $30 $400 22

25 Everyday Value Plus Services and benefits Speech Therapy Set benefits apply. Initial consultation $50 Subsequent consultation $30 Limit $400 Eye Therapy Set benefits apply. Initial consultation $30 Subsequent consultation $20 $400 Occupational Therapy Set benefits apply. Initial consultation $50 Subsequent consultation $30 $400 Full Ambulance Emergency and non-emergency services; Australia-wide coverage; road and air services 100% $20,000 Health Management Gym and Fitness* 100% $100 Health Risk Assessment via Members Online 100% No limit Quit Smoking* $100 Lifetime limit $200 Weight Management* Upon joining $50 Lifetime limit $150 Upon reaching goal $100 Bowel Cancer Screening Kit*^ $22 $22 Diabetes Membership 50% $50 Apparatus^ Asthmatic Spray Appliances 85% $130 every 3 years Blood Glucose Monitoring Machines 85% $150 every 3 years Blood Pressure Machines 85% $100 every 3 years * Subject to eligibility. ^ A letter from your medical practitioner may be required. ~ Gap-free dental check-up includes check-up, scale & clean, X-rays, fluoride treatment and fissure seals. Overall limit $150 every 3 years 23

26 Everyday Value Everyday Value This package gives you the best of both worlds, at a lower premium. You get access to a range of hospital services and extras with selected exclusions like pregnancy, joint replacements and orthodontics so you don t pay for things you probably won t need. Key features $250 excess; nil co-payment No excess for kids Gap-free kids services available Full ambulance cover Hospital cover component If anyone in your family needs to go to hospital, you re covered Australia-wide for a broad range of hospital procedures and all the in-patient services indicated on the comparison table on page 11. You also get access to the following items listed here. Please refer to Hospital cover explained on page 6 for details on waiting periods and more. Additional services Benefit Limit Post Admission Pharmaceutical prescriptions 100% $500 Included programs Home Health Partner See page 48 for details. Exclusions Exclusions are the services for which benefits are not available on this level of cover. They are in addition to the items listed under What s not covered on page 6. Excess and co-payment A $250 excess is payable if you are admitted to hospital. This is waived for dependant children. There is no co-payment. Pregnancy and birth-related services Assisted reproductive services Sterilisation reversal Joint-replacement procedures Surgical weight loss procedures Dialysis for chronic kidney failure 24

27 Everyday Value Extras cover component Your family is covered for an extensive range of useful extras. You can claim benefits at your own recognised provider or, to receive the highest possible benefits, just choose a Health Partners professional. We offer our own dental and optical services and have a state-wide network of participating pharmacies and physiotherapists. Please refer to Extras cover explained on page 8 for details on waiting periods and more. Services and benefits Limit General Dental At Health Partners Dental 60% benefit, for example: Oral exam $32.40 Scale & clean $70.80 Dependant children receive one gap-free check-up per year ~. $700 At other dental providers Set benefits apply; please call us for a quote. Major Dental and Endodontic At Health Partners Dental 60% benefit, for example: Full crown veneered $600 Complete preparation $600 of root canal (one) $ (sub-limit $400 at At other dental providers other dental providers) Set benefits apply; please call us for a quote. Benefits claimed at Health Partners Dental will count towards the limits at other optical providers, and vice versa. Optical At Health Partners Optical 60% benefit for prescription glasses/sunglasses/contact lenses. One pair of gap-free single vision prescription glasses per year (selected range, within annual limits). $300 40% unlimited benefit applies at Health Partners Optical if you reach your limit for the year. 30% discount on sunglasses. No limit. At other optical providers $100 40% benefit for prescription glasses/sunglasses/contact lenses. (sub-limit $55 for frames) Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa. Pharmacy At Health Partners Participating Pharmacies $300 PBS prescriptions, not already subsidised by the Government pay max. of $20 Please ask your pharmacist Private and compounding prescriptions pay max. of $36 about the benefits that apply to your prescription and 20% discount on most non-prescription items. No limit. if you can save more with Some conditions apply. generic brands (if available). 25

28 Everyday Value Services and benefits Physiotherapy Limit At Health Partners Participating Physiotherapists You pay a set gap for most visits, for example: Initial & subsequent consultations pay only $20 Long consultation pay only $25 Dependant children receive two gap-free consultations. At other physiotherapy providers $450 Set benefits apply, for example: Initial consultation $18 (sub-limit $350 at other Subsequent consultation $15 physiotherapy providers) Lymphoedema treatment $30 Note: maximum of $100 Hydrotherapy $8 for hydrotherapy and Group treatment $8 group treatment. Chiropractic/Osteopathic Set benefits apply for the first 6 consultations: Initial consultation $50 Subsequent consultation $32 Set benefits for additional consultations: Initial consultation $25 Subsequent consultation $16 Podiatry Set benefits apply. Initial consultation $30 Subsequent consultation $20 Dietary Set benefits apply. Initial consultation $30 Subsequent consultation $20 Psychology $250 Set benefits apply. Initial consultation $30 Subsequent consultation $20 Speech Therapy Set benefits apply. Initial consultation $30 Subsequent consultation $20 Full Ambulance Emergency and non-emergency services; Australia-wide coverage; road and air services 100% $20,000 Health Management Health Risk Assessment via Members Online 100% No limit Bowel Cancer Screening Kit*^ $22 $22 Diabetes Membership 50% $50 * Subject to eligibility. ^ A letter from your medical practitioner may be required. ~ Gap-free dental check-up includes check-up, scale & clean and X-rays. 26

29 Bronze Plus Bronze Plus This package covers you for the basics in both hospital and extras so that you can keep your costs down when you need dental, optical and physiotherapy. You still get peace of mind with hospital cover for a range of hospital services and only some exclusions, such as pregnancy and joint replacement procedures. Key features $500 excess; $50 co-payment No excess & co-payment for kids Emergency ambulance cover Hospital cover component You will be covered for all the in-patient services indicated on the comparison table on page 11, with benefits for the following post-admission services. You also get access to selected health management and support programs (criteria apply). Please refer to Hospital cover explained on page 6 for details on waiting periods and more. Additional services Benefit Limit Post Admission Pharmaceutical prescriptions 100% $500 Non-surgically implanted prostheses (e.g. prosthetic bras, wigs) 75% $500 Post-surgical recovery aids (e.g. compression garments, braces) 75% $250 Home Nursing Set benefits apply for wound management, IV medication Palliative care (minimum 4 hours) $250 $500 Included programs Health Management Programs Home Health Partner See page 48 for details. Exclusions Exclusions are the services for which benefits are not available on this level of cover. They are in addition to the items listed under What s not covered on page 6. Pregnancy and birth-related services Assisted reproductive services Sterilisation reversal Joint-replacement procedures Surgical weight loss procedures Dialysis for chronic kidney failure Any non-emergency ambulance services. Excess and co-payment A $500 excess and daily co-payment of $50 is payable if you are admitted to hospital. The co-payment is limited to a maximum of 2 days per person per year. The excess and co-payment are waived for dependant children. 27

30 Bronze Plus Extras cover component Your family is covered for essential services that will help you keep your out-of-pocket cost down. You can claim benefits at your own recognised provider or, to receive the highest possible benefits, just choose a Health Partners professional. We offer our own dental and optical services and have a state-wide network of participating pharmacies and physiotherapists. Please refer to Extras cover explained on page 8 for details on waiting periods and more. Services and benefits Limit General and Major Dental and Endodontic At Health Partners Dental 60% benefit, for example: Oral exam $32.40 $1,000 (sub-limit $500 Scale & clean $70.80 for Major Dental At other dental providers and $500 for Endodontic) Set benefits apply; please call us for a quote. Optical At Health Partners Optical 60% benefit for prescription glasses/sunglasses/contact lenses. $270 One pair of gap-free single vision prescription glasses per year (selected range, within annual limits). (sub-limit $150 40% unlimited benefit applies at Health Partners Optical if you reach your limit for the year. for contact lenses) 30% discount on sunglasses. No limit. At other optical providers 40% benefit for prescription glasses/sunglasses/contact lenses. $150 (sub-limit $55 for frames) Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa. Pharmacy At Health Partners Participating Pharmacies $400 PBS prescriptions, not already subsidised by the Government pay max. of $20 Please ask your Private and compounding prescriptions pay max. of $36 pharmacist about the benefits that apply to 20% discount on most non-prescription items. No limit. your prescription and Some conditions apply. if you can save more with generic brands (if available). 28

31 Bronze Plus Services and benefits Physiotherapy Limit At Health Partners Participating Physiotherapists You pay a set gap for most visits, for example: Initial & subsequent consultations pay only $16 Long consultation pay only $25 $600 At other physiotherapy providers (sub-limit $400 at other Set benefits apply, for example: Initial consultation $22 physiotherapy providers Subsequent consultation $17 and for group treatment) Group treatment $10 Emergency Ambulance Emergency services only; Australia-wide coverage; road and air servcies 100% Limit of 2 per year Health Management Gym and Fitness* 100% $150 Health Risk Assessment via Members Online 100% No limit Bowel Cancer Screening Kit*^ $22 $22 * Subject to eligibility. ^ A letter from your medical practitioner may be required. 29

32 Comparing hospital cover options We offer three levels of hospital cover all of which provide you with a range of benefits at your choice of participating hospital (private or public), Australia-wide. Plus, you can access various programs outside of hospital to assist with improving your overall health and wellbeing. Using the table on the next page, simply short-list your preferences based on how much cover you need. Then consider your excess and co-payment options to determine the best fit for your budget. You can purchase hospital cover on its own or together with any level of extras cover. Or see page 11 for our range of package covers that combine hospital and extras together. 30

33 In-patient procedures and services Cardiac procedures Psychiatric services Rehabilitation services Accident-related treatment after joining Pharmaceuticals related to admission (PBS approved) No exclusions on Medicare-recognised procedures Pregnancy and birth-related procedures Assisted reproductive services (e.g. IVF) Sterilisation reversal Joint-replacement procedures Joint-reconstruction procedures Dialysis for chronic kidney failure Surgical weight loss procedures Examples of other procedures Removal of tonsils, adenoids Removal of appendix Removal of wisdom teeth Cataract surgery Additional benefits Home Nursing Discharge prescriptions, prostheses and recovery aids Health Management Programs Home Health Partner Newborn Support Program Emergency Ambulance Non-emergency Ambulance Home Sleep Studies Chronic Condition Management Options Gold Silver Bronze Hospital Hospital Hospital Page 32 Page 34 Page 35 Excess NIL NIL $250 $500 $500 Co-payment NIL $50 $50 $50 $50 No excess or co-payment for kids N/A Included Not included. *See page 6 for details on waiting periods. 31

34 Gold Hospital Gold Hospital GOLD HOSPITAL NIL EXCESS NIL CO-PAYMENT 50 GOLD HOSPITAL 50 NIL EXCESS $50 CO-PAYMENT Our top level of hospital cover provides the broadest range of services so that you have complete peace of mind. You will be covered for all Medicare-recognised procedures and the in-patient services listed on the comparison table on page 31. And so that you receive the best from your cover, you also get access to a range of health management and support programs (criteria apply) and benefits for a number of additional services. Please refer to Hospital cover explained on page 6 for details on waiting periods and more. Additional services Benefit Limit Post Admission Pharmaceutical prescriptions 100% $1,500 Non-surgically implanted prostheses (e.g. prosthetic bras, wigs) 75% $800 Post-surgical recovery aids (e.g. compression garments, braces) 75% $250 Home Sleep Studies Set benefit applies when using a Health Partners participating provider $50 $100 Home Nursing Set benefits apply for wound management, IV medication $5,500 Palliative care (minimum 4 hours) $250 (sub-limit $3,000 for palliative care) Full Ambulance Emergency and non-emergency services; Australia-wide coverage; road and air services 100% $20,000 Chronic Condition Management* Bone density test 75% $100 Compression garments^ 75% $100 per item Diabetes education 75% $50 per consultation Hip safety kit 75% $100 Asthma Foundation membership 50% $20 Overall limit $400 * Eligibility requirements apply. ^ For approved conditions. 32

35 Included programs Health Management Programs Newborn Support Program Home Health Partner See page 48 for details. Exclusions There are no exclusions for any medicallynecessary admission (conditions for which a Medicare rebate applies). Your options There are two levels of Gold Hospital cover, each covering you for all the same services. Simply choose between cover with or without a co-payment. The co-payment is limited to a maximum of 5 days per person per year. The co-payment is waived for dependant children. 33

36 Silver Hospital Silver Hospital 250 SILVER HOSPITAL 250 $250 EXCESS $50 CO-PAYMENT 500 SILVER HOSPITAL 500 $500 EXCESS $50 CO-PAYMENT Our medium level of hospital cover provides a very broad range of services and benefits, giving you complete peace of mind and excess options to reduce your premiums. You will be covered for all Medicare-recognised procedures and the in-patient services indicated on the comparison table on page 31. And so that you receive the best from your cover, you also get access to a range of health management and support programs (criteria apply) and benefits for a number of additional services. Please refer to Hospital cover explained on page 6 for details on waiting periods and more. Additional services Benefit Limit Post Admission Pharmaceutical prescriptions 100% $1,500 Non-surgically implanted prostheses (e.g. prosthetic bras, wigs) 75% $500 Post-surgical recovery aids (e.g. compression garments, braces) 75% $250 Home Nursing Set benefits apply for wound management, IV medication $5,500 Palliative care (minimum 4 hours) $250 (sub-limit $3,000 for palliative care) Full Ambulance Emergency and non-emergency services; Australia-wide coverage; road and air services 100% $20,000 Included programs Health Management Programs Newborn Support Program Home Health Partner See page 48 for details. Exclusions There are no exclusions for any medicallynecessary admission (conditions for which a Medicare rebate applies). Your options There are two levels of Silver Hospital cover, each covering you for all the same services. Simply choose the excess that suits you. The co-payment is limited to a maximum of 5 days per person per year. The excess and co-payment are waived for dependant children. 34

37 Bronze Hospital Bronze Hospital 500 BRONZE HOSPITAL 500 $500 EXCESS $50 CO-PAYMENT Our basic level of hospital cover, gives you cover for a number of services including cardiac and joint reconstructions, but excludes some things like pregnancy and joint replacements. You will be covered for the in-patient services indicated on the comparison table on page 31, with benefits for the following post-admission services. Plus, Bronze Hospital gives you access to a range of health management and support programs (criteria apply). Please refer to Hospital cover explained on page 6 for details on waiting periods and more. Additional services Benefit Limit Post Admission Pharmaceutical prescriptions 100% $500 Non-surgically implanted prostheses (e.g. prosthetic bras, wigs) 75% $500 Post-surgical recovery aids (e.g. compression garments, braces) 75% $250 Home Nursing Set benefits apply for wound management, IV medication Palliative care (minimum 4 hours) $250 $500 Included programs Health Management Programs Home Health Partner See page 48 for details. Exclusions Exclusions are the services for which benefits are not available on this level of cover. They are in addition to the items listed under What s not covered on page 6. Pregnancy and birth-related services Assisted reproductive services Sterilisation reversal Joint-replacement procedures Surgical weight loss procedures Dialysis for chronic kidney failure Emergency and non-emergency ambulance services. Excess and co-payment A $500 excess and daily co-payment of $50 is payable if you are admitted to hospital. The co-payment is limited to a maximum of 5 days per person per year. 35

38 Comparing extras cover options We offer three levels of extras cover all of which cover you for the most popular services like dental, optical, physiotherapy, pharmacy and ambulance. Generally, the higher the level of cover, the higher the limits and benefits you receive. The table on the next page summarises the services included on each of the covers. For more detailed information on what you can claim, see pages You can purchase extras cover on its own or together with any level of hospital cover. Or see page 12 for our range of package covers that combine hospital and extras together. 36