straightforward health insurance Overseas Visitors Cover Australia welcomes you
2 3 Who are GMF Health? GMF Health is a not-for-profit Australian private health insurer, that s been providing affordable health cover to over 69,000 members for over 60 years. If you re looking for great value private health insurance whilst you are living and working in Australia, we offer simple, easy to understand options so you know exactly what you re covered for. Why GMF Health? Not-for-profit Award winning hospital cover We re not-for-profit, so only our members benefit We don t have shareholders to worry about, which means we focus on paying more back to our members and keeping our costs down, which is great news for you! Don t be confused by health insurance we keep it simple We make understanding health insurance easy by offering 3 levels of Extras cover and 2 levels of Overseas Visitors hospital cover, so you know exactly what you are and aren t covered for. It doesn t get much simpler than that. Great value is our middle name GMF Health cover is not only affordable but also great value. We re proud to announce that in both 2011 and 2013 we were awarded by Canstar for Outstanding Value Hospital Cover. Choose your provider You can claim Australia-wide You can claim Australia-wide We make switching easy When transferring from another Australian fund, we honour your full length of membership with your previous fund on an equivalent level of cover, which means you won t lose any benefits or need to re-serve any waiting periods. We let you choose As a GMF member you receive the same amount back regardless of what health provider you choose. We re a trustworthy bunch With over 68,000 members and over 60 years experience, you can trust us to look after your health insurance needs. You can claim Australia-wide It doesn t matter what part of Australia you live in, we ve got your health insurance needs covered.
4 5 Why do you need private health insurance in Australia? Why GMF Overseas Visitors hospital cover? Below is an overview of the Australian health care system and who is covered by it as well as the benefits of having overseas visitor's health insurance for workers. What is Medicare? Australia's public healthcare system is known as Medicare. Medicare provides free or subsidised cover to all Australians. Can we cover you? To be eligible to purchase GMF Overseas Visitors cover, you must hold one of the following visa sub types: 457 Temporary Business Long Stay 401 Temporary Work International Relations 403 Temporary Work Long Stay Activity 402 Occupational Trainee 416 Special Program 420 Entertainment 485 Skilled Graduate 489 Skilled Regional Are you entitled to Medicare? Find out if you're from a country that offers reciprocal health cover in Australia visit immi.gov.au Do you still need private health insurance if you re eligible for Medicare? If you choose not to take out overseas visitors hospital cover, you may experience the following: Long wait times if you want medical treatment in a public hospital. Pay up to $800 if you require an ambulance and your circumstances are not urgent e.g. broken arm. Pay for procedures that are not deemed urgent or life threatening e.g. broken leg. Pay up-front any medical bills charged by specialists in private practices e.g. maternity. Have no choice in medical provider or specialist if you need medical attention. Costs incurred from repatriation. Visa requirements You may not be able to enter Australia without overseas visitors cover as it is often a requirement of your visa application to work in Australia. Peace of mind Access to the best available medical treatment and services. Choice You get to choose your doctor or specialist when you re in a private hospital or public hospital as a private patient. Unlimited fully covered ambulance transport You re fully covered for emergency and non-emergency ambulance transportation, no matter how many times you may need it. Repatriation* In the event of a life altering illness or injury or terminal illness, you'll be covered for benefits towards your transport back to your home country. *Conditions apply and please contact GMF Health for further information.
6 7 Our Overseas Visitor cover options GMF offers two great value and affordable health cover options that are specifically tailored to travellers coming to Australia on working visas. Compare our options Our cover automatically features: Overseas Lite Our entry level option covers: Maternity Unlimited ambulance transport Heart procedures Incurred theatre fees Medication Rehabilitation Prostheses 100% Australian Government Visa compliant See page 9 for the full list of benefits. Access to public hospital Overseas Complete Covers all the same benefits as Overseas Lite plus: Out-of-hospital medical services Out-of-hospital Pharmaceutical Benefits Scheme (PBS) benefits Bone marrow transplant Organ transplant Assisted reproductive services (including IVF) Access to private hospital Join GMF today! Visit gmfhealth.com.au/overseas Call us on 1300 886 241 Monday to Friday 7am 5pm (WST) within Australia Add an excess to reduce how much you pay With an excess added to your cover you ll pay a lower premium now but in the instance of any overnight hospital stays (within a calendar year), you ll pay your chosen excess. If you would like to add an excess, you can choose one of two options: $300 per person (maximum of $600 per couple/family membership per calendar year) $500 per person (maximum of $1,000 per couple/family membership per calendar year) If you don t have an overnight hospital stay, you don t have to pay the excess at all. When can you claim? Once you ve joined GMF, you have to serve waiting periods before you can claim on your benefits. This is a standard process with all health insurers. Waiting periods are put in place to avoid new members making claims shortly after joining or upgrading their cover and then cancelling their membership. Benefits are not paid until the following waiting periods have been served: 12 month waiting period Pre-existing ailments or conditions Maternity and birth related services 6 month waiting period Repatriation (transport for you back to your home country in the event of a life altering injury or terminal illness) 2 month waiting period Rehabilitation, psychiatric care and palliative care Other hospital treatment not deemed pre-existing No waiting period Other medical treatment not provided at a hospital e.g. medical practitioners visits and x-rays (referral required) Other hospital treatment (including surgery) e.g. accidents and appendicitis No need to wait if you re switching from another Australian fund Members transferring to GMF Health from another registered health fund in Australia on an equivalent level of cover will not have to re-serve waiting periods. Please contact GMF Health for more information.
8 9 Exclusions on benefits There are some circumstances that we do not pay a benefit for: If your membership is unfinancial at the time of your treatment or service provided. On claims covered by worker s compensation, third party or legal right. Treatment or services required by your employer or potential employer to be provided to you as a condition of employment. Treatment or services that are not provided in Australia. Care or accommodation in a nursing home. Before a treatment or service has been received. If a claim is not lodged within two years of date of service. For hospital treatment not covered by Medicare for Australian residents, such as cosmetic surgery. For treatment arranged in advance of your arrival in Australia. Compare our levels of hospital cover Benefits 100% Australian Government Visa compliant (DIAC 8501) Fully covered for a private room in a public hospital or a GMF Health contracted private hospital Fully covered for a shared room in a private hospital or a GMF Health contracted private hospital GMF Health Medical Gap Cover Excess options Ambulance transportation Overseas Lite Overseas Complete Will you be covered outside Australia? Assisted reproductive services Bone marrow transplant Broader health cover Coronary/heart and cardiothoracic procedures No, GMF Health is legally obliged to pay for benefits for treatment or services in Australia only for both Hospital and Extras cover. If you are planning to be overseas for more than three months, you can suspend your health insurance without losing any benefits or having to re-serve waiting periods when you return. It will not cost you anything to suspend your membership and you will not need to pay for health insurance while you are out of Australia. The maximum time you can suspend you cover for is three years. Please contact GMF Health to resume your policy if you're returning to Australia for more than 6 months. Travel insurance is recommended if you are travelling abroad. Dialysis Gastric banding, obesity surgeries and other related services Joint replacements Major eye surgery Maternity Organ transplant Out-of-hospital medical services Pharmaceutical Benefits (PBS) In-hospital Pharmaceutical Benefits (PBS) Out-of-hospital Plastic and reconstructive (with CMBS item number only) Prostheses Psychiatric care Rehabilitation Theatre fees
10 11 Need cover for dental, glasses or physio? Having Extras cover is a great way to help you maintain your health and wellbeing without large out-of-pocket expenses. Extras cover you for a range of day to day healthcare services that are not covered by Medicare such as dental, physiotherapy, chiropractic, glasses and contact lenses. GMF Health offers three levels of Extras cover: Complete Extras Our highest level of cover that includes more than 25 services Mid Extras Our intermediate level of cover that includes more than 20 services Why wait? Claim straight away on most Extras Lite Extras Our entry level of cover that includes 9 services You can add Lite, Mid or Complete Extras cover to any level of Overseas Visitors hospital cover. Extras waiting periods We'll waive all the 2, 3, or 6 month waiting periods on Extras. Some services you'll still have to wait, such as antenatal classes, health management aids and hearing aids. Want more information? Visit our website at gmfhealth.com.au/overseas where you ll find a great range of information on our Extras cover and related benefits. More about our benefits Ambulance You will have unlimited cover for urgent and non urgent ambulance transport. Broader health You will have cover to a wide variety of clinically appropriate alternatives to hospital treatment. This can include treatment provided in your own home or in community healthcare clinics, as well as programs to manage or prevent chronic disease. Medical benefits We pay benefits towards two types of medical fees: In-hospital medical fees Includes treatment when you are admitted into a hospital or day-hospital facility, such as doctors, specialists or surgeons. Out-of-hospital medical services (Overseas Complete cover only) Includes treatments from a medical practitioner when you are not admitted into hospital or day hospital facility. This also includes visits to your general practitioner, blood tests, x-rays or specialist. Private and public hospital accommodation We cover 100% of the fees charged for your room in a private or public hospital as a private patient. Pharmaceutical Benefits (PBS) in-hospital When you re in hospital, it s likely that you ll receive medication. We ll pay a benefit for Pharmaceutical Benefits Scheme (PBS) medications that you receive for treatment covered on your policy. A co-payment may apply. Pharmaceutical Benefits (PBS) out-of-hospital (Overseas Complete cover only) You will receive a benefit towards pharmaceuticals prescribed outside of hospital by a medical practitioner that are normally covered by Governments PBS for Australians. A co-payment applies but you have no annual limit. Prostheses We cover the cost of any prostheses (surgically implanted devices) you may need if you have a procedure such as joint replacement or cataract surgery. Repatriation We will help cover the cost of your transport back to your home country if you become terminally ill or suffer a substantial life altering illness or injury. Repatriation benefits are limited to once per person per lifetime and to a maximum limit of $20,000 for Overseas Lite and $40,000 for Overseas Complete cover. Theatre fees Fees charged for the theatre in which your procedure is performed.
12 13 Some confusing terms Benefit This is the amount GMF will pay eligible members towards the cost of health service Medicare Benefit Schedule (MBS) In Australia, all types of medical treatments are reviewed by the Federal Government and, once approved, added to the Medicare Benefits Schedule (MBS) where they are assigned an item number and a schedule fee. No benefit can be paid for medical procedures not allocated an MBS item number and a schedule fee. Out-of-pocket expenses This is the difference between the cost of a Hospital or Extras service and the benefit you receive from GMF. Pharmaceutical Benefits Scheme (PBS) You won't receive a benefit for non-pbs pharmaceutical outside of hospital. About 80% of all available prescription medicines in Australia are subsidised under the Pharmaceutical Benefits Scheme (PBS). Through the PBS, the Australian Government subsidises the cost of listed prescription medicine, making it more affordable for all Australians. Pre-existing ailments and conditions This is an illness or condition which, in the opinion of an independent medical practitioner (appointed by GMF), was known to exist, or where signs or symptoms were evident during the six month period before you became an GMF member, including on the day you joined. This also applies if you transferred to a level of cover with higher benefits. If you proceed with a hospital admission without confirming what benefits you re eligible for and your condition is determined to be pre-existing, you will be required to pay all outstanding hospital and medical charges not covered by Medicare. Pre-existing conditions or ailments do not apply for psychiatric, rehabilitation and palliative care. Premium This is what you pay for your health insurance. Medical benefits We pay benefits towards two types of medical fees: In-hospital medical fees It s important to understand medical gaps before you select your medical practitioners. If your medical practitioner charges more than the Medicare Benefits Schedule fee there ll be a medical gap (fee) you ll need to pay to the doctor. GMF has an arrangement that covers the medical gap. The scheme facilitates payment of the medical gap above the schedule fee in a simple manner that benefits patients and doctors. It is designed to minimise or eliminate out-of-pocket expenses for medical services in hospital. Please call us on 1300 886 241 for further information. Out-of-hospital medical services It s important to understand medical gaps before you select your medical practitioners. If your medical practitioner charges more than the Medicare Benefits Schedule fee there ll be a medical gap (fee) you ll need to pay to the doctor. At GMF we will pay a benefit of 150% of the MBS fee. Co-payments A co-payment is the amount you will have to pay towards treatment of services. This is determined by your chosen level of cover.
14 15 Your checklist There's a lot to organise when you decide to work in Australia. Here's a checklist to help prepare. Research visa options and start preparing a visa application. To find out more visit immi.gov.au Look into rentals or permanent accommodation locations and prices. Make sure your passport is up to date. Research employment opportunities either with your current or prospective employers. Look into and apply for an Australian bank account, depending on your needs. Join GMF today! Visit gmfhealth.com.au/overseas Call us on 1300 886 241 Monday to Friday 7am 5pm (WST) within Australia Take out health insurance with GMF.
GMF Health Head Office 130 Egan Street, Kalgoorlie WA 6430 Postal Address PO Box 513, Kalgoorlie WA 6433 T 1300 886 241 Monday to Friday 7am to 5pm (WST) E welcome@gmfhealth.com.au W gmfhealth.com.au The information in this brochure was correct at time of print. Minor changes may have occurred since that date. If major changes occur, the brochure will be replaced. This brochure should be read carefully and retained for your future reference. Details of any minor changes can be obtained from GMF Health upon request. HBF Health Limited ABN 11 126 884 786 GMF-079 01/07/15