CVER FR VERSEAS VISITRS WRKING VISAS Effective 1 April 2011
WELCME T AUSTRALIA If you re visiting Australia to work, the last thing you want to worry about is what happens if you get sick or have an accident. The healthcare system in Australia is regarded by many as one of the best, but the cost of treatment can be expensive. And as an international visitor, you may not be eligible for cover with Medicare, Australia s public healthcare system. That s why we offer a range of covers made especially to suit the needs of international visitors. So wherever your travels take you within Australia, you can rely on us to keep you covered. ABUT BUPA AUSTRALIA Bupa Australia is a leading private health insurer providing Australians with affordable, high-quality health cover. Bupa Australia provides national coverage for our members. With a presence in every Australian state and territory, we operate under the trusted and respected brands HBA, MBF and Mutual Community, covering over three million Australians. We provide real value for members across a wide range of health services including: hospital; medical; extras; ambulance and pharmacy. As part of this, our members can save by using our extensive, national network of hospital and extras providers. More good news we are about more than health insurance. ur vision is to help our members lead longer, healthier, happier lives. As part of this we have created a range of health programs and online resources, in conjunction with experts, to support our members. If you would like to discuss any information in this brochure: Call 131 243 for HBA and Mutual Community enquiries or 132 623 for MBF enquiries Visit hba.com.au, mbf.com.au or mutualcommunity.com.au Pop by your local centre
WELCME Hospital Cover If you want cover for treatment in hospital, we ve got a range of visitors covers to choose from. You can take out visitors cover on its own, but many people choose to combine it with extras cover. We want to make it as simple as possible for you to find health cover that suits your needs and allows you to focus on the important things like enjoying life. This brochure and the Extras Premium and Benefits Guide for Visitors enclosed contain the information you need to find the cover to suit you. It is important information and should be carefully read and retained. Extras Cover We call them extras because they are services that Medicare often doesn t cover. Extras services include: dental; physiotherapy; chiropractic; optical; massage and much more. There are five levels of extras cover to choose from. You can take out extras cover on its own, or in combination with a level of visitors cover. CNTENTS Let s get started 2 Why get private health insurance? 3 Visitors Cover Choosing your Visitors Cover 4 Visitors Cover at a glance 7 What might suit you? 8 Understanding Visitors Cover 10 Visitors Cover options 14 Extras Cover 26 Extras comparison 28 Understanding Extras Cover 31 Get more back on 34 your Extras Cover Using your Cover Health programs 36 Additional member benefits 38 Join today 40 Easy ways to claim 42 Important information 44 Application form 51 Using your Cover ur health cover affords members more than you might think. We offer a range of health programs and online resources to support our members long term. Look out for our member discounts too! Join Today There are a number of easy ways to join. Simply fill out the application form included, go online, call us or pop into your local centre. Also find out how easy we make it to claim. 1
LET S GET STARTED We understand healthcare systems differ from country to country. So we ve provided some information to help you better understand how the Australian healthcare system works, and what this might mean for you. About Australia s healthcare system The healthcare system in Australia is made up of Medicare and private health insurance. Medicare is Australia s public healthcare system, which provides free or subsidised cover for many healthcare costs and is available to all Australian citizens and permanent residents.* If you are visiting Australia on a working visa you will not be eligible for Medicare unless you are from a country that has a Reciprocal Health Care Agreement (RHCA) with Australia see opposite to find out if this applies to you. It is important to note that even if you are eligible, you will generally only be covered for the very basics that is, for necessary medical treatment. This doesn t include treatment in a private hospital, treatment that is considered ongoing or for elective surgery; and you may be unable to choose your own doctor in hospital. That s where private health insurance comes in, and we have a range of covers made especially to suit the needs of international visitors on working visas. ur visitors cover can provide greater control in choosing where you are treated, who treats you and your preference for the timing of your treatment. It also provides cover for visits to the doctor or specialists in private practice. Plus you can receive extras cover for a wide range of health services including dental, physiotherapy, massage and much more. In short, private health insurance can help to cover the cost of your medical and hospital expenses while you are in Australia, providing security, protection and peace of mind. So, if your health is important to you, talk to us. *Norfolk Island does not participate in the Medicare program. Reciprocal Health Care Agreements Some countries have a Reciprocal Health Care Agreement (RHCA) with Australia. If you are from the United Kingdom, Ireland, Malta, Sweden, Finland, Italy, New Zealand, Norway, Belgium or the Netherlands, you may be eligible for limited benefits from Medicare. The level of protection Medicare gives you depends on which country you come from. To find out whether you have access to Medicare and what level of protection you are eligible for, you should call Medicare on 132 011. What could this mean for you? If you are covered under a Reciprocal Health Care Agreement and are eligible for a Reciprocal Medicare Card you will have to pay the Medicare Levy Surcharge. The Medicare Levy Surcharge is an additional 1% tax on top of the 1.5% Medicare Levy payable by all eligible taxpayers in Australia. Reciprocal Health Cover is an additional cover option that you can purchase to help eliminate the Medicare Levy Surcharge. For more information refer to page 22. If you re not eligible for a Reciprocal Medicare Card, you should be exempt from paying the surcharge. In this instance, please contact Medicare on 132 011 to apply for a Medicare Levy Surcharge exemption. 2
WHY GET PRIVATE HEALTH INSURANCE? Better peace of mind, when you call Australia home. As a visitor to Australia with no or limited access to Medicare, private health insurance means better peace of mind. It s an important asset to have during your stay, freeing you up from worry about the possible cost of medical treatment and allowing you to more fully enjoy your time in Australia. More control over your treatment. ur visitors cover can provide greater control in choosing where you are treated and who treats you. It also provides cover for visits to the doctor or specialists in private practice. Plus, our top-level cover also provides extras cover for a wide range of health services including dental, physiotherapy, massage and much more. We are part of the international Bupa group. Bupa Australia is part of the global Bupa Group, currently serving the healthcare needs of more than 10 million people across approximately 190 countries. Bupa Australia is the largest privately managed health insurer in Australia. Better still, the Bupa Group has no shareholders so all profits are reinvested to improve services and facilities for our members. Avoid paying more at tax time. If you re eligible to take out Reciprocal Health Cover, you may be exempt from paying the Medicare Levy Surcharge. See page 22 for more details. 333
CHSING YUR VISITRS CVER Want to know more details about what is and isn t covered? See pages 10-11 Whilst you re in Australia it is important to have the right level of visitors cover to suit your needs and give you peace of mind. PLATINUM VISITRS CVER Platinum Visitors Cover is our highest level packaged option for visitors on working visas. You ll enjoy a combination of comprehensive cover for excess-free private hospital and medical expenses, and visits to a doctor or specialist in private practice, plus top level extras cover. You can also choose an excess option that can help reduce your premium. GLD VISITRS CVER Gold Visitors Cover provides comprehensive cover for private hospital and medical expenses, and visits to a doctor or specialist in private practice. Plus, you can choose an excess option that can help reduce your premium. CLASSIC VISITRS CVER With Classic Visitors Cover, you will receive cover for all your hospital and medical expenses in any public hospital in Australia, and visits to a doctor or specialist in private practice. Membership Types Single covers the individual member only. Couple covers the member and their partner. Family covers the member, their partner plus their single children under 21 years and single full-time students under 25 years.* *If you have any non full-time students (aged between 21-24 inclusive) they will be required to purchase their own single health insurance cover. 4
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VISITRS CVERS AT A GLANCE VISITRS CVER Here s a quick comparison of our working visitors covers: Please note: If you are applying for a 457 Long Stay Working Visa, the below covers meet the minimum level of insurance required as set out by the Department of Immigration and Citizenship (DIAC). Your cover options Platinum ~ Gold ~ Includes cover for utpatient medical costs* Extras Public and private hospitals Public and private hospitals Classic Public hospitals only All covers include full ambulance transport services and repatriation expenses. Suitable for the following visa types: Long stay working (457); Educational (418); Regional sponsored (475); ccupational (442); Holiday working (417). Please remember that this is a guide only, so if your visa type is not on this list, or if you would like to speak with a Customer Service Consultant, call us or visit your local centre. What are extras? Extras covers expenses for everyday services including dental, optical and physiotherapy. If you select a cover that doesn t automatically include extras (that is, Classic or Gold), you can still take out a separate extras cover with us. Refer to the Extras Cover section of this brochure and the accompanying Extras Premium and Benefits Guide for Visitors to find out more about our great range of extras cover options. For more details call us or visit your local centre. * Includes General Practitioner visits Includes dental, optical, physiotherapy and more ~ Platinum and Gold Visitors Cover have a nil excess and $500 excess option to choose from. 7
WHAT MIGHT SUIT YU? To get a quick idea of which kind of cover might be right for you, check out the profiles below: I d like an all-in-one solution that covers both hospital and extras. You may be interested in our Platinum Visitors Cover or Platinum Visitors Cover with Excess on page 14. I d like to have comprehensive cover with a wide choice of hospitals for treatment including private hospitals. You may be interested in our Gold Visitors Cover or Gold Visitors Cover with Excess on page 18. 8
VISITRS CVER I m young, fit and healthy and looking for basic budget priced cover. You may be interested in our Classic Visitors Cover on page 20. I m from a Reciprocal Health Cover Agreement country and have to pay the Medicare Levy Surcharge. Do you have a cover for me? See Reciprocal Health Cover on page 22. 9
UNDERSTANDING VISITRS CVER What is covered? Hospital costs With private health insurance, you can choose to be treated as a private patient in either a public or a private hospital. Depending on your chosen level of cover you can be fully covered as a private patient in all Members First, Network and public hospitals in Australia. There are a small number of fixed fee hospitals that charge a fixed daily fee for a maximum number of days per stay. These hospitals should inform you of this fee when you make a booking. When admitted to hospital, in most cases you will be covered for all in-hospital charges including: accommodation for overnight or sameday stays operating theatre, intensive care and labour ward fees supplied pharmaceuticals approved by the Pharmaceutical Benefits Scheme and provided as part of your in-hospital treatment allied services including physiotherapy, occupational therapy and dietetics medication, dressings and other consumables most diagnostic tests (e.g. pathology, radiology) no gap prosthesis that are surgically implanted, Government recognised and remain in-situ upon discharge single room where available. An excess may apply depending upon your selected cover. Inpatient medical costs These are the fees charged by your doctor, surgeon, anaesthetist or other specialist for any treatment given to you when you are admitted to a hospital as an inpatient. Put simply, we pay 100% of the Australian Medical Association (AMA) Schedule fee. This is the fee determined by the AMA as the appropriate fee for a specific service. To ensure peace-of-mind, ask your doctor prior to your admission about their fees for your hospital treatment. Remember to also ask your doctor about the fees for other practitioners that may be involved in your hospital treatment such as the anaesthetist, radiologist, pathologist and assistant surgeons. utpatient medical costs This is cover for any treatment you receive from a doctor or specialist in private practice, or as a hospital outpatient anywhere in Australia. Depending on what is set out in your level of cover we cover you for 100% to 150% of the Medicare Benefits Schedule (MBS). The MBS fee is set for each specific service by the Federal Government. utpatient medical cover is available on all of our visitors covers within this brochure. You can also receive benefits on selected pharmacy items prescribed as a hospital outpatient or by a doctor or specialist. Please check your chosen level of cover for more details. What is not covered? Hospital costs Situations when you are likely not to be covered include: during a waiting period when specific services or treatments are excluded or restricted from your level of cover 10
Please ensure you also read the Important Information section on pages 44-50 VISITRS CVER when you are treated at a non-agreement or fixed fee hospital hospital treatment provided by a practitioner not authorised by a hospital to provide that treatment hospital treatment for which Medicare would not pay any benefits, including most cosmetic surgery if you are in hospital for 35 days and you have been classified as a nursing home type patient. In this situation you may receive limited benefits or be required to make a personal contribution towards the cost of your care benefits for pharmaceuticals supplied upon discharge from the hospital some pharmaceutical items and high cost drugs, including compound and experimental items if you choose to use your own allied health provider rather than the hospitals practitioner for services that form part of your in-hospital treatment (e.g. chiropractors, dieticians or psychologists) where compensation, damages or benefits may be claimed by another source (e.g. workers compensation) any treatment or service rendered outside Australia. Medical costs You will not be covered for: medical services for surgical procedures performed by a dentist, surgical podiatrist or any other practitioner or service that is not normally eligible for a rebate by Medicare costs for medical examinations, x-rays, inoculation or vaccinations and other treatments required relating to acquiring a visa for entry into Australia or permanent residency visa. Waiting periods A waiting period is the time between when you joined us and when you are covered for a service or treatment. If you receive a service or treatment during this time, you are not eligible to receive a benefit payment from us, regardless of when you submit the claim. Different waiting periods apply for different services, please see below. the initial waiting period and the waiting period for palliative care, psychiatric and rehabilitation is two months the waiting period for pre-existing ailments, illnesses or conditions and pregnancy related services (including childbirth) is 12 months. Pre-existing ailments A pre-existing ailment is any ailment, illness, or condition that you had signs or symptoms of during the six months before you joined or upgraded to a higher level of cover with us. It is not necessary that you or your doctor knew what your condition was or that the condition had been diagnosed. A condition can still be classed as preexisting even if you hadn t seen your doctor about it before joining or upgrading to a higher level of cover. If you knew you weren t well, or had signs of an ailment that a doctor would have detected (if you had seen one) during the six months prior to joining or upgrading, then the ailment would be classed as pre-existing. A doctor appointed by us decides whether your ailment is pre-existing, not you or your doctor. The appointed doctor must consider your treating doctors opinions on the signs and symptoms of your ailment, but is not bound to agree with them. Please note pre-existing ailments waiting periods apply to all inpatient and outpatient hospital and medical expenses. 11
Medical Gap This refers to the difference between what your doctor charges and the amount we will pay for inpatient and outpatient services. If your doctor charges up to the Medicare Benefits Schedule (MBS) fee or is participating in our Medical Gap Scheme, in most cases you will have no medical gap costs to pay. For doctors who are not participating in our Medical Gap Scheme and are charging above the MBS fee, we will cover up to the Schedule fee (MBS or AMA, depending on your chosen cover) and any amount above that fee you will be required to pay. This is referred to as the Medical Gap. Certainty when you go to hospital We ve negotiated with most private hospitals and day surgeries to ensure you experience certainty about the costs associated with the hospital treatment you receive there. Most of the time you will receive a no out-of-pocket experience when you use our Members First and Network hospitals. At Members First day surgeries, a no out-of-pocket expenses agreement extends to medical treatment (treatment from medical practitioners) too. A small number of hospitals may charge a fixed daily fee, capped at a maximum number of days per stay. These hospitals should inform you of this fee when you make a booking. We recommend you call us first before making a booking to confirm that your hospital of choice gives you certainty of full cover and we can discuss any excess that may be applicable to your level of cover. You can also find out if a hospital has an agreement with us by checking our website. Excess To lower the cost of your visitors cover, you have the option to apply an excess on Platinum or Gold Visitors Cover. The excess is only payable on inpatient hospital treatment and in any hospital. An excess is a set amount you pay upfront before your benefit is paid. The excess is paid each time a person on your membership is admitted into hospital, to a maximum of $500 per Single membership and $1,000 per Family membership in a calendar year. What s the Medical Gap? Gap Schedule fee Schedule fee If your specialist charges up to the Schedule fee, we can cover it completely. You won t need to pay anything further. If your specialist charges above the Schedule fee, there will be a gap. This gap is an extra amount which you will have to pay. 12
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VISITRS CVER PTINS Platinum Visitors Cover Platinum Visitors Cover is our highest level all-in-one solution for visitors, giving you a top level of benefits on hospital, medical treatment and extras, should you become ill or require medical treatment while you re in Australia. Plus you can choose an excess option that can help reduce your premium. Platinum Visitors Cover gives you: comprehensive hospital cover for inpatient services at Members First, Network and public hospitals in Australia medical cover outside of hospital, whilst in Australia. Details of hospital outpatient benefits are covered under What is covered? extras cover for dental, optical, physiotherapy and more. What is covered? You will receive: full cover for inpatient hospital costs, including accommodation and theatre fees. For more details, see page 10 of this brochure cover for the cost of inpatient medical services up to 100% of the Australian Medical Association (AMA) Schedule fee. This is the amount determined by the AMA as the appropriate fee for a specific service medical cover as a hospital outpatient or by a doctor or specialist in private practice anywhere in Australia, for up to 150% of the Medicare Benefits Schedule (MBS). This is the amount determined by the Federal Government as the appropriate fee for a specific service benefits for selected pharmacy items prescribed as a hospital outpatient or by a doctor or specialist. You ll receive 90% of the balance per script item, up to a maximum of $500 per person per calendar year, after you pay the Pharmaceutical Benefit Scheme patient co-payment fee. This is provided the items usage is approved by the Therapeutic Goods Administration (TGA) full ambulance cover (please refer to the Important Information section for more details on ambulance cover) benefits on crutches and wheelchairs, where provided by a recognised provider, covered up to a $500 limit per person per calendar year full cover for repatriation if terminally ill to your country of origin or return of mortal remains once authorised by Bupa Australia. You will also receive cover for repatriation if you suffer a substantial lifealtering illness or injury to your country of origin. This is up to a commercially reasonable amount once the repatriation is authorised by Bupa Australia. 14
Special benefits You will also be covered for special benefits including accommodation (up to $60 per night) and meal costs (up to $30 per day) if your partner, immediate family member, carer or next of kin is required to stay at hospital with you. These benefits are capped at $1,000 per person per calendar year. For more details on what is covered and if you re eligible for these benefits, please refer to the Important Information section of this brochure. You can choose an excess option of: Nil $500 Excess payable per hospital admission (this is capped per calendar year at $500 for single memberships and $1,000 for family memberships). What is not covered? While you are on Platinum Visitors Cover you will not receive cover for assisted reproductive services (including IVF). There are also other occasions when you will not be fully covered and may incur out-of-pocket expenses. Refer to the Important Information section within this brochure and page 10 for What is not covered. Hospital waiting periods the initial waiting period and the waiting period for palliative care, psychiatric and rehabilitation is two months the waiting period for pre-existing ailments, illnesses or conditions and pregnancy related services is 12 months (including childbirth). VISITRS CVER 15
Your extras cover You receive cover for the services listed below at any healthcare provider you choose that is recognised by us, up to your Loyalty Maximums. It s a top level of cover, where you get back 90% of the cost of treatment great cover when you need it most. Services covered You get back Loyalty Maximums per person per calendar year General Dental 90% of cost Year 1 $1,100 Year 4 $1,430 Year 2 $1,210 Year 5 $1,540 Major Dental Year 3 $1,320 Year 6 $1,650 rthodontics 90% of cost Including dentures, crowns, bridgework and precious restorations. Benefits for the replacement of dentures are payable every 3 years. 90% of cost No benefits are payable for Major Dental and rthodontics in the first year of membership. ptical 90% of cost Access a wide range of fixed price lens and frame packages at network optical providers. Contact us for more details. $300 Physiotherapy 90% of cost Year 1 $550 Year 4 $700 Year 2 $600 Year 5 $750 Year 3 $650 Year 6 $800 Chiropractic/steopathy 90% of cost Year 1 $550 Year 4 $700 Year 2 $600 Year 5 $750 Year 3 $650 Year 6 $800 Living Well 90% of cost $100 Speech Therapy 90% of cost Year 1 $700 Year 4 $850 Eye Therapy 90% of cost Year 2 $750 Year 5 $900 Year 3 $800 Year 6 $950 ccupational Therapy 90% of cost Dietary Pharmacy Psychology Podiatry Health Aids and Appliances Hire, Repair and Maintenance of Health Aids and Appliances Natural Therapies 90% of cost 90% of cost (less PBS fee) Covers selected items. You pay a set amount, we refund 90% of the remaining balance per script. See Important Information for full details. 90% of cost 90% of cost 90% of cost 90% of cost up to $100 90% of cost Including acupuncture, Alexander Technique, Chinese herbalism, Exercise Physiology, Feldenkrais, homeopathy, iridology, massage, naturopathy, western herbalism. Massage includes aromatherapy, Bowen Technique, kinesiology, reflexology, shiatsu, and therapeutic massage. Home Nursing 90% of cost up to $350 Antenatal and Postnatal by Midwife 90% of cost $400 16
More from your membership Loyalty maximums recognise you for your loyalty with us. For most extras services, we increase the amount you can claim up to in a year each year up to a maximum of six years. Additional benefit You will also be covered for travel and accommodation benefits for essential medical treatment: $100 for travel expenses and $40 per night up to $150 for accommodation expenses per year. To confirm if you re eligible for this benefit, please refer to the Important Information section of this brochure. Extras waiting periods the initial waiting period is two months the waiting period for Living Well benefits, hire, repair and maintenance of health aids and appliances is six months the waiting period for major dental, orthodontics, pre-existing ailments, illnesses or conditions and selected health aids and appliances is 12 months. VISITRS CVER 17
Gold Visitors Cover Gold Visitors Cover offers top-level protection with benefits on hospital and medical treatment, should you become ill or require medical treatment while you re in Australia. Plus, you can choose an excess option that will help reduce your premium. Many people also choose to combine a level of visitors cover with extras cover. Refer to the Extras Premium and Benefits Guide for Visitors at the back of the brochure for more information on extras cover. Gold Visitors Cover gives you: comprehensive hospital cover for inpatient services at Members First, Network and public hospitals in Australia medical cover outside of hospital, whilst in Australia. Details of hospital outpatient benefits are covered under What is covered?. What is covered? You will receive: full cover for inpatient hospital costs, including accommodation and theatre fees. For more details, see page 10 of this brochure cover for the cost of inpatient medical services up to 100% of the Australian Medical Association (AMA) Schedule fee. This is the amount determined by the AMA as the appropriate fee for a specific service medical cover as a hospital outpatient or by a doctor or specialist in private practice anywhere in Australia, for up to 150% of the Medicare Benefits Schedule (MBS). This is the amount determined by the Federal Government as the appropriate fee for a specific service benefits for selected pharmacy items prescribed as a hospital outpatient or by a doctor or specialist. You ll receive 90% of the balance per script item, up to a maximum of $500 per person per calendar year, after you pay the Pharmaceutical Benefit Scheme patient co-payment fee. This is provided the items usage is approved by the Therapeutic Goods Administration (TGA) full ambulance cover (please refer to the Important Information section for more details on ambulance cover) benefits on crutches and wheelchairs, where provided by a recognised provider, covered up to a $500 limit per person per calendar year full cover for repatriation if terminally ill to your country of origin or return of mortal remains once authorised by Bupa Australia. You will also receive cover for repatriation if you suffer a substantial lifealtering illness or injury to your country of origin. This is up to a commercially reasonable amount once the repatriation is authorised by Bupa Australia. Special benefits You will also be covered for special benefits including accommodation (up to $60 per night) and meal costs (up to $30 per day) if your partner, immediate family member, carer or next of kin is required to stay at hospital with you. These benefits are capped at $1,000 per person per calendar year. For more details on what is covered and if you re eligible for these benefits, please refer to the Important Information section of this brochure. You can choose an excess option of: Nil $500 Excess payable per hospital admission (this is capped per calendar year at $500 for single memberships and $1,000 for family memberships). What is not covered? While you are on Gold Visitors Cover you will not receive cover for assisted reproductive services (including IVF). There are other occasions when you will not be fully covered and may incur out-of-pocket expenses. Please refer to the Important Information section within this brochure and page 10 for What is not covered?. Waiting periods the initial waiting period and the waiting period for palliative care, psychiatric and rehabilitation is two months the waiting period for pre-existing ailments, illnesses or conditions and pregnancy related services (including childbirth) is 12 months. 18
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Classic Visitors Cover Classic Visitors Cover is a basic value cover option. It helps to ensure you have control of your healthcare, should you need hospitalisation or medical treatment as well as being great value. Many people also choose to combine a level of visitors cover with extras cover. Refer to the Premium and Benefits Guide at the back of the brochure for more information on extras cover. Classic Visitors Cover gives you: hospital and medical cover for inpatient services in any public hospital in Australia medical cover outside of hospital, whilst in Australia. Details of hospital outpatient benefits are covered under What is covered?. What is covered? You will receive: cover for inpatient hospital costs in a public hospital, including accommodation (shared room only) and theatre fees, except where exclusions apply. If you choose to be treated in a private hospital, you ll receive minimum benefits only, which may result in large out-of-pocket expenses. For more details, see page 10 of this brochure cover for the cost of inpatient medical services in public hospitals up to 100% of the Australian Medical Association (AMA) Schedule fee. This is the amount determined by the AMA as the appropriate fee for a specific service medical cover as a hospital outpatient or by a doctor or specialist in private practice anywhere in Australia, up to 100% of the Medicare Benefits Schedule (MBS). This is the amount determined by the Federal Government as the appropriate fee for a specific service up to a maximum of $500 per person per calendar year, after you pay the Pharmaceutical Benefit Scheme patient co-payment fee. This is provided the items usage is approved by the Therapeutic Goods Administration (TGA) no excess full ambulance cover (please refer to the Important Information section for more details on ambulance cover) full cover for repatriation if terminally ill to your country of origin or return of mortal remains once authorised by Bupa Australia. In addition, you ll receive cover for repatriation if you suffer a substantial life-altering illness or injury to your country of origin, up to a commercially reasonable amount once authorised by Bupa Australia. What is not covered? While you are on Classic Visitors Cover you will not receive cover for assisted reproductive services (including IVF). There are other occasions when you will not be fully covered and may incur out-of-pocket expenses. Please refer to the Important Information section within this brochure and page 10 for What is not covered?. Waiting periods the initial waiting period and the waiting period for palliative care psychiatric and rehabilitation is two months the waiting period for pre-existing ailments, illnesses or conditions and pregnancy related services (including childbirth) is 12 months. benefits for selected pharmacy items prescribed as a hospital outpatient or by a doctor or specialist. You ll receive 90% of the balance per script item, 20
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Reciprocal Health Cover Reciprocal Health Cover is an additional cover option that you can purchase to help eliminate the Medicare Levy Surcharge. The Medicare Levy Surcharge is an additional 1% tax on top of the 1.5% Medicare Levy payable by all eligible taxpayers in Australia. See page 2 for a quick overview of Reciprocal Health Care Agreements (RHCA) and what that could mean for you. Do you have to pay Australia s Medicare Levy Surcharge? How does Reciprocal Health Cover work? ur Reciprocal Health Cover provides an exemption to the Medicare Levy Surcharge. It doesn t offer any additional cover and can only be purchased in conjunction with Platinum, Platinum with Excess, Gold, Gold with Excess or Classic Visitors Cover. At the end of the financial year, you ll receive a tax statement which can be provided to the Australian Tax ffice to exempt you from paying the Medicare Levy Surcharge. If you: are from a RHCA country and eligible for a Reciprocal Medicare Card in Australia earn over the threshold* amount of $77,000 a year (for singles) or $154,000 a year (for families^) don t have private hospital cover you may be required to pay the Medicare Levy Surcharge. If you re unsure, please discuss with your accountant. Note: if you take out Platinum, Platinum with Excess, Gold, Gold with Excess or Classic Visitors Cover without also taking out Reciprocal Health Cover, you may be required to pay the Medicare Levy Surcharge. Reciprocal Health Cover can help to eliminate the Medicare Levy Surcharge. See page 2 for more details. * Thresholds are applicable as at 1 July 2010 and are indexed annually. ^ Increases by $1,500 per child, after the first child. 22
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Premiums The table below shows the premiums for our visitors cover options. For any further information, simply contact us or visit your local centre. Platinum Platinum with Excess Gold Gold with Excess Classic Reciprocal Health Cover Singles Families Singles Families Singles Families Singles Families Singles Families Singles Families Weekly $52.62 $105.23 $45.19 $90.38 $40.32 $80.63 $34.32 $68.64 $19.64 $39.27 $13.00 $26.00 Monthly $227.97 $455.93 $195.85 $391.69 $174.63 $349.25 $148.83 $297.66 $84.98 $169.95 $56.40 $112.80 Yearly $2,735.58 $5,471.16 $2,350.14 $4,700.28 $2,095.50 $4,191.00 $1,785.96 $3,571.92 $1,019.70 $2,039.40 $676.80 $1,353.60 Premiums include a 10% Goods and Services Tax (GST) on hospital cover, except for Reciprocal Health Cover which has no GST applicable. Save with the Federal Government rebate The Federal Government provides a 30% rebate on private health insurance premiums, helping to make quality healthcover affordable and accessible. You are eligible for the rebate if you hold a Reciprocal Medicare card. It s available on the extras component of Platinum Visitors Cover and Platinum Visitors Cover with Excess and our other extras cover options, as well as Reciprocal Health Cover. Better still, if you re aged between 65 69, the rebate increases to 35% and if you re aged 70 or more, it s 40%. Contact us for further details on extras premiums. Platinum Visitors Cover with the Federal Government 30% Rebate Platinum Visitors Cover with Excess with the Federal Government 30% Rebate Reciprocal Health Cover with the Federal Government 30% Rebate Singles Families Singles Families Singles Families Weekly $45.77 $91.58 $38.34 $76.73 $9.10 $18.20 Monthly $198.37 $396.78 $166.25 $332.54 $39.45 $78.95 Yearly $2,380.78 $4,761.56 $1,995.34 $3,990.68 $473.75 $947.50 Premiums include a 10% Goods and Services Tax (GST) on hospital cover, except for Reciprocal Health Cover which has no GST applicable. Like more information? Please refer to the accompanying Extras Premium and Benefits Guide for Visitors for further details about extras premiums, call us or visit your local centre. 24
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EXTRAS CVERS Please refer to the following Extras pages in this brochure along with your Extras Premium and Benefits Guide for Visitors for details on extras. PLATINUM EXTRAS A wide range of services with the highest benefits and annual maximums from our extras covers. INCLUDES BENEFIT BNUSES! GLD EXTRAS A wide range of services with high benefits and annual maximums. INCLUDES BENEFIT BNUSES! SILVER EXTRAS A wide range of services with a good level of benefits and annual maximums. INCLUDES BENEFIT BNUSES! YUR CHICE EXTRAS A competitively priced extras cover for people who want the freedom to choose four services to suit their needs. INCLUDES LYALTY MAXIMUMS! BRNZE EXTRAS For the young, fit and healthy on a budget this covers a limited range of services. 26
Finding a network provider for your extras cover is easy! Simply go to our website and enter your state and postcode to find one near you. Also, you can now search for a provider using our iphone application which is available on itunes. iphones, ipod touch, itunes and App Store are a trademark of Apple Inc. EXTRAS CVER 27
EXTRAS CMPARISN Services General Dental Major Dental rthodontics ptical Physiotherapy Chiropractic and steopathy Antenatal and Postnatal Waiting periods 2 months 12 months 12 months 2 months 2 months 2 months 2 months Bronze Extras At least 60% cover $350 per person $700 per policy $210 per person $420 per policy (network) $150 per person $300 per policy (non-network) $350 per person $700 per policy Combined annual maximum Your Choice Extras** At least 60% cover Year Amount 1 2 3 4 5 6+ Year 1 2 3 4 5 6 7+ Year 1 2 3 4 5 6 7+ 28 $700 $840 $980 $1,120 $1,260 $1,400 Amount $0 $500 $600 $700 $800 $900 $1,000 Amount $0 $450 $540 $630 $720 $810 $900 Lifetime Limit: $1,300 $260 (network) $180 (non-network) Year 1 2 3 4 5 6+ Year 1 2 3 4 5 6+ Amount $450 $540 $630 $720 $810 $900 Amount $350 $420 $490 $560 $630 $700 $350 sub-limit. Combined with physiotherapy. Silver Extras At least 60% cover Gold Extras At least 75% cover Platinum Extras At least 90% cover Unlimited Unlimited Unlimited $1,000 $1,100 $1,200 $700 Lifetime Limit $2,000 $290 (network) $200 (nonnetwork) $800 Lifetime Limit $2,600 $340 (network) $240 (nonnetwork) $900 Lifetime Limit $2,800 $380 (network) $280 (nonnetwork) $700 $800 $900 $500 $600 $700 $350 $400 $450 All limits are based on per person per calendar year for Your Choice, Silver, Gold and Platinum. Bronze has per person and per policy limits. **You may only select four services at any one time under Your Choice extras and receive benefits for those selected services. nce a selection is made, the selected services are locked in for a period of at least 12 months before you are able to change them. = Loyalty Maximums. For most items at network providers. Annual maximums apply.
Services Natural Therapies Includes acupuncture, Alexander Technique, Chinese herbalism, exercise physiology, Feldenkrais, homeopathy, iridology, naturopathy and Western herbalism. Massage includes aromatherapy, Bowen Technique, kinesiology, reflexology, shiatsu, and remedial massage. Waiting periods 2 months Bronze Extras $100 sub-limit. Combined with physiotherapy, chiropractic, osteopathy, antenatal and postnatal. Your Choice Extras** Year 1 2 3 4 5 6+ Amount $500 $600 $700 $800 $900 $1,000 Includes sub-limits for massage: $100 per person Living Well (see page 36) 6 months Pharmacy^^ 2 months Dietary 2 months Psychology 2 months Podiatry 2 months Speech Therapy Eye Therapy 2 months ccupational Therapy Home Nursing 2 months Health Aids and Appliances (verall) + $50 per person $100 $100 per person $200 per policy Year 1 2 3 4 5 6+ Year 1 2 3 4 5 6+ Amount $300 $360 $420 $480 $540 $600 Amount $400 $480 $560 $640 $720 $800 Sub-Limits Asthma Pumps Blood Glucose Monitors or INR Blood Testing Devices (Coagucheck) Defined Appliances^ Surgical Stockings 12 months CPAP Devices # Hearing Aids TENS Machine Blood Pressure Monitors Hire, Repair and Maintenance of Health Aids and Appliances Travel and Accommodation Emergency Ambulance Services # 6 months 2 months No waiting period 29 1 service per calendar year 1 service per calendar year All limits are based on per person per calendar year for Your Choice, Silver, Gold and Platinum. Bronze has per person and per policy limits. **You may only select four services at any one time under Your Choice extras and receive benefits for those selected services. nce a selection is made, the selected services are locked in for a period of at least 12 months before you are able to change them. = Loyalty Maximums.
Silver Extras Gold Extras Platinum Extras $400 Includes sub-limits for massage: $150 per person $500 Includes sub-limits for massage: $200 per person $500 Includes sub-limits for massage: $200 per person EXTRAS CVER $100 $100 $100 $500 $600 $700 $400 $500 $500 $400 $500 $500 $400 $500 $500 $400 $500 $500 $400 $500 $500 $400 $500 $500 $350 $350 $400 $800 $1,000 $1,200 1 claim every 2 years up to $200 1 claim every 2 years up to $300 1 claim every 2 years up to $400 1 claim per year up to $400 1 claim per year up to $500 1 claim per year up to $600 $500 $800 $1,000 $100 $100 $100 1 claim every 2 years up to $500 1 claim every 2 years up to $750 1 claim every 2 years up to $1,000 1 claim every 3 years up to $500 1 claim every 3 years up to $800 1 claim every 3 years up to $850 $125 per item $150 per item $200 per item $125 per item $150 per item $200 per item $100 $100 $100 $100 Travel $150 Accommodation $100 Travel $150 Accommodation $100 Travel $150 Accommodation 1 service per calendar year 1 service per calendar year 1 service per calendar year ^^Benefits for prescription items that are non-pbs, TGA approved for the use of that condition and not appearing on our exclusions list. +A combined annual maximum applies to this service category. ^Defined appliances includes: insoles, orthopaedic and corrective footwear, pressure garments, braces and artificial limbs. Annual maximums apply per item. # Subject to eligibility. Call us for details. *There are different state ambulance arrangements across Australia. Please see p45 for details. 30
UNDERSTANDING EXTRAS CVER Please ensure you also read the Important Information section on pages 44 50 What is covered? Extras cover provides you with benefits for services that are not claimable by a third party (e.g. Medicare). Medicare does not provide benefits for the below: most dental examinations and treatment most physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry or psychology services acupuncture (unless part of a doctor s consultation) or other natural therapies glasses and contact lenses most health aids and appliances home nursing. With extras cover you can claim benefits for extras services which are listed as part of your chosen level of cover. You will receive benefits as long as: the treatment is given by a private practice provider who is recognised by us the provider meets the criteria set out in our Policy and verseas Visitors Rules. What is not covered? Extras benefits will not be payable: where a third party has provided a benefit including Medicare or other Government bodies (except for hearing aids and breast prosthesis items) for different services within the same modality from the same provider on the same day. For example, if you went to see an acupuncturist and then received a massage from the same provider on the same day, you cannot claim for both services when a prescribed treatment is not custom-made (e.g. orthotics, surgical shoes) when they do not meet the criteria set out in our Policy and verseas Visitors Rules. Please refer to the Extras Premium and Benefits Guide for Visitors in the back of this brochure for specific details about the level of extras cover available to you. 31 31
Waiting periods A waiting period is the time between when you joined us and when you are covered for a service or treatment. If you receive a service or treatment during this time, you are not eligible to receive a benefit payment from us, regardless of when you submit the claim. Different waiting periods apply for different services, please see below: initial waiting period two months hire, repair and maintenance of health aids and appliances; and Living Well Programs six months major dental; orthodontics; selected health aids and appliances and preexisting ailments 12 months. Pre-existing ailments A pre-existing ailment is any ailment, illness, or condition that you had signs or symptoms of during the six months before you joined or upgraded to a higher level of cover with us. It is not necessary that you or your doctor knew what your condition was or that the condition had been diagnosed. A condition can still be classed as preexisting even if you hadn t seen your doctor about it before joining or upgrading to a higher level of cover. If you knew you weren t well, or had signs of an ailment that a doctor would have detected (if you had seen one) during the six months prior to joining or upgrading, then the ailment would be classed as pre-existing. A doctor appointed by us decides whether your ailment is pre-existing, not you or your doctor. The appointed doctor must consider your treating doctors opinions on the signs and symptoms of your ailment, but is not bound to agree with them. 32
33 EXTRAS CVER
GET MRE BACK N YUR EXTRAS CVER If you select any of the Extras Covers included in this brochure you will have access to the following features and benefits. Save with our Australia-wide provider networks ur extensive MBF MemberCare and Members First provider networks offer nation-wide access to dental; optical; physiotherapy and chiropractic services at set prices. If you have extras cover with us, you can save money by choosing these providers, rather than nonnetwork providers, because their fees and any discounts have been negotiated and agreed upfront. Plus you can expect less out-ofpocket expenses and upfront notice of any gap amounts in most instances. Visit our website to find a network provider near you. Also, keep an eye out for the following logos at your providers: Get more back on Extras These are just some of the great benefits you can get by using our MBF MemberCare and Members First network providers: up to 100% and at least 60% back on all general dental treatment^ up to 100% and at least 60% back on most optical, physiotherapy and chiropractic services^ higher annual maximums on optical than non-network providers less out-of-pocket expenses and upfront notice of any gap amounts discounts at optical providers a range of fixed-priced packages on glasses and contact lenses at no additional cost* up to $100 off a wide range of fashion frames 20% off a variety of sunglasses and nonstandard contact lenses. # 70 % 80 % 90 % 60 % 100 % Choose from thousands of network providers across Australia and enjoy on-thespot claiming! ^The percentage you get back on general dental treatment is dependant on your level of cover and up to your annual maximums.*ptical benefits are subject to your level of cover, annual maximums and waiting periods. # Not in conjunction with any other offer. ther non MBF MemberCare/Members First optical benefits ur optical partnership with Specsavers, means you benefit from a choice of fixedprice frames and lenses packages, depending on your level of cover, annual maximums and waiting periods. Visit our website to find an optical partner store near you. 34
Great product features Loyalty maximums on selected covers, we increase the amount you can claim each year by 20% for most services (applies after the first 12 months up to a maximum increase of 100%) Benefit bonus on selected covers, you get 2% more back on your extras claims each year, up to a maximum of 10% (applies each calendar after the first 12 months). Gap Free Dental For Kids We cover the cost of your kids general dental up until they turn 25. This means you ll benefit from no out-of-pocket costs on most dental services like check-ups, teeth cleaning, fillings, x-rays and more. ~ ~ Available only for treatment provided by a network Members First or MBF MemberCare dentist, on benefits payable. Available on Platinum or Platinum Visitors Cover with Excess and Gold, Gold with Excess and Classic Visitors Cover when taken out with Silver, Gold or Platinum Extras. Family memberships only. Includes Major Dental in VIC and SA only. Excludes orthodontics and hospital treatments. Dental fund rules, waiting periods and annual maximums apply. Child dependants only. ngoing support for members We are committed to helping our members lead longer, happier, healthier lives. This means giving ongoing support to help you get value from your cover. We also offer preventative health and wellness programs for their long-term benefit such as Living Well and Positive Health. See page 36 for more details. Exciting member discounts Get discounts on movie tickets, theme parks, airfares, fitness programs and much more! See page 38 for more details about our in2life deals. Get up to 100% and at least 60% back when treated by our network providers.^ EXTRAS CVER 35