Our Product Disclosure Statement (PDS)

Transcription

1 Our Product Disclosure Statement (PDS) Your HIF overseas visitors health insurance in detail. Visit online to get a quote and join. Call or Int l hif.com.au Australia s first certified Carbon Neutral health fund.

2 What s inside? Who is visitors cover for? We cover overseas workers and other visitors to Australia. Hospital and medical cover 4 Basic working visa cover 10 Essentials working visa cover 12 Intermediate working visa cover 14 Comprehensive working visa cover 16 Visitor Saver non-working visa cover 18 Visitor Value non-working visa cover 20 About our Extras cover 22 Ways to claim 23 Extras cover comparison table 24 Feedback, disputes and privacy 46 Frequently asked questions 47 Glossary 50 Our Working Visa covers are suitable for visitors on working visas and aged 64 and under. Our Visitor Saver and Visitor Value cover is suitable for visitors on other visas aged 64 and under. How does the health system work in Australia? We have a health system that combines public and private health care services. Medicare is the public health care system, which provides ed cover for visitors from countries that have a reciprocal agreement, but only for emergency treatment, and only under certain conditions. In any case, with Medicare you aren t able to choose your doctor and you won t be for: Treatment in a private hospital Non-emergency visits to the doctor Extras services like dental and optical care or ambulance transport Also, bear in mind that even if you are entitled to cover from Medicare, you may be put onto a hospital waiting list if your condition is not life threatening. So you re coming to Australia? That s great! Whether you re here working, visiting relatives or you ve decided to make Australia your home, we re sure you ll love it. And hopefully your time here will be accident-free. But just in case something happens, we ve made organising health cover both easy and affordable for you and your family. 2 3

3 Our Hospital and Medical cover options At HIF, we like to make it as simple (and affordable) as possible to choose the right level of health cover for you and your situation. With that in mind, all of our hospital and medical products below can be combined with any of our Extras covers: Basic Working Visa ($500 Excess) shared room in a private hospital Essential Working Visa (No Excess) shared room in a private hospital Intermediate Working Visa (No Excess) shared room in a private hospital Comprehensive Working Visa ($0 or $500/$1000 Excess) private or shared room in a private hospital Visitor Saver ($250/$500 Excess) shared room in a public hospital Visitor Value ($250/$500 Excess) shared room in a private hospital What does our Private Hospital insurance cover? Our Hospital insurance gives you access to the hospital system in Australia your level of cover determines whether you re able to access public hospitals or both public and private hospitals. Before we go on, it s important that you understand the Medicare Benefits Schedule (MBS). The MBS is the schedule of fees set by the Australian Government for standard medical services. As an overseas visitor with HIF insurance, you ll be for at least 100% of the MBS fee if you are admitted (as an inpatient) in to a hospital or a day facility. However, if your doctor charges more than the MBS fee you will need to pay these out-of-pocket expenses yourself. What does our Medical insurance cover? Our Medical insurance covers you for out-ofhospital services, such as consultations with general practitioners, doctors, specialist consultants and other services, including x-rays and blood tests and medical treatment in a hospital emergency or casualty department. Limits and exclusions apply to Visitor Saver, Visitor Value, Basic, Essentials and Intermediate Working Visa cover. For more details, please refer to the individual product information pages further on in this PDS. Urgent ambulance cover Private room, private hospital Shared room, private hospital Private room*, public hospital Shared room, public hospital Theatre fees, prostheses, inpatient (PBS) pharmacy items etc AccessGap Cover Outpatient services & emergency hospital department treatment ( up to MBS fee) Essentials Working Visa Cover for Working Visa Holders Intermediate Working Visa Up to $500 per person per calendar year Comprehensive Working Visa Cover for Non-Working Visa Holders Visitor Saver Visitor Value Up to $500 per person per calendar year Excess $500pp per-admission $500/1000 (optional) $250/500 $250/500 Cardiac (heart) Pregnancy and birth related services Assisted reproduction (IVF) Non-cosmetic eye surgery Basic Working Visa ^ Need a visa letter, pronto? If you re applying for an Australian visa, you may need to provide the Department of Immigration and Border Protection (DIBP) with a Visa Compliance Letter from your health insurer to verify that you have met this requirement. If you choose to join HIF, your letter of visa compliance will be ed to you instantly (PDF format) upon confirming your application. Joint replacement Bone marrow and organ transplants # Repatriation $4,000 lifetime, $4,000 lifetime, once per person once per person $6,000 lifetime, once per person $8,000 lifetime, once per person 4 5 For more details, please refer to the individual cover descriptions. * Where available. # Refer to page 49 for details about repatriation. ^ Please refer to page 11 for more details on Basic Working Visa policy restrictions. Please note: Visitor Saver cover is not a visa-compliant policy, so we cannot issue a letter of visa compliance for this product. If you require non-working visa cover and you need a letter of compliance, please purchase our Visitor Value policy.

4 Exclusions and Conditions Hospital Emergency Department Treatment Under Australian legislation, services provided in the emergency department of a hospital are defined as outpatient medical and not deemed to be a hospital treatment. HIF will therefore only provide benefits for services provided in a hospital Emergency Department, where a person is under HIF Intermediate or Visitor Value ($500 per person, per year), or Comprehensive Working Visa (uned). Benefits for these services are not by Essentials Working Visa policies. Hospital and Medical cover waiting periods Waiting periods (the time you need to wait before you can claim) are necessary for some services. All Australian health funds have waiting periods. Our waiting periods are: Psychiatric, rehabilitation or pallative care regardless of whether or not the condition is pre-existing - All obstetric retated services - 1 All treatment related to a pre-existing condition - 1 What s a pre-existing condition? A pre-existing condition is any ailment, illness, or condition that you had signs or symptoms of during the six months before you joined our fund or upgraded to a higher level of cover or the same cover with a reduced or nil excess. 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 pre-existing even if you haven t seen your doctor about it before joining or upgrading. 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 the Hospital cover then the ailment would be classed as pre-existing. An example would be a person who had been treated for bone cancer, but the cancer had been in remission for one year. Six months after joining the fund the person requires hospitalisation because the cancer had reappeared. The fund medical advisor determined that the hospitalisation was for a pre-existing condition because the type of cancer was not considered cured until it had been in remission for five years. Other examples of pre-existing condition determinations can be found on the PHIO website at: What s not Please note we will not pay a benefit when: a claim for any form of compensation or damages can or will be made services where benefits are claimable from another source travelling to and from Australia services are provided outside Australia the services you re claiming for are not by Medicare for Australian residents services are not by Medicare (e.g. health screening insurance examinations and services that do not have a Medicare Benefits Schedule (MBS) services arranged prior to coming to Australia. 6 7

5 Things you need to know about our Hospital cover When selecting Hospital cover, it s important to ensure that you understand how each level of cover will apply to you, as well as being aware of details such as ations, restrictions or exclusions that might also apply to your chosen cover. AccessGap Cover AccessGap Cover is available on our Comprehensive Working Visa cover. Doctors can charge more than the MBS and if they do, their patients without gap cover insurance will incur an out of pocket expense for the difference between the fee charged and the MBS. The good news is that AccessGap cover is HIF s medical gap cover arrangement, designed to minimise or eliminate these pocket expenses for medical services whilst an in-patient in a registered overnight hospital or day facility. Australian doctors can nominate to opt in or out of the AccessGap arrangement, which may mean that if you choose an AccessGap Doctor you can have lower outof-pocket costs. It is advisable to ask EACH doctor or specialist if they will treat you under the AccessGap cover if you hold a Comprehensive Hospital product. A list of registered participating doctors is available on our website, hif.com.au Healthcare providers HIF covers extras, medical and hospital providers throughout Australia. To confirm if a provider is approved by HIF, go to hif.com.au, us at hello@hif.com.au or call us on or from overseas. Benefits will not be paid for any hospital services provided outside Australia, or for services purchased or provided within Australia from a non-australian provider. Medicare Benefits Schedule (MBS) The Medicare Benefits Schedule (MBS) is the schedule of fees set by the Australian Government for standard medical services. As an overseas visitor you will be entitled to claim at least 100% of the MBS on all HIF hospital products for inpatient services. Excluded services Where services are noted as excluded in your Hospital cover, this means that you are not and you must pay all costs. Hospital Admission If you are admitted to hospital and a private room is the only option available, a copayment per night may apply. This charge will be the difference between your chosen hospital s shared room and private room rate. To confirm the applicable co-payment (if any), please contact your hospital prior to admission. Transferring and upgrading your cover New members who transfer Hospital cover from another Australian health fund to an equivalent level of HIF Hospital cover will not have any waiting periods applied, providing these were served with the previous fund. New members who transfer Hospital cover from another Australian health fund to a higher level of Hospital cover, or equivalent level of cover with a reduced or nil excess, will have qualifying periods applied for the higher level of cover and/ or benefits. During these periods benefits will be payable at the equivalent level of cover to that of your previous fund. Current HIF members who transfer Hospital cover to a higher level of Hospital cover, or equivalent level of cover with a reduced or nil excess, will have qualifying periods applied for the higher level of cover and/or benefits. During these periods benefits will be payable at the lower level of cover. We may recognise cover from an overseas fund if you can provide enough information for us to compare the products with our products. You will need to provide start and end date of cover, all members, recent claims. Want more information about the Australian Health System? Visit the Overseas Visitors Cover category in our online knowledge base for more information on Medicare eligibility, visa compliance letters, and why purchasing HIF Visitors Health Cover is a smart idea. hif.com.au/help To find out more about specific payment amounts for upcoming procedures, please call us on or from overseas. Workers Compensation and Dual Insurance Benefits cannot be claimed and are not payable by HIF where you have or can claim benefits or compensation (in full or in part) for treatment, goods or services from a third party including Workers Compensation or 8 Public Liability sources, your employer or 9 any other Insurance policy.

6 Basic Working Visa (Hospital only cover) This is our entry level cover for visitors to Australia on Working Visas and aged 64 and under. As the name suggests, it covers all the basics and also has a $500 excess applied to reduce the cost, making it the most affordable choice if you just want Hospital cover. However, it doesn t cover outpatient services such as visits to a general practitioner (GP) for things like the flu or a virus. What s if you have to go to hospital and you are admitted (as an inpatient) into a hospital or day facility? Ambulance. You re 100% for uned urgent transport by road ambulance with a government approved ambulance service. That includes emergency admission to hospital, emergency treatment on-site, or interhospital transfer for emergency treatment, where the original admitting hospital does not have the required clinical facilities. It does not extend to transfers due to patient preferences. And if you are admitted as an inpatient into a hospital or day facility: Hospital accommodation. You re for a shared room in a private hospital. Yes, it s visa-compliant! Our Basic Working Visa Cover is the minimum cover required to meet the Department of Border Protection (DIBP) visa requirements. All of our other Working Visa covers are DIBP-compliant too. Inpatient medical (doctors) bills. You re fully for all charges up to the Medicare Benefit Schedule fee (MBS). This includes consultations with doctors and specialists, radiology (e.g. x-rays) and pathology (e.g. blood tests). In-hospital pharmacy drugs. You re required to pay an amount equal to the Australian government patient contribution but you will receive a benefit for the rest of the cost, based on the Pharmaceutical Benefits Schedule (PBS) listed price. This is paid for all PBS listed drugs that are prescribed according to the PBS s approved indications and administered during, and as part of, an admitted episode of care. Benefits may not apply or may be restricted for non - TGA* approved, experimental or high cost drugs. * Therapeutic Goods Administration. Surgically implanted prostheses. You get a benefit at least equal to 100% of the minimum benefit amount listed for No Gap and Gap Permitted prostheses, as listed in the Private Health Insurance (Prostheses) Rules Benefits may be restricted for non-approved medical treatments or consumables. Please note: A medical annual of $1,000, applies per person on this policy. What isn t with Basic? Hospital Emergency Department Treatment Under Australian legislation, services provided in the emergency department of a hospital are defined as outpatient medical and not deemed to be a hospital treatment. HIF will therefore only pay benefits for services provided in a hospital Emergency Department, where a person is under HIF Intermediate Working Visa ($500 per person, per year) or Comprehensive Working Visa covers or Visitor Value ($500 per person). You are not : en route to and from Australia for services provided outside Australia for services arranged prior to coming to Australia. for outpatient services and emergency hospital department treatment. Services that are partially (known as restricted): Restricted Services are hospital services which are only for payments at the basic benefit level. Benefits for the following services are restricted to the rate determined by the relevant state and territory health authority. This means that significant out-ofpocket expenses will apply for these services if you are admitted as an inpatient for the following specified treatments. pregnancy and birth related services psychiatric care and treatment palliative care gastric banding and obesity surgery Services that are not at all (known as exclusions) include: artificial reproductive techniques and investigations or treatment relating to infertility (IVF) bone marrow and organ transplants Any inpatient hospital service not normally by Medicare for Australian residents, including most cosmetic and podiatric surgery outpatient medical services, including visits to doctors and specialists, radiology and pathology, except public hospital emergency department fees that lead to an admission in hospital services and treatments that are by compensation and damages provision services where benefits are claimable from another source including workers compensation, public liability sources, your employer or any other insurance policy minimum policy term is two months. What about repatriation? You are for repatriation up to $4,000 per person, payable once in a lifetime. See page 49 for more information about repatriation. Waiting periods for new and upgrading members Psychiatric, rehabilitation and palliative care Pregnancy and birth related services 1 All other treatment in relation to a pre-existing condition 1 Do you have to pay anything if you are admitted (as an inpatient) into a hospital or day facility? A $500 excess applies per-person peradmission, then you are fully for all inpatient medical (doctor) bills up to the MBS fee. What s more, no copayments are required for a shared room in a public hospital. We recommend you contact us before going to into hospital to find out if you will incur an out-of-pocket expense

7 Essentials Working Visa (Hospital only cover) As the name suggests, this policy covers all the essentials, making it the smart choice if you just want Hospital cover. However, it doesn t cover outpatient services such as x- rays, pathology or visits to a general practitioner (GP) for things like the flu or a virus. What s if you have to go to hospital and you are admitted (as an inpatient) into a hospital or day facility? Ambulance. You re 100% for uned urgent transport by road ambulance with a government approved ambulance service. That includes emergency admission to hospital, emergency treatment on-site, or interhospital transfer for emergency treatment, where the original admitting hospital does not have the required clinical facilities. It does not extend to transfers due to patient preferences. And if you are admitted as an inpatient into a hospital or day facility: Hospital accommodation. You re for a shared room as a private patient in a private hospital. Inpatient medical (doctors) bills. You re fully for all charges up to the Medicare Benefit Schedule fee (MBS). This includes consultations with doctors and specialists, radiology (e.g. x-rays) and pathology (e.g. blood tests). Pharmaceutical drugs. You re required to pay an amount equal to the Australian government patient contribution but you will receive a benefit for the rest of the cost, based on the Pharmaceutical Benefits Schedule (PBS) listed price. This is paid for all PBS listed drugs that are prescribed according to the PBS s approved indications and administered during, and as part of, an admitted episode of care. Benefits may not apply or may be restricted for non - TGA* approved, experimental or high cost drugs. * Therapeutic Goods Administration. Surgically implanted prostheses. You get a benefit at least equal to 100% of the minimum benefit amount listed for No Gap and Gap Permitted prostheses, as listed in the Private Health Insurance (Prostheses) Rules Benefits may be restricted for non-approved medical treatments or consumables. What isn t with Essentials? Hospital Emergency Department Treatment Under Australian legislation, services provided in the emergency department of a hospital are defined as outpatient medical and not deemed to be a hospital treatment. HIF will therefore only provide benefits for services provided in a hospital Emergency Department, where a person is under HIF Intermediate Working Visa ($500 per person, per year) or Comprehensive Working Visa covers or Visitor Value ($500 per person). You are not : en route to and from Australia for services provided outside Australia for services arranged prior to coming to Australia. for outpatient services and emergency hospital department treatment. Services that are not at all (known as exclusions) include: bone marrow and organ transplants artificial reproductive techniques and investigations or treatment relating to infertility (IVF) any service not normally by Medicare for Australian residents, including cosmetic and podiatric surgery outpatient medical services, including visits by doctors and specialists, radiology and pathology, except public hospital emergency department fees that lead to an admission in hospital services and treatments that are by compensation and damages provision services where benefits are claimable from another source including workers compensation, public liability sources, your employer or any other insurance policy minimum policy term is two months. What about repatriation? You are for repatriation up to $4,000 per person, payable once in a lifetime. See page 47 for more information about repatriation. Waiting periods for new and upgrading members Psychiatric, rehabilitation and palliative care All obstetric (pregnancy) related conditions 1 All other treatment in relation to a pre-existing condition 1 Do you have to pay anything if you are admitted (as an inpatient) into a hospital or day facility? There s no excess, and you are fully for all inpatient medical (doctor) bills up to the MBS fee. What s more, no co-payments are required for a shared room in a public hospital. We recommend you contact us before going to into hospital to find out if you will incur an out of pocket expense

8 Intermediate Working Visa (Hospital and Medical cover) A step up from Essentials Working Visa, our mid-range Intermediate option for working visitors aged 64 and under covers you for a shared room in a private or public hospital. Plus, you re for some out-of-hospital medical expenses, such as x- rays and visits to a GP. You can also choose your doctor. What s if you have to go to hospital and you are admitted (as an inpatient) into a hospital or day facility? Ambulance. You re 100% for uned urgent transport by road ambulance with a government approved ambulance service. That includes emergency admission to hospital, emergency treatment on-site, or interhospital transfer for emergency treatment, where the original admitting hospital does not have the required clinical facilities. It does not extend to transfers due to patient preferences. And if you are admitted as an inpatient into a hospital or day facility: Hospital accommodation. You re for a shared room in a private hospital or shared or private room as a public patient in a public hospital. Inpatient medical (doctors) bills. You re fully for all charges up to the Medicare Benefit Schedule fee (MBS). This includes consultations with doctors and specialists, radiology (eg. xrays) and pathology (eg. bloodtests). Theatre fees and labour ward charges. Pharmaceutical drugs. You re required to pay an amount equal to the Australian government patient contribution but you will receive a benefit for the rest of the cost, based on the PBS (Pharmaceutical Benefits Schedule) listed price. This is paid for all PBS listed drugs that are prescribed according to the PBS s approved indications and administered during, and as part of, an admitted episode of care. Benefits may not apply or may be restricted for non - TGA* approved, experimental or high cost drugs. * Therapeutic Goods Administration. Surgically implanted prostheses. You get a benefit at least equal to 100% of the minimum benefit amount listed for No Gap and Gap Permitted prostheses, as listed in the Private Health Insurance (Prostheses) Rules Benefits may be restricted for non-approved medical treatments or consumables. What services are if you are not admitted to hospital? Hospital Emergency Department Treatment Under Australian legislation, services provided in the emergency department of a hospital are defined as outpatient medical and not deemed to be a hospital treatment. All outpatient medical (doctor) bills are, as are public hospital emergency department fees that lead to an admission to hospital. So that s full cover up to the Medicare Benefit Schedule fee (MBS). This includes consultations with doctors and specialists, radiology and pathology (up to $500 per person, per calendar year). What isn t with Intermediate Working Visa? You are not : en route to and from Australia for services provided outside Australia for services arranged prior to coming to Australia. Services that are not at all (known as exclusions) include: bone marrow and organ transplants artificial reproductive techniques and investigations or treatment relating to infertility (IVF) any service not normally by Medicare for Australian residents, including cosmetic and podiatric surgery services where benefits are claimable from another source including workers compensation, public liability sources, your employer or any other insurance policy minimum policy term is two months. What about repatriation? You are for repatriation up to $6,000 per person, payable once in a lifetime. See page 49 for more information about repatriation. Waiting periods for new and upgrading members Psychiatric, rehabilitation and palliative care All obstetric (pregnancy) related conditions 1 All other treatment in relation to a pre-existing condition 1. Do you have to pay anything if you are admitted into a hospital or day facility? There s no excess, and you are fully for all inpatient medical (doctor) bills up to the MBS fee. What s more, no co-payments are required for shared rooms in HIF contracted hospitals. However, you may be required to make an additional co-payment for each day that you stay in a private room or non HIF contracted hospital. Some doctors may charge above the MBS, we recommend you contact us before going to into hospital to find out if you will incur an out of pocket expense

9 Comprehensive Working Visa (Hospital and Medical cover, with optional excess) Comprehensive is the word. This option for working visitors aged 64 and under provides complete peace of mind, with full cover for a private room in a private hospital and out-of-hospital medical expenses for a host of services. Choose your doctor. Visit a GP. And with the excess option, you get it all at a reduced premium. What s if you have to go to hospital and you are admitted (as an inpatient) into a hospital or day facility? Ambulance. You re 100% for uned urgent transport by road ambulance with a government approved ambulance service. That includes emergency admission to hospital, emergency treatment on-site, or interhospital transfer for emergency treatment, where the original admitting hospital does not have the required clinical facilities. It does not extend to transfers due to patient preferences. Theatre fees and labour ward charges. Pharmaceutical drugs. You re required to pay an amount equal to the Australian government patient contribution but you will receive a benefit for the rest of the cost, based on the Pharmaceutical Benefits Schedule (PBS) listed price. This is paid for all PBS listed drugs that are prescribed according to the PBS s approved indications and administered during, and as part of, an admitted episode of care. If you want to be for out-of-hospital pharmecutical drugs you can take out one of our extras products which will pay a benefit towards your prescription if it is listed on the PBS. Benefits may not apply or may be restricted for non - TGA* approved, experimental or high cost drugs. * Therapeutic Goods Administration. Surgically implanted prostheses. You get a benefit at least equal to 100% of the minimum benefit amount listed for No Gap and Gap Permitted prostheses, as listed in the Private Health Insurance (Prostheses) Rules Benefits may be restricted for non-approved medical treatments or consumables. What isn t with Comprehensive Working Visa? You are not : en route to and from Australia for services provided outside Australia for services arranged prior to coming to Australia. Services that are not at all (known as exclusions) include: any service not normally by Medicare for Australian residents, including cosmetic and podiatric surgery services where benefits are claimable from another source including workers compensation, public liability sources, your employer or any other insurance policy What about repatriation? You are for repatriation up to $8,000 per person, payable once in a lifetime. See page 49 for more information about repatriation. Optional excess You can reduce your premium by selecting an optional excess of $500 for a single policy or $1,000 for a family policy. Waiting periods for new and upgrading members Psychiatric, rehabilitation and palliative care All obstetric (pregnancy) related conditions 1 All other treatment in relation to a pre-existing condition 1. Do you have to pay anything if you are admitted into a hospital or day facility? Yes, if you select the optional excess, you will have to pay an excess of $500 per person, per overnight admission, up to a maximum of $1,000 per family policy per calendar year. That said, you are fully for all inpatient medical (doctor) bills up to the Access Gap fee (see page 8) and the excess doesn t apply to same-day surgery. What s more, you aren t required to make any co-payments for any room in an HIF contracted hospital. Some doctors may charge above the MBS, we recommend you contact us before going to into hospital to find out if you will incur an out of pocket expense. And if you are admitted as an inpatient into a hospital or day facility: Hospital accommodation. You re for a shared or private room in a private hospital or as a public patient in a public hospital. Inpatient medical (doctors) bills. You have full AccessGap cover for medical procedures. (See page 8) What services are if you are not admitted to hospital? All outpatient medical (doctor) bills are, which means full cover up to the Medicare Benefit Schedule fee (MBS). This includes consultations with doctors and specialists, radiology and pathology. NB: The minimum policy term is two months

10 Visitor Saver (Hospital cover only) Designed for young holiday makers and visitors on non-working visas. This product covers the basics in a shared room in a public hospital. This cover is not compliant for visa purposes. What s if you have to go to hospital and you are admitted (as an inpatient) into a hospital or day facility? Ambulance. You re 100% for uned urgent transport by road ambulance with a government approved ambulance service. That includes emergency admission to hospital, emergency treatment on-site, or interhospital transfer for emergency treatment, where the original admitting hospital does not have the required clinical facilities. It does not extend to transfers due to patient preferences. And if you are admitted as an inpatient into a hospital or day facility: Hospital accommodation. You re for a shared room as a public patient in a public hospital. Pharmaceutical drugs. You re required to pay an amount equal to the Australian government patient contribution but you will receive a benefit for the rest of the cost, based on the Pharmaceutical Benefits Schedule (PBS) listed price. This is paid for all PBS listed drugs that are prescribed according to the PBS s approved indications and administered during, and as part of, an admitted episode of care. Benefits may not apply or may be restricted for non - TGA* approved, experimental or high cost drugs. * Therapeutic Goods Administration. Surgically implanted prostheses. You get a benefit at least equal to 100% of the minimum benefit amount listed for No Gap and Gap Permitted prostheses, as listed in the Private Health Insurance (Prostheses) Rules Benefits may be restricted for non-approved medical treatments or consumables. What isn t with Visitor Saver? Hospital Emergency Department Treatment Under Australian legislation, services provided in the emergency department of a hospital are defined as outpatient medical and not deemed to be a hospital treatment. You are not : en route to and from Australia for services provided outside Australia for services arranged prior to coming to Australia. Services that are not at all (known as exclusions) include: bone marrow and organ transplants artificial reproductive techniques and investigations or treatment relating to infertility (IVF) any service not normally by Medicare for Australian residents, including cosmetic and podiatric surgery outpatient medical services, including visits by doctors and specialists, radiology and pathology, except public hospital emergency department fees that lead to an admission in hospital services and treatments that are by compensation and damages provision services where benefits are claimable from another source including workers compensation, public liability sources, your employer or any other insurance policy cardiac-related conditions, medical treatment and surgical procedures, including arrhythmias, artery bypass grafts, coronary angioplasty, congenital defects, heart disease, heart transplants, pacemakers, defibrillators and stent insertion. eye surgery (any procedure on the surface or within the structures of the eye) Waiting periods for new and upgrading members All treatment in relation to a pre-existing condition 1. Do you have to pay anything if you are admitted into a hospital or day facility? Yes, you will have to pay an excess of $250 per person per admission up to a maximum of $500 per family policy per calendar year. That said, no co-payments are required for a shared room in a public hospital. We recommend you contact us before going into hospital to find out if you will incur an out-of-pocket expense. Inpatient medical (doctors) bills. You re HIF will therefore only provide benefits for gastric banding and obesity services fully for all charges up to the services provided in a hospital Emergency Medicare Benefit Schedule fee (MBS). joint replacement Department, where a person is under This includes consultations with doctors obstetrics or any maternity related services HIF Intermediate Working Visa ($500 per and specialists, radiology and pathology. person, per year) or Comprehensive Working palliative care services Visa covers or Visitor Value ($500 per person). psychiatric rehabilitation 18 renal dialysis repatriation minimum policy term is two months. 19

11 Visitor Value (Hospital and Medical cover) A step up from Visitor Saver cover, our mid-range value option for visitors on non-working visas aged 64 and under. It covers you for a shared room in a private or public hospital. Plus you re for some out-ofhospital medical expenses, such as x-rays and visits to a GP. You can also choose your doctor. This cover is compliant for visa purposes. What s if you have to go to hospital and you are admitted (as an inpatient) into a hospital or day facility? Ambulance. You re 100% for uned urgent transport by road ambulance with a government approved ambulance service. That includes emergency admission to hospital, emergency treatment on-site, or interhospital transfer for emergency treatment, where the original admitting hospital does not have the required clinical facilities. It does not extend to transfers due to patient preferences. And if you are admitted as an inpatient into a hospital or day facility: Theatre fees and labour ward charges. Pharmaceutical drugs. You re required to pay an amount equal to the Australian government patient contribution but you will receive a benefit for the rest of the cost, based on the PBS (Pharmaceutical Benefits Schedule) listed price. This is paid for all PBS listed drugs that are prescribed according to the PBS s approved indications and administered during, and as part of, an admitted episode of care. Benefits may not apply or may be restricted for non - TGA* approved, experimental or * high cost drugs. Therapeutic Goods Administration. Surgically implanted prostheses. You get a benefit at least equal to 100% of the minimum benefit amount listed for No Gap and Gap Permitted prostheses, as listed in the Private Health Insurance (Prostheses) Rules Benefits may be restricted for non-approved medical treatments or consumables. What services are if you are not admitted to hospital? Hospital Emergency Department Treatment Under Australian legislation, services provided in the emergency department of a hospital are defined as outpatient medical and not deemed to be a hospital treatment. What isn t with Visitor Value? You are not : en route to and from Australia for services provided outside Australia for services arranged prior to coming to Australia. Services that are not at all (known as exclusions) include: bone marrow and organ transplants artificial reproductive techniques and investigations or treatment relating to infertility (IVF) any service not normally by Medicare for Australian residents, including cosmetic and podiatric surgery services where benefits are claimable from another source including workers compensation, public liability sources, your employer or any other insurance policy repatriation minimum policy term is two months. Waiting periods for new and upgrading members Psychiatric, rehabilitation and palliative care All obstetric (pregnancy) related conditions 1 All other treatment in relation to a pre-existing condition 1. Do you have to pay anything if you go to hospital (and are admitted as an inpatient)? Yes, you will have to pay an excess of $250 per person per admission up to a maximum of $500 per family policy per calendar year. That said, no co-payments are required for a shared room in a public hospital, although you may be required to make an additional co-payment for each day that you stay in a private room or a non HIF contracted hospital. You are fully for all inpatient medical (doctor) bills up to the MBS fee. We recommend you contact us before going into hospital to find out if you will incur an out-of-pocket expense. Hospital accommodation. You re for a shared room in a private hospital or shared or private room as a public patient in a public hospital. All outpatient medical (doctor) bills are, as are public hospital emergency department fees that lead to an admission to hospital. So that s full cover up to the Medicare Benefit Schedule fee (MBS). This Inpatient medical (doctors) bills. You re fully for all charges up to the Medicare Benefit Schedule fee (MBS). includes consultations with doctors and specialists, radiology and pathology (up to $500 per person, per calendar year). 20 This includes consultations with doctors and specialists, radiology (eg. xrays) and pathology (eg. bloodtests). 21

12 Things you should know about our Extras Cover Ways to claim Why choose HIF Extras? Here at HIF, we pride ourselves on enabling member choice. So, unlike some health fund insurers who pay lower benefits if you don t go to their preferred providers, with HIF you re free to visit any extras provider in Australia. Our only requirement is that members must visit healthcare providers who are legally qualified to practise in Australia (and approved by HIF). So as long as your preferred doctor, dental provider, optical provider, physiotherapist, chiroprator or other type of healthcare provider is approved by HIF, you re free to use whichever one you want. Our Member Loyalty Program HIF rewards members who retain their Extras cover each year by providing increasing benefits or annual s. Our dental s increase every year from commencement until the maximum is available in your sixth year of membership. Benefits or s for services like optical, physiotherapy, occupational and speech therapy increase after 5 years and benefits or s increase for chiropractic, osteopathic and pharmacy after 3 years. Where a policy is upgraded to a higher level of Extras cover, annual s and benefits will automatically move to the next highest loyalty benefit on the new level of cover and progress each year until all maximum benefits and s are reached. Annual s HIF Extras covers have an annual for most services, which means there is a on how much HIF will pay toward your claims. Most s are for the calendar year (January to December) and each January your benefit s will be refreshed, allowing you to claim benefits again for extras services provided in the new year. Claiming timeframe ation Claims must be made within two years of the service being provided. Approved consultations Unless stated, to be eligible for HIF benefits all services must be provided by a HIF approved health provider at that provider s registered practice address in a face-toface setting, or as otherwise approved by HIF. Video, telephone or online facilitated services, with the exception of HIF approved Hospital Substitute treatment or Chronic Health Disease Management programs, are not approved consultations. Workers Compensation and Dual Insurance Benefits cannot be claimed and are not payable by HIF where you have or can claim benefits or compensation (in full or in part) for treatment, goods or services from a third party including Workers Compensation or Public Liability sources, your employer or any other Insurance policy. Electronic Claiming Providers with electronic claiming technology (HICAPS or isoft) can settle your account with you on the spot. Simply swipe your HIF membership card and pay any difference. SmartClaim for mobile Members who own an Apple or Android mobile device can now submit paid extras accounts of $1000 or less by using their mobile s in-built camera to photograph receipts and invoices. To find out more, visit hif.com.au or download HIF SmartClaim now from the Apple App Store or the Android Market. Fast-Track e-claiming ( /fax) For paid extras accounts of $1000 or less, try our quick and easy Fast-Track option. Simply scan your completed HIF claim form and associated receipts and invoices, and a copy to claims@hif.com.au or fax a copy to (08) or from overseas. To find out more, visit hif.com.au Hospital and AccessGap Accounts If you need to go into hospital, please contact us prior to admission. A number of doctors around Australia can choose to participate in HIF s AccessGap scheme, which means that they may charge above the Medicare Benefit Schedule and subject to condition, HIF will fully pay or cover a proportion of that additional amount on your behalf. Your doctor may send the accounts to HIF direct. If not, you can send the unpaid account to us for processing the HIF and Medicare benefits payable. We will then send the payment direct to your doctor or hospital on your behalf. Please call us before you go into hospital so we can assist you with your claims. By post Complete a claim form and post it to: HIF GPO Box X2221 Perth WA 6847 Claim forms can be downloaded from hif.com.au or mailed to you on request. For more information on the different ways to make a claim, check out the How to Claim page on hif.com.au 22 23

13 Extras comparison table and waiting periods Type of service Saver Special Super Premium Ambulance (urgent) Auxiliary Home Nursing Asthmatic Spacers Chiropractic Complementary Therapies Dental - General Uned Diabetes Education Dietetics Healthy Lifestyle Occupational Therapy Optical Orthoptics (Eye Therapy) Osteopathy Peak-flow Meter Pharmacy Drugs Physiotherapy Podiatry Consultations Speech Therapy Waiting Period Dental - General Limited Up to 12 months Blood Glucose/Pressure Monitor Dental - Major External Prosthesis/Medical Appliances Nebuliser / Humidifier Orthotic Appliances Psychological Consultations Assisted Reproduction Drugs Hearing Aids months 36 months From time to time we promote special offers for new members. Visit hif.com.au for more information and to view our current offers

14 Ambulance benefits Premium Options Super Options Special Options Saver Options Type of service Additional information Benefit Person Benefit Person Benefit Person Benefit Person Ambulance As above Emergency: 100% N/A N/A Emergency: 100% N/A N/A Emergency: 100% N/A N/A Emergency: 100% N/A N/A Nonemergency call-outs and transportation: 100% with a $50 co-payment Nonemergency call-outs and transportation: 100% with a $50 co-payment Nonemergency call-outs and transportation: 100% with a $50 co-payment Nonemergency call-outs and transportation: 100% with a $50 co-payment Interhospital transfers: No benefit Interhospital transfers: No benefit Interhospital transfers: No benefit Interhospital transfers: No benefit 26 27

15 Extras benefits Premium Options Super Options Benefit Person Type of service Additional information Benefit Person No No $18 2 per person per year N/A $18 2 per person per year Asthmatic spacers No No $75 $1,800 per year $120 $1,800 per year Benfits must be ordered by a medical practitioner. Contact us for conditions. Auxiliary Home Nursing No No 75% of cost 1 of either monitor every 3 years 75% of cost 1 of either monitor every 3 years A letter of recommendation from the patient s treating practitioner is required. Max: $200 Max: $200 Blood glucose or blood pressure monitor annual (chiropractic and osteopathic) annual (chiropractic and osteopathic) Spinal adjustment manipulation Spinal adjustment manipulation First visit: $28 annual (chiropractic and osteopathic) annual (chiropractic and osteopathic) First visit: $30 Chiropractic Benefits are paid for spinal manipulation or spinal adjustments carried out by a registered chiropractor approved by HIF. Up to 3 years: $1100 Up to 3 years: $550 Visits 2-10: $23 Up to 3 years: $1300 Up to 3 years: $650 Visits 2-10: $29 Over 3 years: $1300 Over 3 years: $650 Visits 10+: $14 Over 3 years: $1500 Over 3 years: $750 Visits 10+: $18 1 x-ray per year X-ray: $85 1 x-ray per year X-ray: $110 Special Options Saver Options Benefit Person Type of service Additional information Benefit Person N/A N/A N/A No N/A N/A No Asthmatic spacers N/A N/A No N/A N/A No Benfits must be ordered by a medical practitioner. Contact us for conditions. Auxiliary Home Nursing N/A N/A No N/A N/A No A letter of recommendation from the patient s treating practitioner is required. Blood glucose or blood pressure monitor annual dietetics, healthy lifestyle, pharmacy, osteopathic, physiotherapy and podiatry) $700 annual dietetics, healthy lifestyle, pharmacy, osteopathic, physiotherapy and podiatry) $350 Spinal adjustment - manipulation: annual osteopathic, physiotherapy, podiatry and therapies) $900 annual osteopathic, physiotherapy, podiatry and therapies) $450 Spinal adjustment manipulation First visit: $26 First visit: $26 Chiropractic Benefits are paid for spinal manipulation or spinal adjustments carried out by a registered chiropractor approved by HIF Visits 2-10: $21 Visits 10+: $10 X-ray: $65 1 x-ray per year Visits 2-10: $21 Visits 10+: $10 X-ray: $70 1 x-ray per year

16 Extras benefits Premium Options Super Options Benefit Person Type of service Additional information Benefit Person $700 Up to 3 years: $250 No Visits 1-6: $20 Up to 3 years: $500 Visits 1-6: $25 Over 3 years: $350 Visits 7+: $13 Over 3 years: $600 Visits 7+: $17 Benefits are not payable on medicines provided by the practitioner. The treatment must be provided by a practitioner who is registered with HIF in the speciality for which the charge is raised. Complementary therapies - Naturopathy - Homeopathy - Acupuncture - Traditional Chinese Medicine - Remedial massage therapy - Myotherapy Dental No See page 42 for more details 6 visits per No 6 visits per year First visit: $36 year First visit: $36 Diabetics education $18 $18 For consultations or information sessions held by Diabetes Association in relation to diabetes. $324 per year No First visit: $36 $324 per year First visit: $40 $18 $20 Dietetics Benefits are paid on consultations carried out by a registered dietician approved by HIF. Group: $10 Group: $12 Special Options Saver Options Benefit Person Type of service Additional information Benefit Person Up to 3 years: $50 # Over 3 years: $100 # $200 # $400* Visit 1-6: $15 Up to 3 years: $100* Visits 1-6: $16 Visits 7+: $10 Over 3 years: $200* Visits 7+: $11 Benefits are not payable on medicines provided by the practitioner. The treatment must be provided by a practitioner who is registered with HIF in the speciality for which the charge is raised. Complementary therapies - Naturopathy - Homeopathy - Acupuncture - Traditional Chinese Medicine - Remedial massage therapy - Myotherapy Dental See page 42 for more details N/A N/A No N/A N/A No For consultations or information sessions held by Diabetes Association in relation to diabetes. Diabetics education annual dietetics, healthy lifestyle, osteopathy, pharmacy, physiotherapy and podiatry) $700 annual dietetics, healthy lifestyle, osteopathy, pharmacy, physiotherapy and podiatry) $350 No First visit: $36 $252 per year First visit: $36 $18 $18 Dietetics Benefits are paid on consultations carried out by a registered dietician approved by HIF Group: $10 Group: $10 * Subject to combined overall person of $450 and membership of $900 for chiropractic incl. 1 X-ray per year per person, osteopathic, physiotherapy and podiatry. # Subject to combined overall person of $350 and membership of $700 for chiropractic incl. 1 X-ray per year per person, dietetics, healthy lifestyle, pharmacy, osteopathic, physiotherapy, and podiatry.

17 Extras benefits Premium Options Super Options Benefit Person Type of service Additional information Benefit Person No No 75% of fee $1,500 per year. 75% of fee $1,500 per year. Benefits are paid on HIF approved prosthetics items such as artificial limbs, wigs and external mammary prostheses and approved medical devices such as a Tens machine, Circulation Booster and Cam Walker. External Prosthesis/ Medical Appliances e: sub s apply depending upon item. e: sub s apply depending upon item. Conditions apply so please contact us for details prior to purchasing item. $100 $125 Single: $100 Single: $125 Family: $200 Family: $250 Benefits are payable for HIF approved programs delivered by registered providers only. Healthy Lifestyle Please contact us prior to commencing the program or paying subscriptions to ascertain if the program is eligible for a rebate. Healthy Lifestyle services include Gym, Yoga, Pilates, Exercise Physiology, Weight Loss Programs, Health Assessments, Health Management Programs, Quit Smoking Plans, and Skin Cancer Screenings. Special Options Saver Options Benefit Person Type of service Additional information Benefit Person N/A N/A No N/A N/A No Benefits are paid on HIF approved prosthetics items such as artificial limbs, wigs and external mammary prostheses and approved medical devices such as a Tens machine, Circulation Booster and Cam Walker. External Prosthesis/ Medical Appliances Conditions apply so please contact us for details prior to purchasing item. $50 annual dietetics, healthy lifestyle, osteopathic, pharmacy, physiotherapy and podiatry) $700 $75 Single: $50 Single: $75 Family: $100 Family: $100 Benefits are payable for HIF approved programs delivered by registered providers only. Healthy Lifestyle Please contact us prior to commencing the program or paying subscriptions to ascertain if the program is eligible for a rebate. Healthy Lifestyle services include Gym, Yoga, Pilates, Exercise Physiology, Weight Loss Programs, Health Assessments, Health Management Programs, Quit Smoking Plans, and Skin Cancer Screenings

18 Extras benefits Premium Options Super Options Type of service Additional information Benefit Person Benefit Person Hearing aids Benefits are paid on replacement hearing aids after 5 years from date of supply. Up to 5 years: $550 5 to 10 years: $600 per ear Up to 5 years: 1 Over 5 years: 1 per ear No Up to 5 years: $ years: $550 per ear Up to 5 years: 1 Over 5 years: 1 per ear No 10+ years: $700 per ear Humidifier or nebuliser A letter of recommendation from the patient s treating practitioner is required. 75% of cost 1 of either monitor every 3 years. Maximum $180. No 75% of cost 1 of either monitor every 3 years. Maximum $140. No Occupational therapy Benefits are paid on consultations carried out by a registered occupational therapist, approved by HIF. First Visit $60 Subsequent $27 Group $10 (orthoptics, physiotherapy and speech therapy) Up to 5 years: $1200 No First visit: $45 $25 Group: $10 (orthoptics, physiotherapy and speech therapy) Up to 5 years: $900 No Over 5 years: $1500 Over 5 years: $1100 Optical See page 40 for more details Orthotics Benefits are paid on items carried out by a registered podiatrist or orthotic supplier, approved by HIF #. 75% of cost $240 1 every 2 years from date of supply ^ No 75% of cost $200 1 every 2 years from date of supply ^ No # e: benefits are not available for orthotics which are not specifically modified and fitted for the individual member s condition. ^ Orthotic includes associated services such as muscle testing, ROM testing and gait analysis. Special Options Saver Options Type of service Additional information Benefit Person Benefit Person Hearing aids Benefits are paid on replacement hearing aids after 5 years from date of supply. N/A N/A No N/A N/A No Humidifier or nebuliser A letter of recommendation from the patient s treating practitioner is required. N/A N/A No N/A N/A No Occupational therapy Benefits are paid on consultations carried out by a registered occupational therapist, approved by HIF. N/A N/A No N/A N/A No Optical See page 40 for more details Orthotics Benefits are paid on items carried out by a registered podiatrist or orthotic supplier, approved by HIF #. N/A N/A No N/A N/A No # e: benefits are not available for orthotics which are not specifically modified and fitted for the individual member s condition

19 Extras benefits Premium Options Super Options Type of service Additional information Benefit Person Benefit Person Orthoptics (eye therapy) Benefits are paid on items carried out by a registered orthoptics supplier, approved by HIF #. Initial: $50 $25 with occupational physiotherapy and speech therapy No Initial $50 Subsequent $25 with occupational physiotherapy and speech therapy No Up to 5 years: $1200 Up to 5 years: $900 Over 5 years: $1500 Over 5 years: $1100 Osteopathic Benefits are paid on items carried out by a registered osteopath, approved by HIF. First visit: $30 Visits 2-10: $29 Visits 10+: $18 annual (chiropractic and osteopathic) Up to 3 years: $650 annual (chiropractic and osteopathic) Up to 3 years: $1300 First visit: $28 Visits 2-10: $23 Visits 10+: $17 annual (chiropractic and osteopathic) Up to 3 years: $550 annual (chiropractic and osteopathic) Up to 3 years: $1100 Over 3 years: $750 Over 3 years: $1500 Over 3 years: $650 Over 3 years: $1300 Peak Flow Meter N/A $30 1 per year No $30 1 per year No Special Options Saver Options Type of service Additional information Benefit Person Benefit Person Orthoptics (eye therapy) Benefits are paid on items carried out by a registered orthoptics supplier, approved by HIF #. N/A N/A No N/A N/A No Osteopathic Benefits are paid on items carried out by a registered osteopath, approved by HIF. First visit: $26 Visits 2-10: $21 Visits 10+: $16 annual physiotherapy, osteopathic and podiatry) $450 annual physiotherapy, osteopathic and podiatry) $900 First visit: $26 Visits 2-10: $21 Visits 10+: $16 annual dietetics, healthy lifestyle, osteopathic, pharmacy, physiotherapy & podiatry) $350 annual dietetics, healthy lifestyle, osteopathic, pharmacy, physiotherapy and podiatry) $700 Peak Flow Meter N/A N/A N/A No N/A N/A No 35 37

20 Extras benefits Premium Options Super Options Type of service Additional information Benefit Person Benefit Person Pharmacy payable on contraceptives or NHS (PBS) prescriptions or over the counter items purchased with or without a prescription. Member pays PBS contribution. Benefit is 100% of balance up to $80 per script item. Up to 3 years: $200 Over 3 years: $400 No Member pays PBS contribution. Benefit is 100% of balance up to $80 per script item. Up to 3 years: $200 Over 3 years: $400 Physiotherapy Benefits are paid on items carried out by a registered physiotherapist, approved by HIF. First visit: $45 Visits 2-10: $40 Visits 10+: $30 Hydrotherapy: $15 Antenatal: $15 (physiotherapy, occupational, orthoptics and speech therapy) Up to 5 years: $1200 No First visit: $35 Visits 2-10: $29 Visits 10+: $20 Hydrotherapy: $13 Antenatal: $13 (physiotherapy, occupational, orthoptics and speech therapy) Up to 5 years: $900 Group: $15 Over 5 years: $1500 Group: $13 Over 5 years: $1100 $600 sub for hydrotherapy, antenatal and group. $500 sub for hydrotherapy, antenatal and group. Special Options Saver Options Type of service Additional information Benefit Person Benefit Person Pharmacy payable on contraceptives or NHS (PBS) prescriptions or over the counter items purchased with or without a prescription. Member pays PBS contribution. Benefit is 100% of balance up to $80 per script item. $200 No Member pays PBS contribution. Benefit is 100% of balance up to $80 per script item. annual dietetics, healthy lifestyle, osteopathic, pharmacy, physiotherapy & podiatry) $350 Physiotherapy Benefits are paid on items carried out by a registered physiotherapist, approved by HIF. First visit: $32 Visits 2-10: $24 Visits 10+: $19 Hydrotherapy: $13 Antenatal: $13 Group: $8 annual ( chiropractic, physiotherapy, osteopathic and podiatry) $450 $400 sub for hydrotherapy, antenatal and group. annual ( chiropractic, physiotherapy, osteopathic and podiatry) $900 First visit: $32 Visits 2-10: $24 Visits 10+: $19 Hydrotherapy: $13 Antenatal: $13 Group: $8 annual dietetics, healthy lifestyle, osteopathic, pharmacy, physiotherapy and podiatry) $350 $300 sub for hydrotherapy, antenatal and group. No No annual dietetics, healthy lifestyle, osteopathic, pharmacy, physiotherapy and podiatry) $700 annual dietetics, healthy lifestyle, osteopathic, pharmacy, physiotherapy and podiatry) $

21 Extras benefits Premium Options Super Options Type of service Additional information Benefit Person Benefit Person Podiatry* Benefits are paid on consultations carried out by a registered podiatrist, approved by HIF. First visit: $32 $25 Consultations that are not performed in the podiatrist s registered practice: $12 $382 includes podiatry surgery performed in the podiatrist s registered rooms only. No First visit: $32 $23 Consultations that are not performed in the podiatrist s registered practice: $12 $354 includes podiatry surgery performed in the podiatrist s registered rooms only. No Psychology Maximum of 2 sessions will be paid on the same date if there is a minimum of 2 hours between sessions. Benefits are paid on consultations carried out by a registered psychologist, approved by HIF. First visit: $100 $55 Group: $30 per person to a max of $75 per session $1,000 per year No First visit: $75 $55 Group: $25 per person to a max of $75 per session $740 per year No Speech therapy Benefits are paid on items carried out by a registered speech therapist, approved by HIF. First visit: $75 $45 (occupational, orthoptics and physiotherapy) Up to 5 years: $1200 Over 5 years: $1500 No First visit: $75 $45 (occupational, orthoptics and physiotherapy) Up to 5 years: $900 Over 5 years: $1100 No * Benefits not payable when provided as part of treatment provided in, or arranged by a hospital (including surgery). Special Options Saver Options Type of service Additional information Benefit Person Benefit Person Podiatry* Benefits are paid on consultations carried out by a registered podiatrist, approved by HIF. First visit: $32 $23 Consultations that are not performed in the podiatrist s registered practice: $12 annual physiotherapy, osteopathic and podiatry) $450 annual physiotherapy, osteopathic and podiatry) $900 First visit: $32 $23 Consultations that are not performed in the podiatrist s registered practice: $12 annual dietetics, healthy lifestyle, osteopathic, pharmacy, physiotherapy & podiatry) $350 annual : dietetics, healthy lifestyle, osteopathic, pharmacy, physiotherapy and podiatry) $700 Psychology Maximum of 2 sessions will be paid on the same date if there is a minimum of 2 hours between sessions. Benefits are paid on consultations carried out by a registered psychologist, approved by HIF. N/A N/A No N/A N/A No Speech therapy Benefits are paid on items carried out by a registered speech therapist, approved by HIF. N/A N/A No N/A N/A No * Benefits not payable when provided as part of treatment provided in or arranged by, a hospital (including surgery)

22 Extras benefits: Optical - claim 100% of your annual! Type of service Additional information Premium Options Super Options Special Options Saver Options Optical Limit per person Annual, all services s up to 5 years s over 5 years s up to 5 years s over 5 years s up to 5 years s over 5 years s up to 5 years s over 5 years $280 $350 $260 $325 $140 $155 $110 $121 Benefits are paid on items carried out by a registered optometrist or optical provider, approved by HIF. Benefits are not paid on non-prescription safety glasses, protective glasses, tinting, sunglasses, cosmetic glasses or cosmetic contact lenses, or frames not purchased via a registered Australian optical provider. In-store savings Optical discounts on the high street If you currently hold Saver, Special, Super or Premium Extras cover with HIF, you can visit one of these high street retailers today and access the following exclusive member discounts with a simple flash of your HIF member card. Even better, you'll still receive the maximum benefit available on the remaining amount payable after your discount has been deducted. OPSM and Laubman and Pank - 21% discount off frames - 21% off lenses - 21% off lens extras (such as anti-reactive UV coating and tinting - 15% off non-prescription sunglasses - 15% off contact lenses purchased in store - Eye test bulk billed to Medicare EyeBenefit - 20% discount on complete glasses (e.g. frame and lenses) - 15% discount on lenses only - 10% discount on contact lenses Specsavers - 25% discount on complete glasses (e.g. frame and lenses) from the $149 range or above. - 20% discounts on optical extras (including Suntint and UV Filter, Polaroid lenses, Transitions lenses, Driving tints, Drivewear lenses, Thin and Light lenses) - Free Digital Retinal Photography - Free contact lens assessment, fitting and trial (no discount on contact lens purchases) - Eye test bulk billed to Medicare VSP - 15% discount on contact lenses - Free second pair of glasses to the value of $149, where the value of the primary pair is $300 or over and not part of a no-gap deal. Please note: The above discounts only apply to items purchased in brick-and-mortar optical stores. They do not apply to items purchased online. Online savings Online stores and special offers We love making life easier for our members. That's why HIF members with Saver, Special, Super or Premium Extras cover can now buy prescription lenses, frames and contact lenses at potentially lower prices through the following online retail outlets. Rest assured that you'll still receive the maximum benefit available on your current level of cover too. 4 Eyes Optical: 4eyesoptical.com.au AusSpecs: ausspecs.com.au BeSpecd: bespecd.com.au Buy Contacts Online: buycontactsonline.com.au Clearly Contacts: clearlycontacts.com.au - spend $99 & enter code HIF to save 20% + free shipping Glasses Online: glassesonline.com.au Glasses Point: glassespoint.com.au My Lens: mylens.com.au Net Optical: netoptical.com.au Now Contacts: nowcontacts.com.au Optical Direct: opticaldirect.com.au Optics Online: optics-online.com.au Oscar Wylee: oscarwylee.com.au OzContacts: ozcontacts.com.au - save 15% with promo-code HIFOZ15 Specsavers: specavers.com.au Sneaking Duck: sneakingduck.com VisionDirect: visiondirect.com.au WebContacts: webcontacts.com.au WebGlasses: webglasses.com.au Please note: The online discounts listed above do not indicate any preference or priority of provider or traditional store based versus internet based providers. Unlike some other funds, HIF fully supports the principle that members receive the same benefit no matter which provider or service delivery method is chosen. Only HIF members who hold an Extras product are eligible for these discounts. This list is current as at 1 June

23 Extras benefits: Dental annual s Premium Options General - Uned General - Limited Item Number Year 1 Year 2 Year 3 Year 4 Year After 5 Years No Limit No Limit No Limit No Limit No Limit No Limit $1,500 $1,800 $2,100 $2,400 $2,700 $3,000 Inlay/Onlay $1,000 $1,100 $1,200 $1,300 $1,400 $1,500 Special Options General - Uned General - Limited Item Number Year 1 Year 2 Year 3 Year 4 Year After 5 Years No Limit No Limit No Limit No Limit No Limit No Limit $800 $950 $1,150 $1,350 $1,550 $1,750 Inlay/Onlay $500 $600 $700 $800 $900 $1,000 Denture, Crown, Bridge $600 $700 $800 $900 $1,000 $1,100 Denture, Crown, Bridge $1,200 $1,300 $1,400 $1,500 $1,600 $1,700 Periodontic & Endodontic $300 $400 $500 $600 $700 $800 Periodontic & Endodontic Orthodontic (Lifetime Limit*) Total annual s per person Super Options General - Uned General - Limited $700 $800 $900 $1,000 $1,100 $1, $1,500 $1,800 $2,100 $2,400 $2,700 $3,000 $1,500 $1,800 $2,100 $2,400 $2,700 $3,000 Item Number Year 1 Year 2 Year 3 Year 4 Year After 5 Years No Limit No Limit No Limit No Limit No Limit No Limit $1,150 $1,350 $1,550 $1,750 $2,050 $2,350 Inlay/Onlay $700 $800 $900 $1,000 $1,100 $1,200 Denture, Crown, Bridge+ Periodontic & Endodontic Orthodontic (Lifetime Limit*) Total annual s per person $900 $1,000 $1,100 $1,200 $1,300 $1,400 $500 $600 $700 $800 $900 $1, $1,300 $1,500 $1,700 $1,900 $2,200 $2,500 $1,300 $1,500 $1,700 $1,900 $2,200 $2,500 Orthodontic (Lifetime Limit*) Total annual s per person Saver Options General - Uned General - Limited $1,000 $1,200 $1,400 $1,600 $1,800 $2,000 $1,000 $1,200 $1,400 $1,600 $1,800 $2,000 Item Number Year 1 Year 2 Year 3 Year 4 Year Inlay/Onlay Denture, Crown, Bridge+ Periodontic & Endodontic Orthodontic (Lifetime Limit*) Total annual s per person After 5 Years No Limit No Limit No Limit No Limit No Limit No Limit $750 $850 $950 $1,050 $1,150 $1,250 $750 $850 $950 $1,050 $1,150 $1,250 *For more information on Lifetime Limits please refer to Important information about your dental cover on page

24 Important information about your dental cover Benefits are only paid on accounts rendered by a registered dentist or dental prosthetist. The dentist or dental prosthetist must be in private practice. Dental prosthetists are allowed to perform a ed range of services for benefit purposes. There are some items within item code ranges for which HIF does not pay a benefit, or if they are performed with another item in the same course of treatment. Limits apply to the number of times some items, such as bleaching, attract a benefit. Benefits for replacement dentures and partial dentures are not paid within three years of previous supply. Orthodontic s are lifetime s per person. Benefits are not payable in excess of the annual shown and include benefits paid under another health insurance policy. The applicable benefit is payable on the date the service is rendered e.g. the date braces are fitted. Feedback, disputes and privacy Compliments and complaints Your feedback is valuable to us, so don t be afraid to get in touch. You may wish to comment on your personal experiences with HIF, or you may wish to lodge a compliment (or complaint) about the service you ve received from our team. Whatever your feedback relates to, we address each and every compliment/ complaint and will always respond accordingly. Your input is a vital part of ensuring our organisation meets or ideally exceeds your expectations at all times. To submit feedback, simply visit hif.com.au and complete the online feedback form. Alternatively, you can hello@hif.com.au or call us on or (overseas number). Benefits towards orthodontic treatment (including payment plans) are not payable by HIF if the treatment or service has commenced prior to joining HIF. We welcome all customers transferring from other insurers, however if you're engaged in an instalment payment plan with another health provider it is critical (to avoid potential out of pocket expenses) that you clarify the specifics of your arrangement with HIF prior to transferring cover. If you are unsure of your entitlements, please contact us before commencing a course of treatment with full details of the necessary dental items as provided by your dental provider and we will provide you with a benefit estimate. Annual s are refreshed on 1 January each year, so if you re planning a course of treatment it may be financially advantageous to stagger services over two calendar years. Our dispute resolution process We are committed to providing our members with access to the highest level of service and we value the feedback that our members provide. If you have a concern regarding your HIF membership, our products, benefits or our service, we would be happy to hear from you, please call us on or (overseas number) or hello@hif.com.au Your privacy The personal information you provide to us will be primarily used by HIF to deliver health insurance products and services as requested by you. The information supplied by you will remain confidential. This information may be disclosed to third parties and authorised government agencies in order to facilitate the delivery of services Frequently asked questions How long can my child stay on my policy? Providing your child or children are dependent and living with you, they can be included on your policy until they turn 21. If they are studying in an approved Australian education institution, they can remain on your policy until they are 25 years of age. What is Medicare Levy Surcharge (MLS)? The Medicare Levy Surcharge (MLS) is a Federal Government initiative designed to encourage individuals to take out private Hospital cover and use private hospitals, thereby reducing demand on the public system. The surcharge is levied on Australian taxpayers who earn above a certain income and don t have private Hospital cover. For more info visit hif.com.au associated with your health insurance. Failure to provide personal information may result in the failure to process or deliver the service requested. For a complete HIF Privacy Policy brochure, please contact us on or (overseas number) or download a copy at hif.com.au What if you re from a reciprocal country? If you are from a country that has a reciprocal health care agreement with Australia, you are entitled to receive emergency treatment in a public hospital anywhere in Australia. The key word here is emergency. Reciprocal health care agreements aren t designed to replace private travel and health insurance. If you rely on a reciprocal agreement, you may have to wait a while before you re treated, even for emergency treatment. Taking out private health insurance means you won t have to go on a public waiting list. What s more, you ll be able to choose your own doctor and hospital. The countries with reciprocal health care agreements are: New Zealand, the United Kingdom, the Republic of Ireland, Sweden, the Netherlands, Finland, Italy, Belgium, Malta, Slovenia and Norway. However, please note that students from Norway, Finland, Malta and the Republic of Ireland aren t by agreements with those countries. We will gladly discuss the matter with you or escalate the matter to a senior manager if required. Should you be unhappy with the outcome, please rest assured that we have an internal dispute resolution process in place. To escalate your complaint to this level, please put 46 the issue in writing and send it to: 47 Member Action Review Committee HIF, GPO Box X2221, PERTH, WA 6847

25 Frequently asked questions (Cont) What are waiting periods? A waiting period is the standard period of time that must be served as an HIF member before you re eligible to claim a benefit. What happens when I get permanent residency? When you get permanent residency, you will receive a Medicare Eligibility letter. The letter will give you one year to purchase domestic private health insurance cover before you are charged Lifetime Health Cover loading (LHC). When you become eligible for Medicare, you are also entitled to the Federal Government Rebate. What is the Lifetime Health Cover loading (LHC)? The federal Government introduced the Lifetime Health Cover loading to encourage permanent residents of Australia to take out private Hospital cover at a younger age. Basically, it recognises the length of time you ve had private health insurance and rewards that loyalty by offering lower premiums so the earlier you take out health cover, the cheaper your premiums. How is the LHC loading applied? For every year over the age of 30 that you don t have private Hospital cover, a 2% loading is applied to the cost of your insurance (increasing each year until it reaches 70%). For example, a single 37 year old would pay 14% LHC loading so it really pays to take out private Hospital cover sooner rather than later. For couples and families, however, the loading is initially calculated based on your respective dates of birth and then halved. For example, a couple aged 33 and 36 would generate a combined loading of 18% initially (6% + 12%), so the final loading that is applied to their joint policy is 9%. If you find that you will incur a loading, you will be required to pay this on top of the base premium that you re initially quoted for your Hospital cover. If you decide to join HIF, your loading will automatically be applied to the quoted amount once you provide your date of birth. What happens to my visa if I don t take out Hospital cover? If you don t take out Hospital cover and it is a requirement of your visa, your visa will be refused and you won t be able to come to Australia. What if I cancel my cover before my visa runs out? We may be obliged to notify the Department of Immigration and Citizenship if your policy is cancelled. Can I swap health funds if I received a visa compliance letter from another fund? Yes, you can. Your health insurance cover is completely portable and we will even recognise your full length of membership with your previous fund, which means you don t have to re-serve waiting periods you ve already served with another health insurance provider. What is out-patient medical? Out-patient medical refers to any treatment you receive in a doctor s rooms or a hospital emergency/casualty department. For example, a visit to your general practitioner, doctor or specialist, or services such as x-rays or blood tests. How do I claim if I go to a doctor? If you consult a doctor or specialist you will need to pay the charge to the receptionist at the time of your visit. You ll receive a receipt outlining the costs, which you can mail to us with a claim form you can download a claim form from hif.com.au. How long do I need to be for? Refer to the individual policy. If my visa is not approved, can I get a refund? Yes, you are entitled to a refund, although a $50 admin fee will be charged. What do I need to bring when I arrive in Australia? If you currently have health insurance in your country of residence, you will need to bring your policy details, including: The start and end dates of your policy Details of policy coverage and, if possible, a policy document or brochure that outlines exactly what is Who is on the policy Any claims that have been made in the last 1 Your health fund should be able to give you all of this information. What is a pre-existing condition? In accordance with HIF s Fund Rules and The National Health Act, a pre-existing ailment is an ailment, illness or condition of which the signs or symptoms, in the opinion of a medical practitioner appointed by HIF, existed during the six months preceding the day on which the member commenced cover with HIF for: 1. Benefits in accordance with the applicable benefits arrangement; or 2. If applicable, benefits in accordance with a previous benefits arrangement. In forming an opinion referred to above, the medical practitioner appointed by the organisation must have regard to any information relating to the ailment, illness or condition that was given to him or her by the medical practitioner who treated the ailment, illness or condition. This rule applies whether the ailment, illness or condition was known to the member or not. What is repatriation? If you re by our Working Visa covers and you have to be repatriated to your home country because you are terminally ill or suffer from a substantial life-altering illness or injury, we will pay a contribution towards the cost of your return travel with another family member and a professional who s qualified to provide medical supervision. The benefit is only payable after we and the treating medical practitioner agree that repatriation is necessary due to a terminal illness or a substantially life-altering illness or injury. In the event of death, the deceased person s mortal remains, and those of any other person by the policy, may be repatriated to their home country, if legally permissible

26 Glossary AccessGap Cover AccessGap Cover is our medical gap cover arrangement, designed to minimise or eliminate out-of-pocket expenses for medical services when you re an inpatient in a registered overnight hospital or day facility. Admission The period of time during which a person is admitted as an inpatient for a condition or illness into an approved hospital/ day facility for the purpose of receiving hospital treatment until the time they are discharged from the hospital/day facility. Annual The maximum of benefits payable to a member in a calendar year, commencing 1 st January and ending 31 st December. Approved service provider A provider or service that s approved by HIF. If you re unsure about the status of a Hospital, Medical or Extras provider, contact us on Unless stated, Extras services are not approved unless the health provider and HIF member (patient) are both physically present in the health provider s registered practice at the time of a consultation. Benefit The payment due to the primary member for services received by an approved provider. Dependant A person dependent upon the primary member. This includes: Student dependants children, stepchildren, legally adopted children and children to whom the primary member is the legal guardian, where the dependant is under the age of 25 years, unmarried, not in a de facto relationship and enrolled in a full-time course of study at a recognised educational institution. Excess The amount selected on a Hospital cover which the primary member agrees to pay before a benefit will be payable. Excluded service Services that are not by a benefit, so all costs will be paid by you. Extras Cover At HIF, we call ancillary cover Extras it s our name for all those day-to-day health care services, such as dental, optical and physio, plus a whole host more, including emergency ambulance cover. Federal Government Rebate The proportion of private health cover premiums that the Government contributes for permanent Australian residents. HICAPS/ISOFT Providers with HICAPS or ISOFT technology can electronically claim your benefit directly from HIF. Inpatient A person who has been admitted into an approved hospital or day facility, allocated a bed and then discharged following treatment. Non-contracted hospital A private hospital not contracted by the Australian Health Services Alliance or HIF to provide services to HIF members. Out-ofpocket costs cannot be guaranteed in these hospitals (basic default benefit applies). Out-of-pocket The amount remaining to be paid by the member after the HIF benefits have been paid. Outpatient An outpatient is someone who has received medical treatment in a doctor s surgery or casualty department and has not been admitted into hospital. Policy holder A holder of an insurance policy who is referable to HIF. A holder of a HIF insurance policy is referred to as the primary member. Practitioners in private practice A practitioner who does not: a) Use any publicly funded hospital, clinic, health centre or other such facility, including a facility provided by a municipal authority for, or in connection with, the provision of an extras service for which a benefit is claimed under the extras table b) Receive publicly funded assistance or support, whether by way of remuneration, subsidy or otherwise, in connection with the provision of the extras service, except where the extras service is provided at the clinics of strategic alliance partners, joint ventures or HIF s clinics as pre-existing even if you haven t seen your doctor about it before joining or upgrading. 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 the Hospital cover then the ailment would be classed as pre-existing. Primary member The first named member, irrespective of who pays contributions to HIF for the provision of health cover. The primary member also holds the legal responsibility to ensure the membership is kept financial at all times, and holds the right to add or remove dependants from the membership. In the instance that the primary member wishes to provide authority for another person to act on their behalf, a spousal/ agents authority is required. Qualifying periods Any period occurring immediately after joining the fund or joining a higher benefiting table, during which either some or all fund benefit is not payable. Recognised educational institution An Australian educational institution such as a school, college or university, recognised by the Commonwealth, State or Territory Governments. Restricted service Hospital services which are only for payments at the basic benefit level. Transfer certificate The document transferred between registered health funds, detailing the member s fund history (including Certified Age at Entry), confirmation of the financial status of the member and claims history. Pre-existing condition Domestic partners, your own children, stepchildren, legally adopted children to A pre-existing condition is defined as an ailment, illness, or condition that you had whom the primary member is the legal Medicare Benefit Schedule (MBS) signs or symptoms of during the six months guardian (they must be under the age of 21, Waiting periods The schedule of benefits produced by the before you joined our fund or upgraded to a unmarried and not in a de facto relationship, The standard period which applies before Department of Health and Aged Care, listing higher level of cover or the same cover with nor the child of a dependant child). a member becomes eligible for benefit. eligible services, fees and benefits for Medical a reduced or nil excess. It is not necessary Services, including inpatient services. that you or your doctor knew what your condition was or that the condition had been diagnosed. A condition can still be classed For more glossary terms, visit hif.com.au 50 51

27 Follow us on At HIF we re all about choice. Call, or contact us online. hif.com.au or Int l hello@hif.com.au GPO Box X2221 Perth WA 6847 Australia s first certified Carbon Neutral health fund. The information in this brochure is correct as at 1 July Minor changes may occur after that date. If major changes occur, a separate insertion will be included in the brochure or the brochure will be reprinted. HIF members are encouraged to regularly download the latest copy of this brochure from hif.com.au, or contact us and we will send one to you. Health Insurance Fund of Australia Ltd (HIF) ACN An Australian public company ed by guarantee. A registered private health insurer.