This provides a summary of cover and isn t intended to be a comprehensive list of all the services covered.
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1 Top Hospital 1 APRIL 2018 CLOSED PRODUCT NOT AVAILABLE FOR PURCHASE Queensland Country Health Fund Ltd Hospital Cover Top Hospital cover is our most comprehensive hospital product and popular with those looking for complete peace of mind. Covering you for a comprehensive range of hospital services including, but not limited to pregnancy, heart related procedures, major eye surgery and joint replacement surgery. Top Hospital cover can be taken on its own or packaged with any of our extras packages. You can choose a $250 or $500 excess with this cover which is payable on admission to a hospital or day surgery. What You Are Covered For This provides a summary of cover and isn t intended to be a comprehensive list of all the services covered. Choice of doctor/hospital In-hospital rehabilitation treatment Public hospital accommodation as a private patient Cardiac and cardiac related procedures e.g. Open heart surgery Private hospital accommodation (private room if available) Assisted reproductive services e.g. IVF Theatre fees In-hospital psychiatric treatment* Intensive care Appendix removal Tonsils and adenoids removal Colonoscopies Gastroscopies Grommets in ears Gynaecological services Hernia repair Joint reconstructions Back surgery Brain surgery Plastic and reconstructive surgery Obstetric related services e.g. Birth and pregnancy Renal dialysis Hip and knee joint replacement surgery* Major eye surgery cataracts and eye lens procedures Nursing Special Benefit of up to $150 per day $750 per person covered. Home and Bush Benefit up to $50 per visit or $150 per day limited to $1000 per person covered. Medical Gap Cover for the 25% gap between the 75% Medicare Benefit and the Medicare Benefits Schedule fee for inpatient services. Surgically implanted prosthesis benefits Approved prosthesis benefits (artificial hips, knees, etc) as per the approved Government listing. Mammograms and bone density test Benefit up to $75 limited to 2 services for each of the above tests, only if not claimable from another source. Mechanical appliances and artificial aids # Benefit up to 85% of the cost or hire of mechanical appliances and artificial aids approved by Queensland Country Health Fund with an annual limit of $2000 per person per Membership Year. (sub-limits and conditions apply) Gastric banding, sleeving/diversions or bypass (weight loss surgery)* including replacements, repairs and adjustments Access Gap Cover The Access Gap benefit, for inpatient services, is a benefit over and above the Medicare Benefits Schedule for participating doctors. Hearing aids A benefit amount is provided to use over a period of three (3) Membership Years based on the date on which the first purchase of a hearing aid/s is made. The benefit limit is applied based on your length of membership with Queensland Country Health Fund. Benefits are per person and calculated at 85% of purchase cost up to the appropriate limit of benefit. Length of Membership Annual limit Up to 10 years... $ and up to 15 years... $ Years and over... $ 2000 Australian Hearing Services Benefit of $25 per Membership Year per eligible person for the cost of a Hearing Services Card Hospital boarder Benefits up to $35 per day to a maximum of four days per person listed on the Membership, where such accommodation is necessary for the well-being of the patient. * Nursing home type patients We pay a benefit toward a nursing home type patient. This amount is determined by the Federal Government. Certification is required. Benefit Limitation Periods. Hospital benefits payable on these hospital services during the designated benefit limitation period will be the minimum benefit declared by the Minister for Health, except when a waiting period is being served, in which case no benefit applies. Benefit Limitation Periods do not apply to new Members transferring from another private health insurer s hospital cover. # Benefits are not available on second hand equipment or on consumables. A benefit is payable for short term hiring (up to 3 months) of some mechanical aids. The purchase of some machines and monitors are limited to once every three Membership Years. Waiting periods will apply to all benefits outlined.
2 Restricted and excluded services There are no restrictions on this level of cover. There is no benefit entitlement for hospital treatment for which Medicare pays no benefit e.g. most cosmetic surgery. Excess options $250 $500 An excess is an amount you agree to pay upfront before a benefit is paid for overnight or same day hospital/day surgery admissions. You can choose to have a $250 or $500 excess. For a single policy regardless of the number of times within the same Membership Year you are hospitalised, you will only be responsible to pay a total excess contribution per Membership Year equivalent to the selected policy excess option. On a family policy, regardless of the number of people covered or the number of times within the same Membership Year these persons are hospitalised, each individual will only need to pay a total excess contribution per Membership Year equivalent to the selected policy excess option. For a family policy the total maximum excess payment obligation per Membership Year for the entire family is limited to an amount equivalent to twice the chosen excess option. This means for an entire family policy a total maximum excess obligation of $500 per Membership Year would apply on a $250 excess option product, or alternatively $1,000 per Membership Year for a $500 excess option. Children aged 12 and under are exempt from paying an excess. Waiting periods Initial waiting period Palliative care, psychiatric, rehabilitation services, and all other hospital treatment/services where there are no pre-existing conditions (excluding accidental injury*)... Pre-existing ailments, conditions or illnesses... 1 year Pregnancy related services (including childbirth) and assisted reproductive services... 1 year * Cover for an accident is immediate provided it is not recoverable from another source such as Workers Compensation, third party or other liability provision. Sporting accidents sustained by professional sportspeople in activities relating to their full-time employment, including training and competition are subject to a two month waiting period. BENEFIT LIMITATION Only applicable to a policyholder who is new to private health insurance hospital cover or a policyholder transferring their hospital cover in excess of 63 days from ceasing cover. This is an initial period of time during which only a minimum benefit is paid for certain hospital treatments or procedures. Minimum benefits apply for bariatric surgery (weight loss surgery), hip or knee joint replacement surgeries and in-hospital psychiatric treatment within two years of the commencement date of cover. Medical costs These are the fees that are charged by a doctor, surgeon, anaesthetist or other specialist for any treatment given to you whilst you re an inpatient in hospital. Private health insurance means that generally you can choose your own doctor and decide whether you will go into a public or private hospital. If you choose private, this may also mean you will have more of a choice of when your procedure will take place. You are covered for the cost of medical fees up to the Medicare Benefit Schedule (MBS) fee. The MBS fee is the amount set up by the Federal Government for each medical service covered by Medicare. You must be eligible for Medicare in order to be covered up to the MBS fee. If you choose to be treated as a private patient in a hospital (public or private), Medicare will cover you for 75% of the MBS fee for associated medical costs and we will cover the remaining 25%. If your specialist charges more than the MBS fee there will be a gap for you to pay. However, the Queensland Country Health Fund Access Gap Agreement can help eliminate or reduce the gap for you if your doctor/s chooses to use it. Access Gap Cover This is a direct billing arrangement between Queensland Country and your doctor/s that in most instances eliminates your out-of-pocket expenses for in-hospital doctor s fees (the gap). If your doctor charges up to the Medicare Benefits Schedule fee or is participating in the Access Gap Cover Scheme, in most cases you will have limited out-of-pocket costs. For doctors who are not participating in the Access Gap Scheme and are charging above the MBS fee, we will pay the difference between the Medicare benefit and the MBS fee. Any amount above the MBS fee will be the amount you are required to pay and this is referred to as your gap fee or out-of-pocket expenses.
3 Extra value from your Membership EXCLUSIVE UNIT ACCOMMODATION Queensland Country Health Fund has self contained units in both Brisbane and Townsville exclusively available to our Members travelling to those locations for medical treatment. These two bedroom units can be booked at very reasonable rates for an overnight stay or for several weeks, depending on your needs. MECHANICAL AIDS AND APPLIANCES We provide excellent benefits on a range of approved mechanical aids and appliances. We will cover up to 85% of the cost to purchase or short term hire of a selection of aids and appliances. This is limited to $2,000 per person per Membership Year (sub-limits and benefit replacement periods apply to some items). Please contact us regarding benefit availability prior to purchasing an aid or appliance. HEARING AIDS Hearing aids are covered on our Top Hospital product only. A benefit amount is provided to use over a period of three (3) Membership Years based on the date on which the first purchase of a hearing aid/s is made. The benefit limit is applied based on your length of membership with Queensland Country Health Fund - up to 10 years $1,000, years $1,500 and 15+ years $2,000. Benefits are per person and calculated at 85% of purchase cost up to the appropriate limit of benefit. Also, we pay $ 25 towards the cost of an Australian Hearing Services Card. Planning a trip to hospital? If you re planning any treatment or have a hospital procedure coming up, we would love to know about it. If you call us first we can discuss your options, assist with what you re covered for and check that you have served all waiting periods and you re all set to go. This way you can be more confident when attending medical appointments and will have a better idea of what to expect when you re admitted to hospital. Need more info? CALL: VISIT: qldcountryhealth.com.au info@qchfund.com.au
4 Premium Extras 1 APRIL 2018 Queensland Country Health Fund Ltd Extras Cover Premium Extras cover is the highest level of extras health cover we offer. It gives you superior benefits on a wide range of treatments like dental, optical, physiotherapy and chiropractic; and other health care services that aren t always covered by Medicare. With Premium Extras you receive generous rebates for each service, up to your available limits. Benefits listed below are examples only and not a complete list. Dental SERVICES COVERED AND EXAMPLE ITEMS LIMIT $1,400 Per person, per Membership Year for all dental services (excluding orthodontic which has separate claim limits) Diagnostic Sub-limit Periodic oral exam (012) $50 $600 Preventative Scale and clean (114) $79 Mouth guards (151) $150 $800 Restorative Filling/restoration (531) $90 $800 Extractions Tooth extraction - surgical (322) 1 $180 $700 Endodontics Root canal 1st stage (415) 1 $170 $600 Crowns & bridges Full veneered crown (615) 1 $800 $800 (sub-limit accumulating to $1,500 per year after 2 years of membership) Orthodontics PERIOD OF MEMBERSHIP* FIRST ONWARDS MEMBER CATEGORY $3,000 Lifetime Limit. All limits per person. Benefits are paid at 85% of cost. New - no previous cover Nil $1,000 $2,000 $3,000 New or existing Member upgrading extras cover (having served all waiting periods on current Extras cover) Previous extras cover benefit entitlement $1,000 $2,000 $3,000 Transferring from another fund with an equivalent level of cover $1,000 $1,000 $2,000 $3,000 N.B. If an individual has already claimed orthodontic benefits on a previous cover, the amount that has already been claimed by that person will affect the available limit remaining under the Lifetime Limit of their chosen cover. * Period of membership refers specifically to actual period of cover under this product with Queensland Country Health Fund.
5 Optical We have negotiated agreements with a large number of optical providers across Australia. When you visit one of our preferred optical providers you will receive substantial discounts on frames, lenses and contact lenses. Visit our website for a full list of our Premier Providers. SERVICES COVERED AND EXAMPLE ITEMS Frames (110) Single vision lenses (212) Progressive lenses (512) Contact lenses (812) Therapies SERVICE OR CONSULTATION TYPE Physiotherapy LIMIT Per person, per Membership Year or all optical services $285 $55 Subsequent visit $40 LIMIT $1,400 Per person, per Membership Year for all therapy services Sub-limit Group therapy $10 ($150 combined sub-limit applies # ) Exercise physiology $50 Subsequent visit $35 Monthly program fee $35 Combined sub-limit $700 Group therapy $10 ($150 combined sub-limit applies # ) Chiropractic $55 Subsequent visit $35 Remedial massage, Bowen therapy, myotherapy, osteopathy Combined sub-limit $700 Initial & subsequent visit $35 Combined sub-limit $700 Acupuncture Initial & subsequent visit $35 Up to overall limit Audiology Initial & subsequent visit $50 Report $60 Naturopath Up to overall limit Initial & subsequent visit $35 Up to overall limit Dietician $75 Subsequent visit $40 Occupational therapy $80 Subsequent visit $40 Orthoptic therapy No sub-limit. Benefits paid providing overall benefit limit for therapies Up to overall is not limit exceeded. Up to overall limit Initial & subsequent visit $60 Up to overall limit Foot orthoses and orthopaedic shoes Approved appliances (orthoses and custom made footwear) Combined sub-limit $700 85% of cost $150 * Benefits are payable for services rendered by Australian Regional Health Group Limited approved providers registered with Queensland Country Health Fund as well as Bowen Therapists that are registered with the Bowen Association of Australia (BAA), Bowen Therapists Federation of Australian (BTFA), or Australian Traditional Medicine Society (ATMS). # Group therapy has a combined sub-limit for services provided under physiotherapy and exercise physiology.
6 Therapies cont. SERVICE OR CONSULTATION TYPE LIMIT $1,400 Per person, per Membership Year for all therapy services Psychology Sub-limit Initial & subsequent visit $80 Up to overall limit No sub-limit. Benefits paid Speech therapy providing overall benefit $70 limit for all therapies is not Up to exceeded. overall limit Subsequent visit $35 Podiatry Initial & subsequent visit Approved appliances (orthotics) Minor procedures Other Extras SERVICE OR CONSULTATION TYPE Childbirth education Pharmaceutical^ School accidents Healthy living $40 85% of cost 75% of cost $600 LIMIT Per Membership Year 1 $60 $60 Up to $70 per script $500 per person 100% Limit of $750 per child ELIGIBLE SERVICES $150 per person, per Membership Year Participate in a choice of approved weight management programs^^ Participate in other approved health management programs* including: Gym membership Personal training programs Yoga classes Aquatic exercise/rehabilitation* including pool entry and exercise classes (excludes swim classes/lessons) Participate in quit smoking programs Have your skin checked for skin cancers through mole mapping Consultation fees for diabetes educator Consultation fees for metabolic dieticians and nutritionists when providing assistance with weight management Bowel screening tests and bone density test (no doctor s referral will be required) PSA test (one per year) we will cover a second yearly test not covered by Medicare ^ Prescriptions not covered by the PBS, excluding contraceptives and items normally available without prescription and drugs not approved for sale in Australia. A co-payment applies to each prescription item equal to the current PBS Patient Contribution. * To comply with private health insurance legislation you must have been referred by your health care professional to participate in a health management or chronic disease management program to address or improve a specific health or medical condition. A Health Management Program Benefit Approval Form, available on our website, must accompany a claim for these benefits. ^^ Before enrolling in a weight management program please contact the Fund to clarify the eligibility to benefits. Extra value from your membership REWARDING LIMITS Once you have held your extras cover with us for one year, we will automatically increase your annual limits for dental and therapies by $50 per year, up to a maximum of $250. After five years of membership, your limits will increase to $1,650 per person per Membership Year. Rewarding limits do not apply to sub-limits. If you ve had a busy claiming year; visits to the dentist, podiatrist, regular massages, you may be curious about what you have used and what you have left to claim. You can always check your membership online with our Mobile App, available for ios and Android. It s a great way to keep track of all your claims and view benefit limits from the comfort of your own home. You can also process your own claims online for some services and do quotes. To utilise our Mobile App you just need to register and log on. Of course, not everyone is tech savvy, so we are here on the phones to assist you any way that we can. Need more info? CALL: VISIT: qldcountryhealth.com.au info@qchfund.com.au
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