Gold Extras (Effective 1 July 2018)

Transcription

1 This product is not for sale to members joining CUA Health after 16 November 2016 What s Covered Category Dental Optical Non PBS Pharmaceuticals Physiotherapy Chiropractic & Osteopathy Podiatry Alternative Therapies Other Services Service Waiting Period Annual Limit General Dental Includes examinations, preventative treatment, scale and clean, extractions, fillings and x-rays etc. Endodontic (E.g. Root Canal treatment) 1 No Annual limit $500 Major Dental Includes most Periodontics (e.g. treatment of gum disease), root canal, crowns, dentures and bridges etc. Orthodontics Includes provision of braces and adjustments Includes frames, prescription lenses and repairs. Benefits for some prescription drugs that are not subsidised by the Government under Pharmaceutical Benefits Scheme & comply with fund benefit eligibility. Includes one-on-one and group consultations and Pilates/Hydrotherapy sessions by a physiotherapist Benefits towards consultations with an osteopath or chiropractor Benefits towards consultations, biomechanical assessments and custom orthotics. incl. Acupuncture, Naturopathy, Homeopathy, Remedial Massage, Reflexology, Kinesiology, Bowen therapy, Aroma Therapy & Remedial Massage Psychology Cover for consultations in Private Practice only, and if not already covered by Medicare Speech Therapy Benefits for consultations with a speech therapist Eye/Orthoptic Therapy Benefits for consultations with an orthoptist Occupational Therapy Benefits for consultations with occupation therapists Dietetics and Nutrition Benefits for dietitian and nutritionist consultations Exercise Physiology 1 1 $2000 Orthodontics Lifetime limit $2500 per person 6 months $300 $600^^ Year 1 -$600 Year 2 - $650 Year 3+ - $700 Person Family Year 1 -$400 $800 Year 2 - $450 $850 Year 3+ - $500 $900 $600# # Podiatry includes benefits for custom-made podiatry aids (Not pre made or off-the-shelf/customised orthotics). 12 month waiting Period applies. ^^ You pay an amount equivalent to the PBS contribution (e.g. $39.50 as at 1 January 2018) before a benefit is paid + Refer to Health Management Program benefit rules on page 3. Person Family $400 $800 $500

2 Health Aids and Appliances Hearing Aids Ambulance Transport Individual benefits may apply for each type of Health Aid/Appliance. Benefits are only paid towards purchase of appliances. No benefits are paid to rent any device. Includes provision of Hearing aids. Payable once in a 5 year period. Benefits are paid towards purchase and repair of appliances, no benefits paid separately for fitting hearing aids. Includes benefit for repairs (70% of cost) For residents of all states, except QLD and TAS, benefits are payable for Emergency only ambulance transport anywhere in Australia (including Air Ambulance). 12 Months 24 Months No Waiting Period $600 80% of cost (Sub limits apply for some appliances) $1, % Health Management Programs + You can claim benefits towards approved health management programs intended to prevent or manage a diagnosed health condition 6 months Person Family Year 1 -$100 $200 Year 2 - $150 $250 Year 3+ - $200 $300 Waiting Periods There s a period of time you ll need to wait before you can claim certain services from us. This can relate to different situations: When you get health insurance for the first time in Australia. If you switch insurers and haven t fully served your waiting periods with your existing insurer. If you increase your cover (with CUA Health or when switching from another insurer). In the first two situations above, you won t be able to claim until your waiting period is served. However, if you re still within a waiting period when you increase your cover, you ll be able to claim at the level of your previous cover (or a CUA Health cover deemed similar to your cover with the previous fund if you are transferring). Waiting periods have been listed in the table on the first page Additional Benefits Extra general dental benefits for kids: With CUA Health, kids receive additional general dental benefits to help reduce or eliminate the cost of dental care. For routine dental services (periodic oral examination - item 012, scaling/cleaning item 114, and fluoride item 121) there will be no gap payable up to a total value of $250 per visit, for two visits per year. This benefit is within the general dental annual limits and available to dependent children up to age 23. Travel Expenses: You can claim benefits when a hospital admission is required for a policy holder, or a dependant covered on the policy outside their usual place of residence and the return distance trip is greater than 400 km. The benefits are limited to 50% of the cost to a maximum of $200) per year. You ll need to give us a tax invoice that includes the date of service and service provider s ABN. Benefits are not paid for any accommodation required for family members during hospital admission or when no hospital admission is needed e.g. visits to specialists.

3 Mammograms: Benefits can be claimed for Mammograms when not covered by the Medicare rebate. Benefits are limited to $65 per person per year. Member discounts from optical retailers: CUA Health members get additional discounts and free services, assessments or fitting sessions at leading Optical providers including Luxottica (OPSM, Laubman & Pank), OPSM Direct, Specsavers, Eyebenefit, VPS Global and others if they have an extras cover. Refer to refer to cua.com.au/health-insurance or the CUA Health brochure for details of discounts available at each provider. Health aids and appliance sub-limits and business rules Hearing aid: One hearing aid device per person every 5 years (one set every 5 years if a separate hearing aid required per ear Blood glucose monitors: Sub-limit of $350 per person, per year. Nebulisers & asthma pumps: Sub-limit of $200 per year. One service per person every 2 years CPAP devices: Sub-limit of $350 per. One device per person every 2 years. A recognised sleep study program must have been undertaken for a CPAP pump. Replacements for full CPAP masks are payable every 12 months from the date of previous supply. Benefits are not payable towards any hire of CPAP masks and CPAP pump components. TENS machine/circulation boosters: Sub-limit of $125 per year. One device per person every year Peak flow meters/spacers: Sub-limit of $35 per year. One device per person every year Blood pressure monitor: Sub-limit of $125 per year. One device per policy every year Mammary prosthesis: Sub-limit of $125 per year. Repair of Health Aids and Appliances Sub-limit of $100 per year. Benefits only payable if the appliance is not under warranty. Benefits will not be paid within the warranty period. Benefits for repairs count towards the limit of that Health Appliance. No sub-limit for other Aids or appliances including pressure garments, custom-built braces, splints and other approved orthoses. Benefits are only payable for custom-made braces, not for pre-made or off-the-shelf customised items. Benefits for compression stockings or circulation boosters are payable for chemotherapy or lymphedema, venous stasis or major surgery. We may require a letter from a medical provider before payment of wigs, compression stockings or circulation boosters. Benefits for wigs are payable from approved providers for chemotherapy or alopecia only. The list above is not comprehensive and may include other Health Aids and Appliances apart from the ones listed above. Benefits are only paid on purchases from companies with registered Australian Business Numbers (ABNs). We may ask for additional supporting documentation in order to pay a benefit for some other health aids and appliances. E.g. sleep study report for a CPAP device, proof of custom made orthotics, etc. Health management Programs You can claim benefits towards approved health management programs intended to prevent or manage a diagnosed health condition. Benefits are payable for services where they re part of a health management program or are provided on the advice of a health professional approved by us, and where the treatment is intended to improve a specific health condition/s. A letter from a Medical Practitioner referring the program may be needed clearly stating that the referred program is to manage the condition that has been diagnosed and it s expected outcomes. A health

4 management program benefit approval form renewal is required every year. The benefits are limited to 50% of the cost to a maximum of $100 per year. Goods or services that are primarily for the purpose of sport, recreation or entertainment are not eligible for benefits. You ll need to provide us with a health management program benefit approval form along with a tax invoice from the program provider What s Not Covered You will not be covered for treatment under this cover in some circumstances. Some examples of where you may not be covered include amongst others: Any ancillary treatment for which Medicare pays a benefit, like Psychology or Physiotherapy services referred by a GP and paid by Medicare Any difference between the fee for your provider and benefit paid by us. Benefits relating to sport, recreation or entertainment unless they re part of an approved health management program. Services where there is no itemised invoice, date of service, provider details and patients details, or other information that we may ask for to assess that claim. Any treatment considered an inpatient service. Any other treatment that is outside the definition of ancillary services we provide a benefit for. There may be other services not covered, for full details of what s not covered, refer to cua.com.au/health-insurance-insurance.

5 We re here to help If you have any questions about CUA Health we d be happy to help. Here s how you can get in touch with us Phone: Visit: cua.com.au/health-insurance cuahealth@cua.com.au Fax: Post: GPO Box 100, Brisbane QLD 4001 Or drop into your local CUA branch! More information about your cover and CUA Health business rules is available in our CUA Health Member Guide available on our website under brochures and forms section. Please visit CUA Health Insurance is provided by CUA Health Ltd (CHL) which is not an authorised deposit-taking institution. While CUA Health Insurance may be distributed by Credit Union Australia Ltd ABN (CUA), CUA is not liable for this product and does not stand behind CHL. Please note that benefits received under the products referred to in this fact sheet are paid in accordance with CUA Health fund rules. Not every aspect can be covered in this document. The information contained in this fact sheet includes details most relevant to your cover. Please read the information carefully in conjunction with CUA Health Brochure or CUA Health Member Guide (included in your welcome pack or available at cua.com.au/health-insurance-insurance)