Essentials Bundle. Your guide to. Questions? Need Advice? Our consultants are available to help.

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1 Your guide to Essentials Bundle Questions? Need Advice? Our consultants are available to help. Comparethemarket.com.au ACN Level 2, 80 Jephson Street, Toowong Qld 4066 PO Box 301, Toowong Qld 4066 Australia

2 Let s be frank, nobody actually wants to use their hospital insurance, but they do want to make the most of their Extras cover. This Frank fact sheet details what you need to know about the Essentials Bundle; from what s covered to what s excluded plus excesses, annual limits and waiting periods that apply. We recommend that you read and retain this fact sheet along with the 2018 Standard Information Statement for this product and Frank s Important Information. This information is current at the time of publishing (April 2018). what s covered in a hospital? The Essentials Bundle provides benefits towards theatre surgery costs, shared or private room accommodation charges in a participating private hospital* or shared room accommodation charges in a public hospital^ for all procedures unless they are listed as an exclusion or covered in a public hospital only. Accidents Covers accidental injuries sustained after joining Frank. For an accident to be covered, treatment must be sought through a Doctor or an Emergency Department within 48 hours of sustaining the injury and the hospital admission must occur within 90 days. The Doctor s letter / hospital report must be supplied to Frank. Emergency Ambulance Covers emergency ambulance services by a recognised provider Australia wide. Does not include cover for non emergency ambulance transport i.e. from a hospital to your home or ambulance transfers between hospitals. Publicly funded and State Government ambulance schemes are excluded (TAS/NSW/ACT/QLD) Find out more about emergency ambulance services Other Services As long as the service or procedure is covered by Medicare and isn t excluded or restricted (covered in a public hospital only) on this cover, Frank will pay benefits towards participating private hospital theatre surgery costs, shared and private room accommodation charges and surgical implants. For included surgically implanted prostheses, Frank will cover 100% of the prostheses as long as it s on the Department of Health and Ageing s prostheses list. * Fixed benefits are payable in non-participating private hospitals. View Frank s participating private hospitals. What s covered in a public hospital only? The Essentials Bundle provides benefits as a private patient in a public hospital^ only for the following procedures: Palliative care Psychiatric Rehabilitation ^ If you elect to be admitted to a public hospital as a private patient, you are entitled to the minimum benefits payable by private health insurers for a shared room in a public hospital. Electing to be a private patient in a public hospital could result in out of pocket costs to you. Ensure you receive written informed financial consent from your treating doctors and hospital before any hospital admission. w. frankhealthinsurance.com.au p Page 1

3 what s excluded in a hospital? Taking out Frank s Essentials Bundle cover won t give you benefits as a private patient in a public hospital or private hospital for the following services. Cosmetic surgery that isn t medically required Dental implant surgery For dental implants in hospital as an in-patient Dialysis Eye surgery Including cataract surgery, eye lens procedures and corneal transplants Joint replacements Pregnancy IVF and assisted reproductive services Weight loss and obesity related surgeries excess. Per person Couple / Family $500 per year $1,000 per policy per year (if more than one person is hospitalised) There is no excess for kids under 21 years old who are covered as part of a family or single parent family Essentials Bundle. Learn more about hospital excess. hospital waiting periods. Just because you buy hospital cover today, doesn t mean you can claim today. Generally a new health insurance member will need to be with a fund for a period of time before their fund will pay any benefits. This is called a waiting period. The Essentials Bundle has the following waiting periods: 0 days for hospital treatment as a result of an accident 2 months for psychiatric, rehabilitation, palliative care, hospital services and procedures that are not pre-existing conditions 12 months for pre-existing conditions If you ve switched to Frank from another fund on an equal level of cover and have already served waiting periods, you might not have to wait again. Find out more about waiting periods. w. frankhealthinsurance.com.au p Page 2

4 pre-existing conditions. There s a special waiting period for pre-existing conditions. A health insurer s standard waiting period for a service might be 2 months, but if you have a pre-existing condition relating to that service then the waiting period will be 12 months. Learn more about pre-existing conditions. frank gap cover. Every hospital procedure has a minimum benefit payable set by Medicare. This is called the Medicare Benefits Schedule (MBS) Fee. You always get 100% of this back if you have private health insurance. However, if your doctor charges more than this, Frank will cover you up to 120% of the MBS to help reduce your out of pocket costs. Anything your doctor charges above 120% of the scheduled fee is an out of pocket expense. You can check this amount with your doctor. Frank covers 100% of the MBS for pathology and radiology. choice of doctor in a public hospital. When making a decision about which hospital you ll be treated at, keep in mind that not all doctors have admitting rights into all hospitals. Basically, if you have a preferred doctor they might not be allowed treat you in a public hospital. Your doctor will be able to tell you what hospitals they have admitting rights to. are there times Frank won t pay? If you can claim from someone else you can t claim through Frank (think workers compensation). View the full list of what Frank may not be able to pay on a hospital or medical claim. more information about what s covered. Frank has a lot more information about hospital fees, doctors fees, gap and all the nitty gritty. Find out more about hospital and medical fees. Learn more about Medical Gap cover. Before receiving any treatment, check in with Frank for a quote so that you know what you re covered for, how much we ll pay towards the treatment and any out of pocket expenses that you might face. w. frankhealthinsurance.com.au p Page 3

5 extras cover with 60% back. With the Essentials Bundle you get 60% back on included extras. Whatever the provider charges, we pay 60% back up to your annual limits. That means if you are charged $40 for a treatment you ll get $24 back as long as you have served your waiting periods and have available limits. what extras services are covered? Service General, Preventative and Major Dental (combined) Excludes dentures. Dental treatment rules apply for general, preventative, major dental and orthodontic treatments. Dental treatment rules apply Waiting Period 2 months General & Preventative 12 months Major Per person annual limit (per calendar year) $600 From 1 May 2018, save 15-40% off # dental treatments performed by any smile.com.au approved dentist across Australia. Orthodontic A lifetime limit of $1,700 applies for orthodontic services 12 months $500 Optical Benefits are only payable towards prescription glasses and prescription contact lenses Chiropractic & Osteopathy (combined)* A limit of 1 per year applies to Chiropractic X-rays Physiotherapy, Hydrotherapy, Myotherapy and Exercise Physiology (combined)* 6 months $250 2 months $300 2 months $300 Naturopathy, Homeopathy, Acupuncture & Remedial Massage (combined)* 2 months $400 Psychology If you re entitled to a Medicare rebate on your psychology sessions, you cannot claim your out of pocket with Frank. Once you are no longer eligible to claim with Medicare, then you can claim on this cover 2 months $200 # Savings may vary between dentists. It is recommended that members obtain a quote prior to treatment * Benefits will only be paid for one consultation and/or treatment per provider per day You cannot claim on any accessories, exercise equipment, herbs, supplements or pills prescribed by the provider, only consultations w. frankhealthinsurance.com.au p Page 4

6 Service Waiting Period Per person annual limit (per calendar year) Dietetics 2 months $200 Speech Therapy 2 months $200 Podiatry Podiatry Surgery must be performed by an orthopaedic surgeon or an approved podiatric surgeon. Find an approved podiatric surgeon 2 months general podiatry 12 months podiatry surgery $200 Orthotics Benefits can only be claimed if the orthotics are custom made (from a cast or mould taken from you) by a podiatrist in a private practice 12 months $200 Pharmacy (including Travel Vaccinations) Benefits cannot be paid for PBS Scripts, contraceptives, items not on the TGA Register or items purchased overseas. Pharmaceuticals must be classed as either Schedule 4 or Schedule 8 for benefits to be paid Travel Vaccinations Benefits are payable for selected travel vaccinations administered by a doctor or at a vaccine clinic. Find out what s covered on the travel vaccination list. The sublimit sits within the total Pharmacy annual limit (not on top of) 2 months 2 months $300 Maximum of $50 per script (after PBS co-payment deduction) Sublimit $100 Maximum of $50 per item Ambulance VIC, SA, WA and NT residents can claim the full cost of one ambulance subscription per year. Ambulance is covered differently in each state. Find out how ambulance is covered in your state 0 days 1 subscription do I have my choice of extras provider? Yes. Frank believes in freedom of choice, so we pay the same benefits to any registered provider. This means you can use your regular dentist, optometrist or physio and still claim. are there extras services frank won t pay on? Yes there are. This might make us sound mean but if you have a read, you ll see they re fair. Where you are entitled to a rebate from Medicare for extras treatments you cannot claim any out of pocket expenses with Frank. If you re interested, check out the list of things Frank won t pay on. w. frankhealthinsurance.com.au p Page 5

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