Navy Army Air Force. Health cover for the Defence Community and their families. Private Health Insurance. All States/Territories except NT

Transcription

1 Navy Army Air Force Health cover for the Defence Community and their families. All States/Territories except NT

2 Contents About Navy Health 4 Am I Eligible? 5 How do I Join? 6 Membership Types 7 Hospital Cover and Extras Cover Overview 8-9 Hosptial Cover Extras Cover Defence Information 22 Leaving the Defence Force 23 Health and Wellness Initiatives 24

3 Australian Government Private Health Rebate 25 Lifetime Health Cover 26 Medicare Levy Surcharge 27 Other covers offered by Navy Health 28 Membership Information 29 Benefits 30 Benefits Explained 31 Extras Claiming 33 General Information 34 Terms and Conditions 37 Chaz Mostert Bathurst Winner Racing a V8 Supercar can be dangerous, so it s important for me to be covered by private health insurance, I know Navy Health has my back.

4 4 About Navy Health Whether you re a member of the Defence Force or a relative of someone who is, we re here to serve you. We ve been providing great value, premium health cover to members of the Defence Force community for over 60 years. Why choose Navy Health We re a not-for-profit health insurer and a Members Own Health Fund, which means that we are committed to providing lower premiums and higher benefits. Our members come first, demonstrated by our 97% member satisfaction.* We pride ourselves on providing expert knowledge, compassionate service and understanding of what can be a very complicated topic. Along with the 10% reduction in premiums for serving members and eligible Reservists, we offer a range of other benefits for those in the Australian Defence Force. These include the waiving of waiting periods and pre- existing condition restrictions if you join within 90 days of your discharge. The membership takes effect from the first day following discharge. Common Questions Q. Why do I need private hosptial cover? Private hospital cover gives you choices. So whether you want to choose your doctor, choose your hospital or choose when your procedures are performed, private hospital insurance will give you that freedom. Q. Can I just rely on the public system? You can, and many people do. That s why waiting lists can be so long in many public hospitals. If you want your procedure performed when it suits you by the doctor of your choice, you ll need to be in the private system. In addition, depending on your income, the Federal Government may be penalising you for not having private hospital cover through the Medicare Levy Surcharge. And if you re over 30, you may be subject to a Lifetime Health Cover loading. For more information on this please refer to page 26. Q. What if I don t get sick? Life isn t always predictable, and for peace of mind it s worthwhile being prepared for potential future needs. Even if you re a healthy person, private health insurance has many benefits. With General Treatment (Extras) cover you can claim benefits on services that Medicare doesn t typically cover, such as dental, optical, physio and natural therapies. For a healthy person, Extras cover is insurance you ll actually use. * Source: 2016 Discovery Research - Customer Satisfaction Survey

5 Am I Eligible? Navy Health is not only for current Australian Defence Force members, it s available for all serving and ex-serving members of the Australian Defence Forces (Navy, Army & Air Force), Reservists, cadets and their families. If you or anyone in your immediate family has ever been a civilian employee of the Department of Defence or an employee of a contractor to the Australian Defence Forces, you re also eligible. Put simply, if your partner, father, mother, brother, sister, son, daughter, grandfather or grandmother has ever been eligible to join Navy Health, then you re eligible to join too. It s important to remember that if you ve ever been eligible at any stage in your life, you re welcome to join at any time in the future. If you re still not sure, confirm your eligibility at canijoin.com.au or call us on

6 6 How do I Join? Joining Joining is the easy bit. Just decide on the cover you d prefer, determine the premiums and join online at navyhealth.com.au or call us on Transfer from other registered private health insurers There are no waiting periods if you are accepted for membership after transferring a current membership from another Australian Registered Private Health Insurer and had an equivalent level of cover, and completed all waiting periods. Normal waiting periods will apply to those aspects of Navy Health cover not covered previously by your previous insurer, and for those items specifically nominated within the products as requiring extended waiting periods. within your first 30 days of joining, we ll happily refund your premiums. For more information, refer to the Cooling Off Period on page 29. Managing your account Take control of your membership with Online Member Services at navyhealth.com.au Once you have registered (which takes a couple of minutes) you will be able to change/ review your details, make claims on most extras services, check your remaining extras limits and claims history, view tax statements, order new membership cards and much more! Register today at navyhealth.com.au and take control of your health cover. Navy Health will not pay immediate benefits at a higher level than those provided by the previous insurer. Navy Health annual limits will be reduced by the amount of benefit already paid by the previous insurer for similar services in the current benefit year of transfer. Reassurance We ve got a lot of confidence in the cover and service we offer at Navy Health. However, if you do want to leave

7 7 Membership Types Single membership Cover is for the one person only and therefore would need to be adjusted if dependents or a partner were to be added. Couple membership Cover is for the member with a spouse/partner. Family membership Cover is for the member with a spouse/partner, plus; any unmarried children until they attain the age of 22 years or enter into a de facto relationship. any unmarried children between the age of 22 and 25 years who are undertaking a course of study at a publicly funded or private sector tertiary institution which requires a full-time study workload in Australia. Please Note: A dependant who is no longer eligible for cover under a parent s membership is able to take out membership in their own right. If the new cover is started within thirty (30) days at an equivalent level, no additional waiting periods will apply. Aaron Royle Olympic Triathlete Navy Health gives me the confidence that my health and wellbeing is being taken care of. You should advise Navy Health of any unborn children before the expected due date (if possible). The newborn will only be added to a policy after birth. To ensure no waiting periods will apply for newborn children, they must be added within two months of birth (and backdated to date of birth). Single parent family or military family with one serving adult Cover is for one adult and dependants. For a military family with one serving adult, the serving person is the membership owner but cannot make a claim on the membership. Dependants only Dependants only or military family with two serving adults. Cover is for children only. The members (adults) are not entitled to claim benefits on a Dependant only cover. Young adult membership Young Adult Membership is for non-student dependants over 22 years of age. They will remain covered under the existing family hospital cover (at no extra charge) as long as they take up their own extras cover. Young Adult Membership applies until the dependant turns 25 years of age, marry, or enter into a de facto relationship. It s important to note that a non-student dependant must take up any extras cover within 30 days of being ineligible to continue under a parent s membership. Continuity of hospital cover carried over from a parent s membership will be provided as long as the parent s membership is still current. A dependant can take up membership in their own right at any time after being ineligible to continue under their parent s cover, however some waiting periods may apply unless membership is taken up within 30 days. The new membership will take effect from the day after they lose their eligibility on their parent s membership. For more information please call or go to navyhealth.com.au

8 8 Hospital Cover Overview Navy Health offers a range of comprehensive policy options to meet your needs. What s covered Premium Hospital Core Hospital Saver Hospital Saver Plus Excess $0/$200/$500 $200/$500 $500 $500 Cancer Cardiac & cardiac related services 3 Restricted 1 Restricted 1 Restricted 1 Treatment for accidents Tonsils + adenoids Appendicitis Wisdom teeth (Hospital benefits only) Arthroscopy + colonoscopy Pregnancy + pregnancy related services 3 Restricted 1 Restricted 1 Restricted 1 Assisted reproductive services (IVF, etc.) 3 Spinal surgery 3 3 Shoulder surgery Knee reconstruction Psychiatric services 3 Restricted 1 Restricted 1 Restricted 1 Rehabilitation 3 3 Restricted 1 Restricted 1 Palliative care Major eye surgery 3 Dental surgery Kidney dialysis 3 Bariatric surgery 3 Hip & knee replacement 3 Other joint replacement 3 3 Prosthetic appliances Early release home nursing Podiatry surgery Restricted 2 Restricted 2 Restricted 2 Restricted 2 Cosmetic surgery Non-cosmetic surgery/plastic surgery Full ambulance cover Services where Medicare does not pay a benefit All other services recognised by Medicare Health + Care program Covered as a private patient in a public hospital only. If you are treated anywhere else such as a private hospital, you will be significantly out-of-pocket. 2. Limited benefits are available when Podiatric Surgery is performed in a contracted hospital by an Australian Government Accredited Podiatrist. Waiting periods, exclusions, excess payments and pre-existing conditions may apply to your selected cover. Refer to page 34.

9 9 Extras Cover Overview Navy Health offers four levels of extras cover to suit your current lifestyle. What s covered Premium Extras Healthy Living Extras Basic Extras Saver Plus General dental Unlimited Unlimited Major dental (Sub-limits below) $2,000 $1,500 - Periodontics $1,000 $700 - Extractions/oral surgery $1,000 $700 $500 General dental, Periodontics, Extractions, Oral Surgery only $600 (Combined) - Endodontics $1,000 $ Crowns/bridgework $1,000 $ Dentures/implants $1,000 $700 - Orthodontic $2,500 $ Optical $350 $260 $170 $200 Laser eye surgery $1,500 $1, Eye therapy $500 $ Occupational therapy $500 $ Physiotherapy $850 $600 $300 Chiropractic/osteopathy *$750 *$550 *$300 *$300 Podiatry/chiropody $500 $ Dietitian $500 $ Natural therapies *$550 *$320 *$200 *$200 Non-PBS pharmacy $600 $500 $200 $200 Psychology $600 $ Speech therapy $500 $ MPAs $700 $ CPAP devices $1,000 $ Orthopaedic app/orthotics $300 $ Hearing aids $1,300 $ Audiology $500 $ Home nursing $1,000 $1, School accidents $ Ambulance Full Full Full Full For extras cover, the benefit year is 1 July to 30 June. The above table is a general guide only. Before making any decisions regarding these covers please refer to the specific cover information and consider any waiting periods, service exclusions and per family limits that may apply. Refer to page 34. *Family limits apply.

10 10 Premium Hospital As a Premium Hospital member you ll receive up to 100% cover at over 500 private hospitals, recognised public hospitals and day hospital facilities across Australia. Hospital excess Premium Hospital offers no excess, $200 or $500 excess. By choosing an excess, members can take advantage of the lower premiums. Excess payments do not apply to hospital admissions for dependants. The excess applies to the cost of in-patient hospitalisation in either a private, public or day hospital facility. The higher the excess you choose the less your premiums will be throughout the year. Premium Hospital provides members with three excess policy options, enabling you to choose the premium level that best suits your budget. Exclusions Premium Hospital provides coverage for most in-hospital medical procedures that Medicare covers. Exclusions include cosmetic surgery and procedures where Medicare does not pay a benefit. Health + Care program If you elect to leave hospital early to recover at home, provided it is considered medically appropriate, you may be eligible to receive a range of support services in your home. Please refer to page 24 for more information. Hospital excess example On a couple or family policy, if Mary goes to hospital whilst covered under Premium Hospital 200, an excess of $200 is payable. If within twelve months of paying the excess, Mary s husband Joe goes into hospital, the $200 excess is to be paid again. Contracted and non-contracted services For contracted and non-contracted services benefit details, please refer to page 31. For any subsequent hospitalisations in the same rolling 12 month period, no excess is payable. For families and couples, the excess is payable per admission up to the family maximum of 2 adult admissions, in any rolling 12 month period. For singles, the excess is only payable once in any rolling 12 month period (once the excess is paid in full).

11 Hospital Cover What s covered Restricted cover Cancer Cardiac & cardiac related services Treatment for accidents Tonsils + adenoids Appendicitis Wisdom teeth (Hospital benefits only) Arthroscopy + colonoscopy Pregnancy + pregnancy related services Assisted Reproductive services (IVF, etc.) Spinal surgery Shoulder surgery Knee reconstruction Psychiatric services Rehabilitation Palliative care Major eye surgery Dental surgery Kidney dialysis Bariatric surgery Hip & knee replacement Other joint replacement Prosthetic appliances Early release home nursing Full ambulance cover Non-cosmetic surgery/ plastic surgery All other services recognised by Medicare Podiatry surgery What s not covered Cosmetic surgery Services where Medicare does not pay a benefit Waiting periods, exclusions, excess payments and pre-existing conditions may apply to your selected cover. Refer to page 34.

12 12 Core Hospital If you re looking for a policy that offers you a great compromise between coverage and price, then this cover is the one for you. Hospital excess Core Hospital provides members with two excess policy options $200 or $500, enabling you to choose the premium level that best suits your needs. The higher the excess you choose the less your premiums will be throughout the year. For an example of how the excess works see page 10. Excess payments do not apply to hospital admissions for dependants. The excess applies to the cost of in-patient hospitalisation in either a private, public or day hospital facility. Exclusions & restricted cover For services that are restricted, you can only be treated as a private patient in a public hospital. Covered as a private patient in a public hospital only. If you are treated anywhere else such as a private hospital, you will be significantly out-of-pocket. For services that are excluded, no benefits are payable. See table below for services that are not covered or provide restricted cover only. Contracted and non-contracted services For contracted and non-contracted services benefit details, please refer to page 31. Hospital Cover What s covered Restricted cover* What s not covered Cancer Palliative care Cardiac & cardiac Assisted Reproductive Treatment for accidents Dental surgery related services services (IVF, etc.) Tonsils + adenoids Appendicitis Wisdom teeth (Hospital benefits only) Other joint replacement Prosthetic appliances Early release home nursing Pregnancy + pregnancy related services Psychiatric services Podiatry surgery Major eye surgery Kidney dialysis Bariatric surgery Hip & knee replacement Arthroscopy + colonoscopy Non-cosmetic surgery/ Cosmetic surgery Spinal surgery plastic surgery Services where Medicare Shoulder surgery Full ambulance cover does not pay a benefit Knee reconstruction Rehabilitation All other services recognised by Medicare Waiting periods, exclusions, excess payments and pre-existing conditions may apply to your selected cover. Refer to page 34. *Restricted Cover: Covered as a private patient in a public hospital only. If you are treated anywhere else such as a private hospital, you will be significantly out-of-pocket.

13 13 Saver Hospital If you re young, fit and healthy, and looking for basic hospital cover, take a look at our Saver Hospital option. Hospital excess Saver Hospital comes with a $500 excess. The excess applies to the cost of in-patient hospitalisation in either a private, public or day hospital facility. Excess payments do not apply to hospital admissions for dependants. For families and couples, the excess is payable per admission up to the family maximum of 2 adult admissions, in any rolling 12 month period. For singles, the excess is only payable once in any rolling 12 month period (once the excess is paid in full). For an example of how the excess works see page 10. Exclusions & restricted cover For services that are restricted, you can only be treated as a private patient in a public hospital. If you are treated anywhere else such as a private hospital, you will be significantly out-of-pocket. For services that are excluded, no benefits are payable. See table below for services that are not covered or provide restricted cover only. Contracted and non-contracted services For contracted and non-contracted services benefit details, please refer to page 31. Hospital Cover What s covered Restricted cover* What s not covered Cancer Dental surgery Cardiac & cardiac Assisted Reproductive Treatment for accidents Prosthetic appliances related services services (IVF, etc.) Tonsils + adenoids Appendicitis Wisdom teeth (Hospital benefits only) Early release home nursing Non-cosmetic surgery/ plastic surgery All other services Pregnancy + pregnancy related services Psychiatric services Rehabilitation Spinal surgery Major eye surgery Kidney dialysis Bariatric surgery Arthroscopy + colonoscopy recognised by Medicare Podiatry surgery Hip & knee replacement Shoulder surgery Full ambulance cover Other joint replacement Knee reconstruction Cosmetic surgery Palliative care Services where Medicare does not pay a benefit Waiting periods, exclusions, excess payments and pre-existing conditions may apply to your selected cover. Refer to page 34. *Restricted Cover: Covered as a private patient in a public hospital only. If you are treated anywhere else such as a private hospital, you will be significantly out-of-pocket.

14 14 Saver Plus At Navy Health, we know it s important for you to receive good value. Saver Plus, is combined health cover, providing you with private hospital and extras insurance in one product. Designed for those who are young and active, you ll benefit by paying only for the services you use most, giving you more of what you need and less of what you don t. With Saver Plus, you don t pay for the services you re not likely to use such as spinal surgery, major eye surgery and services relating to pregnancy. Quite simply, Saver Plus gives you value for money without losing the things you re likely to need, including hospital, dental and chiro. Exclusions & restricted cover For services that are restricted, you can only be treated as a private patient in a public hospital. If you are treated anywhere else such as a private hospital, you will be significantly out-of-pocket. For services that are excluded, no benefits are payable. See table on your right for services that are not covered or provide restricted cover only. Hospital excess Saver Hospital comes with a $500 excess. The excess applies to the cost of in-patient hospitalisation in either a private, public or day hospital facility. For families and couples, the excess is payable per admission up to the family maximum of 2 adult admissions, in any rolling 12 month period. For singles, the excess is only payable once in any rolling 12 month period (once the excess is paid in full). Excess payments do not apply to hospital admissions for dependants. For an example of how the excess works see page 10. More benefits As a member of Saver Plus, you ll be rewarded with more benefits. You ll receive 65% back on the most widely used extras services. That s up to $1500 worth of extras value per person, per year (1 July to 30 June). Contracted and non-contracted services For contracted and non-contracted services benefit details, please refer to page 31.

15 15 Why choose Navy Health Hospital Cover What s covered Restricted cover* What s not covered Cancer Treatment for accidents Tonsils + adenoids Appendicitis Wisdom teeth (Hospital benefits only) Arthroscopy + colonoscopy Shoulder surgery Knee reconstruction Palliative care Dental surgery Prosthetic appliances Early release home nursing Non-cosmetic surgery/plastic surgery Full ambulance cover All other services recognised by Medicare Cardiac & cardiac related services Pregnancy + pregnancy related services Psychiatric services Rehabilitation Podiatry surgery Assisted Reproductive services (IVF, etc.) Spinal surgery Major eye surgery Kidney dialysis Bariatric surgery Hip & knee replacement Other joint replacement Cosmetic surgery Services where Medicare does not pay a benefit Extras 65% benefit on Annual limit (per person) Waiting period General & major dental Optical Natural therapies Chiropractic, osteopathy, physiotherapy Non-PBS Pharmacy $600 $200 $200 ($400 per family) $300 ($600 per family) $200 2 & 12 months 6 months 2 months 2 months 2 months Waiting periods, exclusions, excess payments and pre-existing conditions may apply to your selected cover. Refer to page 34. *Restricted Cover: Covered as a private patient in a public hospital only. If you are treated anywhere else such as a private hospital, you will be significantly out-of-pocket.

16 16 Premium Extras Annual Limit /Person Waiting Period (months) Dental Covers dental items listed by the Australian Dental Association (ADA) up to a set rebate. General Dental Includes restorations/fillings & Occlusal Therapy unlimited 2 Major Dental Periodontics Extractions / Oral Surgery Endodontics Crowns / Bridgework Dentures / Implants^ ^ For dentures a rolling three year minimum replacement period applies from the first date of service. Set benefits are payable for individual dental services and may not attract the full major dental annual sub-limit. up to $1,000 up to $1,000 up to $1,000 up to $1,000 up to $1,000 $2, Orthodontic Maximum of $2,500 per course of treatment; 80% of provider fee; one service of ADA code 881 per rolling 3 year period. $2, Optical 100% of the fee up to the annual limit Single Vision lens and frame Bifocal / Multifocal lens and frame Contact Lenses Optical benefit is only payable where the lens includes a form of sight correction. A prescription must accompany all claims for benefits. Benefits are not available for lens coatings and features such as anti-reflection or scratch resistant coatings. $350 6 Eye Therapy Initial Consultation Subsequent Consultation $70 $55 $500 2 Laser Eye Surgery 100% of the fee up to the annual limit One service every two (rolling) years. $1, Occupational Therapy Initial Consultation Subsequent Consultation $60 $40 $500 2 Physiotherapy Initial Consultation Subsequent Consultation Group Session Ante/Post Natal Classes # $67 $52 $25 up to $100 $850 2 # Benefit only paid if the provider is a registered physiotherapist or midwife and where benefit not payable by Medicare. Chiropractic Osteopathy Initial Consultation Subsequent Consultation Chiropractic X-rays (1 per person per year) $60 $41 $70 $750 ($1,500 per family) 2 Podiatry Chiropody Initial Consultation Subsequent Consultation Impression Cast Podiatry Surgery. Conditions apply, refer to page 34. $57 $44 $50 $200 $500 2 Dietitian Initial Consultation Subsequent Consultation This is a consultation benefit only and does not cover any prescribed medications, herbal or dietary preparations or organised weight reduction programs. $80 $55 $500 2 Waiting periods, exclusions, excess payments and pre-existing conditions may apply to your selected cover. Refer to page 34.

17 17 Annual Limit /Person Waiting Period (months) Non-PBS Pharmacy Per Prescription Navy Health pays the difference between the cost of the prescription and set cost of the Pharmaceutical Benefit Scheme (PBS), up to the maximum per prescription. The patient pays the cost up to the PBS. Benefits are only payable for legal prescriptions or vaccinations filled by a pharmacist operating in a private practice when ordered by a recognised medical or dental practitioner. We do not pay for products used for contraception, weight reduction or preparations that can be purchased without a prescription. up to $120 $600 2 Natural Therapies Per Service Natural Therapies include Acupuncture, Aromatherapy, Chinese Herbal Medicine, Homeopathy, Myotherapy, Naturopathy, Remedial Massage Therapy, Remedial Therapy, Western Herbal Medicine, and Exercise Physiology. Benefits are not payable on any prescribed medications, herbal or dietary preparations, or weight reduction programs. For more information, refer to page 34. $38 $550 ($1,100 per family) 2 Psychology Initial Consultation Subsequent Consultation Group Therapy Hypnotherapy is payable if the provider is a fully registered member of the Psychology Board in their State / Territory or if they are a clinical member of an approved association. To view Navy Health s Recognised Hypnotherapy Associations, go to navyhealth.com.au $110 $80 $55 $600 2 Speech Therapy Initial Consultation Subsequent Consultation $110 $55 $500 2 Medically Prescribed Appliances (MPAs) 85% of the fee up to the annual limit For more information and conditions please refer to page 35. $700 6 CPAP Devices 100% of the fee up to the annual limit Includes repairs to CPAP device. Three year replacement period applies for new CPAP devices. $1, Orthotics and Orthopaedic Appliances 85% of the fee up to annual limit. Orthopaedic footwear must be for a medically prescribed purpose and constructed for the individual member, by a specialist orthopaedic footwear manufacturer. Commercially available brands of footwear and sporting footwear are not eligible for benefits. Includes repairs to Orthotics. $300 2 Hearing Aids 100% of the fee up to the annual limit Supply of hearing aids is limited to one supply (either single or two aids) every three years. The maximum three year limit applies to any three (rolling calendar) year period from the first date of service. $1, Repairs on Hearing Aids up to $150 Audiology Initial Consultation Subsequent Consultation $70 $55 $500 2 Home Nursing School Accidents Ambulance Services Per Service Home nursing is classified as professional treatment by a registered nurse on the recommendation of a medical practitioner. Benefits include costs that result from a school accident to a member s dependant child. Expenses that are claimable under Medicare or that are claimable from another source are excluded. Claims must be accompanied by notification of the accident on school letterhead. 100% of the cost of ambulance services within Australia provided that the service is from a State/Territory registered ambulance service and deemed medically necessary. $60 $1,000 2 $800 2 unlimited 2 For full pricing and to find extras providers, visit navyhealth.com.au

18 18 Healthy Living Extras Annual Limit /Person Waiting Period (months) Dental Covers dental items listed by the Australian Dental Association (ADA) up to a set rebate. General Dental Includes restorations/fillings & Occlusal Therapy unlimited 2 Major Dental Periodontics Extractions / Oral Surgery Endodontics Crowns / Bridgework Dentures / Implants^ ^ For dentures a rolling three year minimum replacement period applies from the first date of service. Set benefits are payable for individual dental services and may not attract the full major dental annual sub-limit. up to $700 up to $700 up to $700 up to $700 up to $700 $1, Orthodontic Maximum of $2,000 per course of treatment; 70% of provider fee; one service of ADA code 881 per rolling 3 year period. $2, Optical 100% of the fee up to the annual limit Single Vision lens and frame Bifocal / Multifocal lens and frame Contact Lenses Optical benefit is only payable where the lens includes a form of sight correction. A prescription must accompany all claims for benefits. Benefits are not available for lens coatings and features such as anti-reflection or scratch resistant coatings. $260 6 Eye Therapy Initial Consultation Subsequent Consultation $60 $35 $300 2 Laser Eye Surgery 100% of the fee up to the annual limit One service every two (rolling) years. $1, Occupational Therapy Initial Consultation Subsequent Consultation $45 $33 $400 2 Physiotherapy Initial Consultation Subsequent Consultation Group Session Ante/Post Natal Classes # $55 $42 $15 up to $60 $600 2 # Benefit only paid if the provider is a registered physiotherapist or midwife and where benefit not payable by Medicare. Chiropractic Osteopathy Initial Consultation Subsequent Consultation Chiropractic X-rays (1 per person per year) $48 $35 $60 $550 ($1,100 per family) 2 Podiatry Chiropody Initial Consultation Subsequent Consultation Impression Cast Podiatry Surgery. Conditions apply, refer to page 34. $45 $35 $40 $120 $300 2 Dietitian Initial Consultation Subsequent Consultation This is a consultation benefit only and does not cover any prescribed medications, herbal or dietary preparations or organised weight reduction programs. $60 $40 $300 2 Waiting periods, exclusions, excess payments and pre-existing conditions may apply to your selected cover. Refer to page 34.

19 19 Annual Limit /Person Waiting Period (months) Non-PBS Pharmacy Per Prescription Navy Health pays the difference between the cost of the prescription and the set cost of the Pharmaceutical Benefit Scheme (PBS), up to the maximum per prescription. The patient pays the cost up to the PBS. Benefits are only payable for legal prescriptions or vaccinations filled by a pharmacist operating in a private practice when ordered by a recognised medical or dental practitioner. We do not pay for products used for contraception, weight reduction or preparations that can be purchased without a prescription. up to $120 $500 2 Natural Therapies Per Service Natural Therapies include Acupuncture, Aromatherapy, Chinese Herbal Medicine, Homeopathy, Myotherapy, Naturopathy, Remedial Massage Therapy, Remedial Therapy, Western Herbal Medicine, and Exercise Physiology. Benefits are not payable on any prescribed medications, herbal or dietary preparations, or weight reduction programs. For more information, refer to page 34. $32 $320 ($640 per family) 2 Psychology Initial Consultation Subsequent Consultation Group Therapy Hypnotherapy is payable if the provider is a fully registered member of the Psychology Board in their State / Territory or if they are a clinical member of an approved association. To view Navy Health s Recognised Hypnotherapy Associations, go to navyhealth.com.au $90 $70 $35 $400 2 Speech Therapy Initial Consultation Subsequent Consultation $90 $40 $300 2 Medically Prescribed Appliances (MPAs) 85% of the fee up to the annual limit For more information and conditions please refer to page 35. $400 6 CPAP Devices 100% of the fee up to the annual limit Includes repairs to CPAP device. Three year replacement period applies for new CPAP devices. $ Orthotics and Orthopaedic Appliances 85% of the fee up to annual limit. Orthopaedic footwear must be for a medically prescribed purpose and constructed for the individual member, by a specialist orthopaedic footwear manufacturer. Commercially available brands of footwear and sporting footwear are not eligible for benefits. Includes repairs to Orthotics. $200 2 Hearing Aids Supply of hearing aids is limited to one supply (either single or two aids) every three years. The maximum three year limit applies to any three (rolling calendar) year period from the first date of service. $ Repairs on Hearing Aids up to $150 Audiology Initial Consultation Subsequent Consultation $60 $40 $300 2 Home Nursing Ambulance Services Per Service Home nursing is classified as professional treatment by a registered nurse on the recommendation of a medical practitioner. 100% of the cost of ambulance services within Australia provided that the service is from a State/Territory registered ambulance service and deemed medically necessary. $60 $1,000 2 unlimited 2 For full pricing and to find extras providers, visit navyhealth.com.au

20 20 Basic Extras Annual Limit /Person Waiting Period (months) Dental Covers dental items listed by the Australian Dental Association (ADA) up to a set rebate. $500 General Dental Includes restorations/fillings & Occlusal Therapy General Dental services are not subject to an individual category maximum, however, benefits paid towards these procedures do form part of the overall annual benefit limitation. 2 Major Dental Periodontics Extractions / Oral Surgery Set benefits are payable for individual dental services and may not attract the full major dental annual sub-limit. 12 Optical 100% of the fee up to the annual limit Single Vision lens and frame Bifocal / Multifocal lens and frame Contact Lenses Optical benefit is only payable where the lens includes a form of sight correction. A prescription must accompany all claims for benefits Benefits are not available for lens coatings and features such as antireflection or scratch resistant coatings. $170 6 Physiotherapy Initial Consultation Subsequent Consultation Group Session $37 $27 $10 $300 2 Chiropractic Osteopathy Initial Consultation Subsequent Consultation $30 $22 $300 ($600 per family) 2 Non-PBS Pharmacy Per Prescription Navy Health pays the difference between cost of the prescription and set cost of the Pharmaceutical Benefit Scheme (PBS), up to a maximum of $50 per prescription. The patient pays the cost up to the PBS. Benefits are only payable for legal prescriptions or vaccinations filled by a pharmacist operating in a private practice when ordered by a recognised medical or dental practitioner. We do not pay for products used for contraception, weight reduction or preparations that can be purchased without a prescription. up to $50 $200 2 Natural Therapies Per Service Natural Therapies include Acupuncture, Aromatherapy, Chinese Herbal Medicine, Homeopathy, Myotherapy, Naturopathy, Remedial Massage Therapy, Remedial Therapy, Western Herbal Medicine, and Exercise Physiology. Benefits are not payable on any prescribed medications, herbal or dietary preparations, or weight reduction programs. For more information, refer to page 34. $18 $200 ($400 per family) 2 Ambulance Services 100% of the cost of ambulance services within Australia provided that the service is from a State/Territory registered ambulance service and deemed medically necessary. unlimited 2 Waiting periods, exclusions, excess payments and pre-existing conditions may apply to your selected cover. Refer to page 34. For full pricing and to find extras providers, visit navyhealth.com.au

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22 22 Defence Information As an acknowledgement of their commitment and sacrifice, a 10% reduction on payable premiums is offered to serving ADF members, ADF Active Reservists and from 1 July 2017, DVA Gold and White Card Holders. ADF Members To apply the discount, we will require proof of your serving status. Please go to navyhealth.com.au or call for more information. ADF Active Reservist To apply the discount, we will require a completed ADF Reservist declaration and proof that you have transferred/remain an active Reservist prior to the discount being applied. Please go to navyhealth.com.au or call for more information. covered for under your DVA Gold Card to ensure you can make an informed decision regarding. DVA Gold Card members with a family can be removed from the cover whilst the family retains the membership at a single parent level. For more information, refer to page 35 or call us on From 1 July 2017, DVA Gold and White Card Holders To apply the discount, we will require proof of your DVA status (scan/copy of Entitlement Letter or DVA Card) prior to the discount being applied. Please go to navyhealth.com.au or call for more information. Overseas posting In the event, you are posted overseas, Navy Health will allow you to suspend your membership for the relevant period upon production of relevant documentation. DVA Gold Card holders It is up to the DVA Gold Card holder to decide whether or not they wish to maintain their Private Health Insurance. It is important to gain an understanding about what you are

23 23 Leaving the Defence Force I m leaving the ADF. Can I continue my membership? Of course you can. Once you have been eligible, your eligible for life. If you re leaving the ADF (or you re finishing up as an ADF civilian employee or contractor) you can continue your membership, add yourself to the family membership, join again or even join for the first time at a later stage. Things to consider when leaving the defence force: Do you have a Medicare card? If you do not have a Medicare card, go to humanservices.gov.au to apply for your card. Check your family s Medicare card to be sure your name is listed. If not go to the website above for details on how to get your name included. Don t currently have cover with Navy Health? If you don t currently have cover with Navy Health, you firstly need to consider and choose your desired level of cover (hospital and/or extras). Apply for your selected cover before discharge via navyhealth.com.au. We will require a copy of your ADF Separation Certificate/Certificate of services. Already have your family or partner covered? If your family or partner are covered, simply call Navy Health before discharge, and we will add you to the membership. Navy Health will send you new membership cards with your name included. Please Note: Your premium will increase as you will now be claiming on the membership and we will require a copy of your ADF Separation Certificate/Certificate of services. How do I avoid waiting periods and pre-existing conditions restrictions? Avoid all waiting periods and pre-existing condition restrictions, by commencing your cover from the day after discharge. Are you joining the Reserves? If you are going into the Reserves (active) receive a 10% discount on your premiums. Mention your reservists status when speaking with Member Services to enquire about your discount. A completed ADF Reservist declaration and proof that you have transferred/ remain an active Reservist must be submitted prior to the discount being applied. If you re still not sure, please visit navyhealth.com.au or call for more information.

24 24 Health and Wellness Initiatives Health + Care program Sometimes it s hard to keep on top of your health. That s why we ve introduced the Health + Care program. Health + Care offers a range of benefits to help you get and stay healthy, from our customised wellness portal to our chronic disease management program. And best of all, it s free for our hospital covered members.* Find out more at navyhealth.com.au Online wellness portal Want to get healthier? Our online wellness portal is here to help. Start with a comprehensive Health Risk Assessment to determine where your health priorities need to be. From here, we ll help develop a wellness plan and set tasks and goals to work towards better health. You can also upload medical documents and results here to keep all your health information in the one place! To start your wellness journey today, simply log on to Online Member Services and select the Health + Care tab. Pregnancy Whether it is your first or subsequent pregnancy, we understand that every pregnancy is individual and you may require reassurance, guidance and support. The My Pregnancy program is provided by an accredited health care provider and one of our associate providers, Home Support Services (HSS). By enrolling in the program you will have access to a Midwifery Support line from 9am-5pm AEST and will receive five calls from a HSS Midwife. The HSS Midwife will follow you through your pregnancy and in the first early weeks following birth using telephone coaching. The program is available to all members with Premium Hospital, comes at no additional cost to you, as part of your cover. For more information and to enrol in the My Pregnancy program, please download, read and complete the enrolment form at: navyhealth.com.au/member-services/ mypregnancy/ and mail to: Navy Health, Reply Paid 64573, Box Hill VIC Chronic disease management program Need some help managing your health? Navy Health offers a range of services which are designed to help you stay on top of your health, whether it s keeping you out of hospital, or if you do have a hospital stay, helping you get home sooner. Getting out of hospital and home safely as soon as possible is a priority for most people. Often, it s the first and most important step on your road to recovery. Our unique Health + Care program offers a wide range of services designed to assist your recovery all in the comfort of your own home. The program is individually tailored to suit your needs and help you get and stay well. We also offer a wide range of services to help manage chronic illnesses such as coronary artery disease, diabetes and mental health. Through our Health + Care program, we can offer telephonic or face-to-face support (in the comfort of your own home of course!) with a qualified registered nurse, helping you manage your health better and avoid the need for a hospital stay. In addition, we can offer full at home support for many other in-hospital services, such as: Chemotherapy Wound Care Medication Management Pain Management Palliative Care Physiotherapy For more information, or to register, simply call us on or query@navyhealth.com.au * This information is correct as 1 April The program is subject to change without notice.

25 25 Australian Government Rebate Most Australians with private health insurance currently receive a rebate from the Australian Government to help cover the cost of their premiums. The rebate you are eligible for depends on your age*, is incometested and applies to all Navy Health products. The rebate isn t available on the Lifetime Health Cover loading portion of membership payments. Your rebate amount is based on your age* and assessable income. Below are the thresholds set by the Australian Government for the 2016/17 financial year. The income thresholds will remain at the current levels until July The rebate is indexed each year by the difference between the CPI and the industry average increase in premiums using a Government calculated formula. Claiming the rebate If you are eligible for the rebate, there are two ways you can claim: through a reduced premium; or through your tax return with the ATO If you choose to receive your rebate through your insurer, you will be asked to nominate the tier you expect to fall into in order to avoid a tax liability. You can nominate your tier by contacting Navy Health. More information regarding the Federal Government Rebate is available at navyhealth.com.au or by phoning If you aren t sure which rebate tier you should choose, please contact your tax agent, financial advisor or the Australian Taxation Office at privatehealthinsurance Federal Government Rebate* Income for rebate purposes Under 65 years years 70+ years Single $90,000 or less No Tier % % % Couple/Family $180,000 or less Tier 1 Single $90,001 $105,000 Couple/Family $180,001 $210, % % % Tier 2 Single $105,001 $140,000 Couple/Family $210,001 $280, % % % Single $140,001 or more Tier 3 0% 0% 0% Couple/Family $280,001 or more *The rebate is based on the age of the oldest person on your cover

26 26 Lifetime Health Cover Loading The Lifetime Health Cover (LHC) loading is applicable to hospital cover only. From July 1, 2000 any person joining a private health insurer will be subject to the Government s LHC legislation. Briefly, this implies that people joining on or after July 1, 2000 who are 31 years of age or over will pay a premium based on their age at the date they joined the insurer. Hospital base premium costs will increase by 2% for each year of age the person delays joining a health insurer after turning 30 years of age. To calculate the cost of your LHC, multiply your premium by the amount of LHC that applies to you. For example, if you take out hospital cover at age 40 you will pay 20% more than someone who first took out hospital cover at age 30. The maximum loading is 70%. You can also use the LHC calculator available at privatehealth.gov.au to work out what your LHC loading is. If you are considering hospital cover for more than one adult, determine each adult s age and respective LHC loading and then take the average of these loadings. Multiply the average by the hospital premium that you have chosen and then add this calculation to the base premium. To cover small gaps, such as switching from one insurer to another, you are able to be without private hospital cover for periods totalling 1094 days (i.e. three years less one day) during your lifetime, without affecting your loading. If you have a gap of 1095 days you will pay a 2% loading. For every 365 days without cover after that, your loading will increase by 2%. If you apply to your health insurer to suspend your cover for a short period, and it agrees, this period of suspension does not affect your LHC loading (you are considered to be maintaining your cover). Once you have paid a LHC loading on your private hospital insurance for 10 continuous years, the loading is removed as long as you retain your hospital cover. If you drop your hospital cover again for more than the allowable days, you will be liable to pay the LHC loading again. Lifetime Health Cover on discharge Health care costs of serving members are met by the Commonwealth until the date of discharge. This is regarded as the equivalent of private health insurance and as such, no Lifetime Health Cover penalty applies to members of the ADF when they separate, providing they take out hospital cover immediately following discharge. ADF personnel and DVA Gold Card holders If you are a member of the Australian Defence Forces (ADF) your medical services are provided by the ADF, so you are considered to have hospital cover. If you joined the ADF prior to 1 July 2000, your entry age upon discharge will be 30. If you joined the ADF on or after 1 July 2000, your age is that at which you joined the ADF, unless you previously had private health insurance. If you hold a Department of Veterans Affairs (DVA) Gold Card you are considered to have hospital cover. If you have held a Gold Card at any time since 1 July 2000, and the card was subsequently withdrawn by the DVA, you may claim the period you held the card as a period with private health insurance.

27 27 Medicare Levy Surcharge The surcharge aims to encourage individuals to take out private hospital cover and where possible, to use the private system to reduce the demand on the public system. The Medicare Levy Surcharge (MLS) is levied on Australian taxpayers who do not have private hospital cover and who earn above a certain income. The surcharge aims to encourage individuals to take out private hospital cover and where possible, to use the private system to reduce the demand on the public system. The surcharge covers you and your dependants. Your dependants include your spouse, any of your children who are under 21 years of age, or any of your student children who are under 25 years of age. The surcharge is calculated at the rate of 1% to 1.5% of your income for Medicare Levy Surcharge purposes. It is in addition to the Medicare Levy of 2%, which is paid by most Australian taxpayers. Currently you have to pay the surcharge if you are a single person or family/couple earning over the applicable income thresholds (below) AND do not have an approved hospital cover with a registered health fund. You must also pay the surcharge if you are a prescribed person with a taxable income over the threshold, and have any dependants who are not prescribed persons and who are not covered by an approved health cover policy as described above. This means if you are a family, have a combined income over the MLS threshold, and don t have hospital cover for you, your partner, and your children, you will pay the MLS. For more information regarding the MLS please go to navyhealth.com.au or the Australian Taxation Office website at ato.gov.au Income for rebate purposes MLS No Tier No change to rebate or MLS Single Couple/Family $90,000 or less $180,000 or less 0.0% Tier 1 Single $90,001 $105,000 Couple/Family $180,001 $210, % Tier 2 Single $105,001 $140,000 Couple/Family $210,001 $280, % Tier 3 Single Couple/Family $140,001 or more $280,001 or more 1.5%

28 28 Other Covers Offered by Navy Health We know things don t always go to plan, even when you re on holiday. Have peace of mind that Navy Health will have you covered. Travel insurance up and away Holidays are all fun and games until someone gets hurt. Or something gets stolen. Or your luggage gets lost. When you re a long way from home, a holiday can easily turn into a nightmare. Thankfully, things can quickly be patched up if you ve taken out Travel Insurance through Navy Health. With coverage for everything from medical treatment to lost luggage and cancelled tours, we can help make the best of a bad situation. And the best thing is, you don t have to be a Navy Health member to get an exceptional deal on our Travel Insurance. Please read the Product Disclosure Statement (PDS) before making any decisions regarding whether or not this policy is suitable for you. To find out how good that deal can be, get an instant quote or apply online at navyhealth.com.au Personal insurance life and death Life isn t always predictable, and sometimes we need to prepare for the worst no matter how hard it is to think about. This means locking in your family s financial security in the event of the unthinkable happening to you. Our personal insurance pays a nominated lump sum to the beneficiary of your choice when you die. We can also provide financial assistance to you and your family during long-term illnesses and loss of income. Please consider the PDS before deciding if the cover is right for you or your family. For more information, go to navyhealth.com.au Madi Robinson Australian Netballer I wouldn t be without Navy Health as I believe investing in my health is investing in my future.

29 29 Membership Information When does membership commence? Membership will only be accepted from the date when the first contribution is received, or on the date on which the application form is received by Navy Health, whichever is the latest. How can I change my membership? Any changes to the status of membership (i.e. level of cover, adding or deleting dependants) cannot be undertaken without Navy Health receiving advice from the authorised member or person. Likewise, the change cannot be taken as being actioned without the member receiving acknowledgement from Navy Health. The effective date of any change will be the date notification is received by Navy Health. The easiest method of changing details is via Online Member Services at navyhealth.com.au or call us on Cover changes Upward (increased entitlement) changes in the level of cover will result in the member and any persons covered undergoing new waiting periods. Whilst these waiting periods are in force, benefits will still be payable as they would normally have been under the previous level of cover. Higher benefits are not payable for ailments or conditions in evidence at the time of transfer (regardless of whether or not they have been diagnosed) until a waiting period of 12 months has been served. Higher level Maternity (and the management of) and IVF procedure benefits will be payable at the previous benefit level for a period of 12 months after transfer. For transfers within the extras products, the waiting periods for higher benefits are those listed for new members. At all times the benefits paid under a previous level of cover are considered when determining residual benefit entitlements. When are contributions payable? Payment of contributions are always in advance. Direct debit payments can be made on a fortnightly, monthly, six monthly or yearly basis. A 2% discount has been applied for members choosing to pay half yearly and a 4% discount has been calculated for those members choosing to pay annually. When does membership cease? A membership will cease on a date advised and paid to by the member or automatically when contribution payments are more than one month in arrears. Cooling off period Members can choose not to proceed with their Navy Health cover and request to have any premiums reimbursed. This reimbursement is on the provision that the member expresses their request in writing, within 30 days of their cover commencing and that no claims have been lodged or are pending during the 30 day cooling off period. Suspension of membership Navy Health at its absolute discretion may allow, within a clearly defined limited set of circumstances, for a member to suspend their membership for an agreed period. Where the suspension has been approved in writing by the insurer, members will be advised of the conditions relating to waiting periods and pre-existing condition rules which may be applied upon reinstatement of membership. The agreed suspension period is not subject to change without written notification to and written confirmation from Navy Health. ADF personnel can suspend their cover when they are posted overseas. Members who move into continuous full time service (CFTS) can also suspend their cover for the duration of the CFTS. For more information please go to navyhealth.com.au

30 30 Benefits For General Treatment (Extras) the Navy Health benefit year is 1 July to 30 June. For hospital products with an excess, the benefit period is a rolling 12 month period. Benefit year For General Treatment (Extras) the Navy Health benefit year is 1 July to 30 June. For hospital products with an excess, the benefit period is a rolling 12 month period. (i.e. the excess is payable once per adult, in full, up to the family maximum, in any rolling 12 month period). When do benefits cease? Benefits are not payable on any services rendered subsequent to a member s last financial paid to date, the date on which a membership is cancelled or when a membership is in suspension. When are benefits not payable? Benefits are not payable when: claims are over two (2) years from the date of service; when two (2) claims are submitted for the same service on the same day; the provider is not recognised in a private practice or for Natural Therapies, the provider is not recognised by the Australian Regional Health Group (ARHG), Australian Health Practitioner Regulation Agency (AHPRA) Exercise and Sports Science Australia (ESSA) or HICAPS. For a list of registered providers, visit navyhealth.com.au; the service forms any part of a payment from Workers Compensation, Third Party or any other liability provision. Navy Health reserves the right to seek full reimbursement on any benefits paid in these circumstances; the procedure does not have an assigned Commonwealth Medical Benefits Schedule item number; the claim is within a specified waiting or replacement period or annual/sub limits have been reached; Access Gap providers submit medical claims two (2) years after the date of service, unless approved by Medicare Australia for benefits; services performed, or products from outside of Australia; cosmetic surgery; during a period of suspension or when membership is in arrears. Overseas benefits Navy Health will not pay benefits on any services, treatments or products received outside of Australia or when purchased from a provider without an Australian Business Number (ABN). As a consequence we strongly advise all members consider Navy Health Travel Insurance when travelling overseas to cover emergency expenses when outside of Australia. (Refer to navyhealth.com.au for more details.)

31 31 Benefits Explained Navy Health aims to close the gap on outof-pocket in-hospital expenses. A gap payment is the difference between the fee charged by the hospital or doctor and the benefit paid by Navy Health. When treated as a private patient in a hospital, members may face extra costs when the treating doctor charges more than the Medicare Benefits Schedule (MBS) allows for the service provided. Access Gap The Access Gap scheme is designed to help minimise or eliminate these costs. Where there is an agreement in place and the treating doctor chooses to participate in the Access Gap Scheme, the insurer will cover the cost above the MBS fee to an agreed level of the Access Gap fee. If the doctor s fee is higher than the agreed Access Gap fee, the patient is responsible for paying the balance. $400 above the Australian Health Services Alliance (AHSA) set fee for all items except obstetrics. $800 above the AHSA set fee for obstetrics only. Total Doctor s Fee Gap medical The gap is defined as the monetary variation between the MBS fee and the doctor s fee. If the member receives treatment as a private patient in a hospital from a doctor who chooses not to participate in the Access Gap Scheme, Gap Medical benefits will apply. Under Gap Medical benefits, Medicare will cover 75% of the MBS fee for the service that has been provided. The insurer will pay the remaining 25% of the MBS fee. If the doctor charges more than the MBS fee, the member will be responsible for any gap payment. Private hospital and day facilities contracted facilities Prior to admission, please check with your hospital as to whether or not your treatment or service is contracted. Contracted services relate to hospital fees such as accommodation and theatre. MBS Fee Access Gap Fee Gap Navy Health has been able to negotiate 100% benefits on most treatments and services at over Medicare 75% Fund 25% Fund 100% Patient 100% 500 private hospitals and day facilities. Product excesses still apply. To search for agreement hospitals and specialists in your area, please go to navyhealth.com.au

32 32 Benefits Explained Prosthesis items are payable at 100% of the minimum Government recommended fee. There is at least one prosthesis item available for every surgery with no out-of-pocket expense to the patient. Drugs prescribed for discharge and drugs not directly associated with the reason for admission are excluded from contracts and are the patient s responsibility. In addition, if a patient chooses to stay in an executive suite, the patient will be required to pay the difference between the private room benefit and the executive suite charge. Benefits are not payable if treatment is for medical services not recognised by Medicare Australia. For a list of contracted services, please refer to navyhealth.com.au Exclusions Please be aware that sometimes service exclusions may apply for hospital services where Medicare does not pay a benefit. To be sure of coverage, please call Navy Health Member Services on prior to arranging admission. Restricted cover So there s no need for a separate subscription. Transport services by Patient Transport vehicles are not ambulance services and are not covered. Psychiatric treatment and rehabilitation day programs Prior to your admission to a Psychiatric or Rehabilitation Day Program, please check with Navy Health as limits may apply. Private hospital and day facilities Non-contracted services Prior to admission please check with your hospital as to whether or not your treatment or service is contracted. Contracted services relate to hospital fees such as accommodation and theatre. Private emergency rooms fees are not eligible for benefit. If you find that your impending hospital treatment or service is not contracted, we strongly recommend you contact our Member Services team to obtain benefit information prior to admission, as out-of-pocket expenses will apply. Product excesses may also apply. For services that are restricted, you can only be treated as a private patient in a public hospital. If you are treated anywhere else such as a private hospital, you will be significantly out-of-pocket. Accident definition Accident means an unforeseen event, occurring by chance and caused by an external force or object, which results in involuntary injury to the body requiring immediate treatment. This definition excludes unforeseen conditions attributable to medical causes. Full ambulance cover Full ambulance cover is 100% of the cost of ambulance services within Australia provided that the service is from a State/Territory registered ambulance service and deemed medically necessary.

33 33 Extras Claiming You can make claims for most extras services through Online Member Services at navyhealth.com.au Making claims by post, & fax A completed Navy Health claim form must accompany all claims submitted. You can receive payment by direct deposit into a nominated bank account (within Australia and excluding credit cards). Receipts forwarded for benefits will be held by Navy Health on your behalf. Receipts will not be returned to the member. Claim forms can be downloaded from the Navy Health website at navyhealth.com.au Electronic claiming All you need is your Navy Health membership card to use the electronic claiming system. After a consultation, your card can be swiped through the electronic claiming facility by the service provider. They will enter the claim details and process the transaction on your behalf. Once the transaction has been authorised by Navy Health electronically you simply pay the balance amount. (This is the difference between the fee charged for the treatment and the amount paid by Navy Health). Ask your provider if they are connected to an electronic claiming system. Online Members Services claiming You can claim your Extras services (excluding Orthodontic, MPAs and Pharmacy) immediately via Online Member Services. To register and for more information go to navyhealth.com.au If you or your immediate family has been a civilian employee of the Department of Defence or an employee of a contractor to the Australian Defence Forces, you re also eligible.

34 34 General Information Waiting periods Waiting periods for extras items are detailed in this brochure and need to be read carefully in conjunction with the conditions of the selected cover. Hospital benefits are payable after two months of membership on the selected level of cover, excluding pre-existing conditions. Maternity (or admissions related to the management of) and IVF procedures attract a 12 month waiting period at the selected level of cover. If you transfer to a higher level of cover, new waiting periods will be applied. However, benefits at the previous level will still be available whilst the new waiting periods are being served. Transfers between or from products containing a lesser level or predetermined excess will result in additional waiting periods being applied. Any excess applicable to a higher excess product from which a member is transferring will continue to be applied for a period of up to 12 months after transfer. Dependants are required to complete waiting periods of the same length as members. Pre-existing conditions* The pre-existing condition waiting period provides protection for existing members against people joining or upgrading cover only when they require treatment. This assists Navy Health in keeping premiums as low as possible. Claims and benefits within the first 12 months of joining the insurer or increasing to a higher level of cover are subject to the pre-existing condition rule. A pre-existing condition is where signs or symptoms of an ailment, illness or condition, in the opinion of a medical practitioner appointed by Navy Health existed at any time during the six (6) months preceding the day on which you joined the insurer or transferred to a higher benefit cover. This is irrespective of whether your medical practitioner, you and/or your dependants were aware of the condition or ailment. The pre-existing condition rule also applies when resuming a suspended membership and symptoms or signs developed during the suspension period. * Excludes Psychiatric, Rehabilitation and Palliative care. Preferred optical providers If a member uses one of Navy Health s Preferred Optical Providers, they can receive an additional benefit (subject to the annual maximum). To view the list of Preferred Optical Providers go to navyhealth.com.au The Preferred Optical Provider list is subject to change without notice. Prosthetic appliances Prosthesis appliances or devices surgically implanted during a hospital stay are subject to two benefit types, either no gap or gap permitted. These items are listed on the Commonwealth Prosthesis Schedule. When a gap permitted benefit applies the insurer will pay the recommended minimum benefit as shown on the Schedule. The Schedule will have at least one no gap prosthesis or device item for every in hospital procedure on the Medical Benefit Schedule (MBS) for which the insurer provides cover. No benefit is payable where the hospital charges for a prosthetic appliance or device not listed on the Schedule. Podiatry surgery Limited benefits are available when Podiatric Surgery is performed in a contracted hospital by an Australian Government Accredited Podiatrist. For further information, please call Navy Health Member Services on For a list of registered providers, visit navyhealth.com.au Natural therapies and recognised providers Natural therapies include Acupuncture, Aromatherapy, Chinese Herbal Medicine, Exercise Physiology, Homeopathy, Myotherapy, Naturopathy, Remedial Massage Therapy, Remedial Therapy and Western Herbal Medicine.

35 35 Benefits are only payable for services rendered by a recognised provider in a private practice. Benefits are not payable on any prescribed medications, herbal or dietary preparations, or organised weight reduction programs. The provider registration process for Natural Therapy services, including the issuing of provider numbers, is managed by the Australian Regional Health Group (ARHG) and Exercise and Sports Science Australia (ESSA) on behalf of Navy Health. Natural Therapy providers must be a member of ESSA or an eligible member of an association that the ARHG recognises for benefit. Medically Prescribed Appliances (MPA) MPA claims must be accompanied by a referral from a registered practitioner. The following are examples of items that can be claimed under the MPA category: Nebulisers, Humidifiers, Blood Glucose Monitors, Heart Rate/Blood Pressure Monitors, Support Aids/ Mobility Aids, Compression Garments, Non-cosmetic Prosthesis (Premium Extras only), and TENS Machine/ Circulation Booster. The MPA category covers the purchase, hire and repairs to appliances that are covered under the category up to the annual limit. CPAP devices CPAP devices cannot be purchased more than once in any three (3) year period. The maximum three year replacement period applies to any three year rolling period from the first date of purchase. Department of Veterans Affairs Gold Card holders Members who are, or become Department of Veterans Affairs (DVA) Gold Card holders have the option of retaining or cancelling their cover with Navy Health. Where a member chooses to cancel their coverage, they must advise Navy Health in writing of the issue date. The cover will be cancelled from the date Navy Health receives written notification. The person holding the DVA Gold Card may then re-apply for membership to Navy Health without waiting periods or penalties (excluding pre-existing conditions), as they are deemed to have continuity of cover. Any person who has previously held a DVA Gold Card is entitled to join Navy Health from the date their DVA Gold Card is no longer valid without serving any waiting periods (excluding pre-existing conditions). Proof of previous DVA Gold Card status that shows the valid from and to dates is required. Where a member chooses to retain their coverage, benefits will be paid on out-of-pocket costs incurred after the DVA payment, however the benefit must not exceed the total charge or the Navy Health benefits and annual limits. Where a member with a DVA Gold Card has Premium Hospital coverage, Navy Health will pay the supplement (top up) benefit for a private room in a private hospital, as DVA already cover the cost of a shared ward. Ombudsman The Ombudsman (PHIO) was set up by the Government to deal with complaints where the member has not been able to resolve an issue with their insurer. Whilst we actively encourage all members to discuss any such matters with our office in the first instance, the PHIO will gladly mediate if required. The PHIO can be contacted on , by phio.info@ombudsman.gov.au or you can write to: The Ombudsman Office of the Commonwealth Ombudsman GPO Box 442, Canberra ACT 2601 Navy Health rules and constitution New memberships must be in accordance with the rules and constitution of Navy Health Ltd. Benefits are also paid in accordance with these rules. Members can view Navy Health s rules on receipt of a written request. All members are bound by the rules of Navy Health Ltd.

36 36 General Information Health + Care program The Health + Care program is supported by several service providers. Navy Health is not involved in the assessment of patients eligibility to uptake these programs. It is important to know that the early discharge and hospital substitute program is NOT available in all hospitals; referrals to the program are made by your doctor, hospital staff or at the discretion of Navy Health. We recommend you check with your hospital or contact your provider to discuss what services may be available to you. Call for more information about early hospital discharge or hospital substitute programs that may be suitable for your care. Navy Health is continually seeking new initiatives to improve your access to quality health services. For up to date information regarding our Health + Care program, please visit navyhealth.com.au Our integrated program allows for treatment to be provided either in conjunction with hospital care or as a substitute; it may even mean you avoid a hospital stay altogether. For more information about our Health + Care program, refer to navyhealth.com.au Feedback policy If for any reason you are not satisfied with the service you receive from Navy Health or feel that it has failed to meet your expectations, we would appreciate your feedback. We are committed to resolving your complaints in a fair and efficient manner and view your feedback as a vital opportunity to improve. Navy Health provides an accessible, impartial, free-of-charge complaints handling procedure for members. This procedure can be viewed at navyhealth.com.au or by telephoning Broader health cover Broader health cover is supported by the Australian Federal Government and enables private health insurers to pay claims for health services that can be delivered just as effectively at home as they can in hospital. Health and Care is an example of broader health cover at work, assisting our members in achieving and maintaining good health.

37 37 Terms and Conditions Definitions The term member in this booklet refers to a policy holder as defined in the Navy Health Ltd Rules. Security policy At Navy Health we take the issue of member privacy and security very seriously. Under our Privacy Policy, we will NOT discuss any details about a membership except with the policy holder, unless they have given authority for us to do so. There are two types of Authority: Authority to operate Which gives the person permission to change details on the policy and act as the policy holder s proxy. They cannot, however, cancel the policy, only the policy holder can request this. Authority to query Which only allows the person to make enquiries about the policy. Navy Health undertakes security checks whenever you contact our Member Services team to ascertain that we are speaking to the policy holder. We also provide members with the opportunity to establish a password on their policy for added security. Privacy policy Navy Health is committed to protecting and maintaining the privacy of all individuals with whom we deal. We are also committed to complying with the Privacy Act 1988 (Cth) and the Australian Privacy Principles. Our Privacy Policy explains how we manage the personal information which we collect, hold, use and disclose. It also explains how to contact us if you have any further queries about our management of your personal information. This policy applies to you only to the extent that the collection and handling of your personal information by us is subject to the Privacy Act. To view a copy of Navy Health s Privacy Policy visit the Navy Health website at navyhealth.com.au Read and retain Please ensure that you always read and retain all information received from Navy Health, regarding your membership. Information collection statement Navy Health Ltd is a company established under the Corporations Act; You may contact Navy Health Ltd by writing to: Navy Health Ltd, PO Box 172 Box Hill VIC. 3128, or by ing query@navyhealth.com.au or by calling ; You have the right to gain access to the information held by Navy Health Ltd about you but not any other person unless the other person has provided explicit permission for you to do so; The information collected by Navy Health Ltd is only that necessary to provide you with a service or product, such as assessing or processing claims; Navy Health Ltd may disclose any of this information to the following individuals or organisations: As required by law to a government organisation such as the Department of Health, Department of Human Services (Medicare or Centrelink); To a hospital or provider in helping us administer a claim which has been made for services provided; Another organisation who helps us process transactions, access data or provide services, such as contractors who assist us in the provision of customer services; Membership details and benefits paid need to be confirmed to the membership holder. If you choose not to provide information to Navy Health Ltd we may not be able to provide you with your chosen service or benefit; Navy Health Ltd policies for the management of personal information are set out in the publication entitled Navy Health Ltd Privacy Policy available from navyhealth.com.au Direct debit service agreement This agreement ( Direct Debit Service Agreement ) outlines the terms and conditions of the direct debit

38 38 Terms and Conditions arrangements between the person signing the direct debit request ( you ) and Navy Health ( us ). You agree to be bound by these terms and conditions upon your execution of the Direct Debit Request. Direct debit arrangements (a) We will, in accordance with the terms of the direct debit request and any other existing agreement, periodically debit the nominated account for the agreed amount(s). (b) The debits will occur according to the frequency you have nominated i.e. fortnightly, monthly or as agreed. The amount debited will vary according to the amount falling due. (c) If any drawing falls due on a non-business day, it will be debited from the nominated account on the prior business day. Your rights (a) You can change your direct debit arrangements by calling us on or logon to member services at navyhealth.com.au at least five (5) business days prior to the next direct debit. Changes include altering arrangements, stopping an individual debit or cancelling a direct debit request completely. (b) We will give you at least 14 days notice by telephone or writing (including ) of any change to the terms of the direct debit arrangements, unless otherwise agreed. (c) If you believe we have drawn on your account incorrectly, please contact us on so the matter can be resolved. We will make every attempt to resolve the dispute within five (5) business days. Your obligations (a) You must ensure that: (i) before completing the direct debit request, you check the account details of your nominated account are accurate (check against a recent statement from your financial institution); (ii) your nominated account can accept direct debits (your financial institution can confirm this); (iii) your nominated account has sufficient clear funds on the drawing date to allow payment to be made in accordance with the direct debit request and any other existing agreement between you and us. (b) You must advise us immediately if your nominated account is not current. (c) If any drawing is returned or dishonoured by your financial institution, we may, at our discretion, reprocess the transaction following receipt of the notification of return or dishonour, or request an alternative form of payment from you. We may also charge any dishonour fees back to you. Code of conduct Navy Health abides by the Private Health Insurance Code of Conduct. By subscribing to the code, Navy Health ensures that members receive clear information and transparency in their dealings with Navy Health. The code ensures Navy Health will: Continue to improve standards of practice and service; Provide information to members in clear and plain language; Ensure the policy documentation is full and complete; Ensure that Navy Health staff are appropriately trained to provide clear explanations; Provide members with access to an internal dispute resolution procedure and advise members of their rights to take an issue to the Ombudsman. A copy of the code may be provided on request or can be viewed at navyhealth.com.au

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