Private Health Insurance. Navy Army Air Force. Health cover for the Defence Community and their families.

Transcription

1 Private Health Insurance Navy Army Air Force Health cover for the Defence Community and their families.

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 Hospital Cover Extras Cover Defence Information 22 Leaving the Defence Force 23 Health and Wellness Initiatives 25 Australian Government Private Health Rebate 26 Lifetime Health Cover Loading 27 Medicare Levy Surcharge 28 Other covers offered by Navy Health 29 Membership Information 30 Benefits 31 Benefits Explained Extras Claiming 34 General Information Terms and Conditions Kelsey Browne Netballer and Navy Health Member

3 Health Cover for Generations Australian Netball sisters Madi Robinson and Kelsey Browne s grandfather served in the Australian Defence Force, making them eligible to join Navy Health. Madi Robinson Australian Netballer and Navy Health Member

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, eligible Reservists (SERCAT 3-5) and DVA Gold and White Card Holders, 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 must take effect from the first day following discharge. Common Questions Q. Why do I need private hospital 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 27. 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: 2017 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 (SERCAT 3-5), 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 by calling us on Chaz Mostert Supercar Driver and Navy Health Member

6 6 How do I Join? Joining Reassurance 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 We ve got a lot of confidence in the cover and service we offer at Navy Health. However, if you do want to leave within your first 30 days of joining, we ll happily refund your premiums. For more information, refer to the Cooling Off Period on page 30. 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. Navy Health will not pay immediate benefits at a higher level than those provided by the previous insurer. 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 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.

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. 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 options $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) Gastroscopy + 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 may 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 35.

9 9 Extras Cover Overview Navy Health offers four levels of extras cover to suit your current lifestyle. Annual limits are shown below. 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 35. *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 25 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 For any subsequent hospitalisations in the same rolling 12 month period, no excess is payable (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) Gastroscopy + 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 35.

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. 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. 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. 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 may 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 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 Gastroscopy + 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 35. *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. **Excluded Cover: Covered as a public patient in a public hospital.

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 an example of how the excess works see page 10. 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 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 may be significantly out-of-pocket. 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 Gastroscopy + 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 35. *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. **Excluded Cover: Covered as a public patient in a public hospital.

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 may 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. 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

15 15 Hospital Cover What s covered Restricted cover* What s not covered** Cancer Treatment for accidents Tonsils + adenoids Appendicitis Wisdom teeth (Hospital benefits only) Gastroscopy + 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 35. *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. **Excluded Cover: Covered as a public patient in a public hospital.

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 per rolling 3 year period (a treatment plan is required). $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 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 35. $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 35.

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. For more information and conditions please refer to page 33. 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, Exercise Physiology, Reflexology, Bowen Therapy, Kinesiology and Shiatsu. Benefits are not payable on any prescribed medications, herbal or dietary preparations, or weight reduction programs. For more information, refer to page 35. $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 36. $700 6 CPAP Devices Repairs and Maintenance 100% of the fee up to the annual limit Includes repairs to CPAP device. Three year replacement period applies for new CPAP devices (see page 36). $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 Per Service Home nursing is classified as professional treatment by a registered nurse on the recommendation of a medical practitioner. $60 $1,000 2 School Accidents Benefits include costs that result from a school accident to a member s dependant child. Claims must be accompanied by notification of the accident on school letterhead. $800 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 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 per rolling 3 year period. (a treatment plan is required). $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 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 35. $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 35.

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 set cost of the Pharmaceutical Benefit Scheme (PBS), up to the maximum per prescription. For more information and conditions please refer to page 33. 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, Exercise Physiology, Reflexology, Bowen Therapy, Kinesiology and Shiatsu. Benefits are not payable on any prescribed medications, herbal or dietary preparations, or weight reduction programs. For more information, refer to page 35. $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 36. $400 6 CPAP Devices Repairs and Maintenance 100% of the fee up to the annual limit Includes repairs to CPAP device. Three year replacement period applies for new CPAP devices (see page 36). $ 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 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. $ Repairs on Hearing Aids up to $150 Audiology Initial Consultation Subsequent Consultation $60 $40 $300 2 Home Nursing Per Service Home nursing is classified as professional treatment by a registered nurse on the recommendation of a medical practitioner. $60 $1,000 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 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 anti-reflection 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 the cost of the prescription and set cost of the Pharmaceutical Benefit Scheme (PBS), up to the maximum per prescription. For more information and conditions please refer to page 33. 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, Exercise Physiology, Reflexology, Bowen Therapy, Kinesiology and Shiatsu. Benefits are not payable on any prescribed medications, herbal or dietary preparations, or weight reduction programs. For more information, refer to page 35. $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 35. 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 (SERCAT 3-5) and, 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 (SERCAT 3-5) To apply the discount, we will require proof that you have transferred/remain an active Reservist (SERCAT 3-5) prior to the discount being applied. We will also ask you to confirm your Reservist (SERCAT 3-5) status annually. Please go to navyhealth.com.au or call for more information. 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 covered for under your DVA Gold Card to ensure you can make an informed decision regarding Private Health Insurance. 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 36 or call us on 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. DVA card holder must be covered by the policy to apply the discount. 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.

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 service. 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 service. Your current discount status may be affected. 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 (SERCAT 3-5) declaration and proof that you have transferred/ remain an active Reservist (SERCAT 3-5) 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.

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25 25 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 Chronic disease management program We 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-toface 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. Hospital in the home 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. 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 of 1 April The program is subject to change without notice.

26 26 Australian Government Private Health Insurance 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 2017/18 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 Base 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. Rebate information correct as of 1 April 2018.

27 27 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.

28 28 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% Medicare Levy Surcharge information correct as of 1 April 2018.

29 29 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

30 30 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. Partial payments are not accepted. 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