Welcome to the Salesforce Resident Health Plan

Transcription

1 Welcome to the Salesforce Resident Health Plan Health cover designed exclusively for Salesforce resident employees and their families. Salesforce have partnered with GU Health to ensure you and your family have access to a flexible tailored health plan with extensive benefits, to keep you well and healthy. Your plan: Complete Hospital and Business 90 Benefits Salesforce will cover the (full) cost of your Single or Family membership excluding any Lifetime Health Cover (LHC) loading that may apply. Your cover is inclusive of the Australian Government Rebate at Base Tier. If you re choosing a rebate tier other than Base Tier or if you have Lifetime Health Cover Loading (LHC), you ll need to make additional contributions. For more details about your cover and the Australian Government Rebate, please see overleaf. We have attached the product tables for your reference. Who is GU Health? GU Health is Australia s only corporate private health insurance specialist. We ve been providing health cover to many of the world s biggest and most recognised brands for over 15 years, making us specialists in corporate health insurance. With a wealth of experience in servicing the corporate sector, our expertise extends further than just health cover, enabling us to provide personalised service and premium health and wellness benefits. The GU Health difference: Our agreements with private hospitals mean you re covered for hospital accommodation and theatre fees. Extras claiming is based on a percentage of cost, which means more generous rebates. For example, you can claim back 90 per cent of your dental, physiotherapy and optical expenses up to the stated annual limits. An appropriate level of hospital cover with GU Health for you and all your dependants enables you to apply for exemption from the Medicare Levy Surcharge if it applies to you. You have the freedom to use a recognised provider of your choice. You re covered for a wide range of preventative and natural therapies. It s easy to claim using Flex-eClaim, GU Health s innovative online claiming system. You can enjoy GU Health s FastBack claiming service, with benefits paid directly into your bank account Managing your membership is simple with Online Member Services. The Member Support program helps you get you out of hospital sooner.

2 Continuity of cover You re guaranteed continuity of cover if you have served waiting periods with an Australian or internationally recognised registered health fund on an equivalent level of cover, and transfer to GU Health within two months of leaving your previous insurer. If you are transferring from an international health fund, you ll need to provide GU Health with a certificate of cover and your full membership details for assessment. Additional contributions You only need to make additional employee contributions if you: have Lifetime Health Cover (LHC) loading on your hospital cover elect a different rebate tier that better reflects your household income. Waiting periods If you re new to private health insurance, waiting periods will apply to you. Upgrading from a lower level of cover to a higher level of cover may also mean waiting periods. GU Health waiting periods apply to: Psychiatric and Rehabilitation (2 months) Health management services (6 months) Artificial Aids / Appliances (12 months) Dentures (12 months) Elective Cosmetic / Plastic surgery (12 months) Hearing aids (12 months) Major dental services (12 months) Pre-existing conditions (12 months) Pregnancy, pregnancy related and birth-related conditions (12 months). What is Lifetime Health Cover? Lifetime Health Cover (LHC) was introduced by the Australian Government to encourage people to take out private hospital cover at a younger age and lock in lower hospital contribution rates throughout their lifetime. People who take out hospital cover after 30 June following their 31st birthday pay a two per cent loading, on top of their contribution for every year they re over 30 and without hospital cover. For more information on your LHC requirements, please refer to your member booklet.

3 What you need to know about the Australian Government Rebate If you re earning below the income testing threshold, you can apply for the Australian Government Rebate on Private Health Insurance. The Australian Taxation Office (ATO) has grouped earnings over the income thresholds into the following tiers: Rebate effective from 1 April 2014 to 31 March 2015 Income thresholds effective from 1 July 2014 to 30 June 2018 Base Tier Tier 1 Tier 2 Tier 3 Base Tier Tier 1 Tier 2 Tier 3 Aged under % % 9.680% 0% Singles $90,000 or less $90,001 $105,000 $105,001 $140,000 $140,001+ Aged 65 to % % % 0% Families $180,000 or less $180,001 $210,000 $210,001 $280,000 $280,001+ Aged % % % 0% Note: Single parents and couples (including de facto couples) are subject to the family tiers. For families with children, the thresholds are increased by $1,500 for each child after the first. Note: Rebate levels change annually from 1 April, based on the Rebate Adjustment Factor. The Lifetime Health Cover component of a premium is not eligible for the rebate. For more information, please visit the Australian Taxation Office website: ato.gov.au How to join If you ve previously been a GU Health member, please join by completing an application form and returning it directly to us by: FreePost to GU Health, Reply Paid 2988, Melbourne, Vic 8060 (no stamp required) corporate@guhealth.com.au If you ve not previously been a GU Health member you can join online, log onto guhealth.com.au/ salesforcecorporate and enter the company code sfr101. In the New members section click on the link Would you like to join online? and follow the prompts. At the end of this process you will be provided with a GU Health membership number and password. More information Your GU Health Member Relations Team are on hand to answer any questions you may have. Call between 8.30am and 5pm (EST) Monday to Friday, or corporate@guhealth.com.au

4 Complete Hospital Certain benefits could be subject to waiting periods. Members transferring from an equivalent level of cover with another fund will not have to re-serve waiting periods. Please refer to the Waiting Periods outlined in the front of your Membership Booklet, or contact GU Health before undergoing treatment. All public and partner private hospitals Benefit Accommodation (private or shared room) 100% Theatre fees 100% Intensive care 100% Coronary care 100% Pregnancy and birth related services Accommodation is fully covered in a public or partner private hospital, and doctors fees in hospital are covered up to 100% of the Medicare Schedule Fee. Please contact GU Health before being admitted to determine any possible out-of-pocket expenses. Surgically implanted prostheses Elective cosmetic and plastic surgery Only limited benefits apply (as set by the Minister for Health and Ageing). Before attending hospital for these services please call your Member Relations Team to check your entitlements. 100% 100% of the minimum cost for Government approved appliances Limited cover Psychiatric & rehabilitation care 100% Ambulance Full cover within Australia for members residing in NSW/ACT, 100% emergency ambulance transportation for members residing in other states who are not covered by a State Government Ambulance Scheme. For members residing outside of NSW/ACT, the Ambulance account must be coded as emergency transportation by the ambulance service to qualify for benefits. In-hospital Carer Benefit Maximum limit of $500, per member, per year When a member is admitted as a private patient, a benefit can be claimed to help cover the cost of accommodation and meals for their carer (partner, family member or caretaker). The carer needs to stay with the member overnight in order for the meal benefit to be paid. Member Support Program Where clinically appropriate and approved by you and your treating doctor, you may be able to leave hospital early and continue your treatment at home. Contact your Member Relations Team for more information. 100% emergency 100% of cost up to $60 per night for accommodation in hospital and $30 per day for hospital meals (meals are covered when provided at a hospital cafeteria, or patient meal menu) Available Continued over page

5 Complete Hospital continued Access Gap Cover Scheme Through your GU Health hospital cover, you may be able to reduce or eliminate your out-of-pocket expenses when going into hospital using the Access Gap Cover Scheme. Medicare covers you for 75% of the Medicare Schedule Fee for treatments provided by doctors in hospital. Your GU Health hospital cover pays the remaining 25% difference between the Medicare benefit and the Medicare Schedule Fee. If your doctor charges more than the Medicare Schedule Fee, you may experience out-of-pocket expenses known as the Medical Gap. The GU Health Access Gap Cover Scheme is designed to help members avoid or minimise these out-of-pocket expenses, however your doctor/s must agree to participate in the Scheme prior to the start of your treatment. Please contact your Member Relations Team for more information. Special nursing Maximum limit of $1,000 per member, per year when provided by a registered nurse in private practice and recommended by a registered medical practitioner. Available Up to $20 per hour Partner Private Hospitals Partner Private Hospitals are those facilities that have entered into an agreement with GU Health. The agreement guarantees that members with hospital cover will be covered for 100% of accommodation and other associated costs such as theatre fees less any excess (if applicable). Where no agreement exists (Non Partner Private Hospitals), benefits will be paid at the lowest contracted amount for that specified treatment in any agreement hospital in that state, subject to the benefit not being lower than the Default Benefit set by the Minister for Health and Ageing, less any excess (if applicable). Benefits for pharmaceutical drugs are limited to $300 per person per year in hospitals where no agreement exists. Exclusions Medical services that do not attract an MBS item number *Note on Excess: For singles, the excess is payable once per excess year if hospitalised. For couples and families, the excess is payable at the single rate up to a maximum of twice per excess year.

6 Business 90 Benefits Benefits are paid per person, per membership year unless otherwise specified. Benefits are only payable where the service is provided by a GU Health recognised provider in private practice. Certain benefits could be subject to waiting periods. Members transferring from an equivalent level of cover with another fund will not have to re-serve waiting periods. Please refer to the Waiting Periods outlined in the front of your Membership Booklet, or contact GU Health before undergoing treatment. Business 90 Benefits Benefit Maximum limit General Dental Preventative Services 100% of the cost General, Diagnostic, Restorative Services Major Dental Crowns, Bridges, Orthodontic Treatment, Dentures, Prosthodontics, Periodontics, Endodontics Physiotherapy cost cost $2,000 per person, per year $800 per person, per year Optical Prescription optical appliances (glasses and contact lenses) or repairs. cost $300 per person, per year Chiropractic, Osteopathic Limit of two chiropractic x-rays per person per year. Audiology $800 per person, per year combined Dietetics, Natural Therapies Natural Therapies that attract a benefit are: Naturopathy, Homoeopathy, Acupuncture, Herbalism, Chinese Herbalism, Iridology, Nutrition, Aromatherapy, Remedial Massage, Shiatsu, Reflexology, Kinesiology, Bowen Technique, Sports Therapy Massage, Myotherapy, Exercise Physiology, Ayurveda Medicine, Chinese Massage, Traditional Thai Massage. Podiatry, Occupational Therapy, Speech Pathology, Clinical Psychology, Eye Therapy Artificial Aids and Appliances, Hearing Aids, Orthotics For the purchase of approved artificial aids and appliances. Appliances must be purchased from a recognised health practitioner or organisation. Contact your Member Relations Team for more information. Hearing aids - limit of one appliance per person each five years. Pharmaceutical All pharmaceutical prescription items (excluding contraceptives, items normally available without a prescription, or items not related to a medical condition), after the member has paid a sum equal to the current PBS charge. Includes allergy vaccines, travel vaccines, diabetic syringes and hormone implants. Hormones for IVF treatment are not covered. Country Travel and Accommodation For essential travel and accommodation for a patient and attendant within Australia. Benefits are available where extended travel is necessary to access the nearest treatment centre for a disease, injury illness or condition. This benefit is not available for services associated with elective cosmetic surgery, assisted reproduction or reversal of sterility or infertility procedures. cost cost $0.20 per km where travel exceeds 250 km (round trip), and $70 a night for an essential overnight stay $1000 per person, per year combined $500 per person, per year Continued over page

7 Business 90 Benefits continued Health Management Services All Health Management Services are paid at cost of each service up to the yearly limit. Services must cost more than $20. Call your GU Health Member Relations Team on for further details. Health Management Services Benefit Maximum limit Asthma eg. Asthma education (eg. asthma camps, asthma emergency management course), Buteyko, Asthma swim classes Diabetes eg. Diabetes education (eg. diabetes camps) Mental Health eg. Counselling, Family counselling, Life coaching, Suicide prevention, Zoeros life skills courses, Meditation, Flotation tanks, Stress management, Family Life, Live Smart, Bed wetting programs, Family education, Relaxation skills, Alcohol programs, Drug addiction programs Cancer eg. Survivors out patients course, Melanoma imaging, Skin cancer checks, Cancer screening Pregnancy and Childbirth eg. Childbirth education, Lactation classes, Fertility programs Weight and Nutrition eg. Weight loss programs, Fitness or exercise programs, Personal trainer Injury Prevention eg. Alexander Technique, Pilates, Tai chi, Yoga, Feldenkrais, Mediball, Illness & prevention management, Yogalates, Pre Menstral Syndrome/ Womens Health, Reiki Risk Assessment eg. Health risk assessment, Bone density test Disease Management Association Fees eg. Arthritis, Asthma, Coeliac, Crohn s disease, Diabetes, Heart disease Group Therapies eg. Floor/mat work, Hydro therapies, Aqua aerobics 90% of cost of service $200 per Single membership, $400 per Family Membership, per membership year For accredited or recognised programs designed to assist in preventing or improving a specific health condition, where provided by a qualified health practitioner. Accredited programs may target conditions including (but not limited to) alcohol or drug addiction, weight management, asthma, diabetes, mental health, cancer or coronary health. A letter or a completed Health Management Services Authorisation form may be required from your treating doctor or recognised health practitioner before being able to claim on some Health Management services. Please contact your Member Relations Team for more information. Please note this list is subject to change without notice.

8 Salesforce Resident Health Plan All rates presented below are monthly national rates and are applicable from 1 January 2015 to 29 February 2016 Due to government legislation, rates inclusive of rebate are subject to change on 1 April each year. An updated rate sheet will be provided at the time. Complete Hospital and Business 90 Benefits Rates inclusive of rebate No rebate Base Tier Tier 1 Tier 2 Tier 3 Single Cover Family Cover $0.00 $22.00 $44.00 $66.00 $0.00 $44.00 $87.95 $ Note: 1. The hospital contributions quoted above do not include Lifetime Health Cover (LHC) loading. 2. The actual amount of your new contribution rate may include rounding of cents and will depend on the applicable LHC loading, if any (LHC loading not applicable to non-resident cover options). 3. Only rates applicable to the rebate tiers available under your particular corporate health plan are set out above. 4. Your actual entitlement to the Australian Government Rebate on Private Health Insurance may vary depending on your age and income. For more details visit the Australian Taxation Office (ATO) website ato.gov.au or contact your registered tax agent. 5. If your rebate entitlement, as determined by the ATO, differs from rebate claimed under your GU Health membership, any reconciliation necessary will be carried out by the ATO after lodgement of your tax return. 6. Rates inclusive of the Australian Government Rebate on Private Health Insurance are subject to change on 1 April each year due to government legislation. This affects contribution amounts quoted under Base Tier, Tier 1 and Tier 2 above. For more details on the government s indexing of the rebate visit the Department of Health website health.gov.au.