Family 65. For starting and growing your family

Transcription

1 65 Family 65 For starting and growing your family

2 This is the most family friendly policy we ve ever designed. We pay 100% preventative dental care for kids. We all know prevention is better than cure. Set your kids up with a good oral health routine with regular check ups at the dentist. Podiatry for big and little feet. Young kids feet often need attention and care. Feet provide a lot of sensory information to our brains that help with balance, posture and coordination. Concerns about your child s gait can be addressed through early intervention. It s more than occupational therapy. Any issues with developmental delays in children, such as concerns over gross or fine motor skills, can be addressed through occupational therapy. We cover this. Speech therapy supports development. Also known as speech pathology, this type of therapy can help with speech problems, hearing issues, social skills, feeding and swallowing difficulties. No hospital excess payable for children. Ever. Whether its footy or ballet, kids gets aches and sprains. We pay 100% physio for kids. Kids are free. A family pays the same premium as a couple. Now that is family friendly!

3 FAMILY FRIENDLY FEATURES We think Family 65 is the most family friendly product we ve designed. Just look at all these features: 100% preventative dental care for kids 100% physio for kids Speech therapy Podiatry Occupational therapy Psychology No hospital excess payable for kids Higher annual dental cap Higher annual orthodontic cap Families pay the same premium as couples Plain and simple We ve designed our products to let you choose what you want to be covered for in Hospital and how much you get back on your Extras. So for Family 65 you ll get 65% of your provider s fee back, up to your annual cap. That s your provider not ours Most health funds want you to use their providers. We want you to use the ones that you and your children are most comfortable with. If you d like some help finding a dentist, a podiatrist or a speech therapist we re always on the end of the mouse (or the phone) to help. We know families are busy Rather than make you pay the full amount and then have you queue up to get the refund, we use the most popular electronic claiming system HICAPS. Your provider just swipes your Claims Card and we ll pay 65% of their bill instantly. We want to be able to make your family life easier, not harder. Australian owned and growing From the day we started we hoped that busy families would appreciate our straightforward policies and our online way of doing things. Now we re proud to say we provide cover for more than 83,000 Australians.

4 Family 65 Hospital Cover If you go to hospital for treatment the tables below show the sorts of things you re covered for, and the sorts of things you re not covered for. YOU RE COVERED FOR EVERYTHING, EXCEPT Joint replacements, including spine, with prostheses Cataract and eye lens procedures Dialysis for chronic kidney failure Bariatric (lap band) surgery IVF Sterility reversal Spinal fusion Podiatric surgery All other services not covered by Medicare SOME EXAMPLES OF WHAT YOU RE COVERED FOR Treatment for injuries you get in an accident Pregnancy related Removal of your appendix Arthroscopies, colonoscopies and gastroscopies (internal examinations with a fibre optic instrument) Wisdom teeth removal Removal of tonsils and adenoids Knee reconstructions Cardiothoracic (heart and lungs) related services Psychiatric is only covered to a minimum level. For this service Family 65 is only enough to be treated as a private patient in a shared ward of a public hospital, not a private hospital. Going to Hospital Rest assured Family 65 will cover the cost of: Hospital bed, overnight or same day; Meals; Nurses; Operating theatre fees; Intensive care fees; and Government listed surgically implanted prostheses. Your Hospital cover means you can choose to go to any hospital, public or private. We have contracts in place with over 90% of the larger private hospitals that you re likely to use. However, there are some smaller or very specialised hospitals that we don t have contracts with. In the unlikely event that you use one of these uncontracted hospitals we ll pay a Government default rate and then you may be left with significant out of pocket expenses. You don t want this and neither do we. The best thing to do is to check our website, or ring us, to make sure that the hospital you re going to use is one we have a contract with. Or you can ask the hospital directly. Your hospital is also required to advise you in advance of any out of pocket expenses that you may be liable for. To find a hospital we have a contract with go to health.com.au/provider-search Medical services Our Access Gap Cover scheme allows you to reduce or eliminate your out of pocket expenses. On a case by case basis medical practitioners can decide if they will participate in our scheme. Almost 9 out of 10 medical services under the Access Gap Cover scheme have no out of pocket expenses. It s important that before you agree to any treatment, firstly ask your hospital if they have a contract with us, and secondly ask your medical practitioner if they will use our Access Gap Cover scheme so as to minimise your out of pocket expenses. Surgically implanted prostheses The Commonwealth Government Prostheses List details the minimum benefits a health fund has to pay to policy holders who have cover for these prostheses in their product. If you re going to have an operation and need a surgically implanted prostheses you should ask your medical practitioner for a cost estimate of the prostheses they re planning to use. If you re happy with the cost then provide your medical practitioner with informed financial consent in writing is best. Then contact us and we can tell you what out of pocket expenses, if any, related to the prostheses you will be required to pay. Going to a public hospital? Being admitted as a private patient in a public hospital means you have a choice of which doctor treats you. In some cases this could be the same doctor who would have treated you anyway if you were a public patient at the same public hospital. health.com.au will pay minimum benefits for any treatment you receive as a private patient in a public hospital. These minimum benefits are determined by the Government. All hospitals should let you know what expenses you ll be liable for before you choose to be treated as a private patient in a public hospital. These expenses are the difference between what the hospital charges and what the Government sets as the minimum default payment to be paid by health insurers like us. You ll have to cover the difference between what the hospital charges and what the minimum default benefit is. Waiting periods All health insurance providers impose waiting periods. Ours are: 2 months All services, including psychiatric, rehabilitation and palliative care, except the ones listed below; 12 months Pre-existing conditions; Major dental services (for the big jobs more than just a clean). Pregnancy related. Premium discount Pay by direct debit from your bank, building society or credit union cheque or savings account and we ll give you a 4% discount on the cost of your premiums. Payments made by MasterCard or Visa also get the discount. Pricing on the health.com.au website includes this discount. Families pay no more for their premiums than couples. Excess So you can lower the cost of your premiums further we give you a choice of excess: $250 or $500. They apply per person for each hospital admission, and there is an annual cap to limit your expense. The cap depends on the excess you choose and whether your policy covers just one person or more. And of course there is no excess with extras cover or ambulance cover. Ambulance cover health.com.au pays for emergency ambulance transport under every policy we sell. By emergency ambulance transport we mean that you need immediate attention, and your condition or injury is such that you can t be transported to hospital by any other way except ambulance. So relax, with us you re covered. Palliative care Rehabilitation RESTRICTIONS Psychiatric If your medical practitioner chooses not to participate then, by law, health.com.au is only able to pay 25% of the Medicare Benefits Schedule (MBS) fee. Medicare pays 65% of the MBS fee. However medical practitioners are able to charge what they like. If your bill is more than the MBS fee you ll have to pay the difference. If you have dependent children on your policy there is no hospital excess payable for them. Ever. More information You should read this Features Guide along with the health.com.au Policy Guide that can be found at: health.com.au/policy-guide Family 65

5 Family 65 Extras Benefits We pay 100% preventative dental and physiotherapy benefits for children, and introduced podiatry to our list of family friendly Extras. Prevention is better than cure Treating problems early is the best way to avoid problems later in life. With occupational therapy and speech therapy you can address developmental issues early on in your children s lives. And by making preventative dental and physiotherapy gap free we re also making it easier on the family budget. As is usual across the entire industry, annual caps apply for each person on your policy. The table below shows the services we cover along with their caps. All benefits are subject to annual caps. WE PAY 65% OF THE BILL UP TO AN ANNUAL CAP PER PERSON Dental $1000 Of which $500 can be for orthodontic 65 % Optical $200 Occupational therapy $200 Speech therapy $200 Physiotherapy, Chiropractic & Osteopathy in total $350 Podiatry $200 Psychology $200 Non PBS scripts $150 You pay a co-payment of $36.90 and then we pay 65% of the balance Acupuncture, naturopath, remedial massage $250 Health maintenance* $100 e.g. quit smoking courses, gym membership etc HOW TO CLAIM Extras claims We use HICAPS, an electronic system that lets you claim your extras benefit directly after your consultation with more than 45,000 providers across Australia. Based on your level of cover, your entitlements will be authorised when you swipe your Claims Card through an EFTPOS style terminal. If there is a difference between your Extras benefit and the fee charged by your provider then you will need to pay this at the time. Hospital claims When you re discharged from hospital your account will usually be forwarded directly to us. If for some reason you receive a bill then just send it onto us. Medical claims for treatment received while in hospital If your medical practitioner uses our Access Gap Cover scheme you don t need to worry about claiming. The medical claim is sent straight to us. If your medical practitioner doesn t use our scheme you can lodge your medical claims either through Medicare or with us. Benefit payments You will receive your benefits by direct credit, paid electronically into your nominated bank account. Lodging a claim Claims must be lodged within two years of the date of service. Also, please keep your receipts for two years for audit purposes. If your claim can t be processed at the time of your treatment you can claim online 24 hours a day at *Health maintenance benefits are designed to support you in reaching your health goals. We may pay for weight management programs, quit smoking courses or even pilates, so long as they re under the care of your doctor. We ll confirm with your doctor that the program is needed to maintain your health. Family 65

6 1 6 How to use your claims card HAND OVER THE REMAINING FEW BUCKS MAKE AN APPOINTMENT at your favourite healthcare provider 2 Sweet! Your healthcare provider is on board with electronic claiming ARE YOUR PAYMENTS UP TO DATE? Make sure your premium is paid 3 AFTER YOUR TREATMENT GET YOUR CARD SWIPED AT THE COUNTER health.com.au automatically takes care of up to 65% of the bill 5 7 AWESOME you re good to go Can t claim on the spot at your appointment? Don t worry. You can claim online with us 24/7 Benefits go straight into your bank account SERVE YOUR RELEVANT WAITING PERIOD 4 ROCK UP TO YOUR APPOINTMENT (preferably on your bike) STILL GUESSING? visit health.com.au/start

7 CONTACT US We ve made a promise to ourselves to forge a reputation as offering the best customer service in our industry. And you ll be the judge of that. Contact us and we ll endeavour to help you in every way we can. Our website always has the most current information available. So no more out-of-date printed brochures headed for the recycling bin. Whenever there s a change in policy details, premiums or even government legislation surrounding private health insurance, you can be assured of getting up to date information from our website especially via our blog, Facebook page and Twitter feeds. WEB customers@health.com.au BLOG FACEBOOK TWITTER TELEPHONE Monday to Friday POSTAL ADDRESS health.com.au Locked Bag 423 Abbotsford VIC 3067 Customer service with heart Whichever way you interact with us our aim is to provide you with a hassle-free experience. If it s not let us know. Best Start-Up Best Disruptor Family