welcome Australia Links

Transcription

1 welcome Links Australia More access. Less hassle. It s like an upgrade from business class to first class. It s CignaLinks Australia a great health plan that s been made even better. By joining forces with GU Health, one of Australia s largest corporate health insurers, Cigna offers more access to top-quality care, lower costs, faster claims payments, and much more. Two cards are better than one. You already have your Cigna ID card. Use your GU Health card included in this kit when you visit a hospital or someone who specialises in supplementary care in Australia. Then use your Cigna card to get healthcare anywhere else in the world. It s that simple. Your CignaLinks coverage is a complement to your Medicare coverage. In many cases, it will reduce or even eliminate your costs. Here s how two common scenarios play out. We ll go into more depth later. Between GU Health and Medicare, you will receive reimbursement costs Medicare deems appropriate. This applies only to inpatient services from healthcare professionals. Please be aware that your doctor may choose to charge above what Medicare deems appropriate which may lead to out of pocket costs. When Medicare pays for 85% of outpatient services, you will still need to pay the remaining 15%. By law, GU Health cannot reimburse for outpatient medical treatment. CignaLinks and Medicare. Understanding how they work together. When you visit a doctor s office, submit your expenses to Medicare. When you go to the hospital for a planned procedure, contact GU Health in advance so they can coordinate billing with the hospital. Then, on the day of your procedure, all you have to do is show up with your GU Health ID card. When you see someone who specialises in supplementary care like a chiropractor or osteopath they may be able to send claims directly to GU Health by swiping your GU Health ID card through an electronic reader. Instantly, your benefit will come off the bill and you will only have to pay what is left over. If they do not have this functionality, simply pay upfront and submit your receipts for reimbursement. To do this, follow the instructions on the claim form included in this kit.

2 Understand how CignaLinks and Medicare work together. Making changes to your membership. Getting married? Adopting a child? If there s a change in your family status and you need to add or remove coverage, simply contact your employer. Resolving disputes. If you have a complaint with GU Health, we will do all we can to resolve the issue with you. So when an issue arises, get in touch with GU Health. Their professionals will work with you to find a solution. But if you aren t satisfied with the outcome, you can contact the Private Health Ombudsman at Now here s the important part. Before making any appointment, find out if your doctor is registered. Otherwise, you may not get reimbursed. Fortunately, it s easy to find out if any doctor is registered. Just call the number on the back of your GU Health ID card. For full details on what GU Health and Cigna cover, read through the Plan Summary that s included in this kit. Two ways to get paid. How fast do you want to get paid? It s up to you. To get reimbursed as quickly as possible, you must be enrolled in FastBack. If you ve haven t already enrolled and now want to be paid via FastBack, please complete the FastBack form enclosed in this kit or contact the GU Member Relations team at the number on the next page. While not as speedy, you can also choose to get reimbursed by cheque. Certain expenses that you incur may not be covered by GU and Medicare. In these instances, you may be required to pay the charges out of pocket and then submit a claim form for consideration. The fine print. In language you can understand. When it comes to reimbursement, there are many things to keep in mind. But the first thing you should know is the Australian government has created guidelines called the Medicare Benefit Schedule (MBS) on what Fair and Reasonable costs are for most medical services. So the amount of money you get paid back is affected by those guidelines. Here s how it works. Medicare covers up to 75% of fair and reasonable costs for treatments performed in hospitals by medical professionals. GU Health will cover the remaining 25% of the fair and reasonable costs. If the medical professional charges more than what the government considers fair and reasonable, you will have out-of-pocket expenses commonly referred to as a medical gap. Mind the gap. Any doctor has the option to charge an amount above the fair and reasonable limit but must provide you with details on what they will charge and what Medicare and GU Health will cover. If you experience a gap, there are times when GU Health can reduce or eliminate it with Access Gap Cover, which means you pay a lower cost or nothing. You should also know that you can ask your doctor to become part of the GU Health Access Gap Plan. Ultimately, the decision is up to your doctor. Respecting your privacy. With more and more information being transferred electronically, you may wonder what GU Health does to ensure your privacy and security. The answer is a lot. All information you supply to GU Health will be used only for regulatory reporting and to provide proof of your eligibility to GU Health doctors and hospitals. 2

3 It makes healthcare easier. It helps you get the personal service you deserve. To view a copy of the GU Health privacy policy, please visit Guhealth.com.au. Keep it in the family. Want to give your spouse or partner access to your plan information? It s easy. If they are not yet named on the membership and you would like them to be, simply complete a Third Party Policy Access Authority Form. You can get one by contacting GU Health. Once approved, your spouse or partner can access plan information and make changes to the policy but cannot cancel it. It makes healthcare easier. It helps you get the personal service you deserve. And it saves you money. It s CignaLinks Australia. And it s just one of the ways Cigna helps provide easy access to quality healthcare around the world. We re here for you. Need to find a new doctor? Want to file a complaint? Have a question about a payment? For these and all other questions contact the GU Health Member Relations Team. By CignaLinks@guhealth.com.au By phone (within Australia) By phone (outside of Australia) By fax (within Australia) By fax (outside of Australia) If you choose to contact GU Health by phone, remember to call between 8:30 a.m. 5:00 p.m. Australian EST, Monday through Friday. For questions about coverage outside of Australia, reach out to our Service Centre anytime. Simply call or /+44.(0) or send an using CignaEnvoy.com. You can also fax us directly at or toll-free at A legal summary 4 things you should know about Medicare laws and GU Health By law, there are some rules that regulate what GU Health can pay for. Here is a quick overview. GU Health cannot reimburse for any outpatient services. When applicable, you must claim Medicare reimbursement first. GU Health in conjunction with Medicare can reimburse you up to the fair and reasonable costs that have been determined by the Australian government for inpatient medical services. GU Health can only reimburse some supplementary care services. To find out if things like chiropractic treatment, prescriptions, and speech therapy are covered, contact GU Health or refer to your plan summary that is included with this kit. 3

4 an innovative approach to healthcare coverage. Take a few moments to review the services offered by Cigna Global Health Benefits. Am I compliant? Another advantage of your GU Health coverage is that it ensures your compliance with the following issues: Lifetime Health Cover - Those customers who do not have hospital cover with an Australian registered health fund by June 30th following their 31st birthday will have to pay an additional 2% health care premium loading each year. - After a customer secures local health fund coverage and maintains continuous healthcare coverage for a period of 10 years, any additional loading to your healthcare premium will be removed. Medicare - Medicare is Australia s publicly funded national health insurance system and is available to all Australian citizens and persons holding a Permanent Resident visa. - Every eligible taxpayer pays 1.5% of their taxable income towards Medicare. - The Australian government has implemented an additional Medicare levy that affects taxpayers whose annual income exceeds a threshold amount and do not have private health insurance through an Australian local heath fund. - If you earn over a threshold amount and cannot prove that you have an acceptable level of private hospital insurance cover then you will have to pay an additional 1% of your taxable income for each uncovered day during that year. - More information can be obtained on the ATO s website As long as you participate in the CignaLinks plan, you will receive a statement at the end the Australian tax year (June 30th). Be sure to submit this with your tax returns to avoid the Medicare Levy Surcharge. Cigna refers to Cigna Corporation and/or its subsidiaries and affiliates. Cigna Global Health Benefits refers to these subsidiaries and affiliates. Products and services are provided by these subsidiaries, affiliates and other contracted companies and not by Cigna Corporation. Cigna is a registered service mark. This material is provided for informational purposes only. It is believed accurate as of the date of publication and is subject to change. Such material should not be relied upon as legal or medical advice. As always, we recommend that you consult with your independent legal and/or medical advisors. Products and services may not be available in all jurisdictions and are expressly excluded where prohibited by applicable law. Cigna Global Health Benefits web-based tools, such as CignaEnvoy, are available for informational purposes only. Cigna Global Health Benefits web tools are not intended to be a substitute for proper medical care provided by a physician. References to non-partnered organizations or companies, and/or their products, processes or services, do not necessarily constitute an endorsement or warranty thereof Cigna. Some content provided under license. CL E+F CATEGORY.GU.ENG.02.12

5 Links Executive Hospital and Links Executive Benefits Category E Benefits are paid per person per membership year unless otherwise specified. ALL PUBLIC AND PRIVATE HOSPITALS BENEFIT Accommodation (private or shared room) 100% Theatre Fees 100% Intensive Care 100% Same Day Patient 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 Medicare Schedule Fee. Please contact GU Health before being admitted to determine any possible out-of-pocket expenses. Surgically Implanted Prostheses 100% minimum cost for Government approved appliances Psychiatric & Rehabilitation Care 100% Midwifery Where Medicare items are not payable. Up to $800 Special Nursing Maximum limit of $1,000 per person, per year when provided by a registered nurse in private practice and recommended by a registered medical practitioner. 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 GU Health Member Relations Team to check your entitlements. Ambulance Full cover within Australia for members residing in NSW/ACT. 100% emergency ambulance 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. Television & Telephone Member Support Program - Hospital Care at Home 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. Access Gap Cover Scheme Through your GU Health hospital cover, you may be able to reduce or eliminate your outof-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. 100% Limited benefits 100% emergency Up to $10 per day Available Available CL GU SOB-E.ENG.0312 Continued over page

6 Links Executive Hospital and EXCLUSIONS Items not covered by Medicare Links Executive Benefits (continued) ANCILLARY BENEFITS BENEFITS MAXIMUM LIMIT $1,200 per single membership, per year General Dental General, Preventative, Diagnostic, Restorative Services Major Dental Orthodontics, Dentures, Prosthodontics, Periodontics, Endodontics, Crowns, Bridges Note: Orthodontic treatment commenced within 5 years of a previous course will be considered to be a continuation of the previous course of treatment. A maximum of $2,000 per person, per course of treatment applies Optical Prescription optical appliances (glasses and contact lenses) or repairs Physiotherapy, Speech Therapy, Eye Therapy, Occupational Therapy Chiropractic, Osteopathic, Dietetics, Clinical Psychology, Hypnotherapy, Natural Therapies Limit of two chiropractic x-rays per person per year. Note: 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. Audiology Podiatry Note: Orthotic benefits are paid under artificial aids and appliances. Artificial Aids and Appliances 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. cost 80% of the cost 80% of the cost consultation cost consultation cost consultation cost individual cost 80% of the individual cost $2,400 per family membership, per year $1,300 per person during first year of membership, increasing by $175 for each year of continuous membership to a combined maximum limit of $2,000 per person per year $200 during first year of membership, increasing by $25 for each year of current continuous membership to a combined maximum limit of $350 per person per year $1,200 per person, per year combined $1,200 per person, per year combined $200 per person, per year $300 per person, per year $500 per person, per year cost $800 per person, per 5 years CL GU SOB-E.ENG.0312 Continued over page

7 Links Executive Hospital and Links Executive Benefits (continued) ANCILLARY BENEFITS BENEFITS MAXIMUM LIMIT 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. cost $500 per person, per year 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, reversal of sterility or infertility procedures. Mammograms Benefits are only payable when the service does not attract a Medicare benefit. Stress Management and Quit Smoking Courses Benefits for Stress Management and Quit Smoking are payable on GU Health approved courses or programs conducted by accredited psychologists and counsellors registered in private practice and quit smoking programs recognised by GU Health. $0.25 per km where travel exceeds 250 km, and $100 per night for an essential overnight stay AMA recommended cost $500 per person, per year One every two years 50% of the cost $500 per person, per year CL GU SOB-E.ENG.0312