What s covered: Pregnancy (Incl Childbirth) IVF and assisted reproductive services Gastric banding and obesity related services Joint replacements (Incl Revisions) Cataract and eye lens procedures Renal dialysis Cardiac and related services Cancer treatment Non Cosmetic plastic surgery Sterilisation (Incl Reversal) Accidents after joining Psychiatric services Palliative Care Rehabilitation services Minor gynaecological procedures Removal of appendix or Appendicitis treatment Surgical removal of tonsils or adenoids Joint arthroscopy and meniscectomy All other inpatient treatments receiving Medicare benefits Emergency Ambulance Restricted Excess An excess of $500 is payable on this policy for any hospital admission. This is capped at once per person, per year for any overnight or same day hospital admission. Excess does not apply to dependants covered on Famnly or Snngle Parent Polncnes Exclusions On services excluded on this cover (marked with x in the table above), no benefits will be payable for any hospital admission and you may have large out-of-pocket expenses. Restricted Services On Restricted services, after your waiting periods have been served you will be covered in a public hospital with your choice of Doctor only. If treated in a private hospital, benefits will be limited to
default bed fees as set by Federal Government. This may not cover the entire cost of your hospital admission and you may have large out-of-pocket expenses. What s covered: Where a particular procedure or treatment is covered on your policy, benefits will be paid towards the following services: Charges for overnight or same day accommodation in a private or shared room. Intensive care Theatre and labour ward fees. Surgically implanted prostheses (to the minimum benefit listed on the Federal Government s Prostheses List) Medical gap for doctors and surgeons in-hospital medical fees up to the Medicare Schedule Fee. What s not covered: You will not be covered for treatment under this cover in some circumstances. Some examples of where you may not be covered include amongst others: Hospital treatment for which Medicare pays no benefit, like cosmetic surgery Any difference between the fee for your doctor and/or specialist (surgeon, anaesthetist, etc) and the Medicare benefit schedule fee or access Gap Cover agreed fee. Prostheses required for cosmetic surgery are not covered even if they are listed on the Federal Government s Prostheses List, (as the surgery itself is not covered). Other prostheses are covered to the minimum benefit listed on the Federal Government s Prostheses Lis. Gap payments may be applicable to certain prostheses if charged the minimum price. Any items of a personal nature, including TV Rental or phone calls that are not part of the agreed hospital charges The patient s portion applied to any nursing home type patient admission into a public or private hospital. This amount is determined by the Federal Government Experimental and some high-cost drugs not included in the TGA schedule. Services not invoiced by the hospital Treatment provided at an Emergency Department as an outpatient service e.g. Radiation treatment. Benefits relating to sport, recreation or entertainment unless they re part of an approved chronic disease management or a health management program. Extras services for which a Medicare benefit is payable, except as allowable as hospital substitute treatment. Treatment, goods or services provided during a waiting period. See page 10 for more details of waiting periods. Any check-ups or treatment not requiring admission to hospital. Services relating to IVF or other reproductive assistance that don t require hospital admission. The cost of residential aged care e.g. nursing homes, aged care facilities or for associated respite care. There may be other services not covered under this product, for full details of what s not covered, refer to cua.com.au/health-insurance or the CUA Health Member Guide
Waiting Periods: There s a period of time you ll need to wait before you can claim certain services from us. This can relate to different situations: When you get health nnsurance for the fnrst tnme nn Australna. If you swntch nnsurers and haven t fully served your wantnng pernods wnth your exnstnng nnsurer. If you nncrease your cover (wnth CUA or when swntchnng from another nnsurer). In the first two situations above, you won t be able to claim until your waiting period is served. However, if you re still within a waiting period when you increase your cover, you ll be able to claim at the level of your previous cover (or a CUA Health cover deemed similar to your cover with the previous fund if you are transferringh. The following waiting periods apply when you join. Accident or Emergency Ambulance Accident: An unforeseen or a sudden event occurring by chance and caused by an external force or object, resulting in involuntary bodily injury requiring immediate treatment from a medical practitioner, which occurred after joining the fund. It does not include any condition that can be attributed to medical causes. Emergency Ambulance: For residents of all states, except QLD and TAS, benefits are payable for Emergency only ambulance transport by a recognised provider anywhere in Australia (including Air Ambulance). Refer to CUA Health Member Guide for more details. Rehabilitation, Psychiatric Services and Palliative Care Obstetrics related services Pre-existing Conditions Where signs or symptoms of your ailment, illness or condition, in the opinion of the medical practitioner appointed by us, existed at any time during the six months before you purchased your policy or upgraded to a higher level of cover. All other hospital treatments 1 Day 2 Months 12 Months 12 Months 2 months Agreement hospitals CUA Health has agreements with the majority of private hospitals and day surgeries in Australia. If your chosen hospital or day surgery doesn t have an agreement with CUA Health, you may be subject to large out-of-pocket expenses, in addition to any excess payment. Please check with CUA Health or your hospital prior to admission to check if your hospital has an agreement with us or what out-of-pocket expenses may apply if they do not have an agreement. A complete list of agreement hospitals is available at https://www.cua.com.au/healthinsurance/faqs/information-for-policy-holders. Access Gap Cover Scheme The Access Gap Cover Scheme will reduce or in some instances remove your out-of-pocket expenses for specialist care you receive while in hospital. Doctors and specialists who choose to participate in the Access Gap Cover Scheme can bill CUA Health directly. So, not only does your hospital treatment cost you less, but the billing system is made easier for you too. Access to a list of
doctors and specialists participating in the Access Gap Cover Scheme is available at cua.com.au/health-insurance. If your doctor or specialist chooses to use the Scheme, you will either: Have no out-of-pocket expenses, or Be provnded wnth an estnmate of out-of-pocket expenses before your treatment. Your doctor or specialist may choose to use the Scheme on a patient-by-patient basis. At your first consultation with your doctor or specialist you should ask if they will be providing your treatment in hospital with no gap for you to pay. If there is a gap for you to pay, then ask what the gap amount will be.
We re here to help If you have any questions about CUA Health we d be happy to help. Here s how you can get in touch with us Phone: 1300 499 260 Visit: cua.com.au/health-insurance Email: cuahealth@cua.com.au Fax: 1300 797 066 Post: GPO Box 100, Brisbane -LD 4001 Or drop into your local CUA branch! More information about your cover and CUA Health business rules is available in our CUA Health Member Guide available on our website under brochures and forms section. Please visit https://www.cua.com.au/health-insurance/faqs/information-for-policy-holders CUA Health Insurance is provided by CUA Health Ltd (CHL) which is not an authorised deposit-taking institution. While CUA Health Insurance may be distributed by Credit Union Australia Ltd ABN 44 087 650 959 (CUA), CUA is not liable for this product and does not stand behind CHL. Please note that benefits received under the products referred to in this fact sheet are paid in accordance with CUA Health fund rules. Not every aspect can be covered in this document. The information contained in this fact sheet includes details most relevant to your cover. Please read the information carefully in conjunction with CUA Health Brochure and CUA Health Member Guide (included in your welcome pack or available at cua.com.au/health-insurance)