health insurance for singles and couples · 2017-11-17 · it’s up to you to nominate a rebate...
TRANSCRIPT
1 APRIL 2016
HEALTH INSURANCE FOR
SINGLES AND COUPLES
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This brochure provides an overview of the features and benefits of Singles and Couples Combined Cover to enable a good understanding of the level of cover available. For more information regarding health insurance please refer to our “Membership Guide” or visit us at www.qldcountryhealth.com.au
HOW TO JOIN call 1800 813 415www.qldcountryhealth.com.au
“ we offer you flexible, comprehensive and
affordable health cover.”
WelcomeTO QUEENSLAND COUNTRY
CONTENTS
Why do I need
health insurance cover? 4
Singles and Couples Combined Cover 5
Hospital cover 6
What’s covered in Hospital 8
How it works in relation
to doctor’s charges 10
Extras Cover 11
Extras Cover benefits 12
How much are the premiums 14
Managing your health
insurance cover online 16
How to pay contributions 17
In more detail 18
Private Health Insurance complaints
& Privacy Policy 25
Contact details 26
In short, Queensland Country Health Fund (Queensland Country) has been at it for nearly 40 years, and takes pride in offering you a flexible, affordable and comprehensive health cover. Your health is our number one priority.
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As a young person it’s sometimes hard
to understand why it is necessary to
have health insurance. What does health
insurance offer for someone who is
young and healthy?
Making health care services affordableHealth insurance covers more than visits
to the hospital. There are many health care
services that young people need that are not
covered by Medicare. Services like dental,
optical, physiotherapy and massage are not
normally covered by Medicare.
Private health insurance with Queensland
Country can help cover the costs of these
services ensuring you can afford to receive
treatment when you need it.
Avoid higher health insurance costsLifetime Health Cover is a Federal
Government initiative that came into effect
on the 1st July 2000. It is designed to reward
people who join a private health fund earlier
in life by securing lower premiums. Under
Lifetime Health Cover, if you don’t have
hospital cover on the 1st July following your
31st birthday, then for each year you delay
joining, your premium will increase.
Avoid extra taxThe Medicare Levy Surcharge is a Federal
Government initiative to encourage higher
income earners to take out private health
insurance. Under the Medicare Levy
Surcharge you may have to pay an extra
1% to 1.5% in tax if your income* exceeds
certain thresholds and you don’t have
hospital cover.
You may well find that the cost of our Singles
and Couple Combined Cover is less than the
additional surcharge which means you may
be better off financially and have the peace
of mind of having a hospital cover as well.
Australian Government Rebate on private health insuranceThe Australian Government Rebate on
private health insurance was introduced as a
financial incentive to assist Australians afford
private health cover, and to recognise the
contribution that people with private health
insurance are making to their own health
care costs. Rebate entitlement depends on
your age, and income*.
From 1 April 2014, the rebate is now indexed
each year by the difference between CPI and
the industry average increase in premiums
using a Government-calculated formula.
It’s up to you to nominate a rebate tier (based
on your age and income*).
Some people choose to take their rebate up
front as a lower premium, but if you’d prefer
to claim the rebate as a lump sum through
your tax at the end of the financial year, you
can simply choose to pay the full premium
with no rebate deducted.
SINGLES AND COUPLES COMBINED COVER
WHY DO I NEEDHEALTH INSURANCE COVER?
Getting started with health insurance has
never been easier. Queensland Country offers
our Singles and Couples Combined Cover
designed to provide younger people with the
cover they need, without paying for benefits
that won’t be used. Singles and Couples
Combined Cover provides:
• Cover for Private Hospital treatment for a
range of commonly needed treatments for
conditions like tonsillitis, knee reconstructions,
appendicitis etc. This hospital cover has some
restricted and excluded benefits.
• Cover for a number of commonly used extras
like dental, physiotherapy, massage, optical etc.
• Competitive pricing to make health
insurance affordable
Queensland Country offers: Value for money health insurance products with comprehensive benefits
Access to your health insurance policy information via our Online Member Services
Very high levels of Member satisfaction which is confirmed with Member surveys
* This information is intended as a guide only and does not take into account your personal circumstances. For more information regarding the Rebate and MLS, including the calculation method for this income known as income for Medicare Levy Surcharge purposes, please seek the advice of your tax agent, financial advisor or contact the Australian Taxation Office (ATO) Help Line on 132 861 or visit their website at https://www.ato.gov.au/Individuals/Medicare-levy/Medicare-levy-surcharge/Income-for-Medicare-levy-surcharge,-thresholds-and-rates/
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HOSPITAL COVER
AUSTRALIA-WIDE PRIVATE
HOSPITAL NETWORK
PAY LESS WITH ACCESS
GAP COVER
PEACE OF MIND WITH THE
DOCTOR OF YOUR CHOICE
CHOOSE A HIGHER EXCESS
TO LOWER YOUR PREMIUM
Singles and Couples Combined Cover is
a popular choice for young singles and
couples. This covers you for the hospital
services you are more likely to use. This
means if you want the security of hospital
cover at any hospital in our Australia-wide
network but don’t want to pay for benefits
you’re not likely to use (such as hip
replacements) then this is the cover
for you.
Private hospital cover helps you afford
treatment in private or public hospitals. You
can receive the required treatment when and
where you want it, and it can be performed by
the Doctor of your choice. So, as a patient, you
have more control, and more importantly you
can ensure you receive the best medical care.
Private Hospital cover also assists to cover the
gap component over the Medicare Benefits
Schedule for in-patient services*.
*Singles and Couples Combined Cover has some excluded and restricted benefits
Excess
Singles and Couples Combined Cover is
available with the choice of a $250 or
$500 excess for single membership or
couples membership.
The excess that applies in any one
membership year is $250 or $500,
depending on which one you choose. This
means for example that regardless of how
many times hospitalisation is required
throughout the year if you have the $250
excess, you would only pay a maximum of
$250 for single membership, and $500 for
couples membership. The excess applies
to the full cost of hospitalisation at a
public, private or day hospital facility and is
applicable to both adults and dependants
covered under this policy.
Out-of-Pocket Expenses
It is your right to know if there are any
out-of-pocket expenses to help avoid
any surprises later. Knowing how much
your medical treatment will cost is called
Informed Financial Consent and the Federal
Government has introduced a checklist
providing you with the questions you need to
ask before going into hospital.
We recommend that you contact us before
going into hospital so that we can discuss
what your policy will provide cover for.
We would also be happy to send you a copy
of the checklist.
Hospital Network
Queensland Country has negotiated
Purchaser Provider Agreements with most
of the participating private hospitals and day
hospital facilities Australia-wide.
In most instances, the approved hospital
charges for policyholders of a private
hospital policy will be covered in full once
the agreed excess has been deducted. This
means that you will benefit from capped
fees we’ve negotiated and convenient
billing as your invoice will be sent directly to
Queensland Country.
Private hospitals and day hospital facilities
that have not signed an agreement attract
reduced benefits which will mean you may
incur out-of-pocket expenses for in-hospital
treatment. Go to our website to find a hospital
most convenient to you.
www.qldcountryhealth.com.au
What’s Covered in Hospital
We will pay benefits for in-patient services in
a private hospital where a Medicare benefit
is payable and waiting periods have been
served, except for restricted services or
services not covered (see table on page 8).
If you do not have ancillary (extras) cover and
exercise physiology, for example, is required
in hospital as part of your treatment, then you
will not be covered for these services if they
are invoiced separately by the Provider. This
is also the case for any allied services not
covered under this policy.
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WHAT’S COVERED IN HOSPITAL
* Some surgically implanted prostheses may be for an excluded benefit therefore no benefit would be payable in this circumstance,
for example hip replacement.
Waiting periods will apply to all benefits outlined. Please refer to pages 20-21 for further details.
Waiting periods will apply to all benefits outlined. Please refer to pages 20-21 for further details.
What’s covered
Included services Examples of in-hospital treatments we will pay benefits towards:
✔ Appendix treatment
✔ Accidents
✔ Removal of teeth
✔ Knee, shoulder and hip investigations
✔ Removal of tonsils
✔ Hernia surgery
✔ Digestive disorders
✔ Colonoscopies
✔ Kidney stone and gall stone removal
✔ Knee & ankle arthroscopy and reconstructions
✔ Shoulder arthroscopy and reconstructions
What’s covered
Restricted services In-Hospital treatments we will pay a restricted benefit towards:
restricted In-Hospital Psychiatric treatment
restricted Cardiothoracic procedures — for example open heart surgery
restricted Major Eye Surgery — cataract and eye lenses procedures
restricted Obstetric related services — birth and pregnancy related services
restricted Assisted reproductive services — for example IVF
restricted Gastric Banding and Obesity Surgery
restricted Renal Dialysis — for chronic renal failure
What’s not covered
Excluded services In-Hospital treatments we will not pay a benefit towards:
✘ Joint Replacements — for example an artificial hip replacement
✘ Cosmetic Surgery (hospital treatment for which Medicare pays no benefit)
Included services Hospital and doctors’ benefits for included services
✔ Choice of doctor/hospital
✔ Private hospital accommodation
✔ Public hospital accommodation as a private patient (shared room)
✔ Theatre fees
✔ Surgically implanted prosthesis benefits*
✔ Intensive care
✔ In-Hospital rehabilitation treatments (Rehabilitation for hospital services with restricted or excluded benefit entitlement will have reduced or nil benefit eligibility)
✔ Plastic and reconstructive surgery (if medically necessary)
✔ Medical Gap
✔ Doctors charges in hospital where each doctor chooses to opt in to the Queensland Country Access gap scheme
✔Radiography and pathology services charges ordered by your doctor in hospital. 100% cover where the practitioner participates in the Queensland Country Access gap scheme
✔ Most pharmaceuticals directly related to your admission
Restricted Benefits
If a service is covered as a Restricted Benefit, this means you will be covered with your choice of
doctor for shared ward accommodation in a public hospital only. If you go to a private hospital for a
specific service which has Restricted Benefits, it is likely to result in large out-of-pocket expenses.
Restricted Benefits are amounts set by the Government and are generally not enough to cover
accommodation costs in a private hospital. No benefit is paid towards the cost of theatre charges
raised for these services.
Whilst cover with Restricted Benefits entitles you to your choice of Doctor in a public hospital, your
Doctor may not be willing, or able to treat you in a public facility.
Excluded Benefits
An excluded service means you will not be covered in a public or private hospital and will not
receive a payment from Queensland Country for that service. If you think you may need any of the
procedures outlined below you may like to consider taking out a higher level hospital cover.
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HOW IT WORKS IN RELATION TO DOCTORS’ CHARGES
EXTRAS COVER
Medicare uses a Medicare Benefits
Schedule fee (MBS) for calculating rebates
on doctors’ charges. Queensland Country
offers our Access Gap Cover Scheme and
we encourage doctors to participate in
the scheme. Under the Access Gap Cover
Scheme participating doctors who provide a
service in hospital can decide to accept up
to the Health Fund benefit as full settlement
of the account. This means you don’t have
to make any additional payments for that
particular service.
The doctor can also accept the fee as part
of the payment and will inform you of any
gap — called the known gap which you will
have to pay.
If your doctor does not participate in Access
Gap, we will only cover the 25% gap between
the 75% Medicare Benefit and the Medicare
Benefits Schedule fee which may result in
larger out-of-pocket expenses for yourself.
It’s always a good idea to talk to your doctors
about their charges prior to your treatment.
To find doctors who may participate in the
Access Gap Scheme refer to the AHSA
website:
https://www.ahsa.com.au/web/gapcoversearch
Singles and Couples Combined Cover has been
designed to provide good benefits for a broad range
of therapies most likely to be used by young people
while keeping the cover affordable. Whether you need
a massage or a new pair of glasses, Queensland
Country can help.
Online or on-the-spot claiming!To make it even easier to claim your benefit, participating
health professionals have electronic claiming facilities
available. HICAPS/IBA is an electronic health claiming and
payments system that will process your claim for treatment,
on the spot, without leaving the surgery or practice of
your provider.
Alternatively with Online Claiming we’ve now made it easier
than ever to claim for a wide range of services when
on-the-spot claiming isn’t available through your provider.
This service is available after having held cover for three or
more months.
Simply go online using your PC, tablet or smart phone!
You can claim up to $400 per day in benefits for services
up to three (3) months from the actual date of service,
treatment or visit.
For full terms and conditions visit our website
www.qldcountryhealth.com.au
Dental and Optical Premier ProvidersQueensland Country has negotiated agreements with a large
number of Dental and Optical providers. Services at one of
our premier providers are well priced and are likely to reduce
out of pocket expenses for Members.
• GENEROUS ANNUAL LIMITS
FOR GENERAL DENTAL AND
OPTICAL SERVICES
• COVER FOR A WIDE RANGE
OF ALTERNATIVE THERAPIES
INCLUDING REMEDIAL
MASSAGE AND PODIATRY
• EASY CLAIMING WITH HICAPS/
IBA ON THE SPOT CLAIMING
• COMPETITIVE PREMIUMS
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EXTRAS COVER BENEFITS
Services Waiting Period Benefit Limitsper membership year
Examples of maximum benefits
ALTERNATIVE THERAPIES
Chiropractic 2 months $300 per therapy $500 per person up to $1000 per policy
Initial visit – $30Subsequent visit – $30Chiro x-rays – $50Osteopathy
Remedial Massage Therapy*Bowen Therapy*Myotherapy*
Podiatry Initial visit – $30Subsequent visit – $30Orthotics – 85% of cost up to available policy limitsMinor procedures – 75% of cost up to available policy limits
Acupuncture* Initial visit – $30Subsequent visit – $30
Naturopathy*Homeopathy*
Initial visit – $30 Subsequent visit – $30
Dietician Initial visit – $55 Subsequent visit – $35
OTHER SERVICES
Pharmaceutical# 2 months $150 per person up to $300 per policy
$30 per script
Healthy Living Benefit
2 months $125 per person up to $250 per policy
Benefits up to the policy limit areavailable for:
Your choice of quit smoking programs
Your choice of weight management programs
Participate in other approved health management programs** including: - Gym Membership - Personal Training programs
Skin checks through mole mapping
Consultation fees for metabolic dieticians and nutritionists when providing assistance with weight management
* Benefits are payable for services rendered by Australian Regional Health Group approved providers registered with Queensland Country as well as Bowen Therapists that are registered with the Bowen Association of Australia (BAA) or Bowen Therapists Federation of Australia (BTFA)
# Prescriptions not covered by the PBS, excluding contraceptives and items normally available without prescription and drugs not approved for sale in Australia. A co-payment applies to each prescription item equal to the current PBS General Patient Contribution. Please refer to page 23 for more information.
** To comply with private health insurance legislation you must have been referred by your health care professional to participate in a health management program to address, improve or prevent a specific or medical condition. A Health Management Program Benefit Approval Form, available on the website, must accompany claim for these benefits.
OPTICAL BENEFITS
Single & Multi-focallenses & frames
2 months $210 per person up to $420 per policy
Single vision lenses & frames – $210Repair to frames – $210Contact lenses – $210
PHYSIOTHERAPY
Physiotherapy 2 months $400 per person up to $800 per policy
Initial visit – $42Subsequent visit – $32 Group Therapy - $8 (sub limit of $80 applies)
Services Waiting Period Benefit Limits per membership year
Examples of maximum benefits
DENTAL BENEFITS
G E N E RAL D E NTAL:
DiagnosticThis includes examinations, consultations, x-rays etc.
2 months $500 per person up to $1000 per policy
Periodic oral examination – $34 X-rays – $23
PreventativeThis includes cleaning and scaling, fluoride treatment, oral hygiene instruction and mouth guards
2 months Scale & Clean – $56 Fluoride treatment – $17Mouth Guard – $113
Simple Extraction 2 months Simple extraction – $79
RestorativeThis includes composite and amalgam fillings
2 months One surface composite filling – $68
General ServicesOcclusal splints
2 months Occlusal splint – $225
MA J O R D E NTAL:
Surgical ExtractionWisdom teeth extraction, removal of impacted teeth
12 months $500 per person up to $1000 per policy
Surgical extraction – $135
PeriodonticsSpecialised gum treatment
12 months Treatment of acute periodontal infection (per visit) – $38
Endodontic Root canal therapy and root fillings
12 months Filling of one root canal – $128
Crowns/Bridges 12 months Full Veneered Crown – $500
OrthodonticsBraces etc
12 months Braces for upper & lower teeth, including removal plus fitting of retainer – $500 Lifetime Limit – $1000 per person Benefits are paid at 70% of cost
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HOW MUCH ARE THE PREMIUMS?
Join Queensland Country todayJoining our fund is simple. Choose one of the
following options that suit you:
• Call us on 1800 813 415 and complete an application over the phone
• Visit a retail centre and let one of our friendly staff assist you
• Go to our website and apply online through our online application process. The web address is www.qldcountryhealth.com.au
• Drop in to one of Queensland Country Credit Union’s 21 branches throughout Queensland
Switch to Queensland Country Health FundIf you are a member of another health fund,
it’s quick and simple to transfer to us. Simply
complete our membership application and cancel
any direct debits you may have with your old fund.
We will contact your old fund and arrange for the
transfer of cover of the commencement date of
your policy.
What you’ll paySINGLES
COUPLES
Normal 2 and 12 month waiting periods apply with our combined products.
Premiums are quoted with and without an Australian Government Rebate on private health insurance. Australian Government rebates depend on age and income levels. For more information see page 4.
COVER WITH BASE TIER REBATE NO REBATE DEDUCTED
WEEKLY MONTHLY YEARLY WEEKLY MONTHLY YEARLY
Singles and Couples Combined Cover 250
$26.75 $116.00 $1391.80 $36.55 $158.45 $1901.15
Singles and Couples Combined Cover 500
$23.65 $102.65 $1232.00 $32.35 $140.25 $1682.90
COVER WITH BASE TIER REBATE NO REBATE DEDUCTED
WEEKLY MONTHLY YEARLY WEEKLY MONTHLY YEARLY
Singles and Couples Combined Cover 250
$53.55 $232.00 $2784.25 $73.15 $316.95 $3803.20
Singles and Couples Combined Cover 500
$47.40 $205.35 $2464.35 $64.75 $280.50 $3366.25
Money back guaranteeIf you are not completely satisfied with
your new health insurance policy we will
provide a refund of any premium paid (if a
claim hasn’t been made) if you write to us
advising that you are not satisfied with your
policy within 30 days.
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HOW TO PAY CONTRIBUTIONS
MANAGING YOUR HEALTH INSURANCE COVER ONLINE
Queensland Country offers you a variety of payment options so you can choose the best
method for you. You can choose to pay weekly, fortnightly, monthly, quarterly, 6 monthly
or yearly, whichever suits you. If you do choose one of the latter options, we’ll send you a
reminder notice as a courtesy.
As a policyholder it is your responsibility to ensure that the payment amounts are correct and
made in advance, this avoids claims being rejected due to an un-financial status.
Online Member Services (OMS) gives you
the ability to update your membership details
whenever you want, giving you greater control
and easy access.
You can log on at any time of the day and
check your cover; update address details,
change your level of cover and even add a new
addition to the family.
To access OMS, all you need to do is register
on the homepage of our website www.
qldcountryhealth.com.au. The “register” icon
is located at the top right hand corner of
the screen. Once you have registered using
your membership number and your choice of
password, click on the Login tab and enter your
membership number and password.
Now you’re ready to go!
Below is a list of all the different services
you can access by registering:
Claims history
View/print tax statement
Update Membership details
Change contact details
Add new person
Change personal details
Add student dependant or apprentice
Add Medicare card details
Add previous cover details
Make a contribution payment by credit card
Change level of cover
Update your method of payment
Update the way we pay benefits
eg. direct credit
Contribution changes
View benefit limits
Make a claim for ancillary services*
Access to some functions may be limited for your spouse/partner and dependants.
Note: Deadlines may exist for one or more of these payment options. Please consult our Membership Guide for further details.
Direct DebitDirect Debit facilities are
available for policyholders
who prefer to pay through
automatic deductions from
their Bank, Building Society,
Credit Union accounts and
Credit Cards. If this is your
preferred method of payment,
simply nominate this on
application. A reminder notice
is not issued if you pay by
direct debit.
Credit Card Credit Card* facilities are
available to all policyholders
who prefer to pay via this
option. If this is your preferred
method of payment, simply
visit our website and make the
payment online through Online
Member Services (OMS^).
Alternatively, phone us on
1800 813 415.
* We do not accept American
Express or Diners Club.
^ Please see page 16 for
details on how to register
for OMS.
BPAYBPAY facilities are available
to all policyholders who prefer
to pay via this option. BPAY
allows you to pay your health
insurance premium via internet
or phone banking, or at your
financial institution. The
BPAY biller code and your
reference number appear on
all statements. If you don’t
receive regular statements
please contact us and we’ll
be happy to supply you with
your BPAY biller code and
reference number. (This option
is not available to eligible
participants in a Corporate
Health Plan)
SmartBudgetSmartBudget Service —
Queensland Country Credit
Union offers a SmartBudget
service through all their branch
offices. SmartBudget is a
comprehensive budgeting and
bill paying service that provides
a fast and simple way to pay
all your bills. If you would
like more information on this
service, please feel free to
contact Queensland
Country Credit Union on
1800 075 078.
You can choose to pay weekly, fortnightly, monthly, quarterly, 6 monthly or yearly, whichever suits you.
*not all ancillary services (Extras) are claimable through Online Claiming see website for further terms and conditions www.qldcountryhealth.com.au
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Benefit Conditions
Queensland Country will only pay
benefits when:
All applicable waiting periods have
been served
Goods or services are provided in
Australia (not including items imported by
the user via an internet purchase)
The Member has been charged for the
treatment or service
A service or treatment is medically
necessary and clinically relevant
Services are part of a course of treatment
recognised by Queensland Country
The service is provided in person
The service is provided to a person on
the membership
The service or treatment has been
provided by a practitioner or therapist
recognised by Queensland Country
The treatment or service is covered under
the Member’s level of cover
No benefits are payable from another
source (e.g. compensation payment or
Government benefit)
The conditions of the level of cover have
been met
A claim for a service rendered is
submitted for payment within 24 months
of the date of service
The waiting period for that service has
been served
The amount of benefit is calculated on the
cost of the treatment or aid to the Member,
taking into account any allowances or
discounts given by the provider. No benefit
paid by Queensland Country can exceed the
actual charge of the service or appliance.
Benefits are not payable for claims for goods
purchased or rendered outside of Australia or,
for items purchased or hired from overseas
suppliers (including internet purchases)
In more detailWe have included information you may need.
Additional information is available in the
Membership Guide.
Pre-Existing Conditions
A Pre-existing ailment, illness or condition is
one where, after examining evidence, a medical
adviser, or other relevant health care practitioner
appointed by Queensland Country would
consider that signs or symptoms would have
been in existence at any time during the six
months preceding the application for membership
or upgrade of cover. You may have a Pre-existing
Condition, ailment or illness without being aware
of it. In these cases, there is a 12 month waiting
period before you are entitled to claim benefits
for treatment. It is not necessary for the signs or
symptoms to have been diagnosed by a doctor
when a Member joined or upgraded their level
of cover.
Surgery for assisted fertility programs such as
IVF or GIFT (restricted benefit), Sterilisation
or Vasectomy are elective and attract a 12
month waiting period as does obstetrics-related
services.
The 12 month Pre-existing Condition waiting
period can be applied to all hospital or hospital
substitute treatment for which we pay benefits.
However, a two month waiting period applies to
the following services:
all other inpatient hospitalisation services/treatments
approved psychiatric treatment (restricted benefit only)
approved rehabilitation treatment, or
palliative care.
The 12 month waiting period for the treatment
of a Pre-existing Condition can also apply to
ancillary (Extras) services.
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Waiting Period Item / Service
2 months
Hospital:
For all hospital treatments or services where there are no Pre-existing Conditions (excluding Accidental Injury^).
Extras:
Dental: Diagnostic — includes examinations & consultations Preventative — includes cleaning and scaling, fluoride treatment etc. Simple Extraction Restorative — composite and amalgam fillings General services — includes mouth guards and Occlusal splints Optical
Acupuncture
Chiropractor
Remedial Massage Therapy/Bowen Therapy/Myotherapy
Osteopathy
Physiotherapy
Podiatry
Dietitian
Pharmaceutical
Healthy Living Benefits
Sporting & School accidents
12 months
Hospital:
Pre-existing Conditions
All Elective Surgery
Obstetrics-related Services (restricted benefit)
Surgery for assisted fertility programs such as IVF or GIFT (Restricted Benefit)
Elective Surgery (such as sterilization or vasectomy)
Extras:
Major Dental services:
Periodontics — specialised gum treatment Surgical Extraction — includes Wisdom tooth extraction Endodontic Services — includes root canal therapy Crowns and Bridges Orthodontics — Braces etc.
Membership Year
All yearly limits and excesses are
calculated from the anniversary date of the
establishment of the membership.
Singles, Couples & Families
Single: a single policy covers only one person.
Couple: a couple policy covers the person
who establishes the policy as well as one
other partner/spouse. The policy can be
extended to cover dependant children at no
additional cost.
Family: a family policy covers the person who
establishes the policy as well as that person’s
partner and all dependant children.
Single Parent Family: a single parent family
policy covers the person who establishes
the policy as well as that person’s
dependant children.
Waiting Periods
So when will I be fully covered you ask?
Waiting periods apply when you join any
health fund for the very first time or when
you upgrade to a higher level of cover. But
you won’t have to wait if you’re transferring
to Queensland Country from an equivalent or
higher level of cover with another health fund,
or if you’ve been covered by your parents’
membership and you’re just starting out on
your own.
Waiting periods are necessary to keep health
cover fair and aim to protect our existing
policyholders who contribute to a fund over
a period of time for when they may need
cover. If we didn’t have these waiting periods
people may join, claim for something planned
and then leave. Always make sure you have
waited the sufficient period before claiming,
otherwise you may not be covered!
For those of you who are thinking of starting
a family, if you have a single policy, to be sure
your baby has cover, it is necessary to add
a newborn baby to your policy within two
months after the date of their birth.
The baby will not have to serve any waiting
periods* that have already been fully served
by the policyholder providing that the change
is made to the policy within this time frame.
*For policyholders with no previous cover Pre-existing Condition waiting periods may apply to the baby within the first 12 months.
“Always make sure you have waited the sufficient period before claiming, otherwise you may not be covered”
^ 2 month waiting periods apply for most other items or services. The 2 month Waiting Period is waived for treatment arising from an accident (excluding a school and sporting accident) that occurred after joining.
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Contribution in arrears
A policyholder who fails to pay contributions within 63 days of the day of which contributions were due and payable shall be deemed to be unfinancial. No benefits are payable for services rendered whilst a membership remains in arrears. However, provided contributions are paid within 63 days of the due date, the membership will be reinstated. Membership of Queensland Country Health shall automatically cease for any policyholder whose contributions are more than 63 days in arrears.
Length of Stay
Full hospital benefits are not available after 35 days of continuous hospitalisation unless your doctor certifies the need for continued hospital-level care.
Excess
Singles and Couples Combined Cover is available with a choice of a $250 or $500 for single membership or couple membership.
The excess that applies in any one membership year is $250 or $500, depending on which one you choose. This means for example that regardless of how many times hospitalisation is required throughout the year if you have the $250 excess, you would only pay a maximum of $250 for single membership, and $500 for couple membership. The excess applies to the full cost of hospitalisation at a public, private or day hospital facility and is applicable to both adults and dependants covered under this policy.
Dependants
Dependants include a policyholder’s children and stepchildren, legally adopted children or foster children under the age of 21. Dependants turning 21 who are not eligible for cover under a family membership as a student or apprenticeship dependant are required to commence their own membership if they wish to continue private health cover. The good news is that they can move straight across to their own single membership without having to serve any waiting periods.
Dependants may be covered as either student or apprentice dependants under their parent’s membership from 21 years of age up to 25 years of age, provided the following conditions are satisfied:
Is a full time student at a school, college or university who is not aged 25 years or over, or
Is an apprentice who is not aged 25 years or over and does not earn more than $30,000 p.a.
And does not have a partner
If, at any time, your dependant’s situation changes and they no longer meet all the above conditions then please contact us for further information.
Cooling Off Period
Queensland Country will allow any Member who has not yet made a claim to cancel their policy and receive a full refund of any premiums paid within a period of 30 days from the commencement of their policy or upgraded policy.
Recognised Providers
Queensland Country will only pay benefits for ancillary (extras) or dental services where the services are provided by practitioners recognised by Queensland Country. Recognition is subject to change without notice. There are no benefits payable for overseas hospitalisation or ancillary care.
Recognition of providers is for the purpose of determining the payment of benefits and should not be taken or considered in any way as approval of, or any recommendation as to the qualifications and skills of, or services provided by, a practitioner or therapist. Members should check with Queensland Country that their practitioner is recognised before commencing treatment.
Pharmaceutical
The Pharmaceutical Benefits Scheme (PBS) is a national pharmaceutical scheme funded by the Federal Government where patients contribute to the cost of prescribed drugs.
Queensland Country doesn’t cover pharmaceutical prescriptions covered by the Pharmaceutical Benefits Scheme or for contraceptives and items normally available without prescriptions.
We’ll pay benefits as outlined in the Extras table up to the claim limit for this category, with consideration to the maximum individual script benefit limit. The benefit amount per script is calculated by deducting the PBS General Patient Contribution amount from the purchase price (up to script benefit limit). This is conditional on the pharmaceutical prescription being listed in the MIMs Schedule as S4 or S8 and being dispensed in quantities in accordance with this schedule.
We also pay for compound pharmacy scripts, as long as one of the ingredients meets this criteria. The PBS General Patient Contribution amount is reviewed annually by the Government and changes every year on 1 January. As at 1 January 2016, the PBS contribution is set at $38.30.
It’s important to note that a doctor’s letter may be required for some Pharmacy items.
Overseas suspension of membership
If you’re lucky enough to travel overseas, and you’re going to be absent from Australia for more than 4 weeks and less than 24 months, and provided you’ve fulfilled all other criteria, you may apply for a suspension on your membership. To get the full picture, please call us when you’re making your travel plans.
Summary of Rules
The “In more detail” pages contain only a summary of the fund rules. The complete rules of the health benefits fund set out in full the terms and conditions of membership and liability under the fund. These rules are available for inspection at Queensland Country Centre, Level 1, 333 Ross River Road, Aitkenvale QLD 4814.
Private Health Insurance Code of Conduct
Queensland Country Health Fund is a signatory to the Private Health Insurance Code of Conduct. The code was developed by the health insurance industry and aims to promote the standards of service to be applied throughout the industry.
A full copy of the Code is available at www.privatehealth.com.au/codeofconduct
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While we are absolutely committed to providing you with the best possible service, we are only human and sometimes we may make mistakes or see things differently from our policyholders, so we have processes in place to make sure you’re absolutely satisfied.
If you have any complaints, and we hope you don’t, then please contact us immediately -
Call: 1800 813 415
Email: [email protected]
Website: www.qldcountryhealth.com.au
Address: Queensland Country Centre Level 1, 333 Ross River Road Aitkenvale, QLD 4814
We take all complaints very seriously and our understanding staff are here to answer any questions and allay any fears you may have. Your health and wellbeing is our number one priority and if you’re not completely happy with our service we would like to know about it.
If, after we’ve done all we can to rectify the situation, and you’re not satisfied with the outcome, you have every right to contact the Private Health Insurance Ombudsman. The Ombudsman is an independent body formed to help resolve complaints and to provide advice and information to members of private health funds.
You can contact the Ombudsman directly at:
Telephone: 1300 362 072 Select option 4 for Private Health Insurance
Email: [email protected]
Website: www.ombudsman.gov.au
Address: Private Health Insurance Ombudsman Commonwealth Ombudsman GPO Box 442 Canberra, ACT 2601
PRIVACY POLICY
We at Queensland Country are committed to managing personal information in accordance with our Privacy Policy.
Our Privacy Policy is available for your information on our website at www.qldcountryhealth.com.au, or from any of our Service Centres or Queensland Country Credit Union branches.
PRIVATE HEALTH INSURANCE COMPLAINTS
for any reason, you’re not happy with something then please let us know. We will do whatever we can to fix it.
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CONTACT DETAILS
Head Office
Queensland Country Centre
Level 1, 333 Ross River Road
Aitkenvale QLD 4814
Phone: 07 4412 3500
Facsimile: 07 4412 3500
Postal Address:
PO Box 42
Aitkenvale QLD 4814
Aitkenvale Retail Centre
Queensland Country Centre
333 Ross River Road
Willows Retail Centre
Willows Shopping Centre
Kirwan
Mount Isa Retail Centre
70 Camooweal Street
Mount Isa
Burdekin Retail Centre
186 Queen Street
Ayr
Mackay Retail Centre
Caneland Central Shopping Centre
Call: 1800 813 415
E-mail: [email protected]
Web: www.qldcountryhealth.com.au
Queensland Country Health Fund Ltd
ABN 18 085 048 237 is a Registered Private Health Insurer.
HOW TO JOIN
Call us on 1800 813 415 and complete an application
over the phone
Visit a retail centre and let one of our friendly staff
assist you
Go to our website and apply online through our
online application process. The web address is
www.qldcountryhealth.com.au
Drop in to one of Queensland Country Credit Union’s
21 branches throughout Queensland
It’s super easy to join Queensland Country Health Fund.