health insurance for singles and couples · 2017-11-17 · it’s up to you to nominate a rebate...

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


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


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.


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


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


$26.75 $116.00 $1391.80 $36.55 $158.45 $1901.15


$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


$53.55 $232.00 $2784.25 $73.15 $316.95 $3803.20


$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.

S

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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


Drop in to one of Queensland Country Credit Union’s

21 branches throughout Queensland

It’s super easy to join Queensland Country Health Fund.

health insurance for singles and couples · 2017-11-17 · it’s up to you to nominate a rebate...

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