hospital and extras health cover - member benefits€¦ · we encourage you to read this brochure...

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HOSPITAL AND EXTRASHEALTH COVER

April 2018

2 Latrobe Health Services

Like a friend, we guide and empower

our members to take control of their health episodes now

and in the future.

Our Vision

3Latrobe Health Services

We encourage you to read this brochure carefully and retain for future reference.

Hospital cover

Hospital cover at a glance 16

Our hospital cover explained 17

Top Hospital (H3) most comprehensive cover

18

Top Hospital - MemberShare (H) with co-payment options

19

Top Hospital - Family Care (K) with co-payment options for families with adult children

20

Top Hospital - Loyal Members (LM) with a reducing excess

21

Top Hospital - CoverWise (X) with excess options

22

Healthy Start (ST) Designed for young active singles

24

Hospital: Important information 26

Other information

Our Vision 2

Our Member Promise 4

Why choose Latrobe? 5

Australia’s healthcare system 6

Types of hospitals 7

Private Patient’s Hospital Charter 7

What am I covered for in hospital? 8

What are medical benefits? Just Ask!® 9

Waiting periods 10

How do I join? 12

Your membership 13

Ambulance Victoria 27

Government surcharges/incentives 48

Definitions 50

Other information 51

Payment options 52

Claim options 52

Code of Conduct 53

Complaint Resolution 53

Privacy Statement 54

Travel insurance 55

Contact us Back cover

Extras cover

Extras cover at a glance 30

Premier Gold (PG) 32

Family Care Gold (PH) 34

Premier Silver (PV) 36

Premier Plus® (PP) 38

Family Care (PK) 40

Premier (P) 42

Premier Family (PF) 44

Premier Singles (PS) 45

Dental (D) 46

Extras: Important information 47

Contents


A Valuable RELATIONSHIPIt’

s Ea

sier

to b

e in

PAR

TNERSHIP

EMPOWERED to Make Choice

s

To be empowered to make choices about your health needs

It is important for us to know you are empowered to make informed decisions based on the best advice to manage your health needs.

Our experienced staff will:• be accessible to you• listen to your needs• provide clear, accurate and

timely information and advice.

We value our relationship with our membersAs a member you can expect:

To develop a valuable relationship with us

over time

Together with you, we will build a partnership:• that is honest and open• that listens to your feedback • that creates opportunities to

share information.

Respect for each other, honesty and timely feedback will support a growing relationship as we continue to review and improve our services.

To work in partnership with us to navigate any

health episode

We understand the private health industry and appreciate that it can be complex.

Our experienced staff are committed to reducing this complexity and assist in achieving the best available health outcome for each individual member.

We aim to make it as simple and straight forward as possible to understand, manage and access your health cover.


We are a not-for-profit, member-owned health fund established in 1951. We are committed to providing value for our members and helping them make the best choice for their health care needs. In an effort to make health cover more affordable, we offer a range of hospital and extras products to suit your budget.

We know that healthcare is complicated and can, at times, be stressful and difficult to understand. Our Member Promise to you is to provide expert knowledge and understanding throughout your membership with us.

We believe that you should never compromise your health or that of a loved one by forgoing cover for certain procedures in order to reduce your premium. That is why unlike other funds we have no exclusions, on procedures approved by Medicare, on any of our hospital covers.

We are a Members Own Health Fund; together with 17 like minded health insurers we provide a genuine choice when it comes to health insurance. We exist to benefit members, not to profit investors or overseas owners.

Operating since

1951 Not-for-profit Friendly expert staff

Australia wide

insurance

$

Why choose Latrobe?

Australian Government surcharges/incentives

The Australian Government has a range of surcharges and incentives to encourage Australians to take out health insurance. How these initiatives apply vary depending on your age and income. It is recommended that before you make a decision, you familarise yourself with these Government initiatives allowing you to make a more informed decision.

For further information refer to page 48.

No exclusions


Australia’s healthcare system

We want to help you make an informed decision on your health cover needs. It is important that you understand the basics of Australia’s healthcare system and what this means for you and your family.

Hospital cover • gives you control over your health care• allows you to choose your doctor/surgeon• allows you to choose when to be treated• gives you access to be treated as a private patient in a private or public hospital

Extras cover helps with the cost of services that Medicare generally does not cover, such as physiotherapy, chiropractor, dental and optical services.

What is public health cover?Medicare is Australia’s public healthcare system that provides eligible Australian residents with affordable health care. Medicare was established on the understanding that all Australians should contribute to the cost of health care through income tax and the Medicare Levy.

However, Medicare does not cover private hospital costs or allow a choice of doctor, nor does it generally cover a wide range of services such as dental, physiotherapy, chiropractic, etc.

What is private health cover?


Participating private hospitals We have agreements with private hospitals Australia-wide to ensure your hospital charges are fully covered. A list of participating private hospitals is available at latrobehealth.com.au or by contacting us.

Non-participating private hospitalsIf you are planning treatment at a non-participating private hospital, you are strongly urged to contact us, as we cannot guarantee full cover.

Public hospitals It’s your choice to be admitted as a public or private patient; if you’re admitted as a private patient you may incur expenses that are not fully covered by your health cover.

The Private Patient’s Hospital Charter is a guide to what it means to be a private patient in a public hospital, a private hospital or day hospital. It also provides information about what to do if you have a problem with your medical treatment or your private health insurance. For more information, visit latrobehealth.com.au.

Types of hospitals

Private Patient’s Hospital Charter


What am I covered for in hospital?

What am I covered for? • accommodation • theatre fees• prostheses items• intensive and critical care unit fees• medical benefits see page 9Your cover will have no exclusions on procedures approved by Medicare.

What am I not fully covered for? • doctors services provided to you in hospital may leave you with out-of-pocket expenses,

also known as the “Medical gap”• admission to a non-participating private hospital• robotic surgery: not all robotic consumables are covered.• hospital and medical procedures that have no benefit payable under Medicare.

For example but not limited to: » podiatric surgery, dental surgery and cosmetic surgeryFees charged by a dentist or podiatrist are not covered. You may be able to claim a rebate for these fees under your extras cover. For podiatric surgery, no associated services are covered e.g. anaesthesia. Limited benefits apply to hospital charges associated with cosmetic and podiatric surgery.

What am I not covered for? Private hospital cover does not pay benefits towards any services that you receive as an outpatient. To use your hospital cover you must be admitted as an inpatient to hospital.General practitioners, specialist consultations or any diagnostic services provided outside of a hospital stay are generally claimed through Medicare.Treatment at an emergency centre of a private hospital is not covered.

Your hospital cover is designed to contribute towards the costs involved when admitted as a private patient to a private or public hospital.


When you’re admitted to hospital you may have doctors’ bills with out-of-pocket costs. The Federal Government sets the Medicare Benefit Schedule (MBS) fee for all medical services. Medicare pays 75% of that fee and Latrobe pays the remaining 25%. Whilst the Government sets the MBS fees, doctor’s charges are not regulated. If your doctor charges above the schedule fee, known as the ‘Medical Gap’, we will pay additional medical benefits to help reduce your out-of-pocket costs. Refer to the table below.

Our Just Ask!® additional medical benefit scheme encourages you to be informed about your out-of-pocket costs. Informed Financial Consent (IFC) is an estimation of the cost to you when the doctor charges above the MBS. This estimation can be subject to change if MBS item numbers vary at the time of the procedure.We do not limit your choice of doctor. All doctors can participate as long as IFC has been provided. IFC for pathology and radiology may not be possible; these accounts will be paid including the Just Ask!® additional medical benefit. These services are likely to have out-of-pocket costs.

We offer 2 claiming options:• Simplified billing: If your doctor forwards the accounts directly to us with IFC and we

submit the claim to Medicare on their behalf for assessment. Benefits are paid directly to the Doctor and you will only be responsible for the out-of-pocket costs.

• Medicare two way: If your doctor sends the account to you, submit your Medicare claim form, Latrobe claim form and accounts directly to us.

Informed Financial Consent - additional benefits paid by Latrobe

Simplified billing Medicare two way

Specialists 25% 20%

General practitioners 16% 13%

Pathology and Radiology 6% 3%

For more about our Just Ask!® please call us or visit our website.

Just Ask!®

What are medical benefits?


12 months waiting periodHospital cover• pre-existing conditions. For more information refer to page 50.• pregnancy related conditions. For more information refer to page 26.Extras cover• major dental and orthodontic treatment• optical• health appliances• hearing aids• non-surgically implanted prostheses.

3 months waiting periodExtras cover• general dental treatment and mouth guards.

2 months waiting periodHospital cover• all other services, where no other waiting period applies including:

» psychiatric care » rehabilitation » palliative care

Extras cover• all other services

24 months benefit limitation period• a benefit limitation applies to any benefits for weight loss surgery.

For more information refer to page 51.• a benefit limitation may apply for psychiatric care, please contact Latrobe.

For more information refer to page 51.

3

12

2

24

What is a waiting period? A waiting period is the amount of time you are required to serve before you can make a claim on your new health cover. Waiting periods apply to both hospital and extras cover when you:• Join or upgrade your cover (refer to page 26 or 47).• Rejoin after a break in cover

Waiting periods

Benefit limitations will no longer apply from 1 April 2018


How do I join?

3Choose a combined cover with hospital and extras

WE MAKE IT SIMPLE

Choose your level of hospital cover

Choose your level of extras cover

OR OR

1 2

Transferring from another fundYou do not have to re-serve waiting periods that you have already served. If you upgrade your cover, waiting periods may apply to services that were not previously covered. Your membership with your previous fund must be up to date when you transfer; a gap in cover may mean that you will have to re-serve all waiting periods.We are unable to pay claims until we have received a clearance certificate from your previous fund. Your new membership card will not work for electronic claiming while we are waiting for the clearance certificate.Upon receipt of your clearance certificate, your previous cover will be reviewed for benefits claimed and to determine if waiting periods will apply.

Joining Latrobe

Starting a membership with us is simple.

Call us on 1300 362 144

Complete your online application form at latrobehealth.com.auQuick and easy online joining. Your application and Rebate form are completed in the one process.

Have your application completed over the phoneOne of our staff members will complete the application form with you.

Request an application form to be mailed

An application and Rebate form will be mailed for you to complete.

Legislation requires the Australian Government Rebate form to be completed before the Rebate can be applied. Early completion of this form ensures your nominated Rebate is applied to your first payment.


Maintaining your membershipWe know it’s not always easy to contact us during office hours, so take advantage of our online services. Once you have activated your online access, you can make changes or review your details, pay online, view tax statements and more.

Single membership is for one person only.

Family/couple membership is for the member plus:• spouse/partner• dependant children aged under 18• student dependants aged between 18 and 25, who are studying

fulltimeDependant children must not be married or in a defacto relationship.

Family Care membership is for the member plus:• spouse/partner• dependant children aged under 18• non-student and student dependants aged between 18 and 25Dependant children must not be married or in a defacto relationship.

Membership Types

Your membership

Maintaining

Claiming

Third party

Claiming extras coverYour membership will allow you to make claims electronically and pay the gap for services such as dental or physiotherapy.Alternative therapies such as massage, myotherapy and acupuncture cannot be claimed electronically. For these claims you will need to forward a claim form and your account/receipt to us. Claim forms are available on our website, under ‘Publications and forms’.

Access to your membershipA family or couples membership allows you and your partner to have equal authority to make any kind of transaction and to give us any instruction including cancelling your cover. If this doesn’t meet your needs, please call us.

Third party authorityDue to privacy laws we must have your authority to allow another person, other than your partner who is on your membership, to have control or access.

Access


Hospital cover


Hospital cover at a glance

What is not fully covered in hospital?

Treatment not covered by Medicare i.e. procedures that do not have a benefit payable under the Medicare Benefit Schedule. Refer to limited benefits on page 50. Accommodation charges may not be fully covered in a non-participating private hospital.

TOP HOSPITAL

MEMBER SHARE

FAMILY CARE

LOYAL MEMBERS

COVER WISE

H3 H K LM XType of cover p. 18 p. 19 p. 20 p. 21 p. 22

No excess or co-payment

$40 or $70 per day co-payment

Excess options – $150, $250, $500, $750, $1000

Reducing excessFamilies with non-student dependants aged 18 up to their 25th birthday

What is covered?Private or shared room

365 days accommodation cover

Day procedures

Theatre fees

Coronary/heart procedures

Home nursing in lieu of hospitalisation

Intensive care

Joint replacement

Major eye surgery

Delivery and pregnancy related services

Assisted reproductive services

Surgically implanted prostheses

Psychiatric care

Rehabilitation treatment

Private midwife at a hospital birth

Personal comforts – TV, local phone

In-hospital medical gap cover

Just Ask!® medical gap cover

A public hospital and extras package with limited private hospital cover, designed for young active singles, refer to page 24.

HEALTHY START

ST

Helping you to compare hospital cover


Helping you to compare hospital cover

Important: Waiting periods (pg 10) and default and limited benefits (pg 50) may apply. Note: This is a summary of the coverage provided by hospital cover, more information is included in our policy documents.

Our hospital cover explained

What is covered as an inpatient? (not applicable to Healthy Start)

Private or shared room In a participating private hospital you have the choice of a private or shared room; private rooms are subject to availability.

Accommodation chargesIncludes your room, theatre, intensive care, labour and recovery ward fees, medicines and drugs clinically required as part of your treatment.

365 days accommodation cover

For admissions longer than 35 consecutive days, your cover continues when your doctor provides an ongoing Acute Care Certificate.

Day procedures Same day admissions, including knee arthroscopies, chemotherapy and cataract surgery.


All prostheses are covered in accordance with the Commonwealth Prostheses Listing.

Major surgery Coronary/heart procedures, joint replacement and cataract surgery are just some of the major procedures covered.

Delivery and pregnancy related services

Services directly relating to childbirth such as antenatal services, complications of pregnancy, delivery and post natal care.

Assisted reproductive services

Benefits for services provided in hospital to assist conception such as IVF and GIFT.

Psychiatric care Treatment and programs for mental health disorders.

Rehabilitation Treatment to restore self-sufficiency following an illness or injury usually in specialist centres and hospitals.

Supported dischargeA program designed to provide wide range of alternative services that assist members to be discharged from hospital to a safe and supported environment.

Private midwife at a hospital birth

Services of a qualified private midwife instead of an obstetrician. Up to $450 per hospital birth.

TV Hire, local phone The cost of local phone calls and TV hire are included at participating private hospitals (conditions apply)


Medicare pays 75% of the Medicare Benefit Schedule Fee for in-hospital medical charges and Latrobe pays the remaining 25%.


Additional medical benefits to reduce the gap. For more information refer to page 9.


Special benefits:• no co-payment• no excess• no exclusions to procedures approved by Medicare

H3 Top Hospital cover with no excess and no co-payment

Weekly Fortnightly Monthly Quarterly Half yearly Yearly

Single $39.49 $79.04 $171.25 $513.86 $1,027.72 $2,013.46

Family/couple $79.04 $158.09 $342.55 $1,027.72 $2,055.45 $4,026.99

Based on singles and family/couples under the age of 65, with a taxable income of less than $90,000 and $180,000 respectively, with a 25.415% Australian Government Rebate and no Lifetime Health Cover loading.The above rates are inclusive of the direct debit discount. For a personalised quote, contact us or visit latrobehealth.com.au.

Important: Waiting periods (pg 10) and default and limited benefits (pg 50) may apply.

Top HospitalH3With no excess or co-payment

Our comprehensive Top Hospital cover has been designed to have no excess or co-payments. This cover is suitable for singles, couples and families. For a detailed explanation of cover please refer to pages 16-17.


H2 Top Hospital cover with a $40 daily co-payment – maximum $280 per stay


How does the co-payment work?The co-payment is payable for each person covered by your membership. It only applies to the first 7 days of every admission.

Special benefits:• Pay less without reducing cover.• Regardless of whether you choose MemberShare H2 or H1, the co-payment is only $30

for a day procedure.• The co-payment does not apply to public hospital admissions.• No exclusions to procedures approved by Medicare.



Single $35.68 $71.41 $154.73 $464.25 $928.52 $1,819.13

Family/couple $71.41 $142.83 $309.48 $928.55 $1,857.05 $3,638.38



Single $32.84 $65.74 $142.47 $427.51 $855.03 $1,675.22

Family/couple $65.74 $131.52 $284.99 $855.03 $1,710.11 $3,350.43



Top Hospital with co-payment options

HMemberShare

MemberShare has the same level of cover as our Top Hospital and offers a choice of 2 co-payment options, to suit your budget and health care needs. This cover is suitable for singles, couples and families. For a detailed explanation of cover please refer to pages 16-17.


Family CareK

K3 Top Hospital cover with no excess or co-payment

K2 Top Hospital cover with a $40 daily co-payment - maximum $280 per stay


How does the co-payment work?The co-payment is payable for each person covered by your membership. It only applies to the first 7 days of every admission.

Special benefits:• Cover for non-student dependants from 18 up to their 25th birthday.• Regardless of whether you choose Family Care K2 or K1, the co-payment is only $30 for

a day procedure.• The co-payment does not apply to public hospital admissions.• No exclusions to procedures approved by Medicare.

K3 Top Hospital cover with no excess or co-payment


Family $93.34 $186.64 $404.45 $1,213.41 $2,426.84 $4,754.67



Family $86.68 $173.36 $375.63 $1,127.00 $2,254.00 $4,416.06

K1 Top Hospital cover with a 70 daily co-payment - maximum $490 per stay


Family $79.14 $158.33 $343.04 $1,029.14 $2,058.28 $4,032.57

Based on families under the age of 65, with a taxable income of less than $180,000, with a 25.415% Australian Government Rebate and no Lifetime Health Cover loading.The above rates are inclusive of the direct debit discount. For a personalised quote, contact us or visit latrobehealth.com.au.


Top Hospital for families with adult children

Family Care has the same level of cover as our Top Hospital. It is a cost effective option, designed for families with non-student dependants aged 18-25, who are not married or living in a defacto relationship. They can be living away from home and earning their own income. This cover comprises of 3 options. For a detailed explanation of cover please refer to pages 16-17.



Top Hospital with a reducing excess

How does the excess work? If you go to hospital, you pay an excess towards the cost of your same day or overnight hospital stay:• On a single membership, you pay the excess only once in any membership year. • Families or couples pay the excess only for the first 2 hospital admissions in any

membership year.

Year 1 $300 excess

Year 2 $250 excess

Year 3 $200 excess

Year 4 $150 excess

When the hospital cost is less than your excess:• You must pay all accommodation costs for your treatment. • This does not count towards your excess if you have subsequent hospital treatments in

the same year. • Your inpatient medical claims are still covered even if the hospital costs are lower than

the excess.

Special benefits:• For each year you have Loyal Members cover, the amount of the excess reduces and,

after 4 consecutive years, there is no excess to pay.• Your excess will continue to reduce, even if you make a claim.• No exclusions to procedures approved by Medicare.

LM Top Hospital cover with a reducing excess


Single $35.27 $70.59 $152.92 $458.82 $917.70 $1,797.99

Family/couple $70.59 $141.14 $305.88 $917.67 $1,835.40 $3,595.92


LMLoyal Members

After the 4th year, pay no

excess!

Loyal Members has the same level of cover as our Top Hospital, allowing you to have a reducing excess over 4 consecutive years. After the 4th year, you don’t pay the excess. This cover option is suitable for singles, couples and families. For a detailed explanation of cover please refer to pages 16-17.


X1 Top Hospital cover with $150 excess



The options below, X4 and X5, will not exempt you from the Medicare Levy Surcharge.



How does the excess work?If you go to hospital, you pay an excess towards the cost of your same day or overnight hospital stay.

When the hospital cost is less than your excess:• You must pay all accommodation costs for your treatment. • This does not count towards your excess if you have subsequent hospital treatments in

the same year. • Your inpatient medical claims are still covered even if the hospital costs are lower than

the excess.

Special benefits:• Pay less without reducing cover.• Each person only pays the excess once in any calendar year.• Families pay no more than 2 excesses in any calendar year.• No exclusions to procedures approved by Medicare.

CoverWiseXTop Hospital with excess options

CoverWise has the same level of cover as our Top Hospital, offering 5 excess options to suit your budget and health care needs. This cover is suitable for singles, couples and families. For a detailed explanation of cover please refer to pages 16-17.



X



Single $38.29 $76.63 $166.08 $498.26 $996.52 $1,952.40

Family/couple $76.63 $153.30 $332.17 $996.52 $1,993.09 $3,904.81



Single $37.21 $74.43 $161.29 $483.94 $967.93 $1,896.39

Family/couple $74.42 $148.90 $322.63 $967.90 $1,935.86 $3,792.68



Single $33.43 $66.87 $144.88 $434.71 $869.41 $1,703.40

Family/couple $66.87 $133.74 $289.77 $869.41 $1,738.88 $3,406.81

The options below, X4 and X5, will not exempt you from the Medicare Levy Surcharge



Single $25.95 $51.92 $112.51 $337.53 $675.12 $1,322.64

Family/couple $51.92 $103.85 $225.02 $675.12 $1,350.24 $2,645.35



Single $22.99 $45.98 $99.63 $298.99 $598.00 $1,171.62

Family/couple $45.97 $92.00 $199.30 $597.97 $1,195.99 $2,343.19


CoverWise


What is covered in a public hospital?You are covered in a public hospital and can choose your own doctor.

Accommodation in a shared room

Covers your room, theatre, intensive care and recovery ward fees, medicines and drugs clinically required as part of your inpatient treatment. Cover is for a shared room; if you choose a private room, you will pay the extra cost. Otherwise, all your hospital charges will be covered for all procedures.


Medicare pays 75% of the Medicare Benefit Schedule Fee for in-hospital medical charges and Latrobe pays the remaining 25%.


Additional medical benefits to reduce the gap for in-hospital medical charges higher than the Medicare Benefit Schedule Fee.


All prostheses are covered in accordance with the Commonwealth Prostheses Listing. Refer to page 26 of this brochure for more information.

What is not fully covered in a public hospital?Treatment not covered by Medicare i.e. procedures that do not have a benefit payable under the Medicare Benefit Schedule.

What is covered in a private hospital?Cover is restricted to the following specified procedures:

Knee operations – arthroscopy and meniscectomyRemoval of appendix, tonsils, adenoids or wisdom teethDilation and curette where no other procedure is performedAny immediate treatment as a result of an accident (refer to page 50). Immediate treatment refers to the initial treatment required immediately following an accident. This does not include treatment at an emergency department of a hospital.

What is not fully covered in a private hospital?Default benefits will apply to the cost of any admission, other than for the procedures specified above. Significant out-of-pocket costs will be incurred if your admission is not for a specified procedure.Treatment not covered by Medicare i.e. procedures that do not have a benefit payable under the Medicare Benefit Schedule. We strongly recommend that you contact us prior to any hospital admission.

Healthy StartST

Healthy Start is a public hospital and extras package with limited private hospital cover, designed for young active singles.


Cover details:

Maximum benefit Personal limit Membership limit

Limited general dental - $500 $1000

Specified items including diagnostics, most preventative services, extractions, restorations

Other dental $250 Per accident Per accident

Treatment resulting from an accident


Mouth guards $55 $55 -

Supplied by a dentist or dental technician

Optical $125 $125 -

Includes spectacles and repairs, contact lenses and optical prescription sunglasses

Consultations Maximum benefit

Personal limit

Membership limitInitial Subsequent

Chiropractic and osteopathyChiropractic $26 $19 - - -Chiropractic X-ray - - $28 One OneOsteopathy $25 $17 - - -Combined limit: - - - $250 $500

Physiotherapy $27 $22 - - -

Group physiotherapy / hydrotherapy $9 - - - -

Combined limit - - - $300 $600

Ambulance Victoria membership Rebate Maximum benefit

When paid voluntarily, but not as a state tax or levy. $22 single$44 family

ST Standard Rebate with direct debit


Single $22.31 $44.58 $96.67 $290.01 $580.02 $1,160.10

Based on singles under the age of 65, with a taxable income of less than $90,000, with a 25.415% Australian Government Rebate and no Lifetime Health Cover loading. For a personalised quote, contact us or visit latrobehealth.com.au.

Important: Waiting periods (pg 10) and default and limited benefits (pg 50) may apply. Note: A set benefit is paid depending on the treatment item number for services provided in Australia by a Latrobe approved service provider in private practice. All limits apply to a calendar year.

STHealthy Start


Hospital: Important information

Policy documentOnce you become a member, you will receive a policy document that includes relevant information for your cover choice.

Claim time limitWe recommend that you submit all claims as soon as practicable after the service is provided. If claims are not made within 2 years of the date of service, benefits are not payable.

Having a baby?To ensure your newborn is covered at birth, an upgrade from a single membership to a family membership is required 2 months prior to the expected delivery date. Written confirmation of the expected delivery date is required from the treating obstetrician. A family membership automatically covers newborn babies subject to waiting periods served.

Excess / co-paymentAny excess or co-payment amount paid with your previous fund is not transferable; you will be required to pay any excess or co-payment applicable to your cover.

Upgrade of coverThis is any change in cover that entitles you to receive higher benefits. Higher benefits include a higher rebate for a particular service, cover for services not included in your previous level of cover, changing to a hospital cover with lower or no excess or co-payment.

Surgically implanted prostheses A prosthesis is an artificial substitute for a missing body part, used for functional or cosmetic reasons or both. Surgically implanted prostheses are sometimes required during a medical procedure, such as:• a replacement lens for cataract surgery• an artificial hip joint• a pacemaker• a heart valve All prostheses listed on the Commonwealth Prostheses Listing are covered by your hospital cover. If you or your doctor choose a prosthesis that is not on this listing, you will be charged a gap.

Cooling off periodIf you change your mind for any reason and decide to cancel your cover within 30 days of commencing or changing your cover, we will provide a full refund of any premiums that you have paid, provided no claims have been made.

Ambulance Victoria


Ambulance Victoria Add an Ambulance Victoria membership to your health cover

Accidents and incidents occur every day, in every part of the state and in many cases, when we least expect it.

In 2016/17 Ambulance Victoria:• responded to 854,607 incidents by road and air• provided care to 676,176 Victorians• 7,000 more code 1 patients received an emergency ambulance within 15 minutes

Ambulance Victoria membership gives you protection against the cost of world-class emergency and clinically necessary non-emergency treatment and transport services delivered by highly skilled and dedicated paramedics, aided by state-of-the-art equipment and resources. Specifically it includes:• all emergency road ambulance transport• all MICA (Mobile Intensive Care Ambulance) attendance and treatment• all emergency air ambulance and clinically necessary non-emergency air ambulance• all ambulance treatment when transport is not required• the same level of cover for ambulance treatment and transport services provided

interstate as covered in Victoria• all clinically necessary non-emergency patient transport

Add to your health cover. Call Latrobe 1300 362 144.

*Source: Ambulance Victoria 2016/17 Annual Report. Note: Ambulance cover is not included with any Latrobe product. For more information about Ambulance Victoria business rules, please visit www.ambulance.vic.gov.au. Members not residing in Victoria should contact their local Ambulance Service provider regarding ambulance cover in their respective state or territory. Latrobe is an agent of Ambulance Victoria and is authorised to accept new subscriptions and subscription payments on behalf of Ambulance Victoria.

Image courtesy of Ambulance Victoria


Extras cover


Extras cover at a glanceHelping you to compare cover to suit your lifestyle

PREMIER GOLD

PREMIER SILVER PREMIER DENTAL

FAMILYCARE GOLD

FAMILY CARE

PG PV P D PH PKWhat is covered? p. 32 p. 36 p. 42 p. 46 p. 34 p. 40

Acupuncture

Audiology

Blood glucose monitors

Blood pressure monitors

Chiropractic

C-PAP machine

Dietitian

Eye, Occupational and Speech therapies

General dental

Health screenings (mammograms, bone density testing and mole mapping)

Hearing aids

Lymphoedema garments

Major dental

Massage (remedial and therapeutic)

Mouth guard

Myotherapy

Naturopathy

Nebulisers, air compressor pumps

Optical (including spectacles and contact lenses)

Orthodontics

Osteopathy

Pharmacy prescriptions1

Physiotherapy

Podiatry consultations

Podiatry services (including orthotics)

Prostheses (non-surgically implanted)

Psychology

QUIT smoking course

TENS machine

Visiting nurse

Note: A set benefit is paid depending on the treatment item number for services provided in Australia by a Latrobe approved service provider in private practice. All limits apply to a calendar year. Waiting periods may apply. Please refer to page 10. 1Conditions apply, please refer to pharmacy benefits on page 51.

Available with or without a hospital cover


Extras cover at a glance

PREMIER PLUS PREMIER FAMILY PREMIER SINGLES

PP PF PSWhat is covered? p. 38 p. 44 p. 45

Acupuncture

Audiology

Blood glucose monitors

Blood pressure monitors

Chiropractic

C-PAP machine

Dietitian

Eye, Occupational and Speech therapies

General dental Limited Limited

Health screenings (mammograms, bone density testing and mole mapping)

Hearing aids

Lymphoedema garments

Major dental Accident only

Massage (remedial and therapeutic)

Mouth guard

Myotherapy

Naturopathy

Nebulisers, air compressor pumps

Optical (including spectacles and contact lenses)

Orthodontics

Osteopathy

Pharmacy prescriptions1

Physiotherapy

Podiatry consultations

Podiatry services (including orthotics)

Prostheses (non-surgically implanted)

Psychology

QUIT smoking course

TENS machine

Visiting nurse


Only available with a hospital cover


Premier GoldPGAvailable with or without a hospital cover

Cover details:

Years of membership Maximum benefit Personal limit

General dental - - -

Includes diagnostic and preventative services, oral surgery, extractions, endodontics and restorations

Major dentalCrowns, bridgework, dentures and periodontics

1 - No benefit2 - $3003 - $5004 - $8005 - $1000

6+ - $1500

Orthodontics Maximum per year

Maximum per course

Benefits are fixed at the level in which the course commences and paid over a 3 year period

1 No benefit No benefit2 $300 $9003 $400 $12004 $500 $15005 $600 $1800

6 - 9 $800 $240010+ $1000 $3000

Maximum benefit Personal limit

Health appliances: Blood glucose monitor, air compressor, nebuliser, TENS machine, C-PAP machinePer membership every 3 years 90% of cost $250Combined membership limit - $500

Hearing aid $1000 $1000

Includes repairs other than batteries, every 5 years

Lymphoedema garments (4 garments per year) 70% of cost $600

Mouth guards: Supplied by a dentist or dental technician $65 $65

Optical $250 $250


Pharmacy prescription1 (maximum per prescription) $100 $400

Podiatry - $600

Benefits are a set amount depending on item number for consultations, treatment and orthotics prescribed by a podiatrist

Prostheses (non-surgically implanted), every 3 years Up to 90% of cost $800

One of our most comprehensive extras cover with the highest level of benefits. Premier Gold can be taken with or without hospital cover, suitable for families, couples and singles. To compare our extras covers, please refer to page 30.


Consultations Personal limitInitial Subsequent

Acupuncture $40 $32 $1000

Audiology $65 $65 $1000

Chiropractic $46 $29 -

Chiropractic X-ray $80 $80 OneCombined limit - - $350

Dietitian $45 $40 $1000

Eye therapy $50 $40 $1000

Health screening: mammograms, bone density testing, mole mappingEvery 2 years - - $75

Massage - remedial and therapeutic $36 $32 $350

Myotherapy $40 $35 $1000

Naturopathy $30 $30 $250

Occupational therapy $50 $50 $1000

Osteopathy $45 $30 $1000

Physiotherapy $42 $37 -

Group physiotherapy / hydrotherapy consultation $15 $15 -

Combined limit - - $1000

Psychology $80 $80 $450

Speech therapy $60 $60 $1000

Visiting nurse $45 $18 $1000

Ambulance Victoria membership Rebate Personal limit

When paid voluntarily, but not as a state tax or levy. Limited to 1 family or 2 single subscriptions 100%

PG Standard Rebate with direct debit


Single $19.31 $38.61 $83.71 $251.19 $502.39 $984.28

Family/couple $38.61 $77.27 $167.42 $502.38 $1,004.77 $1,968.56



PGPremier GoldAvailable with or without a hospital cover


Family Care GoldPHAvailable with or without a hospital cover

Cover details:

Years of membership Maximum benefit Personal limit

General dental - - -

Including diagnostic and preventative services, oral surgery, extractions, endodontics and restorations


1 - No benefit2 - $3003 - $5004 - $8005 - $1000

6+ - $1500


Maximum per course


1 No benefit No benefit2 $300 $9003 $400 $12004 $500 $15005 $600 $1800

6 - 9 $800 $240010+ $1000 $3000


Health appliances: Blood glucose monitor, air compressor, nebuliser, TENS machine, C-PAP machinePer membership every 3 years 90% of cost $250Combined membership limit - $500

Hearing aid $1000 $1000


Lymphoedema garments (4 garments per year) 70% of cost $600

Mouth guards: Supplied by a dentist or dental technician $65 $65

Optical $250 $250


Pharmacy prescription1 (maximum per prescription) $100 $400

Podiatry - $600


Prostheses (non-surgically implanted), every 3 years Up to 90% of cost $800

Designed for families with non-student dependants aged 18-25, who are not married or living in a defacto relationship. They can be living away from home and earning an income. Family Care Gold can be packaged with our Family Care hospital cover. To compare our extras covers, please refer to page 30.


PHFamily Care GoldAvailable with or without a hospital cover


Consultations Personal limitInitial Subsequent

Acupuncture $40 $32 $1000

Audiology $65 $65 $1000

Chiropractic $46 $29 -

Chiropractic X-ray $80 $80 OneCombined limit - - $350

Dietitian $45 $40 $1000

Eye therapy $50 $40 $1000

Health screening: mammograms, bone density testing, mole mappingEvery 2 years - - $75

Massage - remedial and therapeutic $36 $32 $350

Myotherapy $40 $35 $1000

Naturopathy $30 $30 $250

Occupational therapy $50 $50 $1000

Osteopathy $45 $30 $1000

Physiotherapy $42 $37 -

Group physiotherapy / hydrotherapy consultation $15 $15 -

Combined limit - - $1000

Psychology $80 $80 $450

Speech therapy $60 $60 $1000

Visiting nurse $45 $18 $1000



PH Standard Rebate with direct debit


Family $39.02 $78.04 $169.07 $507.27 $1,014.61 $1,987.80

Based on family/couples under the age of 65, with a taxable income of less than $180,000, with a 25.415% Australian Government Rebate and no Lifetime Health Cover loading.The above rates are inclusive of the direct debit discount. For a personalised quote, contact us or visit latrobehealth.com.au.


Premier SilverPVAvailable with or without a hospital cover

Cover details:

Years of membership

Maximum benefit

Personal limit

Membership limit

General dental - - $1200 $2400



1 - No benefit -2+ - $1200 $2400

Combined general and major dental limit - - $1200 $2400


Maximum per course


1 No benefit No benefit -2 $300 $900 -3 $3671 $1100 -4 $450 $1350 -5 $550 $1650 -

6+ $6672 $2000 -


Blood pressure monitor - - $100

Per membership every 3 years

Health appliances: Blood glucose monitor, air compressor, nebuliser, TENS machine, C-PAP machinePer membership every 3 years 80% of cost $250 -Combined limit - $500 $500

Hearing aid $650 $650 -Includes repairs other than batteries, every 5 years

Lymphoedema garments 70% of cost $500 -

(4 garments per year)

Optical $180 $180 -


Pharmacy prescription3 and allergy/travel vaccinesPharmacy prescription $35 $250 $500Allergy/travel vaccines 70% of cost $200 -Combined limit: - $350 $700

Podiatry - $300 -Benefits are a set amount depending on item number for consultations, treatment and orthotics prescribed by a podiatrist

Prostheses (non-surgically implanted) Up to 70% of cost $800 -

Every 3 years

An affordable cover with a comprehensive range of benefits. It can be taken as a stand alone product or packaged with a hospital cover, suitable for singles, couples and families. To compare our extras covers, please refer to page 30.


PVPremier SilverAvailable with or without a hospital cover

Consultations Personal limit


Audiology $30 $25 $300 -

Dietitian $30 $25 $300 -

Health screening: Mammograms, bone density testing, mole mappingEvery 2 years - - $55 -

Physiotherapy $30 $25 - -

Group physiotherapy / hydrotherapy $12 - - -

Combined limit - - $350 $700

Psychology (each consultation) $50 - - -Group consultation $20 - - -Combined limit - - $300 -

Speech therapy, eye therapy or occupational therapy$30 $25 - -

Combined limit - - $350 $700


Personal limit


QUIT smoking course - - $70 per course - -Benefit for the completion of a QUIT smoking course

Therapies: chiropractic, osteopathy, naturopathy, massage, acupuncture, myotherapy$26 $20 - - -

Chiropractic X-ray - - $28 One -Combined limit - - $450 $900

Visiting nurse - - $17 per visit $250 $500



PV Standard Rebate with direct debit


Single $12.45 $24.91 $54.01 $161.98 $324.02 $634.86

Family/couple $24.91 $49.84 $107.97 $324.02 $648.09 $1,269.72


Note: A set benefit is paid depending on the treatment item number for services provided in Australia by a Latrobe approved service provider in private practice. All limits apply to a calendar year. Waiting periods may apply. Please refer to page 10. 13rd year benefit is $366. 23rd year benefit is $666. 3Conditions apply, please refer to pharmacy benefits on page 51.


Premier Plus®PPOnly available with a hospital cover

Cover details:

Years of membership

Maximum benefit

Personal limit

Membership limit




1 - No benefit -2 - $3003 - $600

4+ - $1000 $2000Combined general and major dental limit - - $1000 $2000


Maximum per course



6+ $600 $1800 -


Health appliances: Blood glucose monitor, air compressor, nebuliser, TENS machine, C-PAP machinePer membership every 3 years 70% of cost $200Combined limit - $400 $400

Health screening: Mammograms, bone density testing, mole mappingLimit every 2 years $45 $45 -


Lymphoedema garments 70% of cost $500 -(4 garments per year)

Mouth guards $55 $55 -Supplied by a dentist or dental technician

Optical $125 $125 -


Podiatry - $300 -


Prostheses (non-surgically implanted) Up to 70% of cost $500 -Every 3 years

Psychology (each consultation) $50 $300

Our middle range extras cover, only available with a hospital cover. Suitable for singles, couples and families. To compare our extras covers, please refer to page 30.


PPPremier Plus®

Only available with a hospital cover


Personal limit


Acupuncture $25 $17 - $300 -

Audiology $25 $17 - $300 -

Dietitian $25 $17 - $300 -

Myotherapy $25 $17 - $300 -

Therapies and servicesChiropractic $26 $19 - - -Chiropractic X-ray - - $28 One -Physiotherapy $27 $22 - - -Group physiotherapy / hydrotherapy $10 - - - -

Osteopathy, eye therapy, naturopathy, visiting nurse, occupational therapy, speech therapy, massage

$25 $17 - - -

Pharmacy prescription1 - - $25 - -Combined limit - - - $300 $600

Ambulance Victoria membership Rebate Maximum benefit Membership limit

When paid voluntarily, but not as a state tax or levy. Limit 1 family subscription or 2 single subscriptions

$44 family$22 single

$44$44

PP Standard Rebate with direct debit


Single $7.45 $14.91 $32.30 $97.01 $193.98 $380.09

Family/couple $14.91 $29.82 $64.66 $193.98 $388.01 $760.23




Family CarePKAvailable with or without a hospital cover

Cover details:

Years of membership

Maximum benefit

Personal limit

Membership limit




1 - No benefit -2 - $3003 - $600



Maximum per course



6+ $600 $1800 -


Health appliances: Blood glucose monitor, air compressor, nebuliser, TENS machine, C-PAP machinePer membership every 3 years 70% of cost $200 -Combined limit - $400 $400

Health screening: Mammograms, bone density testing, mole mappingLimit every 2 years $45 $45 -


Lymphoedema garments 70% of cost $500 -

(4 garments per year)



Optical $125 $125 -


Podiatry - $300 -Benefits are a set amount depending on item number for consultations, treatment and orthotics prescribed by a podiatrist


Psychology (each consultation) $50 $300 -

Designed for families with non-student and student dependants aged 18-25, who are not married or living in a defacto relationship. They can be living away from home and earning an income. This cover can be packaged with our Family Care hospital cover. To compare our extras covers, please refer to page 30.


PKFamily Care


Available with or without a hospital cover


Personal limit


Dietitian $25 $17 - $300 -

Acupuncture $25 $17 - $300 -

Audiology $25 $17 - $300 -

Myotherapy $25 $17 - $300 -

Therapies and servicesChiropractic $26 $19 - - -Chiropractic X-ray - - $28 One -Physiotherapy $27 $22Group physiotherapy / hydrotherapy $10 - - - -

Osteopathy, eye therapy, naturopathy, visiting nurse, occupational therapy, speech therapy, massage

$25 $17 - - -



When paid voluntarily, but not as a state tax or levy. Limit 1 family subscription or 2 single subscriptions $44 $44

PK Standard Rebate with direct debit


Family/couple $18.66 $37.38 $80.97 $243.01 $486.08 $952.32



PremierPAvailable with or without a hospital cover

Cover details:

Years of membership

Maximum benefit

Personal limit

Membership limit




1 - No benefit -2 - $3003 - $600



Maximum per course



6+ $600 $1800 -


Health appliances: Blood glucose monitor, air compressor, nebuliser, TENS machine, C-PAP machinePer membership every 3 years: 70% of cost $200 -Combined limit - $400 $400

Hearing aid $500 $500 -




Optical $125 $125 -


Podiatry - $300 -



Psychology (each consultation) $50 $300 -

Designed for those who do not wish to take out a hospital cover. However if you wish to combine it with a hospital cover, you will receive a bonus upgrade to our Premier Plus®. To compare our extras covers, please refer to page 30.


PPremierAvailable with or without a hospital cover



Personal limit


Acupuncture $25 $17 - $300 -

Audiology $25 $17 - $300 -

Dietitian $25 $17 - $300 -

Therapies and servicesChiropractic $26 $19 - - -Chiropractic X-ray - - $28 One -Physiotherapy $27 $22Group physiotherapy / hydrotherapy $10 - - - -

Osteopathy, eye therapy, naturopathy, visiting nurse, occupational therapy, speech therapy

$25 $17 - - -





$44$44

P Standard Rebate with direct debit


Single $8.19 $16.40 $35.51 $106.65 $213.30 $417.88

Family/couple $16.40 $32.80 $71.08 $213.30 $426.60 $835.81


Bonus upgrade to Premier Plus® if combined with a hospital cover

Bonus upgrade


Premier FamilyPFOnly available with a hospital cover

Cover details:

Years of membership

Maximum benefit

Personal limit

Membership limit

Limited general dental - - $500 $2000

Specified items including diagnostics, most preventative services, extractions and restorations

Other dentalTreatment resulting from an accident - $250 Per accident -

Combined dental limit - - $500 $2000




Optical $125 $125 -Includes spectacles and repairs, contact lenses and optical prescription sunglasses


Personal limit


Therapies and servicesChiropractic $26 $19 - - -Chiropractic X-ray - - $28 One -Physiotherapy $27 $22 - - -Group physiotherapy / hydrotherapy $9 - - - -

Osteopathy, podiatry $25 $17 - - -Pharmacy prescription1 - - $25 $150 $300Combined limit - - - $250 $500




$44$44

PF Standard Rebate with direct debit


Family/couple $9.23 $18.52 $40.18 $120.54 $241.08 $472.36



Designed for couples and families who want basic extras cover when combined with a hospital product. To compare our extras covers, please refer to page 30.


PSPremier SinglesOnly available with a hospital cover

Cover details:

Years of membership


Limited general dental - - $400

Specified items including diagnostics, most preventative services, extractions and restorations


Mouth guards $55 $55


Optical $125 $125


Pharmacy prescription1 $25 $150

ConsultationsMaximum benefit Personal limit

Initial Subsequent

Therapies and servicesChiropractic $26 $19 - -Chiropractic X-ray - - $28 OnePhysiotherapy $27 $22 - -Group physiotherapy / hydrotherapy $9 - - -

Osteopathy $25 $17 - -Combined limit - - - $250


When paid voluntarily, but not as a state tax or levy. Limited to a single subscription. $22 $22

PS Standard Rebate with direct debit


Single $3.47 $6.93 $15.08 $45.26 $90.52 $177.38

Based on singles under the age of 65, with a taxable income of less than $90,000, with a 25.415% Australian Government Rebate and no Lifetime Health Cover loading.The above rates are inclusive of the direct debit discount. For a personalised quote, contact us or visit latrobehealth.com.au.


Designed for individuals who want basic extras cover when combined with a hospital product. To compare our extras covers, please refer to page 30.


DentalDAvailable with or without a hospital cover

Note: A set benefit is paid depending on the treatment item number for services provided in Australia by a Latrobe approved service provider in private practice. All limits apply to a calendar year. Waiting periods may apply. Please refer to page 10.

Cover details:

Years of membership

Maximum benefit

Personal limit

Membership limit

General dental - - $1000 $2000Including diagnostic and preventative services, oral surgery, extractions, endodontics, restorations and mouth guards


1 - No benefit -2 - $3003 - $600


D Standard Rebate with direct debit


Single $5.41 $10.82 $23.46 $70.40 $140.80 $275.85

Family/couple $10.82 $21.64 $46.93 $140.80 $281.61 $551.76


For singles, couples and families wanting dental-only cover. It can be purchased with or without a hospital cover. Orthodontics is not included in this policy. To compare our extras covers, please refer to page 30.


Extras: Important information

Policy documentOnce you become a member, you will receive a policy document that includes relevant information for your cover choice.

Claim time limitWe recommend that you submit all claims as soon as practicable after the service is provided. If claims are not made within 2 years of the date of service, benefits are not payable.

Upgrade of coverThis is any change in cover that entitles you to receive higher benefits. Higher benefits include a higher rebate for a particular service, cover for services not included in your previous level of cover.

Approved service Provider To be able to claim:• The service or product must be provided in Australia.• The provider must be approved by Latrobe for the particular service or

product being claimed.• Providers are not automatically approved for all services or products that

they provide. For example, we may approve a naturopath for naturopathy services, but not for massage or myotherapy.

Medicare benefitsWhere the member has claimed a Medicare benefit, no private heath insurance benefit is payable.

Cooling off periodIf you change your mind for any reason and decide to cancel your cover within 30 days of commencing or changing your cover, we will provide a full refund of any premiums that you have paid, provided no claims have been made.

M


Australian Government Rebate The Australian Government Rebate on private health insurance helps reduce the cost of health insurance. The Rebate you are entitled to will depend on your income and age and is indexed annually by the Australian Government.

Medicare Levy SurchargeThe Medicare Levy Surcharge is an extra tax paid by Australian taxpayers who don’t have an appropriate level of private hospital cover and are considered by the Australian Government to be high income earners. It applies to singles, couples and families.The Surcharge varies depending on your taxable income and is in addition to the Medicare Levy, which is paid by most Australian taxpayers. Extras cover without hospital cover will not provide an exemption to the Surcharge.

Government surcharges/incentives

The Australian Taxation Office has specific rules regarding how to define your income for Australian Government Rebate purposes and Medicare Levy Surcharge purposes.For further information contact your accountant, financial planner or visit the Australian Taxation Office website, ato.gov.au.


Government surcharges/incentives

Lifetime Health CoverLifetime Health Cover is an Australian Government initiative designed to encourage people to take out private hospital cover at a younger age and maintain it throughout their lifetime. You have until 1 July after your 31st birthday to take out private hospital cover, otherwise you may be required to pay a loading on top of the base cover rate. The loading is 2% for each year you delay joining, to a maximum of 70%. After 10 continuous years of cover, the loading will no longer apply.The Lifetime Health Cover table is designed to give you an idea of the percentage that you will need to pay on top of the base rate.

• Lifetime Health Cover does not apply to extras cover or ambulance subscriptions.

• If you were born before 1 July 1934, you are not affected and you do not pay a loading.

• Special rules apply to people in the following categories: » Leaving the Australian Armed Services or the

Antarctic Division. » An immigrant or a refugee. » An Australian citizen, but you were overseas when

you turned 31. » No longer entitled to a Veterans’ Affairs Gold Card.

If you are unsure whether you have to pay a loading, we strongly recommend that you call us for further information.

After 10 continuous years of cover,

the loading will no longer apply.

Your age on 1 July prior to joining

Lifetime Health Cover loading

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

22%

24%

26%

28%

30%

32%

34%

36%

38%

40%

42%

44%

46%

48%

50%

52%

54%

56%

58%

60%

62%

64%

66%

68%

70% maximum

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65+

Remember, the longer you wait to take out health cover, the more the loading will increase.


Definitions

AccidentAn occurrence causing a physical injury or bodily condition, resulting from the application of unintentional external force and requiring immediate treatment. Accident does not include:• illness• operational procedures• the effects of alcohol• drugs of addiction• non-prescribed drugs• pregnancy, aggravation of an existing

physical injury or condition

Accommodation Covers meals, bed fees, theatre fees and treatment including nursing care. It does not include:• radiology• pathology• treatment by doctors

Admission (to hospital)Refers to a period of time in hospital for which accommodation charges are raised. It does not include treatment at an emergency centre of a hospital.

Calendar yearA calendar year starts on 1 January and ends on 31 December annually.

Default benefitsThey are the minimum level of benefits health funds must pay for valid claims for treatment provided in a shared ward in public hospitals. These are set and periodically reviewed by the Government.

Limited benefits / restricted benefits Is a minimal level of benefit paid for treatment in non-participating private hospitals, for nursing home type patients and for treatments not covered by Medicare, for example: dental, podiatric and cosmetic surgery.

Medicare Is a publicly funded universal healthcare system in Australia. Operated by the Department of Human Services, Medicare is the primary funder of health care in Australia for Australian citizens, permanent residents and Norfolk Islanders.

Medicare Benefit Schedule (MBS) The Government sets a MBS fee for most services provided by your doctor, including radiology and pathology.

Membership yearA 12-month period commencing on the day you join Latrobe, or change to another product.

Non-surgically implanted ProsthesesA replacement body part not surgically implanted; benefits are only payable when ordered by a Latrobe approved provider.

Pharmaceutical Benefits Scheme (PBS)The PBS is an Australian Government Scheme that subsidises the cost of certain drugs.

Pre-existing conditionsThis refers to any ailment, illness or condition where the signs or symptoms were, in the opinion of an appointed medical advisor, in existence at any time in the period of 6 months ending on the day you joined or upgraded your cover. Does not apply to psychiatric, rehabilitation and palliative care.


Other information

Claiming whilst overseas?While you are overseas, your membership does not cover you for any medical, hospital or other health services.

Compensation from other sourcesYou are not entitled to claim benefits from us if compensation and/or damages can be claimed from another source.

Exclusions Some funds have exclusions for particular conditions, which means that you are not covered for treatment as a private patient in a public or private hospital. We do not have any exclusions for procedures approved by Medicare.

Membership for non-residents of AustraliaIf you are not eligible for full Medicare benefits, please contact us.

Pharmacy benefitsPharmacy includes:• prescribed drugs and medicines

dispensed by a pharmacist• travel and allergy vaccinations dispensed

by a pharmacist or doctorIt does not include contraceptives and PBS subsidised prescriptions. The benefit is calculated after deducting the current PBS general patient contribution.

Benefit limitations (refer to pg 10) A benefit limitation period is an initial period of time during which only a minimum benefit is paid. The benefit limitation will be applied for a period of 2 years to new members who have not held previous hospital cover, or the hospital cover has lapsed by more than 30 days. The benefits payable will be the minimum benefit as declared by the Minister for Health and Ageing, except when a waiting period is also being served, in which case no benefit is payable.

Please note that our Fund Rules govern all matters to do with membership and the operation of our Fund. These Rules must comply with all relevant Government legislation. When you apply for a Latrobe membership, you agree to abide by the Rules, which you can view upon request.


Payment options

Claim options

Swipe your membership cardThis simple and convenient service includes the following treatments: chiropractic, dental, dietetics, optical, occupational therapy, osteopathic services, physiotherapy, podiatry, psychology and speech therapy.

MailSimply complete a claim form and attach your fully detailed provider accounts and receipts to: Latrobe Health Services, Reply Paid 41, Morwell VIC 3840.

Smart’nEasyRegister for our Smart’nEasy claim service. Within two business days of receiving your mailed claim, we pay your benefits directly into your nominated account.

Latrobe branch (9.00am - 5.00pm, Monday to Friday).

Direct debitPayments are automatically debited from your nominated banking account, MasterCard or VISA credit card. You also qualify for a discount on your premium.

BPayFast, easy and at any time of the day or night!

MasterCard or VISAPhone us on 1300 362 144 (8.30am - 5.00pm AET, Monday - Friday) or register online at latrobehealth.com.au

Post BillpayOptions to pay by internet, by phone or in person at any Australia Post office.

MailSend a cheque payable to Latrobe Health Services along with the tear off slip at the bottom of your renewal account to: Latrobe Health Services, Reply Paid 41, Morwell VIC 3840.

Latrobe branch (9.00am - 5.00pm, Monday to Friday).


Code of ConductThe Private Health Insurance Code of Conduct is a self-regulatory Code to promote informed relationships between private health funds, members, agents and brokers. As part of our commitment under the Code we will:• continuously work towards improving the standards of practice and service in the private

health insurance industry• provide information to members in plain language• promote better informed decisions about our health insurance products and services• provide information to members on their rights and obligations under their relationship

with us• provide members with easy access to our internal dispute resolution procedures, which

will be undertaken in a fair and reasonable mannerPlease contact us if you would like a copy of the Code of Conduct, or for more information on the Private Health Insurance Code of Conduct, go to latrobehealth.com.au

Complaint ResolutionWe believe the way we resolve complaints is a very important aspect of being able to deliver excellent member service. We actively encourage feedback in an effort to improve our products and services and our relationship with you. As part of this, we ensure you have access to a readily available, confidential and free complaint resolution process.

How to lodge a complaintContact us with details about the complaint:

1300 362 144 (8.30am - 5.30pm, Monday to Friday)[email protected] Services Manager, Latrobe Health Services, Reply Paid 41, Morwell VIC 3840.Latrobe branch (9.00am - 5.00pm, Monday to Friday).

Private Health Insurance OmbudsmanThe Ombudsman provides free and independent services to handle unresolved issues between members and their health fund.

Complaints hotline: 1300 362 072Email: [email protected]: www.ombudsman.gov.au

Code of Conduct

Complaint Resolution


Privacy Statement

Privacy Statement - Your Privacy is important to usLatrobe’s Privacy Statement details our commitment to your privacy and the procedures and systems that are in place to ensure compliance with the Australian Privacy Principles for the protection against inappropriate use of your personal or sensitive information.

Who is collecting my personal and sensitive information?Your personal and/or sensitive information is being collected, used and/or stored by Latrobe Health Services and we may be contacted by:

1300 362 [email protected] Health Services, Reply Paid 41, Morwell VIC 3840

Why is my personal and sensitive information being collected?We collect your personal and sensitive information to enable us to provide the products and services as a health insurer. These may include providing health benefits cover, as well as a range of other products and services which we bring to you either directly or as agents for others, including general insurance, travel insurance and ambulance cover.

What happens if my personal and sensitive information is not collected?If we do not collect your personal and sensitive information, membership with Latrobe and coverage for benefits will not be possible for health, general or travel insurance.

Who will Latrobe disclose my personal and sensitive information to?We may be required to disclose some or all of your personal and sensitive information to individuals or organisations who provide services to us to assist us in fulfilling our functions and activities, or with whom you have direct dealings and who have provided services to you, for example hospitals, doctors, dentists, optometrists, third party insurers.

Is any of my personal or sensitive information disclosed to overseas recipients?Latrobe does not disclose any personal or sensitive information to overseas recipients.

How can I access my personal information or make a complaint?Our Privacy Statement provides full details of the above points and also information of how you can access any information we may hold about you, how a complaint may be lodged and how we will deal with that complaint.


Prepare for the unexpectedBuy your travel insurance online from Latrobe and receive 25% off*

latrobehealth.com.au

* Discount applies to the current listed price. Please note that discounts are not cumulative. Insurance issued by QBE Insurance (Australia) Limited ABN 78 003 191 035, AFSL 239545. A Product Disclosure Statement (PDS) should be considered before buying these products. A PDS can be obtained by calling 1300 362 144. Normal acceptance criteria applies.

Travel insurance

1300 362 1448.30am – 5.30pm weekdays (closed Victorian public holidays)

03 5128 9289

[email protected]

Latrobe Health Services Limited. Reply Paid 41, Morwell VIC 3840

ABN 94 137 187 010

latrobehealth.com.au

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Note: The information contained in this brochure is current at the time of issue, 1 April 2018, and replaces all previously published material.

hospital and extras health cover - member benefits€¦ · we encourage you to read this brochure...

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