Healthy
You
Healthy You
T H E H E A LTH B E N E F I T S G U I D E
F O R E V E RYO N E
1 APRIL 2016
Welcome
TO QUEENSLAND COUNTRY
OU R P U R P O S E
O U R H I STO RY
Queensland Country Health Fund is part of a Member owned
Queensland Country has been in the business of providing
group and therefore exists to meet the health insurance
private health insurance cover to Queenslanders for nearly
needs of Queenslanders by:
40 years. Established in 1977 as the MIM Employees Health
- Improving the health and wellbeing of our Members
- Providing market leading benefits
- Maintaining competitive premiums
- Delivering superior, personalised and genuine service
Society, the fund was developed to assist Members to protect
themselves against the financial burden of rising hospital and
ancillary health care costs. In January 1999 we began trading
as Queensland Country Health Fund continuing the traditions
of affordable and comprehensive health cover backed by
superior, personalised and genuine service.
Whether you’re new to health insurance or just thinking about
making a move from another insurer, give us a call to find
out how exceptional benefits and genuine service makes a
refreshing change!
Head
office
[2]
CONTE NTS
Why private health insurance? 4
On-the-spot claiming 29
Have existing health insurance? 6
Easy online claiming
30
Why us? 8
Manage your cover online
31
Which cover is right for you? 10
How to pay contributions 33
Hospital cover 12
In more detail 34
Lower your premiums with an excess!
14
Government initiatives
40
Extras cover 18
Private Health Insurance Complaints 42
Cover Packages
23
[3]
W HY I S
P R IVAT E
H E ALT H
I N S U RAN CE
Doctor
for me?
With private Hospital cover you can
choose your own doctor, and decide
whether you will go to a public or private
hospital that your doctor attends.
Whether you’re looking for yourself
or your family, Queensland Country
has you covered.
Hospital
Private Hospital cover gives you the choice of being
treated in either a public or private hospital with more
choice over the hospital you stay in!
have long
Public System
With private health insurance you avoid
ls
si
of
To
n
Re
e
ry
Su
rg
e
ct
ra
ta
lK
ne
m
ov
al
Su
rg
er
y
292
Days
H
100
ea
rt
200
000
[4]
309
Days
Ca
300
Queensland hospital waiting times at 90th
percentile as reported by the Australian
Institute of Health and Welfare, Australian
Hospital Statistics 2013-2014
Re
400
428
Days
To
ta
DAYS WAITI N G
500
pl
ac
em
en
t
public hospital waiting times!
90
Days
Queensland Country
Health Fund
r
alth Cove
He
Lifetime
as to when
Take out Hospital cover early in
life to guarantee lower premiums.
Having private health insurance definitely has its rewards.
It affords you the peace of mind and the security of health
Higher income earners who
care options and benefits simply not available today through
take out Hospital cover will
the public health care system.
avoid paying the Medicare Levy
Surcharge.
9,389
*
34,850
Private
HAVE TO PAY
*
24,690
*
Some of the most common hospital procedures, if provided in a public hospital can have
lengthy waiting lists. Alternatively, if the medical treatment is provided in a private hospital
the cost could easily be thousands of dollars if you don’t have Private Hospital cover.
* Source Queensland Country Health Fund claim records 2015/2016.
[5]
HAVE E X I S T I NG
H EALT H
I N S U RANCE?
It’s too easy to transfer!
At Queensland Country we believe Private
Health Insurance should be easy to understand,
easy to claim on but, most of all, it should be easy
to join or transfer to us in the first place!
[6]
Will I need to serve any waiting periods
when I switch to Queensland Country?
What we need!
If you switch from another Australian registered health
To complete the transfer to Queensland Country, you will
fund, you are guaranteed ‘portability’ of cover by law. What
be provided with a Transfer Certificate from your previous
this means is that you can transfer from one health fund to
health insurance fund.
another without having to re-serve waiting periods you’ve
already served with your current fund.
This important document confirms your health cover
history, your Lifetime Health Cover status, and ensures
We’ll recognise any waiting periods (or portions of waiting
you receive continuity of cover by ensuring that we apply
periods) you’ve already served if you join us within 63 days
all appropriate waiting period waivers.
of leaving your previous health fund.
If your existing health fund sends your Interfund Transfer/
The only time waiting periods apply when you transfer to us
Clearance Certificate to you, and not us, you’ll need to
from another fund is when your Queensland Country cover
forward the certificate to us.
offers a higher level of benefits than your previous cover. In
this case, you’ll be entitled to the same level of benefits as
you had under your previous cover until you’ve served the
Your transfer certificate is required before any benefits
can be paid.
waiting period for the higher level of benefits.
If you transfer from a cover with a higher excess to one with
a lower excess (for example, from a $500 excess to a $250
excess), that counts as an upgrade in your cover. In this case
you may have to pay your previous higher excess until you’ve
served the waiting period for the new, higher level of cover.
Join or Switch to
Queensland Country today!
[7]
97%
O F R E S PO N D E N TS
VO I C E D TH AT
T H EY W E R E
S AT I S F I E D W ITH
Q U E E N S L AN D
C O U N TRY
Why Us?
Source: Member Satisfaction Survey 2016
Member focused
medical practitioners throughout Australia. This ensures peace of
At Queensland Country our primary focus is on continually
for in-hospital services within Australia, wherever they may go!
exploring ways to satisfy the needs of our policyholders.
As part of a Member owned group, we invest heavily in making
Adult children are also covered
our policyholders experience unique and refreshing.
Adult children can remain on a family cover up to the age of 21
We are driven to design and deliver exceptional value private
health insurance products, whilst maintaining a simpler and more
satisfying experience for our growing, loyal Member base!
Happy members
To ensure we maintain our high service standards, and to ensure
mind and ensures that our policyholders receive maximum cover
years at no extra cost, and can continue to stay on their family’s
policy up to the age of 25 years if they are studying full-time or
an apprentice earning up to $30,000 p.a. and are not married or
in a de-facto relationship. If they are not studying
full-time or an apprentice we are able to offer our Extended
Family cover option, a cost effective alternative for those families
with adult dependants ensuring peace of mind for everyone.
our products continually meet our policyholder’s needs, every year
For more information please see page 37.
Queensland Country conduct a survey of its’ Members to
ensure we keep touch with what our Members really think!
Home away from home!
The good news is that from our last Member survey in 2016
As the majority of our policyholders live in regional and remote
we were pleased to hear that 97% of respondents voiced that
areas of Queensland, it is often necessary for people to travel to
they were satisfied with Queensland Country. We will always
Townsville or Brisbane for essential medical treatment. This can
strive to improve our already highly regarded reputation for
mean high accommodation expenses for family accompanying
exceptional Member service, to ensure our policyholders
the patient. Queensland Country has addressed this issue for
always have a smile on their face!
policyholders with the purchase of a number of two bedroom
Australia-wide cover
furnished apartments in “McIlwraith on the Park” in the Brisbane
Being the only regionally based health insurer in Queensland
in Pimlico, providing our Members with a home away from
enables us to understand the health care needs of people in
home. These units are available at concessional rates for our
this state better than anyone. However, policyholders who move,
policyholders exclusively for use associated with a medical need.
work or play interstate can also rest easy. Queensland Country in
conjunction with the Australian Health Service Alliance (AHSA)
have entered into an agreement with most private hospitals and
[8]
suburb of Auchenflower, close to the Wesley Hospital together
with “Roy Harris Place” in Townsville, near the Mater Hospital
We are the only health fund in Australia to provide
this benefit!
Managing your membership online
Our own Dental Practice!
Not only can you get product information from our website,
Queensland Country Dental is Queensland Country Health Fund’s
but once you are a Member you can securely access and even
Member only dental practice located in the Queensland Country
update a range of details concerning your cover. You can do a lot
Centre in Aitkenvale, Townsville.
of things that you may normally expect to have to call us for; this
The practice offers a full range of dental services and focuses on
gives you greater control over your cover and gives you the ability
improving the oral health of Members.
to update your details whenever you need to.
All Health Fund Members can access high quality dental care.
All you need to do is visit our website
Members with Premium Extras will have low or no out of pocket
www.qldcountryhealth.com.au and register with our online
expenses on diagnostic and preventive treatments, including
services on the homepage. This will give you access to our
check-ups, scale and clean and mouthguards.
system and you’ll be able to update a variety of details. It will take
just a minute to register. For more information see page 31.
Sponsorships and community support
Queensland Country is committed to supporting local
Members with Essential Extras, Young Extras or any of our
Hospital cover products are also eligible for treatment at
Queensland Country Dental at concessional prices.
For further information on the dental practice go to
www.qldcountryhealth.com.au/dental
communities, and in doing so is proud to be an official partner
of the Women’s National Basketball League (WNBL) team Townsville Fire, as well as Bronze sponsors of the Intrust Super
Cup Rugby League team - Northern Pride.
Backing our commitment to healthier communities we also
sponsor the Townsville Running Festival, and Mackay and Bowen
Triathlon events.
Queensland Country also supports local community groups
through sponsorship of events and also donations. An example
of this includes the RACQ NQ Rescue Helicopter.
[9]
Hospital cover
Extras cover
If you are concerned about public
If you need assistance with the cost of
hospital waiting times and want to
visits to the dentist, optometrist, physio
ensure that quality timely care is
and other health services that Medicare
available for yourself or your family
does not normally provide a benefit for,
by a doctor of your choice then
then Extras cover is for you!
one of our Private Hospital cover
range may suit you!
Top Hospital
Top Hospital 250
Premium Extras
Top Hospital 500
Essential Extras
Intermediate Hospital 250
Intermediate Hospital 500
Public Hospital
[ 10 ]
Young Extras*
*Young Extras is the only Extras cover option that can be taken as
a stand alone Extras product. All other Extras products need to be
packaged with any of our Hospital cover options.
Choose your level of Hospital cover based on your needs and budget.
Private Hospital Cover
Description
Excess Options
Top Hospital
Our most comprehensive hospital product
and popular with those looking for
complete peace of mind.
No excess payable.
Top Hospital 250
Provides a comprehensive Hospital cover
where you pay the first $250 towards any
inpatient hospitalisation in return for a
lower premium.
$250 excess per person per membership
year up to a maximum of $500
for a family policy.
Top Hospital 500
Provides a comprehensive Hospital
cover where you pay the first $500 towards
any inpatient hospitalisation in return for the
lowest premium in our Top Hospital cover
range.
$500 excess per person per membership
year up to a maximum of $1,000
for a family policy.
Provides a great value mid level Hospital
cover ideal for a young or healthy person
who doesn’t want to pay for hospital
services they feel less inclined to need.
$250 excess per person per membership
year up to a maximum of $500
for a family policy.
Provides a great value mid level Hospital
cover ideal for a young or healthy person
who doesn’t want to pay for hospital
services they feel less inclined to need.
$500 excess per person per membership
year up to a maximum of $1,000
for a family policy.
Description
Excess Options
Public Hospital cover is exactly as the
name suggests - cover in a public hospital.
Limited benefits are paid towards inpatient
treatment in a private hospital.
No excess payable.
Intermediate Hospital
250
Intermediate Hospital
500
Public Hospital Cover
Public Hospital
Choose your level of Extras cover based on your expected frequency of use and budget.
Extras Cover
Description
Provides superior visit benefits for an extensive range
Premium Extras
of dental, optical and therapy services with generous
annual limits.
Provides benefits for the same comprehensive range
Essential Extras
of services as our Premium Extras just with slightly
lower benefits and annual limits, keeping the policy
cost down.
Provides generous benefits for all the services that
Young Extras
younger people generally use. It is tailor made to keep
premiums low but the benefits high.
[ 11 ]
HOS P ITAL C OVE R
WHAT YOU ARE COVERED FOR
This provides a summary of cover and isn’t intended to be a comprehensive list of all the services covered
TOP HOSPITAL COVER
NIL
EXCESS
$250
EXCESS
$500
EXCESS
INTERMEDIATE
HOSPITAL COVER
$250
$500
EXCESS
EXCESS
Choice of Doctor/Hospital
Public Hospital Accommodation
as a Private Patient (Shared room,
please refer to page 35.)
Private Hospital
Accommodation*
Theatre Fees*
Surgically Implanted Prosthesis
Benefits Prosthesis benefits
(artificial hips, knees, etc) as per the
Government listing.
Intensive Care*
Medical Gap Cover for the 25% gap
between the 75% Medicare Benefit and
the Medicare Benefits Schedule fee for
inpatient services.
Tonsils and Adenoids Removal^
Appendix Removal^
Colonoscopies^
Grommets in Ears^
Gynaecological Services^
Hernia Repair^
Joint Reconstructions^
Back Surgery^
Brain Surgery^
Plastic and Reconstructive
Surgery^
In-Hospital Rehabilitation
Treatment* Rehabilitation for hospital
services with restricted or excluded
benefit entitlement will have reduced or
nil benefit eligibility.
Obstetric Related Services*
R
e.g. birth and pregnancy.
Assisted Reproductive Services*
R
e.g. IVF.
In-Hospital Psychiatric
Treatment*
Cardiothoracic Procedures*
▵
R
eg. open heart surgery.
*
Major Eye Surgery e.g. cataracts
and eye lens procedures.
Gastric banding, sleeving/
diversions or bypass
(weight loss surgery)* including
replacements, repairs and adjustments.
Renal Dialysis* e.g. chronic failure
Access Gap Cover The Access Gap
benefit, for inpatient services, is a benefit
over and above the Medicare Benefits
Schedule for participating Doctors.
[ 12 ]
R
R
▵
R
R
PUBLIC HOSPITAL
COVER
NIL EXCESS
TOP HOSPITAL COVER
NIL
EXCESS
$250
EXCESS
$500
EXCESS
INTERMEDIATE
HOSPITAL COVER
$250
EXCESS
$500
EXCESS
PUBLIC HOSPITAL
COVER
NIL EXCESS
Nursing Home Type Patients
We pay a benefit toward a nursing home
type patient. This amount is determined
by the Federal Government. Certification
is required.
Hip and Knee Joint Replacement
Surgery*
Mechanical Appliances and
Artificial Aids# Benefit up to 85% of
▵
the cost or hire of mechanical appliances
and artificial aids approved by
Queensland Country Health with a limit
of $2000 per person, per membership
year.
Mammograms and Bone Density
Test Benefit up to $50 limited to 2
services for each of the above tests, only
if not claimable from another source.
The membership year limit is $200 per
person covered.
Hearing Aids Benefit limit is
provided every 3 years with the limit
amount applied based on your length of
membership with Queensland Country
Health: Up to 10 years $1000, 10-15
years $1500 and 15 years+ $2000.
Benefits per person are calculated
at 85% of purchase cost up to the
appropriate limit of benefit. Any hearing
aid cannot be replaced within 3 years
from its original purchase date.
Australian Hearing Services
Benefit of $25 per membership year per
eligible person for the cost of a Hearing
Services Card.
Nursing Home and Bush — Benefit up
to $60 per visit or $150 per day limited
to $1000 per person, per membership
year. Special — Benefit of up to
$150 per day $750 per person, per
membership year.
Hospital Boarder Benefits up to $35
per day to a maximum of four days per
person listed on the membership, where
such accommodation is necessary for
the well-being of the patient.
Cosmetic Surgery (hospital
treatment for which Medicare pays no
benefit.)
Irrespective of which hospital cover you have chosen, any ancillary service provided during your hospital stay will not be able to be claimed against the
fund unless you have cover for these services under an ancillary (Extras) product eg. physiotherapy, dieticians, exercise physiologists etc.
If you have chosen Public Hospital cover and are an inpatient at a private hospital or day surgery, you will have a benefit entitlement to the default rate benefit only.
For hospital services or treatments that have Restricted benefit availability under Intermediate Hospital Cover, no benefit is paid towards the cost of theatre charges raised for
inpatient services in a private hospital or day surgery. If you have chosen Public Hospital cover and are an inpatient at a private hospital or day surgery, you will have a benefit
entitlement to the default rate benefit only.
Benefits are not available on second hand equipment or on some consumables. A benefit is payable for short term hiring (up to 3 months) of some mechanical aids. The purchase
of some machines and monitors are limited to once every 3 membership years. Waiting periods will apply to all benefits outlined. Please refer to page 38 for further details.
Services we don’t pay benefits towards.
Stands for BLP - Benefit Limitation Period. Hospital benefits payable on these hospital services during the designated benefit limitation period will be the minimum benefit declared
by the Minister for Health, except when a waiting period is being served, in which case no benefit applies. See Benefit Limitation Period information in this brochure.
Stands for Restricted Benefit. Covered for shared ward accommodation in a public hospital only. If you go to private hospital or day surgery for these services it is likely to result in
large out-of-pocket expenses.
For more information on our Hospital cover go to page 34 'In more detail'.
[ 13 ]
LOW E R YO U R
PREMIUMS
with an Excess!
[ 14 ]
AN EXCESS IS THE AMOUNT YOU AGREE TO
CONTRIBUTE TOWARDS HOSPITAL COSTS IF YOU
ARE ADMITTED TO A PUBLIC OR PRIVATE HOSPITAL
OR A DAY SURGERY. THE MORE EXCESS YOU
AGREE TO PAY, THE LOWER YOUR PREMIUM
WILL BE.
Our private hospital cover range has flexible excess options to ensure there is an
affordable cover for everyone!
Our Top Hospital cover has a choice of a nil, $250 or $500 hospital excess, whilst our
Intermediate Hospital cover has only two hospital excess options of $250 or $500.
The excess is only payable if you, or someone on your policy, is admitted as an inpatient to
a public hospital (as a private patient), private hospital or a day surgery. It does not apply to
Extras cover.
The excess calculation is membership year based.*
The most you’ll have to pay each membership year if you choose a cover with a hospital
excess is outlined below:
EXCESS TYPE
SINGLES COVER
COUPLES/FAMILY/SINGLE PARENT COVER
MAXIMUM PER
MEMBERSHIP YEAR
MAXIMUM PER PERSON
PER MEMBERSHIP YEAR
MAXIMUM PER POLICY
PER MEMBERSHIP YEAR
$250 EXCESS
$250
$250
$500
$500 EXCESS
$500
$500
$1000
EXCESS EXEMPTION FOR YOUNG CHILDREN - TOP HOSPITAL COVER ONLY
With our Top Hospital cover, you will not be charged an excess if your child up to and
including the age of 12 years is admitted to hospital for medical treatment. This excess
exemption for children 12 years and under is NOT applicable under our Intermediate
Hospital cover and Singles and Couples combined cover. It is exclusive to our range of
Top Hospital covers ONLY.
* Membership year is defined on page 37.
[ 15 ]
E XTRAS
As well as Hospital cover, we also provide Ancillary cover — better known as
Extras cover — which can be bundled together with your Hospital Cover.
We have three levels of Extras cover here at Queensland Country and this provides benefits for a range of general private
health services that are not covered by Medicare. This includes Dental, Optical and Physiotherapy, Podiatry etc.
As well as looking after you if you are unwell, we also want you and your family to stay well. With our Extras cover you’ll get
great benefits on a whole range of healthcare treatments and services and it’s a great incentive to keep that six-monthly
dental check-up, new pair of glasses or even a therapeutic massage.
With our three Extras covers - Premium Extras, Essential Extras and Young Extras, you can be confident that you’ll be
covered from head to toe.
Premium
Extras
Essential
Extras
provides you and your family with a comprehensive range of therapies and benefits with
generous limits to ensure out-of-pocket expenses are kept to a minimum and can only be
purchased in conjunction with a Hospital cover.
provides a comprehensive range of therapies and benefits with lower limits and premiums and
can only be purchased in conjunction with a Hospital cover.
provides a broad range of therapies and a good level of benefits with limits on a per person per
Young
Extras
policy basis, and can be purchased on its own or in conjunction with a Hospital cover. Young
Extras is designed as an entry level Extras cover and is best suited for young people under the
age of 30.
Dental and Optical
Premier Providers
Queensland 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.
Further details of these providers can be seen at
http://www.qldcountryhealth.com.au/member/preferred-provider
[ 16 ]
HEALTHY LIVING BENEFITS
REWARDING LIMITS
As well as helping you to get well we want to help you to stay
Once you have held cover under either our Premium or Essential
well. Therefore we have introduced benefits to encourage you
Extras products for a year, we automatically increase your annual
to live a healthy lifestyle. We will pay up to $150 per person per
claim limits for Dental (excluding Orthodontic) and our full range
membership year to assist you to:
of Therapies by $50 per year.
*
Participate in your choice of weight management programs
Participate in quit smoking programs
We provide this loyalty incentive for the first 5 years of cover, and
continue to honour this for as long as you hold cover under the
above eligible products. For example, after 5 years continuous
P
articipate in other approved health management
cover on our Premium Extras product, the annual limit per person
programs including:
for Dental would have increased to $1650 per person per
**
- Gym Membership
membership year.
- Personal Training programs
Loyalty limit increases do not apply to sub limits or individual
Have your skin checked for skin cancers through
mole mapping
service/item benefits.
The benefits outlined in the Health Benefits Guide are a summary
Consultation fees for Diabetes Educator
of benefits payable and do not provide comprehensive details
C
onsultation fees for Metabolic dieticians and nutritionists
of all benefits. To confirm the details or any conditions that may
when providing assistance with weight management
apply, please contact us on 1800 813 415.
B
owel Screening tests and Bone Density tests (no doctors
referral will be required)
P
SA Test (one per year). We will cover a second yearly test not
covered by Medicare.
*
Benefit payable under Premium Extras
** T
o 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 health or medical condition. A Health
Management Program Benefit Approval Form available on our website must
accompany claim for these benefits.
[ 17 ]
E XTRAS
LIMITS PER MEMBERSHIP YEAR AND WHAT WE’LL PAY
TYPE OF SERVICE
WAITING PERIODS
DENTAL
PREMIUM EXTRAS
EXAMPLE OF BENEFITS
OVERALL LIMIT
Diagnostic
This includes examinations, consultations and
Xrays etc.
2 months
eg. Periodic Oral Exam - $45
X-rays - $30
$600
sub limit^
Preventative
This includes cleaning and scaling, fluoride treatment
and mouth guards
2 months
eg. Scale & Clean - $75
Fluoride Treatment - $22
Mouth guard - $150
$800
sub limit^
Periodontics
eg. Specialised Gum Treatments
12 months
Simple Extraction
Surgical Extractions
Wisdom teeth extraction, removal of impacted teeth
2 months
12 months
Endodontic
eg. Root canal therapy and root fillings
$500
sub limit^
eg. Simple Extractions - $105
Surgical Extraction - $180
$700
sub limit^
12 months
eg. Root Canal obturation one canal - $170
$600
sub limit^
Restorative
Composite fillings and amalgam fillings
2 months
eg. One surface composite
filling - $90
$800
sub limit^
Crowns/Bridges
12 months
(accumulating to $1500 per year
after 2 years of membership) eg.
Full Veneered Crown - $800
$800
sub limit^
Prosthodontics
Dentures etc.
12 months
eg. Full upper and lower denture
- $850
$850
sub limit^
General Services
2 months
eg. Occlusal splints - $300
$500
sub limit^
*Benefits paid on dental item numbers only, unless hospital cover
is held and all waits have been served for any in-patient services.
Orthodontics
Braces etc.
$1400 overall
benefit limit
per person per
membership year
for all Dental
services (excluding
Orthodontics which
has separate
claim limits)
Sub limits apply^
12 months
$1000
(increasing to $2000 after completion of 2 years membership*
$3000 available after completion of 3 years membership*)
$3000 Lifetime limit. All limits per person. Benefits are paid at 85% of cost.
*Years of membership refers to the actual period of cover on
Premium Extras products only.
2 months
Total benefit for optical items
or services is limited to
a maximum of $285 per person,
per membership year
OPTICAL
Single Vision Spectacles
Bifocal Spectacles
Multifocal Spectacles
Contact Lenses (hard or soft)
Repairs to frames/spectacle frames only/
replacement lenses
^ Dental Sub Limits: the maximum benefit amount claimable per person for treatment/service in a specific area of dentistry per membership year. This is providing an individual person’s overall dental
benefit limit for the membership year has not already been reached. If this was the case no further dental benefits can be claimed by this individual on any area of dentistry until new membership year
commences. Individual dental item benefits apply.
X Service we don’t pay a benefit towards
[ 18 ]
ESSENTIAL EXTRAS
EXAMPLE OF BENEFITS
YOUNG EXTRAS
OVERALL LIMIT
EXAMPLE OF BENEFITS
eg. Periodic Oral Exam - $32
X-rays - $21
$400
sub limit^
eg. Periodic Oral Exam - $34
X-rays - $23
eg. Scale & Clean - $53
Fluoride Treatment - $15
Mouth guard - $105
$500
sub limit^
eg. Scale & Clean - $56
Fluoride Treatment - $17
Mouth guards - $113
$300
sub limit^
X
eg. Simple Extractions - $74
Surgical Extraction - $126
$400
sub limit^
$900 overall benefit limit
per person per
membership year for
all Dental services
(excluding Orthodontics
which has
separate claim limits)
Sub limits apply^
eg. Simple Extractions - $79
Surgical Extraction# - $135
eg. Root Canal obturation one canal - $119
$350
sub limit^
eg. One surface composite
filling - $63
$500
sub limit^
(accumulating to $1000
per year after 2 years
of membership)
eg. Full Veneered Crown - $550
$550
sub limit^
eg. Full Veneered Crown - $500
eg. Full lower denture - $350
$500
sub limit^
X
eg. Occlusal splints - $210
$300
sub limit^
eg. Occlusal splints - $225
X
eg. One surface composite filling - $68
OVERALL LIMIT
$500 per person
up to $1,000
per policy per
membership year.
Combined limit
claimable for General
and Major Dental
(Surgical Extractions
and Crowns and
Bridges only)
$500
(increasing to $1000 after completion of 2 years membership*
$1500 available after completion of 3 years membership*)
$1500 Lifetime limit. All limits per person.
Benefits are paid at 50% of cost.
*Years of membership refers to the actual period of cover on
Essential Extras products only.
No cover for Orthodontics
Total benefit for optical items
or services is limited to
a maximum of $200 per person,
per membership year
Total benefit for optical items
or services is limited to
a maximum of $210 per person up to $420
per policy per membership year
[ 19 ]
LIMITS PER MEMBERSHIP YEAR AND WHAT WE’LL PAY
TYPE OF SERVICE
PREMIUM EXTRAS
WAITING PERIODS
THERAPIES
CONSULTATION TYPE OR SERVICE
Acupuncture*
2 months
Initial and Subsequent - $35
Audiology
2 months
Initial and Subsequent - $50
Report - $60
Chiropractic
2 months
Initial and Subsequent - $35
X-rays - $60
(not reading of x-rays)
OVERALL LIMIT
$700
combined
sub limit#
Remedial Massage/Bowen Therapy/
Myotherapy*
2 months
Initial and Subsequent - $35
Osteopathy
2 months
Initial - $35 Subsequent - $35
Naturopathy/Homeopathy*
2 months
Initial and Subsequent - $35
Dietitian
2 months
Initial - $75 Subsequent - $40
Occupational Therapy
2 months
Initial - $80 Subsequent - $40
Orthoptic Therapy
2 months
Initial and Subsequent - $60
2 months
85% of cost
$150 sub
limit
2 months
Initial and Subsequent - $40
Approved appliances (orthotics) 85% of cost
Minor Procedures - 75% of cost
$600 sub
limit##
2 months
Initial - $55 Subsequent - $40
Group Therapy - $10
($100 combined sub limit applies
for Group therapy services provided
under Physiotherapy and/or Exercise
Physiology)
Foot Orthoses and Orthopaedic Shoes
(orthoses and custom made footwear)
Podiatry
Physiotherapy
Exercise Physiology
2 months
Initial - $50 Subsequent - $35
Monthly Program fee - $35
Group Therapy - $10
($100 combined sub limit applies for
Group therapy services provided under
Physiotherapy and/or Exercise Physiology)
Psychology
2 months
Initial and Subsequent - $80
Report - $80
Group Therapy - $80
Speech Therapy
2 months
Initial - $70 Subsequent - $35
$1400 overall
benefit
limit per person
per
membership
year for
all Therapy
services
Sub limits may
apply
$700
combined
sub limit###
OTHER EXTRAS
Childbirth Education
12 months
$60
Pharmaceutical^^
2 months
Up to $50
Limit of $500 per person
per membership year
School Accidents
2 months
100% - Limit of $750
per dependent child
per membership year
Healthy Living (see Healthy Living benefits
information on previous page 17)
2 months
$150 per person per
membership year
^^ 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 42 for more information.
# Combined Sub limit: the maximum benefit amount claimable per person per membership year for a combination of Chiropractic, Remedial Massage/ Bowen Therapy/ Myotherapy and Osteopathic services. Group
Therapy has a combined sub limit for services provided under Physiotherapy and Exercise Physiology. This is providing an individual person’s overall Therapies benefit limit for the membership year has not already been
reached. If this was the case no further therapy benefits can be claimed by this individual on any therapy until new membership year commences. Individual visit benefits apply.
## Sub limits: the maximum benefit amount claimable per person per membership year for Podiatry services. This is providing an individual person’s overall therapies benefit limit for the membership year has not already
been reached. If this was the case no further benefits can be claimed on this (or any) therapy until new membership year commences.
[ 20 ]
ESSENTIAL EXTRAS
CONSULTATION TYPE OR SERVICE
YOUNG EXTRAS
OVERALL LIMIT
CONSULTATION TYPE OR SERVICE
Initial and Subsequent - $25
Initial and Subsequent - $30
Initial and Subsequent - $35
Report - $42
X
Initial and Subsequent - $25
X-rays - $50
(not reading of x-rays)
Initial and Subsequent - $30
X-rays - $50
(not reading of x-rays)
Initial and Subsequent - $25
$500
combined
sub limit#
Initial and Subsequent - $30
Initial - $28 Subsequent - $25
Initial and Subsequent - $30
Initial and Subsequent - $25
Initial and Subsequent - $30
Initial - $53 Subsequent - $28
Initial - $55 Subsequent - $35
Initial - $56 Subsequent- $28
X
Initial and Subsequent - $42
X
85% of cost
Initial and Subsequent - $28
Approved appliances (orthotics) 85% of cost
Minor Procedures - 75% of cost
Initial - $39 Subsequent - $28
Group Therapy - $7
($70 combined sub limit
applies for Group therapy services
provided under Physiotherapy and/or
Exercise Physiology)
Initial - $35 Subsequent - $25
Monthly Program fee - $25
Group Therapy - $7
($70 combined sub limit applies for
Group therapy services provided
under Physiotherapy and/or Exercise
Physiology)
$100 sub
limit
$400 sub
limit##
OVERALL LIMIT
$900 overall benefit
limit per person per
membership year for
all Therapy services
Sub limits may apply
$300 per therapy
$500 per person
up to $1000 per policy
X
Initial and subsequent - $30
Approved appliances (orthotics) 85% of cost up to available policy limits
Minor Procedures - 75% of cost up to
available policy limits
Initial - $42 Subsequent - $32
Group Therapy - $8
(sub limit of $80 applies)
$400 per person up to $800 per policy
$500
combined
sub limit###
X
Initial and Subsequent - $56
Report - $56
Group Therapy - $56
X
Initial - $49 Subsequent - $25
X
$42
X
Up to $30
Limit of $300 per person per
membership year
Up to $30
Limit of $150 per person
up to $300 per policy
per membership year
100%- Limit of $450
per dependent child
per membership year
X
$125 per person per
membership year
$125 per person up to $250
per policy per membership year
### Combined Sub limit: the maximum benefit amount claimable per person per membership year for a combination of Physiotherapy and Exercise Physiology services. This is providing an individual person’s overall
Therapies benefit limit for the membership year has not already been reached. If this was the case no further therapy benefits can be claimed by this individual on any therapy until new membership year commences.
Individual visit benefits apply. There are specific requirements to claim for Exercise Physiology. Contact the Fund for details.
* 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 (BT FA).
membership Year limits are calculated from the anniversary date of the establishment of the policy.
X Service we don’t pay a benefit towards
[ 21 ]
[ 22 ]
C OVE R PACKAG E S
We provide our policyholders with a
simple, but flexible product range,
allowing a choice of health cover to
meet any budget or need
To keep it simple and easy to understand you can choose one
of our three broad hospital cover options – Top, Intermediate or
Public. You then select an eligible excess option that you are
comfortable with, and that’s your hospital cover locked in!
Then if you wish you can add an Extras cover that best suits you or
your family’s needs! Choose between our Premium,
Essential or Young Extras covers.
You can even take Young Extras as a stand-alone product.
It’s that simple!
[ 23 ]
S i ngles cover
SINGLE HOSPITAL PREMIUMS
WITH BASE TIER REBATE
PRODUCT
WEEKLY
MONTHLY
YEARLY
TOP HOSPITAL
$34.80
$151.00
TOP HOSPITAL 250
$31.55
TOP HOSPITAL 500
NO REBATE DEDUCTED
WEEKLY
MONTHLY
YEARLY
$1,812.35
$47.60
$206.30
$2,475.60
$136.75
$1,641.40
$43.10
$186.85
$2,242.10
$28.15
$121.95
$1,463.40
$38.45
$166.60
$1,998.95
INTERMEDIATE HOSPITAL 250
$21.55
$93.60
$1,123.70
$29.50
$127.90
$1,534.95
INTERMEDIATE HOSPITAL 500
$18.50
$80.20
$962.65
$25.30
$109.60
$1,314.95
PUBLIC HOSPITAL
$18.55
$80.35
$964.50
$25.35
$109.80
$1,317.50
SINGLE HOSPITAL
+ EXTRAS PREMIUMS
PRODUCT
WITH BASE TIER REBATE
WEEKLY
MONTHLY
YEARLY
TOP HOSPITAL + PREMIUM EXTRAS
$46.60
$202.10
TOP HOSPITAL + ESSENTIAL EXTRAS
$41.55
TOP HOSPITAL + YOUNG EXTRAS
NO REBATE DEDUCTED
WEEKLY
MONTHLY
YEARLY
$2,425.70
$63.70
$276.10
$3,313.45
$180.10
$2,161.40
$56.80
$246.05
$2,952.40
$40.00
$173.40
$2,080.60
$54.65
$236.85
$2,842.00
TOP HOSPITAL 250 + PREMIUM EXTRAS
$43.35
$187.85
$2,254.80
$59.25
$256.65
$3,079.95
TOP HOSPITAL 250 + ESSENTIAL EXTRAS
$38.25
$165.85
$1,990.40
$52.30
$226.55
$2,718.85
TOP HOSPITAL 250 + YOUNG EXTRAS
$36.70
$159.10
$1,909.60
$50.15
$217.35
$2,608.45
TOP HOSPITAL 500 + PREMIUM EXTRAS
$39.90
$173.05
$2,076.75
$54.55
$236.40
$2,836.80
TOP HOSPITAL 500 + ESSENTIAL EXTRAS
$34.80
$151.00
$1,812.45
$47.60
$206.30
$2,475.75
TOP HOSPITAL 500 + YOUNG EXTRAS
$33.30
$144.25
$1,731.65
$45.50
$197.10
$2,365.35
INTERMEDIATE HOSPITAL 250
+ PREMIUM EXTRAS
$33.40
$144.75
$1,737.05
$45.65
$197.75
$2,372.75
INTERMEDIATE HOSPITAL 250
+ ESSENTIAL EXTRAS
$28.30
$122.70
$1,472.75
$38.70
$167.65
$2,011.70
INTERMEDIATE HOSPITAL 250
+ YOUNG EXTRAS
$26.75
$116.00
$1,391.90
$36.55
$158.45
$1,901.30
INTERMEDIATE HOSPITAL 500
+ PREMIUM EXTRAS
$30.30
$131.30
$1,576.00
$41.40
$179.40
$2,152.80
INTERMEDIATE HOSPITAL 500
+ ESSENTIAL EXTRAS
$25.20
$109.30
$1,311.70
$34.45
$149.30
$1,791.75
INTERMEDIATE HOSPITAL 500
+ YOUNG EXTRAS
$23.65
$102.55
$1,230.90
$32.35
$140.10
$1,681.35
PUBLIC HOSPITAL + PREMIUM EXTRAS
$30.35
$131.45
$1,577.90
$41.45
$179.60
$2,155.35
PUBLIC HOSPITAL + ESSENTIAL EXTRAS
$25.25
$109.40
$1,313.55
$34.50
$149.50
$1,794.25
PUBLIC HOSPITAL + YOUNG EXTRAS
$23.70
$102.70
$1,232.70
$32.40
$140.30
$1,683.85
YOUNG EXTRAS
$5.15
$22.35
$268.20
$7.05
$30.55
$366.35
[ 24 ]
Couple/Family cover
COUPLE/FAMILY HOSPITAL
PREMIUMS
WITH BASE TIER REBATE
PRODUCT
WEEKLY
MONTHLY
YEARLY
TOP HOSPITAL
$69.65
$302.00
TOP HOSPITAL 250
$63.10
TOP HOSPITAL 500
NO REBATE DEDUCTED
WEEKLY
MONTHLY
YEARLY
$3,624.30
$95.20
$412.55
$4,950.65
$273.60
$3,283.25
$86.25
$373.75
$4,484.80
$56.30
$243.90
$2,927.20
$76.90
$333.20
$3,998.45
INTERMEDIATE HOSPITAL 250
$43.20
$187.05
$2,245.20
$59.00
$255.55
$3,066.85
INTERMEDIATE HOSPITAL 500
$37.00
$160.40
$1,924.90
$50.55
$219.10
$2,629.35
PUBLIC HOSPITAL
$37.05
$160.70
$1,928.75
$50.65
$219.55
$2,634.60
COUPLE/FAMILY HOSPITAL
+ EXTRAS PREMIUMS
PRODUCT
WITH BASE TIER REBATE
NO REBATE DEDUCTED
WEEKLY
MONTHLY
YEARLY
WEEKLY
MONTHLY
YEARLY
TOP HOSPITAL + PREMIUM EXTRAS
$93.30
$404.30
$4,851.50
$127.45
$552.25
$6,626.95
TOP HOSPITAL + ESSENTIAL EXTRAS
$83.10
$360.15
$4,322.15
$113.55
$492.00
$5,903.90
TOP HOSPITAL + YOUNG EXTRAS
$80.00
$346.75
$4,161.05
$109.30
$473.65
$5,683.85
TOP HOSPITAL 250 + PREMIUM EXTRAS
$86.75
$375.85
$4,510.45
$118.50
$513.40
$6,161.10
TOP HOSPITAL 250 + ESSENTIAL EXTRAS
$76.55
$331.70
$3,981.10
$104.60
$453.15
$5,438.05
TOP HOSPITAL 250 + YOUNG EXTRAS
$73.45
$318.35
$3,820.05
$100.35
$434.85
$5,218.00
TOP HOSPITAL 500 + PREMIUM EXTRAS
$79.90
$346.20
$4,154.35
$109.15
$472.90
$5,674.70
TOP HOSPITAL 500 + ESSENTIAL EXTRAS
$69.65
$302.10
$3,625.05
$95.20
$412.65
$4,951.70
TOP HOSPITAL 500 + YOUNG EXTRAS
$66.60
$288.65
$3,464.00
$91.00
$394.30
$4,731.65
INTERMEDIATE HOSPITAL 250
+ PREMIUM EXTRAS
$66.75
$289.35
$3,472.40
$91.20
$395.25
$4,743.15
INTERMEDIATE HOSPITAL 250
+ ESSENTIAL EXTRAS
$56.55
$245.25
$2,943.10
$77.30
$335.00
$4,020.15
INTERMEDIATE HOSPITAL 250
+ YOUNG EXTRAS
$53.50
$231.80
$2,781.95
$73.10
$316.65
$3,800.05
INTERMEDIATE HOSPITAL 500
+ PREMIUM EXTRAS
$60.60
$262.65
$3,152.10
$82.80
$358.80
$4,305.65
INTERMEDIATE HOSPITAL 500
+ ESSENTIAL EXTRAS
$50.40
$218.55
$2,622.75
$68.90
$298.55
$3,582.60
INTERMEDIATE HOSPITAL 500
+ YOUNG EXTRAS
$47.30
$205.10
$2,461.65
$64.65
$280.20
$3,362.55
PUBLIC HOSPITAL + PREMIUM EXTRAS
$60.65
$263.00
$3,155.95
$82.90
$359.25
$4,310.90
PUBLIC HOSPITAL + ESSENTIAL EXTRAS
$50.50
$218.90
$2,626.65
$69.00
$299.00
$3,587.90
PUBLIC HOSPITAL + YOUNG EXTRAS
$47.40
$205.45
$2,465.55
$64.75
$280.65
$3,367.85
YOUNG EXTRAS
$10.30
$44.70
$536.75
$14.10
$61.10
$733.20
[ 25 ]
Single Parent cover
SINGLE PARENT HOSPITAL
PREMIUMS
WITH BASE TIER REBATE
PRODUCT
WEEKLY
TOP HOSPITAL
MONTHLY
YEARLY
$55.75
$241.55
TOP HOSPITAL 250
$50.45
TOP HOSPITAL 500
NO REBATE DEDUCTED
WEEKLY
MONTHLY
YEARLY
$2,898.80
$76.15
$329.95
$3,959.65
$218.75
$2,625.45
$68.95
$298.85
$3,586.25
$45.00
$195.00
$2,340.45
$61.50
$266.40
$3,196.95
INTERMEDIATE HOSPITAL 250
$43.20
$187.05
$2,245.20
$59.00
$255.55
$3,066.85
INTERMEDIATE HOSPITAL 500
$37.00
$160.40
$1,924.90
$50.55
$219.10
$2,629.35
PUBLIC HOSPITAL
$37.05
$160.70
$1,928.75
$50.65
$219.55
$2,634.60
SINGLE PARENT HOSPITAL
+ EXTRAS PREMIUMS
PRODUCT
WITH BASE TIER REBATE
WEEKLY
NO REBATE DEDUCTED
MONTHLY
YEARLY
WEEKLY
MONTHLY
YEARLY
TOP HOSPITAL + PREMIUM EXTRAS
$79.35
$343.80
$4,126.00
$108.40
$469.65
$5,635.95
TOP HOSPITAL + ESSENTIAL EXTRAS
$69.15
$299.70
$3,596.70
$94.50
$409.40
$4,912.95
TOP HOSPITAL + YOUNG EXTRAS
$66.05
$286.25
$3,435.60
$90.25
$391.05
$4,692.90
TOP HOSPITAL 250 + PREMIUM EXTRAS
$74.05
$321.05
$3,852.60
$101.20
$438.55
$5,262.50
TOP HOSPITAL 250 + ESSENTIAL EXTRAS
$63.90
$276.95
$3,323.30
$87.30
$378.30
$4,539.50
TOP HOSPITAL 250 + YOUNG EXTRAS
$60.75
$263.50
$3,162.20
$83.05
$359.95
$4,319.45
TOP HOSPITAL 500 + PREMIUM EXTRAS
$68.55
$297.30
$3,567.65
$93.70
$406.10
$4,873.25
TOP HOSPITAL 500 + ESSENTIAL EXTRAS
$58.40
$253.15
$3,038.30
$79.80
$345.85
$4,150.20
TOP HOSPITAL 500 + YOUNG EXTRAS
$55.35
$239.75
$2,877.20
$75.60
$327.50
$3,930.15
INTERMEDIATE HOSPITAL 250
+ PREMIUM EXTRAS
$66.75
$289.35
$3,472.40
$91.20
$395.25
$4,743.15
INTERMEDIATE HOSPITAL 250
+ ESSENTIAL EXTRAS
$56.55
$245.25
$2,943.10
$77.30
$335.00
$4,020.15
INTERMEDIATE HOSPITAL 250
+ YOUNG EXTRAS
$53.50
$231.80
$2,781.95
$73.10
$316.65
$3,800.05
INTERMEDIATE HOSPITAL 500
+ PREMIUM EXTRAS
$60.60
$262.65
$3,152.10
$82.80
$358.80
$4,305.65
INTERMEDIATE HOSPITAL 500
+ ESSENTIAL EXTRAS
$50.40
$218.55
$2,622.75
$68.90
$298.55
$3,582.60
INTERMEDIATE HOSPITAL 500
+ YOUNG EXTRAS
$47.30
$205.10
$2,461.65
$64.65
$280.20
$3,362.55
PUBLIC HOSPITAL + PREMIUM EXTRAS
$60.65
$263.00
$3,155.95
$82.90
$359.25
$4,310.90
PUBLIC HOSPITAL + ESSENTIAL EXTRAS
$50.50
$218.90
$2,626.65
$69.00
$299.00
$3,587.90
PUBLIC HOSPITAL + YOUNG EXTRAS
$47.40
$205.45
$2,465.55
$64.75
$280.65
$3,367.85
YOUNG EXTRAS
$10.30
$44.70
$536.75
$14.10
$61.10
$733.20
[ 26 ]
Extended Family Cover
EXTENDED FAMILY HOSPITAL
+ EXTRAS PREMIUMS
WITH BASE TIER REBATE
NO REBATE DEDUCTED
PRODUCT
WEEKLY
MONTHLY
YEARLY
WEEKLY
MONTHLY
YEARLY
TOP HOSPITAL + PREMIUM EXTRAS
$118.45
$513.45
$6,161.60
$161.85
$701.35
$8,416.50
TOP HOSPITAL + ESSENTIAL EXTRAS
$105.60
$457.55
$5,490.50
$144.25
$625.00
$7,499.80
TOP HOSPITAL 250 + PREMIUM EXTRAS
$110.10
$477.30
$5,727.70
$150.45
$652.00
$7,823.80
TOP HOSPITAL 250 + ESSENTIAL EXTRAS
$97.25
$421.35
$5,056.65
$132.85
$575.60
$6,907.15
TOP HOSPITAL 500 + PREMIUM EXTRAS
$101.35
$439.15
$5,270.30
$138.45
$599.90
$7,199.00
TOP HOSPITAL 500 + ESSENTIAL EXTRAS
$88.40
$383.20
$4,599.20
$120.80
$523.50
$6,282.30
SINGLE PARENT EXTENDED FAMILY
HOSPITAL + EXTRAS PREMIUMS
WITH BASE TIER REBATE
NO REBATE DEDUCTED
PRODUCT
WEEKLY
MONTHLY
YEARLY
WEEKLY
MONTHLY
YEARLY
TOP HOSPITAL + PREMIUM EXTRAS
$100.80
$436.75
$5,241.30
$137.70
$596.60
$7,159.40
TOP HOSPITAL + ESSENTIAL EXTRAS
$87.85
$380.80
$4,570.20
$120.05
$520.20
$6,242.70
TOP HOSPITAL 250 + PREMIUM EXTRAS
$94.10
$407.75
$4,893.10
$128.55
$557.00
$6,683.80
TOP HOSPITAL 250 + ESSENTIAL EXTRAS
$81.15
$351.85
$4,222.05
$110.90
$480.60
$5,767.15
TOP HOSPITAL 500 + PREMIUM EXTRAS
$87.05
$377.25
$4,527.60
$118.95
$515.35
$6,184.50
TOP HOSPITAL 500 + ESSENTIAL EXTRAS
$74.15
$321.35
$3,856.50
$101.30
$439.00
$5,267.80
[ 27 ]
WE BELIEVE
THAT CLAIMING
BENEFITS SHOULD
BE QUICK & EASY
so you’ve got more time
to relax and enjoy life!
[ 28 ]
On-the-spot
claiming for Extras
To make it even easier to claim
Depending on your level of cover, and
your benefit, participating health
if your provider has the appropriate
professionals have electronic claiming
facility, you can claim these services
facilities available.
through HICAPS:
HICAPS/IBA allows you to simply
Dentists, Endodontists,
swipe your Queensland Country
Periodontists, Dental Prosthetist/
membership card at the end of your
Advanced Dental Technicians,
consultation or treatment, automatically
Prosthodontists, Paediatric Dentists
deducting your benefit entitlement
from the amount you’ve been
charged. Then, all you have to pay is
Dispensing Optometrists,
Optical Dispensers
the difference.
Physiotherapists
By using electronic claiming you don’t
Chiropractors
have to lodge a manual claim, so no
Osteopaths
need to fill out a claim form and no
waiting for the claim to be processed.
To find out if your health
service provider has
HICAPS visit them online at
www.hicaps.com.au
Podiatrists
Occupational Therapists
Psychologists
Massage Therapy
[ 29 ]
Easy Online
Claiming!!
Save time and get your money back
even faster - online claiming is now
available. (once you have held cover
Homeopathy
with us for 3 or more months)
M
assage
We’ve now made it even easier to claim
Naturopathy
for a wide range of services when on-
Occupational Therapy
the-spot claiming isn’t available through
your provider. Simply go online using
O
ptical
your PC, tablet or smart phone!
Osteopathy
Log in to Online Member Services
Physiotherapy
where you will find instructions on how
to submit your claim, it’s really easy!!
Podiatry consultations only –
No benefit for Orthotics
You can claim up to $400 per day in
and/or appliances payable via
benefits for services up to 3 months
Online claiming
from the actual date of the service,
treatment or visit*.
The following services# can be claimed
online, depending on your level of cover
Acupuncture
Audiology
Chiropractor
Dental – General services only.
NO major dental or Orthodontic
[ 30 ]
Dietetics
Psychology
Speech Therapy
* Eligible benefits are only claimable after 3 months of
membership with the fund.
# Some of these services are not available on
Young Extras cover.
Receipts are not required to be submitted with your online
claim, however we may request them for review and ask
that you keep your receipts for 12 months from the date of
claiming.
Full terms and conditions for online claiming can be found on
our website www.qldcountryhealth.com.au/members/claims
Manage your
cover online
Online Member Services (OMS)
Below is a list of all the different
gives you the ability to update your
services you can access by registering:
membership details whenever you
want, giving you greater control and
Claims history
easy access.
View/print tax statement
You can log on at any time of the day
Update membership details
and check your cover, update address
Change contact details
details, change your level of cover and
even add a new addition to the family.
To access OMS, all you need to do is
Add new person
Change personal details
register on the homepage of our website
A dd student dependant
www.qldcountryhealth.com.au. The
or apprentice
“register” icon is located at the top right
hand corner of the screen. Once you
Add Medicare card details
have registered using your membership
Add previous cover details
number and your choice of password,
M
ake a contribution payment by
click on the Login tab and enter your
membership number and password.
Now you’re ready to go!
credit card
Update your method of payment
NB. Access to some functions may
Change level of cover
be limited for your spouse/partner
Update the way we pay benefits
and dependants.
eg. direct credit
Contribution changes
View benefit limits
[ 31 ]
[ 32 ]
HOW TO PAY
C ONTR I B UTION S
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 choose to pay by a method other than direct
debit from a bank account or credit card, and your payment frequency is quarterly or greater, we will 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.
Your policy will commence from a future date that you nominate or simply the date that your application is received by us or
Queensland Country Credit Union. We will then forward a membership card to your address.
Direct Debit
Credit Card
BPAY
SmartBudget
Direct Debit facilities are
Credit Card* facilities are
BPAY facilities are available
SmartBudget Service —
available for policyholders
available to all policyholders
to all policyholders who
Queensland Country Credit
who prefer to pay through
who prefer to pay via this
prefer to pay via this option.
Union offers a SmartBudget
automatic deductions from
option. If this is your preferred
BPAY allows you to pay your
service through all their
their Bank, Building Society,
method of payment, simply
health insurance premium via
branch offices. SmartBudget
Credit Union accounts and
visit our website and make
internet or phone banking, or
is a comprehensive budgeting
Credit Cards. If this is your
the payment online through
at your financial institution.
and bill paying service that
preferred method of payment,
Online Member Services
The BPAY biller code and
provides a fast and simple
simply nominate this upon
(OMS^). Alternatively, visit
your reference number
way to pay all your bills. If you
application. A reminder notice
one of our Retail Centres
appear on all statements.
would like more information
is not issued if you pay by
located in Townsville,
If you don’t receive regular
on this service, please feel
direct debit.
Mount Isa, Ayr and Mackay.
statements please contact us
free to contact Queensland
Details appear at the back of
and we’ll be happy to supply
Country Credit Union on
this brochure, or phone us on
you with your BPAY biller
1800 075 078.
1800 813 415.
code and reference number.
* We do not accept American Express
(This option is not available
or Diners Club
^P
lease see page 31 for details on
how to register for OMS
to eligible participants in a
Corporate Health Plan)
Note: Deadlines may exist for one or more of these payment options.
Please consult our Membership Guide for further details.
You can choose to pay weekly, fortnightly, monthly,
quarterly, 6 monthly or yearly, whichever suits you.
[ 33 ]
I N MOR E DETAI L...
Membership Guide
We have prepared a Membership Guide to outline a summary of the rules that apply to your membership.
Please ask for a Membership Guide or access it by visiting us at www.qldcountryhealth.com.au. It should
be read in conjunction with this Health Benefits Guide.
Hospital Benefits
TOP HOSPITAL COVER
Queensland Country’s most comprehensive Hospital product and popular with those looking for complete peace of mind. Covering you
for a complete range of hospital services including Pregnancy, Heart related procedures, Major eye surgery and Joint Replacement
surgery. Top Hospital can be taken on its own or packaged with any of our Extras packages. You can reduce your premiums by paying an
excess when admitted to hospital you have a choice of $0, $250 or $500.
BENEFIT LIMITATION PERIODS
Our Top Hospital cover requires a policyholder (who is new to
private health insurance hospital cover) to be with Queensland
Country for a period of 24 months before certain hospital
services are fully covered. Benefit Limitation Periods will apply to
the following services:
· Bariatric Surgery (weight loss surgery): including but
not limited to gastric banding; gastric sleeving/diversion;
and gastric bypass surgery; including replacement, repair
or adjustments.
· Hip or Knee Joint Replacements: During the first 24
months of cover (but after the standard hospital waiting
periods have been served), benefits payable for these
services will be limited to restricted benefits.
· In-Hospital Psychiatric Treatment: During the first 24
months of cover (but after the standard hospital waiting
period have been served) benefits for these will be limited to
restricted benefits.
Restricted benefits will only cover you for a stay in a shared ward
of a public hospital. But it will not cover the cost for a stay in a
private room in a public hospital or a stay in a private hospital,
and you will incur large out-of-pocket expenses to cover the
difference in costs.
[ 34 ]
Benefit Limitation Periods will not apply if you are
transferring from another health fund’s hospital cover
providing you are transferring within 63 days of ceasing
the previous cover.
INTERMEDIATE HOSPITAL COVER
A great value mid-level hospital cover ideal for a young or healthy
person who doesn’t want to pay for hospital services they feel
less inclined to need like Pregnancy, IVF, Heart Surgery, Major
Eye Surgery, Renal Dialysis, In-Hospital Psychiatric care or even a
Hip or Knee replacement. A very cost effective option if you want
comprehensive cover for the vast majority of hospital treatments
and are prepared to have limited or no cover for the Restricted or
Excluded services under this cover.
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 services in a private hospital.
Not every hospital cover product has benefit restrictions, please
refer to hospital cover tables on pages 12-13 to determine
benefit entitlement conditions for individual hospital products.
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.
Waiting periods may also apply to all restricted services.
EXCLUDED BENEFITS
REDUCE YOUR MEDICAL COSTS
Your doctor, surgeon and anaesthetist will all charge for their
services separately to your hospital accommodation costs. Their
fees are known as medical expenses. These medical expenses
are assessed against the Medicare Benefits Schedule (MBS)
fees, which are set down by the government. If you are admitted
to hospital as a private patient. Medicare will pay 75% of the
MBS fee for your medical expenses. Queensland Country will
pay the remaining 25% of the MBS fee.
An excluded service means you will not be covered in a public or
However, some doctors charge more than the MBS fee. This
private hospital and will not receive a payment from Queensland
can result in significant out-of- pocket expenses. Queensland
Country for that service. If you think you may require treatment
Country’s private hospital cover can help reduce or avoid these
for any excluded services you may like to consider taking one of
extra expenses through our Access Gap agreement.
our Top Hospital cover products.
However, should you wish to have full benefit entitlement for any
of the restricted or excluded services under our Intermediate
ACCESS GAP - MINIMISE OUT-OFPOCKET EXPENSES
Hospital cover, you will need to upgrade your policy to one of
Access Gap is a major feature of our hospital cover.
our Top Hospital cover options at least 12 months in advance to
Participation by your doctor in Access Gap could significantly
provide cover for hospital services that are listed as Restricted or
reduce medical costs for inpatient hospital services, or in some
Excluded services.
cases, may eliminate them completely.
PUBLIC HOSPITAL COVER
By making arrangements with your doctor before going into
hospital you will have an understanding of the costs for the
Public Hospital cover is exactly as the name suggests -
medical procedure based on how the doctor will charge for
cover for treatment in a public hospital.
their services.
Public Hospital cover is a basic level of hospital cover designed
Under this direct billing arrangement Queensland Country
for those who want to be treated as a private patient in a public
will pay a higher amount to your doctor if he or she agrees to
hospital. This cover option will allow you or your family to choose
participate and charge you fees in accordance with
your own doctor (if he/she is willing, or able to treat you in a
the agreement.
public facility) and receive treatment as a private patient in a
If your doctor agrees, it means that they are willing to accept
public hospital. This means we will pay for the cost of shared
ward accommodation only up to the level prescribed by the
Federal Minister for Health, if admitted as a private patient. So if
you choose to be admitted in a private room in a public hospital,
you will incur further out-of-pocket expenses.
However public hospital cover will not assist in avoiding waiting
times in the public hospital system, and would also mean that if
a set fee for their services that is more than the MBS fee, and
means you are likely to have lower out-of-pocket costs, and in
some cases, none at all!
Participation by your doctor in Access Gap is voluntary. There is
no obligation to do so.
Your doctor must inform you of the total of any out-of-pocket
you require to be treated in a private hospital or day surgery you
expenses you will have to meet before you go to hospital.
will face high out-of-pocket expenses, which may not be the case
You can search for doctors who may participate in the Access
if you were to choose one of our Private Hospital cover options.*
*Some hospital services under our Intermediate Hospital cover have restricted or
excluded benefit entitlement however. Please see Hospital Cover table for details
of these restrictions and exclusions.
Gap Scheme by referring to the AHSA website https://www.
ahsa.com.au/web/gapcoversearch
We also recommend that you contact us before going into
hospital or day surgery so that we can discuss the level of benefit
your policy provides you.
MEDICARE
OUR BENEFIT 25%
OUR BENEFIT
OUT-OF-POCKET
REBATE 75%
(MEDICAL GAP)
(ACCESS GAP)
EXPENSES
MEDICARE BENEFIT SCHEDULE
(MBS) FEE
ACCESS GAP
YOU R D O CTOR’S F E E
[ 35 ]
PRE-EXISTING CONDITIONS
HOSPITAL NETWORK
A pre-existing ailment, illness or condition is one where, after
Queensland Country has negotiated Purchaser Provider
examining evidence, a medical adviser, or other relevant health
Agreements with most of the participating private hospitals and
care practitioner appointed by Queensland Country would
day hospital facilities Australia-wide. In most instances, the
consider that signs or symptoms would have been in existence
approved hospital charges for policyholders of a Top Hospital
at any time during the six months preceding the application for
policy will be covered in full once the agreed excess has been
membership or upgrade of cover. You may have a pre-existing
deducted. This means that you will benefit from capped fees
condition, ailment or illness without being aware of it. In these
we’ve negotiated and convenient billing as your invoice will be
cases, there is a 12 month waiting period before you are entitled
sent directly to Queensland Country.
to claim benefits for treatment. It is not necessary for the
Private hospitals and day hospital facilities that have not signed
signs or symptoms to have been diagnosed by a doctor when a
member joined or upgraded their level of cover.
an agreement attract reduced benefits which will mean you may
incur out-of-pocket medical expenses for in-hospital treatment.
Surgery for assisted fertility programs such as IVF or GIFT,
Go to our website to find a hospital most convenient to you.
Sterilisation or Vasectomy are elective and attract a 12 month
www.qldcountryhealth.com.au
waiting period as does obstetrics-related services.
The 12 month pre-existing condition waiting period can
BENEFIT CONDITIONS
be applied to all hospital or hospital substitute treatment
Queensland Country will only pay benefits when:
for which we pay benefits. However, a two month waiting
period applies to the following services:
Goods and services are provided in Australia
a pproved psychiatric treatment
T he Member has been charged for the treatment or service
a pproved rehabilitation treatment, or
A service or treatment is medically necessary and clinically
p
alliative care.
relevant
The 12 month waiting period for the treatment of a pre-existing
Services are part of a course of treatment recognised by
condition can also apply to ancillary (Extras) services.
Queensland Country
PROSTHESIS BENEFIT
The service is provided in person
We provide a benefit towards surgically implanted prostheses
and other items on the Federal Government prostheses list.
MECHANICAL APPLIANCES
AND AIDS
To help you maintain your health we provide an excellent benefit
on our Top Hospital cover of up to 85% of the cost of mechanical
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
T he treatment or service is covered under the Member’s level
of cover
No benefits are payable from another source (e.g.
appliances and artificial aids approved by Queensland Country
compensation payment or Government benefit)
within a membership year limit of $2,000 per person covered.
The conditions of the level of cover have been met
For some mechanical aids the benefit is for hire only. Products
covered include: blood pressure monitor, glucometer, tens
machine, crutches, walking frame, wigs etc.
Benefits are not available on second hand equipment or on
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
consumables. A benefit is payable for short term hiring (up
The benefit limitation period for that service has been served
to 3 months) of some mechanical aids. The purchase of some
(where applicable)
machines & monitors are limited to once every 3 years from the
date of purchase.
The amount of benefit is calculated on the cost of the
treatment or aid to the Member, taking into account any
A letter of referral from your doctor or other practitioner may be
allowances or discounts given by the provider. No benefit paid by
required. Please contact us regarding benefit availability prior to
Queensland Country can exceed the actual charge of the service
purchasing an aid or appliance.
or appliance.
Mechanical Appliances and Aids coverage is not
available on our Intermediate Hospital or Public
Hospital cover products.
[ 36 ]
MEMBERSHIP YEAR
All yearly limits and excesses are calculated from the anniversary
date of the establishment of the membership.
Types of Memberships
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 that person’s partner. 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
(up to 21 years). Student and apprentice dependants can be
covered up to age 25*.
Single Parent Family: a single parent family policy covers
the person who establishes the policy as well as that person’s
dependant children (up to 21 years). Student and apprentice
Is an apprentice who is not aged 25 years or over and does
not earn more than $30,000 p.a;
Is not married or living in a de facto relationship
If, at any time, your student dependant’s situation changes and
they no longer meet all the above conditions then please contact
us for further information.
Covering adult children
Extended Family cover# will allow all adult children between 21 &
25 years to remain on their family or single parent policy (as long
as they are not married or in a de facto relationship).
The Extended Family cover policy premium will of course be
higher than our standard family or single parent family policy, but
will prove to be a financially more economical option for eligible
dependant children, in comparison to having them take out their
own cover at an equivalent level.
#
Extended Family cover option will be restricted to Top Hospital and Premium
Extras or Essential Extras packaged covers only. It will not be available to family
or single parent policies with any Hospital Only Product, Intermediate Hospital,
or Intermediate Hospital and Extras package, Private Hospital and Young Extras
Product, Singles and Couples Combined cover Products or Public Hospital and
Extras packaged covers.
dependants can be covered up to age 25*.
Extended Family^^: a family policy option which covers the
CONTRIBUTIONS IN ARREARS
person who establishes the policy as well as that person’s
A policyholder who fails to pay contributions within 63 days of the
partner and all dependant children up to the age of 25* years.
In the case of a single parent family, the Extended Family policy
will cover the person who establishes the policy as well as that
person’s dependant children up to the age of 25* years.
* As long as the dependant child is not married or living in a de facto relationship.
See Dependants information below for further details.
^^ Only Top Hospital and Premium/Essential Extras Packaged covers are available
for Extended Family policies. Not available for any Hospital Only cover, Extras
only covers, packaged Top Hospital and Young Extras; or Public Hospital and
Extras covers.
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 all
outstanding contributions are paid within 63 days of the due date,
the membership will be re-instated. Membership of Queensland
Country Health shall automatically cease for any policyholder
whose contributions are more than 63 days in arrears.
LENGTH OF STAY
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 policy as a student or apprenticeship dependant are
required to commence their own policy 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.
Full hospital benefits are not available after 35 days of
continuous hospitalisation unless your doctor certifies the need
for continued hospital-level care.
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
Alternatively, dependants between 21 & 25 years who do not
qualify as a student or apprentice dependant may stay on your
family policy for an additional premium. Please refer to the
section “Covering Adult Children”.
apply for a suspension on your membership.
Dependants will be covered as student dependants under their
parent’s membership from 21 years of age up to 25 years of age,
provided the following conditions are satisfied:
If you develop a condition or ailment during the suspension, you
Is a full time student at a school, college or university who is
(For further information, please call us when you’re making your
travel plans.)
won’t be covered by your policy. Once you reactivate your policy
pre-existing condition waiting periods for that condition will apply.
For information on pre-existing conditions, please see page 36.
not aged 25 years or over; or
[ 37 ]
RECOGNISED PROVIDERS
WAITING PERIODS
Queensland Country will only pay benefits for ancillary, dental
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. For full details, please refer to our Membership
Guide under the heading “Transferring from another Fund”.
and nursing 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.
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.
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 their
date of birth.
INFORMATION
The baby will not have to serve any waiting periods* that have
already been fully served by the policyholder providing that the
Please ensure that you read all documentation provided to you
change is made to the policy within this time frame.
before any decision is made to purchase a health insurance
product and ensure you retain a copy of the documentation for
future reference.
BENEFIT REPLACEMENT PERIOD
A Benefit Replacement Period applies to certain mechanical
appliances and hearing aids. This means that, once you have
been paid a benefit for a particular aid, you must wait for a
certain period of time from the date of purchase of the item
before you are entitled to a benefit for the replacement of that
item. These Benefit Replacement Periods apply per Member.
BENEFIT
REPLACEMENT
PERIOD
ITEMS
Blood glucose
monitors — (Glucometer)
Blood
Pressure Monitor
C-pap
3 years
Machine and
Humidifier and
initial mask and tubing
Tens Machine — (not
circulation booster)
Hearing Aids
[ 38 ]
If you want to change your existing level of Extras cover for one
that is more extensive you will be required to serve waits on the
increased benefits only.
*For policyholders with no previous cover, the pre-existing condition waiting periods
may apply to the baby within the first 12 months.
Waiting periods
2 months
12 months
EXTRAS
HOSPITAL
Hospital:
2 months
12 months
Pre-existing Conditions
For all hospital
treatments or services
where there are no
Pre-existing Conditions
(excluding Accidental
Injury^)
Elective Surgery
Obstetrics-related Services
Mechanical Aids &
Appliances
Mammograms & Bone
Density Tests
Surgery for assisted fertility
programs such as IVF
or GIFT, sterilization or
vasectomy, elective surgery
Dental:
Major Dental services:
Diagnostic — includes
examinations &
consultations
Periodontics —
specialised gum
treatment
Preventative — includes
cleaning and scaling,
fluoride treatment, mouth
guards etc.
Surgical Extraction —
includes wisdom tooth
extraction
Simple extraction
Restorative — composite
and amalgam fillings
General services —
includes occlusal splints
Optical
Endodontic Services
— includes root canal
therapy
Crowns and Bridges
Prosthodontics —
Dentures
Child birth education
Acupuncture
Audiology
Chiropractor
Hearing Aids
Massage Therapy
Australian Hearing Services
Osteopathy
Nursing Home Type Patients
Naturopath
Nursing
Dietician
Hospital Boarder
Foot Orthoses & Orthopedic
Shoes
Occupational Therapy
Orthoptic Therapy
Physiotherapy
Exercise Physiology
Podiatry
Psychology
Speech Therapy
Pharmaceutical
School and Sporting
Accidents
Healthy Living Benefits
^The 2 month Waiting Period is waived for treatment arising from an accident (excluding a school and sporting accident) that occurred after joining.
[ 39 ]
GOVE R N M E NT
I N ITIATIVE S
AUSTRALIAN GOVERNMENT REBATE
ON PRIVATE HEALTH INSURANCE
LIFETIME HEALTH COVER
The Federal Government rebate scheme was introduced in
that came into effect on 1 July 2000. It is designed to reward
January 1999. The basis for the initiative was to provide a
people who join a private health fund earlier in life by securing
financial incentive to assist Australians in affording private health
lower premium payments.
insurance cover.
Under Lifetime Health cover, if you don’t have Hospital cover on
The scheme, now known as the Australian Government Rebate
the 1st of July following your 31st birthday, then for each year you
on private health insurance introduced means testing of the
delay joining, your membership fees will increase. In fact you will
rebate in 2012, which resulted in the rebate entitlement being
pay a loading of 2% on top of the base rate on your premium (or
determined by both income* and age.
on your share of a couple or family premium) up to a maximum
This change resulted in person/s on higher incomes having their
rebate entitlement either reduced, or depending on their income*,
have no entitlement to receive any rebate assistance at all.
It is the responsibility of a Member to nominate an appropriate
rebate tier (based on age and income*). For current financial year
income thresholds refer to table over page.
Lifetime Health cover (LHC) is a Federal Government initiative
loading of 70%. Once you have stayed with private Hospital cover
for 10 continuous years and keep it, you stop paying that loading
as a reward for commitment to the private health system. Be
aware that the loading may be reapplied if you then cease to hold
a Hospital cover and subsequently take it up again.
By joining Hospital cover as soon as possible, you can stop this
continuous increase and your loading will be frozen at the rate
The Australian Government Rebate on private health insurance
that matched your age when you joined (known as your Certified
will apply to the base hospital premium only and will not apply
Age at Entry or CAE). As long as you maintain your Hospital
to the portion of hospital premium that has any Lifetime Health
cover, your loading percentage will continue to be set according
Cover Loading applied. (See Lifetime Health Cover section for
to your CAE, and will not increase each year. People who took out
further information).
and maintained a Hospital cover dated prior to 1 July 2000 will
A Member can choose to claim the appropriate rebate up front
pay a base rate premium regardless of their age.
as a lower premium; however can also nominate to claim a lower
People born before 1 July 1934 can take out Hospital cover at
rebate than their entitlement, or in fact no rebate at all, and
reconcile this when lodging their annual tax return.
The Australian Government Rebate on private health insurance
underwent further changes in April 2014. The rebate eligibility is
now based on a Member’s age and income* and will be indexed
any time and pay only the base rate.
When transferring Hospital cover from another registered fund,
make sure you use your CAE (the age at which you joined), rather
than the age you are now, to calculate the correct fee.
by CPI (Consumer Price Index). Essentially this will mean that
Under the Federal Government’s Lifetime Health Cover legislation
the standard rebate amounts that have historically applied will be
the loading of 2% does not apply to Extras cover.
indexed each year using a ratio of the average industry premium
Note: Due to the Australian Government’s rounding rules for the
increases and CPI.
rebate, actual premiums for Hospital and/or Extras coverage can
Premiums quoted by the Fund will take into consideration
vary from this calculation by up to 10 cents.
these latest changes and will not require additional input or
calculation by our Members apart from the standard age and
income* information.
* This information is intended as a guide only and does not take into account your personal
circumstances. For information on the Rebate 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-forMedicare-levy-surcharge,-thresholds-and-rates/
[ 40 ]
MEDICARE LEVY SURCHARGE
The Medicare Levy Surcharge will not apply
to any Queensland Country policyholder
The Medicare Levy Surcharge (MLS) is levied on payers of
who has a Hospital cover.
Australian tax who do not have Hospital cover under a private
health insurance policy and who earn above a certain income.
The Medicare Levy Surcharge is applied
The surcharge aims to encourage individuals to take out private
on a pro-rata basis. If you take out Hospital
Hospital cover, and where possible, to use the private hospital
cover part-way through the financial year you’ll still avoid the
system to reduce the demand on the public health care system.
surcharge but only for the period you held Hospital cover.
People who don’t have private health insurance Hospital cover,
For current income thresholds refer to table below.
and who have an income for MLS purposes^ in excess of the
thresholds set down by the Australian Taxation Office (ATO)
pay a surcharge of between 1.0% to 1.5% of income . This
^
^ This information is intended as a guide only and does not take into account your personal
circumstances. There is a different income test for the application of MLS, which is known as
income for Medicare levy surcharge purposes. For more information about what is included
surcharge is in addition to the standard Medicare Levy of 2%
as income for Medicare levy surcharge purposes, please seek the advice of your tax agent or
of taxable income.
Accountant or contact the Australian Taxation Office (ATO) Help Line on 132 861 or visit the
ATO website https://www.ato.gov.au/Individuals/Medicare-levy/Medicare-levy-surcharge/Incomefor-Medicare-levy-surcharge,-thresholds-and-rates/
AUSTRALIAN GOVERNMENT REBATE ON PRIVATE HEALTH INSURANCE
REBATE TIER
BASE TIER
TIER 1
TIER 2
TIER 3
SINGLES
Income Threshold (2016/17 financial year)
UP TO $ 90,000
$ 90,001-105,000
$105,001-$140,000
$ 140,001 AND
ABOVE
FAMILIES
Income Threshold (2016/17 financial year)
UP TO $ 180,000
$ 180,001-210,000
$210,001-$280,000
$ 280,001 AND
ABOVE
R E BATE E NTITLE M E NT^ BAS E D O N AG E (O F TH E O LD E ST P E R S O N O N YO U R C OVE R) AN D I N COM E*
< AGE 65
26.791%
17.861%
8.930%
0%
AGE 65-69
31.256%
22.326%
13.395%
0%
AGE 70+
35.722%
26.791%
17.861%
0%
0%
1%
1.25%
1.50%
MEDICARE LEVY SURCHARGE
Rebate percentages shown are equivalent to the actual rebate entitlement and are effective for payments made from 1 April 2016 and are indexed annually.
T
his information is intended as a guide only and does not take into account your personal circumstances. For information on the income 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/
[ 41 ]
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
PRIVATE HEALTH INSURANCE
COMPLAINTS
If, for any reason, you’re not happy with
something then please let us know.
We will do whatever we can to fix it.
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.
amount from the purchase price (up to script benefit limit).
If you have any complaints, and we hope you don’t, then please
This is conditional on the pharmaceutical prescription being
contact us immediately -
listed in the MIMs Schedule as S4 or S8 and being dispensed
Call: 1800 813 415
in quantities in accordance with this schedule. We also pay for
Website: www.qldcountryhealth.com.au
Email: info@qchfund.com.au
Address: Queensland Country Centre
Level 1, 333 Ross River Road 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.
PRIVATE HEALTH INSURANCE CODE
OF CONDUCT
Queensland Country Health 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
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:
phio.info@ombudsman.gov.au
Website:
www.ombudsman.gov.au
Address: Private Health Insurance Ombudsman Commonwealth Ombudsman
The “In more detail” pages contain only a summary of the fund
GPO Box 442
rules. The complete rules of the health benefits fund set out in
Canberra, ACT 2601
full the terms and conditions of membership and liability under
Australia
the fund.
PRIVACY POLICY
These rules are available for inspection
We at Queensland Country are committed to managing personal
SUMMARY OF RULES
at Queensland Country Centre,
Level 1, 333 Ross River Road,
Aitkenvale QLD 4814.
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
Retail Centres or Queensland Country Credit Union branches.
[ 42 ]
QU E E N S LAN D COU NTRY H EALTH FU N D
Townsville Contact Centre: 1800 813 415
Email: info@qchfund.com.au Web: qldcountryhealth.com.au
HEAD OFFICE
Queensland Country Centre, Level 1
333 Ross River Road
Aitkenvale Qld 4814
Phone: 07 4412 3500
Fax: 07 4412 3500
Post: 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
QUEENSLAND COUNTRY DENTAL
Queensland Country Centre
333 Ross River Road
Aitkenvale
QU E E N S LAN D COU NTRY CR E D IT U N ION
BEAUDESERT
Beaudesert Fair Shopping Centre
BOWEN
37 Williams Street
BRISBANE
Koala House
Cnr Creek & Adelaide Street
BURDEKIN
Ayr - 186 Queen Street
Home Hill - 6 Eighth Avenue
CAIRNS
Smithfield - Smithfield Shopping Centre
Earlville - 514–516 Mulgrave Road
CHARTERS TOWERS
Town Plaza Shopping Centre
COLLINSVILLE
13 Stanley Street
JIMBOOMBA
Jimboomba Shopping Centre
MACKAY
Caneland Central Shopping Centre
Mount Pleasant Shopping Centre
MOUNT ISA
70 Camooweal Street
STANTHORPE
3 Maryland Street
TIERI
Tieri Shopping Centre
TOWNSVILLE
Aitkenvale - Queensland Country Centre,
333 Ross River Road
Deeragun - Deeragun Village
The Townsville Hospital - Main Foyer, Douglas
Magnetic Island - Nelly Bay
Kirwan - Willows Shopping Centre
WEIPA
Cnr Kerr Point Drive & Commercial Avenue
[ 43 ]
HOW TO JOI N
It’s super easy to join Queensland Country Health Fund.
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
Queensland Country Health Fund Ltd
ABN 18 085 048 237 is a Registered Private Health Insurer.