Let’s get together. Health Cover for Everyone.
Finding the right health insurance partner has benefits. Health Partners is a South Australian member owned health fund, run only to benefit members. It’s what makes us different, and it’s why people stay with us. See the difference a member owned health partner can make. We’re here This brochure gives a comprehensive overview of our cover, but please call our team anytime if you have any questions. Call 1300 113 113 Monday to Friday 8am – 8pm Saturday 9am – 1pm Visit healthpartners.com.au Email us
[email protected] Switching is simple We’ll contact your current insurer Waiting periods already served switch with you There’s a 30 day cooling off period to make sure you’re happy
Health Partners is a signatory to the Private Health Insurance Code of Conduct. Go to ahia.org.au/codeofconduct.
Let us guide you Your health insurance partner
2
Finding the perfect cover
4
Hospital cover explained
6
Extras cover explained
8
Package cover Package cover options
10-29 10
Prime Living
14
Family Essentials
20
Couples Choice
24
Singles Starter
27
Hospital cover Comparing hospital cover options
30-35 30
Gold Hospital
32
Silver Hospital
34
Bronze Hospital
35
Extras cover Comparing extras cover options Gold Extras
36-47 36 38
Silver Extras
42
Bronze Extras
45
Natural Plus
47
Health management and support programs
48
Government surcharges and incentives
49
Things you should know
50
Claiming your way
52
Where to find us
53
Joining is simple
54
The information in this brochure should be read and retained in conjunction with Health Partners’ Product Disclosure Statement (PDS). The PDS contains additional important information on the general terms of membership and cover with Health Partners, including our Privacy Policy, Resolution Process and health insurance initiatives from the Australian Government. This is available at healthpartners.com.au/PDS or by calling us on 1300 113 113.
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Your Health Insurance Partner With over 75 years of experience, we’ve been around long enough to understand what Australians expect from their health fund.
Simply better service
Simply better dental
We’re here to help when members have questions or need assistance. When you call, you’ll speak with a friendly and knowledgeable team member – not a machine – right here in Adelaide, who will happily assist you.
We’ve been providing members with direct access to quality dental care and generous dental benefits for more than 25 years. With over 30 surgeries across three locations, Health Partners Dental is the largest privately owned dental practice in South Australia where members get the best value. F ull range of services – everything from routine checkups to extractions, crowns, implants and more. etween 60% and 100% back on B general and major dental services. S erving people of all ages and needs with expertise in special needs dentistry and children’s preventative dental. mergency dental treatment – E we’re here for you when you need us.
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Find out more at dental.healthpartners.com.au
Simply better optical Health Partners Optical stores have been combining quality eye care with exceptional value and service for more than 20 years. You can enjoy everything we have to offer, across four locations. etween 60% and 100% back B on prescription eyewear. minimum 40% ongoing benefit A if you reach your limits. F ree digital retinal imaging when recommended by an optometrist – we won’t compromise on delivering the highest standard of eye care. he latest diagnostic equipment T to help detect eye diseases earlier, for your peace of mind. t least 30% off our huge range A of sunglasses, all year round. ver 100 designer brands to choose O from to suit all budgets, including gap-free and low-gap options. Find out more at optical.healthpartners.com.au
Unbeatable pharmacy benefits
Participating physiotherapists
With our state-wide pharmacy network extras members can get unique benefits and discounts at 50 pharmacies, at no extra cost.
We have a network of over 45 participating physiotherapists where members pay a low set gap or no-gap at all. When you visit, you’ll also know upfront what your out-of-pocket expense will be in most instances. Making it simple is what we’re all about.
And because most of us regularly depend on our local pharmacy, all of our extras and package covers include pharmacy benefits. Plus, extras and package members save 20% on most non-prescription items, every day of the year! That includes vitamins, beauty products, pain relief, gifts, quit smoking products and much more. (Conditions apply; see page 51).
Each practice is specifically chosen to ensure access and quality services at locations to suit you. Visit ‘Partner Search’ at healthpartners.com.au for locations.
More for members As the largest open South Australian not-for-profit health fund, we’re constantly reinvesting in member benefits at a level above the industry average. That means our members receive more – not shareholders.
$ Member discounts Members enjoy various special offers like $12 Wallis movie tickets, discounted sports gear, plus special member pricing for travel insurance. Visit ‘For Members’ at healthpartners.com.au.
Visit ‘Partner Search’ at healthpartners.com.au for locations.
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Finding the perfect cover We’ve taken a simple approach to private health insurance which allows you to pick and choose from our range of covers. You can combine your own hospital and extras; select a package cover which combines the two for you; or if you prefer, choose hospital or extras on its own.
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Pages 10-29 Package cover combines hospital and extras in the one package for you – we have four to choose from to suit different life stages and budgets. Or design your own package by selecting one of our hospital covers and adding one of our extras covers.
Pages 30-35 Hospital cover helps cover your costs when you are treated as a private patient in hospital. It also gives you options – like being treated by your own doctor, shorter waiting times for elective surgery and the timing of your treatment.
Pages 36-47 Extras cover gives you affordable access to services generally not covered by Medicare such as dental, optical, physiotherapy, chiropractic, pharmacy and much more. With Health Partners’ own dental and optical centres, and extensive physiotherapy and pharmacy networks, members receive exclusive benefits and discounts – at no extra cost.
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Hospital cover explained The following information applies to all Health Partners hospital covers – purchased individually or in a package – so it’s worth taking some time to read through it. We’ve kept the details simple, so when you’ve read this, simply review the comparison tables to determine the level of cover you need.
What’s not covered There are some situations where your Health Partners hospital cover will not cover you:
If you’re after hospital cover in a package with extras, see the table on page 11.
Outpatient services
For hospital cover on its own, see the table on page 31.
mergency department facility fees E (unless otherwise specified)
What’s covered? Hospital cover helps pay for Medicare-recognised procedures when you are admitted to hospital. With all hospital cover options, you are eligible to receive benefits at your choice of participating hospitals (private or public), Australia-wide. If the procedure or service you require is included in your cover, Health Partners will: Pay for: Your accommodation in hospital (including registered day facilities) Your theatre, labour ward and intensive care fees All PBS prescriptions relating to your admission, while you’re in hospital An extensive range of government-recognised surgically implanted prostheses Access to a range of health management and support programs. Pay towards: In-patient medical expenses. (See page 7 for information on medical expenses and how to avoid or reduce out-of-pocket expenses) A range of additional services depending on your level of cover. 6
Services at unregistered day facilities
xcluded services (see individual cover E options for details).
Limited benefits Limited benefits apply for admissions where a Medicare rebate does not apply to the treatment procedures or to restricted services (see individual cover options for details). Benefits paid are in accordance with the Federal Government default payment schedule. This may result in large out-of-pocket expenses. Please refer to the PDS for other hospital limitations and restrictions.
Excess and co-payment With Health Partners you can select from various excess and co-payment options when deciding on your hospital cover. An excess is the amount you agree to pay towards your hospital accommodation, should you need to go to hospital. This is payable on admission, once only per person, to a maximum of twice per membership per rolling year (that is, 12 months from the date of the first admission). The co-payment is the daily amount you agree to pay (in addition to any applicable excess) towards your hospital accommodation. Maximum co-payment amounts apply per person and per membership per rolling year (that is, 12 months from the date of the first admission).
Excess and co-payments are only payable if you are admitted to hospital and are in addition to any out-of-pocket expenses (also known as ‘gaps’) incurred for in-hospital medical treatment.
Waiting periods
How to reduce your medical expenses
Generally, after two months you can claim benefits for hospital services available on your level of cover, except for the following where 12-month waiting periods apply:
The benefits you are entitled to for in-patient medical services are based on the Commonwealth Medicare Benefits Schedule. When you are admitted to hospital, Medicare pays 75% of the Medicare Schedule Fee and Health Partners covers the remaining 25%. The ‘gap’ is the amount charged above the Medicare Scheduled Fee, which you pay. Should you need hospital care, you can eliminate or reduce the gap with Health Partners Access Gap Scheme. When your doctor uses Access Gap you will either: have no gap to pay, or know your exact gap before treatment. Your doctor can bill Health Partners direct, to make claiming even simpler for you. To determine if your doctor participates in Access Gap contact us or visit ‘Doctor search’ at healthpartners.com.au. It is your doctor’s choice to use Access Gap on a patient-by-patient basis. It is important to ask your doctor if they, or any other assisting doctor, will participate in Health Partners Access Gap Scheme. Ask if you will have a gap to pay and if so, how much it will be. This will encourage your doctor to participate in Access Gap. Any excess or co-payment applicable to your level of cover will still apply.
Waiting periods are the initial periods after joining or upgrading your private hospital cover during which you cannot claim hospital benefits.
Pregnancy and birth-related services, including IVF Pre-existing conditions Home nursing Home sleep studies. Waiting periods do not apply for: Newborn babies added to a family hospital cover within 60 days after their birth Treatment required immediately following an accidental injury sustained after you’ve joined. You may be able to obtain immediate benefits if you are transferring from another health fund with an equivalent level of cover. See the PDS for more information.
Pre-existing conditions A pre-existing condition is one where signs or symptoms of an ailment, illness or condition, in the opinion of a medical practitioner appointed by the Fund, existed at any time during the six months preceding the date on which you purchased or upgraded your hospital cover. A 12-month waiting period applies for pre-existing conditions. This does not apply to psychiatric conditions, palliative care and rehabilitation (2 month wait applies).
For more information see the Product Disclosure Statement at healthpartners.com.au/PDS or contact us. 7
Extras cover explained With extras cover, you can claim for a range of services that generally aren’t covered by Medicare and that aren’t covered by your hospital cover. The following information applies to all Health Partners extras covers – purchased individually or in a package – so it’s worth taking some time to read through this. We’ve kept the details simple, so when you’ve read this, simply review the comparison tables to determine the level of cover you need. If you’re looking for extras cover in a package with hospital, see the table on page 12. For extras cover on its own, see the table on page 37.
Save with Health Partners professionals You can claim benefits for extras services at your own recognised provider or, to receive the highest possible benefits, just choose a Health Partners professional. To find your nearest Health Partners professional, visit ‘Partner Search’ at healthpartners.com.au. Health Partners Dental When you visit one of our dental centres, you can get back as much as 100% and no less than 60% on general dental treatment. Major dental treatment is also available on most covers, with benefits ranging from 60% to 100%. Health Partners Optical You can expect unbeatable benefits and discounts when you visit any of our optical centres. You get back as much as 100% and no less than 60% for optical prescription items (including contact lenses and sunglasses). Plus, our unique ‘unlimited benefit’ means that if you reach your annual limits, you can keep on saving on prescription items at a minimum of 40%.
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Health Partners Participating Pharmacies We have a state-wide network of participating pharmacies where you receive on-thespot benefits and discounts. Pharmacy benefits are included on all levels of extras and package covers and are exclusively available at participating pharmacies. Health Partners Participating Physiotherapists When you visit any one of our participating physiotherapists you will pay a low, set gap or no-gap at all for most treatments, allowing you to save more. Physiotherapy benefits are included on all levels of extras and packaged covers.
Benefits A benefit is the amount you receive back when you make a claim. If the service you require is included in your cover, Health Partners will help you cover the costs by paying the benefit specific to your cover. Benefits are listed for each level of cover on pages 14-29 and 38-47. Except where otherwise stated, benefits and limits are per person, per calendar year. There are instances when extras benefits are not payable, such as when a provider is not recognised by us or when your health cover payments are not up to date. If you’re unsure, it’s always best to contact us. Not all benefits are listed in this brochure for all extras services. To check if a specific item is covered, please contact us. If transferring, benefits paid by your previous fund within the current calendar year or specified period will count towards your limits with Health Partners for the same period.
Recognised providers
Waiting periods
We will pay benefits when the service provider is recognised by us for benefit purposes. Contact us to determine if your provider is a Health Partners recognised provider.
Waiting periods are the initial periods after joining or upgrading your extras cover during which you cannot claim extras benefits.
Limits For most extras services, there are limits to the amounts that you can claim back or the number of times you can claim a benefit, during the calendar year or the specified period. Health Partners offers some unlimited benefits and discounts – allowing you to save more. All of our limits are per person unless otherwise stated. Refer to the benefits listed on pages 14-29 and 38-47 for details.
Lifetime limits Some extras have lifetime limits which indicate the total amount you can claim in your lifetime. Once you reach the limit, no further benefits will apply.
After two months you can claim benefits for all extras services available on your level of cover, except for the following, where the respective waiting periods apply: Major Dental
12 months
Orthodontic
12 months
Apparatus
12 months
Laser Eye Surgery
36 months
You may be able to obtain immediate benefits if you are transferring from another health fund with an equivalent level of cover. Some conditions apply; see the PDS for more information..
For more information see the Product Disclosure Statement at healthpartners.com.au/PDS or contact us. 9
Package cover options Package cover combines hospital and extras in the one package for you – we have four to choose from to suit different life stages and budgets.
Hospital cover component
Extras cover component
F or details relating to the hospital component of our package covers, including what’s covered, what’s not covered, excess and co-payment, limited benefits, waiting periods, pre-existing conditions and how to reduce your medical expenses, see pages 6-7.
F or details relating to the extras component of our package covers, including benefits, limits, lifetime limits, Health Partners professionals and waiting periods, see pages 8-9.
Hospital and extras cover can be purchased individually. (See pages 30-31 and 36-37 to compare your options)
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Prime Living
Page 14
Family Couples Essentials Choice Page 20
Page 24
Singles Starter Page 27
In-patient procedures and services Cardiac procedures
Psychiatric services
Rehabilitation services
Accident-related treatment after joining
Pharmaceuticals related to admission (PBS approved) Joint-reconstruction procedures
Joint-replacement procedures
Eye surgery
Pregnancy and birth-related procedures
Assisted reproductive services (e.g. IVF)
Sterilisation reversal
Dialysis for chronic kidney failure
Surgical weight loss procedures
Removal of tonsils, adenoids
Removal of appendix
Removal of wisdom teeth
Cataract surgery
Non-PBS prescriptions
Home Health Partner
Home Nursing
Non-surgical prostheses & recovery aids
Health Management Programs
Home Sleep Studies
Chronic Condition Management Service
Newborn Support Program
Examples of other procedures
Additional benefits
Excess & co-payment Excess
NIL $300 $300 $500
Co-payment
NIL NIL NIL NIL
No excess or co-payment for kids
N/A
Included
11
Restricted benefits apply
N/A N/A
Not included. See page 7 for details on waiting periods.
Prime Living Extras benefits
Page 14
Family Couples Essentials Choice Page 20
Page 24
Singles Waiting Starter period* (mths) Page 27
Page 9
General Dental
2
Major Dental
12
Endodontic
Optical
2
Pharmacy
2
Physiotherapy
2
2
2 Gym & Fitness (under Health Management) Emergency Ambulance
2
Non-emergency Ambulance
2
Chiropractic/Osteopathic
2
Podiatry
2
Speech Therapy
2
Dietary
2
Psychology
2
Orthodontic
12
Orthotics
2
Occupational Therapy
2
Eye Therapy
2
Exercise Physiology
Naturopathy
Acupuncture
2
Hypnotherapy
2
Natural Therapies
Massage
2
Laser Eye Surgery
36
Pilates
2
Apparatus
2 2
2
12
Emergency Department 2 Facility Fee Included
Not included. *See page 9 for details on waiting periods.
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Prime Living
Prime Living Key features
If you’re looking for a comprehensive package, look no further than Prime Living. Offering the highest level of benefits on any of our package products – with selected exclusions for things you probably won’t need and no hospital excess. Prime Living provides benefits for services like laser eye surgery as well as benefits of up to 100% on dental, optical, physiotherapy and pharmacy, plus Australia-wide ambulance cover.
Nil excess; nil co-payment Up to 100% back for dental, optical and physiotherapy Laser eye surgery Full ambulance cover Emergency facility fee
Hospital cover component
You will be covered for all Medicare-recognised procedures and the in-patient services listed on the comparison table on page 11. And so that you receive the best from your cover, you get access to a range of health management and support programs (criteria apply) and up to 100% back for a number of additional services. Please refer to ‘Hospital cover explained’ on page 6 for details on waiting periods and more.
Additional services
Benefit
Limit
Post Admission Non-PBS prescriptions
Up to 100%
$1,500
Non-surgically implanted prostheses (e.g. prosthetic bras, wigs)
100%
$1,500
Post-surgical recovery aids (e.g. compression garments, braces)
100%
$250
$100
$200
100%
$500
Home Sleep Studies Set benefit applies when using a Health Partners participating provider
Home Nursing Wound management, IV medication, palliative care
Included programs Health Management Programs Home Health Partner Chronic Condition Management Service See page 48 for details.
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Exclusions Exclusions are the services for which benefits are not available on this level of cover. They are in addition to the items listed under ‘What’s not covered’ on page 6. regnancy and birth-related services P Assisted reproductive services Sterilisation reversal Surgical weight loss procedures
Prime Living
Extras cover component You will be covered for our highest level of extras as detailed below. You can claim benefits at your own recognised provider or just choose a Health Partners professional where you get 100% back for dental, optical and most physiotherapy treatments. Please refer to ‘Extras cover explained’ on page 8 for details on waiting periods and more.
Services and benefits
Limit
General Dental At Health Partners Dental and Barossa Dental 100% benefit applies. At other dental providers
No limit
A schedule of benefits applies; please call us for a quote.
Major Dental and Endodontic At Health Partners Dental and Barossa Dental 100% benefit applies. At other dental providers
$1,600
A schedule of benefits applies; please call us for a quote. Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa
Optical At Health Partners Optical 100% benefit for prescription glasses/prescription sunglasses/contact lenses. 60% unlimited benefit applies at Health Partners Optical if you reach your limit for the year. 50% discount on sunglasses. No limit. At other optical providers
$500 ($300 sub-limit for other optical providers)
100% benefit for prescription glasses/prescription sunglasses/contact lenses. Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa
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Prime Living
Services and benefits
Limit
Pharmacy At Health Partners Participating Pharmacies
$1,000
PBS prescriptions, not already subsidised by the Government.
pay max. of $20
Please ask your
Private and compounding prescriptions.
pay max. of $37
pharmacist about the benefits that apply to your prescription and if
20% discount on most non-prescription items. No limit. Some conditions apply.
you can save more with generic brands.
Physiotherapy At Health Partners Participating Physiotherapists 100% benefit for initial, subsequent and long consultations, and hydrotherapy and lymphoedema treatment.
$1,500
At other physiotherapy providers
($1,000 sub-limit for other
70% benefit applies.
physiotherapy providers. $300 sub-limit for Pilates)
Pilates Set benefits apply.
Per session
$20
Natural Therapies/Naturopathy/ Acupuncture/Hypnotherapy 70% benefit applies.
$800 ($200 sub-limit for each modality)
Chiropractic/Osteopathic/Exercise Physiology 80% benefit applies.
$750 ($1,500 limit per membership)
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Prime Living
Services and benefits
Limit
Podiatry/Orthotics 70% benefit applies.
$750 ($400 sub-limit for orthotics)
Dietary Set benefits apply.
Initial consultation
$60
Subsequent consultation
$40
Set benefits apply, for example:
Initial consultations
$140
Subsequent consultations
$120
Set benefits apply, for example:
Initial consultation
$100
Subsequent consultation
$70
Set benefits apply, for example:
Initial consultations
$60
Subsequent consultations
$40
Set benefits apply, for example:
Initial consultations
$60
Subsequent consultations
$40
$750
Psychology $750
Speech Therapy $750
Eye Therapy $750
Occupational Therapy $750
Laser Eye Surgery Laser correction eye surgery
100%
Lifetime limit $4,000
100%
$20,000
Full Ambulance Emergency and non-emergency services; Australia-wide coverage; road and air services.
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Prime Living
Services and benefits
Limit
Emergency Department Private hospital emergency facility fee
100%
Limit of 1 per year, up to $250
Health Management Gym and Fitness*
100%
$200
Health Risk Assessment
100%
No limit
Quit Smoking*
via Members Online
100%
$100, lifetime limit $400
Weight Management*
Upon joining
$50
Upon reaching goal
$200
Lifetime limit $250
Bowel Cancer Screening Kit*
$30
$30
Diabetes Membership
100%
$100 per membership
Bone Density test*
100%
$100
Compression garments^*
100%
$100 per item
Diabetes education*
100%
$100 per consultation
Hip safety kit*
100%
$100
Asthma Foundation membership*
100%
$100 per membership
*For approved conditions or when medically necessary, subject to eligibility requirements. For full details see Health Partners Product Disclosure Statement. ^ A letter from your medical practitioner may be required.
Apparatus^ Asthmatic Spray Appliances
100%
$130 every 3 years
Blood Glucose Monitoring Machines
100%
$250 every 3 years
Blood Pressure Machines
100%
$100 every 3 years
Hearing Aids
100%
Limit based on continuous years of membership: 1-2 years $800 3+ years $1,600 Benefit is limited to once every 3 years.
Sleep Apnoea Machines (CPAP)
100%
$1,500 every 5 years
Sleep Apnoea Machines (CPAP) – Support Service
100%
$250 every 5 years
^ A letter from your medical practitioner may be required.
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Family Essentials
Family Essentials This package providing cover for both hospital and extras – so you can keep your costs down when you need essentials like dental, optical, physiotherapy and pharmacy. It includes gap-free services for kids for dental, optical and physio and no excess if they need to go hospital. Selected exclusions and restrictions mean you won’t pay for things you probably won’t need.
Key features $ 300 excess; nil co-payment No excess for kids Gap-free kids’ services available Orthodontics included Orthotics included Full ambulance cover
Hospital cover component
If anyone in your family needs to go to hospital, you’re covered Australia-wide for a broad range of hospital procedures and all the in-patient services indicated on the comparison table on page 11. You also get access to the following listed items. Please refer to ‘Hospital cover explained’ on page 6 for details on waiting periods and more.
Additional services
Benefit
Limit
Post Admission Non-PBS prescriptions
Up to 100%
$1,000
Non-surgically implanted prostheses (e.g. prosthetic bras, wigs)
100%
$1,500
100%
$100 per year
Home Nursing Wound management, IV medication, palliative care
Included programs ealth Management Programs H Home Health Partner Newborn Support Program Chronic Condition Management Service See page 48 for details.
Dialysis for chronic kidney failure
Restrictions Limited benefits are available for the following in a public hospital or accredited day surgery: Pregnancy and birth related services Joint replacement procedures
Exclusions Exclusions are the services for which benefits are not available on this level of cover. They are in addition to the items listed under ‘What’s not covered’ on page 6. Assisted reproductive services Sterilisation reversal Eye surgery Surgical weight loss procedures 20
Excess and co-payment A $300 excess is payable if you are admitted to hospital. This is waived for dependant children. There is no co-payment.
Family Essentials
Extras cover component Your family is covered for an extensive range of useful extras. You can claim benefits at your own recognised provider or, to receive the highest possible benefits, just choose a Health Partners professional. We offer our own dental and optical services and have a state-wide network of participating pharmacies and physiotherapists. Please refer to ‘Extras cover explained’ on page 8 for details on waiting periods and more.
Services and benefits
Limit
General Dental At Health Partners Dental and Barossa Dental 70% benefit applies. Dependant children receive one gap-free check-up per year.~ 100% benefit for one standard Health Partners mouthguard.^ At other dental providers A schedule of benefits applies; please call us for a quote. 100% benefit towards one standard mouthguard.^
No limit
$80 limit
~Gap-free dental check-up includes exam, scale & clean, X-rays, fluoride treatment and fissure seals (items numbers: 11, 12, 13, 22, 25, 111, 114, 115, 121, 161). ^Benefit for one standard mouthguard (item no. 151) can only be claimed once per person, per year at either Health Partners Dental or other dental providers.
Major Dental / Endodontic At Health Partners Dental and Barossa Dental 70% benefit applies. At other dental providers A schedule of benefits applies; please call us for a quote.
$1,000 (sub-limit $600 at other dental providers)
Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa
Orthodontic 70% benefit for treatment by an orthodontist. 50% benefit for treatment by a general dentist. Includes spacers, orthodontic plates, retainers. A treatment plan may be required.
Lifetime limit of $800 after 12 months, increasing by $200 each year to a maximum lifetime limit of $2,400.
Optical At Health Partners Optical 70% benefit for prescription glasses/prescription sunglasses/contact lenses. One pair of gap-free single vision or multifocal prescription glasses per year (selected range, within annual limits). 40% unlimited benefit applies at Health Partners Optical if you reach your limit for the year. 30% discount on sunglasses. No limit.
$350 ($250 sub-limit for other optical providers)
At other optical providers 50% benefit for prescription glasses/prescription sunglasses/contact lenses.. Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa 21
Family Essentials
Services and benefits
Limit
Pharmacy At Health Partners Participating Pharmacies PBS prescriptions, not already subsidised by the Government. Private and compounding prescriptions.
pay max. of $20 pay max. of $37
20% discount on most non-prescription items. No limit. Some conditions apply.
$500 Please ask your pharmacist about the benefits that apply to your prescription and if you can save more with generic brands.
Physiotherapy At Health Partners Participating Physiotherapists You pay a set gap for most visits, for example: Initial & subsequent consultations pay only $16 Long consultation pay only $25 Dependant children receive two gap-free consultations per year. At other physiotherapy providers 70% benefit applies.
Pilates Set benefits applies
$650 ($400 sub-limit for other physiotherapy providers. $200 sub-limit for Pilates)
Per session
$20
Initial consultation Subsequent consultation Initial consultation Subsequent consultation
$50 $32 $25 $16
Initial consultation Subsequent consultation
$30 $25
Initial consultations Subsequent consultations
$50 $30
$400
Initial consultations Subsequent consultations
$50 $30
$400
Chiropractic/Osteopathic Set benefits apply for the first 6 consultations: Set benefits for additional consultations:
$500
Podiatry Set benefits apply:
Orthotics
$400 (sub-limit $200 for orthotics)
60% benefit applies.
Dietary Set benefits apply.
Psychology Set benefits apply.
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Family Essentials
Services and benefits
Limit
Speech Therapy Set benefits apply.
Initial consultations
$50
Subsequent consultations
$30
Set benefits apply.
Initial consultations
$30
Subsequent consultations
$20
Set benefits apply.
Initial consultations
$50
Subsequent consultations
$30
$400
Eye Therapy $400
Occupational Therapy $400
Full Ambulance Emergency and non-emergency services; Australia-wide coverage; road and air services.
100%
$20,000
Massage/Naturopathy/Acupuncture 70% benefit applies.
$500 ($200 sub-limit for each modality)
Health Management Gym and Fitness*
100%
$100
Health Risk Assessment
100%
No limit
Quit Smoking*
via Members Online
100%
Lifetime limit $100
Weight Management*
$50
Lifetime limit $50
Bowel Cancer Screening Kit*
$22
$22
Diabetes Membership
50%
$50 per membership
*For approved conditions, subject to eligibility requirements. For full details see Health Partners Product Disclosure Statement.
Apparatus^ Asthmatic Spray Appliances
85%
$100 every 3 years
Blood Glucose Monitoring Machines
85%
$200 every 3 years
Blood Pressure Machines
85%
$100 every 5 years
Sleep Apnoea Machines (CPAP)
85%
$1,500 every 5 years
^ A letter from your medical practitioner may be required.
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Couples Choice
Couples Choice Our Couples Choice package provides cover for the basics in both hospital and extras – so that you can keep your costs down when you need essentials like dental, optical, physiotherapy and pharmacy. You get peace of mind with hospital cover for a broad range of hospital services with some exclusions, like joint replacements and pregnancy, so you’re not paying for things you don’t need.
Key features $ 300 excess; nil co-payment Pregnancy Loyalty Reward Medicare Levy Surcharge exempt Access to member discounts and offers Emergency ambulance
Hospital cover component
If you or your partner needs to go to hospital, you’re covered Australia-wide for a broad range of hospital procedures and all the in-patient services indicated on the comparison table on page 11. You also get access to the following items listed here. Please refer to ‘Hospital cover explained’ on page 6 for details on waiting periods and more.
Additional services
Benefit
Limit
Post Admission Non-PBS prescriptions
100%
$500
Included programs
Restrictions
regnancy loyalty reward P Home Health Partner See page 48 for details.
Limited benefits are available for the following in a public hospital or accredited day surgery.
Exclusions Exclusions are the services for which benefits are not available on this level of cover. They are in addition to the items listed under ‘What’s not covered’ on page 6. Pregnancy and birth-related services Assisted reproductive services Sterilisation reversal Joint-replacement procedures Surgical weight loss procedures Dialysis for chronic kidney failure Eye surgery
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Psychiatric services Rehabilitation services
Excess and co-payment A $300 excess is payable if you are admitted to hospital. There is no co-payment.
Pregnancy loyalty reward While pregnancy and birth related services are exclusions on Couples Choice cover, the Pregnancy Loyalty Reward will allow you to transfer to any Health Partners cover where pregnancy and birth related services are included after 2 years of continuous Couples Choice cover without serving the usual 12 month waiting period. All other waiting periods will still apply.
Couples Choice
Extras cover component With Couples Choice you and your partner are covered for an extensive range of useful extras. You can claim benefits at your own recognised provider or, to receive the highest possible benefits, just choose a Health Partners professional. We offer our own dental and optical services and have a state-wide network of participating pharmacies and physiotherapists. Please refer to ‘Extras cover explained’ on page 8 for details on waiting periods and more.
Services and benefits
Limit
General Dental At Health Partners Dental and Barossa Dental 60% benefit applies.
$700
At other dental providers 50% benefit applies.
Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa
Major Dental / Endodontic At Health Partners Dental and Barossa Dental 60% benefit applies.
$500 (sub-limit $400 at other dental providers)
At other dental providers 50% benefit applies.
Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa
Optical At Health Partners Optical 60% benefit for prescription glasses/prescription sunglasses/contact lenses. One pair of gap-free single vision prescription glasses per year (selected range, within annual limits). 40% unlimited benefit applies at Health Partners Optical if you reach your limit for the year. 30% discount on sunglasses. No limit.
$350 ($250 sub-limit for other optical providers)
At other optical providers 50% benefit for prescription glasses/prescription sunglasses/contact lenses. Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa
Pharmacy At Health Partners Participating Pharmacies
$150
PBS prescriptions, not already subsidised by the Government.
pay max. of $20
Please ask your pharmacist
Private and compounding prescriptions.
pay max. of $37
about the benefits that apply to your prescription
20% discount on most non-prescription items. No limit. Some conditions apply.
and if you can save more with generic brands. 25
Couples Choice
Services and benefits
Limit
Physiotherapy At Health Partners Participating Physiotherapists You pay a set gap for most visits, for example: Initial & subsequent consultations pay only $18
Long consultation
pay only $25
At other physiotherapy providers
$600 ($400 sub-limit at other
60% benefit applies.
physiotherapy providers,
Pilates
for chiropractic and
Set benefits apply.
Per session.
$20
osteopathy. $200 sub-limit for Pilates)
Chiropractic/Osteopathic 60% benefit applies.
Podiatry/Dietary Set benefits apply.
Initial consultation
$30
Subsequent consultation
$20
$300
Massage/Naturopathy/Acupuncture 60% benefit applies.
$300 (sub-limit $150 for each modality)
Emergency Ambulance Emergency services only; Australia-wide coverage; road and air services.
100%
Limit of 2 per year.
Gym and Fitness*
100%
$100
Bowel Cancer Screening Kit*
$22
$22
Health Management
*For approved conditions, subject to eligibility requirements. For full details see Health Partners Product Disclosure Statement.
26
Singles Starter
Singles Starter This package covers you for the basics in both hospital and extras – so that you can keep your costs down when you need dental, optical, physiotherapy and pharmacy. You still get peace of mind with hospital cover for a broad range of hospital services with only some exclusions, such as pregnancy and joint replacement procedures.
Key features $ 500 excess Emergency ambulance cover Medicare Levy Surcharge Access to member discounts and offers
Hospital cover component
You will be covered for all the in-patient services indicated on the comparison table on page 11, with benefits for the following additional services. You also get access to selected health management and support programs (criteria apply). Please refer to ‘Hospital cover explained’ on page 6 for details on waiting periods and more.
Additional services
Benefit
Limit
Post Admission Non-PBS prescriptions
Included programs Home Health Partner See page 48 for details.
Exclusions Exclusions are the services for which benefits are not available on this level of cover. They are in addition to the items listed under ‘What’s not covered’ on page 6.
100%
$500
Restrictions Limited benefits are available for the following in a public hospital or accredited day surgery: Psychiatric services Rehabilitation services
Excess and co-payment A $500 excess is payable if you are admitted to hospital.
regnancy and birth-related services P Assisted reproductive services Sterilisation reversal Joint-replacement procedures Surgical weight loss procedures Dialysis for chronic kidney failure Eye surgery
27
Singles Starter
Extras cover component With Singles Starter you are covered for essential services that will help you keep your out-of-pocket cost down. You can claim benefits at your own recognised provider or, to receive the highest possible benefits, just choose a Health Partners professional. We offer our own dental and optical services and have a state-wide network of participating pharmacies and physiotherapists. Please refer to ‘Extras cover explained’ on page 8 for details on waiting periods and more.
Services and benefits
Limit
General and Major Dental and Endodontic At Health Partners Dental and Barossa Dental 60% benefit applies.
$600 (sub-limit $400
At other dental providers 50% benefit applies.
Endodontics)
for Major Dental and/or
Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa
Optical At Health Partners Optical 60% benefit for prescription glasses/prescription sunglasses/contact lenses. One pair of gap-free single vision prescription glasses per year (selected range, within annual limits). 40% unlimited benefit applies at Health Partners Optical if you reach your limit for the year. 30% discount on sunglasses. No limit.
$300 ($200 sub-limit for other optical providers)
At other optical providers 50% benefit for prescription glasses/prescription sunglasses/contact lenses.. Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa
Pharmacy At Health Partners Participating Pharmacies
$150
PBS prescriptions, not already subsidised by the Government.
pay max. of $20
Please ask your pharmacist
Private and compounding prescriptions.
pay max. of $37
about the benefits that apply to your prescription
20% discount on most non-prescription items. No limit. Some conditions apply.
and if you can save more with generic brands.
28
Singles Starter
Services and benefits
Limit
Physiotherapy At Health Partners Participating Physiotherapists You pay a set gap for most visits, for example: Initial & subsequent consultations pay only $20
Long consultation
pay only $25
At other physiotherapy providers
($400 sub-limit for other
60% benefit applies.
physiotherapy providers,
Pilates Set benefits apply.
$500
for chiropractic and Per session.
$15
osteopathy. $200 sub-limit for Pilates)
Chiropractic/Osteopathic 60% benefit applies.
Massage/Naturopathy/Acupuncture 60% benefit applies.
$300 (sub-limit $100 for each modality)
Emergency Ambulance Emergency services only; Australia-wide coverage; road and air services.
100%
Limit of 2 per year.
Gym and Fitness*
100%
$100
Bowel Cancer Screening Kit*
$22
$22
Health Management
*For approved conditions, subject to eligibility requirements. For full details see Health Partners Product Disclosure Statement.
29
Comparing hospital cover options We offer three levels of hospital cover – all of which provide you with a range of benefits at your choice of participating hospital (private or public), Australia-wide. Plus, you can access various programs outside of hospital to assist with improving your overall health and wellbeing. Using the table on the next page, simply short-list your preferences based on how much cover you need. Then consider your excess and co-payment options to determine the best fit for your budget. You can purchase hospital cover on its own or together with any level of extras cover. Or see page 11 for our range of package covers that combine hospital and extras together.
30
Gold Hospital
Silver Hospital
Bronze Hospital
Page 32
Page 34
Page 35
In-patient procedures and services Cardiac procedures
Psychiatric services
Rehabilitation services
Accident-related treatment after joining
Pharmaceuticals related to admission (PBS approved)
Joint-reconstruction procedures
Joint-replacement procedures
No exclusions on Medicare-recognised procedures
Pregnancy and birth-related procedures
Assisted reproductive services (e.g. IVF)
Sterilisation reversal
Dialysis for chronic kidney failure
Surgical weight loss procedures
Removal of tonsils, adenoids
Removal of appendix
Removal of wisdom teeth
Cataract surgery
Home Nursing
Non-PBS prescriptions
Non-surgical prostheses and recovery aids
Health Management Programs
Home Health Partner
Newborn Support Program
Emergency Ambulance
Non-emergency Ambulance
Home Sleep Studies
Chronic Condition Management Service
Examples of other procedures
Additional benefits
Options Excess
NIL NIL $250 $500
$500
Co-payment
NIL $50 $50 $50
$50
No excess or co-payment for kids
N/A
Included
Restricted benefits apply
Not included. See page 6 for details on waiting periods. 31
Gold Hospital
GOLD HOSPITAL
50
Gold Hospital NIL EXCESS NIL CO-PAYMENT
GOLD HOSPITAL 50 NIL EXCESS $50 CO-PAYMENT
Our top level of stand alone hospital cover provides the broadest range of services – so that you have complete peace of mind. You will be covered for all Medicare-recognised procedures and the in-patient services listed on the comparison table on page 31. And so that you receive the best from your cover, you also get access to a range of health management and support programs (criteria apply) and benefits for a number of additional services. Please refer to ‘Hospital cover explained’ on page 6 for details on waiting periods and more.
Additional services
Benefit
Limit
Post Admission Non-PBS prescriptions
100%
$1,500
Non-surgically implanted prostheses (e.g. prosthetic bras, wigs)
75%
$800
Post-surgical recovery aids (e.g. compression garments, braces)
75%
$250
$50
$100
Home Sleep Studies Set benefit applies when using a Health Partners participating provider
Home Nursing Set benefits apply for wound management, IV medication
$5,500 (daily limit $250 and sub-limit $3,000 for palliative care)
Palliative care (minimum 4 hours) $250
Full Ambulance Emergency and non-emergency services; 100% Australia-wide coverage; road and air services.
$20,000
Health Management* Bone density test
75%
$100
Compression garments
75%
$100 per item
Diabetes education
75%
$50 per consultation
Hip safety kit
75%
$100
Asthma Foundation membership
50%
$20 per membership Overall limit $400
* For approved conditions or when medically necessary, subject to eligibility requirements. For full details see Health Partners Product Disclosure Statement.
32
Included programs Newborn Support Program Home Health Partner Chronic Condition Management Service See page 48 for details.
Exclusions There are no exclusions for any medicallynecessary admission (conditions for which a Medicare rebate applies).
Your options There are two levels of Gold Hospital cover, each covering you for all the same services. Simply choose between cover with or without a co-payment. The co-payment is limited to a maximum of 5 days per person per rolling year. The co-payment is waived for dependant children.
33
Silver Hospital
SILVER HOSPITAL 250 $250 EXCESS $50 CO-PAYMENT
500
250
Silver Hospital SILVER HOSPITAL 500 $500 EXCESS $50 CO-PAYMENT
Our medium level of stand alone hospital cover provides a very broad range of services and benefits, giving you complete peace of mind and excess options to reduce your premiums. You will be covered for all Medicare-recognised procedures and the in-patient services indicated on the comparison table on page 31. And so that you receive the best from your cover, you also get access to a range of health management and support programs (criteria apply) and benefits for a number of additional services. Please refer to ‘Hospital cover explained’ on page 6 for details on waiting periods and more.
Additional services
Benefit
Limit
Post Admission Non-PBS prescriptions
100%
$1,500
Non-surgically implanted prostheses (e.g. prosthetic bras, wigs)
75%
$500
Post-surgical recovery aids (e.g. compression garments, braces)
75%
$250
Home Nursing Set benefits apply for wound management, IV medication
$5,500 (daily limit $250 and sub-limit $3,000 for palliative care)
Palliative care (minimum 4 hours) $250
Full Ambulance Emergency and non-emergency services; 100% Australia-wide coverage; road and air services.
Included programs Health Management Programs Newborn Support Program Home Health Partner Chronic Condition Management Service See page 48 for details.
Exclusions There are no exclusions for any medicallynecessary admission (conditions for which a Medicare rebate applies).
34
$20,000
Your options There are two levels of Silver Hospital cover, each covering you for all the same services. Simply choose the excess that suits you. The co-payment is limited to a maximum of 5 days per person per rolling year. The excess and co-payment are waived for dependant children.
Bronze Hospital
500
Bronze Hospital BRONZE HOSPITAL 500 $500 EXCESS $50 CO-PAYMENT Our basic level of stand alone hospital cover gives you cover for many services including cardiac and joint reconstructions, but excludes some things like pregnancy and joint replacements. You will be covered for the in-patient services indicated on the comparison table on page 31, with benefits for the additional services listed below. Plus, Bronze Hospital gives you access to a range of health management, emergency ambulance and support programs (criteria apply). Please refer to ‘Hospital cover explained’ on page 6 for details on waiting periods and more.
Additional services
Benefit
Limit
Post Admission Non-PBS prescriptions
100%
$500
Non-surgically implanted prostheses (e.g. prosthetic bras, wigs)
75%
$500
Post-surgical recovery aids (e.g. compression garments, braces)
75%
$250
100%
Limit of 2 per year
Emergency ambulance Emergency services only; Australia-wide coverage; road and air services
Home Nursing Set benefits apply for wound management, IV medication $250
Palliative care (minimum 4 hours)
Included programs Health Management Programs Home Health Partner Chronic Condition Management Service See page 48 for details.
$500
Exclusions
Restrictions
Exclusions are the services for which benefits are not available on this level of cover. They are in addition to the items listed under ‘What’s not covered’ on page 6.
Limited benefits are available for the following in a public hospital or accredited day surgery:
regnancy and birth-related P services Assisted reproductive services Sterilisation reversal Joint-replacement procedures Surgical weight loss procedures Dialysis for chronic kidney failure
A $500 excess and daily copayment of $50 is payable if you are admitted to hospital. The copayment is limited to a maximum of 5 days per person per rolling year.
Psychiatric services Rehabilitation services
Excess and co-payment
35
Comparing extras cover options We offer three levels of extras cover – all of which cover you for the most popular services like dental, optical, physiotherapy, pharmacy and ambulance. Generally, the higher the level of cover, the higher the limits and benefits you receive. The table on the next page summarises the services included on each of the covers. For more detailed information on what you can claim, see pages 38-46. You can purchase extras cover on its own or together with any level of hospital cover. Or see page 12 for our range of package covers that combine hospital and extras together.
36
Gold Extras
Silver Extras
Page 38
Page 42
Bronze Waiting Extras period* (mths) Page 45
Page 9
General Dental
2
Major Dental
12
Endodontic
Optical
2
Pharmacy
2
Physiotherapy
2
Emergency Ambulance
2
Non-emergency Ambulance
2
Health Management (e.g. gym & fitness)
2
Orthodontic
12
Naturopathy
2
Acupuncture
2
Chiropractic/Osteopathic
2
Exercise Physiology
2
Podiatry
2
Pilates
2
Orthotics
2
Dietary
2
Psychology
2
Hypnotherapy
2
Massage
2
Speech Therapy
2
Eye Therapy
2
Occupational Therapy
2
RDNS
2
Apparatus (e.g. h earing aids, sleep apnoea machine)
12
2
Natural Plus (optional add-on cover; see page 47) 15 Natural Therapies (including massage) Included
Available
Available
Available
2
Not included. *See page 9 for details on waiting periods.
37
Gold Extras
Gold Extras Our top level of stand alone extras cover provides the broadest range of services – including health management benefits for quitting smoking and weight management. ou can claim benefits at your own recognised provider or, to receive the highest possible Y benefits, just choose a Health Partners professional. We offer our own dental and optical services and have a state-wide network of participating pharmacies and physiotherapists.
Please refer to ‘Extras cover explained’ on page 8 for details on waiting periods and more.
Services and benefits
Limit
General Dental At Health Partners Dental and Barossa Dental 85% benefit applies. Dependant children receive 2 gap-free check-ups per year~. One gap-free standard mouthguard per year.
No limit
At other dental providers A schedule of benefits applies; please call us for a quote. ~ Gap-free dental check-up includes exam, scale & clean, X-rays, fluoride treatment and fissure seals (item numbers: 11, 12, 13, 22, 25, 111, 114, 115, 121, 161).
Major Dental At Health Partners Dental and Barossa Dental 85% benefit applies. 40% unlimited benefit applies at Health Partners Dental if you reach your limit for the year.
$1,000
At other dental providers A schedule of benefits applies; please call us for a quote. Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa.
Endodontic At Health Partners Dental and Barossa Dental 70% benefit applies. 40% unlimited benefit applies at Health Partners Dental if you reach your limit for the year.
$1,000
At other dental providers A schedule of benefits applies; please call us for a quote. Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa.
Orthodontic 70% benefit for treatment by an orthodontist.
Lifetime limit of
50% benefit for treatment by a general dentist.
$500 after 1 year,
Includes spacers, orthodontic plates, retainers.
$1,500 after 2 years
A treatment plan may be required. 38
and $2,500 after 5 years.
Gold Extras
Services and benefits
Limit
Optical At Health Partners Optical 70% benefit for prescription glasses/sunglasses/contact lenses.
$350 prescription glasses
One pair of gap-free single vision or multifocal prescription glasses per year (selected range,
$210 contact lenses
within annual limits). 40% unlimited benefit applies at Health Partners Optical if you reach your limit for the year. 30% discount on sunglasses, solutions and accessories. No limit. At other optical providers 50% benefit for prescription glasses/sunglasses/contact lenses.
$250 (sub-limit $100
for frames)
Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa.
Pharmacy At Health Partners Participating Pharmacies $600 PBS prescriptions, not already subsidised by the Government.
pay max. of $20
Please ask your
Private and compounding prescriptions.
pay max. of $37
pharmacist about the
benefits that apply to
20% discount on most non-prescription items. No limit. Some conditions apply.
your prescription and if
you can save more with
generic brands.
Physiotherapy At Health Partners Participating Physiotherapists You pay a set gap for most visits, for example: Initial & subsequent consultations pay only $12
Long consultation
pay only $20
$1,000
Dependant children receive 4 gap-free consultations per year.
(sub-limit $500 at other
At other physiotherapy providers
physiotherapy providers
Set benefits apply, for example: Initial consultation
$30
and for group treatment)
Subsequent & long consultations $24 Group treatment
$10
Per consultation
$10
Set benefits apply.
Initial consultation
$28
Subsequent consultation
$21
Pilates Set benefit applies.
$100
Naturopathy
Acupuncture $350 Set benefits apply.
Initial consultation
$29
Subsequent consultation
$21 39
Gold Extras
Services and benefits
Limit
Chiropractic/Osteopathic Set benefits apply, for example:
Initial consultation
$42
Subsequent consultation
$25
Radiology (in providers’ rooms)
60%
Exercise Physiology Set benefits apply.
Initial consultation
$28
Subsequent consultation
$21
Group consultation
$8
$400
Podiatry Set benefits apply.
Initial consultation
$33
Subsequent consultation
$24
Surgery (in providers’ rooms)
85%
$350
Orthotics Set benefits apply; please call us for a quote.
$300
Dietary Set benefits apply.
Initial consultation
$60
Subsequent consultation
$35
Group consultation
$15
$450
Psychology Set benefits apply, for example:
Initial consultation
$75
Subsequent consultation
$70
Hypnotherapy Set benefit applies.
Per consultation
$400
$60
Massage (Remedial or Therapeutic) Set benefit applies.
Per consultation
$20
$100
Speech Therapy Set benefits apply, for example:
Initial consultation
$75
$400, or $600 after 5 years
Subsequent consultation
$45
of continuous membership.
Eye Therapy Set benefit applies.
40
Per consultation
$25
$250
Gold Extras
Services and benefits
Limit
Occupational Therapy Set benefits apply, for example:
Initial consultation
$50
$350, or $500 after 3 years
Subsequent consultation
$40
of continuous membership.
100%
$150
RDNS Already subsidised RDNS services
Full Ambulance Emergency and non-emergency services; 100% Australia-wide coverage; road and air services.
$20,000
Health Management Gym and Fitness*
100%
$200
Health Risk Assessment via Members Online Quit Smoking*
100% 100%
No limit $100, lifetime limit $200
Weight Management*
$50 $100
Lifetime limit $150
Bowel Cancer Screening Kit*
$22
$22
Diabetes Membership
50%
$50 per membership
Upon joining Upon reaching goal
* For approved conditions or when medically necessary, subject to eligibility requirements. For full details see Health Partners Product Disclosure Statement.
Apparatus^ Asthmatic Spray Appliances
85%
$130 every 3 years
Blood Glucose Monitoring Machines 85% Blood Pressure Machines 85%
$250 (sub-limit $100 for blood pressure machines) every 3 years.
Hearing Aids
Limit based on
85%
continuous years of
Health Partners
membership:
1-4 years $800
5-9 years $900
10+ years $1,150
Maximum benefit is limited to once every 3 years.
Sleep Apnoea Machines
85%
$1,500 every 5 years
CPAP Apparatus Support
$30
$150 every 5 years
Per consultation
^ A letter from your medical practitioner may be required.
41
Silver Extras
Silver Extras Our medium level of stand alone extras cover offers generous benefits on the most popular services. ou can claim benefits at your own recognised provider or, to receive the highest possible benefits, Y just choose a Health Partners professional. We offer our own dental and optical services and have a state-wide network of participating pharmacies and physiotherapists.
Please refer to ‘Extras cover explained’ on page 8 for details on waiting periods and more.
Services and benefits
Limit
General Dental At Health Partners Dental and Barossa Dental 60% benefit applies. No limit Dependent children receive 1 gap-free check-up per year.~ At other dental providers
A schedule of benefits applies; please call us for a quote. ~ Gap-free dental check-up includes exam, scale & clean and X-rays (item numbers: 11, 12, 22, 111, 114).
Major Dental At Health Partners Dental and Barossa Dental 60% benefit applies. 40% unlimited benefit applies at Health Partners Dental if you reach your limit for the year.
$500
At other dental providers
A schedule of benefits applies; please call us for a quote. Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa.
Endodontic At Health Partners Dental and Barossa Dental 60% benefit applies. 40% unlimited benefit applies at Health Partners Dental if you reach your limit for the year.
$500
At other dental providers A schedule of benefits applies; please call us for a quote. Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa.
Orthodontic 60% benefit for treatment by an orthodontist. 40% benefit for treatment by a general dentist. Includes spacers, orthodontic plates, retainers. A treatment plan may be required.
42
Lifetime limit of $200 after 1 year, $1,000 after 2 years.
Silver Extras
Services and benefits
Limit
Optical At Health Partners Optical 60% benefit for prescription glasses/sunglasses/contact lenses.
$270 prescription glasses
One pair of gap-free single vision prescription glasses per year (selected range, within annual limits).
$150 contact lenses
40% unlimited benefit applies at Health Partners Optical if you reach your limit for the year. 30% discount on sunglasses, solutions and accessories. No limit. At other optical providers 40% benefit for prescription glasses/sunglasses/contact lenses.
$200 (sub-limit $55
for frames)
Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa.
Pharmacy At Health Partners Participating Pharmacies $500 PBS prescriptions, not already subsidised by the Government.
pay max. of $20
Please ask your
Private and compounding prescriptions.
pay max. of $37
pharmacist about the
benefits that apply to
20% discount on most non-prescription items. No limit. Some conditions apply.
your prescription and if
you can save more with
generic brands.
Physiotherapy At Health Partners Participating Physiotherapists You pay a set gap for most visits, for example: Initial & subsequent consultations pay only $16 At other physiotherapy providers
Long consultation
pay only $25
Set benefits apply, for example: Initial consultation
$26
Subsequent consultations
$20
Group treatment
$10
$750 (sub-limit $450 at other physiotherapy providers and for group treatment)
43
Silver Extras
Services and benefits
Limit
Naturopathy Set benefits apply.
Initial consultation
$26.40
Subsequent consultation
$20.40
Acupuncture Set benefits apply.
Initial consultation
$27.60
Subsequent consultation
$21
Chiropractic/Osteopathic $350 Set benefits apply, for example:
Initial consultation
$30
Subsequent consultation
$21
Radiology (in providers’ rooms)
60%
Exercise Physiology Set benefits apply.
Initial consultation
$24
Subsequent consultation
$18
Group consultation
$6
Podiatry Set benefits apply.
Initial & subsequent consultations $15
$60
Full Ambulance Emergency and non-emergency services; Australia-wide coverage; road and air services. 100%
$20,000
Health Management Gym and Fitness*
100%
$150
Health Risk Assessment
100%
No limit
Bowel Cancer Screening Kit*
$22
$22
Diabetes Membership
50%
$50 per membership
via Members Online
* For approved conditions or when medically necessary, subject to eligibility requirements. For full details see Health Partners Product Disclosure Statement.
44
Bronze Extras
Bronze Extras Bronze Extras offers a range of basic extras – so that you can keep your costs down when you need dental, optical and physiotherapy. You still get peace of mind with ambulance benefits and enjoy unbeatable pharmacy benefits and discounts. You can claim benefits at your own recognised provider or, to receive the highest possible benefits, just choose a Health Partners professional. We offer our own dental and optical services and have a state-wide network of participating pharmacies and physiotherapists.
Please refer to ‘Extras cover explained’ on page 8 for details on waiting periods and more.
Services and benefits
Limit
General Dental and Endodontic At Health Partners Dental and Barossa Dental 60% benefit applies. At other dental providers
$500
A schedule of benefits applies; please call us for a quote.
Optical At Health Partners Optical 60% benefit for prescription glasses/sunglasses/contact lenses.
$120
40% unlimited benefit applies at Health Partners Optical if you reach your limit for the year. 30% discount on sunglasses, solutions and accessories. No limit. At other optical providers 40% benefit for prescription glasses/sunglasses/contact lenses.
$100 (sub-limit $55
for frames)
Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa.
45
Bronze Extras
Services and benefits
Limit
Pharmacy At Health Partners Participating Pharmacies $200 PBS prescriptions, not already subsidised by the Government.
pay max. of $20
Please ask your
Private and compounding prescriptions.
pay max. of $37
pharmacist about the
benefits that apply to
20% discount on most non-prescription items. No limit. Some conditions apply.
your prescription and if
you can save more with
generic brands.
Physiotherapy At Health Partners Participating Physiotherapists You pay a set gap for most visits, for example: Initial & subsequent consultations pay only $18 At other physiotherapy providers
Long consultation
Set benefits apply, for example: Initial consultation
pay only $25 $18
Subsequent consultation
$15
Group consulation
$8
$350 (sub-limit $250 at other physiotherapy providers and for group treatment).
Full Ambulance Emergency and non-emergency services; 100% Australia-wide coverage; road and air services.
46
$20,000
Natural Plus
Natural Plus When it comes to improving your health and enjoying your lifestyle, Health Partners has you covered with Natural Plus. This is an optional add-on cover that provides benefits for a range of natural therapies. Natural Plus is available with all levels of stand alone extras cover.
Services and benefits
Limit
Natural Therapies Remedial Massage, Bowen Therapy, Chinese Herbalism, Western Herbalism, Feldenkrais, Myofascial Release, Shiatsu, Reflexology, Iridology, Alexander Technique,
$160
Kinesiology, Therapeutic Massage, Swedish Massage, Myotherapy, Nutritionist
Per consultation
$20
Benefits are payable for consultations by recognised providers only and are limited to one consultation per person per day for all natural therapies. Please refer to ‘Extras cover explained’ on page 8 for details on waiting periods and more.
47
Health management and support programs Your hospital cover gives you access to various programs outside of hospital to assist with improving your overall health and wellbeing. Simply check the level of your hospital cover to see which programs you’re covered for.
Health Management Programs
Home Health Partner
Newborn Support Program
Health management programs can cover Coronary Artery Disease, Bone Health and Type 2 Diabetes. They are designed to support members who are looking to improve the way they manage their condition(s) and overall health. All applications are individually assessed by Health Partners prior to enrolment.
Home Health Partner is a unique service designed to make the transition from hospital to home easier for you. If it is appropriate, you can elect to leave hospital early after an operation and continue receiving care in the comfort of your own home.
Newborn Support Program provides you with free support from qualified midwives during pregnancy and the first year of your baby’s life. It offers advice and support in areas such as high blood pressure during pregnancy, breast feeding, sleeping and advice on solids after birth.
Members suffering from chronic disease, complex health or mental health issues and are otherwise determined by Health Partners as requiring ongoing medical support will be entitled to register for a Chronic Condition Management service which provides telephone-based information and support for self-management of these health conditions.
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We can ensure you receive all the support you need to help you on the road to recovery. By working with the hospital staff and your doctor, services such as nursing care and home help can be arranged. We may also assist you to avoid a hospitalisation altogether. All cases are individually reviewed by the hospital prior to your discharge to the care of your GP, with a care plan developed appropriate to your clinical needs.
Support is available via email and phone, along with online links to credible sources and useful sites and resources. You can apply via Members Online when you (or your partner) become pregnant. Application forms are also available at healthpartners.com.au or upon request.
Government surcharges and incentives Private health cover legislation may affect your choice of health cover. The following will help you understand how you can benefit from the incentives and avoid unnecessary expenses. The Rebate
Medicare Levy Surcharge
he Australian Government Rebate on Private Health T Insurance was introduced as a financial incentive to help Australians afford private health cover. The rebate depends on your age, is income-tested and applies to all Health Partners products. The rebate may be claimed as a reduction in your premiums or via your tax return and we can help you nominate your most suitable rebate tier.
The Medicare Levy Surcharge (MLS) is a maximum 1.5% surcharge imposed on people who earn above a certain income and who do not have private hospital cover. The level of surcharge depends on your level of income for MLS purposes and is payable in addition to the Medicare Levy.
The rebate is indexed by the lesser of CPI or the percentage change in your premium each year, using a Government calculated formula.
For further details visit healthpartners.com.au or call us.
Lifetime Health Cover Lifetime Health Cover (LHC) is a Government initiative designed to encourage you to take out private hospital cover earlier in life and to maintain your cover. For every year you are over 30 and do not have hospital cover you will pay an additional 2% loading on top of your ‘base’ hospital contribution. Please note that the Rebate does not apply to the LHC component of your private health cover.
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Things you should know This brochure outlines the benefits and services available with Health Partners health covers and does not contain all of the Fund’s rules. It should be read and retained in conjunction with Health Partners’ Product Disclosure Statement (PDS). The information in this document is correct at time of printing and subject to change. Product Disclosure Statement (PDS)
Complaints
The PDS contains additional important information on the general terms of membership and cover with Health Partners, including who can be covered on a membership, our Privacy Policy, Resolution Process and health insurance initiatives from the Australian Government. Please read and consider the PDS before joining or changing your cover.
At Health Partners we recognise that despite our best intentions, members may have concerns or complaints regarding their membership with us. Should you have a concern or complaint, please contact us directly via phone, email or mail. We have a formalised Resolution Process to ensure that all feedback and concerns are heard and addressed fairly and satisfactorily. You can view this process online at healthpartners.com.au.
This is available at healthpartners.com.au/PDS or by calling 1300 113 113.
Prior to treatment We recommend you call us before commencing treatment to clarify your benefit eligibility.
Participating hospitals Participating private hospitals are hospitals which have an agreement with Health Partners. This ensures you receive quality benefits and services at most hospitals Australia-wide. For more information, contact us.
Membership types We offer single, couple, family, family focus and sole parent memberships. For details on who can be covered under each membership type, please call us or visit our website at healthpartners.com.au.
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Private Patients’ Hospital Charter The Charter is a guide on your rights and responsibilities as a private patient in a private, public or day hospital. The guide is issued by the Minister of Health and Ageing and is available from Health Partners.
Review Period If you are not satisfied with your new cover, we will refund your contributions in full, provided it is within 30 days of joining or changing cover and no claims have been made.
Your Choice Health Partners respects and encourages individual members’ choices when it comes to selecting the type of treatment/practitioner for their health needs. Provider recognition is not to be taken as Health Partners’ endorsement or recommendation of any particular service, treatment or practitioner.
Privacy Your privacy is always a priority at Health Partners. For a copy of our Privacy Policy visit healthpartners.com.au or call us. Please read this when joining and ensure that every person on your membership is aware of Health Partners Privacy Policy.
Contribution rates and quotations Please contact us for a quote on your choice of cover. You will be asked to confirm your (and your partner’s/spouse’s) lifetime health cover loading, if applicable. Your quote can also be tailored according to your eligible rebate tier. For more information, see page 49 or call us. We will be happy to help you. You can also get a quote online in just minutes at healthpartners.com.au.
Up-to-date payments For fast and seamless claiming, please ensure that your health cover payments are up to date. HICAPS claiming is not available if your payments are in arrears. Please call us if you are experiencing any difficulties with payment.
Direct-debit Service Agreement The Direct-debit Service Agreement includes the responsibilities of both Health Partners and the member to ensure a smooth and secure operation of your direct debit. Please read this when selecting the direct-debit payment option. For a copy of our Direct-debit Service Agreement visit healthpartners.com.au or call us.
Pharmacy 20% discount Extras and package members are eligible to receive 20% discount on most non-prescriptions items, upon presentation of their Health Partners membership card at a participating Health Partners pharmacy. It is for personal use only and excludes agency lines (e.g. X-Lotto), Schedule 3 recordable items and total store category sales of 40% or more.
Glossary For a glossary on some of the commonly used terms in health insurance, visit healthpartners.com.au/glossary.
Other useful resources Information about private health insurance and government initiatives such as the Rebate, Lifetime Health Cover and Medicare Levy Surcharge can also be found at: privatehealth.gov.au humanservices.gov.au ombudsman.gov.au
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Claiming your way Your options don’t end at health cover. When it comes to claiming, choose the option to suit you. Health Partners App
Direct billing with Access Gap Cover
Simply download the free app to your smartphone, register your details, take a photo of your itemised account and submit.
If your doctor has chosen to participate in Access Gap, they’ll send your medical bill directly to us. Once we’ve paid it, we’ll send you a statement to let you know the benefits that have been paid on your behalf. If there is any amount outstanding, this will be payable by you.
With no paperwork or hassle, most benefits are paid within 2 business days of your claim being submitted.
Online Submit your claim in three simple steps via Members Online at healthpartners.com.au.
On the spot Your claim can be processed on-the-spot whenever you visit a HICAPS provider or Health Partners professional. Simply present your membership card at the time of service and you will only have the balance to pay – or nothing at all, depending on your level of cover.
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Claim form Claim forms are available on our website, at our centres and upon request. Supply your direct credit details for electronic payment or opt for cheque payment. Once the form is completed (with itemised accounts attached), you can mail it freepost to Health Partners Claims Assessor, Reply Paid 1493, Adelaide SA 5001. If you prefer, submit your claims in person at any Health Partners Member Services, Dental or Optical centre. Please note that over-the-counter cash claiming is not available.
Where to find us With over 100 Health Partners professionals across South Australia, we’re always in reach.
Health Partners Member Services
Health Partners Optical
Call 1300 113 113 for all enquiries or come in and see us at:
For appointments, please call the number listed for each of our 4 locations:
Adelaide:
101 Pirie Street
Adelaide:
Modbury:
27 Smart Road
Goodwood: 92 King William Road 1300 116 116
[email protected] healthpartners.com.au
101 Pirie Street
Modbury: 27 Smart Road
1300 115 115 1300 127 127
Woodcroft: 185-191 Bains Road 1300 191 191
[email protected] optical.healthpartners.com.au
Health Partners Participating Dentists Call 1300 114 114 for all appointments at any one of our 3 locations: Adelaide:
Level 1, 101 Pirie Street
Modbury: Level 1, 27 Smart Road Woodcroft: 185-191 Bains Road
[email protected] dental.healthpartners.com.au Barossa Dental Call 08 8562 1444 for all enquiries:
Health Partners Participating Pharmacy and Physiotherapy To find the Health Partners provider nearest to you, visit the ‘Partner Search’ at healthpartners.com.au from your computer, tablet or smartphone, or call us on 1300 113 113. We have 50 pharmacies and over 45 physiotherapists across metropolitan Adelaide and country South Australia.
Nuriootpa: 37 Barossa Valley Way
[email protected] barossadental.com.au
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Joining is simple Choose from three convenient options. If you have any questions, we’re just a phone call away.
Call 1300 113 113. Our friendly and experienced staff can help you from 8am to 8pm, Monday to Friday and 9am to 1pm on Saturdays.
Join online 24/7 at healthpartners.com.au
Complete and return the attached membership application form.
Transferring from another fund?
Payment options
That’s simple too. Just include your membership details when you apply and we will take care of the rest for you. And, if you switch to an equivalent level of cover you may not have to re-serve your waiting periods. Please refer to the PDS for more information or contact member services.
We offer a 3% discount for direct-debit payments which can be made fortnightly*, monthly, quarterly, half-yearly or yearly.
Commencement of your cover Your cover will commence automatically on the date that you apply, unless you have requested your membership to commence at a later date. Benefits are payable once your first payment is received and applicable waiting periods have been served.
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If you prefer, we can send you an account or you may select payroll if your employer is registered for payroll with Health Partners. *Fortnightly payments from bank account only.
Notes
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Notes
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Adelaide 101 Pirie Street Modbury 27 Smart Road Head Office Level 3, 101 Pirie Street, Adelaide Health Partners, Reply Paid 1493, Adelaide SA 5001 General enquires 1300 113 113 or 1800 182 322 for country and interstate callers Fax (08) 8113 2259 Website healthpartners.com.au Email
[email protected]
HPP01/1604
Health Partners is a registered private health insurer since 1937. All information in this brochure is effective 1 April 2016. Health Partners Ltd ABN 43 128 282 904
