Overseas Student Health Cover - OSHC

Allianz Global Assistancewelcomes you to Australia!We understand that maintaining your health is an importantpart of making your stay in Australia as safe and enjoyableas possible.Allianz Global Assistance is here to assist and provideservices and information that make it easy to understandand use the health cover which is available to you, whilststudying in Australia.What is OSHC?Overseas Student Health Cover (OSHC) is health insurance forinternational students which provides cover for the costs of:• Out of hospital medical treatment• In hospital medical treatment• Prescription medicines• Surgically implanted prostheses• Emergency ambulance transportThe Department of Health and Ageing (DHA) regulatesOSHC and OSHC providers.Why is OSHC important?Student Visa requirementThe Australian Government through the Department ofImmigration and Citizenship requires all holders of a StudentVisa to maintain OSHC during their entire stay in Australia.Section one:OSHC Essentials policyWho is eligible for OSHC?Overseas students are eligible for OSHC. You are an overseasstudent if you are:(a) a person who is the holder of a Student Visa; or(b) a person whoiiiiiiis an applicant for a Student Visa; andis the holder of a Bridging Visa; andwas, immediately before being granted theBridging Visa, the holder of a Student Visa.Single or Family CoverYour Certificate of Insurance will show which cover and policyyou have selected. Your cover may be either:• Single – covering only the overseas student; or• Dual family – covering the overseas student, and either oneadult spouse or recognised de facto partner or one or morechildren or step-children under the age of 18 years who arenot married; or• Multi family – covering the overseas student and morethan one dependant, which can only include one adultspouse or recognised de facto partner and one or moredependant children.Maintaining OSHC is a mandatory conditionAccording to Student Visa condition 8501, overseas studentswho do not maintain their OSHC are at risk of having theirvisa cancelled.Medical treatment can be expensiveOverseas students are not eligible for Medicare (the publichealth insurance system for Australian Residents). Withoutaccess to Medicare, overseas students may have difficultypaying for medical treatment. In most cases, hospital treatmentwill cost more than $800 per day.2 3

Benefits covered under your policyMedical and hospital benefitsIn the event of medical treatment being required by you orany dependants covered under your policy and occurringduring the period of cover, we will pay benefits for the following:ServiceOut of hospital medical servicesMedical servicesprovided by most generalpractitioner servicesAll other medical servicessuch as pathology andradiology (includingspecialists)In hospital medical servicesMedical services providedin hospitalPublic hospital – admittedpatient in shared ward,hospital same day services,accommodation, accidentand emergency and outpatient medical, and postoperativeservicesPrivate hospital/registeredday hospital facilityBenefit per serviceBenefit amount as listed in theMedicare Benefits Schedule (MBS)100% of the MBS fee*Benefit amount as listed in theMedicare Benefits Schedule (MBS)85% of the MBS fee*100% of the Medicare BenefitsSchedule Fee.The rate determined by State andTerritory health authorities forservices charged to a patient who isnot an Australian resident.100% of the contracted chargesfor all insurable costs raised byone of our agreement hospitalswith a minimum of shared wardaccommodation.ServicePrescription medicinesFor prescription medicinesprescribed by your doctor.Excludes:medications, drugs orother treatments notprescribed by a doctoror not listed on thePharmaceutical BenefitsScheme (PBS).Surgically implanted prosthesesSurgically implantedprostheses and other itemsincluded on the FederalGovernment’sprostheses listAmbulance servicesWhen medically necessaryfor admission to hospital orfor emergency treatmentBenefit per servicePrescription medicines benefitfor expenses exceeding theequivalent of the currentPharmaceutical Benefits Scheme(PBS) patient contribution forgeneral beneficiaries up to a:• maximum benefit of $50 perprescribed item• maximum amount per calendaryear for Single cover of $300• maximum amount per calendaryear for Family cover of $600Each individual in a family has alimit equivalent for a single personas long as the family maximumbenefit has not been used.100% of the cost as listed on theAustralian Prostheses list.100% of the charge for transportby an ambulance provided byor under an arrangement withan approved ambulance servicewhen medically necessary foradmission to hospital or foremergency treatment.* Benefits payable as per the Medicare Benefits Schedule FeeYou may incur out of pocket costs for hospital expenses4 5

How long do I have to be covered?The Australian Government requires that you have continuousOSHC for the entire length of your stay in Australia.You can purchase OSHC for the proposed length of your StudentVisa (as provided by you to us).Periods of cover:1 Your OSHC Policy is only valid whilst you hold a currentStudent Visa and have paid the full premium required.2 You are insured for the period of cover shown on yourCertificate of Insurance, starting on the commencementdate shown and ending on the expiry date shown.3 Your cover ceases on the date of your departure fromAustralia, the date you cease to hold a Student Visa, or onthe expiry date shown on your Certificate of Insurance,whichever occurs first. However if you leave Australia on aholiday but return prior to the expiry date shown on yourCertificate of Insurance and you still hold a current StudentVisa when you return, your cover will recommence on yourreturn to Australia and continues for the remaining periodof your cover.4 The minimum period for which you must have OSHCcover is the duration of your Student Visa, unless a medicalcondition verified by a doctor and acquired during the termof your Student Visa has resulted in you being unfit to travelhome. However you will be required to provide to DIACevidence of continuous coverage by OSHC for the proposedduration of your Student Visa as a condition of beinggranted a Student Visa for that proposed duration.5 It is a Student Visa requirement that OSHC must becontinuous for the term of your Student Visa. If you allowyour OSHC to lapse whilst on a Student Visa, and you wishto renew your OSHC during the duration of your StudentVisa, you must pay the premiums for the lapsed period.6 No benefits are payable for claims incurred by you duringthe lapsed period of your OSHC.7 Regardless of the general exclusions listed in this policy,no additional waiting periods will apply to claims youmake if you have allowed your OSHC to lapse whilst on aStudent Visa and have since renewed your OSHC during theduration of your Student Visa.Services which are not covered under your policy:(a) services provided by physiotherapists, osteopaths,chiropractors, naturopaths or any other ancillary services(b) medications, drugs or other treatments not prescribed by adoctor and not included in the PBS(c) any costs associated with dental treatment, unless theservices provided meet the requirements of the MedicareBenefits Schedule(d) optical charges(e) the co-payment payable by you under Australian law or asa result of the provider charging in excess of the MedicareBenefits Schedule Fee(f) service fees charged by a doctor or hospital which are notincluded in the benefits covered under your policy.General exclusionsBenefits are not payable for:(a) for services and treatment rendered as part of an assistedreproductive program, including but not limited toin-vitro fertilisation;(b) for treatment rendered outside of Australia, whether ornot in connection with a course of study and includingtreatment necessary en route to or from Australia;(c) for treatment arranged in advance of the dependant’sor overseas student’s arrival in Australia;(d) for treatment rendered to a dependant or overseas studentin the first twelve months after arrival in Australia wherethat treatment is for a pre-existing condition (other thana pre-existing condition of a psychiatric nature). Thisexclusion does not apply where a medical practitionercertifies, and we agree, that the dependant or overseasstudent required emergency treatment in Australia.We will not unreasonably withhold our agreement;(e) where an application was made for a Student Visa by anonshore applicant, who previously did not hold a StudentVisa, treatment rendered to a dependant or overseasstudent in the first twelve months after purchase of OSHCwhere that treatment is for a pre-existing condition (otherthan a pre-existing condition of a psychiatric nature). This6 7

exclusion does not apply where a medical practitionercertifies, and we agree, that the dependant or overseasstudent required emergency treatment in Australia.We will not unreasonably withhold our agreement;(f) for treatment of secondary conditions or disabilitiesdirectly arising from the conditions or disabilities to whichsubclause (d) and (e) applies will be treated in accordancewith the provisions of subclause (d) and (e) respectively;(g) treatment for a pregnancy related condition for adependant or an overseas student where total duration ofthe overseas student’s visa and any immediately precedingvisa is less than three months. If an overseas student on aninitial visa of less than three months duration obtains a newStudent Visa to increase their stay to three months or morethen this exclusion ceases from the date of issue of thesecond visa;(h) for transportation of a dependant or overseas student intoor out of Australia in any circumstance;(i) for services and treatment which are covered bycompensation or damages, entitlements or payments ofany kind; and(j) for elective cosmetic surgery.For the purposes of these exclusions, the date of an overseasstudent or dependant arriving in Australia, and whether or nota condition is a pre-existing condition, will be determined inaccordance with the section 'Waiting period for pre-existingconditions' below.Waiting period for pre-existing conditionsThere is a waiting period for pre-existing conditionsYou cannot claim for costs arising during the waiting period ifsuch costs arise from a pre-existing condition (other than apre-existing condition of a psychiatric nature).The waiting period is calculated as 12 months commencing from:• the date you or your dependant (as the case may be) arrivedin Australia; or• the date your Student Visa was granted,whichever is the later date.A pre-existing condition is an ailment, illness or conditionthe signs or symptoms of which (in the opinion of a medicalpractitioner approved or appointed by us) existed in the periodof six months ending on the later of:• the date you or your dependant (as the case may be) arrivedin Australia; or• the date your Student Visa was granted.In forming this opinion, the medical practitioner must haveregard to any information in relation to the ailment, illness orcondition provided to that medical practitioner by the medicalpractitioner who treated the ailment, illness or condition.This includes an ailment, illness or condition that was present,but had not been diagnosed by a medical practitioner at thetime of your arrival in Australia or the date your Student Visawas granted, whichever is the later date.A pre-existing condition includes a secondary related conditionor disability directly arising from a pre-existing condition.Other important mattersThis section explains your and our rights and responsibilitiesunder this policy.1 HospitalisationIf you or a person covered under your policy is hospitalised, youor the hospital must advise us as soon as possible.2 Protection of your personal informationThe information that you provide is collected for the purpose ofarranging and issuing you with your OSHC policy and assessingand managing any claims you may make under this policy.Your personal information is disclosed to organisations such aseducational institutions, Lysaght Peoplecare, AGA AssistanceAustralia Pty Ltd, our sales and marketing agents, governmentdepartments, medical practitioners, and medical assistanceproviders, hospitals, claims assessors and investigators.When you apply for this policy you agree, in respect of anyclaim, to us collecting from, using and disclosing your personalinformation (including medical information) to your healthcareprovider for the purpose of administering your claim and to usdisclosing your personal information to DIAC in the event thatyou receive a premium refund for whatever reason or cancelyour OSHC policy. Please contact Allianz Global Assistance if youwould like access to your information.8 9

3 Transferring from another OSHC FundIf you transfer to Allianz Global Assistance OSHC from anotherOSHC Fund and can provide documentary proof of the periodyou had cover with the other Fund, we will take this periodof cover into account when assessing the waiting period forany pre-existing condition. If you are transferring to AllianzGlobal Assistance OSHC, we require that you obtain a clearancecertificate from your current OSHC Fund.To arrange your transfer visit us at oshcallianzassistance.com.au orcall 13 OSHC (13 6742) or mail us at oshc@allianz-assistance.com.au4 Resolving your concernsAny enquiry or concerns relating to this policy should bereferred to:Allianz Global AssistanceOverseas Student Health CoverLocked Bag 3001TOOWONG QLD 4066Telephone 13 OSHC (13 6742)Private Health Insurance OmbudsmanThe Private Health Insurance Ombudsman has beenestablished to assist with enquiries and complaints aboutany aspect of private health insurance. The Ombudsmanis independent of private health funds, private and publichospitals and the Government. Information may be obtained orcomplaints lodged about health insurance by telephoning theOmbudsman’s office toll free on 1800 640 695.5 Premium refundsYou can apply in writing for a pro-rata refund of premium forthe unexpired portion of your policy if:(a) you paid your premium and did not come to Australia(b) you paid your premium on the basis of an extended stay butthe extension of authorised stay was not granted by DIAC(c) you are obliged to cease studies and leave Australia beforethe end of a period of approved stay for reasons beyondyour control(d) you have been granted permanent residence in Australia(e) you were not resident in Australia for a continuous period of3 months or more but whilst holding a valid Student Visa(f) you can provide proof of OSHC provided by another organisationwhich includes the period covered by the organisation.Please note:• Refunds are calculated on a monthly pro-rata basis, with aminimum refund of one month.• A minimum cover period of 3 months is payable if cover iscancelled whilst in Australia.• Any amount that we retain on these grounds is treated as afee for processing your refund.• There is no minimum cover period payable if cover is cancelledprior to arrival in Australia.6 You must help us recover any money we have paidIf a claim made by you and paid by us under this policy is subjectto recovery action by us against a third person you must dothe following:• Assign your rights in relation to the recovery of any amountwe have paid under this policy.• Provide us with reasonable assistance to recover paymentsmade by us.• Reimburse us for any amounts paid to you as part of asettlement for claims paid by us.7 You must provide additional information upon requestYou must provide all information and details that we mayreasonably require in order to process any medical andhospital claims.8 Compensation fundBenefits are not payable if your claim is for a loss which isrecoverable by compensation under any workers compensationor transport accident laws or by any government sponsoredFund, Plan, or Medical Benefit Scheme, or any other similar typelegislation required to be effected by or under a law.9 FraudInsurance fraud places additional costs on honest policy holders.Fraudulent claims force insurance premiums to rise.We encourage the community to assist in the prevention ofinsurance fraud. You can help by reporting insurance fraud.All information will be treated as confidential. Report insurancefraud by calling 1800 453 937.10 11

Words with special meaningsSome words in this policy have special meanings and aredefined below.“benefit” means an amount of money we will pay to youor on your behalf for approved expenses incurred by you inaccordance with your policy.“Bridging Visa” has the meaning given by subsection 5 (1) ofthe Migration Act 1958.“co-payment” means the amount you must contribute towardsa claim. It is the difference between the amount payable underthe Medicare Benefits Schedule and the amount actuallycharged for the medical service.“dependant” means a person who is:(a) a spouse or de facto partner of an overseas student; or(b) a child or step-child of an overseas student who isunmarried and has not turned 18."DIAC" means the Department of Immigration and Citizenship.“doctor” means a person qualified and registered to practicemedicine or surgery in Australia."emergency treatment" means the treatment of any of thefollowing conditions:(a) risk of serious morbidity or mortality and requiring urgentassessment and resuscitation; or(b) suspected acute organ or system failure; or(c) an illness or injury where the viability of function of a bodypart or organ is acutely threatened; or(d) a drug overdose, toxic substance or toxin effect; or(e) psychiatric disturbance whereby the health of the patient orother people is at immediate risk; or(f) severe pain where the viability or function of a body part ororgan is suspected to be acutely threatened; or(g) acute haemorrhaging and requiring urgent assessment andtreatment; or(h) a condition that requires immediate admission to avoidimminent morbidity or mortality and where a transfer toanother facility is impractical."hospital” means an established hospital registered underAustralian legislation that provides in-patient medical care.“hospital same day services” means minor medical, surgicalor diagnostic treatment provided in a registered hospital ormedical centre, which does not require you to be confined in ahospital overnight but must be admitted as a day patient.“injury” or “injured” means bodily injury.“limit” means the maximum amount of payment by us. A limitapplies per person as long as the maximum benefit has notbeen used if you have a family policy (this includes both dualfamily or multi-family policies). Unless otherwise stated yourlimit relates to the maximum amount payable under a standard12 month policy and is pro rata according to the length of coverof your policy."medical practitioner" has the meaning given to it in theHealth Insurance Act 1973.“overseas student” has the same meaning as in Rule 18 of theHealth Insurance Business Rules, that is:(a) a person who is the holder of a Student Visa; or(b) a person who:i is an applicant for a Student Visa; andii is the holder of a Bridging Visa; andiii was, immediately before being granted the BridgingVisa, the holder of a Student Visa.“PBS patient contribution” means the co-payment you arerequired to pay, by law, towards the cost of a prescription beforewe start to calculate your benefit. The co-payment you haveto pay is the same as an Australian who does not receive anyconcessional payments.“Pharmaceutical Benefit Scheme” or “PBS” means theCommonwealth Scheme for the payment of pharmaceuticalbenefits detailed in Part VII of the National Health Act.“premium” means the premium payable for your OSHC policy,including all taxes and charges.“prescription medicines” means those medicines that requirea prescription completed by a doctor or other authorisedpractitioner in order to be dispensed by a registered pharmacist.Benefits are only payable on prescription medicines listed withinthe Pharmaceutical Benefits Scheme.12 13

“schedule fee” means the amount as determined from time totime by the Australian Government and listed in the MedicareBenefits Schedule as the standard fee for a certain treatmentor service.“Student Visa” has the meaning given by subsection 5(1) of theMigration Act 1958 and includes a Bridging Visa.“we”, “us” and “our” means Lysaght Peoplecare Limited, aprivate health insurer under the Private Health Insurance Act2007 (Cth) and AGA Assistance Australia Pty Ltd (trading asAllianz Global Assistance) as the manager of this OverseasStudent Health Cover product.“you” or “your” means the person or persons named in theCertificate of Insurance under the heading ‘Insured Persons’.Section two:Members guideOSHC 24 hour helpline - 1800 814 781In the event of a medical or personal situtation, we will assist you with:(a) 24 hour medical advice and assistance(b) 24 hour referrals to a doctor for medical treatment(c) 24 hour telephone access to a solicitor for legal advice(d) 24 hour access to an interpreting service(e) assistance to replace travel documents or passports(f) any messages which need to be passed to your family orfriends in the event of an emergency.In a medical emergency call triple zero (000).AGA Assistance Australia Pty Ltd trading as Allianz GlobalAssistance has been appointed by the underwriter to administerall assistance services. Please note that the provision of assistanceservices to you is not deemed to be acceptance of cover incircumstances where no cover is otherwise available to you underthis policy.The Australian healthcare systemIt is very important that you have a good understanding of theAustralian healthcare system. If you understand the healthcaresystem in Australia, you will be able to access the best and mosteffective treatment for you.General practitionersIf you are not in a medical emergency situation, the first point ofcontact is a general practitioner (GP), medical practitioner or localhealth/medical centre. You can access many services at your localhealth centre. Some of the services available are:• General medicine and simple diagnostic screenings.• Assessment and treatment of health problems and injuries.• First aid services as needed.• Women’s and men’s health.• Referrals to specialist services.In most cases, it is necessary for you to make an appointmentto see your doctor.14 15

Accident and emergency treatmentMany hospitals have a 24 hour Accident and Emergencydepartment. Accident and Emergency departments should onlybe accessed in the case of emergency situations. When you visitan accident and emergency department, a nurse will assess youand if your illness or injury is not deemed as an emergency, youmay need to wait a long time to see a doctor.Hospital treatmentIf you have been admitted for emergency treatment, contactAllianz Global Assistance immediately on 1800 814 781. If youhave been referred to hospital for a non emergency admission,contact the claim department on 1800 651 349 prior toadmission. You will need to provide Allianz Global Assistancewith the details of your treatment and hospital stay. We willthen be able to confirm your cover and assist you with makingarrangements for payment to the hospital.Public admissionGenerally, OSHC covers the total cost of your stay andtreatment as an in-patient in a shared ward of a public hospital.As a public patient, your doctors will be nominated by thehospital. After your hospital discharge your care will be carriedout in either the outpatient clinic, by one of the hospital'sspecialists in his/her private rooms or you will be referred toyour local general practitioner.Private admissionYou can choose to be treated in a private hospital. Through ourrelationship with Lysaght Peoplecare we have arrangementsin place with most private hospitals in Australia. Theseagreement hospitals ensure that an agreed schedule of fees(including in-patient accommodation, theatre and special unitaccommodation fees as appropriate) is charged by the hospitaland paid by Allianz Global Assistance on a member’s behalf. Youmay incur out of pocket costs for private hospital expenses.There are only a few private hospitals that are not part of theseagreement hospitals. In these cases, we may not cover the fullcost of your hospitalisation however, if you call us for a chatbefore you go into hospital we’ll be able to tell you how much itwill cost you. Members who choose a non-agreement hospitalmay incur out of pocket expenses for hospital related services.How do I find a doctorDirect billing servicesIn order to minimise your medical expenses, you can attend ahealth service or doctor that direct bills Allianz Global Assistance.You can find your closest direct billing service on our website atwww.oshcallianzassistance.com.au. You simply have to showyour valid Allianz Global Assistance OSHC membership card,and the bill for the covered portion of your service will be sentdirectly to Allianz Global Assistance.Other medical providersYou can attend any other medical practice or doctor inAustralia. In most cases, you will be required to pay the bill,and submit a claim to Allianz Global Assistance in order to getyour benefit reimbursed. Some medical practices or doctorsmay charge more than the benefit payable, in which case youwill be required to pay a co-payment that is not covered byyour policy.Your claiming optionsFor paid and unpaid accountsOnline claimsStep 1 Go to the website :www.oshcallianzassistance.com.auStep 2Step 3Step 4Step 5Step 6Step 7Click on 'Students'Enter your policy number, family name and dateof birth to loginConfirm your detailsSelect 'File a Claim' from the menu and followthe promptsUpon successful submission of an online claim,a unique claim number will be provided. Writethis claim number at the top of each of your taxinvoices/receiptsPost the original tax invoices/receipts directly toAllianz Global AssistanceIt is important that you keep a copy of all your invoicesand receipts.16 17

Postal claimsStep 1Step 2Step 3Step 4Obtain a claim form from your educationalinstitutution, an Allianz Global Assistance OSHCmember service point or download and print a formoff from our websiteComplete the claim form in full. Please write clearlyand sign the form ensuring you have clearly writtenyour OSHC policy number on the formAttach your receipts to the claim formPost the claim form, original tax invoices andreceipts directly to Allianz Global AssistanceIt is important that you keep a copy of all your invoicesand receipts.For paid accounts onlyCash claimsA Cash claim is a convenient way of processing your claimon‐campus. Cash claims are available at most major institutions.There is a limit of $105 per invoice, and your medical bill musthave already been paid by you.Unpaid accountsIf you have not paid your medical or hospital bill, the benefit willbe paid:• to the nominated health care provider (eg. doctor or hospital).You are responsible for any ‘co-payment’ payable to the provider.In some instances our claims officers will contact you to requestmore information. If you have further questions about claims, visitthe ‘Claiming made easy’ fact sheet on our website lised below.We will endeavour to process your claim within 10 working daysof receiving a completed claim form and all original documents.If we need additional information, a written request will be sentto you within 10 working days.Helpful servicesOnline services and informationSimple and easy to use services and important information canbe found at our website www.oshcallianzassistance.com.auMembers servicesIf you need assistance with any matter, contact our friendly andhelpful member service officers on 13 OSHC (13 6742), whowill be able to assist you.Step 1Step 2Bring your original receipts to your local AllianzGlobal Assistance OSHC representative who willprocess your claimYou will receive a voucher that you can take to anAustralia Post outlet to redeem for cashClaims reimbursementPaid accountsIf you have paid your medical or hospital bill, your benefit will bereimbursed in Australian dollars by:• Direct debit - into your nominated Australian bank account;or• Bank cheque - sent to your postal address as nominated on yourclaim form - please ensure your postal address is correct and upto date.18 19

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Allianz Global AssistanceOverseas Student Health Cover - EssentialsOnline services and informationwww.oshcallianzassistance.com.auMembers services and general enquiries13 OSHC (13 6742)Claims1800 651 349OSHC 24 hour helplineMedical assistance, legal and interpreting services1800 814 781In a medical emergency call triple zero (000)This insurance is arranged and managed byAGA Assistance Australia Pty LtdABN 52 097 227 177Trading as Allianz Global Assistance74 High Street Toowong QLD 4066Locked Bag 3001, Toowong QLD 4066AustraliaPhone: in Australia 13 OSHC (13 67 42)From overseas: +61 7 3305 7000Fax: +61 7 3305 7009oshc@allianz-assistance.com.auwww.oshcallianzassistance.com.auEffective 6 Decemeber 2012Allianz Global Assistance Overseas Student Health Cover policies are authorisedunder a Deed entered into between Lysaght Peoplecare Limited and theAustralian Government through the Department of Health and Ageing.Other optionsAllianz Global Assistance Overseas Student Health Reverse Cover is managed by AGAWhen used on a coloured background.This should be a rare situation.Assistance Australia Pty Ltd ABN 52 097 227 177Betradingcareful that it doesasnotAllianzclash.GlobalExamples of when this logo may beAssistance. Lysaght Peoplecare Limited ABN 95 087 used include 648 banners, 753, promo a items private healthand uniforms.insurer under the Private Health Insurance Act 2007 (Cth), is the underwriter ofAllianz Global Assistance Overseas Student Health Cover policies.MonoFor 1 colour print situations.