Member Guide - RACT

April 2013If you find better value health insurance within 60 days of joining and haven’t madea claim, simply cancel your membership and we’ll give you your money back!HEALTH INSURANCE1

Why get private health insurance?Why choose RACT Health Insurance?Why hospital cover?The most common reasons for taking out hospitalcover include:3 Greater choice of who treats you3 More choice regarding when and where you’retreated.3 Having cover makes out of pocket costs much moremanageable, providing financial protection.3 Peace of mind knowing that you are covered whenyou need it the most.Why extras cover?Extras is the health insurance you want to use becauseit gives you access to benefits for services Medicarewon't cover such as:3 Dental & Orthodontic care to keep your teethhealthy3 Visits to the Physio, Chiropractor or RemedialMassage.3 Optical care including glasses or contact lenses.3 You can claim on the spot using your RACT HealthInsurance membership card at more than 26,000providers nationally.There are financial benefits too...Save on taxIf your taxable income is over the amount set by theGovernment, you can avoid paying the extra 1% -1.5%Medicare Levy Surcharge (depending on your income)by taking out any one of our hospital covers for youand your dependants. You can find more informationat privatehealth.gov.au or ato.gov.auAvoid paying more after you turn 31By taking out hospital cover before 1 July after your31st birthday you’ll avoid paying a higher premium.If you join hospital cover after this date you’ll pay anextra 2% on the premium for every year you don’thave health insurance after you turn 30, up to a totalof 70%. See pages 44-45 for details.3 Member loyalty program - Connect Rewards Plus(see page 40)3 Not-for-profit private health insurer60-day money-back guarantee:If you find better value health insurance within60 days of joining and haven’t made a claim,we’ll refund your money in full. It’s that simple!4 5

What life stage are you? Join today. It’s as easy as 1, 2, 3…Follow our easy to use guide to help you find the most suitable cover for your current life stage.1. Family membership covering:a) You (the fund member).b) Your partner – a person with whom you are living in a bona-fidedomestic relationship.c) Your child dependants under the age of 21 years (including step, adopted andpermanent foster children).d) Your student dependants who are under 25 years old who are:– single– full-time apprentices, full-time trainees or full-time students at a school, college,university or institution recognised by us and who primarily rely on you (the fundmember) for maintenance and support.STEP 1: Choose your coverDo you want hospital or extras cover, or both?STEP 2: Choose your level of coverSelect the level that best suits your needs.Choose your hospital coverPlatinum Gold Silver Bronze2. Young couples membership: covering you and your partner (as definedabove in 1b). With some exclusions for services you might not need.Choose your excess levelYou can reduce the cost of your hospital cover by having a calendar year excess.3. Mature couples membership: covering you and your partner(as defined above in 1b).Level 0($0 excess)Level 1($250 single and$500 families/couples/single parents)Level 2($500 single and$1000 families/couples/single parents)4. Single parents hospital: covering you, your children and dependants asdefined above in 1c) and 1d).Choose your extras coverPlatinum Gold Silver Bronze5. Single membership: covering one fund member only.Please note: These life stage illustrations are a reference guide only and should be read in conjunction withthe information in this member guide. If you prefer to speak to a trained health insurance consultant pleasecall 13 27 22.STEP 3: Join RACT Health InsuranceThere are 3 simple ways to join:1. Get a quote and join online at ract.com.au/healthinsurance2. Call 13 27 223. Fill in the application form at the back of this member guide6 7

Choosing the right hospitalChoosing the right extrasPlatinumGoldPlatinumGoldComprehensive cover for total peaceof mind with increased medical gapcoverage and a single room guarantee.Page 14High level of cover for a wide range oftreatments with medical gap benefits.Page 16Comprehensive cover on an extensiverange of services for total peace ofmind. Get more back with higherbenefits and increased annual limits.Page 24High level of cover on a wide rangeof services with generous benefitsand annual limits.Page 24SilverBronzeSilverBronzeModerate level of cover for commontreatments in a Private Hospitalexcluding a range of treatments andservices to help reduce the premium.Page 18Basic level of cover for treatment as aPrivate Patient in a Public Hospital withsome exclusions to reduce the premium.Page 20Moderate level of cover on a commonlyused range of services with a mediumlevel of benefits and annual limits.Page 24Basic level of cover on a limited rangeof extras services. Basic benefits andannual limits apply.Page 24Excess optionsYou can reduce the cost of your hospital cover by choosing a yearly excess (based on calendar year).There are 3 different excess levels available on Platinum, Gold, Silver and Bronze Hospital:Level 0 Nil excessLevel 1 ($250 single and $500 families/couples/single parents)Level 2 ($500 single and $1000 families/couples/single parents)Mix and match your hospital and extras productsTake out hospital or extras stand-alone or choose to join a comprehensive hospital with basic extras or vice versa.Get the cover that suits you best.8 9

Waiting periodsWhat are waiting periods?A waiting period is the time between when you joinRACT Health Insurance and when you can startclaiming. Waiting periods exist to protect members’funds from those who wait until they are sick and thenjoin a health fund just to claim large sumsimmediately.Waiting periods apply to:• new members to health insurance (members whohave never held hospital or extras cover with ahealth fund)• existing RACT Health Insurance members whoupgrade to a higher level of cover or reduce theirexcess payable• members who transfer from another health fundwho have not fully served the required waiting and/or benefit limitation period for equivalent benefits• treatment for a pre-existing condition.Waiting periodsHospital services (when included on cover)Waiting periodAccidents – Bodily injuries resulting from accidents which occur after the date of joining RACT HealthInsurance or upgrading to a higher coverNo waiting periodObstetrics and maternity12 monthsPre-existing ailment, illness or condition (other than psychiatric, rehabilitation and palliative care)12 monthsAny other benefit for hospital (or hospital substitution) treatment2 monthsExtras services (when included on cover)Waiting periodAll extras benefits except as specified below2 monthsOptical6 monthsMajor dental services (Including full & partial dentures, orthodontics, crown & bridgework, endodonticservices such as root canal, gold fillings, indirect restorations, surgical extractions of a tooth/teethincluding wisdom teeth)12 monthsHealth appliances including nebuliser pump, blood glucose monitor, pressure garments, sleep apnoeamonitor, extremity pump, hearing aids, orthopaedic appliances (approved by us), prostheses(non-surgical, approved by us), TENS monitor, podiatry surgical procedures and orthotic appliances (foot)12 months10 11

Quick hospital cover comparisonThis table provides a quick comparisonof the main features of RACT HealthInsurance's hospital covers and mustbe read in conjunction with the detailedinformation in this member guide.3 Cover provided in participating private hospital3 Public hospital cover as a private patient only.Not recommended for private hospital treatment✗ No benefits payable# Partial Coverage, a co-payment of $100 per day applies up to amaximum of $700 per admission^ Benefits for a single room in a public hospital will result in significantout-of-pocket expenses.Quick hospital cover comparison Platinum Hospital Gold Hospital Silver Hospital Bronze HospitalAccidents 3 3 3 3Single room guarantee a 3 ✗ ✗ ✗Accommodation – single room (where available) 3 3 # ^Accommodation – shared room 3 3 3 3Admission excess waiver for child dependantsaged under 213 3 ✗ ✗Broader health cover 3 3 3 3Cataract surgery and corneal transplants b 3 3 ✗ 3HOSPITAL COVERCosmetic surgery b (limited benefits - see page 57) 3 3 ✗ 3Delivery suite b 3 3 ✗ 3Dental Implants b 3 3 ✗ 3Gastric banding and all obesity surgeries b 3 3 e ✗ ✗a We will pay you $50 per day (up to maximum of $150 for 3 days) if youstay in a shared room when you requested a single room. See page 56for more details.b A pre-existing condition (PEC) is one where signs or symptoms of yourailment, illness or condition, in the opinion of a medical practitionerappointed by RACT Health Insurance (not your own doctor), existed atany time during the six months preceding the day on which youpurchased your hospital cover or upgraded to a higher level of hospitalcover and/or benefit entitlement. Please refer to pages 54 and 57 formore information.c Limited benefits may apply to high cost drugs. Drugs purchasedoutside the hospital are not included.d If the fund believes that a patient, following a review of the case (onthe basis of information provided by the hospital either internally orusing an agreed independent source), is not receiving acute care after35 days continuous hospitalisation, RACT Health Insurance benefits willbe reduced to nursing home type patients benefits and will be paid inaccordance with the default benefit determined by the HealthDepartment. All nursing home type patients are required to pay part ofthe cost of hospital accommodation.e During the first 24 months of cover (after the standard hospital waitingperiods have been served), benefits payable for these services will belimited to public hospital benefits only. See page 47 for moreinformation.Haemodialysis 3 3 e ✗ ✗Intensive and coronary care b 3 3 3 3IVF and related services b 3 3 ✗ 3Joint reconstruction e.g. knee b 3 3 3 3Joint replacement e.g. hip b 3 3 ✗ 3Medical gap cover 3 3 3 3Medical gap cover – increased benefit 3 ✗ ✗ ✗Nursing home type patients d 3 3 3 3Obstetrics b 3 3 ✗ 3Other agreed charges c 3 3 3 3Participating private hospital 3 3 3 ✗Psychiatric 3 3 e 3 e 3Rehabilitation 3 3 3 3Same-day treatment b 3 3 3 3Surgically implanted prostheses b(govt. prescribed benefits)3 3 3 3Theatre b 3 3 3 312 13

Platinum HospitalHOSPITAL COVERRecommended for:Platinum Hospital gives you comprehensive cover for totalpeace of mind with increased medical gap coverage and asingle room guarantee. 1HOSPITAL COVERWhat’s covered in a participating private hospital?Platinum Hospital provides cover 2 at participating private hospitals for:3 Private hospital accommodation^3 Single room guarantee 13 Increased medical gap cover (see pages 22-23 for details)3 Delivery suite3 Theatre3 Intensive and coronary care3 Same-day treatment3 Surgically implanted prostheses (Government prostheses list group benefits 3 )3 Other agreed charges.What's covered in a public hospital?You’ll be covered 2 for hospital accommodation costs when you are admitted to asingle or shared room (subject to bed availability) as a private patient in a publichospital.Increased medical gap coverPlatinum Hospital provides members access to increased benefits when treated bya doctor or specialist if admitted to hospital. As a member on our comprehensivecover you will have a higher level of protection by receiving more back on selectedservices. We recommend you contact us for a benefit estimate before commencingtreatment to confirm the benefit payable.Excess optionsYou can reduce your premium by selecting one of thefollowing calendar year excess options:Excess options tableAdmission excess(private hospital – overnight)Admission excess(public hospital orday stay)Level 0excessLevel 1excessLevel 2excessnil $250 $500nil $125 $250^Other private hospitalsFixed benefits are payable in non-participatingprivate hospitals(see page 54 for more details).Maximum annual excess – perpersonMaximum annual excess –singlesMaximum annual excess –familiesTo find out more about excess payments see page 51.nil $250 $500nil $250 $500nil $500 $1,000No excess applies for child dependants under 21 onPlatinum Hospital cover.Waiting periodsPlease refer pages 11 and 57 regarding waitingperiods and pre-existing conditions.1 We will pay you $50 per day (up to a maximum of $150 for 3 days) if youstay in a shared room when you requested a single room. See page 56 formore details.2 Limited benefits may apply to cosmetic surgery and high cost drugs.Drugs purchased outside the hospital are not included.3 Benefits are no higher than the No Gap Government prescribed benefit.14

Gold HospitalHOSPITAL COVERRecommended for:Gold Hospital gives you a high level of cover for a wide range oftreatments with medical gap benefits.What's covered in a participating private hospital?Gold Hospital provides cover 1 at participating privatehospitals for:3 Private hospital accommodation^ in a sharedor single room (where available)3 Medical gap (see pages 22-23 for details)3 Delivery suite3 Theatre3 Intensive and coronary care3 Same-day treatment3 Surgically implanted prostheses(Government prostheses list group benefits 2 )3 Other agreed charges.What's covered in a public hospital?You’ll be covered 1 for hospital accommodation costs when you are admitted to asingle or shared room (subject to bed availability) as a private patient in a publichospital.Healthy Start BenefitGold Hospital cover provides an additional benefit of up to $500 per childbirthadmission to help cover the obstetrician’s medical gap (inpatient services only).For further details see page 52.Excess optionsYou can reduce your premium by selecting one of thefollowing calendar year excess options:Excess options tableAdmission excess(private hospital – overnight)Admission excess(public hospital orday stay)Maximum annual excess – perpersonMaximum annual excess –singlesMaximum annual excess –familiesLevel 0excessTo find out more about excess payments see page 51.Level 1excessLevel 2excessnil $250 $500nil $125 $250nil $250 $500nil $250 $500nil $500 $1,000No excess applies for child dependants under 21 onGold Hospital cover.^Other private hospitalsFixed benefits are payable in non-participatingprivate hospitals(see page 54 for more details).Waiting periodsPlease refer to the information on pages 11 and57 regarding waiting periods and pre-existingconditions.Benefit limitation periodsA 24-month benefit limitation period applies tothe following services:• Psychiatric• Haemodialysis• Gastric banding and all obesity surgeriesSee page 47 for more information.1 Limited benefits may apply to cosmetic surgery and high cost drugs.Drugs purchased outside the hospital are not included.2 Benefits are no higher than the No Gap Government prescribed benefit.HOSPITAL COVERNo excess applies for child dependants under 21 on Gold Hospital cover.16

Silver HospitalHOSPITAL COVERRecommended for:Silver Hospital gives you a moderate level of cover for commontreatments in a private hospital excluding a range of treatmentsand services to help reduce the premium.ExclusionsTo reduce the premium, Silver Hospital excludes the following services:✗ Obstetrics✗ Joint replacement✗ Cosmetic surgery✗ IVF and related services✗ Cataract surgery and corneal transplants✗ Haemodialysis✗ Gastric banding and obesity surgeries✗ Dental implantsWhat's covered in a participating private hospital?For services not listed under 'exclusions' Silver Hospital provides cover 1 atparticipating private hospitals for:3 Private hospital accommodation^ in a shared room3 Partial cover in a single room (a co-payment of $100 per day, capped at 7 daysper admission applies) 23 Medical gap (see pages 22-23 for details)3 Theatre3 Intensive and coronary care3 Same-day treatment3 Surgically implanted prostheses (Government prostheses list group benefits 3 )3 Other agreed charges.Excess optionsYou can reduce your premium by selecting one of thefollowing calendar year excess options:Excess options tableAdmission excess (privatehospital – overnight)Admission excess(public hospital orday stay)Maximum annual excess – perpersonMaximum annual excess –singlesMaximum annual excess –familiesLevel 0excessTo find out more about excess payments see page 51Level 1excessLevel 2excessnil $250 $500nil $125 $250nil $250 $500nil $250 $500nil $500 $1,000Unlike Platinum and Gold covers the excess appliesfor child dependants on all Silver Hospital covers.^Other private hospitalsFixed benefits are payable in non-participatingprivate hospitals(see page 54 for more details).Waiting periodsPlease refer to the information on pages 11 and57 regarding waiting periods and pre-existingconditions.Benefit limitation periodsA 24-month benefit limitation period applies tothe following service:• PsychiatricSee page 47 for more information.1 Limited benefits may apply to high cost drugs. Drugs purchased outsidethe hospital are not included.2 Please note that some private hospitals only have single rooms andco-payments will apply.3 Benefits are no higher than the No Gap Government prescribed benefit.HOSPITAL COVERWhat's covered in a public hospital?For services not listed under 'exclusions' Silver Hospital cover provides cover* as aprivate patient in a public hospital for accommodation^ in a shared room or partialcover in a single room (co-payments of $100 per day apply for single rooms,capped at 7 days per admission).18

Bronze HospitalHOSPITAL COVERRecommended for:Bronze Hospital gives you a basic level of cover for treatmentas a private patient in a public hospital with some exclusions toreduce the premium.A suitable option if you want to avoid the Medicare LevySurcharge (details on page 53) or lock in your lifetime healthcover (details on pages 44–45) certified age of entry.ExclusionsTo reduce the premium, Bronze Hospital excludes the following services:✗ Haemodialysis✗ Gastric banding and all obesity surgeriesWhat's covered in a public hospital?For services not listed under 'exclusions' Bronze Hospital cover provides cover foraccommodation costs when you’re admitted to a shared room in a recognisedpublic hospital, less your excess if applicable (subject to bed availability). 1Excess optionsYou can reduce your premium by selecting anexcess which is payable once every calendar year.Choose from one of the following excess options:Excess options tableMaximum annual excess– per personMaximum annual excess– singlesMaximum annual excess– familiesLevel 0excessTo find out more about excess payments see page 51.Level 1excessLevel 2excessnil $250 $500nil $250 $500nil $500 $1,000Unlike Platinum and Gold covers the excess appliesfor child dependants on all Bronze Hospital covers.Waiting periodsPlease refer to pages 11 and 57 regardingwaiting periods and pre-existing conditions.Please note: Benefits for a single room in apublic hospital or treatment in a private hospitalwhen using Bronze Hospital cover will result insignificant out-of-pocket expenses. For furtherinformation on private patient benefits onBronze Hospital cover, please call us on 13 27 22.* 1 Limited benefits may apply to high cost drugs. Drugs purchasedoutside the hospital are not included.2 Benefits are no higher than the No Gap Government prescribedbenefit.HOSPITAL COVERWhat's covered in a private hospital?For services not listed under 'exclusions' fixed benefits are payable foraccommodation in private hospitals. The benefit depends on the type of treatment,accommodation or surgery received and length of the hospital stay. Additionalprivate hospital costs such as theatre and delivery suite charges are not covered byBronze Hospital cover.Additional benefitsIn both public and private hospitals, our Bronze Hospital cover includes benefits for:3 Medical gap (see pages 22–23 for details)3 Surgically implanted prostheses (Government prostheses list group benefits 2 )3 Nursing home type patients – Government prescribed benefits are availabletowards non-acute hospital care.20

What is medical gap cover?HOSPITAL COVERRACT Health Insurance's medical gap cover is a billingsystem that provides higher benefits than thescheduled fee which will reduce or even eliminateyour out-of-pocket costs for doctor or specialist feeswhen treated in hospital.What is a scheduled fee (MBS)?The Federal Government has created a schedule offees (Medicare Benefits Schedule) set for eligibleservices by doctors in a hospital or day surgery.Medicare pays 75% of this scheduled fee forin-patient medical treatments and RACT HealthInsurance pays the other 25%, up to 100% of theMedical Benefit Schedule (MBS) fee.Medical gap cover - Gold, Silver andBronze Hospital coversIn the event that your doctor chooses to use ourmedical gap cover and where the actual fee for theanticipated service is greater than the MBS fee, anadditional medical gap benefit will be paid equal to20% of the MBS fee for each service.Note: Additional medical gap benefits are not payable towards thecost of imaging or pathology services within the Gold, Silver andBronze Hospital covers. Contact RACT Health Insurance on 13 27 22for details.is the known gap.Option 2 - No GapIf your doctor chooses to use our medical gap coverand not charge a patient gap, your RACT HealthInsurance benefit and the Medicare benefit will fullycover the doctor’s charges. In these instances, yourdoctor will bill us direct and you’ll pay nothing.Multiple doctorsIf others are involved in your treatment (such asanaesthetists) you should ask RACT Health Insurance,your doctor or the other medical professionals if theywill be using our medical gap cover system.If they choose not to, you’ll still receive a combinedMedicare and RACT Health Insurance benefit of up to100% of the MBS fee and (if applicable) any ConnectRewards Plus dollars you may have accrued formedical out-of-pocket costs that exist.The participation in our medical gap cover by anymedical practitioner is not a recommendation orendorsement by RACT Health Insurance of thatpractitioner.Medical gap cover –Platinum Hospital coverPlatinum Hospital provides medical gap coverregardless of whether your doctor participates ornot. Where the actual fee for the anticipatedservice is greater than the MBS fee, an additionalmedical gap benefit will be paid, that in mostcases will be in excess of 20% of the MBS feefor each service, as paid under our Gold, Silverand Bronze Hospital covers. The additionalmedical gap benefit under Platinum Hospital willvary by eligible service. Please contact us priorto treatment to determine your additionalmedical gap cover benefit.ImportantThis information is provided as a guide only.Before you have any treatment, we suggest youcontact us for the most up to date information.In an emergencyIn the case of an emergency, it may not bepossible for a participating doctor to advise youof their fees in advance. Please contact usshould this occur.HOSPITAL COVEROur medical gap cover optionsIf your doctor or specialist is one of more than 14,000who choose to participate in the RACT HealthInsurance medical gap cover system, two options areavailable for our Gold, Silver and Bronze Hospital covers:Option 1 - Known GapYour doctor chooses to use the RACT Health Insurancemedical gap cover system - and charge a knownpatient gap. To participate, your doctor must informyou in writing of the cost of the anticipated services,the Medicare and RACT Health Insurance benefits andthe patient gap before any treatment commences.They must bill us direct for the RACT Health Insuranceand Medicare benefits. We’ll arrange to pay thesebenefits direct to your doctor and all you’ll need to payNote: Additional medical gap benefits are not payable towardsthe cost of most imaging or pathology services within PlatinumHospital cover. Contact RACT Health Insurance on 13 27 22for details.22

Extras coverEXTRAS COVERCoverage comparison tableThis table details your extras optionsat a glance using an easy to follow star system.The more stars shown, the better the coverageand benefits.Extras services Platinum Extras Gold Extras Silver Extras Bronze ExtrasAcupuncture ★ ★ ★ ★ ★ ★★★★ ★★★Ambulance ★ ★ ★ ★ ★★★★ ★★★★Audiology ★ ★ ★ ★ ★★★★ ★★★For a more detailed benefits comparisonsee pages 26-39.Blood glucose monitor ★ ★ ★ ★ ★★★★ ★★★Chiropractic ★ ★ ★ ★ ★ ★★★★ ★★★Dental – General ★ ★ ★ ★ ★★★★ ★★★ ★★★Dental – Major ★ ★ ★ ★ ★★★★ ★★★ ★★★Dental – Dentures ★ ★ ★ ★ ★★★★ ★★★ ★★★Dental – Orthodontics ★ ★ ★ ★ ★★★★ ★★★ ★★Dietetics ★ ★ ★ ★ ★★★★ ★★★EXTRAS COVER# Remedial massage benefits are only available under Connect RewardsPlus as detailed on pages 40-41Extremity pump ★ ★ ★ ★ ★★★★ ★★★★Eye therapy ★ ★ ★ ★ ★★★★ ★★★Dietary fluoride supplement ★ ★ ★ ★ ★★★★ ★★★★ ★★★★Foot orthotics ★ ★ ★ ★ ★★★★ ★★★Hearing aids ★ ★ ★ ★ ★★★★ ★★★Home nursing – Visiting/Bush/Private Nursing Service ★ ★ ★ ★ ★★★★ ★★★★Homeopathy ★ ★ ★ ★ ★ ★★★★ ★★★Hydrotherapy ★ ★ ★ ★ ★ ★★★★ ★★★ ★★★Myotherapy ★ ★ ★ ★ ★ ★★★★ ★★★ ★★★Naturopathy ★ ★ ★ ★ ★ ★★★★ ★★★Nebuliser pump ★ ★ ★ ★ ★★★★ ★★★★Occupational therapy ★ ★ ★ ★ ★★★★ ★★★ ★★★Optical ★ ★ ★ ★ ★ ★★★★ ★★★ ★★★Orthopaedic appliances (RACT Health Insurance approved) ★ ★ ★ ★ ★★★★ ★★★ ★★★Osteopathy ★ ★ ★ ★ ★ ★★★★ ★★★Pharmacy – Private script ★ ★ ★ ★ ★★★★ ★★★ ★★★Physiotherapy ★ ★ ★ ★ ★ ★★★★ ★★★ ★★★Podiatry – Consultation ★ ★ ★ ★ ★★★★ ★★★Podiatry – Surgical procedures ★ ★ ★ ★ ★★★★ ★★★Pressure garments (RACT Health Insurance approved) ★ ★ ★ ★ ★★★★ ★★★Prostheses (RACT Health Insurance approved non-surgical ) ★ ★ ★ ★ ★★★★ ★★★ ★★★Psychology ★ ★ ★ ★ ★★★★ ★★★Remedial massage ★ ★ ★ ★ ★ ★★★★ # #Sleep apnoea monitor ★ ★ ★ ★ ★★★★ ★★★★Speech therapy ★ ★ ★ ★ ★★★★ ★★★TENS monitor ★ ★ ★ ★ ★★★★ ★★★★Weight loss programs★ ★ ★ ★ ★24 25

Detailed extras comparisonEXTRAS COVERExtras services Waiting Periods Platinum Extras Gold Extras Silver Extras Bronze ExtrasAcupuncturesee Naturopathy/Homeopathy/AcupunctureAmbulance transport 12 monthsTransport benefit per trip $300 $300 $300Annual limit per person each calendar year $500 $500 $500Audiology 2 2 monthsInitial visit 80% $25 $25Subsequent visit 80% $20 $20Annual limit per person each calendar year $350 $350 $400 2Blood glucose monitor 12 monthsBenefit:Chiropractic / Osteopathy 4 2 monthsN/A80% up to $650 permonitor 3a $200 3b $150 3bInitial visit 80% $26 $25Important note: The table opposite must be read along with thefootnotes below.1. Ambulance – Tasmanian Ambulance services are provided by thestate government scheme. Outside Tasmania, you can claim up to$300 for a single trip or up to $500 per calendar year ontransportation only.2. Audiology – The annual limit of $400 per person each calendaryear includes combined benefits for audiology, speech therapy andeye therapy.3a. Blood glucose monitor – Benefits are limited to 1 monitor permembership every 3 years. A doctor’s letter of recommendationmust accompany each claim for benefits. Up to 80% per monitor to amaximum of $650, combined limit for blood glucose monitor,nebuliser pump, TENS monitor and sleep apnoea monitor.3b. Blood glucose monitor – Benefits are limited to 1 monitor permembership every 3 years. A doctor’s letter of recommendation mustaccompany each claim for benefits.4. Chiropractic/Osteopathy – There is a limit of 1 chiropractic X-rayper person/single membership each calendar year. Benefits will onlybe paid for one consultation and/or treatment per provider per day.5. Chiropractic/Osteopathy – The annual limit of $700 per person/single membership and $1,000 per family membership eachcalendar year includes combined benefits for chiropractic (includingchiropractic X-rays) and osteopathy.6. Chiropractic/Osteopathy – The annual limit of $350 per person/single membership and $700 per family membership each calendaryear includes combined benefits for chiropractic (includingchiropractic X-rays) and osteopathy.7. Chiropractic/Osteopathy – The annual limit of $350 per person/single membership and $600 per family membership each calendaryear includes combined benefits for chiropractic (includingchiropractic X-rays), osteopathy, naturopathy, homeopathy andacupuncture.EXTRAS COVER2-10 subsequent visits 80% $21 $17Further visits 80% $17 $15Chiropractic X-ray (1 per person) $80 $80 $40Annual limit per person/single membership each calendar year $700 5 $350 6 $350 7Annual limit per family membership each calendar year $1,000 5 $700 6 $600 7All extras services must be provided by practitioners in private practice who are appropriately registered withrecognised bodies approved by us.We recommend you call 13 27 22 for a benefit estimate before commencing treatment to confirm the benefit payable.For services other than dental, benefits for initial consultation per therapy type are available each calendar year.26 27

Detailed extras comparisonEXTRAS COVERExtras services Waiting Periods Platinum Extras Gold Extras Silver Extras Bronze ExtrasDENTALMAJOR DENTAL (see important note for dental) 12 monthsOrthodontic Benefits example: Fixed appliance treatment – upper and lower jawtreatment by a registered specialistMaximum benefits per calendar year12 months85% up to $500 peryear incr. to $850 at10 years85% up to $450 peryear incr. to $850 at10 years75% up to $320 peryear incr. to $570 at6 yearsMaximum benefit per course of treatment $2,550 $2,550 $1,710 $90075% up to $300per yearLifetime benefit limit $2,900 $2,900 $1,900 $1,050Important note: The table opposite must be read along with thefootnotes below.Important note for dental: The benefits shown are the annual limitsfor each type of dental service. The annual limit is a combinedGeneral and Major Dental limit per person, per calendar year. Thereare further sub limits within some of these dental services e.g. theindividual benefit for one crown on Platinum or Gold Extras is $300.General dental – There is a range of dental procedures that cannotbe claimed when provided on the same day e.g. a filling on a tooththat has been removed. There are also limits on the number of dentalprocedures you can have e.g. periodic examinations are limited to 2per calendar year. Dental benefits for some procedures cannot bepaid unless tooth identifications (ID) are supplied by the provider.The general dental limits for dental examinations and scale & cleanprocedures are available per person on a calendar year basis.For services other than dental, benefits for 1 initial consultation areavailable each calendar year.Preventative dental – A detailed list of item numbers and definition ofbenefits payable under preventative dental can be found on page 49.EXTRAS COVERDentures (see important note for dental) 12 monthsNew full upper and lower dentures per 2 years $500 $500 $420 $420Combined crown and bridgework (see important note for dental) 12 monthsAnnual limit per person each calendar year $900 $600 $450 $450Indirect restorations (see important note for dental) 12 monthsAnnual limit per person/single membership each calendar year $400 $400 $350 $350Annual limit per family membership each calendar year $700 $700 $700 $700Implants (see important note for dental) 12 monthsAnnual limit per person each calendar year $400 $400 $400 $400GENERAL DENTAL(For more information see general dental note)2 monthsa) Diagnostic services 2 months Set benefits apply Set benefits apply Set benefits apply Set benefits applyb) Preventative services e.g. periodic examination 2 per calendar year, removal ofplaque 3 per calendar year. Annual limit per person per calendar year. Seepreventative dental note2 monthsUp to $450per personUp to $300per personUp to $200per personUp to $200per personc) Simple extractions (not including surgical extractions of wisdom teeth) 2 months Set benefits apply Set benefits apply Set benefits apply Set benefits applyd) Restorative services (limited benefits apply to precious restorations) 2 months Set benefits apply Set benefits apply Set benefits apply Set benefits applyANNUAL LIMIT(see important note for dental)12 monthsAnnual limit per person each calendar year $2,000 $2,000 $1,000 $1,000All extras services must be provided by practitioners in private practice who are appropriately registered with recognisedbodies approved by us.We recommend you call 13 27 22 for a benefit estimate before commencing treatment to confirm the benefit payable.For services other than dental, benefits for initial consultation per therapy type are available each calendar year.28 29

Detailed extras comparisonEXTRAS COVERExtras services Waiting Periods Platinum Extras Gold Extras Silver Extras Bronze ExtrasDietetics 2 monthsInitial visit 80% $54 $27Subsequent visit 80% $25 $21Class attendance 80% $10 $10Annual limit per person each calendar year $350 $350 $350Extremity pump 8 12 monthsBenefit $300 $300 $300Eye therapy and speech therapy 2 monthsImportant note: The table opposite must be read along withthe footnotes below.8. Extremity pump – Benefits are limited to 1 extremity pump permembership every 3 years. A doctor’s letter of recommendationmust accompany each claim for benefits.9. Eye therapy and speech therapy – The annual limit of $500per person each calendar year includes $500 for eye therapy and$500 for speech therapy.10. Eye therapy and speech therapy – The annual limit of $400per person each calendar year includes combined benefits foraudiology, eye therapy and speech therapy.11. Fluoride dietary supplement – Benefits are only payabletowards the cost of dietary fluoride supplements (tablet or liquidform) dispensed by a chemist or dentist in private practice.EXTRAS COVERInitial visit 80% $54 $27Subsequent visit 80% $25 $21Annual limit per person each calendar year $500 9 $500 9 $400 10Fluoride dietary supplement 11 2 monthsBenefit of up to 80% 85% 85% 85%Maximum benefit per person each calendar year $45 $45 $45 $45Hearing aids 12 monthsBenefit of up to 100% 100% 80%Maximum benefit per person every 3 years $800 $800 $400Homeopathysee Naturopathy/Homeopathy/AcupunctureMyotherapysee Physiotherapy/Myotherapy/Hydrotherapy2 months2 monthsAll extras services must be provided by practitioners in private practice who are appropriately registered with recognisedbodies approved by us.We recommend you call 13 27 22 for a benefit estimate before commencing treatment to confirm the benefit payable.For services other than dental, benefits for initial consultation per therapy type are available each calendar year.30 31

Detailed extras comparisonEXTRAS COVERExtras services Waiting Periods Platinum Extras Gold Extras Silver Extras Bronze ExtrasNaturopathy / Homeopathy / Acupuncture 12 2 monthsInitial visit 80% $25 $192-10 subsequent visits 80% $20 $17Further visits 80% $17 $14Annual limit per person/single membership each calendar year $600 13 $350 14 $350 15Annual limit per family membership each calendar year $900 13 $700 14 $600 15Nebuliser pump 12 monthsBenefitNursing – Visiting / Home / Registered Nurse (Private Practice) 17 2 months80% up to $650 permonitor 16a $150 16b $150 16bHome (bush) nursing benefit for each visit 80% $8 $8Visiting / Registered nurse (private practice) benefit per hour 80% $8 $8Maximum benefit for each day $48 $48 $48Important note: The table opposite must be read along with thefootnotes below.12. Naturopathy/Homeopathy/Acupuncture – Benefits will be paidfor 1 consultation and/or treatment per provider per day within thegroup of chiropractic (excluding X-rays), naturopathy, homeopathyand osteopathy.13. Naturopathy/Homeopathy/Acupuncture – The annual limit of$600 per person/single membership and $900 per familymembership each calendar year includes combined benefits forremedial massage, naturopathy, homeopathy and acupuncture.14. Naturopathy/Homeopathy/Acupuncture – The annual limit of$350 per person/single membership and $700 per familymembership each calendar year includes combined benefits forremedial massage, naturopathy, homeopathy and acupuncture.15. Naturopathy/Homeopathy/Acupuncture – The annual limit of$350 per person/single membership and $600 per familymembership each calendar year includes combined benefits fornaturopathy, homeopathy, acupuncture, chiropractic and osteopathy.16a. Nebuliser pump – Benefits are limited to 1 monitor permembership every 3 years. A doctor's letter of recommendation mustaccompany each claim for benefits. Up to 80% per monitor, up to$650 combined limit for blood glucose monitors, nebuliser pump,TENS monitor and sleep apnoea monitor.16b. Nebuliser pump – Benefits are limited to 1 nebuliser pump permembership every 3 years. A doctor’s letter of recommendation mustaccompany each claim for benefits.17. Nursing – Visiting/home/registered nurse (private practice)– The annual limit of $1,000 per person each calendar year includescombined benefits for home (bush) nursing and visiting/registerednurse. Visiting nurse benefits apply towards a registered nurse inprivate practice on recommendation from a medical practitioner.EXTRAS COVERAnnual limit per person each calendar year $1,000 $1,000 $1,000All extras services must be provided by practitioners in private practice who are appropriately registered with recognisedbodies approved by us.We recommend you call 13 27 22 for a benefit estimate before commencing treatment to confirm the benefit payable.For services other than dental, benefits for initial consultation per therapy type are available each calendar year.32 33

Detailed extras comparisonEXTRAS COVERExtras services Waiting Periods Platinum Extras Gold Extras Silver Extras Bronze ExtrasOccupational therapy 2 monthsInitial visit 80% $54 $31 $312-10 subsequent visits 80% $25 $21 $21Further visits 80% $17 $17 $17Annual limit per person/single membership each calendar year $500 18 $500 18 $350 19 $350 20Annual limit per family membership each calendar year $800 18 $800 18 $600 19 $600 20Optical 21 6 monthsPrescription spectacles, contact lenses and frames – benefit of up to(Laser eye surgery claimable on Platinum Extras only)100% 100% 80% 80%Annual limit per person each calendar year $300 $250 $170 $170Orthopaedic appliances 22 12 monthsBenefit of up to 80% 80% 80% 80%Maximum benefit per item $115 $115 $115 $115Limit per person every 3 years $400 23 $400 23 $400 24 $400 25Orthopaedic appliance repairs 2 monthsAnnual limit per person each calendar year $40 $40 $40 $40Orthotic appliances (foot) 26 12 monthsImportant note: The table opposite must be read along with thefootnotes below.18. Occupational therapy – The annual limit of $500 per person/single membership and $800 per family membership each calendaryear only includes benefits for occupational therapy.19. Occupational therapy – The annual limit of $350 per person/single membership and $600 per family membership each calendaryear includes combined benefits for physiotherapy, myotherapy,occupational therapy and hydrotherapy.20. Occupational therapy – The annual limit of $350 per person/single membership and $600 per family membership each calendaryear includes combined benefits for physiotherapy, myotherapy,occupational therapy and hydrotherapy.21. Optical – Non-prescription sunglasses and repairs are excluded.22. Orthopaedic appliances (approved by us) – Must be custommade or approved by us. A doctor’s letter recommending theappliance must accompany each claim for benefits. Orthopaedicappliances attract benefits where the application of which hasresulted from, and is required immediately following the injury orsurgery to the injury necessitating the appliance, for purposes otherthan or additional to support. For an appliance to be custom made, aplaster cast or mould must be taken. Customising, heat moulding,trimming or adjusting an existing ‘off the shelf’ appliance does notinvolve this process and therefore does not constitute a custom madeappliance. There are some conditions, therefore we recommend youcall 13 27 22 for a benefit estimate to confirm the benefit payable.23. Orthopaedic appliances (approved by us) – The limit of $400per person is available each calendar year for orthopaedic appliances.24. Orthopaedic appliances (approved by us) – The limit of $400per person is available every 3 years. This limit includes combinedbenefits for orthopaedic appliances and pressure garments.25. Orthopaedic appliances (approved by us) – The limit of $400per person is available every 3 years for orthopaedic appliances.26. Orthotic appliances (foot) – Orthotic appliances must becustom made. For an orthosis to be custom made, a plaster cast ormould must be taken. Customising, heat moulding, trimming oradjusting an existing ‘off the shelf’ appliance does not involve thisprocess and therefore does not constitute a custom made appliance.27. Orthotic appliances (foot) – The annual limit of $400 per personeach calendar year includes combined benefits for podiatry visits,orthotic appliances (foot) and podiatric surgical procedures.EXTRAS COVERBenefit of up to 80% 80% 80%Maximum benefit per item $115 $115 $115Annual limit per person/single membership each calendar year $230 $230 $400 27Annual limit per family membership each calendar year $460 $460Osteopathy see Chiropractic / Osteopathy 2 monthsAll extras services must be provided by practitioners in private practice who are appropriately registered with recognisedbodies approved by us.We recommend you call 13 27 22 for a benefit estimate before commencing treatment to confirm the benefit payable.For services other than dental, benefits for initial consultation per therapy type are available each calendar year.34 35

Detailed extras comparisonEXTRAS COVERExtras services Waiting Periods Platinum Extras Gold Extras Silver Extras Bronze ExtrasImportant note: The table opposite must be read along with thefootnotes below.Pharmacy – private script 28 2 months28. Pharmacy – Private script benefits are only payable towards thecost of prescription pharmaceuticals dispensed via a provider inprivate practice. Benefits are not payable towards the cost ofcontraceptives or NHS (PBS) prescriptions, food supplements, naturalremedies (including Modifast/Optifast), over the counter itemsMembers pay the first maximum Pharmaceutical Benefits Scheme (PBS) contribution then100% 100% $40 $40purchased with or without a prescription and pharmaceuticalsthe following benefit is paidtowards the balancepurchased overseas and not listed on the Australian Register ofTherapeutic Goods.Annual limit per person/single membership each calendar year $350 $350 $250 $25029. Physiotherapy/Myotherapy/Hydrotherapy – For physiotherapyAnnual limit per family membership each calendar year $550 $550 $400 $400and hydrotherapy only, class attendance is limited to $240 per personeach calendar year and this limit is included within your annual limit.Benefits will be paid for 1 consultation and/or treatment per providerPhysiotherapy / Myotherapy / Hydrotherapy 29 2 monthsper day. Physiotherapy consultation must be for a minimum of 15-20minutes to qualify for one-on-one physiotherapy benefits.30. Physiotherapy/Myotherapy/Hydrotherapy – The annual limit ofInitial visit 80% $36 $31 $31$700 per person/single membership and $1,000 per familymembership each calendar year includes combined benefits for2-10 subsequent visits 80% $26 $21 $21physiotherapy, myotherapy and hydrotherapy.31. Physiotherapy/Myotherapy/Hydrotherapy – The annual limit ofFurther visits 80% $18 $17 $17$500 per person/single membership and $800 per familymembership each calendar year includes combined benefits forClass attendance 80% $10 $10 $10physiotherapy, myotherapy and hydrotherapy.32. Physiotherapy/Myotherapy/Hydrotherapy – The annual limit of$350 per person/single membership and $600 per familyAnnual limit per person/single membership each calendar year $700 30 $500 31 $350 32 $350 33membership each calendar year includes combined benefits forphysiotherapy, myotherapy, occupational therapy and hydrotherapy.Annual limit per family membership each calendar year $1,000 30 $800 31 $600 32 $600 3333. Physiotherapy/Myotherapy/Hydrotherapy – The annual limit of$350 per person/single membership and $600 per familymembership each calendar year includes combined benefits forPodiatry 2 monthsphysiotherapy, myotherapy, occupational therapy and hydrotherapy.Initial visit 80% $35 $2734. Podiatry – The annual limit of $350 per person each calendaryear includes combined benefits for podiatry visits and podiatricSubsequent visit 80% $25 $21surgical procedures.35. Podiatry – The annual limit of $400 per person each calendarComprehensive treatment – initial visit 80% $35 $35year includes combined benefits for podiatry visits, podiatric surgicalprocedures and orthotic appliances (foot).Comprehensive treatment – subsequent visit 80% $25 $25Video analysis 80% $25 $25Plaster of Paris 80% $25 $25Surgical procedures – benefit of up to 12 months 80% 80% 80%Maximum benefit per surgical procedure $115 $115 $115EXTRAS COVERAll extras services must be provided by practitioners in private practice who are appropriately registered with recognisedbodies approved by us.We recommend you call 13 27 22 for a benefit estimate before commencing treatment to confirm the benefit payable.For services other than dental, benefits for initial consultation per therapy type are available each calendar year.36 37

Detailed extras comparisonExtras services Waiting Periods Platinum Extras Gold Extras Silver Extras Bronze ExtrasPressure garments 36 12 monthsBenefit of up to 80% 80% 80%Maximum benefit per item $115 $115 $115Limit per person every 3 years $350 37 $350 37 $400 38Important note: The table opposite must be read along with thefootnotes below.36. Pressure garments – Are used for the treatment of burns,lymphodaema or for post-operative surgery up to 60 days fromhospital discharge. For benefits to be payable garments must besupplied through a private company or therapist in private practice.A doctor’s letter recommending the appliance must accompany eachclaim for benefits. We recommend you contact us for a benefitestimate to confirm the benefit payable.37. Pressure garments – The limit of $350 per person is availableeach calendar year for pressure garments.38. Pressure garments – The limit of $400 per person is availableevery 3 years. This limit includes combined benefits for orthopaedicappliances (approved by us) and pressure garments.39. Prostheses (non-surgical) – Prostheses include a range ofapproved non-surgically implanted prostheses (e.g. wigs). A doctor’sletter of recommendation must accompany each claim for benefits.We recommend you contact us for a benefit estimate to confirm thebenefit payable.40. Prostheses (non-surgical) – The limit of $400 per person is thebenefit available for prostheses each calendar year.41. Remedial massage – Benefits will be paid for 1 consultationand/or treatment per provider per day within the group ofphysiotherapy, myotherapy and remedial massage.42. Remedial massage – The annual limit of $600 per person/singlemembership and $900 per family membership each calendar yearincludes combined benefits for remedial massage, naturopathy,homeopathy and acupuncture.43. Remedial massage – The annual limit of $350 per person/singlemembership and $700 per family membership each calendar yearincludes combined benefits for remedial massage, naturopathy,homeopathy and acupuncture.44a. Sleep apnoea monitor – Benefits are limited to 1 monitor permembership every 3 years. A doctor’s letter of recommendation mustaccompany each claim for benefits. Up to 80% per monitor to amaximum of $650, combined limit for blood glucose monitor,nebuliser pump, TENS monitor and sleep apnoea monitor.44b. Sleep apnoea monitor – Benefits are limitedto 1 sleep apnoea monitor per membership every3 years. A doctor’s letter of recommendation must accompany eachclaim for benefits.45a. Tens monitor – Benefits are limited to 1 monitor permembership every 3 years. A doctor’s letter of recommendation mustaccompany each claim for benefits. Up to 80% per monitor to amaximum of $650, combined limit for blood glucose monitor,nebuliser pump, TENS monitor and sleep apnoea monitor.45b. TENS monitor – Benefits are limited to 1 TENS monitor permembership every 3 years. A doctor’s letter of recommendation mustaccompany each claim for benefits.46. Weight loss program – Benefit payable only when participationin a recognised weight loss program is recommended in writing by adoctor. See page 48 for more details.EXTRAS COVERProstheses (non-surgical) 39 12 monthsBenefit of up to 85% 85% 80% 80%Maximum benefit per item $300 $300 $300 $300Maximum benefit per person every 3 years $400 40 $400 40 $400 $400Psychology 2 monthsInitial visit 80% $54 $40Second visit 80% $54 $25Subsequent visit 80% $25 $25Group therapy initial visit 80% $27 $20Group therapy second visit 80% $27 $12.50Group therapy subsequent visit 80% $12.50 $12.50Annual limit per person/single membership each calendar year $500 $500 $350Annual limit per family membership each calendar year $800 $800 $600EXTRAS COVERRemedial massage 41 2 monthsInitial visit 80% $20Subsequent visit 80% $20Annual limit per person/single membership each calendar year $600 42 $350 43Annual limit per family membership each calendar year $900 42 $700 43Sleep apnoea monitor 12 monthsBenefit80% up to $650 perperson 44a $200 44b $200 44bSpeech therapy see eye therapy and speech therapy 2 monthsTENS monitor 12 monthsBenefitWeight loss program 462 months80% up to $650 perperson 45a $100 45b $100 45bBenefit on achieving 10% of start weight $100Benefit on achieving goal weight (within 24 mths) $100Lifetime benefit limit per policy $400All extras services must be provided by practitioners in private practice who are appropriately registered with recognised bodiesapproved by us. We recommend you call 13 27 22 for a benefit estimate before commencing treatment to confirm the benefit payable.For services other than dental, benefits for 1 initial consultation per therapy type are available each calendar year.38 39

Member loyalty programTake out combined hospital and extras coverand enjoy the extra benefits of the RACTHealth Insurance member loyalty program,Connect Rewards Plus.Connect Rewards Plus rewards memberson combined covers with Connect Rewardsdollars. The amount of dollars you receivedepends on how long you’ve been an RACTHealth Insurance member and your level ofhospital cover. So the longer you have beenwith us the more rewards dollars you’llreceive!Here’s how it worksThe tables below break down the Connect RewardsPlus dollars earned based on membership tenure andlevel of hospital cover.Years of Membership withRACT Health Insurance1 - 3 4 & 5 6 & 7 8 & 9 10+Tenure $0 $40 $60 $80 $100+Cover Platinum Gold Silver BronzeUse your rewards to reduce or eliminate out-of-pocket expenses3 Claim inpatient medical gap3 * Double your optical limit3 Reduce your hospital excess3 * Increase annual limits for:• pharmacy• physiotherapy• hearing aids• chiropractic/osteopathic3 * Increase major dental benefits including:• crowns• bridgework• dentures• surgical extractions• implants• indirect restorations• gold fillings• orthodontic• endodontic servicesTHINGS you should knowProductBonusWe have combined the benefits of membershiptenure and level of hospital cover in the table belowto detail the entire benefit you will receive.Cover$80 $40 $20 $0Years of Membership withRACT Health Insurance1 - 3 4 & 5 6 & 7 8 & 9 10+Platinum $80 $120 $140 $160 $180Gold $40 $80 $100 $120 $140Silver $20 $60 $80 $100 $120Bronze $0 $40 $60 $80 $100Note: Benefits listed in this table apply to family, couples and single parentmemberships. Rewards for singles are half those listed in the table.Benefit examples1. A family on Gold Hospital and Gold Extras who have held continuouscombined cover for 8 years will receive $120 Connect Rewards Plusdollars in that year.2. A single on Platinum Hospital and Bronze Extras after their first year ofcover will receive $40 Connect Rewards Plus dollars.Connect Rewards Plus benefit entitlements remainavailable while combined hospital and extras cover iscontinuously maintained.Note: *Only available on services already included in your extras cover and only when annual limits have been reached.You can also save money on services not coveredClaim up to 70% of the cost of the following when purchased from a RACT HealthInsurance approved provider:3 Remedial massage (up to $17 per visit)3 Swimming lessons (see page 50 for further details)3 Orthopaedic shoes – must be supplied by a registered podiatrist and be custom made3 Joint supports3 Melanoma surveillance photography3 Nicotine replacement therapy patches3 Quit smoking programs3 Blood pressure monitor (limited to 1 monitor per membership every 3 years)3 Bowel Cancer Risk Identification Kit (up to 100% of the cost limited to onekit per person each 2 years)3 Antenatal class benefits up to $70 per year (Classes must be provided by thehospital and not included in the hospital contract. Excludes Silver Hospital).Please note: Services listed within the program must be provided by practitioners who are registered withrecognised bodies approved by us. Contact us on 13 27 22 to confirm if a supplier is recognised. A doctor'sletter of recommendation may be required to claim some items. Details can be found in the ConnectRewards Plus section on page 50 with Important Information.THINGS you should know40 41

Rebate and Medicare LevyPayment and Claiming optionsAustralian Government Rebateon Private Health InsuranceUntil recently most Australians with private healthinsurance received a 30% rebate to help cover thecost of their premiums. From 1 July 2012, your privatehealth insurance rebate became income tested (seetable below).If you expect to earn more than $84,000 as a single, ormore than $168,000 as a family you will need to usethe table below to calculate your rebate tier.There are a number of ways to claim the Private HealthInsurance Rebate:– As a premium reduction through RACTHealth InsuranceMedicare Levy SurchargeThe Medicare Levy Surcharge (MLS) is a surcharge(additional tax) on people who do not hold eligibleprivate hospital cover and who earn above $84,000for singles or $168,000 for families.On 1 July 2012, the Medicare Levy Surcharge incometest changed. The amount that you pay will now bebased on income tiers:Tier 1 – A 1% Medicare Levy Surcharge will be paidby people who earn more than $84,000 as a single or$168,000 as a family.Tier 2 – A levy of 1.25% will apply to people who earnmore than $97,000 as a single or $194,000 as afamily.Payment1. Direct debitYou can have your premiums deducted directly fromyour bank, credit union or building society. Billingand reminder notices will not be sent. By paying bydirect debit, you receive 2% off RACT HealthInsurance rates.2. Credit cardWhen you choose this option, your premiums areautomatically debited from your MasterCard or Visacredit card. Billing and reminder notices will not be sent.How to claimThere are a number of ways you can claim yourbenefits including:1. Bulk bill or electronic payment systems direct at yourprovider (dependent on your provider, some may nothave this facility)2. Visit our website at ract.com.au/healthinsurance andmake your claims online through the RACT HealthInsurance member area.3. Complete an RACT Health Insurance claim formand post to us along with your itemised receipt and/or account– As a direct payment from a Medicare office– As a tax off-set when lodging your annual tax return.If you choose to claim your rebate through RACT HealthInsurance, you can nominate a tier you expect to be inand we can adjust your rebate.For more information visit health.gov.au/privatehealth,speak with a tax professional or call RACT HealthInsurance on 13 27 22.Tier 3 – A levy of 1.5% will apply to people who earnmore than $130,000 as a single or $260,000 as afamily.If you or your family do not have hospital cover, or youchoose not to maintain your cover, you may have topay the Medicare Levy Surcharge based on the newincome test (see table below).For more information please consult a tax professionalor call RACT Health Insurance on 13 27 22THINGS you should know2012-13 Rebate and Medicare Levy Surcharge Calculation Table:Unchanged Tier 1 Tier 2 Tier 3Singles $84,001 or less $84,000–97,000 $97,001–130,000 $130,001 or moreCouples/Families $168,000 or less $168,001–194,000 $194,001–260,000 $260,001 or morePrivate Health Insurance RebateUnder 65 years 30% 20% 10% 0%65-69 years 35% 25% 15% 0%70 years & over 40% 30% 20% 0%Medicare Levy SurchargeAll Ages 0.0% 1.0% (unchanged) 1.25% 1.5%4. Lodge your claim at a Medicare office, which willforward it to RACT Health Insurance for processing.THINGS you should knowPlease note: As soon as one member on the membership moves to the next age bracket the entire membership will receiveeither 35% or 40% (depending on your level of income).42 43

Lifetime health cover loadingThe Federal Government introduced thelifetime health cover (LHC) initiative on the1 July 2000.From this date, anyone who joins ahospital cover of a registered health fundwill be given a certified age at entry (CAE)status - which represents their age whenthey first joined a hospital cover after1 July 2000.If you’re over the age of 30, the sooner you take outhospital cover, the less you’ll pay later. In summary,the Health Cover LHC loading applies if you wereaged 31 or over on the 1 July just passed and aretaking out hospital cover for the first time. Under theLHC, in addition to the rates listed in our rate charts,a 2% loading is applied for each year you are agedover 30 when you join. The Federal Government 30%Rebates apply to your total premiums, including anyLHC loading. Lifetime health cover applies to hospitalcover and does not apply to extras.Your age on1 July before taking outhospital coverLifetime health coverloading %Your age on1 July before taking outhospital coverLifetime health coverloading %30 0% 48 36%31 2% 49 38%32 4% 50 40%33 6% 51 42%34 8% 52 44%THINGS you should knowIf you joined a hospital cover before this date you areassigned a CAE of 30 and you’ll pay the base rate (thelowest premium) for your hospital cover (thepremiums listed in our rate charts are quoted at baserates). If you joined after this date and therefore havea CAE of over 30, you’ll pay a 2% loading for eachyear your CAE is above 30 to a maximum loading of70% at age 65. Where you have had to pay a LHCloading, and have done so for a continuous period of10 years, the loading will no longer apply on the dayafter the last day of the 10-year period. People born onor prior to 1 July 1934 are exempt from the CAErequirement.To use the LHC table on the opposite page,follow these steps.Step 1. Determine your age as at the 1 Julyjust passed.Step 2. Find that age on the table to findyour lifetime health cover loading.Step 3. Add this percentage increase to thehospital rates quoted in the RACT HealthInsurance rate charts. If your hospital coverhas two adults aged over 30, just add 1% foreach year you are both over 30 to the basehospital rates quoted in this member guide.If you need help, please call our customerservice centre on 13 27 22.35 10% 53 46%36 12% 54 48%37 14% 55 50%38 16% 56 52%39 18% 57 54%40 20% 58 56%41 22% 59 58%42 24% 60 60%43 26% 61 62%44 28% 62 64%45 30% 63 66%46 32% 64 68%47 34% 65 and over Capped at 70%If your situation changesPeriods of absenceAs members may need to discontinue their hospitalcover membership for brief periods, lifetime healthcover allows a period or periods of absence through amember’s lifetime without affecting their CAE. Lifetimehealth cover rules provide members of private healthinsurance who need to drop their membership, forwhatever reason, a cumulative period of 1,094 daysabsence through their lifetime without affecting theirCAE. Members will need to re-serve waiting periodswhen they return to the fund.Membership suspensionApproved periods of suspension, which will not affecta member’s CAE, are explained on page 56.THINGS you should know44 45

Important informationIMPORTANT INFORMATIONBefore you join or transfer your healthinsurance we recommend you read thefollowing important information.If you have any question give us a call on13 27 22.We remind you to contact us for abenefit estimate before commencing anytreatment to confirm the benefit payableand that our premiums may vary foreach state/territory. Please retain thismember guide with any other RACT HealthInsurance documents.IndexApplication for membership with RACT Health Insurance.........47Arrears.....................................................................................47Audits.......................................................................................47Benefit limitation periods..........................................................47Claiming...................................................................................47Code of Conduct.......................................................................50Compensation or damages .....................................................50Community rating.....................................................................50Connect Rewards Plus.............................................................50Customer Service Charter........................................................50Dependants..............................................................................51Electronic claiming...................................................................51Excess......................................................................................51Exclusions................................................................................52Healthy Start Benefit................................................................52If things go wrong....................................................................52Insure? Not sure?.....................................................................53Liabilities of fund members to RACT Health Insurance.............53Medicare levy surcharge..........................................................53Membership card.....................................................................53Membership for non-residents of Australia...............................53Migrants...................................................................................54Overseas travel........................................................................54Participating providers..............................................................54Payment in advance.................................................................54Pre-existing condition (PEC).....................................................54Privacy.....................................................................................55Proof of age..............................................................................55Recommendation or endorsement...........................................55Refunds....................................................................................55Replacement rule.....................................................................55Restrictions..............................................................................55Single room guarantee.............................................................56Standard Information Statement..............................................56State of the Health Funds Report..............................................56Suspension..............................................................................56Transferring from another health fund......................................56Waiting periods........................................................................57RACT Health Insurance is provided by GMHBA Limited.References to “RACT Health Insurance” and “GMHBA” arereferences to GMHBA Limited. References to “RACT” arereferences to The Royal Automobile Club of Tasmania.Application for membership with RACT Health InsuranceYou’ll be asked to complete a membership application whenyou join RACT Health Insurance or make changes to yourmembership. For example, when you change your level ofcover or add/remove a person covered by your membership.You can make changes to your membership at any time.When you complete a membership application it’s importantthat you provide us with all the information requested to allowus to maintain an accurate record of your membership. It isalso important that the information you provide is true andcorrect.RACT Health Insurance will consider your membership void ifyou provide false or incorrect information on your membershipapplication and premiums received in advance for coveragebeyond the termination date will be refunded. RACT HealthInsurance uses the terms ‘fund member’, ‘spouse/partner’ and‘dependant’ to define the people covered by a membership.Only the person nominated as the fund member can authorisechanges to the membership unless the fund member haspreviously authorised the spouse/partner to make suchchanges.Similarly, correspondence issued by RACT Health Insurancewill be addressed to the fund member and it is the fundmember’s responsibility to notify RACT Health Insurance of anychange of address. The signing of the membership applicationand the payment of any premium constitutes an acceptance ofany conditions laid down in the regulations of the fund in forceat that time or as they may be amended from time to time.RACT Health Insurance reserves the right to refuse admissionto membership of any level of health insurance except BronzeHospital cover.In the event that any member or person named on themember's membership is convicted in a court of law of assaultor similar offence against a staff member related to that staffmember’s performance of their duties, has obtained orattempted to obtain an improper advantage, for themselves orfor any other member, or is convicted in a court of law of fraudagainst the fund, the Board may in its discretion, declare themember's membership void.The status of the member's membership will be assessed withany outstanding claims being honoured and any premiumsshall be refunded. Any other rights accrued to the member willbe forfeited.46 47ArrearsRACT Health Insurance fund members are responsible forensuring their premiums are up to date. Membership willcease when premiums fall into arrears of more than 2 monthsafter the premium due date. To claim benefits a fund membermust be financial at the time of incurring the expense for theservice or treatment.AuditsRACT Health Insurance undertakes audit activities in order toprotect members’ assets and contain costs. From time to time,in the general interest of members, an RACT Health Insurancerepresentative may contact you with a request for assistanceto monitor costs – whether relating to benefits paid or chargesraised by health care providers. Your co-operation with suchrequests is critical to our cost containment efforts, and will betreated in a completely confidential manner.Benefit limitation periodsDuring your first 24 months of cover (after the standardhospital waiting periods have been served) Gold Hospital andSilver Hospital cover are subject to benefit limitations onselected services. This means that the benefits payable onthese services are limited to receive the public hospital defaultbenefits only, during the 24-month benefit limitation period.Once the waiting period and benefit limitation period has beenserved, you will have access to the benefits applicable on yourlevel of cover. Applicable benefit limitation periods can befound in product descriptions under the hospital tab of thismember guide.ClaimingClaims may be made by post or by the assignment of yourbenefit entitlement to a hospital or health care provider. Inorder to assess your claim and calculate your benefit, we willneed the following information:• A completed claim form when remitted by post or via aprovider, and• The fully itemised health care account/s, and,if you have paid the account/s, the original receipt/s.Photocopies/facsimiles of accounts and/or receipts cannotbe acceptedRegistered members can now also claim for select servicesonline at ract.com.au/healthinsurance:1. Members need to be registered for web services2. Member needs to agree to terms and conditions whichincludes agreeing to keep receipts for 2 years as they willbe audited3. Service must already be paid for.IMPORTANT INFORMATION

Important informationIMPORTANT INFORMATIONYou’ll also be required to provide additional documentationwith claims for the services/items including:• A doctor’s letter of recommendation is required to be lodgedwith claims for the following items/services: blood glucosemonitor, extremity pump, nebuliser pump, appliances, sleepapnoea monitor, pressure garments, approved orthopaedicappliances by us, non-surgical prostheses, TENS monitor,nicotine replacement therapy patches, learn to swimlessons, blood pressure monitors and joint supports.• An orthodontic treatment plan certificate, completed by thetreating orthodontist/dentist, is required before orthodonticbenefits can commence. You can obtain an orthodontictreatment plan certificate by calling us on 13 27 22. For thepurpose of benefit payments, orthodontic treatment isregarded as commencing on the date the appliance isoriginally fitted. Limits apply every calendar year.• Weight loss program is only payable when recommended inwriting by a doctor for the purpose of preventing orimproving a specific health condition/s. The weight lossprovider must be a member of the Weight ManagementCouncil of Australia and agree to abide by the WeightManagement Code of Practice, including: Weight WatchersAustralia – Jenny Craig Weight Loss Centres Pty Ltd –Fernwood – Simplicity Weight Loss. Benefits are onlypayable for weight loss program fees and not meals orexercise components.Upon claiming, members are required to provide the followingin support of their claim for weight loss program benefits:• A report from the weight loss provider or photocopy of yourmembership record of fees paid at the time that themilestone is reached.• A report from the weight loss provider or photocopy of yourmembership record of weight loss achieved fromcommencement of the program.An initial benefit of $100 is payable upon membersachieving a 10% loss of their start weight. Another benefit ofup to $100 is payable on members achieving their goalweight where achieved within 24 months and up to the totalof program fees not already reimbursed. Where program feesare less than $100 at each of these milestones, RACT HealthInsurance will pay the total of the program fees only and not$100. A 2 month waiting period for commencement ofweight loss program applies.• RACT Health Insurance reserves the right to take thefollowing actions against any policy holder or persons whereimproper, fraudulent or indiscretion occurs while makingclaims against the fund. Actions that may be taken are:- Suspension of electronic claiming with the period of timedetermined by the fund depending on the severity of theincident- Restitution (voluntary or negotiated)- Prosecution- No extras benefit will be payable unless a medical reason/condition is present- Services for both extras and hospital benefits must bevalidated by clinical notes. No benefit is payable wherethere are no clinical notes outlining the service provided.The clinical notes must be legible, written in English andbe understandable by a peer.Physiotherapy consultation must be for a minimum of 15-20minutes to qualify for one-on-one physiotherapy benefits.Unpaid accounts (other than hospital accounts)Claims for unpaid accounts will be paid by direct credit (whereavailable) or cheque. The benefit cheque will be made payableto the health care provider. The cheque should be immediatelyforwarded to the health care provider, together with yourpayment for any account balance.Paid accountsBenefits for paid accounts will be paid:• by exception cheque, made payable to the fund member• directly credited into the member's financial institutionaccount• to RACT Health Insurance, where the member requests thatthe benefit refund is, either in part or full, used to pay RACTHealth Insurance premiums.Medical benefitsClaims for medical benefits can only be paid after your claimfor medical services has been assessed by Medicare (except inthe case of claims made through our medical gap cover – seepage 22 for details) and your claim for hospital benefits hasbeen assessed and paid. Our benefits are not payable forservices rendered when the patient is not a hospital inpatient.Agent’s authorityYou may authorise another person to collect benefits on yourbehalf by completing the Agent’s Authority section of the claimform. The fund member and the agent (the person who is beingauthorised to collect the benefits) must sign the authority. Theagent will be requested to sign the claim form again whenbenefits are paid.Item numbers included under Preventative Dental limit:ItemNumber011012013014015016017ADA ScheduleComprehensive oral examinationPeriodic oral examinationOral examination – limitedConsultationConsultation – extended (30 minutes or more)Consultation by referralConsultation by referral – extended(30 minutes or more)Simplified definitionEvaluation of all teeth, also includes recording medicalhistoryFollow-up consult, records all changes to patient's teethsince previous consultA "problem focused" consult done immediately prior torequired treatmentA consult to seek advice/discuss treatment regarding aspecific conditionA consult to seek advice/discuss treatment regarding aspecific condition – 30 minutes or moreA consult with a patient referred by a dental or medicalpractioner for the management/opinion of a specific dentalconditionA consult with a patient referred by a dentalor medical practitioner for the management/opinion of aspecific dental condition – for 30 minutes or more018 Written report (not elsewhere included) A written report of the patient's care111Removal of plaque and/or stainRemoval of plaque/stain from all surfacesof the teeth113 Recontouring of pre-existing restoration(s) Reshaping/repolishing of existing fillings114 Removal of calculus – first visit Removal of tartar from the surfaces of the teeth115121Removal of calculus – subsequent visitTopical application of remineralizing and/orcariostatic agents, one treatmentFollow-up consult to remove all tartar from the surfaces ofthe teethAn application of an agent to the surfacesof the teeth eg: calcium salts, fluorideIMPORTANT INFORMATION48 49

Important informationIMPORTANT INFORMATIONCode of ConductRACT Health Insurance is brought to you byGMHBA Limited, proud to be a compliantmember of the Private Health InsuranceCode of Conduct. The Private Health Insurance Code ofConduct is designed to help you by providing clear informationand transparency in your relationships with health insurers.The Code covers four main areas of conduct in private healthinsurance ensuring:• you receive the correct information on private healthinsurance from appropriately trained staff;• you are aware of the internal and external dispute resolutionprocedures with RACT Health Insurance;• policy documentation contains all the information you requireto make a fully informed decision about your purchase andall communications between you and RACT Health Insuranceare conducted in a way that ensures appropriate informationflows between the parties; and• all information between you and RACT Health Insurance isprotected in accordance with national and state privacyprinciples.You can download the Code at www.privatehealth.com.au/codeofconduct.phpCommunity ratingRACT Health Insurance is a strong supporter of the principlesof community rating. As such, RACT Health Insurance will notdiscriminate between members on the basis of their health orany other reason described below.When making decisions in relation to members, RACT HealthInsurance will disregard the following:1. The suffering by the member of a chronic disease, illness orany other medical condition.2. The gender, race, sexual orientation or religious belief of aperson.3. The age of a member, except in relation to lifetime healthcover loadings.4. Any other characteristic of a person (including but not justmatters such as occupation or leisure pursuits) that arelikely to result in an increased need for extras or hospitaltreatment.5. The frequency with which a person needs hospital treatmentor general treatment.6. The amount, or extent, of the benefits to which a memberbecomes, or has become, entitled during a period.Compensation or damagesWhere you or your dependants have a right to claim damagesor compensation from any other person or body, you arerequired to pursue that entitlement prior to lodging a claim forbenefits with us. A claim should only be lodged with us ifaction at law is unsuccessful.A letter of denial is required. This includes WorkCare, TAC,public liability and third-party claims.Connect Rewards PlusThe Connect Rewards Plus program pays reward dollars tomembers on combined hospital and extras cover according tothe level of hospital cover and number of years members havebeen with RACT Health Insurance.• RACT Health Insurance does not recommend or endorse anyhealth or medical program, therapy or appliance in respectof which Connect Rewards Plus benefits are offered or paid.Some programs, treatments or appliances should not beundertaken or used without medical advice.• In circumstances where family/couples/single parentmemberships change to a single membership, the existingmembership may retain the Connect Rewards accrued.• Connect Rewards Plus is a membership reward. ConnectRewards Plus entitlements cannot be transferred from onemembership to another.• When you have a hospital admission that results inout-of-pocket expenses, we’ll write to you within 60 – 90days of your hospital discharge to ask if you would like to useyour Connect Rewards Plus dollars towards the cost of theinpatient medical gap. In the letter, we’ll include your currentConnect Rewards Plus balance. You must have a ConnectRewards balance and an out-of-pocket medical expense ofat least $50 at the time of discharge to qualify for benefits.You can only claim Connect Rewards benefits for inpatientmedical gap by producing a copy of the letter and completingthe form attached to it. These types of claims cannot beprocessed in branches on the spot without the memberhaving received a letter from RACT Health Insurance first.• Swimming lessons, orthopaedic shoes, joint supports,melanoma surveillance photography, nicotine replacementtherapy patches and blood pressure monitor claims must beaccompanied by a written recommendation by a doctor,including a health management plan and approved by RACTHealth Insurance.Customer Service CharterAs testament to our commitment to you, we have developed aCustomer Service Charter, which is our written assurance toyou that we take our service delivery seriously. The charterdetails our promises and guarantee to you as well as whathappens in the event something goes wrong. To view ourCustomer Service Charter visit ract.com.auDependants1. RACT Health Insurance membershipChild dependants: are covered up until they turn 21 years ofage if they no longer meet the criteria for student dependants.Child dependants that do not meet the criteria (of a studentdependant) will be terminated off the membership from thedate they turned 21. They have 2 months to organise healthinsurance from this date; however, their new membership willcommence from the date they turned 21. They won't have toserve waiting periods when transferring to an equivalent orlower level of health insurance.Student dependants: are covered up until they turn 25 yearsof age. They have 2 months to organise health insurance fromthis date; however, their new membership will commence fromthe date they turned 25. They will not be required to servewaiting periods when transferring to an equivalent or lowerlevel of health insurance.Student dependants – mid year school/ apprenticeship &traineeship leavers: who transfer from their parents’ RACTHealth Insurance membership within 2 months of leavingschool or finishing an eligible apprenticeship or traineeshipthrough a registered training group are not required to servewaiting periods when transferring to an equivalent or lowerlevel of cover. A letter from their school or registered traininggroup confirming the date of completion is required.Student dependants – end of year school/ apprenticeship& traineeship leavers: are covered under their parents’ familyor single parent membership until 31 March the following year.They will not be required to serve waiting periods whentransferring to an equivalent or lower level of health insurance.Group training is an employment and training arrangementwhereby an organisation employs apprentices and traineesunder an apprenticeship/traineeship training contract andplaces them with host employers. A registered group trainingorganisation undertakes the employer responsibilities for thequality and continuity of the apprentices’ and trainees’employment and training. To qualify for a traineeship and beeligible to attract Australian Government incentives, there mustbe a registered training contract between the trainee and theemployer. Please contact us on 13 27 22 for more information.2. Other fundsStudent dependants whose parents are fund members ofanother registered health fund may join RACT Health Insurancewithin 2 months of ceasing to be a dependant, on a level ofcover equal to or less than that held by their parents, withoutserving waiting periods. An acceptable transfer certificate andclaims history must be received.3. Previously uninsuredPreviously uninsured dependants may join RACT HealthInsurance within 2 months of leaving school or on completionof a full-time apprenticeship/traineeship, and receiveimmediate Bronze Hospital cover benefits, except for anypre-existing condition/illness (other than for psychiatric,rehabilitation and palliative care) and maternity cases, forwhich a waiting period of 12 months will apply.All waiting periods must be served for extras benefits andhospital benefits that are higher than those available from theBronze Hospital cover.Child dependant excessNo excess applies for child dependants under 21 on ourPlatinum and Gold Hospital family hospital covers listed in thismember guide.Electronic claimingWhen you have RACT Health Insurance extras cover you canuse your RACT Health Insurance membership card to claimelectronically on the spot when this facility is available at yourhealth care provider. After the service has been provided, yourmembership card will be swiped through the terminal, yourclaim details entered and your claim will usually be processedelectronically within seconds. Once your claim is authorised byRACT Health Insurance, you simply pay any difference betweenthe full fee for the treatment and the amount claimed by RACTHealth Insurance.If there is an unexpected rejection of your claim at point ofservice, your provider should contact RACT Health Insuranceon 13 27 22 to clarify the issue at the time of the servicetaking place.ExcessRACT Health Insurance hospital covers often feature an excessto let our members share some of the cost of hospitaladmissions in return for lower premiums. The excess iscalendar year based.Excess – hospital onlyAn excess is deducted from the benefit paid by RACT HealthInsurance. For example, if our full benefit for a hospital staywas $5,000 and the member has a $250 excess on theirhospital cover, the benefit would reduce by the amount of theexcess and an adjusted benefit of $4,750 would be paid.Where one member on a couples, family or single parentexcess cover is admitted to hospital they will only pay amaximum amount per person as opposed to the maximumamount per membership. This is usually half the maximumannual excess per policy.No excess applies for child dependants under 21 on ourPlatinum and Gold Hospital family hospital covers listed in thismember guide.IMPORTANT INFORMATION50 51

Important informationIMPORTANT INFORMATIONExclusionsYou cannot claim for the following:• Benefits are only payable on itemised and originalaccount/s. Account/s that have been altered in any way willnot be accepted. Providers are required to re-issue anyaccount/s or endorse any alterations.• The supply of contraceptives, fertility and IVF drugs anditems available through the Pharmaceutical Benefit Scheme(PBS).• Natural remedies (includes Modifast & Optifast).• Food supplements.• Pharmacy items, where they are available over the counterand purchased with or without a prescription.• Supply of liquid-filled Temazepam capsules.• Pharmaceuticals purchased overseas and not listed on theAustralian Register of Therapeutic Goods.• Dental procedures carried out and charged direct to the fundmember/dependant by a dental mechanic, other than anadvanced dental technician.• A range of dental procedures when provided on the sameday, e.g. a filling on a tooth that has been removed.• Dental procedures where a limit on the number you canhave has been exceeded.• Dental procedures unless tooth identifications (ID) aresupplied by the provider.• Services/treatment for which the member and/or dependanthas a right to claim damages or compensation from anyother person or body.• Treatment where the member and/or dependant is eligiblefor free treatment under any Commonwealth or StateGovernment Act.• Services/treatment rendered more than 2 years prior to thedate of claiming.• Services/treatment that is not covered by your membershipand/or is rendered while the membership is in arrears or issuspended.• Services/treatment rendered by a practitioner not in privatepractice and/or not recognised by bodies approved by us.• Pressure garments purchased for reasons other thantreatment of burns, lymphoedema or for postoperativesurgery up to 60 days from hospital discharge only.• Specified (and approved by us) orthopaedic appliancespurchased for support purposes only.• Hiring of equipment (unless otherwise stated).• Mass immunisation, services rendered in the course of thecarrying out of a mass immunisation.• Services not rendered face to face (e.g. remotely over thephone).• Foot orthotics provided by a physiotherapist or chiropractor.• Additional medical gap benefits where the medical serviceis rendered by a medical practitioner employed full-time inthe public sector.• Treatment is provided to themselves, a member of theprovider's family and/or to a provider's business partner andtheir family members or any other people not independentfrom the practice. Family members include: wife/husband,brother/sister, children, parents, grandparents, grandchildrenof the provider/business partners and their spouse/partner.• Benefits for lifestyle-related services that primarily take theform of sport, recreation or entertainment.• Fund benefits, payable under a hospital or extras cover shallnot exceed the fees and/or charges raised for any treatmentand/or services covered for benefits under the relevantcover, after taking into account benefits paid from any othersource.• Benefits for services or treatment received overseas.Extras services purchased over the internetBenefits will be paid for extras services purchased over theinternet from Australian providers (optical and pharmaceutical)where a script is provided. Consistent with current RACT HealthInsurance rules, benefits for services or treatment receivedoverseas are excluded.Healthy Start BenefitOur Healthy Start Benefit has been introduced to help cover anobstetrician medical gap (inpatient service only). For GoldHospital product level 0/1/2, an additional benefit of $500 (upto the actual fee less the standard medical benefit andadditional gap medical benefit) is payable where the episode isfor the birth of a child. This benefit will be paid per episode andnot per child (i.e. the additional benefit is up to $500 formultiple births as well as single births). When you have ahospital admission that results in an out-of-pocket expense forthe birth of a child, we’ll send you a payment of up to $500within 60-90 days of your hospital discharge. For furtherinformation on the Healthy Start Benefit we recommend youcall us on 13 27 22.If things go wrongOur mission to be your trusted partner in the provision ofprivate health insurance goes beyond providing qualityaffordable products and high levels of customer service.While we receive many letters of praise about our products andcustomer service advisors, like any organisation we aren’tperfect and on occasions we also receive complaints. Webelieve that your complaints are of equal or greater importancethan praise.As such we have stringent guidelines in place to ensure weacknowledge you in the most efficient and timely manner.So, in the unfortunate circumstance that you have a concern orcomplaint you can contact us through the following channelsand can expect an acknowledgement as indicated below:1. Talk to an RACT Health Insurance representativeYou can talk to a representative by calling 13 27 22 oremailing healthinsurance@ract.com.au. We respond to allour phone calls immediately, and will follow up all e-mailand telephone messages within 24 hours.2. Write to usWe will provide an acknowledgement within 5 working daysfor written correspondence.Where the matter is complex we will attempt to finalisewithin a month. However, where the difficulty of the matterprecludes this, we will inform you of the progress.3. Write to the Member Services Review Committee (MSRC)If, after receiving our response, you are still not satisfied youcan write to the Member Services Review Committee(MSRC). We have appointed a panel of highly experiencedemployees including subject matter experts, first lineleaders, a senior and executive manager, who meetregularly to discuss any issues received from members. Theaim of the MSRC is to listen to you and provide decisionsthat are fair and equitable for all our members. You willreceive an acknowledgement of your correspondence within5 working days of the committee’s weekly meeting.You’re welcome to write to the MSRC at RACT HealthInsurance, Reply Paid 1292, Hobart TAS 7001.4. Contact our Member Satisfaction ManagerIf you require further clarification about the decision made atthe MSRC please write to the Member Satisfaction Managerat RACT Health Insurance, Reply Paid 1292, Hobart TAS7001. We will acknowledge your correspondence within 5days of receipt. Where the matter is complex we will attemptto finalise within a month; however, where the complexity ofthe matter precludes this, we will keep you informed of theprogress.If you’re still dissatisfied with the outcome, free independentadvice is available from the Private Health InsuranceOmbudsman. You can contact the Ombudsman on freecall1800 640 695 or Suite 2, Level 22, 580 George Street, SydneyNSW 2000.Insure? Not sure?If you need more information about private health insuranceplease refer to the Private Health Insurance AdministrationCouncil (PHIAC) guide “Insure? Not sure?”, which can bedownloaded from www.phiac.gov.au/for-consumers/insure-not-sure/Liabilities of fund members to RACT Health InsuranceA member can be liable to RACT Health Insurance for unpaidpremiums and for overpayments. Overpayments can be madeby RACT Health Insurance to a fund member, either through anerror in completing a claim, or an error in processing a claim. Ifan overpayment is made, the fund member is liable to repaythe amount of the overpayments to RACT Health Insurance ondemand.If a fund member is liable to RACT Health Insurance for unpaidpremiums or overpayments then RACT Health Insurance hasthe right to deduct the amount of that liability from any moniesdue by RACT Health Insurance to the fund member on anyaccount.Medicare Levy SurchargeThe Medicare Levy Surcharge (MLS) is an additional tax whichAustralians need to pay if they are without private healthinsurance hospital cover and are earning over $84,000 as asingle or $168,000 as a couple/family. If you do not hold aneligible hospital cover (or if you drop your hospital cover) youwill have to pay additional tax on top of the standard MedicareLevy that applies to all Australian taxpayers.On 1 July 2012 the Federal Government increased the MLSfor higher income earners to encourage people to maintaintheir private health insurance, rather than adding to thealready long waiting lists for public hospitals. The surchargepayable is now based on income tiers. Please refer to thetable on page 42 for more details.For more information please see privatehealth.gov.au orato.gov.au.Membership cardWhen you join RACT Health Insurance, you’ll receive amembership card that identifies you as a member. The cardshows your membership number and who is covered. RACTHealth Insurance contact details are listed on the back of thecard. Have your membership card on hand when you arrangeadmission to hospital, visit a participating provider or when youcall RACT Health Insurance with any questions.A new card may be issued when you make changes to yourmembership. Please note that an existing card will becomeinvalid whenever a new membership card is issued. Keep yourcard safe and please advise RACT Health Insurance if your cardis lost or stolen.Membership for non-residents of AustraliaRACT Health Insurance hospital covers are designed for peoplewho have full Medicare eligibility. These covers will not meetthe cost of public hospital treatment, medical treatment ordiagnostic services for people who do not have full Medicareeligibility. Temporary residents of Australia who do not have fullMedicare eligibility should contact RACT Health Insurance on 1327 22 to discuss appropriate health insurance arrangements.IMPORTANT INFORMATION52 53

Direct Debit Service AgreementIMPORTANT INFORMATIONTerms:1. This agreement relates only to the Direct Debit Scheme andmethod of premium payments and does not affect theconditions of membership laid down in the regulations in forceat this time or as amended from time to time.2. All communication issued by RACT Health Insurance inrelation to the Direct Debit Request and Agreement for Paymentof Premiums by Direct Debit will be issued to the RACT HealthInsurance member irrespective of whether it is the members, oranother persons/party’s financial institution account to whichthe Direct Debit Request and Agreement for Payment ofPremiums by Direct Debit relate.3. The frequency of direct debit deductions will be as specifiedin the Direct Debit Request.The RACT Health Insurance membership should be paid to thedate of the direct debit deduction. If the membership is not paidto this date, the direct debit deduction may include all arrearsowing.5. A cancellation of the Direct Debit Request must be receivedby RACT Health Insurance in writing on the prescribed form atleast 7 days prior to the stated cancellation date. The request isto be signed and dated by the account holder. Faxedcancellations will be accepted. Cancellations notified bytelephone will not be accepted. The cancellation of the DirectDebit Request does not constitute cancellation of the RACTHealth Insurance membership.6. Alterations to membership or account details must bereceived in writing, on the prescribed form/s at least 7 daysbefore the next scheduled direct debit deduction date.7. RACT Health Insurance will notify the member in the event ofany alteration to the Direct Debit Request Service Agreement, atleast 14 days prior to the direct debit deduction date.8. A refund of premiums cannot be issued within 14 days of thedirect debit deduction date. This allows sufficient time for theFinancial Institution to advise RACT Health Insurance of anydirect debit deduction dishonour.9. Direct debit deductions through ‘BECS’ is not available on allaccounts and it is the responsibility of the member to check thesuitability of the account for direct debit deductions.10. It is the responsibility of the member to ensure thatsufficient funds are held in the account to cover the direct debitdeduction. If there are not sufficient funds in the account tocover the direct debit deduction any resulting FinancialInstitution fees are the responsibility of the member.11. Direct debit deductions will take place on the date/frequency specified in your Direct Debit Request unless thosedates fall on a non working day (i.e. weekend or public/bankholiday) in which instance the direct debit deduction will occuron the first working day following the scheduled date. Membersmust contact the Financial Institution if they are uncertain of thedirect debit deduction date.12. If a direct debit deduction is dishonoured, RACT HealthInsurance may attempt to make subsequent deductions at anytime, including arrears of premium and any financial institutionfees incurred on the dishonour.13. After three consecutive direct debit deduction dishonoursRACT Health Insurance will remove the membership from thedirect debit scheme.14. Details of the Financial Institution account will be treatedconfidentially. The account holder agrees that RACT HealthInsurance may supply to the member, or any FinancialInstitution with which RACT Health Insurance has entered intoan agreement to enable participation in the direct debit scheme,or the Financial Institution specified by the account holder onthe direct debit request, any information relating to themember’s account with RACT Health Insurance, or any credit ordebit to the member’s account with RACT Health Insurance, orany credit or debit to RACT Health Insurance account with aFinancial Institution.15. Dispute Resolution Processi. It is the responsibility of the member to contact RACT HealthInsurance in the event of a member claim or complaint.ii. RACT Health Insurance will promptly investigate the claimand advise the member if the claim is accepted as a validclaim or, if it is disputed by RACT Health Insurance, thereasons why it has been disputed (including withoutlimitation details of the authority given to RACT HealthInsurance by the customer, including a copy of the originalrecord of the Direct Debit Request and Agreement forPayment of Premiums by Direct Debit).16. RACT Health Insurance is unable to accept direct debits onthe 29th, 30th and the 31st of any month.17. If a frequency is not selected RACT Health Insurance willdefault the frequency to monthly debits. If a date is not selectedRACT Health Insurance will default the date to the next availabledate for your frequency.58

RACT OfficesHobartRACT House 179 – 191 Murray StLauncestonCnr York & George StsDevonport119 Rooke Street MallBurnie24 North TerraceRosny ParkRosny Mall, 2 Bayfield StreetGlenorchyCnr Main Road & Terry StreetKingstonShop 60 Channel Court13 27 22ract.com.au/healthinsuranceFax: (03) 6232 0020Postal Address: GPO Box 1292Hobart, Tasmania 7001Brought to you by GMHBA Limited59