Member Guide - RACT

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