Member Guide - RACT

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