Wellbeing Two - Southern Cross Healthcare

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Example of benefits under our Wellbeing Two planThese are some of the benefits that our Wellbeing Two plan offers. For more details on the benefits and maximums for this plan, andany exclusions or conditions that may apply, call 0800 800 181 and request a policy document.BENEFITSWellbeing TwoYour refund will be the maximum in this column, the reasonable charge for this healthcare service or youractual costs – whichever is the lowest amount.*CONSULTATIONSMedical Practitioner Band II consultationsMedical Practitioner Band III consultationsMedical Practitioner Band IV consultationsPsychiatrist consultationsIMAGING AND DIAGNOSTICSX-rays (excluding x-rays performed by a dentist,chiropractor or Oral Surgeon)ScintigraphyUltrasound (excluding varicose vein (legs)treatment or obstetrics ) / MammographyCT scan (excludes Calcium Scoring)MRI scanMyocardial perfusion scanCardiac tests$150 for initial consultation, $115 for follow-up consultation (no annual limits)$300 for initial consultation, $125 for follow-up consultation (no annual limits)$175 for initial consultation, $125 for follow-up consultation (no annual limits)$750 per claims year$500 per claims year$700 per claims year$500 per claims year (each benefit)$1,500 per claims year$2,000 per claims year$1,500 per testSome cover for Treadmill ECG, Holter monitoring, Ambulatory blood pressure monitoring, Cardiovascularultrasound, Dobutamine, stress and transoesophagael echocardiography (for full details see policy document)TREATMENTSurgeryUp to $75,000 per operation. See example oppositeMinor surgery$350 per procedureRECOVERY (4 months after surgery; the preceding surgery must have been eligible for cover under your policy)Home nursing$125 per day, up to $2,000 per claims year (by a Registered Nurse in private practice on referralfollowing surgery)Post-operative physiotherapy$60 per visit, up to $300 per claims year (must be related to eligible surgery)Speech and language therapy$70 per visit, up to $350 per claims year (must be related to eligible surgery)SUPPORTHospital cash allowance$50 per night / up to $500 per admission / up to $2,400 per claims year (for an adult)Ambulance$180 per claims year ( following admission in public facility or an Affiliated Provider in-patient admission)Waiver of premium24 months free cover for surviving partner and dependant children (under the age of 21) who were membersof Southern Cross, upon the death of the policyholder prior to the age of 60NON SURGICAL HOSPITALISATIONMedical hospitalisation (excludes hospice,Accommodation $700 per day, up to $25,000 per claims yeargeriatric, oncology, psychiatric)Chemotherapy treatment$25,000 per course of treatment, up to $60,000 per claims yearRadiotherapy treatmentAffiliated Provider only. Policy limits will apply. Prior to receiving treatment your Affiliated Provider will advisethe balance payable by you.SURGICAL ALLOWANCESOverseas treatment allowance$10,000 per claims yearAFTER 1 YEAR CONTINUOUS COVERSterilisation$5,000 one-off paymentAFTER 3 YEARS CONTINUOUS COVERGastric banding/bypass allowance$7,500 one-off paymentBilateral breast reduction allowance$5,000 one-off payment*See the chart in your policy document for how your refund will be calculated.
Example of surgery cost reimbursementTo give you an idea of how your surgery costs are reimbursed under the Wellbeing Two plan, we have chosen a common operation.It involves the removal of the gall bladder by way of ‘key hole’ surgery (Laparoscopic Cholecystectomy) for a patient suffering fromgall stones. Details of this example are highlighted in the table below.EXAMPLE: Removal of gall bladderComponents of surgery:Assume youwere chargedthe amountstated inthis column:In this example,your refund fromSouthern Crosswill be:Your shareof the cost inthis examplewill be:Surgeon’s operating fee $2,522$2,522 $0Anaesthetist’s fee $762 $762 $0Surgeon’s initial consultationHospital accommodation per daymaximum per operation$150$712Your refund from yourWellbeing Two plan willbe your actual costs upto $75,000 based onreasonable charges*$150$712$0$0Operating theatre fee $1,584 $1,584 $0In-hospital X-ray and ECG $86 $86 $0Ancillary hospital charges $1,350 $1,350 $0Laparoscopic disposables $833 $833 $0Intensive care and specialin-hospital nursing$108 $108 $0In-hospital post operative physiotherapy $80 $80 $0TERMS AND CONDITIONSAll dollar figures include GST charged by providers.Claims year - This is not a calendar year, but each successive12 month period from your claims anniversary date.Claims fall into the period based on the date of treatment,not the date of the claim or receipt.Other terms and conditions (including limitations and exclusions)apply. This benefit summary should be read in conjunction withthe policy documents available on request.*See the chart in your policy document for how your refund will be calculated.
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Wellbeing Two - Southern Cross Healthcare

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