All benefits listed are effective 1 April 2009.
Important Information
Some waiting periods may apply, depending on the cover you select and whether you are transferring from another health fund. It is important you read and understand the information below. Please call us on 1300 113 113 if you would like the discuss your eligibility for benefits.
Extras
After 2 months you can claim benefits on all extras services except for the following:
- major dental (such as crowns, bridges, implants and dentures) - 1 year
- apparatus benefits (eg asthmatic spray appliances, blood glucose monitors, hearing aids and sleep apnoea machines) - 1 year (see Gold Extras for eligibility)
- orthodontic benefits
- Silver Extras
- $200 after 1 year or
- $1,000 after 2 years.
- Gold Extras
- $500 after 1 year or
- $1,500 after 2 years or
- $2,500 after 5 years.
- hearing aids - based on years of continuous Gold Extras membership
- $800 after 1 year of continuous Gold Extras membership or
- $900 after 5 years of continuous Gold Extras membership or
- $1,150 after 10 years of continuous Gold Extras membership.
Maximum benefits limited to once every 5 years.
Hospital
A waiting period of 2 months applies for all hospital benefits. This is extended to
12 months when:
- you have a pre-existing condition. A pre-existing condition is one where signs or symptoms of your ailment, illness or condition, in the opinion of a medical practitioner appointed by the health fund (not your own doctor), existed at any time during the six months preceding the day on which you puchased your Hospital Cover benefits.
- your hospital admission is in connection with pregnancy or childbirth
- accessing home nursing benefits.
If hospitalisation is contemplated in the first 12 months of membership we strongly recommend that you contact us so that eligibility for hospital benefits can be determined.
Please note that not all private treatment is covered by private health insurance (eg cosmetic surgery not medically required).
When you transfer from another health fund or upgrade you cover
Extras
You obtain immediate access to all Extras benefits, including immediate access to Health Partners professionals, if you transfer with equivalent Extras Cover, provided you have served the relevant waiting periods, except:
- if you upgrade your level of cover — a 2-month wait applies to the additional benefits provided by a higher level of cover
- further waiting periods may apply to major dental, orthodontic, and apparatus benefits depending on the length of time you have been covered for these services during this time you will receive the same benefits as your previous equivalent cover.
- if there is a lapse in cover of 30 days or more when transferring.
This also applies to current Health Partners members upgrading their cover.
Hospital
You obtain immediate access all Hospital benefits if you transfer with equivalent cover, provided you have served the relevant waiting periods, except:
- if you upgrade your cover. Waiting periods apply for the additional benefits provided by the higher level of cover as outlined above. During this time you will receive the same benefits and pay the same excess and co-payments as your previous equivalent cover
- if there is a lapse of in cover of 30 days or more when transferring.
This also applies to current Health Partners members upgrading their cover.
If you are transferring your Hospital Cover to Health Partners, we recommend you keep your cover with your former fund until the date you transfer to Health Partners. This will ensure you are not without cover and that you will not use any of your permitted days without Hospital Cover under Lifetime Health Cover.
Benefits paid by your former fund will count towards your yearly maximums in your first year of membership with Health Partners. Loyalty bonuses or accrued entitlements with your former fund are not transferable to Health Partners.
The 'Right to Change' brochure produced by the PHIO is a useful guide when transferring between funds. Please contact us if you would like a copy.
When transferring from your former fund to Health Partners, your Lifetime Health Cover Loading will remain the same. |