Let’s get
together.
Health Cover for Everyone.
Finding the
right health
insurance
partner has
benefits.
Health Partners is a South Australian
member owned health fund, run only
to benefit members. It’s what makes us
different, and it’s why people stay with
us. See the difference a member owned
health partner can make.
We’re here
This brochure gives a comprehensive
overview of our cover, but please call our
team anytime if you have any questions.
Call 1300 113 113
Monday to Friday 8am – 8pm
Saturday 9am – 1pm
Visit healthpartners.com.au
Email us [email protected]
Switching is simple
We’ll contact your current insurer
Waiting periods already served
switch with you
There’s a 30 day cooling off period
to make sure you’re happy
Health Partners is a signatory to the
Private Health Insurance Code of Conduct.
Go to ahia.org.au/codeofconduct.
Let us guide you
Your health insurance partner
2
Finding the perfect cover
4
Hospital cover explained
6
Extras cover explained
8
Package cover
Package cover options
10-29
10
Prime Living
14
Family Essentials
20
Couples Choice
24
Singles Starter
27
Hospital cover Comparing hospital cover options
30-35
30
Gold Hospital
32
Silver Hospital
34
Bronze Hospital
35
Extras cover
Comparing extras cover options
Gold Extras
36-47
36
38
Silver Extras
42
Bronze Extras
45
Natural Plus
47
Health management and support programs
48
Government surcharges and incentives
49
Things you should know
50
Claiming your way
52
Where to find us
53
Joining is simple
54
The information in this brochure should be read and retained in conjunction with Health Partners’ Product Disclosure
Statement (PDS). The PDS contains additional important information on the general terms of membership and cover
with Health Partners, including our Privacy Policy, Resolution Process and health insurance initiatives from the Australian
Government. This is available at healthpartners.com.au/PDS or by calling us on 1300 113 113.
1
Your Health
Insurance Partner
With over 75 years of experience, we’ve been around long enough to
understand what Australians expect from their health fund.
Simply better service
Simply better dental
We’re here to help when members
have questions or need assistance.
When you call, you’ll speak with a
friendly and knowledgeable team
member – not a machine – right
here in Adelaide, who will happily
assist you.
We’ve been providing members
with direct access to quality dental
care and generous dental benefits
for more than 25 years.
With over 30 surgeries across three
locations, Health Partners Dental is
the largest privately owned dental
practice in South Australia where
members get the best value.
F ull range of services –
everything from routine checkups to extractions, crowns,
implants and more.
etween 60% and 100% back on
B
general and major dental services.
S erving people of all ages and
needs with expertise in special
needs dentistry and children’s
preventative dental.
mergency dental treatment –
E
we’re here for you when you
need us.
2
Find out more at
dental.healthpartners.com.au
Simply better optical
Health Partners Optical stores have
been combining quality eye care
with exceptional value and service
for more than 20 years. You can
enjoy everything we have to offer,
across four locations.
etween 60% and 100% back
B
on prescription eyewear.
minimum 40% ongoing benefit
A
if you reach your limits.
F ree digital retinal imaging when
recommended by an optometrist –
we won’t compromise on delivering
the highest standard of eye care.
he latest diagnostic equipment
T
to help detect eye diseases earlier,
for your peace of mind.
t least 30% off our huge range
A
of sunglasses, all year round.
ver 100 designer brands to choose
O
from to suit all budgets, including
gap-free and low-gap options.
Find out more at
optical.healthpartners.com.au
Unbeatable
pharmacy benefits
Participating
physiotherapists
With our state-wide pharmacy
network extras members can get
unique benefits and discounts at
50 pharmacies, at no extra cost.
We have a network of over 45
participating physiotherapists
where members pay a low set
gap or no-gap at all. When you
visit, you’ll also know upfront
what your out-of-pocket expense
will be in most instances. Making
it simple is what we’re all about.
And because most of us regularly
depend on our local pharmacy,
all of our extras and package
covers include pharmacy benefits.
Plus, extras and package
members save 20% on most
non-prescription items, every day
of the year!
That includes vitamins, beauty
products, pain relief, gifts, quit
smoking products and much more.
(Conditions apply; see page 51).
Each practice is specifically
chosen to ensure access and
quality services at locations to suit
you. Visit ‘Partner Search’ at
healthpartners.com.au for locations.
More for members
As the largest open South
Australian not-for-profit health
fund, we’re constantly reinvesting
in member benefits at a level
above the industry average.
That means our members receive
more – not shareholders.
$
Member discounts
Members enjoy various special
offers like $12 Wallis movie tickets,
discounted sports gear, plus
special member pricing for travel
insurance. Visit ‘For Members’
at healthpartners.com.au.
Visit ‘Partner Search’ at
healthpartners.com.au
for locations.
3
Finding the
perfect cover
We’ve taken a simple approach to private health insurance
which allows you to pick and choose from our range of covers.
You can combine your own hospital and extras; select a package cover which
combines the two for you; or if you prefer, choose hospital or extras on its own.
4
Pages 10-29
Package cover combines
hospital and extras in the one
package for you – we have four
to choose from to suit different
life stages and budgets. Or design
your own package by selecting
one of our hospital covers and
adding one of our extras covers.
Pages 30-35
Hospital cover helps cover
your costs when you are treated
as a private patient in hospital.
It also gives you options – like
being treated by your own
doctor, shorter waiting times for
elective surgery and the timing
of your treatment.
Pages 36-47
Extras cover gives you
affordable access to services
generally not covered by
Medicare such as dental, optical,
physiotherapy, chiropractic,
pharmacy and much more.
With Health Partners’ own dental
and optical centres, and extensive
physiotherapy and pharmacy
networks, members receive
exclusive benefits and discounts –
at no extra cost.
5
Hospital cover explained
The following information applies to all Health Partners hospital
covers – purchased individually or in a package – so it’s worth taking
some time to read through it.
We’ve kept the details simple, so when you’ve
read this, simply review the comparison tables to
determine the level of cover you need.
What’s not covered
There are some situations where your
Health Partners hospital cover will not cover you:
If you’re after hospital cover in a package with extras,
see the table on page 11.
Outpatient services
For hospital cover on its own, see the table on page 31.
mergency department facility fees
E
(unless otherwise specified)
What’s covered?
Hospital cover helps pay for Medicare-recognised
procedures when you are admitted to hospital. With
all hospital cover options, you are eligible to receive
benefits at your choice of participating hospitals
(private or public), Australia-wide.
If the procedure or service you require is included in
your cover, Health Partners will:
Pay for:
Your accommodation in hospital (including
registered day facilities)
Your theatre, labour ward and intensive
care fees
All PBS prescriptions relating to your admission,
while you’re in hospital
An extensive range of government-recognised
surgically implanted prostheses
Access to a range of health management and
support programs.
Pay towards:
In-patient medical expenses. (See page 7 for
information on medical expenses and how to
avoid or reduce out-of-pocket expenses)
A range of additional services depending on
your level of cover.
6
Services at unregistered day facilities
xcluded services (see individual cover
E
options for details).
Limited benefits
Limited benefits apply for admissions where a Medicare
rebate does not apply to the treatment procedures or
to restricted services (see individual cover options for
details). Benefits paid are in accordance with the Federal
Government default payment schedule. This may
result in large out-of-pocket expenses. Please refer to
the PDS for other hospital limitations and restrictions.
Excess and co-payment
With Health Partners you can select from various
excess and co-payment options when deciding
on your hospital cover.
An excess is the amount you agree to pay towards
your hospital accommodation, should you need to
go to hospital. This is payable on admission, once only
per person, to a maximum of twice per membership
per rolling year (that is, 12 months from the date of
the first admission).
The co-payment is the daily amount you agree
to pay (in addition to any applicable excess) towards
your hospital accommodation. Maximum co-payment
amounts apply per person and per membership per
rolling year (that is, 12 months from the date of the
first admission).
Excess and co-payments are only payable if you are
admitted to hospital and are in addition to any
out-of-pocket expenses (also known as ‘gaps’)
incurred for in-hospital medical treatment.
Waiting periods
How to reduce your medical expenses
Generally, after two months you can claim benefits for
hospital services available on your level of cover, except
for the following where 12-month waiting periods apply:
The benefits you are entitled to for in-patient
medical services are based on the Commonwealth
Medicare Benefits Schedule. When you are admitted
to hospital, Medicare pays 75% of the Medicare
Schedule Fee and Health Partners covers the
remaining 25%. The ‘gap’ is the amount charged
above the Medicare Scheduled Fee, which you pay.
Should you need hospital care, you can eliminate
or reduce the gap with Health Partners Access Gap
Scheme. When your doctor uses Access Gap you
will either:
have no gap to pay, or
know your exact gap before treatment.
Your doctor can bill Health Partners direct, to make
claiming even simpler for you.
To determine if your doctor participates in
Access Gap contact us or visit ‘Doctor search’ at
healthpartners.com.au. It is your doctor’s choice to
use Access Gap on a patient-by-patient basis. It is
important to ask your doctor if they, or any other
assisting doctor, will participate in Health Partners
Access Gap Scheme. Ask if you will have a gap to pay
and if so, how much it will be. This will encourage your
doctor to participate in Access Gap.
Any excess or co-payment applicable to your level
of cover will still apply.
Waiting periods are the initial periods after joining or
upgrading your private hospital cover during which
you cannot claim hospital benefits.
Pregnancy and birth-related services, including IVF
Pre-existing conditions
Home nursing
Home sleep studies.
Waiting periods do not apply for:
Newborn babies added to a family hospital cover
within 60 days after their birth
Treatment required immediately following an
accidental injury sustained after you’ve joined.
You may be able to obtain immediate benefits if you are
transferring from another health fund with an equivalent
level of cover. See the PDS for more information.
Pre-existing conditions
A pre-existing condition is one where signs or
symptoms of an ailment, illness or condition, in the
opinion of a medical practitioner appointed by the
Fund, existed at any time during the six months
preceding the date on which you purchased or
upgraded your hospital cover.
A 12-month waiting period applies for pre-existing
conditions. This does not apply to psychiatric
conditions, palliative care and rehabilitation
(2 month wait applies).
For more information see the Product Disclosure Statement at healthpartners.com.au/PDS or contact us.
7
Extras cover explained
With extras cover, you can claim for a range of services that generally aren’t
covered by Medicare and that aren’t covered by your hospital cover.
The following information applies to all Health Partners
extras covers ­– purchased individually or in a package
– so it’s worth taking some time to read through this.
We’ve kept the details simple, so when you’ve
read this, simply review the comparison tables to
determine the level of cover you need.
If you’re looking for extras cover in a package with
hospital, see the table on page 12.
For extras cover on its own, see the table on page 37.
Save with Health Partners professionals
You can claim benefits for extras services at your own
recognised provider or, to receive the highest possible
benefits, just choose a Health Partners professional.
To find your nearest Health Partners professional, visit
‘Partner Search’ at healthpartners.com.au.
Health Partners Dental
When you visit one of our dental centres,
you can get back as much as 100% and
no less than 60% on general dental treatment. Major
dental treatment is also available on most covers, with
benefits ranging from 60% to 100%.
Health Partners Optical
You can expect unbeatable benefits
and discounts when you visit any of
our optical centres. You get back as much as 100%
and no less than 60% for optical prescription items
(including contact lenses and sunglasses). Plus,
our unique ‘unlimited benefit’ means that if you
reach your annual limits, you can keep on saving on
prescription items at a minimum of 40%.
8
Health Partners
Participating Pharmacies
We have a state-wide network of
participating pharmacies where you receive on-thespot benefits and discounts. Pharmacy benefits are
included on all levels of extras and package covers and
are exclusively available at participating pharmacies.
Health Partners
Participating Physiotherapists
When you visit any one of our participating
physiotherapists you will pay a low, set gap or no-gap
at all for most treatments, allowing you to save more.
Physiotherapy benefits are included on all levels of
extras and packaged covers.
Benefits
A benefit is the amount you receive back when you
make a claim. If the service you require is included in
your cover, Health Partners will help you cover the
costs by paying the benefit specific to your cover.
Benefits are listed for each level of cover on
pages 14-29 and 38-47.
Except where otherwise stated, benefits and limits
are per person, per calendar year.
There are instances when extras benefits are not
payable, such as when a provider is not recognised by
us or when your health cover payments are not up to
date. If you’re unsure, it’s always best to contact us.
Not all benefits are listed in this brochure for all
extras services. To check if a specific item is covered,
please contact us.
If transferring, benefits paid by your previous fund
within the current calendar year or specified period
will count towards your limits with Health Partners
for the same period.
Recognised providers
Waiting periods
We will pay benefits when the service provider is
recognised by us for benefit purposes. Contact us
to determine if your provider is a Health Partners
recognised provider.
Waiting periods are the initial periods after joining or
upgrading your extras cover during which you cannot
claim extras benefits.
Limits
For most extras services, there are limits to the amounts
that you can claim back or the number of times you can
claim a benefit, during the calendar year or the specified
period. Health Partners offers some unlimited benefits
and discounts – allowing you to save more. All of our
limits are per person unless otherwise stated. Refer to
the benefits listed on pages 14-29 and 38-47 for details.
Lifetime limits
Some extras have lifetime limits which indicate the
total amount you can claim in your lifetime. Once you
reach the limit, no further benefits will apply.
After two months you can claim benefits for all
extras services available on your level of cover, except
for the following, where the respective waiting
periods apply:
Major Dental
12 months
Orthodontic
12 months
Apparatus
12 months
Laser Eye Surgery
36 months
You may be able to obtain immediate benefits if you
are transferring from another health fund with an
equivalent level of cover. Some conditions apply; see
the PDS for more information..
For more information see the Product Disclosure Statement at healthpartners.com.au/PDS or contact us.
9
Package cover options
Package cover combines hospital and extras in the one package for you –
we have four to choose from to suit different life stages and budgets.
Hospital cover component
Extras cover component
F or details relating to the hospital
component of our package covers,
including what’s covered, what’s not
covered, excess and co-payment,
limited benefits, waiting periods,
pre-existing conditions and how to
reduce your medical expenses, see
pages 6-7.
F or details relating to the extras
component of our package covers,
including benefits, limits, lifetime limits,
Health Partners professionals and
waiting periods, see pages 8-9.
Hospital and extras cover can be purchased individually.
(See pages 30-31 and 36-37 to compare your options)
10
Prime Living
Page 14
Family
Couples Essentials Choice
Page 20
Page 24
Singles
Starter
Page 27
In-patient procedures and services
Cardiac procedures
Psychiatric services
Rehabilitation services
Accident-related treatment after joining
Pharmaceuticals related to admission (PBS approved)
Joint-reconstruction procedures
Joint-replacement procedures
Eye surgery
Pregnancy and birth-related procedures
Assisted reproductive services (e.g. IVF)
Sterilisation reversal
Dialysis for chronic kidney failure
Surgical weight loss procedures
Removal of tonsils, adenoids
Removal of appendix
Removal of wisdom teeth
Cataract surgery
Non-PBS prescriptions
Home Health Partner
Home Nursing
Non-surgical prostheses & recovery aids
Health Management Programs
Home Sleep Studies
Chronic Condition Management Service
Newborn Support Program
Examples of other procedures
Additional benefits
Excess & co-payment
Excess
NIL $300$300 $500
Co-payment
NIL NILNIL NIL
No excess or co-payment for kids N/A
Included
11
Restricted benefits apply
N/AN/A
Not included. See page 7 for details on waiting periods.
Prime Living
Extras benefits
Page 14
Family
Couples Essentials Choice
Page 20
Page 24
Singles
Waiting
Starterperiod* (mths)
Page 27
Page 9
General Dental
2
Major Dental
12
Endodontic
Optical
2
Pharmacy
2
Physiotherapy
2
2
2
Gym & Fitness (under Health Management)
Emergency Ambulance
2
Non-emergency Ambulance
2
Chiropractic/Osteopathic
2
Podiatry
2
Speech Therapy
2
Dietary
2
Psychology
2
Orthodontic
12
Orthotics
2
Occupational Therapy
2
Eye Therapy
2
Exercise Physiology
Naturopathy
Acupuncture
2
Hypnotherapy
2
Natural Therapies Massage
2
Laser Eye Surgery
36
Pilates
2
Apparatus 2
2
2
12
Emergency Department 2
Facility Fee
Included
Not included. *See page 9 for details on waiting periods.
12
Prime Living
Prime Living
Key features
If you’re looking for a comprehensive package, look no
further than Prime Living. Offering the highest level of
benefits on any of our package products – with selected
exclusions for things you probably won’t need and
no hospital excess. Prime Living provides benefits for
services like laser eye surgery as well as benefits of up to
100% on dental, optical, physiotherapy and pharmacy,
plus Australia-wide ambulance cover.
Nil excess; nil co-payment
Up to 100% back for dental,
optical and physiotherapy
Laser eye surgery
Full ambulance cover
Emergency facility fee
Hospital cover component
You will be covered for all Medicare-recognised procedures and the in-patient services listed on the comparison
table on page 11. And so that you receive the best from your cover, you get access to a range of health
management and support programs (criteria apply) and up to 100% back for a number of additional services.
Please refer to ‘Hospital cover explained’ on page 6 for details on waiting periods and more.
Additional services
Benefit
Limit
Post Admission
Non-PBS prescriptions
Up to 100%
$1,500
Non-surgically implanted prostheses (e.g. prosthetic bras, wigs)
100%
$1,500
Post-surgical recovery aids (e.g. compression garments, braces)
100%
$250
$100
$200
100%
$500
Home Sleep Studies
Set benefit applies when using a Health Partners participating provider
Home Nursing
Wound management, IV medication, palliative care
Included programs
Health Management Programs
Home Health Partner
Chronic Condition Management Service
See page 48 for details.
14
Exclusions
Exclusions are the services for which benefits are not
available on this level of cover. They are in addition to
the items listed under ‘What’s not covered’ on page 6.
regnancy and birth-related services
P
Assisted reproductive services
Sterilisation reversal
Surgical weight loss procedures
Prime Living
Extras cover component
You will be covered for our highest level of extras as detailed below.
You can claim benefits at your own recognised provider or just choose a Health Partners professional where
you get 100% back for dental, optical and most physiotherapy treatments.
Please refer to ‘Extras cover explained’ on page 8 for details on waiting periods and more.
Services and benefits
Limit
General Dental
At Health Partners Dental and Barossa Dental
100% benefit applies.
At other dental providers
No limit
A schedule of benefits applies; please call us for a quote.
Major Dental and Endodontic
At Health Partners Dental and Barossa Dental
100% benefit applies.
At other dental providers
$1,600
A schedule of benefits applies; please call us for a quote.
Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa
Optical
At Health Partners Optical
100% benefit for prescription glasses/prescription sunglasses/contact lenses.
60% unlimited benefit applies at Health Partners Optical if you reach your limit for the year.
50% discount on sunglasses. No limit.
At other optical providers
$500
($300 sub-limit for other
optical providers)
100% benefit for prescription glasses/prescription sunglasses/contact lenses.
Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa
15
Prime Living
Services and benefits
Limit
Pharmacy
At Health Partners Participating Pharmacies
$1,000
PBS prescriptions, not already subsidised by the Government.
pay max. of $20
Please ask your
Private and compounding prescriptions.
pay max. of $37
pharmacist about the
benefits that apply to
your prescription and if
20% discount on most non-prescription items. No limit. Some conditions apply.
you can save more with
generic brands.
Physiotherapy
At Health Partners Participating Physiotherapists
100% benefit for initial, subsequent and long consultations, and hydrotherapy and
lymphoedema treatment.
$1,500
At other physiotherapy providers
($1,000 sub-limit for other
70% benefit applies.
physiotherapy providers.
$300 sub-limit for Pilates)
Pilates
Set benefits apply. Per session
$20
Natural Therapies/Naturopathy/
Acupuncture/Hypnotherapy
70% benefit applies.
$800
($200 sub-limit for
each modality)
Chiropractic/Osteopathic/Exercise Physiology
80% benefit applies.
$750
($1,500 limit per
membership)
16
Prime Living
Services and benefits
Limit
Podiatry/Orthotics
70% benefit applies.
$750
($400 sub-limit
for orthotics)
Dietary
Set benefits apply.
Initial consultation
$60
Subsequent consultation
$40
Set benefits apply, for example:
Initial consultations
$140
Subsequent consultations
$120
Set benefits apply, for example:
Initial consultation
$100
Subsequent consultation
$70
Set benefits apply, for example:
Initial consultations
$60
Subsequent consultations
$40
Set benefits apply, for example:
Initial consultations
$60
Subsequent consultations
$40
$750
Psychology
$750
Speech Therapy
$750
Eye Therapy
$750
Occupational Therapy
$750
Laser Eye Surgery
Laser correction eye surgery 100%
Lifetime limit $4,000
100%
$20,000
Full Ambulance
Emergency and non-emergency services;
Australia-wide coverage; road and air services.
17
Prime Living
Services and benefits
Limit
Emergency Department
Private hospital emergency facility fee 100%
Limit of 1 per year,
up to $250
Health Management
Gym and Fitness*
100%
$200
Health Risk Assessment
100%
No limit
Quit Smoking*
via Members Online
100%
$100, lifetime limit $400
Weight Management*
Upon joining
$50
Upon reaching goal
$200
Lifetime limit $250
Bowel Cancer Screening Kit*
$30
$30
Diabetes Membership
100%
$100 per membership
Bone Density test*
100%
$100
Compression garments^*
100%
$100 per item
Diabetes education*
100%
$100 per consultation
Hip safety kit*
100%
$100
Asthma Foundation membership*
100%
$100 per membership
*For approved conditions or when medically necessary, subject to eligibility requirements. For full details see Health Partners Product Disclosure Statement.
^ A letter from your medical practitioner may be required.
Apparatus^
Asthmatic Spray Appliances
100%
$130 every 3 years
Blood Glucose Monitoring Machines
100%
$250 every 3 years
Blood Pressure Machines
100%
$100 every 3 years
Hearing Aids
100%
Limit based on
continuous years
of membership:
1-2 years $800
3+ years $1,600
Benefit is limited to once
every 3 years.
Sleep Apnoea Machines (CPAP)
100%
$1,500 every 5 years
Sleep Apnoea Machines (CPAP) – Support Service
100%
$250 every 5 years
^ A letter from your medical practitioner may be required.
18
Family Essentials
Family Essentials
This package providing cover for both hospital
and extras – so you can keep your costs down
when you need essentials like dental, optical,
physiotherapy and pharmacy. It includes gap-free
services for kids for dental, optical and physio and
no excess if they need to go hospital. Selected
exclusions and restrictions mean you won’t pay for
things you probably won’t need.
Key features
$ 300 excess; nil co-payment
No excess for kids
Gap-free kids’ services available
Orthodontics included
Orthotics included
Full ambulance cover
Hospital cover component
If anyone in your family needs to go to hospital, you’re covered Australia-wide for a broad range of hospital
procedures and all the in-patient services indicated on the comparison table on page 11. You also get access
to the following listed items.
Please refer to ‘Hospital cover explained’ on page 6 for details on waiting periods and more.
Additional services
Benefit
Limit
Post Admission
Non-PBS prescriptions
Up to 100%
$1,000
Non-surgically implanted prostheses (e.g. prosthetic bras, wigs)
100%
$1,500
100%
$100 per year
Home Nursing
Wound management, IV medication, palliative care
Included programs
ealth Management Programs
H
Home Health Partner
Newborn Support Program
Chronic Condition Management Service
See page 48 for details.
Dialysis for chronic kidney failure
Restrictions
Limited benefits are available for the following in
a public hospital or accredited day surgery:
Pregnancy and birth related services
Joint replacement procedures
Exclusions
Exclusions are the services for which benefits are not
available on this level of cover. They are in addition to
the items listed under ‘What’s not covered’ on page 6.
Assisted reproductive services
Sterilisation reversal
Eye surgery
Surgical weight loss procedures
20
Excess and co-payment
A $300 excess is payable if you are admitted to
hospital. This is waived for dependant children.
There is no co-payment.
Family Essentials
Extras cover component
Your family is covered for an extensive range of useful extras. You can claim benefits at your own recognised
provider or, to receive the highest possible benefits, just choose a Health Partners professional. We offer our
own dental and optical services and have a state-wide network of participating pharmacies and physiotherapists.
Please refer to ‘Extras cover explained’ on page 8 for details on waiting periods and more.
Services and benefits
Limit
General Dental
At Health Partners Dental and Barossa Dental
70% benefit applies.
Dependant children receive one gap-free check-up per year.~
100% benefit for one standard Health Partners mouthguard.^
At other dental providers
A schedule of benefits applies; please call us for a quote.
100% benefit towards one standard mouthguard.^
No limit
$80 limit
~Gap-free dental check-up includes exam, scale & clean, X-rays, fluoride treatment and fissure seals (items numbers: 11, 12, 13, 22, 25, 111, 114, 115, 121, 161).
^Benefit for one standard mouthguard (item no. 151) can only be claimed once per person, per year at either Health Partners Dental or other dental providers.
Major Dental / Endodontic
At Health Partners Dental and Barossa Dental
70% benefit applies.
At other dental providers
A schedule of benefits applies; please call us for a quote.
$1,000
(sub-limit $600 at
other dental providers)
Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa
Orthodontic
70% benefit for treatment by an orthodontist.
50% benefit for treatment by a general dentist.
Includes spacers, orthodontic plates, retainers.
A treatment plan may be required.
Lifetime limit of $800
after 12 months,
increasing by $200
each year to a maximum
lifetime limit of $2,400.
Optical
At Health Partners Optical
70% benefit for prescription glasses/prescription sunglasses/contact lenses.
One pair of gap-free single vision or multifocal prescription glasses per year (selected range,
within annual limits).
40% unlimited benefit applies at Health Partners Optical if you reach your limit for the year.
30% discount on sunglasses. No limit.
$350
($250 sub-limit for other
optical providers)
At other optical providers
50% benefit for prescription glasses/prescription sunglasses/contact lenses..
Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa
21
Family Essentials
Services and benefits
Limit
Pharmacy
At Health Partners Participating Pharmacies
PBS prescriptions, not already subsidised by the Government.
Private and compounding prescriptions.
pay max. of $20
pay max. of $37
20% discount on most non-prescription items. No limit. Some conditions apply.
$500
Please ask your pharmacist
about the benefits that
apply to your prescription
and if you can save more
with generic brands.
Physiotherapy
At Health Partners Participating Physiotherapists
You pay a set gap for most visits, for example: Initial & subsequent consultations pay only $16
Long consultation
pay only $25
Dependant children receive two gap-free consultations per year.
At other physiotherapy providers
70% benefit applies.
Pilates
Set benefits applies
$650
($400 sub-limit for other
physiotherapy providers.
$200 sub-limit for Pilates)
Per session
$20
Initial consultation
Subsequent consultation
Initial consultation
Subsequent consultation
$50
$32
$25
$16
Initial consultation
Subsequent consultation
$30
$25
Initial consultations
Subsequent consultations
$50
$30
$400
Initial consultations
Subsequent consultations
$50
$30
$400
Chiropractic/Osteopathic
Set benefits apply for the first 6 consultations:
Set benefits for additional consultations:
$500
Podiatry
Set benefits apply:
Orthotics
$400
(sub-limit $200 for
orthotics)
60% benefit applies.
Dietary
Set benefits apply.
Psychology
Set benefits apply.
22
Family Essentials
Services and benefits
Limit
Speech Therapy
Set benefits apply.
Initial consultations
$50
Subsequent consultations
$30
Set benefits apply.
Initial consultations
$30
Subsequent consultations
$20
Set benefits apply.
Initial consultations
$50
Subsequent consultations
$30
$400
Eye Therapy
$400
Occupational Therapy
$400
Full Ambulance
Emergency and non-emergency services;
Australia-wide coverage; road and air services.
100%
$20,000
Massage/Naturopathy/Acupuncture
70% benefit applies.
$500 ($200 sub-limit
for each modality)
Health Management
Gym and Fitness*
100%
$100
Health Risk Assessment
100%
No limit
Quit Smoking*
via Members Online
100%
Lifetime limit $100
Weight Management*
$50
Lifetime limit $50
Bowel Cancer Screening Kit*
$22
$22
Diabetes Membership
50%
$50 per membership
*For approved conditions, subject to eligibility requirements. For full details see Health Partners Product Disclosure Statement.
Apparatus^
Asthmatic Spray Appliances
85%
$100 every 3 years
Blood Glucose Monitoring Machines
85%
$200 every 3 years
Blood Pressure Machines
85%
$100 every 5 years
Sleep Apnoea Machines (CPAP)
85%
$1,500 every 5 years
^ A letter from your medical practitioner may be required.
23
Couples Choice
Couples Choice
Our Couples Choice package provides cover for the
basics in both hospital and extras – so that you can
keep your costs down when you need essentials
like dental, optical, physiotherapy and pharmacy.
You get peace of mind with hospital cover for
a broad range of hospital services with some
exclusions, like joint replacements and pregnancy,
so you’re not paying for things you don’t need.
Key features
$ 300 excess; nil co-payment
Pregnancy Loyalty Reward
Medicare Levy Surcharge exempt
Access to member discounts
and offers
Emergency ambulance
Hospital cover component
If you or your partner needs to go to hospital, you’re covered Australia-wide for a broad range of hospital
procedures and all the in-patient services indicated on the comparison table on page 11. You also get access to
the following items listed here.
Please refer to ‘Hospital cover explained’ on page 6 for details on waiting periods and more.
Additional services
Benefit
Limit
Post Admission
Non-PBS prescriptions
100%
$500
Included programs
Restrictions
regnancy loyalty reward
P
Home Health Partner
See page 48 for details.
Limited benefits are available for the following in
a public hospital or accredited day surgery.
Exclusions
Exclusions are the services for which benefits
are not available on this level of cover. They are
in addition to the items listed under ‘What’s not
covered’ on page 6.
Pregnancy and birth-related services
Assisted reproductive services
Sterilisation reversal
Joint-replacement procedures
Surgical weight loss procedures
Dialysis for chronic kidney failure
Eye surgery
24
Psychiatric services
Rehabilitation services
Excess and co-payment
A $300 excess is payable if you are admitted
to hospital. There is no co-payment.
Pregnancy loyalty reward
While pregnancy and birth related services are
exclusions on Couples Choice cover, the Pregnancy
Loyalty Reward will allow you to transfer to any
Health Partners cover where pregnancy and
birth related services are included after 2 years of
continuous Couples Choice cover without serving
the usual 12 month waiting period. All other waiting
periods will still apply.
Couples Choice
Extras cover component
With Couples Choice you and your partner are covered for an extensive range of useful extras. You can
claim benefits at your own recognised provider or, to receive the highest possible benefits, just choose a
Health Partners professional. We offer our own dental and optical services and have a state-wide network of
participating pharmacies and physiotherapists.
Please refer to ‘Extras cover explained’ on page 8 for details on waiting periods and more.
Services and benefits
Limit
General Dental
At Health Partners Dental and Barossa Dental
60% benefit applies.
$700
At other dental providers
50% benefit applies.
Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa
Major Dental / Endodontic
At Health Partners Dental and Barossa Dental
60% benefit applies.
$500
(sub-limit $400 at
other dental providers)
At other dental providers
50% benefit applies.
Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa
Optical
At Health Partners Optical
60% benefit for prescription glasses/prescription sunglasses/contact lenses.
One pair of gap-free single vision prescription glasses per year (selected range,
within annual limits).
40% unlimited benefit applies at Health Partners Optical if you reach your limit for the year.
30% discount on sunglasses. No limit.
$350
($250 sub-limit for other
optical providers)
At other optical providers
50% benefit for prescription glasses/prescription sunglasses/contact lenses.
Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa
Pharmacy
At Health Partners Participating Pharmacies
$150
PBS prescriptions, not already subsidised by the Government.
pay max. of $20
Please ask your pharmacist
Private and compounding prescriptions.
pay max. of $37
about the benefits that
apply to your prescription
20% discount on most non-prescription items. No limit. Some conditions apply.
and if you can save more
with generic brands.
25
Couples Choice
Services and benefits
Limit
Physiotherapy
At Health Partners Participating Physiotherapists
You pay a set gap for most visits, for example: Initial & subsequent consultations pay only $18
Long consultation
pay only $25
At other physiotherapy providers
$600
($400 sub-limit at other
60% benefit applies.
physiotherapy providers,
Pilates
for chiropractic and
Set benefits apply. Per session. $20
osteopathy. $200 sub-limit
for Pilates)
Chiropractic/Osteopathic
60% benefit applies.
Podiatry/Dietary
Set benefits apply.
Initial consultation
$30
Subsequent consultation
$20
$300
Massage/Naturopathy/Acupuncture
60% benefit applies.
$300 (sub-limit $150
for each modality)
Emergency Ambulance
Emergency services only; Australia-wide coverage; road and air services.
100%
Limit of 2 per year.
Gym and Fitness*
100%
$100
Bowel Cancer Screening Kit*
$22
$22
Health Management
*For approved conditions, subject to eligibility requirements. For full details see Health Partners Product Disclosure Statement.
26
Singles Starter
Singles Starter
This package covers you for the basics in both
hospital and extras – so that you can keep your
costs down when you need dental, optical,
physiotherapy and pharmacy. You still get peace
of mind with hospital cover for a broad range of
hospital services with only some exclusions, such as
pregnancy and joint replacement procedures.
Key features
$ 500 excess
Emergency ambulance cover
Medicare Levy Surcharge
Access to member discounts
and offers
Hospital cover component
You will be covered for all the in-patient services indicated on the comparison table on page 11, with benefits
for the following additional services. You also get access to selected health management and support programs
(criteria apply).
Please refer to ‘Hospital cover explained’ on page 6 for details on waiting periods and more.
Additional services
Benefit
Limit
Post Admission
Non-PBS prescriptions
Included programs
Home Health Partner
See page 48 for details.
Exclusions
Exclusions are the services for which benefits
are not available on this level of cover. They are
in addition to the items listed under ‘What’s not
covered’ on page 6.
100%
$500
Restrictions
Limited benefits are available for the following in
a public hospital or accredited day surgery:
Psychiatric services
Rehabilitation services
Excess and co-payment
A $500 excess is payable if you are
admitted to hospital.
regnancy and birth-related services
P
Assisted reproductive services
Sterilisation reversal
Joint-replacement procedures
Surgical weight loss procedures
Dialysis for chronic kidney failure
Eye surgery
27
Singles Starter
Extras cover component
With Singles Starter you are covered for essential services that will help you keep your out-of-pocket cost
down. You can claim benefits at your own recognised provider or, to receive the highest possible benefits, just
choose a Health Partners professional. We offer our own dental and optical services and have a state-wide
network of participating pharmacies and physiotherapists.
Please refer to ‘Extras cover explained’ on page 8 for details on waiting periods and more.
Services and benefits
Limit
General and Major Dental and Endodontic
At Health Partners Dental and Barossa Dental
60% benefit applies.
$600 (sub-limit $400
At other dental providers
50% benefit applies.
Endodontics)
for Major Dental and/or
Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa
Optical
At Health Partners Optical
60% benefit for prescription glasses/prescription sunglasses/contact lenses.
One pair of gap-free single vision prescription glasses per year (selected range,
within annual limits).
40% unlimited benefit applies at Health Partners Optical if you reach your limit for the year.
30% discount on sunglasses. No limit.
$300
($200 sub-limit for other
optical providers)
At other optical providers
50% benefit for prescription glasses/prescription sunglasses/contact lenses..
Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa
Pharmacy
At Health Partners Participating Pharmacies
$150
PBS prescriptions, not already subsidised by the Government.
pay max. of $20
Please ask your pharmacist
Private and compounding prescriptions.
pay max. of $37
about the benefits that
apply to your prescription
20% discount on most non-prescription items. No limit. Some conditions apply.
and if you can save more
with generic brands.
28
Singles Starter
Services and benefits
Limit
Physiotherapy
At Health Partners Participating Physiotherapists
You pay a set gap for most visits, for example: Initial & subsequent consultations pay only $20
Long consultation
pay only $25
At other physiotherapy providers
($400 sub-limit for other
60% benefit applies.
physiotherapy providers,
Pilates
Set benefits apply. $500
for chiropractic and
Per session. $15
osteopathy. $200 sub-limit
for Pilates)
Chiropractic/Osteopathic
60% benefit applies.
Massage/Naturopathy/Acupuncture
60% benefit applies.
$300 (sub-limit $100
for each modality)
Emergency Ambulance
Emergency services only; Australia-wide coverage; road and air services.
100%
Limit of 2 per year.
Gym and Fitness*
100%
$100
Bowel Cancer Screening Kit*
$22
$22
Health Management
*For approved conditions, subject to eligibility requirements. For full details see Health Partners Product Disclosure Statement.
29
Comparing hospital cover options
We offer three levels of hospital cover – all of which provide you
with a range of benefits at your choice of participating hospital (private
or public), Australia-wide. Plus, you can access various programs outside
of hospital to assist with improving your overall health and wellbeing.
Using the table on the next page, simply short-list your preferences based on how much
cover you need. Then consider your excess and co-payment options to determine the best
fit for your budget.
You can purchase hospital cover on its own or together with any level of extras cover.
Or see page 11 for our range of package covers that combine hospital and extras together.
30
Gold Hospital
Silver
Hospital
Bronze
Hospital
Page 32
Page 34
Page 35
In-patient procedures and services
Cardiac procedures
Psychiatric services
Rehabilitation services
Accident-related treatment after joining
Pharmaceuticals related to admission (PBS approved)
Joint-reconstruction procedures
Joint-replacement procedures
No exclusions on Medicare-recognised procedures
Pregnancy and birth-related procedures Assisted reproductive services (e.g. IVF)
Sterilisation reversal
Dialysis for chronic kidney failure
Surgical weight loss procedures
Removal of tonsils, adenoids
Removal of appendix
Removal of wisdom teeth
Cataract surgery
Home Nursing
Non-PBS prescriptions
Non-surgical prostheses and recovery aids
Health Management Programs
Home Health Partner
Newborn Support Program
Emergency Ambulance
Non-emergency Ambulance
Home Sleep Studies
Chronic Condition Management Service
Examples of other procedures
Additional benefits
Options
Excess
NIL NIL $250$500
$500
Co-payment
NIL $50$50$50
$50
No excess or co-payment for kids N/A
Included
Restricted benefits apply
Not included. See page 6 for details on waiting periods.
31
Gold Hospital
GOLD
HOSPITAL
50
Gold Hospital
NIL EXCESS
NIL CO-PAYMENT
GOLD
HOSPITAL 50
NIL EXCESS
$50 CO-PAYMENT
Our top level of stand alone hospital cover provides the broadest range of services – so that you have
complete peace of mind.
You will be covered for all Medicare-recognised procedures and the in-patient services listed on the
comparison table on page 31.
And so that you receive the best from your cover, you also get access to a range of health management
and support programs (criteria apply) and benefits for a number of additional services.
Please refer to ‘Hospital cover explained’ on page 6 for details on waiting periods and more.
Additional services
Benefit
Limit
Post Admission
Non-PBS prescriptions
100%
$1,500
Non-surgically implanted prostheses (e.g. prosthetic bras, wigs)
75%
$800
Post-surgical recovery aids (e.g. compression garments, braces)
75%
$250
$50
$100
Home Sleep Studies
Set benefit applies when using a Health Partners participating provider
Home Nursing
Set benefits apply for wound management, IV medication
$5,500
(daily limit $250 and
sub-limit $3,000
for palliative care)
Palliative care (minimum 4 hours) $250
Full Ambulance
Emergency and non-emergency services; 100%
Australia-wide coverage; road and air services.
$20,000
Health Management*
Bone density test
75%
$100
Compression garments
75%
$100 per item
Diabetes education
75%
$50 per consultation
Hip safety kit
75%
$100
Asthma Foundation membership
50%
$20 per membership
Overall limit $400
* For approved conditions or when medically necessary, subject to eligibility requirements. For full details see Health Partners Product Disclosure Statement.
32
Included programs
Newborn Support Program
Home Health Partner
Chronic Condition Management Service
See page 48 for details.
Exclusions
There are no exclusions for any medicallynecessary admission (conditions for which
a Medicare rebate applies).
Your options
There are two levels of Gold Hospital cover, each
covering you for all the same services. Simply choose
between cover with or without a co-payment.
The co-payment is limited to a maximum of 5 days
per person per rolling year.
The co-payment is waived for dependant children.
33
Silver Hospital
SILVER
HOSPITAL 250
$250 EXCESS
$50 CO-PAYMENT
500
250
Silver Hospital
SILVER
HOSPITAL 500
$500 EXCESS
$50 CO-PAYMENT
Our medium level of stand alone hospital cover provides a very broad range of services and benefits, giving you
complete peace of mind and excess options to reduce your premiums.
You will be covered for all Medicare-recognised procedures and the in-patient services indicated on the
comparison table on page 31.
And so that you receive the best from your cover, you also get access to a range of health management and
support programs (criteria apply) and benefits for a number of additional services.
Please refer to ‘Hospital cover explained’ on page 6 for details on waiting periods and more.
Additional services
Benefit
Limit
Post Admission
Non-PBS prescriptions
100%
$1,500
Non-surgically implanted prostheses (e.g. prosthetic bras, wigs)
75%
$500
Post-surgical recovery aids (e.g. compression garments, braces)
75%
$250
Home Nursing
Set benefits apply for wound management, IV medication
$5,500
(daily limit $250 and
sub-limit $3,000
for palliative care)
Palliative care (minimum 4 hours) $250
Full Ambulance
Emergency and non-emergency services; 100%
Australia-wide coverage; road and air services.
Included programs
Health Management Programs
Newborn Support Program
Home Health Partner
Chronic Condition Management Service
See page 48 for details.
Exclusions
There are no exclusions for any medicallynecessary admission (conditions for which a
Medicare rebate applies).
34
$20,000
Your options
There are two levels of Silver Hospital cover, each
covering you for all the same services. Simply
choose the excess that suits you. The co-payment
is limited to a maximum of 5 days per person per
rolling year.
The excess and co-payment are waived for
dependant children.
Bronze Hospital
500
Bronze Hospital
BRONZE
HOSPITAL 500
$500 EXCESS
$50 CO-PAYMENT
Our basic level of stand alone hospital cover gives you cover for many services including cardiac and joint
reconstructions, but excludes some things like pregnancy and joint replacements.
You will be covered for the in-patient services indicated on the comparison table on page 31, with benefits for
the additional services listed below. Plus, Bronze Hospital gives you access to a range of health management,
emergency ambulance and support programs (criteria apply).
Please refer to ‘Hospital cover explained’ on page 6 for details on waiting periods and more.
Additional services
Benefit
Limit
Post Admission
Non-PBS prescriptions
100%
$500
Non-surgically implanted prostheses (e.g. prosthetic bras, wigs)
75%
$500
Post-surgical recovery aids (e.g. compression garments, braces)
75%
$250
100%
Limit of 2 per year
Emergency ambulance
Emergency services only; Australia-wide coverage; road and air services
Home Nursing
Set benefits apply for wound management, IV medication
$250
Palliative care (minimum 4 hours)
Included programs
Health Management Programs
Home Health Partner
Chronic Condition
Management Service
See page 48 for details.
$500
Exclusions
Restrictions
Exclusions are the services for
which benefits are not available on
this level of cover. They are
in addition to the items listed
under ‘What’s not covered’ on
page 6.
Limited benefits are available for
the following in a public hospital or
accredited day surgery:
regnancy and birth-related
P
services
Assisted reproductive services
Sterilisation reversal
Joint-replacement procedures
Surgical weight loss procedures
Dialysis for chronic kidney failure
A $500 excess and daily copayment of $50 is payable if you
are admitted to hospital. The copayment is limited to a maximum of
5 days per person per rolling year.
Psychiatric services
Rehabilitation services
Excess and co-payment
35
Comparing extras cover options
We offer three levels of extras cover – all of which cover you
for the most popular services like dental, optical, physiotherapy, pharmacy
and ambulance.
Generally, the higher the level of cover, the higher the limits and benefits you receive.
The table on the next page summarises the services included on each of the covers. For more detailed
information on what you can claim, see pages 38-46.
You can purchase extras cover on its own or together with any level of hospital cover.
Or see page 12 for our range of package covers that combine hospital and extras together.
36
Gold Extras
Silver
Extras
Page 38
Page 42
Bronze Waiting
Extrasperiod* (mths)
Page 45
Page 9
General Dental
2
Major Dental
12
Endodontic
Optical
2
Pharmacy
2
Physiotherapy
2
Emergency Ambulance
2
Non-emergency Ambulance
2
Health Management (e.g. gym & fitness)
2
Orthodontic
12
Naturopathy
2
Acupuncture
2
Chiropractic/Osteopathic
2
Exercise Physiology
2
Podiatry
2
Pilates
2
Orthotics
2
Dietary
2
Psychology
2
Hypnotherapy 2
Massage
2
Speech Therapy
2
Eye Therapy
2
Occupational Therapy
2
RDNS
2
Apparatus (e.g. h
earing aids,
sleep apnoea machine)
12
2
Natural Plus (optional add-on cover; see page 47)
15 Natural Therapies (including massage)
Included
Available
Available
Available
2
Not included. *See page 9 for details on waiting periods.
37
Gold Extras
Gold Extras
Our top level of stand alone extras cover provides the broadest range of services – including
health management benefits for quitting smoking and weight management.
ou can claim benefits at your own recognised provider or, to receive the highest possible
Y
benefits, just choose a Health Partners professional. We offer our own dental and optical services
and have a state-wide network of participating pharmacies and physiotherapists.
Please refer to ‘Extras cover explained’ on page 8 for details on waiting periods and more.
Services and benefits
Limit
General Dental
At Health Partners Dental and Barossa Dental
85% benefit applies.
Dependant children receive 2 gap-free check-ups per year~.
One gap-free standard mouthguard per year.
No limit
At other dental providers
A schedule of benefits applies; please call us for a quote.
~ Gap-free dental check-up includes exam, scale & clean, X-rays, fluoride treatment and fissure seals (item numbers: 11, 12, 13, 22, 25, 111, 114, 115, 121, 161).
Major Dental
At Health Partners Dental and Barossa Dental
85% benefit applies.
40% unlimited benefit applies at Health Partners Dental if you reach your limit for the year.
$1,000
At other dental providers
A schedule of benefits applies; please call us for a quote.
Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa.
Endodontic
At Health Partners Dental and Barossa Dental
70% benefit applies.
40% unlimited benefit applies at Health Partners Dental if you reach your limit for the year.
$1,000
At other dental providers
A schedule of benefits applies; please call us for a quote.
Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa.
Orthodontic 70% benefit for treatment by an orthodontist.
Lifetime limit of
50% benefit for treatment by a general dentist.
$500 after 1 year,
Includes spacers, orthodontic plates, retainers.
$1,500 after 2 years
A treatment plan may be required.
38
and $2,500 after 5 years.
Gold Extras
Services and benefits
Limit
Optical At Health Partners Optical
70% benefit for prescription glasses/sunglasses/contact lenses.
$350 prescription glasses
One pair of gap-free single vision or multifocal prescription glasses per year (selected range,
$210 contact lenses
within annual limits).
40% unlimited benefit applies at Health Partners Optical if you reach your limit for the year.
30% discount on sunglasses, solutions and accessories. No limit.
At other optical providers 50% benefit for prescription glasses/sunglasses/contact lenses.
$250 (sub-limit $100
for frames)
Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa.
Pharmacy
At Health Partners Participating Pharmacies $600
PBS prescriptions, not already subsidised by the Government.
pay max. of $20
Please ask your
Private and compounding prescriptions.
pay max. of $37
pharmacist about the
benefits that apply to
20% discount on most non-prescription items. No limit. Some conditions apply.
your prescription and if
you can save more with generic brands.
Physiotherapy At Health Partners Participating Physiotherapists
You pay a set gap for most visits, for example:Initial & subsequent consultations pay only $12
Long consultation
pay only $20
$1,000
Dependant children receive 4 gap-free consultations per year.
(sub-limit $500 at other
At other physiotherapy providers
physiotherapy providers
Set benefits apply, for example:Initial consultation
$30
and for group treatment)
Subsequent & long consultations $24
Group treatment
$10
Per consultation
$10
Set benefits apply.
Initial consultation
$28
Subsequent consultation
$21
Pilates Set benefit applies. $100
Naturopathy
Acupuncture $350
Set benefits apply.
Initial consultation
$29
Subsequent consultation
$21
39
Gold Extras
Services and benefits
Limit
Chiropractic/Osteopathic Set benefits apply, for example:
Initial consultation
$42
Subsequent consultation
$25
Radiology (in providers’ rooms)
60%
Exercise Physiology Set benefits apply.
Initial consultation
$28
Subsequent consultation
$21
Group consultation
$8
$400
Podiatry Set benefits apply.
Initial consultation
$33
Subsequent consultation
$24
Surgery (in providers’ rooms)
85%
$350
Orthotics Set benefits apply; please call us for a quote.
$300
Dietary Set benefits apply.
Initial consultation
$60
Subsequent consultation
$35
Group consultation
$15
$450
Psychology Set benefits apply, for example:
Initial consultation
$75
Subsequent consultation
$70
Hypnotherapy Set benefit applies.
Per consultation
$400
$60
Massage (Remedial or Therapeutic)
Set benefit applies.
Per consultation
$20
$100
Speech Therapy Set benefits apply, for example:
Initial consultation
$75
$400, or $600 after 5 years
Subsequent consultation
$45
of continuous membership.
Eye Therapy Set benefit applies.
40
Per consultation
$25
$250
Gold Extras
Services and benefits
Limit
Occupational Therapy Set benefits apply, for example:
Initial consultation
$50
$350, or $500 after 3 years
Subsequent consultation
$40
of continuous membership.
100%
$150
RDNS Already subsidised RDNS services
Full Ambulance Emergency and non-emergency services; 100%
Australia-wide coverage; road and air services.
$20,000
Health Management Gym and Fitness*
100%
$200
Health Risk Assessment
via Members Online
Quit Smoking*
100%
100%
No limit
$100, lifetime limit $200
Weight Management*
$50
$100
Lifetime limit $150
Bowel Cancer Screening Kit*
$22
$22
Diabetes Membership
50%
$50 per membership
Upon joining
Upon reaching goal
* For approved conditions or when medically necessary, subject to eligibility requirements. For full details see Health Partners Product Disclosure Statement.
Apparatus^
Asthmatic Spray Appliances
85%
$130 every 3 years
Blood Glucose Monitoring Machines
85%
Blood Pressure Machines
85%
$250 (sub-limit $100 for
blood pressure machines) every 3 years.
Hearing Aids
Limit based on
85%
continuous years of
Health Partners
membership:
1-4 years $800
5-9 years $900
10+ years $1,150
Maximum benefit is limited
to once every 3 years.
Sleep Apnoea Machines
85%
$1,500 every 5 years
CPAP Apparatus Support $30
$150 every 5 years
Per consultation
^ A letter from your medical practitioner may be required.
41
Silver Extras
Silver Extras
Our medium level of stand alone extras cover offers generous benefits on the most popular services.
ou can claim benefits at your own recognised provider or, to receive the highest possible benefits,
Y
just choose a Health Partners professional. We offer our own dental and optical services and have
a state-wide network of participating pharmacies and physiotherapists.
Please refer to ‘Extras cover explained’ on page 8 for details on waiting periods and more.
Services and benefits
Limit
General Dental
At Health Partners Dental and Barossa Dental
60% benefit applies.
No limit
Dependent children receive 1 gap-free check-up per year.~
At other dental providers
A schedule of benefits applies; please call us for a quote.
~ Gap-free dental check-up includes exam, scale & clean and X-rays (item numbers: 11, 12, 22, 111, 114).
Major Dental
At Health Partners Dental and Barossa Dental
60% benefit applies.
40% unlimited benefit applies at Health Partners Dental if you reach your limit for the year.
$500
At other dental providers
A schedule of benefits applies; please call us for a quote.
Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa.
Endodontic
At Health Partners Dental and Barossa Dental
60% benefit applies.
40% unlimited benefit applies at Health Partners Dental if you reach your limit for the year.
$500
At other dental providers
A schedule of benefits applies; please call us for a quote.
Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa.
Orthodontic 60% benefit for treatment by an orthodontist.
40% benefit for treatment by a general dentist.
Includes spacers, orthodontic plates, retainers.
A treatment plan may be required.
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Lifetime limit of
$200 after 1 year,
$1,000 after 2 years.
Silver Extras
Services and benefits
Limit
Optical At Health Partners Optical
60% benefit for prescription glasses/sunglasses/contact lenses.
$270 prescription glasses
One pair of gap-free single vision prescription glasses per year (selected range, within annual limits).
$150 contact lenses
40% unlimited benefit applies at Health Partners Optical if you reach your limit for the year.
30% discount on sunglasses, solutions and accessories. No limit.
At other optical providers 40% benefit for prescription glasses/sunglasses/contact lenses.
$200 (sub-limit $55
for frames)
Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa.
Pharmacy
At Health Partners Participating Pharmacies $500
PBS prescriptions, not already subsidised by the Government.
pay max. of $20
Please ask your
Private and compounding prescriptions.
pay max. of $37
pharmacist about the
benefits that apply to
20% discount on most non-prescription items. No limit. Some conditions apply.
your prescription and if
you can save more with generic brands.
Physiotherapy At Health Partners Participating Physiotherapists
You pay a set gap for most visits, for example:Initial & subsequent consultations pay only $16
At other physiotherapy providers
Long consultation
pay only $25
Set benefits apply, for example:Initial consultation
$26
Subsequent consultations
$20
Group treatment
$10
$750
(sub-limit $450 at other
physiotherapy providers
and for group treatment)
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Silver Extras
Services and benefits
Limit
Naturopathy Set benefits apply.
Initial consultation
$26.40
Subsequent consultation
$20.40
Acupuncture Set benefits apply.
Initial consultation
$27.60
Subsequent consultation
$21
Chiropractic/Osteopathic $350
Set benefits apply, for example:
Initial consultation
$30
Subsequent consultation
$21
Radiology (in providers’ rooms)
60%
Exercise Physiology Set benefits apply.
Initial consultation
$24
Subsequent consultation
$18
Group consultation
$6
Podiatry Set benefits apply.
Initial & subsequent consultations $15
$60
Full Ambulance Emergency and non-emergency services; Australia-wide coverage; road and air services.
100%
$20,000
Health Management Gym and Fitness*
100%
$150
Health Risk Assessment
100%
No limit
Bowel Cancer Screening Kit*
$22
$22
Diabetes Membership
50%
$50 per membership
via Members Online
* For approved conditions or when medically necessary, subject to eligibility requirements. For full details see Health Partners Product Disclosure Statement.
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Bronze Extras
Bronze Extras
Bronze Extras offers a range of basic extras – so that you can keep your costs down when you
need dental, optical and physiotherapy. You still get peace of mind with ambulance benefits and
enjoy unbeatable pharmacy benefits and discounts.
You can claim benefits at your own recognised provider or, to receive the highest possible
benefits, just choose a Health Partners professional. We offer our own dental and optical services
and have a state-wide network of participating pharmacies and physiotherapists.
Please refer to ‘Extras cover explained’ on page 8 for details on waiting periods and more.
Services and benefits
Limit
General Dental and Endodontic
At Health Partners Dental and Barossa Dental
60% benefit applies.
At other dental providers
$500
A schedule of benefits applies; please call us for a quote.
Optical At Health Partners Optical
60% benefit for prescription glasses/sunglasses/contact lenses.
$120
40% unlimited benefit applies at Health Partners Optical if you reach your limit for the year.
30% discount on sunglasses, solutions and accessories. No limit.
At other optical providers 40% benefit for prescription glasses/sunglasses/contact lenses.
$100 (sub-limit $55
for frames)
Benefits claimed at Health Partners Optical will count towards the limits at other optical providers, and vice versa.
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Bronze Extras
Services and benefits
Limit
Pharmacy
At Health Partners Participating Pharmacies $200
PBS prescriptions, not already subsidised by the Government.
pay max. of $20
Please ask your
Private and compounding prescriptions.
pay max. of $37
pharmacist about the
benefits that apply to
20% discount on most non-prescription items. No limit. Some conditions apply. your prescription and if
you can save more with generic brands.
Physiotherapy At Health Partners Participating Physiotherapists
You pay a set gap for most visits, for example:Initial & subsequent consultations pay only $18
At other physiotherapy providers
Long consultation
Set benefits apply, for example:Initial consultation
pay only $25
$18
Subsequent consultation
$15
Group consulation
$8
$350
(sub-limit $250 at other
physiotherapy providers
and for group treatment).
Full Ambulance Emergency and non-emergency services; 100%
Australia-wide coverage; road and air services.
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$20,000
Natural Plus
Natural Plus
When it comes to improving your health and enjoying your lifestyle, Health Partners has you
covered with Natural Plus. This is an optional add-on cover that provides benefits for a range
of natural therapies.
Natural Plus is available with all levels of stand alone extras cover.
Services and benefits
Limit
Natural Therapies
Remedial Massage, Bowen Therapy,
Chinese Herbalism, Western Herbalism,
Feldenkrais, Myofascial Release, Shiatsu, Reflexology, Iridology, Alexander Technique, $160
Kinesiology, Therapeutic Massage,
Swedish Massage, Myotherapy, Nutritionist
Per consultation
$20
Benefits are payable for consultations by recognised providers only and are limited to one consultation
per person per day for all natural therapies. Please refer to ‘Extras cover explained’ on page 8 for details
on waiting periods and more.
47
Health management and
support programs
Your hospital cover gives you access to various programs outside of hospital to assist
with improving your overall health and wellbeing.
Simply check the level of your hospital cover to see which programs you’re covered for.
Health Management
Programs
Home Health
Partner
Newborn Support
Program
Health management programs
can cover Coronary Artery
Disease, Bone Health and Type
2 Diabetes. They are designed
to support members who are
looking to improve the way they
manage their condition(s) and
overall health. All applications are
individually assessed by Health
Partners prior to enrolment.
Home Health Partner is a unique
service designed to make the
transition from hospital to home
easier for you. If it is appropriate,
you can elect to leave hospital
early after an operation and
continue receiving care in the
comfort of your own home.
Newborn Support Program
provides you with free support
from qualified midwives during
pregnancy and the first year of
your baby’s life. It offers advice
and support in areas such as high
blood pressure during pregnancy,
breast feeding, sleeping and
advice on solids after birth.
Members suffering from
chronic disease, complex health
or mental health issues and
are otherwise determined by
Health Partners as requiring
ongoing medical support will be
entitled to register for a Chronic
Condition Management service
which provides telephone-based
information and support for
self-management of these
health conditions.
48
We can ensure you receive all the
support you need to help you on
the road to recovery. By working
with the hospital staff and your
doctor, services such as nursing care
and home help can be arranged.
We may also assist you to avoid
a hospitalisation altogether.
All cases are individually reviewed
by the hospital prior to your
discharge to the care of your
GP, with a care plan developed
appropriate to your clinical needs.
Support is available via email and
phone, along with online links to
credible sources and useful sites
and resources.
You can apply via Members
Online when you (or your partner)
become pregnant. Application
forms are also available at
healthpartners.com.au or
upon request.
Government surcharges
and incentives
Private health cover legislation may affect your choice of health cover. The following
will help you understand how you can benefit from the incentives and avoid
unnecessary expenses.
The Rebate
Medicare Levy Surcharge
he Australian Government Rebate on Private Health
T
Insurance was introduced as a financial incentive
to help Australians afford private health cover. The
rebate depends on your age, is income-tested and
applies to all Health Partners products. The rebate
may be claimed as a reduction in your premiums or
via your tax return and we can help you nominate
your most suitable rebate tier.
The Medicare Levy Surcharge (MLS) is a maximum
1.5% surcharge imposed on people who earn above a
certain income and who do not have private hospital
cover. The level of surcharge depends on your level of
income for MLS purposes and is payable in addition
to the Medicare Levy.
The rebate is indexed by the lesser of CPI or the
percentage change in your premium each year, using
a Government calculated formula.
For further details visit
healthpartners.com.au or call us.
Lifetime Health Cover
Lifetime Health Cover (LHC) is a Government
initiative designed to encourage you to take out
private hospital cover earlier in life and to maintain
your cover. For every year you are over 30 and do
not have hospital cover you will pay an additional 2%
loading on top of your ‘base’ hospital contribution.
Please note that the Rebate does not apply to the
LHC component of your private health cover.
49
Things you
should know
This brochure outlines the benefits and services available with Health Partners
health covers and does not contain all of the Fund’s rules. It should be read and
retained in conjunction with Health Partners’ Product Disclosure Statement (PDS).
The information in this document is correct at time of printing and subject to change.
Product Disclosure Statement (PDS)
Complaints
The PDS contains additional important information
on the general terms of membership and cover
with Health Partners, including who can be covered
on a membership, our Privacy Policy, Resolution
Process and health insurance initiatives from the
Australian Government. Please read and consider
the PDS before joining or changing your cover.
At Health Partners we recognise that despite our
best intentions, members may have concerns or
complaints regarding their membership with us.
Should you have a concern or complaint, please
contact us directly via phone, email or mail. We have
a formalised Resolution Process to ensure that all
feedback and concerns are heard and addressed fairly
and satisfactorily. You can view this process online at
healthpartners.com.au.
This is available at healthpartners.com.au/PDS or
by calling 1300 113 113.
Prior to treatment
We recommend you call us before commencing
treatment to clarify your benefit eligibility.
Participating hospitals
Participating private hospitals are hospitals which
have an agreement with Health Partners. This
ensures you receive quality benefits and services at
most hospitals Australia-wide. For more information,
contact us.
Membership types
We offer single, couple, family, family focus and sole
parent memberships. For details on who can be
covered under each membership type, please call us
or visit our website at healthpartners.com.au.
50
Private Patients’ Hospital Charter
The Charter is a guide on your rights and
responsibilities as a private patient in a private,
public or day hospital. The guide is issued by the
Minister of Health and Ageing and is available
from Health Partners.
Review Period
If you are not satisfied with your new cover, we
will refund your contributions in full, provided it is
within 30 days of joining or changing cover and
no claims have been made.
Your Choice
Health Partners respects and encourages individual
members’ choices when it comes to selecting
the type of treatment/practitioner for their health
needs. Provider recognition is not to be taken as
Health Partners’ endorsement or recommendation
of any particular service, treatment or practitioner.
Privacy
Your privacy is always a priority at
Health Partners. For a copy of our Privacy Policy
visit healthpartners.com.au or call us. Please read
this when joining and ensure that every person
on your membership is aware of Health Partners
Privacy Policy.
Contribution rates and quotations
Please contact us for a quote on your choice of
cover. You will be asked to confirm your (and your
partner’s/spouse’s) lifetime health cover loading, if
applicable. Your quote can also be tailored according
to your eligible rebate tier. For more information, see
page 49 or call us. We will be happy to help you.
You can also get a quote online in just minutes at
healthpartners.com.au.
Up-to-date payments
For fast and seamless claiming, please ensure that
your health cover payments are up to date. HICAPS
claiming is not available if your payments are in
arrears. Please call us if you are experiencing any
difficulties with payment.
Direct-debit Service Agreement
The Direct-debit Service Agreement includes
the responsibilities of both Health Partners
and the member to ensure a smooth and secure
operation of your direct debit. Please read this
when selecting the direct-debit payment option.
For a copy of our Direct-debit Service Agreement
visit healthpartners.com.au or call us.
Pharmacy 20% discount
Extras and package members are eligible to receive
20% discount on most non-prescriptions items, upon
presentation of their Health Partners membership
card at a participating Health Partners pharmacy.
It is for personal use only and excludes agency lines
(e.g. X-Lotto), Schedule 3 recordable items and total
store category sales of 40% or more.
Glossary
For a glossary on some of the commonly used terms in
health insurance, visit healthpartners.com.au/glossary.
Other useful resources
Information about private health insurance
and government initiatives such as the Rebate,
Lifetime Health Cover and Medicare Levy
Surcharge can also be found at:
privatehealth.gov.au
humanservices.gov.au
ombudsman.gov.au
51
Claiming
your way
Your options don’t end at health cover. When it comes to claiming, choose the
option to suit you.
Health Partners App
Direct billing with Access Gap Cover
Simply download the free app to your smartphone,
register your details, take a photo of your itemised
account and submit.
If your doctor has chosen to participate in Access
Gap, they’ll send your medical bill directly to us.
Once we’ve paid it, we’ll send you a statement to let
you know the benefits that have been paid on your
behalf. If there is any amount outstanding, this will be
payable by you.
With no paperwork or hassle, most benefits are paid
within 2 business days of your claim being submitted.
Online
Submit your claim in three simple steps via Members
Online at healthpartners.com.au.
On the spot
Your claim can be processed on-the-spot whenever
you visit a HICAPS provider or Health Partners
professional. Simply present your membership card
at the time of service and you will only have the
balance to pay – or nothing at all, depending on your
level of cover.
52
Claim form
Claim forms are available on our website, at our
centres and upon request. Supply your direct credit
details for electronic payment or opt for cheque
payment. Once the form is completed (with itemised
accounts attached), you can mail it freepost to
Health Partners Claims Assessor, Reply Paid 1493,
Adelaide SA 5001.
If you prefer, submit your claims in person at any
Health Partners Member Services, Dental or Optical
centre. Please note that over-the-counter cash
claiming is not available.
Where to
find us
With over 100 Health Partners professionals across South Australia,
we’re always in reach.
Health Partners Member Services
Health Partners Optical
Call 1300 113 113 for all enquiries
or come in and see us at:
For appointments, please call the number listed for
each of our 4 locations:
Adelaide:
101 Pirie Street
Adelaide: Modbury:
27 Smart Road
Goodwood: 92 King William Road 1300 116 116
[email protected]
healthpartners.com.au
101 Pirie Street
Modbury: 27 Smart Road
1300 115 115
1300 127 127
Woodcroft: 185-191 Bains Road 1300 191 191
[email protected]
optical.healthpartners.com.au
Health Partners Participating Dentists
Call 1300 114 114 for all appointments
at any one of our 3 locations:
Adelaide: Level 1, 101 Pirie Street
Modbury: Level 1, 27 Smart Road
Woodcroft: 185-191 Bains Road
[email protected]
dental.healthpartners.com.au
Barossa Dental
Call 08 8562 1444 for all enquiries:
Health Partners Participating
Pharmacy and Physiotherapy
To find the Health Partners provider
nearest to you, visit the ‘Partner Search’ at
healthpartners.com.au from your computer,
tablet or smartphone, or call us on 1300 113 113.
We have 50 pharmacies and over 45
physiotherapists across metropolitan Adelaide
and country South Australia.
Nuriootpa: 37 Barossa Valley Way
[email protected]
barossadental.com.au
53
Joining
is simple
Choose from three convenient options. If you have any questions, we’re just
a phone call away.
Call 1300 113 113.
Our friendly and experienced
staff can help you from
8am to 8pm, Monday to Friday
and 9am to 1pm on Saturdays.
Join online 24/7 at
healthpartners.com.au
Complete and return
the attached membership
application form.
Transferring from another fund?
Payment options
That’s simple too. Just include your membership
details when you apply and we will take care of
the rest for you. And, if you switch to an equivalent
level of cover you may not have to re-serve your
waiting periods. Please refer to the PDS for more
information or contact member services.
We offer a 3% discount for direct-debit payments
which can be made fortnightly*, monthly, quarterly,
half-yearly or yearly.
Commencement of your cover
Your cover will commence automatically on the
date that you apply, unless you have requested
your membership to commence at a later date.
Benefits are payable once your first payment is
received and applicable waiting periods have
been served.
54
If you prefer, we can send you an account or you
may select payroll if your employer is registered
for payroll with Health Partners.
*Fortnightly payments from bank account only.
Notes
55
Notes
56
Adelaide 101 Pirie Street
Modbury 27 Smart Road
Head Office Level 3, 101 Pirie Street, Adelaide
Health Partners, Reply Paid 1493, Adelaide SA 5001
General enquires 1300 113 113 or 1800 182 322 for country and interstate callers
Fax (08) 8113 2259
Website healthpartners.com.au
Email [email protected]
HPP01/1604
Health Partners is a registered private health insurer since 1937.
All information in this brochure is effective 1 April 2016.
Health Partners Ltd ABN 43 128 282 904