Wesley LifeShape Clinic
Services Rebate Guide
This document is to be used as a guide only.
Clients must speak to:
• Their private health insurance company
• Medicare
• Their GP
• Their income tax accountant and/or
• The ATO
directly to determine exact rebates on Wesley LifeShape Clinic services.
Guide last updated on 04/04/2013
wesleylifeshape.com.au
© 2013 Wesley Health
Private Health Insurance*
PH: 13 16 42
Individuals
Families
Level of
Cover
Annual Limits
Dietetics /
Nutrition
Annual
Limits Ex.
Physiology
Mid Plus
$200
$350
$200
$150
Top Cover
$250
$550
$300
$250
Dental Plus
$200
$350
Nil
$150
Top Extras
$600
$300
$500
$400
Family Basic
Saver
Family Plus
$200
$300
Nil
Nil
$300
$350
$200
$150
Mid Plus
$200
$350
$200
$150
Top Cover
$250
$550
$300
$250
Dental Plus
$200
$350
Nil
$150
Top Extras
$600
$300
$500
$400
Annual Limits
Healthy
Psychology
Lifestyle Bonus
Benefits
Rebate 65%
of the cost
Rebate 75% of
the cost
Rebate 50%
of the cost
Rebate 65%
of the cost
Rebate 50%
of the cost
Rebate 65%
of the cost
Rebate 65%
of the cost
Rebate 70%
of the cost
Rebate 50%
of the cost
Rebate 65%
of the cost
* This table is to be used as a guide only. Clients must speak to their insurance company directly to determine exact rebates on services.
Guide last updated on 04/04/2013
Private Health Insurance*
PH: 13 4 135
Please note annual changes occur in April*
Level of
Cover
Annual Limits
Dietetics /
Nutrition
Annual
Limits Ex.
Physiology
Annual Limits
Psychology
Living Well
Program
Individuals
Standard
Hospital with
Silver Extras
$400
$400 (Classed
as Natural
Therapies)
$400
$50
Families
Standard
Hospital with
Silver Extras
$400
$400 (Classed
as Natural
Therapies)
$400
$50
Benefits
Dietitian $40
initial and $19
subsequently.
Psychology
$27 initial
and $27
subsequently.
Dietitian $40
initial and $19
subsequently.
Psychology
$27 initial
and $27
subsequently.
* This table is to be used as a guide only. Clients must speak to their insurance company directly to determine exact rebates on services.
Guide last updated on 04/04/2013
Private Health Insurance*
PH: 134 190
Individuals
Families
Level of
Cover
Annual Limits
Dietetics /
Nutrition
Annual Limits
Ex. Physiology
Annual Limits
Psychology
Healthy Lifestyle
Bonus
Top Extras 55
$200
Nil
$200
Nil
Top Extras 70
$400
Nil
$400
Nil
Top Extras 85
$500
Nil
$500
Nil
Ultra Health
Cover
Ultra Health
Cover
$600
Nil
$600
Nil
$600
Nil
$600
Nil
For members who joined Medibank Private prior to January 1, 2011, Health Insurance Products were previously known as Healthy Plus, Smart Plus,
Advantage Plus and Premier Plus. Members with these products may also be eligible to claim for Healthy LifeStyle Bonuses.
* This table is to be used as a guide only. Clients must speak to their insurance company directly to determine exact rebates on services.
Guide last updated on 04/04/2013
Private Health Insurance*
PH: 13 13 34
Annual Limits
Dietetics /
Nutrition
Annual
Limits Ex.
Physiology
Top Plus &
Super Multi
Cover
$300
$375
$300
$150
Dietitian $45 initial
and $35 subsequently.
General Extras
Plus
NIL
$250
NIL
NIL
$25 initially, $20
subsequently.
Top Plus &
Super Multi
Cover
$350
$250
$600
$200
Dietitian $55 initial
and $40 subsequently.
Exercise physiology
$40 initial and $33
subsequently.
Fit and Free
Extras
$300
$600
$300
NIL
$30 / 28 Ex Phys
$45 / 30 Dietetic
$75 Psych
Level of
Cover
Individuals
Families
Annual Limits
Healthy
Psychology Lifestyle Bonus
Benefits
* This table is to be used as a guide only. Clients must speak to their insurance company directly to determine exact rebates on services.
Guide last updated on 04/04/2013
Private Health Insurance*
PH: 133 423
HBF clients receive different rebates depending on how long they have had their cover*
Level of
Cover
Individuals
Ultimate Cover
Annual Limits
Dietetics /
Nutrition
Annual
Limits Ex.
Physiology
Combined max for Dietetics & $400 under 3 years
Nutrition
of membership
$500 under 3 years
$800 3-6 years
$600 over 3 years
$1100 6 years & over
of membership
Annual Limits
Psychology
Weight
Management
$600
$200
Nil
$50
$600
$200
Sub limits apply for
Nutritionist
$300 under 3 years
$400 over 3 years
Premium
Essentials
Families
Ultimate Cover
$400
Nil
Combined max for Dietetics & $400 under 3 years
Nutrition
of membership
$500 under 3 years
$800 3-6 years
$600 over 3years
$1100 6 years & over
of membership
Sub limits apply for
Nutritionist
$300 under 3 years
$400 over 3 years
Additional
Invidual and Families
Premium
Essentials
$400
Nil
Nil
$100
Wellness
$200
$300
$450
$200
* This table is to be used as a guide only. Clients must speak to their insurance company directly to determine exact rebates on services.
Guide last updated on 04/04/2013
Enhanced Primary Care (EPC)*
Enhanced Primary Care Referrals:
•
•
Wesley Lifeshape Clinic accepts EPC Referrals
An EPC Referral enables a client to see an Allied Health Professional (Dietitian, Exercise Physiologist, Psychologist)
for a maximum of 5 times per year. Portions of these consultations are then claimable through Medicare.
EPC and the Chronic Disease Management (CDM) Medicare items on the Medicare Benefits Schedule (MBS) enable GPs to
plan and coordinate the health care of patients with chronic or terminal medical conditions, including patients with these
conditions who require multidisciplinary, team-based care from a GP and at least two other health or care providers. The
items are designed for patients who require a structured approach to their care.
A ‘chronic medical condition’ is one that has been or is likely to be present for at least six months, including but not
limited to asthma, cancer, cardiovascular disease, diabetes mellitus, musculoskeletal conditions and stroke.
Whether a patient is eligible for CDM services is a clinical judgement for the GP, taking into account the patient’s medical
condition and care needs, as well as the general guidance set out in the MBS.
Maximum No. of Rebate Given for Total Rebates^
Consultations
WLSC Services^
5
$52.95
$264.75
^ Medicare rebates are subject to change, rebate figures correct as at 04/04/2013
* This information is to be used as a guide only. Clients must speak to their GP directly to determine if they are eligible for an EPC Referral
Guide last updated on 04/04/2013
Medicare Safety Net*
Thresholds as at 1 January 2011:
Threshold amount
Who it is for
How it is calculated
What the benefit is
Original
$421.70
All Medicare
cardholders
Based on gap amount
Extended concession
and FTB(A)
$610.70
Out-of-pocket costs
Extended general
$1221.90
Concession
cardholders and
families eligible for
FTB(A)
All Medicare
cardholders
100% of schedule fee
for out-of-hospital
services
80% of out-of-pocket
costs or the EMSN
benefit cap for out-ofhospital services
““
““
What out-of-hospital services are covered?
Some examples of services where costs count towards the Medicare Safety Net are:
•
•
•
•
•
•
•
•
•
GP and specialist consultations
blood tests
CT scans
pap smears
psychiatry
radiotherapy
tissue biopsies
ultrasound
x-rays.
* This information is to be used as a guide only. Clients must speak to
Medicare directly to determine if they are eligible for the Medicare Safety Net
Guide last updated on 04/04/2013
What are the benefits?
Once you reach a Medicare Safety Net threshold, visiting a doctor or having tests may cost you less.
For example: if you reach a threshold and then visit your doctor who charges you $65.00 for a standard consultation, you will receive your Medicare
benefit of $34.30. You will also receive 80 per cent of your out-of-pocket costs (($65.00 - $34.30) x 80 per cent), giving you an extra $24.60. So in this example it will only
cost you $6.10 to visit your doctor. An out-of-pocket cost is the difference between the Medicare benefit and what your doctor charges you.
Net Medical Expenses Tax Offset*
Summary:
If an individual and their dependants collectively spend more than $2,120 (indexed annually) on eligable medical expenses
(after rebates) in a financial year, they may be able to claim a tax offset. The offset is 20% of whatever is left (or ‘the excess’)
of net medical expenses over $2,120 that were paid in a financial year. Net medical expenses are the total amount spent on
medical expenses minus any reimbursements paid by private health insurance or Medicare. From 1 July 2012, the medical
expenses tax offset is means tested and those people earning more than a certain amount may be subject to a higher
threshold and lower rebate.
Example:
Nicola’s total medical expenses for herself and her dependants for the 2012-13 financial year came to $4,500.
Nicola has private health cover, so she subtracts the refund she received from her private cover as well as Medicare, from her
total expenses, to find out her net medical expenses.
$4,500 - $1,700 = $2800
Because Nicola’s net medical expenses are more than $2,120, she is able to claim the medical expenses tax offset. She takes
$2,120 from her net amount.
$2,800 - $2,120 = $680
Nicola takes the remaining net medical expenses amount, and multiplies it by 20%.
$800 x 20% = $136
Nicola is able to claim $136 back as her Medical Expenses Tax offset.
* This information is to be used as a guide only. Clients must speak to the income tax accountatnt and/or Australian Taxation Office directly to determine exact medical tax offset rebates. Guide last updated on 04/04/2013
Better Access Program*
If you feel that psychological factors may be contributing to your weight gain; you may be eligible for additional Psychology appointments through the
Better Access Program. Generally speaking, people whose lives are impacted by the following list of conditions may qualify for the Better Access Program:
Generalised Anxiety Disorder
Depression
Bereavement DisordersEating Disorders
Alcohol Use Disorders
Drug Use Disorders
Mixed Anxiety and Depression
Sleep Problems
Adjustment Disorder
Body Image Disorders
The above list is not exhaustive: eligibility for the Program is determined by a Doctor. To ascertain your eligibility, please make a 30 minute appointment
with your GP or with our Clinic Doctor. Our Clinic Doctor’s consultation fee is $163.35, which must be paid for in full on the day. This fee is fully refundable
through Medicare* and must be claimed from Medicare prior to attending any Psychology consultations.
The Better Access Program entitles you to five one hour Psychology consultations. These consultations cost $170 each and must be paid for on the day.
Medicare will rebate $84.80 - $124.50 of each consultation fee*.
After attending the initial five consultations, you will need to arrange a 30 minute review appointment with your Doctor. During this time, the Doctor will
review your progress and decide if a further five consultations are warranted.
If you have any questions regarding the Better Access Program, please ask your GP, Dietitian or Psychologist; or you can talk to our Client Services Staff.
Please take careful note of the following cancellation policy as it will be enforced: Appointments cancelled within 24 hours of the consultation, or
appointments not attended on the day of the consultation, will incur a cancellation fee of $85.
* All prices are subject to change per the Medicare Benefits Schedule.
* This information is to be used as a guide only. Clients must speak to their GP directly to determine if they are eligible for the Better Access.