Emergency & non-emergency ambulance
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1 Prime Living Nil excess Up to 100% Nil excess Up to 100% back for dental, optical and physiotherapy Emergency & non-emergency ambulance Generous pharmacy prescription limits Laser eye surgery cover Health Partners Support Programs The Prime Living Package provides benefits for services like laser eye surgery and up to on dental, optical, physiotherapy and pharmacy. Hospital cover component You will be covered for all eligible Medicare-recognised procedures, except those listed under exclusions. You also get access to a range of health and wellness support programs (criteria apply) and up to 100% back for a number of additional services. In-patient Procedures and Services Here are some examples of the most common claims we receive for inpatient procedures and services, but if you have any specific concerns that you would like addressed please call us on Chemotherapy Colonoscopy/Endoscopy/Cystoscopy Eye surgery Heart surgery (eg. Coronary Angioplasty) Hysterectomy/Vasectomy Insulin Pumps Joint reconstruction procedures Joint replacement procedures Pharmaceuticals related to admission (PBS approved) Psychiatric services Rehabilitation services Removal of Kidney Stones/Gallstones/Appendix Removal of Tonsils/Adenoids Speech/Sound Processors (e.g. Cochlear Implant) Spinal surgery Surgical removal of wisdom teeth* Exclusions Exclusions are the services for which benefits are not available on this level of cover. Assisted reproductive services Pregnancy and birth-related services Sterilisation/Vasectomy reversal Surgical weight loss procedures Loyalty benefits Loyalty benefits apply for Insulin Pump replacements and Speech/Sound Processor replacements, as follows: 50% benefit after 3 years of continuous Prime Living membership 70% benefit after 4 years of continuous Prime Living membership after 5+ years of continuous Prime Living membership Maximum applicable benefit is limited to once every 5 years. Waiting periods - Hospital Waiting periods apply when you join without current cover or upgrade to a higher level of cover. *Dental Extras cover also required to receive benefits for dental item numbers used in the procedure. Health Partners Support Programs Home Health Partner Health Coaching Pre-existing conditions Home nursing Home sleep studies All other hospital services Laser Eye Surgery 12 months 2 months 36 months Included Exclusions Please refer to the Health Partners Product Disclosure Statement for details about benefits, waiting periods and claiming. Current as at 1 April Prime Living Page 1 of 5
2 Post Admission Benefit Non-PBS prescriptions 100% $1,500 Non-surgically implanted prostheses (e.g. prosthetic bras, wigs) 100% $1,500 Aids for recovery (e.g. compression garments, braces) 100% $250 Home Sleep Studies Benefit Set benefit applies when using a Health Partners recognised provider $100 $200 Home Nursing Benefit For treatment provided by a Registered Nurse who meets Health Partners recognition criteria (eg. wound management, IV medication) 100% $500 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 choose a Health Partners professional where you get 100% back for dental, optical and most physiotherapy treatments. Please refer to the Health Partners Product Disclosure Statement for details about benefits, waiting periods and claiming. General Dental At Health Partners Dental and Barossa Dental applies. At other dental providers A schedule of benefits applies; please call us for a quote. No limit Major Dental/Endodontic/Periodontic At Health Partners Dental and Barossa Dental applies. At other dental providers A schedule of benefits applies; please call us for a quote. $1,600 Benefits claimed at Health Partners Dental will count towards the limits at other dental providers, and vice versa. Optical At Health Partners Optical 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 non-prescription sunglasses. No limit. 30% off solutions and accessories. No limit. $500 ($300 sub-limit at other optical providers) At other optical providers 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. Current as at 1 April Prime Living Page 2 of 5
3 Pharmacy At Health Partners Participating Pharmacies PBS prescriptions, not already subsidised by the Government: Private prescriptions, including: Vaccinations Hormone implants Allergen implants Compounding prescriptions pay max. of $20 pay max. of $37 pay max. of $37 $1,000 Please ask your pharmacist about the benefits that apply to your prescription and if you can save more with generic brands. 20% discount on most non-prescription items. No limit (some conditions apply). Physiotherapy At Health Partners Participating Physiotherapists - your choice of: General Physiotherapist There is no gap for: Initial & subsequent consultations Long consultations Hydrotherapy Focus Physiotherapist* You pay a set gap for: Initial & subsequent consultations pay only $12 Long consultations pay only $12 Hydrotherapy At other physiotherapy providers $1,500 ($1,000 sub-limit for other physiotherapy providers; $300 sub-limit for pilates) Pilates Per session $20 *Physiotherapists with advanced qualifications (eg. a Master s Degree) recognised by the Australian Physiotherapy Association as Titled Physiotherapists; select practices only. Chiropractic/Osteopathy/Exercise Physiology 80% benefit applies. ($1,500 limit per membership) Acupuncture/Naturopathy/Massage/Natural Therapies*/Hypnotherapy $800 ($200 sub-limit per modality) *Includes remedial massage, bowen therapy, chinese herbalism, western herbalism, feldenkrais, mysofascial release, shiatsu, reflexology, iridology, Alexander Technique, kinesiology, therapeutic massage, Swedish massage, myotherapy, nutritionist. Dietary Benefit Podiatry/Orthotics ($400 sub-limit for orthotics) Current as at 1 April Prime Living Page 3 of 5
4 Psychology Benefit Initial consultation $140 Subsequent consultation $120 Speech Therapy Benefit Initial consultation $100 Subsequent consultation $70 Occupational Therapy Benefit Eye Therapy Benefit Laser Eye Surgery Benefit Laser correction eye surgery 100% Lifetime limit $4,000 Benefit available after 3 continuous years of Prime Living membership. Wellness for Life* Benefit Asthma Australia Membership 100% $100 per membership ~ Bone Density Test 100% $100 ~ Bowel Cancer Screening Kit $30 $30 Diabetes Education 100% $100 per consultation ~ Diabetes Membership 100% $100 per membership Gym and Fitness 100% $200 Mole Check Body Scans 75% $100 Quit Smoking 100% $100 (Lifetime limit $400) Weight Management Upon joining $50 Upon reaching goal $200 Lifetime limit $250 *For approved conditions or when medically necessary, subject to eligibility requirements; supporting documentation will be required. For further details refer to the Programs, Health Aids and Appliances explained section of the Health Partners Product Disclosure Statement. ~ Asthma Australia membership, bone density test, diabetes education, compression garments and hip safety kit are a combined group limit of $500. Current as at 1 April Prime Living Page 4 of 5
5 Aids and Appliances^ Benefit Asthmatic Spray Appliances (e.g. pump/nebuliser, spacers) 100% $130 every 3 years Compression Garments* 100% $100 per item ~ Blood Glucose Monitoring Machines 100% $250 every 3 years Blood Pressure Machines 100% $100 every 3 years Hearing Aids 100% $800 up to 3 years $1,600 over 3 years Based on continuous years of Prime Living membership. Maximum applicable benefit is limited to once every 3 years. Hip Safety Kit* 100% $100 ~ Low Vision Optical Magnification Aids 85% $50 every 3 years Sleep Apnoea/CPAP Apparatus 85% up to 2 years 85% over 2 years and under 5 years 100% 5 years and over up to 2 years $1,000 over 2 years and under 5 years $1,500 5 years and over Based on continuous years of Prime Living membership. Maximum applicable benefit is limited to once every 5 years. Circulation Booster (e.g. TENS Machine) 85% $50 every 3 years ^A letter from your medical practicioner may be required. For further details refer to the Programs, Health Aids and Appliances explained section of the Health Partners Product Disclosure Statement. ~ Asthma Australia membership, bone density test, diabetes education, compression garments and hip safety kit are a combined group limit of $500. Ambulance Benefit Emergency and non-emergency services including on-the-spot, road and air services; Australia-wide coverage 100% 1 per person, per year up to $20,000 Waiting periods - General Treatment Refer to the Member Guide for full details on General Treatment waiting periods and loyalty tiers. Benefits vary according to cover level. It is the policyholder s responsibility to understand what is and what is not covered by their health insurance policy, therefore this information should be read and retained in conjunction with the Health Partners Product Disclosure Statement or Member Guide, particularly in relation to limits, waiting periods, restrictions and exclusions that may apply, plus Government incentives and surcharges. A glossary of terms that might assist can be found on the Health Partners website, along with the Fund Rules. If you are requiring treatment, you can call us on to check if you are covered and if your provider or chosen hospital is recognised by us. Current as at 1 April Prime Living Page 5 of 5
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