Please read this Policy Summary carefully and retain it for future reference.

Transcription

1 1 WESTFUND POLICY SUMMARY TOP-LEVEL EXTRAS COVER SUITABLE FOR THOSE COMMITTED TO MAINTAINING A PROACTIVE AND HEALTHY LIFESTYLE. GENEROUS LIMITS ON A COMPREHENSIVE RANGE OF BENEFITS. Please read this Policy Summary carefully and retain it for future reference. For further policy information, definitions and claiming requirements please refer to Westfund s Membership Terms and Conditions, which can be downloaded at alternatively, call Westfund on to request a copy. General Dental Diagnostic & Preventive ontics Endodontics Fillings Extractions/Oral Surgery General Dentist 1 Specialist Dentist Set item benefits depending on item number annual limit Some items attract higher benefits where completed by Specialist Dentist Major Dental Crowns Bridges Implants Veneers 1 Set item benefits depending on item number $1500 per member Dentures annual limit Orthodontia (Unless otherwise stated) Completed by Orthodontist Completed by General Dentist 1 Accrues at a rate of $650 per member per policy ; lifetime limit of $3250 Accrues at a rate of $520 per member per policy ; lifetime limit of $2600 Orthodontia is capped at $3250 with General Dentist sub-limit applying Detailed Treatment Plan must be provided prior to commencement of Orthodontia Dental retainers 1 Set item benefits 2 services per item number per member Orthodontic consultations/xrays completed by Orthodontist Dental Top Up Use towards eliminating the gap on General Dental and Dentures 1 85% annual limit Consultations / x-rays completed by General Dentist are paid at set item rebates 1 of gap $300 $600 For dental completed by General Dentist

2 2 WESTFUND POLICY SUMMARY Optical (prescription only) Frames Vision Lenses Bifocal Lenses Multifocal Lenses Contact Lenses Physiotherapy / Exercise Physiology Group/ Class Individual Physiotherapy $10 $52 Exercise Physiology $10 $40 Chiropractic / Osteopathic Chiropractic Chiropractic X-ray Osteopathic $40 $70 $40 Complementary Therapies $350 per member $520 $1040 $400 $800 benefit towards tinting, coating or add-ons. Benefits also apply for Irlen lenses Two chiropractic x-rays per member per calendar Group/ Class Individual Sub- Remedial Massage & Myotherapy Acupuncture & Chinese Herbalism N/A $35 $350 $700 N/A $35 $350 $700 Dietetics & Nutrition $10 $55 $350 $700 Home Nursing (up to 6 hrs/over 6 hrs) N/A $18/$72 $225 $450 Vision (Eye) Therapy N/A $35 $350 $700 Occupational Therapy 1 $10 $70 $350 $700 for surgical Podiatry treatment $42 Surgical Treatment by a N/A $336 $672 Podiatrist Clinical Psychology $420 $840 Speech Therapy (initial/subsequent) $42 $60/$42 $384 $768 $750 $1500

3 3 WESTFUND POLICY SUMMARY Prescriptions, Injections, Vaccinations For Private, n-pbs, n-nhs $75 per prescription for the amount that exceeds the PBS co-payment $600 per member Doctor letter required in some instances (see Membership Terms and Conditions) Health Management Fitness Centre Aquatic Programs Weight Loss Programs Virtual Gastric Banding Diabetes Education Vitamins Omega 3 Probiotics Preventative Health $150 $300 Fitness, Weight Loss, Virtual Gastric Banding and Aquatic Programs require a Medicare Registered Practitioner to complete a Health Management Claim Form to confirm the Program is medically necessary. Forms are available for download at www. westfund.com.au/helpful-resources/formsand-downloads/ (Unless otherwise stated) Preventative Health Tests -Bone Density Test, Bowel Testing Kit, Calcium Score, Mammogram, Mole Scan, Thin Prep Pap Test $45 per member The test must be recommended by a Medicare Registered Practitioner and cannot be Medicare claimable Ear and Eye Preventative Health Checks Audiology Test, Corneal Topography, Optical Coherence Tomography, Retinal Photography $80 $160 per member The health check must be provided by a Medicare Registered Practitioner and cannot be Medicare claimable. Antenatal Classes and pre/postnatal consultations 1 $120 per policy Lifetime Includes: Lactation Consultation and Post-Partum Assessments Hypnotherapy for Quit Smoking $250 per member Lifetime Chronic Disease Association Fees $30 per member Includes - Asthma Foundation, Diabetes Australia, Arthritis Australia, Coeliac Association, Crohn s and Colitis Australia, Parkinson s Australia, Multiple Sclerosis (MS) Australia, Alzheimer s Australia, National Association of people with HIV Australia (NAPWHA), Lupus Association of Australia, MedicAlert Foundation, Stoma Associations (Ostomy, Colostomy)

4 4 WESTFUND POLICY SUMMARY n Surgically Implanted Prostheses Health Aid or Appliance Blood Glucose Monitor s Item Blood Pressure Monitor $150 Braces Compression Garments $200 Burn Suits $800 INR Monitor $200 Mammary Prostheses and Brassieres $400 Nebuliser $200 Custom Made Orthopaedic Boot Custom Made/ Preformed Orthotics $400 $300 Peak Flow Meter $35 12 Wigs months $300 Artificial Limbs $200 CPAP (sleep apnoea) Machine EPAP Treatment Oral Appliance for diagnosed snoring CPAP Masks / Accessories and TENS Accessories Low Vision Aids Mobility Aids Oxygen and Accessories Oximeter $750 $750 Repairs to Devices TENS Machine $200 Hearing Aids & Frequency Modulated Systems 36 months $2000 Claimable per member Every two s s s s Letter of Recommendation Every 1 Every 1 unless relevant hospitalisation is recorded with Westfund Every 1 Every 1 unless relevant hospitalisation is recorded with Westfund Every 1 Every 1 Every 1 unless initial purchase of the device is recorded with Westfund Benefit available for hire and purchase fees Letter of recommendation not required if n Surgically Implanted Prostheses claimed through HICAPS by a Medicare Registered Practitioner Repairs to devices are only available to appliances listed in this table

5 5 WESTFUND POLICY SUMMARY Member Advantages - Member Advantages provide additional benefits to our members and require individual forms to claim. Forms are available for download at: Optical Bonus Sunglasses Forced Retrenchment/ Protected Industrial Action Ambulance Emergency Ambulance Transport 36 months $80 per member to use towards outof-pocket costs, accrues to $160 if no optical claims made at any provider in consecutive s $75 per member per calendar Waiver of premiums up to six months 1 day annual limit Emergency Ambulance transport is ambulance transportation of an unplanned and non-routine nature for the purpose of providing immediate medical attention to a person in the opinion of the treating medical officer. An ambulance service where subsequent transport to a hospital is not required is covered under nonemergency patient transport. n-emergency Patient Transport $5000 per member n-emergency patient transport is ambulance transportation including on the spot treatment where a time critical ambulance response is not essential however clinical monitoring is required for the purpose of providing Medical attention to a person in the opinion of the treating medical officer. Available only at Westfund Eye Care Centres. Bonus can be used towards prescription glasses and contacts only Available only at Westfund Care Centres Must be due to Forced Retrenchment or Protected Industrial Action Benefit eligible for Westfund recognised ambulance service providers in Australia. Westfund covers the cost of transport by either covering the cost of state government levies or covering the ambulance account Finding a registered provider Westfund has established a Provider of Choice Network to ensure members have no or known out-of-pocket expenses for selected General Treatment services. To see if a Provider of Choice is in your area use our search facility at: Finding a registered General Treatment provider Our search facility in the Member Online Area of our website can help you find registered providers; simply go to: login to the Member Online Area and go to Find Providers. Alternatively, you can find registered providers at Other important information Westfund s Privacy Policy is available at: To register a complaint please visit: Westfund Health Insurance is a signatory to the Private Health Insurance Code of Conduct. You can get a copy of the code at: