Issue 02 October 10
How stuff works getting the best from your health cover can be as simple as knowing where to look and when to ask.
Getting to know your health cover is an almost impossible task! Unlike car or house insurance, which cover you for relatively few things, your health cover potentially pays benefits for hundreds of different products, services and treatments – you’ll never know them all off by heart. What you can do to make sure you get the best from your cover is make sure that you know where to look for answers and when to ask questions. In this issue we tackle some of the trickier topics that can confuse people, and introduce you to the resources available to help you get to know your cover better.
Contents
Editor Simone Tregeagle Design Team Scope, scopedesign.com.au The health information provided in be well is intended to be informative only and should be carefully evaluated for its source, accuracy, completeness and relevance for your purposes. It is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional. You should always obtain appropriate professional advice relevant to your particular circumstances. railway + transport health fund ltd (abn 93 087 648 744) is a registered health benefits organisation.
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from the CEO
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How your cover works
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How ambulance cover works
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How our health and wellbeing programs work
Health insurance is complicated, probably much more so than any other type of insurance. Our job is make sure that you have access to the information and assistance you need when you have questions – that’s what this issue is all about.
Getting the best from your health cover can be as simple as knowing where to look. Find (almost) everything you need to know about what you’re covered for, how much you’ll get back, how your cover works and how to find your way through the healthcare system with these handy resources.
Fortunately, this is not a topic many of us know too much about, but it’s important to know you’ll be covered if you ever need it. Find out the facts and check your level of cover.
If you have hospital cover with rt, you’re eligible to use these two great programs: one designed to help you improve your health and wellbeing and the other to help you get well in the comfort of your own home.
how government incentives work
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Rebate, Lifetime Health Cover, Medicare Levy … all your questions answered – what they are, how they affect you and what you need to know about them.
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Confused about these? Here’s a couple of topics that can tend to trip people up: find out more about why you’re not covered for purchases you make overseas, and how to make the most of your orthodontic entitlements.
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How claims work
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How our online centre works
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Making claims is what it’s really all about, find out more about how, when and where you should be making claims.
Have you registered yet to use our online member centre? With instant access to make changes to your membership, and a new service that makes it possible for you to view your claims history and track claims, it’s handy to know about.
It’s that time of year again It won’t be long before our minds turn to the end of another year and Christmas holiday travels. Find out what you need to do if you have adult children on your cover and why you should leave your health cover behind if you’re travelling this summer.
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from the CEO The first thing you might notice about this issue of be well, is that there’s a new face welcoming you from the CEO page. I’m Michael Prior, a member of the rt board of directors and am currently acting in the role of CEO. Glenn Campbell, who served as CEO since 2006, and who led the organisation through a period of significant change, growth and reinvigoration resigned his position in August. At the time of writing, the board is recruiting for the role and I expect that by time the next issue of be well comes around, we’ll be introducing our new CEO to you. In this issue we continue in our efforts to help you better understand your health cover. The fact is that health insurance is complicated, probably much more so than any other type of insurance, and our view is that it’s probably impossible to ever feel like you really understand your cover well. The best we can do is make sure that you have access to the information and assistance you need to help you when you have questions. One of the most important things you can do when it comes to using your health cover, is not make assumptions. Our team is available to help you check your cover, confirm what you’re covered for, and they can even tell you exactly how much you can expect to get back – armed with all that information, there will be no nasty surprises. Throughout this issue we’ve also tackled a range of topics that we find members are often confused about – ambulance cover, orthodontic cover, overseas purchases, and the various government programs that can either cost you money or save you money. As always, if you have any questions, please feel free to call or email our member care team. Also in this issue you’ll find some information about what to do with your cover as we approach the end of another year. If you have children finishing their studies, it may be time for them to 2
Our team is available to help you check your cover, confirm what you’re covered for, and they can even tell you exactly how much you can expect to get back.
And finally, congratulations to our Sydneybased City2Surf team. The staff, their families and friends braved the infamous ‘heartbreak hill’ and went the 14km distance to raise money for the rt Families Foundation. It was a stunning day and a wonderful achievement for everyone who participated. I’d like to take this early opportunity to wish you and your family a safe and merry Christmas, and a healthy and happy New Year. consider their own health cover options. Your adult children are automatically eligible to remain on your family cover until the age of 21, after that, we have a couple of different options available, depending on whether they are studying or working. If you’re not certain about whether your kids are covered, see our article on page 24 or give our team a call. As you opened this issue of be well you will have also found enclosed a notice of meeting for this year’s annual general meeting (AGM) and information about our board member elections. I encourage all members to take the opportunity to participate in this process by sending in your ballot and attending our AGM. For regular attendees, please note that the AGM will be held at a new venue this year after our regular venue was unavailable. All the information you need is contained in the notice of meeting, and I hope to see you there.
Take care and be well.
Michael Prior Director and Acting CEO
As the year draws to an end, I’d like to take the opportunity to congratulate the rt team for seeing the fund named by the Financial Review’s Smart Investor magazine as one of the nation’s ‘best value’ health funds, for the third year running! This is a fantastic endorsement of the great value rt offers its members. The team also recently participated in the ATA contact centre of the year awards, and while we were not successful on the night, it is a great indicator of just how important it is to us to be delivering exceptional customer service.
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How your cover works A to Z of rt
You’ll get the best from your health cover by using it well and making sure you understand what you’re covered for, or at least which questions to ask. If you haven’t already made use of these great resources, designed to help you get to know your cover better, visit our website to have a look, www.rthealthfund.com.au.
If you’re looking for information about how your cover works, this will tell you everything you need to know. It’s all the rules, regulations and details. Log in to our online member centre where you’ll find the A to Z in the ‘library’ section.
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cover guides
The last couple of issues of our be well magazine have been dedicated to helping you understand your cover better, and know how to get the most from it. Find out more about how your health cover works by visiting www.rthealthfund.com.au/be_well.html.
These are comprehensive tables that list everything you’re covered for and how much you can expect to get back. Take a look at the ‘rt members’ area of our website and click on the page ‘how do you know what you’re covered for’.
OF A-ZOF EEA-Z TH TH HH ALT ALT HE RT RTHE ND ND FU FU
The A-Z of rT heAlTh fund Contents Joining Your membership Cover for the kids Waiting periods Benefits Making claims Making payments Your hospital cover Your extras101 cover Your ambulance cover Health and wellbeing programs Travelling overseas Government programs Fund rules and policies Complaints Regulatory bodies
Joining The A-Z of rt health fund is intended to be the ultimate guide to your health cover and how it works. We’ve grouped the content 4 into specific topic areas that we hope make it easy for you to find what you’re looking 6 for. If you still have questions or need 8 clarification, please call our member care team on 1300 886 123. We’re here to help 9 and we’d value your feedback about how 11 well we’re doing when it comes to providing you with the information you need 14 to better understand your health cover. 16 An online version of the A-Z can be found 1
24 at www.rthealthfund.com.au/atozofrt.html. You’ll also find a pdf version of this document 27 available for download. 28 If you’re looking for detailed information about 30 your cover and what you can claim, you can download detailed cover tables from our 32 website. Visit www.rthealthfund.com.au, click 34 on ‘member login’ at the top of the screen and you’ll find what you’re looking for in the ‘library’ 35 within the online member centre. 36 If you have a suggestion or feedback about this guide, we’d love to hear from you. Please email us at help@rthealthfund.com.au.
Version 2. Effective 1 April 2010. Fund rules and policies are subject to change without notice. If a change will adversely affect your membership and/or benefits, we will notify you in writing. Depending on the issue, this may be through a personally addressed letter, via email or through our member magazine, be well.
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There are two types of health funds in Australia – unrestricted funds that anyone can join, and ‘exclusive’ membership funds that require special eligibility to join. rt is an exclusive membership health fund. We exist specifically to provide health cover to transport and electricity industry employees and their families. Membership eligibility Any current or former employees of a railway, transport or electricity industry organisation and their family – including partner, kids and extended family – are eligible to join. So, you are able to join if you or any member of your extended family has ever worked for a: – government or privately owned land, sea or air transport company – government or privately owned electricity company – government body responsible for administering the transport or electricity industries – company that provides contract services to any of the above organisations. Non-residents of Australia Australian residents with full Medicare entitlements are able to join (provided they also meet our other eligibility requirements, as described above). We are unable to provide full cover to anyone who is ineligible, or only partly eligible, for Medicare. If you’re in this situation, we recommend that you look for an ‘overseas visitor’ cover (offered by some Australian health funds) to make sure that you are fully covered in the event that you need hospitalisation during your stay in Australia.
use you’re Remember, beca ember your m nd fu h alt an rt he n join too, ca ily m immediate fa work in the even if they don’t ity industries ric ct transport or ele hip makes them – your members good news and e th eligible. Share our team a call to ask them to give 1300 886 123. r, compare cove
Membership types We offer a choice of four membership types, depending on who you want to cover: 1. Single – covers one adult. 2. Couple – covers two married or de facto adults (including same sex couples). 3. Single Parent Family – covers one adult and all dependant children. 4. Family – covers two married or de facto adults (including same sex couples) and all dependant children of either or both adults. Adult children can remain covered by your membership up to the age of 25. See page 7 for details. Health cover choices We like to keep things pretty straightforward, so we offer a small range of easy-tounderstand covers. You can choose from: Private Hospital + Extras (our top level of cover) There are no exclusions with our Private Hospital Cover: you’re covered for treatment in the hospital of your choice, with the doctor of your choice. And our Extras Cover gives you generous rebates on a huge range of health and wellbeing products, services and treatments.
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r care team Call your rt membe at 123, email us on 1300 886 com.au help@rthealthfund. at or visit us online fund.com.au www.rthealth
How ambulance cover works
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Fortunately, most of us will never see the inside of an ambulance, so it’s not something we think about until we find ourselves in the middle of an often stressful and confusing situation, wondering if we are covered, and exactly what’s included. Ambulance cover isn’t only something to think about if you are a little older or if you have been unwell. If you break your arm skiing, get injured on a family picnic, or just trip over your four-legged friend and break your ankle, it’s good to know that you’re covered for the trip to hospital. And it’s especially important if you live in or travel to regional or remote areas where you need to be transported to a city for treatment after an accident. It often comes as a big surprise to people that Medicare doesn’t cover the cost of ambulance treatment and transportation. Unless you have ambulance cover, you will be paying for the service – and it can be very expensive. Ambulance cover is one of those deceptively simple-looking things, which aint. There’s emergency versus nonemergency cover; ambulance treatment 6
versus ambulance transportation; and the ambulance cover that comes with your health cover versus the one you might buy from your state ambulance scheme. Let’s try to break it down. Each of rt’s hospital covers includes cover for ambulance, and the extent of ambulance cover you have depends entirely on where you live. When you’re looking at ambulance cover, check that you understand the difference between cover for ambulance attendance and ambulance transportation. Sometimes an ambulance will attend, but the person will not be transported to hospital because thankfully the emergency has passed, or wasn’t as serious as it first seemed. In this case, if you are only covered for emergency transportation, the ambulance service will charge an attendance fee, but you won’t be able to make a claim. Only residents of NSW and the ACT are fully covered for ambulance attendance and transportation by the cover that comes with our hospital covers. If you are a resident of another state, we recommend you look into additional cover offered by your state government ambulance scheme if you’re after something more comprehensive.
These detai ls can be co nfusing, but they ar e importan t, and never more so th an the day you need to use your co ver. We wan t to help yo make sure u that you’ve mad decisions fo r yourself an e the right d your fam if that day co ily mes. As alw ays, if you’ not certain re about exac tly what yo are covered u for, please 1300 886 12 call us, 3.
If you live in:
Then you’re covered for:
NSW or ACT
• Unlimited cover • Emergency and non-emergency ambulance attendance and transportation • Cover applies no matter where you are in Australia
QLD
If you’re a Queensland resident, you pay a Community Ambulance Levy through your electricity bill. Your rt hospital cover therefore does NOT include cover for ambulance. For more information visit www.ambulance.qld.gov.au.
VIC, SA, WA and NT
• $5,000 per person, per year • Emergency ambulance transportation (no cover for non-emergency transportation or ambulance attendance only) • Cover applies no matter where you are in Australia You can take out a higher level of ambulance cover, which includes non-emergency and ambulance attendance, with these state-based organisations: Victorian Ambulance Service, www.ambulance.vic.gov.au South Australian Ambulance Service, www.saambulance.com.au St John Ambulance Western Australia, www.stjohnambulance.com.au St John Ambulance Northern Territory, www.stjohnnt.org.au
TAS
• $5,000 per person, per year • Emergency ambulance transportation (no cover for non-emergency transportation or ambulance attendance only) • Cover only applies when Tasmanian residents use the ambulance service while in Queensland or SA (there is no cover for Tasmanian residents while in Tasmania, Victoria, WA, NT, NSW or ACT) The Tasmanian Ambulance Service provides a free service to all Tasmanian residents, www.dhhs.tas.gov.au.
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How our health and wellbeing programs work Our health and wellbeing programs are designed to help you take care of your health in two very different ways. Health4life is designed to give support and assistance to people living with a chronic illness, and hospital at home is about making sure that when you’re unwell you have options available to help you get the best of care without having to check into a hospital. If you have hospital cover with us, both of these programs are available to you at absolutely no extra cost.
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Chronic illnesses include (but are not limited to) conditions such as asthma, diabetes, arthritis, depression, cancer and heart disease, and they affect up to 70% of all Australians. While most were once associated with ‘getting older’, today they are becoming more prevalent in all age groups and affecting men and women alike. Our health4life program is designed to help our members prevent or manage the effects of chronic illness in their lives.
Health4life: helping you stop chronic illness from controlling your life Chronic illnesses can often have profound effects on a person’s physical, emotional and mental wellbeing, making it difficult to carry on with daily routines and relationships. The positive news is that in many cases chronic illness can be ‘managed’ and even prevented by adopting specific behaviours and making lifestyle changes. But this can be difficult to do alone. We want to help you improve your health and enjoy a better quality of life. What’s it all about? If a doctor has diagnosed you with a chronic illness and/or multiple risk factors for developing a chronic illness, our health4life program can help you make the changes you need to improve your health and your quality of life.
Here’s how it works You’ll be assigned a case manager who will work with you throughout the course of the program. This will be either a six or 12-month period, depending on the severity and complexity of your condition.
The positive news is that in many cases chronic illness can be ‘managed’ and even prevented by adopting specific behaviours and making lifestyle changes.
Through a series of regular phone consultations, you’ll be provided with information about your condition and assistance in developing strategies to help manage it through positive health behaviours. You’ll be supported in setting goals and achieving them, with a focus on clearing away the barriers and roadblocks that may have prevented you from making a change for the better in the past. And, you’ll receive up-to-date advice, information and referrals to the additional support and services available to you. Interested in finding out more? The health4life program is available absolutely free to members with any hospital cover who have served the minimum two-month general services waiting period.
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The objective is to bring hospital care to you, so you can concentrate on your recovery.
Hospital at home: we bring the hospital home to you Bringing healthcare to people at home means they’re more likely to be comfortable and relaxed, which can improve recovery time and reduce the chances of secondary infections or relapse. And it’s great for morale, as people enjoy a much better quality of life in familiar surroundings with family and friends nearby. The objective is to bring hospital care to you, so you can concentrate on your recovery. What’s it all about? Hospital at home can help you get home from hospital faster, or avoid a hospitalisation altogether, by providing you with ‘hospital equivalent’ treatment and follow-up care in your own home. The program is available for all kinds of treatments and post-procedure support. It’s ideal for people undergoing regular medical treatments that could easily be provided at home or for those living in regional areas where a hospital stay can mean being far from home. Here’s how it works If your treating doctor agrees that hospital treatment at home is right for you, then in consultation with your doctor and the hospital, we’ll arrange for you to receive the services you need from registered practitioners who specialise in home-based care. During the program you might receive home visits from a range of different health service providers, including your doctor, nurses, physiotherapists and so on – all the
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same types of practitioners who would have looked after you in hospital. The type and frequency of visits you receive will depend on your condition and will be determined by your doctor. Your condition will be constantly assessed and, where necessary, your recovery or treatment plan will be changed to accommodate your needs. Interested in finding out more? The hospital at home program is available absolutely free to members with hospital cover who have served the applicable hospital waiting periods. If your doctor agrees that leaving hospital early (or avoiding it altogether) is appropriate for your situation, both you and your doctor will need to complete a referral and consent form.
Visit our website for more information For enrolment and consent forms visit our website and click on ‘rt members’, ‘health and wellbeing programs’, www.rthealthfund.com.au.
With an increasing number of people these days travelling overseas and becoming more comfortable with making purchases from overseas companies online, where does your health cover fit in?
VISIT
Confused about these?
u d.com.a ealthfun w w w.r th er y thing you for ev b ou t know a need to lth cover. a your he
Double-check before you double-click Health insurance legislation in Australia is pretty clear on this one. We’re not allowed to cover you for healthcare products, services or treatments you purchase overseas. We recommend you suspend your cover if you’re travelling overseas, since you can’t use it while you’re away (read more about suspending your cover on page 24). Similarly, we can’t cover you for products you purchase where the transaction takes place overseas, whether you’re overseas yourself or sitting in front of your computer at home. If it’s an approved product, which you have cover for, and you’re purchasing from an Australian company then you’re okay. But if the company you’re buying from is overseas and you are bringing the product into the country, you won’t be covered. If you’re not 100% sure, give us a quick call before you make your purchase.
This can be a confusing one, if you’re planning orthodontic treatment, please call our member care team before you get started so you understand how to get the best from your cover.
Orthodontic benefits that will give you a reason to smile rt provides a fantastic level of orthodontic benefits: up to $3,000 per person covered by your membership. To get the most from your orthodontic benefits it’s important that you understand how it works, and, especially if you’ve been an rt member for a while and claimed for orthodontics before, that there’s been a change in recent years. Here’s how it works: if you have our Extras Cover (not Fit + Healthy Extras), each person is covered up to a lifetime limit of $3,000 for orthodontics. The $3,000 can’t be claimed all at once though. You can claim 70% of your invoiced amount, up to a maximum of $1,000 per year, each year for three years. To get the best from your cover, ask your orthodontist to work out a payment plan with you rather than paying everything up front. If they invoice you each year for not less than $1,500 (70% of which is your annual limit of $1,000) then you’ll be able to claim back your full orthodontic entitlement. It’s important to understand, at least from the point of view of your health cover, there’s no benefit in paying the full amount up front; no matter how much you actually pay you can only claim back a maximum of $1,000 per year, and you can only receive your full $3,000 limit by paying in installments. If you pay up front you’ll only be able to make one claim for a maximum of $1,000. You can’t use that same upfront payment receipt to claim again in the second and third years.
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How claims work
This is the nuts and bolts of it all: you pay us money and we pay you money. Here’s how it works.
What you should know about extras cover claims First, make sure that the product, service or treatment you're planning to claim is covered. If you're not 100% certain, please check with us. Even if it’s something you’ve made a claim for before, if it’s been a year or two, give us a quick call to make sure nothing’s changed. We can let you know if you’re covered as well as exactly how much you’ll be getting back, so there'll be no surprises. Extras cover benefits are paid where: • the service or treatment is provided in Australia • in the case of product purchases, where the transaction takes place in Australia (that means you’re not covered for items you purchase in person, online, by phone or mail order overseas. There’s more about this on page 11.) • the provider or practitioner is recognised by rt • you’ve served the waiting periods, and • the treatment is necessary or appropriate to the condition.
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Did you know?
d claim You can now downloa and te, bsi we r forms from ou m for r you lete mp co n eve new r ou h on screen wit no more ‘editable’ claim form – lete, mp co ce handwriting! On ail, fax or em and n sca can you eipts. post your form and rec
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People are usually stunned when they realise that the cost of their hospital stay has run into thousands, if not tens of thousands, of dollars.
You have up to two years from the date you pay for the product, service or treatment to lodge your claim. So, if you have a box of old receipts lying around, have a rummage through for anything you might have forgotten about. If it's less than two years old, and you've had cover with us the whole time, send it in. When you're ready to make a claim, there are a couple of different ways you can go about it: Use your rt membership card to claim on the spot. If your practitioner uses either HICAPS or iSOFT, they'll swipe your card through a special terminal when you're about to pay your bill. The information gets sent directly to us, the claim is lodged right there on the spot and all you pay is any difference between the amount of your rt rebate and the cost of the treatment. It's brilliant – there's no paperwork to fill in and you aren't out of pocket while you wait for your claim to be paid.
Send us a claim form. If on-the-spot claiming isn't available, you do it the old fashioned way: fill in a claim form, send it in with your receipts or account, and we'll send you a cheque – or even better – drop the money straight into your bank account. You can send your claim forms and receipts by scanning and emailing, faxing or posting. Please remember that we'll keep whatever documentation you send to us, so if you’re sending in your originals it’s a good idea to keep a copy for your own records. You can download claim forms from our website, and even complete the form on screen, then print and send it. Visit www.rthealthfund.com.au and click on ‘rt members’ and then ‘handy forms’. What you should know about hospital cover claims Generally, when you go to hospital all of the hospital’s accommodation charges will be billed directly to us rather than to you, but you will receive accounts from the doctors who treat you. Claims for doctors’ fees are shared between Medicare and us: Medicare pays 75% of the Medicare Benefits Schedule (MBS) fee and we pay the remaining 25%. If your doctor has charged you an amount that is higher than the MBS fee, the additional amount will be an out-of-pocket expense that you’re responsible for paying unless he or she agreed in advance to participate in our Access Gap Cover – it gets a bit complicated from here on in … if you know you have a hospital stay coming up, please call our member care team so they can help you understand how it all works and how you might be able to minimise or even eliminate your out-of-pocket costs.
fee and will forward the account to us for payment of the remaining 25%. Alternatively, you can send the two-way claim form to us after you’ve been to Medicare, just attach a copy of your Medicare statement (that’s what they’ll give you after they’ve paid their portion of the claim) to your completed rt claim form. One of the unfortunate things about hospitals sending their bills directly to us is that you don’t get the chance to see what amazing value your hospital cover provides. People are usually stunned when they realise that the cost of their hospital stay has run into thousands, if not tens of thousands, of dollars. You’re welcome to call us following a hospital stay to find out exactly how much we paid on your behalf, and if the amount of your hospital claim is more than $3,000 you’ll receive a benefit statement from us showing how much we paid. If you’re interested in knowing more about just how much some common medical procedures actually cost, check out the article ‘How much stuff costs’ in our last issue of be well, visit www.rthealthfund.com.au/be_well.html. What you should know about ambulance cover claims If you are treated or transported by ambulance, you’ll receive an account from the ambulance service. All you need to do is complete the details requested on the back of the account, and send it in to us along with a completed rt claim form. Read more about ambulance cover and make sure you understand what you’re covered for on page 5.
Here’s how you make a claim for your doctors’ fees. If your doctor agreed to participate in our Access Gap Cover, send your accounts and a completed claim form directly to us. If your doctors didn’t use Access Gap Cover, take your accounts to Medicare and submit a ‘two-way’ claim form. Medicare will pay 75% of the MBS For a great explanation of how hospital cover and Access Gap Cover works, take a look at the article ‘Everything you’ve always wanted to know about hospital cover’ in our ‘industry insiders’ issue of be well. It’s available to read online or to download at www.rthealthfund.com.au/be_well.html.
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Did you know? We have contracts in place with 498 private hospitals Australia-wide, so no matter where you are in the country, we’ve got you covered. Find out if your preferred hospital is on our list by using the hospital search facility in our online member centre. Find out how below.
How our online member centre works Have you registered to use our online member centre yet? Setting yourself up to access your membership online is fast, easy and convenient. It means you can check and change information about your membership anytime you like. Plus, we’ve recently launched a new online service so you can check on the progress of your claims and see when they are received, logged and paid by us.
Once you’re logged in, here’s what you can do: – Partner authority – check and change
your ‘partner authority’ status. If it says ‘not granted’, it means your partner (if named on the membership) is not currently authorised to make changes, enquiries or claims. You can instantly change this to ‘granted’ giving your partner full authority over the membership. The only thing he or she won’t be able to do is cancel or suspend the membership, only the main member can do that. – Correspondence – download copies of your benefit statements showing what you’ve claimed and how much you got back. – Tax statements – download copies of your tax and lifetime health cover statements. – Cover details – check your membership details, including the name of your cover, who’s covered, how much you pay, the date you joined and the date you’re paid up until. – NEW Claims – view a history of all the claims you’ve made since 1 January 2009. You can search by the date, type of claim or who made the claim. Plus, check on the progress of your current claims, when they were received, where they’re up to in the process and when they are paid.
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– Provider search – look up which private
– –
– – –
hospitals have a contract with us (there’s 498 Australia-wide), which doctors participate in our Access Gap Cover, and find a registered extras provider. Contact details – check and change your address, telephone and email details. Bank account – check and change the details of the account you use to pay your contributions by direct debit, or the account you want us to pay your claims benefits into. Download forms – find all the forms you need here. Library – download detailed information about what you’re covered for, copies of our newsletters, annual report and more. Change password – create your own easy-to-remember password.
If you haven’t registered yet, visit www.rthealthfund.com.au and click on ‘member login’ at the very top of the screen. Grab your rt membership number (it’s on your membership card) and follow the prompts to register. Within a minute or two you’ll receive an email from us with your password, and you’re ready to go. It’s as easy as that.
Visit
.com.au ww w.rthealthfund er rtn pa to set up a authority for . your membership
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How government incentives work
Carrots and sticks: government programs you should know at least a little about The government runs a number of programs designed to encourage and support people in having private health cover – particularly hospital cover – which helps to ease some of the pressures on the public system. Some will save you money, and some could cost you money, so it’s worthwhile having at least a basic understanding of how they work.
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k get stuc ! Don’t load ing the carry ealth etime H
a Lif l paying hospita If you’re ading on your ve a h to o le e eligib le who Cover L b t h ig ou m e op cover, y d. This year, p ten e ding for v a o lo m e re th it to g t in rs y fi a en p e the have be us years will b ed under v o o continu ings rem -year rule. n eir load have th ment’s new te . w ern lo v e o b g e re o th Re ad m 3. You can pay 100% of your contribution and claim your rebate through your income tax return.
Everyone who is a Medicare cardholder and a member of a registered private health fund in Australia is eligible to receive the rebate.
Federal Government Rebate on Private Health Insurance
You might have heard of this referred to as the ‘30% rebate’. Basically, the government believes that having private health insurance is good for you – so good in fact that it’s prepared to pick up some of the tab and help make your cover that much more affordable. • if you are under the age of 65, the government will pay 30% of the cost of your health cover • if you are aged between 65 and 69, it’ll pay 35% of the cost • and if you are over 70, it’ll pay 40% Everyone who is a Medicare cardholder and a member of a registered private health fund in Australia is eligible to receive the rebate, no matter what their level of income or type of membership – the rebate applies to singles, couples, and families and to hospital, extras and ambulance cover. (Note though, it doesn’t apply to ambulance cover provided by a state government ambulance scheme, only to ambulance cover provided by health funds. Read more about ambulance cover on page 5.) There are three different ways you can receive your rebate, choose whichever suits you best: 1. You can take the rebate as a reduction in your contribution payment – we discount the cost of your health cover by the rebate you are entitled to, and you pay the difference. 2. You can pay 100% of your contribution and then claim your rebate as a refund through Medicare.
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Deciding which way to receive your rebate is something that is best discussed with your accountant, tax agent or financial adviser. You can change the way you receive your rebate anytime, so you’re not locked in to any decision you make. You don’t need to do anything in particular to receive your rebate, you would have completed all the details we needed as part of your application form when you first joined. If you’re interested in knowing more about the rebate, talk to us, or take a look at the Commonwealth Department of Health and Ageing website, www.health.gov.au.
Lifetime Health Cover
Lifetime Health Cover (LHC) was introduced in the year 2000. The idea is to give people an incentive to take out private hospital cover before the age of 31 (and to maintain it throughout their lifetime) by enabling those people to pay lower contributions than people who take out hospital cover later, or who allow their cover to lapse for long periods. Here’s how it works: if you join private hospital cover for the first time before the 1st of July immediately following your 31st birthday, then you’ll pay the ‘base rate’ offered by the health fund. For every year you are over 31 when you join, you add 2% to the base rate contribution. The amount you have to pay above the base rate is called your ‘Lifetime Health Cover Loading’. For example, if you take out private hospital cover for the first time when you are 40 you’ll pay 20% more than someone who takes it out at 30 (2% loading per year x 10 years = 20% loading). The maximum loading that anyone would ever have to pay is 70%, and that’s if they took out private hospital cover for the first time when they are 65. Anyone born on or before 1 July 1934 is exempt from the LHC
Loading; they can join hospital cover at anytime and only pay the base rate, the same as someone who joins when they are 30. Your certified age of entry (CAE) This is a flash-sounding term for the age at which you first take out private hospital cover. It is used to determine whether or not you will have to pay an LHC Loading. If you are under the age of 31 when you first take out hospital cover, your CAE will be ‘30’, whether or not you were actually 30 years old at the time you joined. All this number does is tell the various computer systems that need to talk to each other that you are not liable to pay a loading. If you are over the age of 31 when you first take out private hospital cover, your CAE will be your actual age at joining. Absent days You can lock in your LHC Loading (or no loading) by maintaining your hospital cover. Throughout your lifetime the government allows you to be without private hospital cover for a total of 1,094 days (three years, less one day) without incurring an LHC Loading. These are called ‘absent days’ and they only start to kick in after you’ve turned 31. But take note: even though you may not incur an LHC Loading during your absent days, you may need to serve waiting periods again when you next take out hospital cover. If you suspend your rt hospital cover, the period of suspension does not count toward your number of absent days. You can read more about suspending your cover on page 24. New 10-year loading limit The government realised that while Lifetime Health Cover was a good incentive for younger people, it was a disincentive for older people, because if you joined after you were 31 you would have a loading for the rest of your life. In 2007 a new rule came into effect, which says that your LHC Loading will be removed after you’ve held
Could you afford to keep your cover without the rebate?
In July each year, all health funds send a ‘tax statement’ to anyone who has held health cover with them in the previous financial year. The statement shows you exactly how much the government has paid toward the cost of your health cover. When you see the numbers in black and white, it’s easy to understand what a big impact the rebate has on how much you pay, and how much more expensive your health cover would be without it. As part of its 2009 budget, the government introduced a proposal to means test the rebate. Means testing would reduce and, in some cases, completely remove the rebate for many members. This proposal was blocked twice by the Senate prior to the recent election but that doesn’t mean it won’t be back for a third time! As a member of a private health fund and someone who benefits from the rebate, it’s important that you are aware of the impact proposals such as this could have on your personal or family budget, and even if you’ve never done anything like it before, pick up the phone or write a letter to your local member of parliament and tell them you value your rebate. There are around 11 million people in Australia with private health cover, and 11 million voices are difficult to ignore! For more information visit www.privatehealth.com.au/rebate.
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hospital cover continuously for ten years. This year, people who have held their hospital cover since the year 2000 will be the first to have their LHC Loading removed. If you have an LHC Loading on your rt hospital cover, we may have written to you to ask you to provide documents from any fund you were previously a member of in order to know when your ten years are up. Because the ten-year limit is a relatively recent change, health funds have not previously collected that information, so if you have a loading but you’ve been with us for less than ten years, we’ll need you to provide us with the information that tells us how long you’ve been paying your loading. If you are interested in reading more, take a look at the Commonwealth Department of Health and Ageing website, www.health.gov.au.
if you have a loading but you’ve been with us for less than ten years, we’ll need you to provide us with the information that tells us how long you’ve been paying your loading.
Medicare Levy Surcharge
Most of us pay a Medicare Levy through our income tax, it’s 1.5% of our taxable income and it’s automatically deducted from our pay packets. The Medicare Levy helps to fund the public health system. People who earn over certain amounts, and who don’t have private hospital cover (extras cover doesn’t count in this instance), may also have to pay an additional 1% levy, called the Medicare Levy Surcharge (MLS). If you don’t have private hospital cover and you earn more than $70,000 a year as a single person, or over $140,000 a year as a couple or family, you’ll probably have to pay the surcharge (the family income threshold increases by $1,500 for each dependant child after the first). To avoid paying the MLS, you must have private hospital cover, and if you choose a cover with an excess it must be a maximum excess of $500 per year for a single and $1,000 per year for couples and families. All of our hospital covers and excess options will exempt you from having to pay the MLS. If you have dependant children you must cover them; a person with a family cannot avoid the MLS by taking out cover as a single. If you are interested in reading more, visit the Australian Taxation Office website at www.ato.gov.au. There’s no getting around it, these government programs, incentives and disincentives can be confusing, so if you’d like to speak to a real person who can explain it all, please give our member care team a call on 1300 886 123.
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saved you a If your health cover has ected happened, for tune when the unexp ence that leaves eri exp or if you’ve had an ’ll never drop you in no doubt that you re it. Send sha to e lov ’d your cover, we your story to .au help@rthealthfund.com or mail to po box 1100 4. burwood north nsw 213
It’s that time of year again With summer just around the corner it’s that time of year when our minds turn to the end of another school year and Christmas travels. In the midst of this year’s silly season rush, don’t forget your health cover. We’ve got your kids covered If you’ve got kids covered under your membership aged between 21 and 25, we’ll be checking in with you at the beginning of 2011 to confirm their student status. Kids studying full-time at an approved Australian school, college or university can remain covered by your family membership up until the age of 25. In February each year we write to you to ask you to reconfirm their student status, or to let us know that they’re no longer eligible for student cover. So even if you have a child who’s finishing up his or her studies at the end of this year, you don’t need to do anything yet. They’ll remain fully covered over the Christmas season, and you’ll hear from us in February. If it’s time for them to come off your family cover and start out on their own, we’ll help you all make that transition in the New Year.
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Heading overseas this summer? Don’t forget to leave your health cover behind You can only use your private health cover while you are in Australia and for products and services you purchase here. If you’re not going to be in the country, you can’t use your health cover, so why keep paying for it? You can suspend your cover if you’re going overseas for a holiday or for work, from one month right up to a couple of years. It means you’re not paying for something you can’t use and you don’t have to drop your cover for an extended period while you’re away. There are a few simple terms and conditions, such as, you must suspend your cover before you leave the country, you can only suspend a whole membership (not just cover for one or two people on the membership), and you must have been an rt member for at least 12 months. Suspending your hospital cover does not count toward your number of ‘absent days’ (see page 21 for more about this) but, if you are away for an extended period, it may result in you having to pay the Medicare Levy Surcharge (MLS) (see page 23). Give our member care team a call when you’re planning your overseas break, and we’ll talk you through the details.
Keep in touch with this handy contact card call
1300 304 321 1300 886 123
to make a payment to talk to us email help@rthealthfund.com.au fax 1300 887 123 mail po box 1100 burwood north nsw 2134 visit 46 burwood road burwood nsw 2134 139 keira street wollongong nsw 2500 2/28 donald street hamilton nsw 2303 1/59a melbourne street south brisbane qld 4101 www.rthealthfund.com.au
Cut out and keep this card so you can phone, fax, email or visit us anytime – there’s one for your wallet and one for the fridge – or one for you and one for your partner. To make it nice and easy all our contact details are the same, no matter where you are in Australia.
1300 304 321 1300 886 123
call to make a payment to talk to us email help@rthealthfund.com.au fax 1300 887 123 mail po box 1100 burwood north nsw 2134 visit 46 burwood road burwood nsw 2134 139 keira street wollongong nsw 2500 2/28 donald street hamilton nsw 2303 1/59a melbourne street south brisbane qld 4101 www.rthealthfund.com.au
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Did you know research shows that people find health insurance confusing?
No kidding.
It’s confusing enough with all the rules, regulations, government programs, incentives and penalties. Then most health funds like to roll out dozens of different health covers – each one making it sound like you have the top level of cover available – wrapped in a mountain of fine print. We prefer to keep it simple with a small range of easy-tounderstand covers, and no itty-bitty fine print to confuse you. It seems to be an approach that works, too. The Australian Financial Review’s Smart Investor magazine has named rt among its ‘best value’ health funds in the country for three years running. (2008 + 2009 + 2010)