rt spring newsletter 09 by team scope

the magazine for rt health fund members

special edition

the ultimate guide to your health cover

be well.

cover, specifically: how it works, what you’re covered for, and how you can get the best value from your cover. Health insurance can be complicated, and we are constantly mindful of how we can make it easier for you to understand, and help you make the best decisions for yourself and your family. I hope this edition goes a long way toward answering some of your questions.

from the CEO

Earlier this year we completed our annual member satisfaction survey, and I’d like to again thank everyone who participated. Your feedback has provided us with invaluable insights into your experience as a member of rt health fund. As we always do, we’ve looked carefully at the results and identified a range of improvements that we can make to our products, service and interactions with you. This edition of be well has come about as a direct response to you telling us that you want to understand more about your health

I reported in the last edition that we had enjoyed a strong improvement in relation to overall member satisfaction – a result that we were very proud to have achieved. But that doesn’t mean there aren’t still improvements we can make. In addition to more information about what you’re able to claim and how your cover works, some of the things you told us you’d like to see us doing better included: making it easier for partners to make changes or claims on a membership (we’ve addressed this by adding a ‘partner authority’ to all new member applications, running our ‘partner authority’ blitz in the last edition of be well, and giving you the ability to grant a partner

authority yourself via our online service centre); there was also some feedback about the nuts and bolts of interacting with us: emails or faxes that go missing, or calls that go unreturned. We have streamlined and improved our operations to ensure that we reduce the margin of error. As an example, soon all incoming faxes will be automatically captured and delivered to recipients via email – no more lost fax pages. On the plus side, you told us that you were happy with the fast turnaround time on your enquiries and claims, that you find our staff to be friendly and helpful, that you appreciate us making sure your calls are answered by real people rather than machines, that you find our communications clear and easy to understand, and that you’re happy with the value for money your health cover provides. The reason we are so focused on understanding and responding to your feedback is that we are a not-for-profit fund – we exist solely for the benefit of our members. There are no shareholders

the magazine for rt health fund members | special edition

1 to keep happy with dividends, and there’s no corporate head office monitoring our profitability. It’s members and their satisfaction with the fund that is most important to us. Interestingly, it is estimated that by the end of this year over 70% of Australians with private health cover will be covered by ‘for profit’ funds. It’s a significant change to the health insurance landscape, which up until not so long ago was almost entirely not-for-profit. We know this is an important issue for our members and we are staunchly dedicated to retaining our not-for-profit status. It would be remiss of me to not briefly mention some of the issues relating to health insurance that you may have heard about in the media recently. In the ‘nothing to report yet’ category there is the issue of the introduction of a ‘sliding scale’ to means test the 30% rebate, and increases to the Medicare Levy Surcharge. While these initiatives have been proposed by the government, the bills haven’t yet passed through the senate, so they remain, at least for

now, government proposals. The other significant development you may have heard something about is the National Health and Hospitals Reform Commission Report (otherwise known as the ‘Bennett Report’), which has made some 123 recommendations for healthcare reform in Australia, including the introduction of 100% cover for outpatient medical services, the introduction of a Denticare program (‘universal’ cover for basic dental), and a raft of changes in management and structure designed to address the immense challenges facing our healthcare system. We’ll report back to you on these developments as they move closer to becoming realities rather than just recommendations. Finally, we are approaching yet another AGM and in this edition we are calling for nominations from members interested in standing for a position on our board of directors. You will notice that we have implemented new policies and constitutional changes in response to our regulatory obligations to ensure that only

suitably qualified directors are appointed. We look forward to hearing from you if you believe you can make a significant contribution to the governance of the fund in a role on our board, and otherwise hope to see you at our AGM on 18 November this year. Until next time, take care and be well.

Glenn Campbell Chief Executive Officer

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contents

Editor Simone Tregeagle Design team scope design teamscope.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.

3 – getting the best value from your health cover – the inside scoop If you want to get the most from your health cover, it helps to have a little inside information and the scoop on a few ‘tricks of the trade’. 6 – everything you’ve always wanted to know about hospital cover Have you ever wondered exactly how your hospital cover works? This handy guide covers the basics and lets you know where to go to find out more. 10 – getting the kids covered Everything you need to know about how and when to start covering your little ones, as well as what to do when they’re not so little anymore.

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13 – when it comes to helping our members ‘be well, get well and stay well’, we’re putting our money where our mouth is Our top priority is making sure that you have everything you need to be well get well and stay well – and these new programs do just that. 16 – getting to the nuts and bolts of it all We’re working hard to make sure that you can find all the information you need quickly and easily.

17 – making claims fast and easy Take a look at how we’re making claiming faster and easier with electronic claiming and direct deposit options. 19 – Smart Investor magazine spills the beans … again! It’s official! Smart Investor has named us one of Australia’s best-value health funds for the second year running. 20 – welcome to rt, 24/7 We know how precious your time is, so we’re working toward making it easier for you to manage your health cover online whenever it suits you. 22 – would you like to play a key role in the governance of your health fund? It’s that time of year again – with the AGM fast approaching we’re calling for nominations for a position on the rt board of directors. 24 – we’re who you call when you need a helping hand The Families Foundation is an independent charity run by rt staff on a volunteer basis – and here’s why they think it’s important enough to give up their free time to do it.

the magazine for rt health fund members | special edition

getting the best value from your health cover – the inside scoop

“ If you’re going overseas for a holiday or for work, from one month right up to a couple of years, you can suspend your cover.”

As easy as we try to make it, the fact is that health insurance is just plain complicated. With all the rules, regulations, programs and schemes in play, it helps to have a friend in the business – and luckily for you, you do! Here’s the ‘inside scoop’ from our in-house experts on how to get the best value from your health cover. Going solo? The ‘formula’ for health cover pricing is basically the same across the entire health insurance industry: cover for a single person costs half as much as cover for a family. A ‘family’ membership includes two adult partners and their kids (however many there are), which is brilliant value for two-parent families, but these days families don’t always look like that. We’ve introduced a new category with our Private Hospital Cover for single parent families. It includes one adult and all the kids at just one-anda-half times the cost of a single cover, and helps make keeping the family protected with top-level hospital cover just that little bit easier. 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? If you’re going overseas for a holiday or for work, from one month right up to a couple of years, you can suspend your cover. It means you’re not paying for health cover you can’t use and you don’t have to drop your cover for an extended period while you’re away. Beat the price rise by paying in advance Getting permission to increase the cost of health cover is a highly regulated process for all health funds. In very basic terms, the ‘bean counters’ calculate how many members we have, the cost of claims made in the last couple of years, how many claims are likely in the coming year, the current cost of healthcare services, and presto! – they figure out how much each member should be contributing to ensure that all those claims can be paid. Once that’s done, the Commonwealth Department of Health and Ageing must approve any application for an increase. Because we operate under these very

be well. 4 “ We’ve recently joined forces with OPSM, OPSM Direct, Laubman & Pank, Budget Eyewear and Vision Plus-WA to offer our members a huge 23% discount on frames and lenses, and a 15% discount on contact lenses.”

stringent conditions, and because we’re not-forprofit, we put a lot of effort into keeping our pricing as lean as possible. So rest assured that if we write to tell you about an increase, we’ve spent months making sure it’s the bare minimum. And while you can’t avoid a price rise forever, you can beat it for up to a year by paying your contributions in advance between the time we write to advise you that an increase is coming, and the date that it comes into effect (which is usually 1 April each year). During this window of time you can pay any amount, up to a whole year in advance, at the current rate. A New Year’s resolution to keep At midnight on 31 December each year all your benefit limits expire, and from 1 January your annual limits re-set. You can’t ‘roll over’ any unused limits from year to year, so make a New Year’s resolution to time your claiming carefully and make sure you’re getting the most back from your cover every year. Remember the two-year limit You can claim the cost of products, services and treatments right up to two years from the date of service – so clean out your records and if you find any unclaimed costs that are less than two years old, send them in and we’ll take care of them!

Go the whole hog If you just have Extras Cover with us (without hospital cover), you’ll have some restrictions on your general dental and specialist therapies benefits (physio, chiro and so on) that don’t apply when you have both hospital and extras together. To get the maximum from your Extras Cover add on a hospital cover. Get to know our free member programs We’re in the business of helping people take care of their health. And we think that means doing more than just paying claims. Our health management programs are designed to help you to be well, get well and stay well – and they’re available to you as part of your hospital cover, absolutely free. Find out more on pages 13-15. Announcing new discounts on glasses We’ve recently joined forces with OPSM, OPSM Direct, Laubman & Pank, Budget Eyewear and Vision Plus-WA to offer our members a huge 23% discount on frames and lenses, and a 15% discount on contact lenses. Just let the store staff know that you’re an rt member at the time of purchase, and they’ll offer you the discount right there on the spot.

the magazine for rt health fund members | special edition

5 Let’s talk If you’re having trouble keeping your health cover payments up – or if you’re considering leaving us because you think you’ve found a better offer elsewhere – let’s talk. There are options we can explore to help you keep your cover going, and if you’re thinking of switching, why not let us help you make an informed decision? We know our health covers are among the best around (heck, Smart Investor magazine has named us one of the best-value health funds in the country two years in a row!), so if you’re looking at a better deal elsewhere, we’d love to know about it. We can help you work through the health insurance mumbo jumbo so you can be sure you’re making the best decision.

For more information on any of these handy insider tips, call our member care team on 1300 886 123. Please remember, this is summary information and there may be other details you should know or conditions that apply, so please make sure you have all the information before making any changes to your cover.

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everything you’ve always wanted to know about hospital cover How hospital cover actually works is a bit tricky, and it’s only made more complicated by the fact that you’re usually stressed or worried when you really need to understand it the most. But describing exactly how hospital cover works in the space available here is kind of like trying to fit an elephant into a phone booth! So these are the highlights, and hopefully they’ll answer at least some of your questions.

“ When you are admitted to hospital, there are three places that charges will come from: the hospital, your doctors and any prostheses or pharmaceuticals.”

What does your hospital cover pay for? When you are admitted to hospital, there are three places that charges will come from: there’s the hospital itself; the doctors and other healthcare professionals who treat you; and the cost of any prostheses or pharmaceuticals you’re given. Let’s take a look at each of these a little more closely. Hospitals – The hospital charges you for the use of its facilities: your room; the use of the operating theatre, labour ward, ICU; your meals; and so on. How much you’ll be covered for depends on whether you go to a hospital that we have a contract with, and which of our hospital covers you have. We have contracts in place with most private hospitals and day surgeries in Australia. We’re part of an alliance of health funds that negotiates prices with hospitals and we have more contracts in

place than some of the biggest health funds in the country. You can find a comprehensive list of our contracted hospitals on our website – visit www.rthealthfund.com.au. Assuming that you have our Private Hospital Cover, and you go to a contracted hospital, you won’t have to pay a cent for the use of the standard hospital facilities (unless you’ve chosen to take your cover with an excess, in which case you’ll pay the excess and then we’ll pick up the rest). The only things that aren’t paid for are some of life’s little luxuries, like television hire and the daily newspaper. If you have our Fit + Healthy Cover there will be some things that are not included. If you have our Basic Hospital Cover, you’ll only receive a very low level benefit (the ’default benefit’) toward the cost of your private hospital accommodation. You will have substantial out-of-pocket costs if you choose to be treated in a private hospital with our Basic Hospital Cover.

the magazine for rt health fund members | special edition

7 One thing to remember about hospital cover is that you must be admitted to the hospital as an inpatient before your cover comes into play. If you are treated in the emergency ward of a private hospital, or as an outpatient, by law your hospital cover can’t pay the costs.

If you have Fit + Healthy or Basic Hospital Cover, please make sure you understand the exclusions and restrictions that apply, and that you’re comfortable with these. While you can upgrade at any time, remember that you’ll have a waiting period of up to a year before your full top-level hospital benefits kick in. If you have any doubts at all about whether you’ve got the right level of cover for your age and stage of life, give us a quick call for a chat. It could be the best ten minutes you’ll spend all year. Doctors and other healthcare professionals – This is where out-of-pocket costs usually come from, and here’s why: in Australia we have what’s called the Medicare Benefits Schedule (MBS). It’s a list of every medical treatment and procedure that the government considers ‘medically necessary’, and everything on the list has been allocated an item number and a set fee, called the MBS fee (you can see a full list of MBS items and fees at www9.health.gov.au/mbs/search.cfm). Think of the MBS fee as being a bit like the ‘recommended retail price’ (RRP) you see on merchandise in stores. The RRP is just that – a recommendation – the store can charge whatever it likes for the goods, and the

MBS fee works the same way. Doctors can charge any amount they like over and above the MBS fee, and this is where you can be left holding the bill because Medicare reimburses you for 75% of the MBS fee and your private hospital cover is only allowed to pay the remaining 25%. Anything above the MBS fee, as you can see, isn’t covered by anyone. For outpatient medical services, like visits to your GP or specialist, Medicare covers 85% of the MBS fee, but your health insurance can’t pay a benefit at all, so the remaining 15% (and anything above that) is left to you. When a doctor bulk bills, they choose to set their fee at 85% of the MBS fee, which is covered by Medicare, and that’s why it doesn’t cost you a cent to see them. Access Gap Cover – the trick to managing your out-of-pocket medical costs While it doesn’t have a very descriptive name, Access Gap Cover is the government program that helps people reduce or eliminate out-of-pocket medical expenses when they receive treatment in hospital. Basically, it allows health funds to pay a

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“ Visit our website for a handy checklist of questions to ask your doctor, the hospital and us to ensure you’re fully informed about the costs if you have a hospital stay coming up.”

higher rebate than the amount specified by the MBS fee, if the doctor agrees. It works in one of two ways: 1. Your doctor may agree to a set charge based on a special Access Gap Cover schedule of fees which is higher than the MBS fee. In this case, your health cover and Medicare will pay the entire amount and there will be no ‘gap’, so you’ll have no out-of-pocket costs. 2. Your doctor may still choose to charge an amount higher than the Access Gap Cover fee, but will tell you in advance exactly how much, so you’ll know up front what your out-of-pocket costs will be. Doctors are not required to participate in Access Gap Cover, and will usually decide whether they will on a case-by-case basis, so it’s up to you to discuss this option with your doctor. You need to have the same conversation with each doctor who will treat you in hospital, including (but not limited to) your surgeon, anaesthetist, pathologist and so on. Visit our website for a handy checklist of questions to ask your doctor, the hospital and us to ensure you’re fully informed about the costs if you have a hospital stay coming up. You can also look up a list of doctors who participate in our Access Gap Cover

on our website – visit www.rthealthfund.com.au – if you don’t find your doctor on the list, ask him or her anyway. Pharmaceuticals and prostheses – Basically, your hospital cover pays for prostheses according to the federal government prostheses list, and pharmaceuticals that aren’t already covered by the Pharmaceutical Benefits Scheme (PBS), but only if they’re considered ‘medically necessary’ and are directly related to the treatment or procedure you’re having in hospital. There are some that you’ll be covered 100% for, and others that will leave you with some out-of-pocket costs. To be on the safe side, ask your doctor for the item number of the prostheses you’re going to be receiving, or the name of the pharmaceuticals, and give us a call to find out how much you can expect to be covered for. Remember, when the time comes that you need to use your hospital cover, you don’t have to go it alone. Our member care team is here to help and happy to take you through everything you need to know to make the best decisions for yourself and your family. Call us any time on 1300 886 123.

the magazine for rt health fund members | special edition

Just because you have private hospital cover, should you use it? Private hospital cover gives you access to options – the doctor of your choice, the hospital of your choice, the timing of your choice – which is all a whole lot better than being stuck on a public hospital waiting list and having to be treated by whoever is allocated your case. But sometimes you don’t get to have a say in these things, whether you have private cover or not. If you’re taken to hospital because of an accident or emergency, chances are you’ll go to the nearest public hospital with an emergency department, where you’ll be treated as a public patient under Medicare. If the staff decide that you need to be admitted to the hospital, you’ll be asked if you have private hospital cover. If you say ‘yes’, you will be admitted as a private patient and both the hospital and your doctors will start billing you as a private patient, which may result in out-of-pocket costs that you weren’t prepared for.

s o her e ’s the thing –

just because you have private hospital cover doesn’t mean you have to use it. You can tell the hospital that you have private cover but that you choose instead to be admitted as a public patient, or you can simply not tell them about your cover at all. As a public patient you’ll be treated under Medicare, and will see the doctors that are available at the time. You can choose not to use your private cover anytime you need to go to hospital – emergency or not. Health cover is all about having choices – and if you’ve got the cover then you’ve got the power to make your own choices, whatever the circumstances.

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getting the kids covered Kids and health cover can both be unbelievably confusing in their own right, but when you combine the two, even the most experienced parents can wind up scratching their heads. Here’s the lowdown on combining your kids and your health cover!

“ Private Hospital Cover gives you your choice of doctor and hospital for a hospital birth, plus, you’ll be eligible to participate in our pregnancy, birth + beyond support program at absolutely no cost.”

Having a baby? From our point of view, the best possible cover you can have if you’re having a baby is a combined Private Hospital + Extras Cover. Your Extras Cover will assist with the cost of your antenatal classes (claimed under ‘physiotherapy’), and if you choose to have a homebirth, there’s cover for your midwife visits and the delivery. Private Hospital Cover gives you your choice of doctor and hospital for a hospital birth, plus, you’ll be eligible to participate in our pregnancy, birth + beyond support program at absolutely no cost (read more about that on page 13). You’ll need to have held the hospital cover for a minimum of 12 months before your baby is born in order to get past the waiting period, and you should make sure you’re on the right type of cover (either a family or single parent family cover) at least two months before your baby is due to make sure he or she is fully covered from birth – more about that later. If you have our Fit + Healthy Cover, you’re not covered at all for anything to do with pregnancy or childbirth,

and if you have our Basic Hospital Cover, you are covered for the doctor of your choice, but only in a public hospital. If you are at all concerned that you don’t have the right level of cover, whether you’re planning a baby or want to make sure you’re covered ‘just in case’, please give our member care team a call for a chat on 1300 886 123.

What about all those doctors’ appointments? We recently received a letter from a member asking why visits to the obstetrician aren’t covered. There’s a very simple reason for it – hospital cover only applies to medical treatment you receive as an inpatient in hospital (that is, when you are admitted to the hospital). Health funds are not allowed to cover outpatient medical treatment, such as visits to a GP or specialist, which is why we can pay for the costs once you’re admitted to the hospital for the birth, but can’t cover the cost of the doctor’s visits during your pregnancy.

the magazine for rt health fund members | special edition

“ Babies aren’t actually admitted to hospital at the time of their birth (mum is, but baby is not) unless the baby is born with a medical condition that requires treatment.”

Do you need to upgrade? Babies aren’t actually admitted to hospital at the time of their birth (mum is, but baby is not) unless the baby is born with a medical condition that requires treatment. To make sure that your baby will be fully covered from the time of birth you may need to upgrade your level of cover.

And baby makes … four? If you’re having a multiple birth, the first baby is not admitted to hospital (unless he or she requires medical treatment) but each subsequent baby is automatically admitted and will be charged for accommodation, so it’s important that you upgrade your membership (if necessary) before the birth to ensure that each baby is covered.

If you have a single membership

You’ll need to upgrade to a family or single parent family membership at least two months before your baby’s birth.

If you have a couples membership

You’ll need to upgrade to a family membership at least two months before your baby’s birth – there is no additional charge to change from a couples to a family membership.

If you have a family or single parent family membership

If you have served your 12-month obstetric waiting period, your new baby will be covered immediately from birth. All you need to do is drop us a line before he or she is three months old so that we can add him or her to your membership without any waiting periods applying. There is no additional charge to add your new baby to your cover.

If you wait until after the birth to upgrade your cover, your baby may have to serve waiting periods, which means that he or she will not be covered for immediate treatment.

be well. 12 Help with your pregnancy, birth + beyond Having a baby is an exciting time, but when you suddenly realise how much you don’t know it can get a bit daunting. That’s why we offer our members the pregnancy, birth + beyond program. It’s all about supporting parentsto-be throughout their pregnancy and right up until baby’s first birthday with personalised midwife support, information, references to community services and much more. Read more on page 13.

Adding older kids Dependant children are defined as the ‘natural, adopted or foster children of either or both adults on the membership’. You can add additional dependant children to a family or single parent family membership at any time, and at absolutely no cost, but if you have a single membership you’ll need to upgrade to cover the kids. If you’re planning on becoming a newly combined family, all you need to do is contact us with the kids’ details to get them covered. If they’ve never been covered by a health fund before, they may have waiting periods to serve. Dependant children can remain covered by your membership right up until their 21st birthday, provided that they are not married or living in a de facto relationship. 21 the key to the door, and their own health cover Once they turn 21, the kids are no longer considered (by us at least) to be dependant children, but they can remain on your family health cover until their 25th birthday if they are studying full-time at an approved Australian school, college or university, and are not married or living in a de facto relationship – this is called student dependant cover. Once they turn 25 though, it’s time for them to take out their own health cover – and the good news is that because you’re an rt member, the kids can automatically join in their own right.

School accident cover Did you know our Extras Cover includes benefits for treatment needed as the result of a school accident? It covers your kids for essential health care due to an injury sustained at school, while participating in a school activity or while travelling to or from school. The range of treatments and services that can be claimed is extensive and each case is considered individually, so contact us to discuss your circumstances. This benefit is intended for use where the school has no other type of insurance to cover the costs of the treatment needed.

If there’s anything else you need to know about kids and health cover, feel free to give our member care team a call, they’re there to help,

1300 886 123.

the magazine for rt health fund members | special edition

when it comes to helping our members we’re putting our money where our mouth is We’re in the business of health. And for us, that means more than just paying claims and helping cover the costs when our members are unwell or injured. We like to do as much as we can to make sure people don’t find themselves in that boat in the first place. That’s why we’ve introduced three life-changing programs as part of our hospital covers – all available at absolutely no extra cost.

“ You’ll have unlimited access to experienced midwives via email and telephone, giving you the chance to discuss the progress of your pregnancy … ”

• Y ou’ll have unlimited access to experienced midwives via email and telephone, giving you the chance to discuss the progress of your pregnancy, ask about any health issues and concerns you have, and for all the invaluable advice you’ll need after your baby arrives. • You’ll have free access to our pregnancy website, which will help you track the progress of your baby’s development week by week, and provide you with additional information about having a Here’s how it works: healthy pregnancy and caring for your new baby. • You’ll be introduced to a midwife who will follow • You’ll receive a series of helpful and practical books your pregnancy, offering information, support and on healthy pregnancies, babies and toddlers. references to community services through a series • And, you’ll even receive a special gift upon of one-on-one telephone consultations scheduled to the birth of your baby. take place both before and after your baby arrives. Pregnancy, birth + beyond is available to members with our Private Hospital Cover. Pregnancy, birth + beyond Being armed with practical and relevant information, and having access to expert midwives whenever you need them will give you the peace of mind of knowing that there’s help at hand with any questions or issues that arise during your pregnancy. And because this program extends until baby’s first birthday, it also helps you navigate the changes and challenges that come with adjusting to a new baby.

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“ If it is possible to provide the treatments you need in your home, and if you, your doctor and the hospital agree that it is appropriate for you, then we can help.”

Hospital at home Our hospital at home program can help you to 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. If it is possible to provide the treatments you need in your home, and if you, your doctor and the hospital agree that it is appropriate for you, then we can help. Our objective is to bring the hospital to you, so you can concentrate on your recovery in the comfort and privacy of your own home. Here’s how it works: If your treating doctor agrees that hospital treatment at home is right for you, then our health services division will work in consultation with your doctor and hospital, arranging for you to receive all the services you need. All the people involved in your home treatment and recovery planning will be

experienced health service providers with specialist knowledge of home-based hospital care, and the number and type of visits you’ll receive will be determined by your doctor. Hospital at home is available to members with any level of hospital cover. Health4life Chronic diseases include (but are not limited to) conditions such as asthma, diabetes, arthritis, depression, cancer and heart disease. And they 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 diseases can be ‘managed’, and sometimes even prevented, by adopting specific behaviours and making lifestyle changes. But we know this can be difficult to do alone. Our heatlh4life program is designed to support you in improving your health so you can enjoy a better quality of life.

the magazine for rt health fund members | special edition

“ Our heatlh4life program is designed to support you in improving your health so you can enjoy a better quality of life.”

Here’s how it works: • You’ll be assigned a case manager who will work with you over the course of six or 12 months, depending on the severity and complexity of your condition. • Through a series of regular phone consultations, you’ll receive information about your condition and assistance in developing strategies to help manage it through positive health behaviours. To help you to turn these new behaviours into strong and lasting habits, you’ll get the support you need to set goals and achieve them, with a focus on clearing away the barriers that may have prevented you from making a change for the better in the past. • Plus, you’ll receive up-to-date advice, information and referrals to the additional support and services available to you. Health4life is available to members with any level of hospital cover.

Waiting periods apply for each of these programs, and there are a few terms and conditions, but they’re not too arduous – after all, it’s in our best interests to help you be well, get well and stay well. We want to make it as easy as possible for you to access these programs, but our most important consideration is making sure that they are going to be beneficial for you.

For more information, enrolment and referral forms call our member care team on

1300 886 123

or visit our website, www.rthealthfund.com.au.

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getting to the nuts and bolts of it all At the end of the day, we understand there’s really two things that are most important to our members – knowing what you’re covered for and how much you’ll get back. And we’re working on making that easier for you to keep track of.

“ What we are doing is working on ways to help you get more information at your fingertips.”

With car or house insurance, there are a couple of things you’re insuring against and you generally know exactly how much you’ll get back if you need to make a claim. When it comes to health insurance though, it’s a very different story. There are literally tens of thousands of different products, services and treatments that you could claim, which makes helping you keep up to date with exactly what you’re covered for nigh on impossible. What we are doing is working on ways to help you get more information at your fingertips. • W e’ve just launched new detailed product tables for each of our covers. They are a comprehensive list of the main benefit categories you’re entitled to claim, and tell you what your annual limits are and how much you’ll get back (where possible). You can view and download these from the library in the member service area of our website (read more on page 20 if you aren’t already registered to access your health cover online). If you’re not an online kind of person, give us a call and we’ll send some out to you. • We’ve also just launched the most detailed information we’ve ever had available for members about how your health cover works, it’s called the A to Z of rt, and you can have a look around it online

at www.rthealthfund.com.au/atozofrt. Again, if you can’t get online, let us know and we’ll send you a copy. • We’re working on new online functionality that will make it possible for you to look up exactly what you’re covered for, how much you’ve claimed and how much you’ve got left before you’ve used up all your limits. • We’re also working on making a detailed list of dental item numbers and benefits available, so you can get a quote from your dentist and then jump online with your dental item numbers to find out how much you’ll get back. And then there’s the old-fashioned way – give us a call, let us know what product, service or treatment you’re planning and we’ll let you know how much you’ll get back. Given the nature of health insurance and the enormous array of different health-related products, services and treatments available, it’s still likely to be a while before we can offer you a fully automated option, but hopefully some of the solutions we have in place now – together with those that we’re working on – will help you feel more like you’re getting the best from your health cover.

the magazine for rt health fund members | special edition

making claims fast and easy Some members have told us that they’re a little confused about how the claiming process works – or that they’re unsure about electronic claiming: how it works, where you can use it and so on. So here, in a nutshell, are the ins and outs of making claims.

“ You can nominate a bank account for claims payments to be made into when you complete your claim form, or online anytime through the online service centre.”

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 ask us. We can also let you know how much you’re likely to get back too, so there’ll be no surprises. 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 for on-thespot claiming with HICAPS or iSOFT – If your practitioner offers this service, they’ll swipe your card through a special terminal when you’re about to pay your bill. The information gets sent directly to us, and the claim is lodged right there on the spot. All you pay is any difference between the amount of your rt rebate and the cost of the treatment.

Electronic claiming is often available through dentists, optometrists, physiotherapists, chiropractors, osteopaths, podiatrists, speech pathologists, occupational therapists, psychologists, dietitians, remedial massage therapists, naturopaths and acupuncturists. Ask your practitioner when you make your appointment if they offer electronic claiming, and visit the HICAPS and iSOFT websites for more information, www.hicaps.com.au and www.ibahealth.com. Send us a claim form – If on-the-spot claiming is not available, then you do it the old fashioned way: fill in a claim form, send us your receipts or account, and we’ll send you a cheque – or even better – drop the money straight into your bank account. You can nominate a bank account for claims payments to be made into when you complete your claim form, or online anytime through the online service centre.

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give us a call if you would like to find out how much your hospital cover saved you after your hospital stay.

1300 886 123

“ People are usually stunned to know that the cost of their hospital stay has run to thousands, if not tens of thousands, of dollars.”

Hospital Claims Generally, all of the hospital’s charges will be billed directly to us, but you will receive accounts from the doctor or doctors who treat you. If your doctor agreed to participate in our Access Gap Cover, send your accounts and a completed claim form directly to us. If they didn’t use Access Gap Cover, take your accounts to Medicare and submit a ‘two-way’ claim form. Medicare will pay 75% of the Medicare Benefits Schedule (MBS) 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. If your doctor has charged 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 (read more about how Access Gap Cover

works on page 7). Please note that we retain any original documents, so it’s a good idea to keep a copy for your records before sending in your claim. One of the unfortunate things about the hospital sending the 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 to know that the cost of their hospital stay has run to thousands, if not tens of thousands, of dollars. You’re welcome to call us following a hospital stay to find out exactly how much was paid on your behalf. If the hospital costs exceed $5,000 we’ll send you a benefit statement to let you know how much we paid.

the magazine for rt health fund members | special edition

Smart Investor magazine spills the beans … again! We’ve been named one of the country’s best-value health funds by the Australian Financial Review Smart Investor magazine for the second year running. Out of every product offered by every health fund in the country, they reckon our Private Hospital + Extras Cover is one of the best around.

“ Once you’re a member, you’re entitled to remain a member for life, whether you keep working in the transport or electricity industries or not.”

With results like this, the news about rt is spreading fast and one of the questions we get asked most often is, “Who can join?” And for those people who are already members, “Do I have to leave the fund if I change jobs?” Well, there’s good news on both fronts. As the industry fund for people who work in transport and electricity, we’re open to all comers: public or private sector, land, sea or air transportation and electricity industry. And the good news is that if you’re a member, your family can join too. So if you’re excited about what a great deal you’re getting, feel free to tell your mum, dad, kids, brothers and sisters about us – they’re all welcome on board, thanks to your membership. Once you’re a member, you’re entitled to remain a member for life, whether you keep working in the transport or electricity industries or not.

Do you think the people you work with would like to know more about us? If you work for a transport or electricity industry organisation, or a company that provides contract services to the transport or electricity industries, everyone in your workplace may be eligible to join. If you’d like one of our corporate relationship managers to have a chat about what we can do for your company, we’d love to hear from you.

drop a noteelato haye, Rebecca D

and she’ll be in touch to talk you through what rt can do for your workplace, rebeccad@rthealthfund.com.au.

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welcome to rt, 24/7 Have you registered to use our online service centre yet? Setting yourself up to access your membership online is fast and easy, and means you can check and change information about your membership anytime you like. To register, visit our website and click on ‘member log in’ at the very top of the screen. If you’re visiting for the first time, 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. Here’s what you’ll find inside …

B C D E F G H I J A

guide on next page

the magazine for rt health fund members | special edition

e n li on w e n g n i c u od tr n i we’re all the time, functions

coming soon will be new tools that make it possible for you to: look up your claims and remaining benefit limits for the year; nominate a preference to receive certain items from us by email rather than mail; and make low-value extras claims online.

Your membership summary page (A) Partner authority – If you have a partner or spouse on your membership and your partner authority says ‘not granted’ it means your partner has not been authorised to request information, make changes, sign claim forms and so on. Changing this field to ‘granted’ will instantly give them all the same rights to the membership that the primary member has (with the exception of cancelling the membership). (B) Correspondence – At the moment, you’ll find your benefit statements in here, so you can see how much your health cover has paid on your behalf. In future, you’ll be able to access a whole range of different correspondence, which means no more misplaced letters. (C) Tax statements – View, download or print copies of your tax or lifetime health cover statements. (D) Cover details – View a summary of your membership – the name of your cover, who’s covered, how much you pay, the date you joined and the date you’re paid up to.

(E) Provider search – Look up which hospitals have a contract with us, which doctors participate in our Access Gap Cover and find a registered extras provider. (F ) Contact details – View, check and change your address, telephone or email details. (G) Bank account details – View, check and change your bank account details for the account you pay your contributions through if you pay by direct debit, or the account that you want us to pay your claim benefits into. (H) Download forms – Find all the forms you need here. (I) Visit the library – Download detailed cover tables, copies of our constitution, annual report, newsletters and more. (J) Change password – Create your own password to access the site here.

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would you like to play a key role in the governance of your health fund? This year there is one Board position to be contested in the lead up to our 120th Annual General Meeting on 18 November 2009. We are now calling for nominations from suitably qualified and eligible candidates for this position.

“ Any member can nominate for a position on the rt board, provided you meet the eligibility criteria which includes having been a financial member of the fund for a minimum of 24 months.”

Being a board member is a rewarding experience but one that comes with great responsibilities and requires a commitment to being actively involved in the corporate governance of the fund. While the board delegates day-to-day management to the CEO and senior management team, it remains responsible for appointing, reviewing and overseeing the performance of that team. Under the Board’s ‘Fit and Proper’ policy, Board members must bring a range of financial and commercial skills and experience to the role, including: • the level of skill that a ‘reasonable person’ would be expected to bring to the position (the law holds directors to that standard) • the ability to think strategically, financially, commercially, legally, ethically, short term and long term • strong commercial experience commensurate with the job

• t he ability to complement the overall mix of skills required for the board • qualifications and experience in one or more of law, general commercial, health economics, marketing, finance/accounting Nominees must also meet the requirements of PHIAC and ASIC, must sign the ‘Fit and Proper Person’ declaration and pass the following: • police check • bankruptcy check • eligibility declaration • public search of APRA database of disqualified persons • ASIC disqualified person register check Any member can nominate for a position on the rt board, provided you meet the eligibility criteria which includes having been a financial member of the fund for a minimum of 24 months.

the magazine for rt health fund members | special edition

23 “ Please note, nominations close at 4.30pm on Wednesday 14 October 2009.”

If you plan on nominating for a position on the Board, you should also ensure you are fully aware of all the legal responsibilities and potential liabilities of Board members as set down by the Corporations Act 2001 and the Australian Securities and Investments Commission Act 2001. Nomination forms and details about eligibility and the electoral process are available online at www.rthealthfund.com.au/board.html or by contacting our member care team on 1300 886 123. Please note that nominations close at 4.30pm on Wednesday 14 October 2009. You might not be interested in a position on the Board yourself, but you can have your say about who your Board members are. On 21 October a pack will be sent to all current financial members containing an invitation to the Annual General Meeting (which will be held at the Mercure Hotel, Broadway, Sydney, on Wednesday 18 November 2009) and everything you need to cast your vote in the board elections.

if you wish to receive a copy of our annual report in the mail. In the past two years we have asked you to let us know if you’d rather not receive a printed copy of our annual report in the mail. This year, we’re making a significant change to that process which we believe will bring responsible savings to the organisation. We’re asking you to let us know if you do want to receive a printed copy of our annual report this year. If you tick ‘yes’ on the form on the back of your address sheet, you’ll receive a copy of the report along with your notice of meeting and board member election materials. If we don’t hear from you, you’ll still receive the notice of meeting and related election materials, but you won’t get a copy of the annual report. Instead we’ll let you know where you can access the report to read online.

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RT FAMILIES FOUNDATION

supporting our communities

“ … by day we might look like mildmannered insurance company folk, but after hours and on weekends we’re out there running golf days, chocolate drives, Easter raffles and getting sponsored to do crazy things … ”

we’re who you call when you need a helping hand Forget everything you ‘know’ about insurance companies. We’ve gone back to our beginnings and found a way to give people a helping hand when they need it most – which is why a group of big-hearted rail workers started this fund back in 1889. We’re in the business of helping people, and we’ve been at it for 120 years now. But these days, with so many rules and regulations governing the way health funds work and what we can and can’t cover people for, there are times when we’d like to help, but we just aren’t able to. That’s why we started the rt Families Foundation. The Families Foundation is an independent charity that is run on a 100% volunteer basis by rt staff. Make no mistake: by day we might look like mildmannered insurance company folk, but after hours and on weekends we’re out there running golf days, chocolate drives, Easter raffles and getting sponsored to do crazy things like participate in fun runs, all in the name of raising money to help people. And we love it. In the past 12 months we’ve had the incredible privilege of being able to help a number of families when they had nowhere else to turn:

• W e helped one family send their three kids off to school with new uniforms, books and supplies for the year when they were struggling to make ends meet because mum was so unwell that dad had to leave his job to take care of her. • We helped another family buy a special adjustable bed for a great-grandmother who couldn’t lie down to sleep at night. She finally got a good night’s sleep, and her children, grandchildren and great grandchildren got to see her smiling again. • And we helped a single mother buy a vital piece of equipment for her daughter who suffers from a debilitating disease. These families have touched all of our lives. We were deeply honoured to be able to help some good people who were simply running out of options. But we know that our work is far from done – there are plenty more families who could use a bit of a helping hand in tough times.

the magazine for rt health fund members | special edition

If you, or someone you know, could use a helping hand to access medical care, medicine, treatment or equipment that isnâ&#x20AC;&#x2122;t covered by Medicare or private health cover, maybe we can help. Send us a note at rtfamiliesfoundation@rthealthfund.com.au and weâ&#x20AC;&#x2122;ll be in touch.

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