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Private Health Insurance Standard Information Statement - Combined Policy This Statement provides basic information for the purposes of comparison only. For full explanation of this combined hospital and general treatment policy please contact the health insurer on 1300 199 802 or visit http://www.health.com.au. HEALTH INSURER: health.com.au WHO IS COVERED: One adult PRODUCT NAME: Heart Hospital with Basic 75 Extras ($500 MONTHLY PREMIUM: # $212.98 (before any rebate or loading) M EDICARE L EVY S URCHARGE : Exempt excess) AVAILABLE FOR: Residents of Tasmania # You may be entitled to an Australian Government rebate on this premium. Your premium may include a Lifetime Health Cover loading and/or an insurer discount depending on your individual circumstances. Check with your insurer for more details. Hospital Component The following applies to the hospital component for the Heart Hospital with Basic 75 Extras ($500 excess) policy from health.com.au. WHAT'S COVERED IF I HAVE TO GO TO HOSPITAL ? Hospital treatment, including accommodation as a private patient in a private or public hospital Doctors' bills in hospital (see below) (Ambulance is covered by State government) WHAT SERVICES ARE NOT COVERED AT ALL ? (Exclusions) WHAT SERVICES ARE ONLY COVERED TO A LIMITED EXTENT ? (Restrictions, Benefit Limitation Periods) HOW LONG ARE THE WAITING PERIODS FOR NEW AND UPGRADING MEMBERS? WILL I HAVE TO PAY ANYTHING IF I GO TO HOSPITAL ? (Excesses, Co-payments, Medical/Hospital gaps) WHAT OTHER FEATURES DOES THIS POLICY HAVE? Cataract and eye lens procedures Pregnancy and birth related services Assisted reproductive services Joint replacements ie shoulder, knee, hip and elbow, including revisions Dialysis for chronic renal failure Gastric banding and related services Hospital treatment for which Medicare pays no benefit eg most cosmetic surgery Other services (see insurer for details) You are not fully covered for: Psychiatric services No benefit limitation periods 2 months for palliative care, rehabilitation and psychiatric treatment 12 months for treatments relating to other pre-existing ailments 2 months for all other treatments EXCESS: You will have to pay an excess of $500 per admission. This is limited to a maximum of $500 per year. EXTRA COST PER DAY (CO-PAYMENTS): No co-payments DOCTORS' AND HOSPITAL BILLS: Almost 9 out of 10 medical services paid for by this health insurer in Tasmania have no out-of-pocket expenses. This insurer also has arrangements that may mean lower out-of-pocket expenses on doctors' bills. You may also have to pay other costs depending upon: the doctor(s) chosen the treatment you are having the hospital you go to Before you go to hospital, you should ask your doctor, hospital and health insurer about any out-of-pocket costs that may apply to you. Heart Hospital cover is perfect for a family who is done having children, or singles and couples who want the added safety of cover for cardiac complications. Please note further exclusions include; Insulin Pumps, Cochlear Implants, Neurostimulators and all Spinal Surgery. HEA/J91/TDSA10 issued 02 March 2017 www.PrivateHealth.gov.au General Treatment Component The following applies to the general treatment component for the Heart Hospital with Basic 75 Extras ($500 excess) policy from health.com.au. PREFERRED SERVICE PROVIDER ARRANGEMENTS: This health insurer does not operate a preferred provider scheme. SERVICES COVER DENTAL WAITING PERIOD (MONTHS) 2 General dental BENEFIT LIMITS (PER 12 MONTHS) $700 per policy EXAMPLES OF MAXIMUM BENEFITS Periodic oral examination - 75% of charge Scale & clean - 75% of charge Fluoride treatment - 75% of charge Surgical tooth extraction - 75% of charge (combined limit for general dental, major dental, endodontic & orthodontic - Sub-limits Full crown veneered - 75% of charge apply) Major dental 12 Orthodontic 12 OPTICAL (eg prescribed 2 $225 per policy NON PBS PHARMACEUTICALS - - PHYSIOTHERAPY 2 $400 per policy CHIROPRACTIC 2 PODIATRY - - - PSYCHOLOGY - - - ACUPUNCTURE 2 $300 per policy NATUROPATHY 2 REMEDIAL MASSAGE 2 $225 per policy HEARING AIDS - - - - - - Endodontic 12 spectacles / contact lenses) B LOOD GLUCOSE MONITORS AMBULANCE n/a Filling of one root canal - 75% of charge Braces for upper & lower teeth, including removal plus fitting of retainer - 75% of charge (combined limit for physiotherapy & chiropractic) (combined limit for acupuncture & naturopathy) Single vision lenses & frames - 75% of charge Multi-focal lenses & frames - 75% of charge Initial visit - 75% of charge Subsequent visit - 75% of charge Initial visit - 75% of charge Subsequent visit - 75% of charge Initial visit - 75% of charge Subsequent visit - 75% of charge Initial visit - 75% of charge Subsequent visit - 75% of charge Initial visit - 75% of charge Subsequent visit - 75% of charge Covered by State government Osteopathy benefits payable from Physiotherapy and Chiropractic limit. OTHER FEATURES: Dental sublimit of $350 per person per year is available for Orthodontic treatment. Health maintenance benefits of up to $150 per person for things like Gym memberships. Benefits are also payable towards Occupational and Speech therapies. See; https://health.com.au/customers/ for more details HEA/J91/TDSA10 issued 02 March 2017 www.PrivateHealth.gov.au