Overseas Visitors Cover Terms and Conditions
Effective 23 May 2013
A person may purchase overseas cover if they are a resident of an overseas country and visiting Australia on a temporary basis, a citizen of an overseas country intending to reside permanently in Australia or a citizen of Australia who is residing overseas PROVIDED THAT in all cases the member is not eligible for full Medicare benefits.
Any member that becomes eligible for full Medicare benefits should contact us immediately to arrange alternative cover as they will no longer be entitled to coverage under their Overseas Visitors Cover.
Evidence to support any information contained on the application form such as identity, nationality, or age may be required at the discretion of the Fund.
A single membership covers one person (the member) only. A couple’s membership covers the member and one other adult. A family membership covers the member and their spouse, defacto or partner and dependant children as well as sole parents with one or more eligible dependant children.
A dependant is a child aged up to 23 years old who is unmarried. Upon application dependants can continue to be covered under a family membership up until the age of 25 years, while they remain unmarried or not in a de facto relationship and continue to attend an Australian Unity approved full-time course of study at a school, college or university in Australia.
Unless otherwise offered or agreed by Australian Unity, premiums are payable monthly, or in monthly multiples, in advance. Australian Unity may not accept premium payments that exceed 12 months from the current paid to date of the membership.
Under Premium Overseas Visitors Cover the premium is classified into two price tiers: under 65 years and 65 and older. The age of a member at the time of joining is the determinant of the premium. Under a couple or family policy, the age of the oldest member will be used to determine the premium tier.
5. Membership Arrears
All premiums should be paid in advance. Failure to pay a premium within 60 days of the expiration of the last payment period will result in cancellation of the membership and benefit entitlements.
6. Notice of Premium and benefit changes
Australian Unity has the right to change the premium and benefi ts of Overseas
Visitors Cover at any time.
Notice will be provided in writing to either the postal or email address notifi ed to Australian Unity. Please ensure that your address and other contact details are kept up to date.
A Goods and Services Tax (GST) applies (currently 10%) to Overseas Visitor Cover in accordance with A New Tax System (Goods and Services Tax) Act 1999. GST does not apply to other types of private health insurance cover.
8. Hospital cover
Hospitalisation in an Australian Unity Agreement Private Hospital or Public Hospital is available at the insured rate up to the overall yearly limit as set under chosen level of Overseas Visitors Cover.
Payment of benefits for hospitalisation in excess of 35 days will require medical evidence certifying the need for on-going acute care in hospital to be provided to Australian Unity. Surgical procedures listed on the Government Exclusion List may require medical certification before benefits are payable.
Benefits are payable toward the cost of in-hospital PBS pharmaceuticals, but excludes experimental and high cost non-PBS drugs.
Excess is an amount of money the Member agrees to pay the Hospital towards the accommodation costs of a Hospital admission in exchange for a lower premium payable under their chosen cover.
Exclusions are selected treatments under a Hospital cover where Hospital and Medical benefits will not be payable by Australian Unity. Refer to your product fact sheet for specific benefit entitlements.
Restricted benefits are hospital benefits, either for a set time frame or for the duration of the cover, that covers you as a private patient in a shared ward of a public hospital. In private hospitals, limited benefits will be payable towards your accommodation and government approved surgical prosthesis. We will not cover private hospital theatre or labour ward fees or costs associated with admission to an intensive or coronary care unit. This benefit is not suitable for cover towards the costs of an admission to Private hospital and significant out of pockets will apply. Contact Australian Unity before undergoing treatment.
Accident means any injury inflicted as a result of unintentional, unexpected actions or events which requires timely treatment by a registered Medical Practitioner but excluding accidental illness, surgical procedures, pregnancy, aggravation of a pre-existing condition, injuries or illnesses induced by alcohol or drug dependence.
Accident Cover. Where a Hospital cover offers this benefit the accident must have occurred after joining that level of cover to be eligible for benefits. The provision of this benefit is at the discretion of Australian Unity and will be based in the advice of Australian Unity’s appointed medical or para-medical practitioner.
12. Agreement Private Hospitals
Agreement private hospital means a private hospital or day hospital facility that has entered into a hospital purchaser-provider agreement with Australian Unity.
13. Ambulance Benefits
Benefits are payable for emergency ambulance transportation for treatment at a hospital. The account must be coded as an emergency by the Ambulance Service to qualify for benefits.
Benefits under Working Visa Cover are payable for medically necessary ambulance transportation where there is a clinical need for para-medical supervision during transportation to a hospital or other approved medical facility due to the patient’s medical condition.
Benefits will not be payable on ambulance transportation where the member is covered under an ambulance subscription scheme or the transportation is claimable from another source.
14. Extras Cover
Benefits: Treatment or consultations will only be payable on the basis of one consultation per patient, per practitioner, per day.
A consultation is eligible for benefits where it is conducted on a face-to-face basis. It excludes services delivered online or over the telephone unless part of an approved Australian Unity Chronic disease or health management program.
Benefit Replacement Period: means a continuous period of time that must occur between any two purchases of the same type of artificial aid or appliance item before benefits are payable.
15. Recognised Providers
Benefits are only payable for ancillary, dental and nursing services provided by practitioners recognised by Australian Unity and in private practice. Recognition is subject to change without notice. Recognition by Australian Unity is for benefit payment purposes only and should not be taken or construed in any way as sponsorship, approval of, or any recommendation as to the qualifications and skills of, or services provided by, a practitioner or therapist. Members should check that their practitioner is recognised by Australian Unity before commencing treatment.
16. Waiting periods
Generally, you may claim on services received on and from the commencement of your membership, except where waiting periods apply as outlined in your product fact sheet.
Waiting periods apply when you join, upgrade your cover, reduce your excess or re-join after a break in cover.
When upgrading your cover you may claim benefits at the higher rate for services provided except where a waiting period applies. The benefit will be paid that is equivalent to your previous cover until the waiting period on the new level of cover has been served.
Benefits are only payable on claims made for services rendered within Australia and are limited to the insured rate or the actual amount charged, which ever is less. Conditions and benefits apply at the date of service.
Benefits are not payable for periods during which a membership has premium payments in arrears or is suspended, nor are they payable on claims submitted more than two years after the date of service.
Australian Unity benefits are not payable where a member has a right to claim damages, compensation or benefits from any other source or where such a right to claim later arises. The member is required to reimburse Australian Unity for any benefits paid where damages, compensation or benefits is later received from another source. Please contact our Customer Service team on advice concerning compensation claims.
18. Yearly maximums
All yearly maximums, excesses and benefit limits are calculated from 1st January each calendar year. Yearly maximums are not transferable to any other person under the Membership.
Australian Unity is committed to keeping fund premiums to a minimum, and one way of doing this is to ensure that claims for treatment or services raised by healthcare providers are charged and benefits paid are accurate and correct.
Australian Unity may undertake audits of Hospital or Extras claims, and may contact you to assist or seek written consent. Your details will be kept confidential at all times.
20. Transferring from another fund
If a person joins Australian Unity within 30 days of ceasing their previous health cover with another registered Australian private health fund, the following benefits will be recognised depending on the type of cover you have purchased:
Non-working Visitors Cover; the initial two-month waiting period will be waived. Working Visa Cover; coverage under a policy that meets the health insurance requirements for a 457 visa. The time served under this membership and benefits paid with the previous health fund will be taken into account when calculating Australian Unity waiting periods and benefits payable.
A Transfer Certificate from the previous registered Australian private health fund must be supplied.
21. Cooling off Period
We will allow any health member who has not yet made a claim to cancel their membership and receive a full refund of any premiums paid within a period of 30 days from the commencement of their health cover.
22. Refund Policy
After the cooling off period a member wishing to cancel their membership and seek a refund of premiums paid in advance may do so in writing. Any refund will be calculated from the actual date the refund application is received by Australian Unity, or such later date as set out in the notice, and may attract an administration charge not exceeding $50 per membership.
In the case of visa denials, a refund of premiums paid will be provided where the applicant was unsuccessful in obtaining an entry visa to Australia.
A copy of the letter of visa denial must also be forwarded with the cancellation request.
Members on Working Visa Cover and the highest Non-working Visitor Cover can apply for a suspension of membership if they are travelling overseas. An application must be received prior to your departure from Australia, and your membership must be financial by at least one month in advance of the requested suspension date.
Eligibility criteria for temporary suspension are:
- Minimum period of membership – 3 months
- Minimum suspension time – 1 month
- Maximum suspension time – 12 months
- There must be a 12 month break between suspensions.
Benefits will not be payable for any hospital or extras services that occur during the suspension period. Waiting periods cannot be served while a membership is suspended.
24. Visa Requirements
For Working Visa Covers, it is the responsibility of the member to understand their visa requirements as set out by the Department of Immigration and Citizenship and to ensure that the health insurance purchased meets these requirements.
Australian Unity may be required to notify the Department of Immigration and Citizenship of members who have cancelled their cover.
25. Becoming a Member
Australian Unity health benefit fund members may be eligible to become a member of Australian Unity Limited ABN 23 087 648 888 after completing two years of continuous membership. Australian Unity health benefit fund members joining through a corporate group membership or members on an overseas product are generally ineligible to become members of Australian Unity Limited.
26. Summary of Terms & Conditions
This brochure contains only a summary of the fund rules. The complete rules of the health benefits fund set out in full the terms and conditions of membership and liability under the fund. These rules are available for inspection at Australian Unity, 114 Albert Road, South Melbourne VIC 3205.