Please click one of the links below to view the Terms and Conditions for your Overseas
Visitors Cover:
Terms and Conditions – Overseas Visitors cover (Premium, Standard and Budget)
1. Eligibility
A person may purchase Overseas Visitors Cover if the person is 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 ineligible for full
Medicare benefits under the Health Insurance Act 1973. Should you become eligible
for full Medicare benefits you should contact us immediately as eligibility to purchase
Overseas Visitors Cover should cease.
2. Single/Family membership
Single membership covers the member only. Family membership covers the member and
eligible dependants as defined in point 3.
3. Dependants
A family membership covers the member, spouse/ defacto (if any) and their dependant
children up to the age of 23 years. Children can also be included under the family
membership while they remain unmarried and continue to attend an Australian Unity
approved full-time course of study at a school, college or university in Australia
up until the age of 25 years.
4. Accident
Accident means any injury inflicted as a result of unintentional and unexpected
actions or events which require treatment by a registered medical practitioner,
but excluding accidental illness, surgical procedures, pregnancy, injuries or illnesses
induced by alcohol, drug dependence or aggravation of a pre-existing condition.
5. Members transferring from other funds
Hospital cover: If a member joins Australian Unity within 30 days of ceasing
their previous cover from another Australian Private Health Fund the initial 2-month
waiting period will be waived. A Transfer Certificate from the previous fund must
be supplied. All other applicable waiting periods such as for pre-existing and obstetrics
will apply.
Extras cover: Years of membership and Extras benefits paid with another Australian
Private Health Fund will be taken into account in calculating Australian Unity qualifying
periods and extras benefits payable if the member joins an Australian Unity Extras
product within 30 days of ceasing extras membership with their previous Australian
Private Health Fund.
Please request a Transfer Certificate from your previous fund after joining Australian
Unity, or tick the "Request for Transfer Certificate", in the My Health Fund Details
section of the application form.
6. Waiting Periods
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All hospital/medical treatment: (unless the member joins prior to or within two
weeks of arriving in Australia, in which case the two month waiting period is waived)
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2 months
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All childbirth, pregnancy and related obstetric services (available on Standard
and Premium Overseas Visitors Cover only)
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12 months
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Cardiac conditions (waiting period applicable to Budget Overseas Visitors Cover
only)
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24 months
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Optical benefits and eye examinations
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6 months
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Treatment for pre-existing conditions
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12 months
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* A pre-existing condition is any illness, ailment or condition, the signs or symptoms
of which were known, or which a medical or paramedical practitioner appointed by
the company considers, after examining information furnished by the member’s practitioner,
and other material relevant to a claim for benefits, were in existence in the member
or his/ her dependant at any time preceding the commencement or transfer date. This
is irrespective of whether the member or dependant was aware of the pre-existing
illness, ailment, or condition, and includes all proposed elective or cosmetic procedures.
Australian Unity may request further medical evidence in determining eligibility
for benefits.
7. Waiting Periods for Extras Cover
In most cases Australian Unity gives you immediate cover. However, subject to the
following tables, benefits generally will not be payable in the first 12 month for
pre-existing conditions.
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Extraction of wisdom teeth
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6 months
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Optical
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6 months
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St John Ambulance First Aid Course
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6 months
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Pre-existing conditions
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12 months
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Major Dental (including dentures, crowns, bridgework, implants)
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12 months
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Orthodontics
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12 months
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Orthotics
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12 months
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Hearing Aids
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12 months
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Blood glucose monitors/Blood pressure monitors
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12 months
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Asthma pumps/Peak Flow Meters
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12 months
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TENS Pain Control Machine
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12 months
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C-PAP Airways Pressure machine
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12 months
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Non-surgical prostheses
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12 months
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After enrolment or transferring to a higher benefit level of cover, benefits will
generally be paid immediately at the higher rate except where the condition is subject
to a waiting period.
Dental Maximums - Extras cover. Please note that the dental benefit maximums
under Extras cover are different and can affect your dental entitlement when transferring
from one Extras product to another. Additional qualifying periods apply when transferring
to Comprehensive Extras or Super Extras from Basic Extras for crowns, bridges, etc.
and for overall dental maximums.
8. Medical benefits
Medical benefits will be paid to the levels detailed in the Australian Unity Overseas
Visitors Health Cover Product Rules. The reference document for the payment of medical
benefits will be the Medicare Benefits Schedule of Fees and Services. The method
and guidelines to determine the amount of an eligible claim for medical benefits
will be as detailed in the Medicare Benefits Schedule, as at the date a professional
service was rendered. Benefits under Australian Unity’s Medical Gap Cover Scheme
are not available under these covers. Members will have an out-of-pocket cost if
the medical practitioner charges more than the benefits paid by Australian Unity.
9. Exclusions from benefits
The following are excluded services:
- Pre-existing conditions on Standard and Budget Overseas Visitors Cover
- IVF, GIFT and all infertility/sterility treatment programs
- Psychiatric and Rehabilitation programs/services unless as a result of an accident
occurring in Australia after the member was accepted for membership. Premium Overseas
Visitors Cover offers benefits on Psychiatric and Rehabilitations services after
12 months continuous membership
- Elective cosmetic surgery unless as a result of an accident or surgical scarring
occurring in Australia after the member was accepted for membership
- Fees charged by hospitals when you are not admitted to hospital (e.g. hospital fee
for treatment in Emergency Department)
- Emergency ambulance is excluded on Budget Overseas Visitors Cover
- Obstetrics, child birth and pregnancy services are excluded on Budget Overseas Visitors
Cover
- Non Hospital Pharmacy – see section 28 for details
- Benefits for cataract conditions are excluded on Budget Overseas Visitors Cover
10. Compensation from other sources
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 are later received from another source.
Please contact our claims department for advice concerning compensation claims.
11. Extent of benefits
Benefits are limited to the insured rate or actual amount charged, whichever is
less. Conditions and benefits apply as at the date of service. Payment of benefits
on Hospital cover for hospitalisation in excess of 35 days will require medical
evidence to be provided to Australian Unity certifying the need for on-going acute
care in hospital. Surgical procedures listed on the Government Exclusion List may
require medical certification before benefits are payable. Hospitalisation benefits
are available at the insured rate for 365 days per year subject to medical certification
as to the need for on-going acute care or until the yearly maximum benefit entitlement
has been paid.
Public hospitals or non-agreement private hospitals
Subject to total benefits set out in paragraph 11, benefits for accommodation in
public hospitals or non-agreement private hospitals are limited to a maximum of
$350 per person, per day on Budget Overseas Visitors Cover and $600 per person,
per day on Standard Overseas Visitors Cover. Premium Overseas Visitors Cover has
no daily limits.
12. Total benefits
All yearly maximums and benefit limits are calculated from 1 January through to
31 December each year. The total overall benefit payable by Australian Unity in
a calendar year will be:
- Budget Overseas Visitors Cover: $30,000 per person up to a maximum per family of
$60,000.
- Standard Overseas Visitors Cover: $50,000 per person up to a maximum per family
of $100,000.
- Premium Overseas Visitors Cover: $120,000 per person up to a maximum per family
of $240,000.
13. Claims
Benefits are not payable for periods during which a membership is in arrears nor
are they payable on claims submitted more than two (2) years after the date of service.
14. Liability
Australian Unity may refuse to pay a claim should an application or claim form contain
false or inaccurate information or where the member is in arrears.
15. Membership application/renewal
The company reserves the right to decline an application for membership or to decline
to renew the membership of a member.
16. Membership arrears
All contributions should be paid in advance. Failure to pay a contribution within
14 days of the expiration of last contribution period will result in cessation of
the membership and benefit entitlements.
17. Membership Suspension
Members covered under Premium Overseas Visitors Cover who need to undertake an extended
overseas trip or return to their home country for a period of time may apply for
(prior to departure) a suspension of their membership.
Eligibility criteria for temporary suspension
- Minimum period of membership – 3 months
- Minimum suspension time – 1 month
- Maximum suspension time – 12 months
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.
Premium payments must be up-to-date so that you are covered for at least one month
after your departure date.
18. Visa Requirements
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.
19. Refund Policy
General refund request - A member wishing to claim a refund of contributions
paid in advance must apply to the Australian Unity in writing. A refund will be
calculated minus an administration fee of no more than $50.
Refunds prior to arrival in Australia - For members wishing to cancel their
membership prior to arrival in Australia, a refund will be calculated minus a membership
establishment fee of $240 for a single policy and up to $480 for a family policy.
Refunds due to unsuccessful visa applications - Where the applicant was unsuccessful
in obtaining an entry visa to Australia a refund will be calculated minus an administration
fee of no more than $50. In this case, a copy of the letter of visa denial must
also be forwarded with the cancellation request.
20. GST
A Goods and Services Tax (GST) applies (currently 10%) to Overseas Visitors Cover
in accordance with A New Tax System (Goods and Services Tax) Act 1999. GST does
not apply to Extras cover.
21. Premium Overseas Visitors Cover dental benefits
The general and preventative dental benefits of Premium Overseas Visitors Cover
are based on Australian Unity's Dental Schedule of Benefits (E7) Basic Extras. This
should be used as a guide only, please contact Australian Unity to confirm the benefits
applicable before proceeding with any treatment.
22. Medical repatriation
The provision of this benefit is at the discretion of Australian Unity. Up to $20,000
in benefits (included within the annual limit) will be payable for medically necessary
services and transportation and where a medical or paramedical practitioner appointed
by Australian Unity considers, after examining information furnished by the member’s
practitioner, and other material relevant to a claim that it is medically necessary
to repatriate the member to their country of origin. Benefits will not be payable
on:
- any pre-existing conditions for Standard and Budget members
- any pre-existing conditions known to a Premium member or their medical practitioner
at the time of joining Overseas Visitors Cover but not declared on the application
- treatment which in the opinion of our practitioner could be delayed until the member's
scheduled original date of return to their country of origin
23. Recognised providers
Benefits are only payable for services provided by private practice health service
practitioners which are recognised by Australian Unity. Recognition of health service
practitioners 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.
24. Agreement hospitals
Agreement hospital means a private hospital or day hospital facility that has entered
into a hospital purchaser-provider agreement with Australian Unity. Please contact
Australian Unity for a list of agreement hospitals.
25. Age upon application
The age of a member at the time of joining is a determinant of the price of Premium
Overseas Visitors Cover. The price is classified into two price tiers, under 65
years and 65 and older.
If the membership is a couple or family, the age of the oldest member will be used
to determine the price tier of the membership.
26. Notice for benefit/ rate change
Australian Unity has the right to change the price of Overseas Visitors Cover and
add or remove benefits with 30 days notice. Notice will be provided in writing to
the address notified to Australian Unity. Please ensure your address details are
kept up to date.
27. Disclosure
In order to assess your application for Overseas Visitors Cover you must sign the
declaration on the application form and provide details of any pre-existing conditions
where asked.
28. Pharmacy benefits when admitted to hospital
Benefits payable toward the cost of in-hospital pharmaceuticals will be limited
to a maximum of $5,000 per person per calendar year.
There are no benefits payable for drugs prescribed on discharge from hospital or
for any pharmaceutical prescriptions outside of hospital with the exception of Premium
Overseas Visitors Cover. Budget and Standard members requiring cover for pharmacy
scripts outside of hospital should consider taking Australian Unity extras cover.
29. Summary of Rules
These terms and conditions should be used as a guide only. The complete Australian
Unity Overseas Visitors Health Cover Product Rules set out in full the terms and
conditions of membership for each health insurance provider offered by Australian
Unity. These rules are available for inspection at Australian Unity, 114 Albert
Road, South Melbourne VIC 3205.
Terms and Conditions – Overseas Visitors Cover (457 Visitors Health Cover)
1. Eligibility
A person may purchase 457 Visitors Health Cover if the person is a resident of an
overseas country and visiting Australia on a subclass 457 - Business (long stay)
visa, PROVIDED THAT in all cases the member is ineligible for Medicare benefits
under the Health Insurance Act 1973. Should you become eligible for full Medicare
benefits you should contact us immediately as eligibility to contribute to Overseas
Visitors Cover should cease. Australian Unity may request applicants to provide
evidence of obtaining a Subclass 457 visas to confirm eligibility for this cover.
2. Single/Family membership
Single membership covers the member only. Family membership covers the member and
eligible dependants as defined in point 3.
3. Dependants
A family membership covers the member, spouse/ defacto (if any) and their dependant
children up to the age of 23 years. Children can also be included under the family
membership while they remain unmarried and continue to attend an Australian Unity
approved full-time course of study at a school, college or university in Australia
up until the age of 25 years. Contact Australian Unity for eligible courses.
4. Accident
Accident means any injury inflicted as a result of unintentional and unexpected
actions or events which require treatment by a registered medical practitioner,
but excluding accidental illness, surgical procedures, pregnancy, injuries or illnesses
induced by alcohol, drug dependence or aggravation of a pre-existing condition.
5. Members transferring from other funds
Years of membership and benefits paid with another Australian Private Helth fund
will be taken into account in calculating Australian Unity waiting periods and benefits
payable if the member joins Australian Unity 457 Visitor health cover within 30
days of ceasing membership with their previous Australian Private Health Fund. A
Transfer Certificate must be requested from your previous Health Fund after joining
Australian Unity, or complete and return the Transfer Request section of an Australian
Unity application form.
6. Waiting periods
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All hospital/medical treatment: unless the member joins prior to or within two weeks
of arriving in Australia)
|
Two months
|
|
Treatment for Psychiatric and Rehabilitation
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Two months
|
|
Treatment for pre-existing conditions*
|
12 months
|
|
All childbirth, pregnancy and related obstetric services
|
12 months
|
* A pre-existing condition is any illness, ailment or condition, the signs or symptoms
of which were known, or which a medical or paramedical practitioner appointed by
the company considers, after examining information furnished by the member’s practitioner,
and other material relevant to a claim for benefits, were in existence in the member
or his/ her dependant at any time preceding the commencement or transfer date. This
is irrespective of whether the member or dependant was aware of the pre-existing
illness, ailment, or condition, and includes all proposed elective or cosmetic procedures.
Australian Unity may request further medical evidence in determining eligibility
for benefits.
7. Waiting Periods for Extras Cover
457 Visitors Health Cover does not include benefits for general treatment like Physiotherapy,
Dental or Acupuncture; however cover can be purchased in addition to your visitors
cover should you wish to have cover for these and other general treatments.
In most cases Australian Unity gives you immediate Extras cover. However for pre-existing
conditions other than the conditions listed below, benefits will not be payable
in the first 12 months.
For the following benefits, these waiting periods apply. No benefits are payable
during the waiting periods.
|
Extraction of wisdom teeth
|
6 months
|
|
Optical
|
6 months
|
|
St John Ambulance First Aid Course
|
6 months
|
|
Pre-existing conditions
|
12 months
|
|
Major Dental (including dentures, crowns, bridgework, implants)
|
12 months
|
|
Orthodontics
|
12 months
|
|
Orthotics
|
12 months
|
|
Hearing Aids
|
12 months
|
|
Blood glucose monitors/Blood pressure monitors
|
12 months
|
|
Asthma pumps/Peak Flow Meters
|
12 months
|
|
TENS Pain Control Machine
|
12 months
|
|
C-PAP Airways Pressure machine
|
12 months
|
|
Non-surgical prostheses
|
12 months
|
After enrolment or transferring to a higher benefit level of cover, benefits will
generally be paid immediately at the higher rate except where the condition is subject
to a waiting period.
Dental maximums - Extras cover. Please note that the dental benefit maximums
under Extras cover are different and can affect your dental entitlement when transferring
from one Extras product to another. Additional qualifying periods apply when transferring
to Comprehensive Extras or Super Extras from Basic Extras for crowns, bridges, etc.
and for overall dental maximums.
8. Medical benefits
Medical benefits will be paid to the levels detailed in the Australian Unity Overseas
Visitors Health Cover Product Rules. The reference document for the payment of medical
benefits will be the Medicare Benefits Schedule of Fees and Services. The method
and guidelines to determine the amount of an eligible claim for medical benefits
will be as detailed in the Medicare Benefits Schedule, as at the date a professional
service was rendered. Benefits under Australian Unity’s Medical Gap Cover Scheme
are not available under these covers. Members will have an out-of-pocket cost if
the medical practitioner charges more than the benefits paid by Australian Unity.
9. Exclusions from benefits
The following are excluded services:
- IVF, GIFT and all infertility/sterility treatment programs
- Elective cosmetic surgery unless as a result of an accident or surgical scarring
occurring in Australia after the member was accepted for membership
- Emergency department fees charged by a Public Hospital if you are not admitted to
hospital
- Emergency department fees charged by a Private Hospital
- Non hospital pharmacy – see section 27 for details
- Bone marrow and organ transplants
- Surgery by a Podiatrist
- Services provided outside of Australia
10. Compensation from other sources
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 are later received from another source.
Please contact our claims department for advice concerning compensation claims.
11. Extent of benefits
Benefits are limited to the insured rate or actual amount charged, whichever is
less. Conditions and benefits apply as at the date of service. Payment of benefits
on Hospital cover for hospitalisation in excess of 35 days will require medical
evidence to be provided to Australian Unity certifying the need for on-going acute
care in hospital. Surgical procedures listed on the Government Exclusion List may
require medical certification before benefits are payable. Hospitalisation benefits
are available at the insured rate for 365 days per year subject to medical certification
as to the need for on-going acute care or until the yearly maximum benefit entitlement
has been paid.
Limited benefits apply to hospitalisations for Obstetrics, Rehabilitation, Psychiatry
or Palliative care. Benefits paid will only be equal to the rate of a shared room
in Public Hospital only.
Non-agreement private hospitals
Benefits for accommodation in non-agreement private hospitals are limited. Please
contact Australian Unity for benefits entitlements.
12. Total benefits
All yearly maximums and benefit limits are calculated from 1 January through to
31 December each year. The total overall benefit payable by Australian Unity in
a calendar year will be:
- AUD $1 million per person
13. Claims
Benefits are not payable for periods during which a membership is in arrears nor
are they payable on claims submitted more than two (2) years after the date of service.
14. Liability
Australian Unity may refuse to pay a claim should an application or claim form contain
false or inaccurate information or where the membership payments are in arrears.
15. Membership application/renewal
The company reserves the right to decline an application for membership or to decline
to renew the membership of a member.
16. Membership arrears
All contributions should be paid in advance. Failure to pay a contribution within
14 days of the expiration of last contribution period will result in cessation of
the membership and benefit entitlements.
17. Membership suspension
Members covered under the 457 Visitors Health Cover who need to undertake an extended
overseas trip or return to their home country for a period of time may apply for
(prior to departure) a suspension of their membership.
Eligibility criteria for temporary suspension:
- Minimum period of membership – 3 months
- Minimum suspension time – 1 month
- Maximum suspension time – 12 months
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.
Premium payments must be up-to-date so that you are covered for at least one month
after your departure date.
18. Visa Requirements
While Australian Unity has endeavoured to provide a compliant cover, which meets
the requirements of visa Condition 8501, for holders of subclass 457 visas. 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.
19. Refund Policy
General refund request - A member wishing to claim a refund of contributions
paid in advance must apply to the Australian Unity in writing. A refund will be
calculated minus an administration fee of no more than $50.
Refunds prior to arrival in Australia - For members wishing to cancel their
membership prior to arrival in Australia, a refund will be calculated minus a membership
establishment fee of $240 for a single policy and up to $480 for a family policy.
Refunds due to unsuccessful visa applications - Where the applicant was unsuccessful
in obtaining an entry visa to Australia a refund will be calculated minus an administration
fee of no more than $50. In this case, a copy of the letter of visa denial must
also be forwarded with the cancellation request.
20. GST
A Goods and Services Tax (GST) applies (currently 10%) to Overseas Visitors Cover
in accordance with A New Tax System (Goods and Services Tax) Act 1999. GST does
not apply to Extras cover.
21. 457 Visitors Health Cover ambulance benefits
Benefits will be 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 where the member is covered under an ambulance subscription
scheme or the transportation is claimable from another source.
22. Medical repatriation
The provision of this benefit is at the discretion of Australian Unity. Up to $20,000
in benefits (included within the annual limit) will be payable for medically necessary
services and transportation and where a medical or paramedical practitioner appointed
by Australian Unity considers, after examining information furnished by the member’s
practitioner, and other material relevant to a claim that it is medically necessary
to repatriate the member to their country of origin. Benefits will not be payable
on:
- any pre-existing conditions known to a member or their medical practitioner at the
time of joining 457 Visitors Health Cover but not declared on the application
- treatment which in the opinion of our practitioner could be delayed until the member's
scheduled original date of return to their country of origin
23. Recognised providers
Benefits are only payable for services provided by private practice health service
practitioners which are recognised by Australian Unity. Recognition of health service
practitioners 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.
24. Agreement hospitals
Agreement hospital means a private hospital or day hospital facility that has entered
into a hospital purchaser-provider agreement with Australian Unity.
25. Notice for benefit/ rate change
Australian Unity has the right to change the price of 457 Visitors Cover and add
or remove benefits with 30 days notice. Notice will be provided in writing to the
address notified to Australian Unity. Please ensure your address details are kept
up to date.
26. Disclosure
In order to assess your application for 457 Visitors Cover you must sign the declaration
on the application form and provide details of any pre-existing conditions where
asked.
27. Pharmacy benefits when admitted to hospital
Benefits payable are limited towards the cost of in-hospital pharmaceuticals only.
There are no benefits payable for drugs prescribed on discharge from hospital or
for any pharmaceutical prescriptions outside of hospital. Members requiring cover
for pharmacy scripts outside of hospital should consider taking Australian Unity
Extras cover.
28. Summary of Rules
These terms and conditions should be used as a guide only. The complete Australian
Unity Overseas Visitors Health Cover Product Rules set out in full terms and conditions
of membership under the Fund. These rules are available for inspection at Australian
Unity, 114 Albert Road, South Melbourne VIC 3205.
