Terms and Conditions for Overseas Visitors Cover
The following information is a guide to your cover, however before you undergo any treatment while in Australia, please call Australian Unity on 13 29 39 8:30am-8:30pm (Australian Eastern Standard Time), Monday-Saturday Australia-wide, to obtain complete and up-to-date information regarding your benefit entitlements.
Overseas Visitors Cover Terms and Conditions
1. Eligibility
A person may contribute to 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 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.
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 continue to 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. Waiting Periods
All Overseas Visitors Cover
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All hospital/medical treatment: Two months (unless the member joins prior to or within two weeks of arriving in Australia).
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Standard and Premium Overseas Visitors Cover has a 12 month waiting period on childbirth, pregnancy and related obstetric services.
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Budget Overseas Visitors Cover has a 24 month waiting period on cardiac conditions.
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Premium Overseas Visitors Cover has a 6 month waiting period on optical benefits.
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Treatment for pre-existing conditions is only available on Premium Overseas Visitors Cover after 12 months continuous membership.
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'Extras' Health Services: waiting periods apply. Please contact us for details.
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5. 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.
6. Exclusions from benefits
The following are excluded services:
- Pre-existing condition on Standard and Budget Overseas Visitors Cover. 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.
- 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 24 for details
- Benefits for cataract conditions are excluded on Budget Oveaseas Visitors Cover
7. 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.
8. 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 and/or until the yearly maximum benefit entitlement has been paid.
Benefits for accommodation in a 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.
9. Total benefits
All yearly maximums and benefit limits are calculated from 1st January each calendar year through to 31 December. 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.
10. Claims
Benefits are not payable for periods during which a membership is unfinancial nor are they payable on claims submitted more than two (2) years after date of service.
11. 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 unfinancial.
12. Membership application/renewal
The company reserves the right to decline an application for membership or to decline to renew the membership of a member.
13. Membership arrears
All contributions should be paid in advance. Failure to pay contribution within 14 days of the expiration of last contribution period will result in cessation of the membership and benefit entitlements.
14. Visa Requirements
It is the responsibility of the memeber 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.
15. Refund Policy
A member wishing to claim a refund of contributions paid in advance must apply to the Fund in writing. Any refund will be calculated from the actual date the refund application is received by Australian Unity and will attract an administration fee of no more than 15%. There is no refunds payable on memberships of 3 months or less unless the applicant was unsuccessful in obtaining an entry Visa to Australia. In this case, a copy of the letter of visa denial must also be forwarded with the cancellation request.
16. 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.
17. 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.
18. 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 for any pre-existing conditions not declared on the application or for treatment which in the opinion of our practitioner could be delayed until the member’s return 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
19. Recognised providers
Benefits are only payable for services provided by health service 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.
20. Agreement hospitals
Agreement hospital means a private hospital or day hospital facility that has entered into a hospital purchaser-provider agreement with Australian Unity.
21. Age upon application
The age of a member at the time of joining is a determinant to 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.
22. 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.
23. Disclosure
In order to assess your application for Overseas Visitors Cover you must sign the declaration on the application form and provide detail of any pre-existing conditions where asked.
24. Pharmacy benefits when admitted to hospital
Benefits payable toward the cost of in-hospital pharmaceuticals will be limited to a maximum of $5000 per person per calendar year.
There are no benefits payable for drugs prescribed on discharge from hospital or for any pharmaceutical prescriptins 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.
25. 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.
Extras Cover Terms & Conditions
The following information is provided as a guide to your Extras cover.
1. Student Dependant
A student dependant may be defined as any person who is related to a member who contributes to the family health cover premium being:
- that member’s unmarried child, legally adopted child or stepchild who has not attained the age of 23 years
- that member’s unmarried child, legally adopted child or stepchild who has not attained the age of 25 years and who is pursuing an approved full-time course of study at school, college or university.
2. An Approved Course of Study
An approved course of study means secondary and tertiary academic study, trade apprenticeships and industry, employer or government training schemes, provided that the course of study results upon completion in the dependant being qualified to seek or maintain gainful employment in the general workforce and that the dependant is not, or will not remain, dependant upon the member for personal care, domestic or social support after having attended the course of study.
3. Waiting Periods for Extras Cover
In most cases Australian Unity gives you immediate 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.
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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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Members transferring from an equivalent level of extras cover with another fund will not have to re-serve qualifying periods.
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.
For pre-existing conditions, benefits will not be payable for the first 12 months of membership for any illness, ailment or condition, the signs or symptoms of which were known, or which a medical or para-medical 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 during the six months 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.
Dental Maximums - Smart tables / Extras tables. Please note that the dental benefit maximums under these tables are different and can affect your dental entitlement when transferring from one table to another. Additional qualifying periods apply when transferring to tables E2 or E3 from a Smart table for crowns, bridges, etc. and for overall dental maximums.
4. Single / Couple / Family Membership
A single membership covers one person (the member) only. A couple membership, covers the member and one other person who is not a dependant child of the member. A family membership covers the member and their spouse / defacto / partner and dependant children as well as sole parents with one or more eligible dependant children.
5. ‘Accident’
Means any injury inflicted as a result of unintentional, 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.
6. Dependants
A family membership covers the member, spouse / defacto and their dependant children up to the age of 23 years.
Children continue to be included under the family membership while they remain unmarried and continue to attend an Australian Unity approved full-time course of study up to the age of 25 years.
7. Members transferring from other funds extras cover
Years of membership and extras benefits paid with another fund will be taken into account in calculating Australian Unity qualifying periods and extras benefits payable if the member joins an Australian Unity extras table within 30 days of ceasing extras membership with their previous Registered Health Fund.
Please request a Transfer Certificate from the previous fund after joining Australian Unity, or tick the "Request for Transfer Certificate", in the My Health Fund Details section of the application form.
8. 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. Please contact the Claims Analysis section for advice concerning compensation claims.
9. 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.
10. Claims
Benefits are not payable for periods during which a membership is unfinancial or suspended, nor are they payable on claims submitted more than two years after the date of service.
11. Liability
Australian Unity will not be liable should an application or claim form contain false or inaccurate information or where the member is unfinancial.
12. Yearly Maximums
All yearly maximums and limits are calculated from 1st January each calendar year.
13. Year of Entitlement
A member’s year of entitlement is calculated on the number of calendar years of membership with Australian Unity less any applicable 12 month qualifying periods, eg. major dental.
14. 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.
15. Rate Change
Australian Unity’s rate guarantee policy ensures that contributions paid in advance are protected against the rate change (the member will also be eligible for any increase in benefits). Once contributions are due again, they will be payable at the new rate.
16. Summary of Rules
This page 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 all Australian Unity Sales Centres.
Note: Australian Unity gives no endorsement of any products supplied to members by suppliers listed under ‘Wellplan Rewards’.