Frequently asked questions

If you are less than two months behind in your contributions, your health fund has to allow you to pay your outstanding contributions and maintain continuity of cover. This means that your private health insurance will be considered to have been continuous during this period. If you are more than two months behind in your contributions, your health fund would most likely consider you not to be a member of that fund. You should discuss this with your health fund.

Suspension rules vary between private health funds. If your health fund won't suspend your membership, you can check with other funds to see if they are prepared to grant you a suspension. Information relating to the various health funds can be found in the Yellow Pages or on the Internet. The Private Health Insurance Administration Council (PHIAC) web site details all registered health funds within each State. It also provides contact details for each fund and a link to each fund's web site, if one exists. If you are unable to suspend your membership, you may be able to lapse your cover without penalty under the Lifetime Health Cover period of absence provision.

Most health funds allow their members to suspend their private health insurance in certain circumstances, eg. when going overseas. However, suspension rules vary between private health funds in relation to the length of time allowed and the grounds for granting the suspension. While your cover is suspended, you will remain a member of the health fund and you will not be required to pay premiums. However, you will not be covered during the period that your membership is suspended. This means that you cannot claim any benefits in the period that your cover is suspended. If a health fund agrees to grant you a period of suspension, you will not be required to serve further waiting periods or pre-existing ailment waiting periods (except where any waiting periods or pre-existing ailment waiting periods were not completed at the time of the suspension), provided you resume your premium payments at the end of the agreed suspension period. If you are unable to suspend your membership, you may be able to lapse your cover without penalty under the Lifetime Health Cover period of absence provision.

You should ask your health fund if they are prepared to offer a suspension of your health cover while you are overseas. Suspending your membership allows you to stop paying your premiums for the time that you are overseas and then return to private health insurance at the end of your suspension period without having to re-serve any waiting periods. If you have not served your total waiting period or pre-existing ailment waiting period at the time your suspension is granted, you will have to serve the rest of your waiting period when you resume contributions at the end of your suspension period. Suspension rules vary between private health funds in relation to the length of time allowed and the grounds for granting the suspension. If you are still overseas at the end of the agreed suspension period granted by your health fund and they are unable to extend the suspension, you can check with other funds to see if they are prepared to grant a further suspension or you can resume paying your premiums from overseas until you return to Australia. While your private health cover is suspended by your health fund, you are considered to have private health cover for Lifetime Health Cover purposes. You will not be required to pay any age-based loading on your premium provided you resume your premium payments at the end of the agreed suspension period.

Yes. You can change health funds at any time. However, if you change to a higher level of cover you may have to serve a waiting period before you can claim benefits at this higher level.

Yes. You can change health funds at any time. However, if you change to a higher level of cover you may have to serve a waiting period before you can claim benefits at this higher level.

When you join a health fund or increase your level of cover you may have to wait some time before you are able to claim benefits. This waiting period protects you and others in your health fund by making sure that people can not join a health fund solely for the purpose of making a claim, and then dropping their cover. This type of "hit and run" behaviour results in increased premiums for everyone.

The Government supports universal access by all Australians to public health services under Medicare, irrespective of private health insurance status. People with private insurance can therefore choose to use Medicare or private health services depending upon their particular health needs. In addition, privately insured patients using private services still draw substantially upon Medicare as well as health funds. For example, Medicare provides a number of Commonwealth funded health benefits such as the 75% Medical Benefits Schedule (MBS) rebate on in-hospital medical services (for people with private health insurance), the 85% (MBS) rebate on out-of-hospital medical services (e.g. GP visits) and the Pharmaceutical Benefits Scheme (which subsidises the costs of pharmaceuticals). On the other hand, health fund benefits cover 25% of the MBS fee for in-hospital medical services. Health fund benefits may also not cover the total cost of hospital treatment, which in turn can result in an out-of-pocket expense. This out-of-pocket expense is referred to as the medical gap. To remove the requirement that privately insured patients pay the Medicare Levy would therefore be inequitable.

No. Health funds are not allowed to refuse membership to people on the grounds of health status, age or claims history. Health funds can impose waiting periods for pre-existing ailments.

Even if you have private health insurance, you are still able to be treated as a public patient in a public hospital under Medicare at no charge, should you wish to do so.

Health funds may offer loyalty bonuses to members in recognition of length of membership. A loyalty bonus may be offered as a discount on premiums or as goods and services. The decision to offer a loyalty bonus and the type of bonus is at the discretion of the health funds. You should contact your health fund to find out what kind of loyalty bonuses it offers and how they are applied.

Prior to Government reforms such as the 30% Rebate and Lifetime Health Cover, the number of Australians with private health insurance was falling. This decline in membership numbers was creating unsustainable pressure on the public health system by substantially increasing Medicare costs. The Government is committed to easing the burden on Medicare by striking a better balance between the private and public sectors, ensuring that Australians have a choice in their health care through a viable private health industry operating alongside a high quality public system with universal access.

The contact details for the health funds can be found in the Yellow Pages under health insurance. Or, if you would like information relating to the various health funds via the Internet, the Private Health Insurance Administration Council (PHIAC) web site details all registered health funds within each State. It also provides contact details for each fund and, if they have a web site, a link to each fund's website.

If you feel that you have been treated unfairly, or you are unhappy with the service and information provided by your health fund, you should contact the Private Health Insurance Ombudsman which is established to assist consumers in these situations. The free call phone number is 1800 640 695.

If you cannot afford the premiums for private health insurance or do not wish to take out private health insurance for any other reason, you can continue to access the public hospital system through Medicare on the basis of clinical need.

Yes, even if you have private health insurance you are able to access the public hospital system through Medicare.

No, the decision to purchase private health insurance is entirely up to you. However, if you are eligible for Medicare, and you earn an annual income in excess of $50,000 for singles and in excess of $100,000 for couples/families (with family income being adjusted by $1,500 per annum for each child after the first), you will be required to pay the Medicare Levy Surcharge if you do not have an appropriate level of private health insurance. This Medicare Levy Surcharge is 1% of your income. The surcharge is administered by the Australian Taxation Office who can be contacted on 13 28 61 or http://www.ato.gov.au.

If you were ill before you took out private health insurance, you will have to serve a pre-existing ailment waiting period before you are covered for treatment associated with your illness. This waiting period is usually 12 months, however, you should check this with your fund.

When you join a health fund or increase your level of cover you may have to wait some time before you are able to claim benefits. This waiting period protects you and others in your health fund by making sure that people can not join a health fund solely for the purpose of making a claim, and then dropping their cover. This type of "hit and run" behaviour results in increased premiums for everyone.

Private health insurance does not cover medical services that are provided out of hospital and which are covered by Medicare. These services include GP visits and consultations with specialists. Private health insurance may not cover the total cost of the doctors' services provided to you in hospital, which in turn may leave you with an out of pocket expense. This out of pocket expense is referred to as the gap. Individual health funds can inform you whether they offer a product that covers you for all or part of the gap, and will provide details of the doctors and hospitals with which they have agreements to cover the gap. You can check with your health fund to see what it offers.

If you purchase hospital cover with a private health insurance fund, you will be covered for some or all of the costs of being a private patient in either a public or private hospital. Alternatively, you can still be treated as a public patient in a public hospital at no charge to you under Medicare, should you wish. The exact amount of hospital treatment you are covered for depends on the level of hospital cover that you purchase, as well as the hospital and doctor you choose and whether they have an agreement with your health fund. You can also purchase ancillary cover (also known as extras cover) that may offer you cover for services out of hospital that are generally not provided under Medicare, such as: dental treatment ambulance chiropractic treatment home nursing podiatry physiotherapy occupational therapy speech therapy glasses and contact lenses

No. The decision to purchase private health insurance is a personal choice. People who cannot afford the premiums for private health insurance or do not wish to take out private health insurance for any other reason, continue to have the right to access the public hospital system through Medicare on the basis of clinical need. Please note that even if you have private health insurance, you can still elect to be treated as a public patient in a public hospital under Medicare.

Being a private health insurance member allows you to be treated in a private or public hospital as a private patient. This means that you may be able to choose the doctor that treats you, the hospital you are treated in and a time for treatment that suits you. Private health insurance also provides cover for services not covered by Medicare such as physiotherapy, dental, optometry and podiatry services. Many people rely on private health insurance to access services they would otherwise be unable to afford. The decision to purchase private health insurance is a personal choice. People who cannot afford the premiums for private health insurance or do not wish to take out private health insurance for any other reason, continue to have the right to access the public hospital system through Medicare on the basis of clinical need.

You may purchase private health insurance to cover all or some of the costs of health care as a private patient. There are two types of private health insurance cover available: hospital cover and ancillary (or extras) cover. Hospital insurance covers all or some of the costs of hospital treatment as a private patient including doctor's charges and hospital accommodation. This applies when you are a private patient in a public or private hospital or day hospital facility. Ancillary cover helps with the cost of services such as physiotherapy, dental and optical treatment. Some funds offer packaged products that cover both hospital and ancillary services. Generally, the more extensive the health cover, the greater the contribution rate (premium). When choosing your private health insurance, it is important to make sure it suits your particular needs, as well as your budget. Health funds should provide you with the information to make an informed choice about a private health insurance cover that is appropriate for you.

No. Only Australian registered private health insurers can offer OSHC. This is because the Australian Government wants to be able to monitor and regulate insurers covering people living temporarily in Australia. The Government is not able to protect the interests of people insured by overseas insurance companies in the same way.

Your educational institution may have an agreement with a specific OSHC provider. You can choose to take our OSHC with your institutions provider, or with the Australian OSHC provider of your choice. You may transfer to another OSHC provider at any time, but you may incur a ‘refund processing fee’ if you transfer midway through a period of cover. If you have paid in advance, you can get a refund. To obtain a refund you must provide proof to your previous health insurer that you have a valid OSHC policy with a new health insurer that overlaps the period covered by your previous health insurer. When transferring between health insurers, any periods of membership served with one health insurer will count toward waiting periods with your new health insurer, providing there is no lapse in membership.

Renewing your OSHC is easy. You can renew your cover by either contacting the provider of your OSHC or the institution at which you study. If you have allowed your cover to lapse, when you renew your OSHC you will have to back-pay for any period that your were not covered by OSHC. Providers of OSHC will not pay medical costs for periods when you were not covered by OSHC.

If you don’t renew your OSHC, you will have to meet the full cost of all hospital and medical treatment that you and your dependents need while you are in Australia. This can be very expensive. In fact, a number of international students who have not renewed their OSHC have experienced significant financial difficulties. If you don’t renew your OSHC, you will also be in breach of your student visa conditions.

It is a visa requirement that from 1 July 2010, students must obtain OSHC for the proposed duration of their student visa. If you extend the length of your student visa, you must renew your OSHC policy. Further information regarding student visas is available at the Department of Immigration and Citizenship website (www.immi.gov.au/students/)

When you receive a bill for medical treatment, there are generally two choices. You can pay the bill and then get a refund from your health insurer, or the unpaid account can be given directly to your health insurer. For pharmaceutical claims, you need to pay the chemist first and then claim back from your health insurer. Hospital bills are normally sent directly to health insurers for payment. However, arrangements for payment of treatment expenses will vary between health insurers. You should contact your health insurer for further information.

You can choose to visit any general practitioner or go to the outpatients department of a public hospital. If necessary, the doctor will refer you to a specialist for further treatment. If you require hospitalisation, you can choose to be admitted to either a public hospital or a private hospital. Make sure you check with your OSHC provider before you are admitted to a private hospital because not all services will be covered if you go to a private hospital and you may have to pay extra if the private hospital does not have contractual arrangements with your OSHC provider.

The average cost of OSHC is $382 (Australian Dollars) for 12 months single cover, $764 for 12 months family cover (current as at January 2010).

High cost pharmaceuticals

Under OSHC policies, benefits are paid for up to $50 per pharmaceutical item to a maximum of $300 a year for a single membership ($600 for a family membership). Overseas students may face significant out of pocket costs if they need treatment with pharmaceuticals, particularly oncology (cancer) treatment.

Other treatments/services not covered under OSHC

assisted reproduction services, such as in-vitro fertilisation (IVF) treatment arranged before coming to Australia treatment needed while travelling to or from Australia treatment during the first 12 months of membership for pre-existing medical conditions or disabilities pregnancy-related services if the length of the visa is three months or less transportation of an overseas student or dependent into or out of Australia for any reason treatment covered by provisions for compensation and damages. OSHC does not pay for general treatment (ancillary or extras cover, for example dental, optical or physiotherapy). Overseas students requiring cover for these types of health services may take out Extra OSHC provided by an OSHC provider or general treatment cover with any Australian registered private health insurer. Overseas students are also free to supplement OSHC with other insurance, such as international travel insurance. If you require Extra OSHC or general treatment cover, you should contact the insurers for further information.

OSHC provides a safety net for international students. It includes cover for visits to the doctor, some hospital treatment, ambulance cover and limited pharmaceuticals. OSHC includes cover for: the benefit amount listed in the Medicare Benefits Schedule (MBS) for out-of-hospital medical services (for example, a general practitioner) 100%of the MBS fee for in-patient medical services (for example, surgery) public hospital shared ward accommodation private hospital shared ward accommodation (only for hospitals that have contractual arrangements with the overseas student’s health insurer) day surgery accommodation some prosthetic devices limited pharmaceuticals ambulance services.

You can arrange to pay for your OSHC through your educational institution or you can purchase OSHC online by visiting the OSHC providers’ websites. You retain the right of choice of OSHC provider even where your educational institution makes a specific recommendation because they have negotiated a preferred provider arrangement with a particular insurer.

Australian Health Management BUPA Australia Medibank Private OSHC Worldcare nib OSHC

People who must take out OSHC are overseas students undertaking formal studies in Australia and their dependents (for example, spouses and children under 18 years old). For the purposes of OSHC, ‘overseas student’ means: a person who is the holder of a student visa; or a person who: is an applicant for a student visa; and is the holder of a bridging visa; and was immediately before being granted the bridging visa, the holder of a student visa. The Department of Immigration and Citizenship requires overseas students to maintain OSHC for the duration of time they are in Australia. You will need to buy OSHC before you come to Australia, to cover you from when you arrive. You will also need to maintain OSHC throughout your stay in Australia.

Norwegian students

As a result of an agreement between the Australian and Norwegian governments, all Norwegian students are provided with adequate health insurance by the Norwegian government and the compulsory OSHC visa requirement is waived for Norwegian students.

Swedish students

Swedish students may be waived the compulsory OSHC visa requirement. Swedish students whose insurance is provided by CSN International (the Swedish National Board of Student Aid) or Kammarkollegiet (the Swedish Legal, Financial and Administration Agency) will not need to take out OSHC. If you are a Swedish student who is not covered by CSN or Kammarkollegiet, you will need to take out OSHC.

OSHC is insurance to assist international students meet the costs of medical and hospital care that they may need while in Australia. OSHC will also pay limited benefits for pharmaceuticals and ambulance services.

After hours services provided by GP Super Clinics will be determined depending on the local needs and priorities of the community, taking into account the availability of existing after hours GP services.

No. GPs and other health practitioners recognised by the Medicare Benefits Schedule practising in GP Super Clinics will be strongly encouraged (though not compelled) to bulk bill MBS funded services.

The Australian Government will work closely with local doctors, health professionals and communities to ensure that the services offered at a GP Super Clinic complement and enhance – but do not compete with – existing services. The range of services will be tailored to the needs and priorities of the local community. It is anticipated that most GP Super Clinics services would include privately practising GPs; chronic disease management services; and a range of services provided by nurses and allied health professionals, such as physiotherapists, occupational therapists, dietitians, podiatrists, psychologists, osteopaths, speech pathologists, exercise physiologists and audiologists.

GP Super Clinics are health centres that will allow privately practising GPs and other health care providers, including nurses, allied health professionals, physicians and specialists to work together with greater access to medical and information technology, to provide multidisciplinary care which is tailored to the needs and priorities of the local community. The clinics will also allow people who require treatment from a range of health care providers to access these services more conveniently. The GP Super Clinics may also support the future primary care workforce by providing teaching rooms and facilities for students and new graduates, in addition to prevocational doctors and GP registrars within a high quality clinical training environment.

You can obtain publications, flyers or brochures via http://www.health.gov.au/internet/main/publishing.nsf/Content/publica tions-ordering

Some health problems associated with international travel are vaccine preventable. Travellers should consult a travel medical centre, or their local doctor, at least 6 - 12 weeks before departure, for a check-up and to discuss required and recommended vaccinations for specific regions. The websites below provide information about vaccinations and tips for staying healthy while overseas: Smartraveller (Department of Foreign Affairs and Trade); International travel and health (World Health Organization); and Travelers’ health (US Center for Disease Control & Prevention).

For help in finding a position as a medical practitioner in Australia, please see the Doctor Connect website which is run by the Department of Health and Aging: http://www.doctorconnect.gov.au The Australian Government has contracted several medical recruitment agencies to support appropriately qualified overseas trained doctors through the recruitment process leading to employment as general practitioners (GP) or specialists in the Australian medical workforce. Also, please see the page http://www.doctorconnect.gov.au/internet/otd/Publishing.nsf/Conten t/work-Finding-a-job which has a checklist for overseas trained doctors (OTDs) and suggestions on how to find a position.

Information regarding the Aged Care Funding Instrument (ACFI) Classification form can be viewed via http://www.health.gov.au/internet/main/publis hing.nsf/Content/New+Funding+Model+for+Residential+Aged+Care-1

Many children experience minor side effects following immunisation. Most side effects last a short time and the child recovers without any problems. Common side-effects of immunisation are redness, soreness and swelling at the site of an injection, mild fever and being grizzly or unsettled. Serious reactions to immunisation are very rare, however if they do occur consult your doctor immediately. It is important to remember that vaccines are many times safer than the diseases they prevent.

Information regarding Community Aged Care Package (CACP) can be viewed via http://www.agedcareaustralia.gov.au/internet/agedcare/publishing.nsf/ Content/CACP-1

Information regarding 'how my elderly parents can stay at home' can be viewed via: http://www.agedcareaustralia.gov.au/internet/agedcare/publishing.nsf/Co ntent/EACH

The Home & Community Care report can be viewed or downloaded via: http://www.health.gov.au/internet/main/publishing.nsf/Content/ hacc-annual-report-07-08.htm

In general, the normal immune response takes approximately two weeks to work. This means protection from an infection will not occur immediately after immunisation. Most immunisations need to be given several times to build long lasting protection. For example, a child who has been given only one or two doses of diphtheria-tetanus-pertussis vaccine (DTPa) is only partially protected against diphtheria, whooping cough (pertussis) and tetanus, and may become sick if exposed to these diseases. However, some vaccines give protection after only one dose.

The Aged Care Asset Assessment form can be downloaded via http://www.health.gov.au/internet/main/publishing.nsf/Content/age ing-rescare-aaform.htm

The Residential Care Manual can be viewed or downloaded via http://www.health.gov.au/internet/main/publishing.nsf/Conte nt/ageing-manuals-rcm-rcmindx1.htm

Vaccination means having a vaccine - that is actually getting the injection. Immunisation means both receiving a vaccine and becoming immune to a disease, as a result of being vaccinated.

Keep the aid on file for future use.

Yes

Please follow http://www.pbs.gov.au/html/consumer/browseby/product for the PBS listing.

If sufficient services to satisfy the requirements for both services have been performed yes. (Note: partial assessment which is usually a major component of adjustment items cannot be included when determining services provided in these cases.) If it is decided at the assessment the client will need to be refitted, you should not claim an adjustment.

Many of medicines available on prescription are subsidised under the PBS. Some of the reasons why your medicine may not be available on the PBS are: the manufacturer has not registered the medicine to treat your particular condition with the Therapeutic Goods Administration (TGA); the manufacturer has not applied to the government’s independent expert committee – the Pharmaceutical Benefits Advisory Committee (PBAC) – to evaluate the listing of your medicine on the PBS; or the manufacturer hasn’t yet supplied sufficient evidence, or the evidence supplied does not support a recommendation by the PBAC.

Before a medicine can be subsidised through the PBS, the Pharmaceutical Benefits Advisory Committee (PBAC) must assess it. The PBAC, an independent expert body whose membership includes doctors, other health professionals and a consumer representative, recommends new drugs to be listed.

You are eligible to apply for the program if you are an Australian Citizen or permanent resident 21 years or older, and you are: a Pensioner Concession Card Holder receiving a Sickness Allowance from Centrelink the holder of a Gold Repatriation Health Card (DVA) issued for all conditions the holder of a White Repatriation Health Card (DVA) issued for conditions that include hearing loss a dependent of a person in one of the above categories a member of the Australian Defence Force; or undergoing an Australian Government funded vocational rehabilitation service and you are referred by your service provider.

From 1 January 2010, if you’re a general patient who needs a lot of medicines, once you’ve reached the Safety Net threshold of $1,281.30, you will pay the concessional rate ($5.40) for further PBS prescribed items for the remainder of the calendar year. From 1 January 2010, if you or your family receive PBS medicines at the concessional rate, your patient copayment per prescription item will be removed once you’ve reached the Safety Net threshold of $324.00. Further PBS prescribed medicines are provided free for the remainder of the calendar year.

It is illegal to take or send PBS subsidised medicine out of Australia for reasons other than for your personal use or the use of someone travelling with you (eg. a child). A doctor's prescription or letter may be adequate to present to Customs to confirm that the drugs are required for the treatment of a medical condition and that possession is in accordance with Australian laws. There are specific arrangements which allow PBS medicines to be sent from Australia for use by Government officers working overseas. To avoid breaking drug laws overseas you should contact the embassy/consulate of all of the countries you will be visiting and confirm any special requirements (eg number of doses permitted). Should the overseas authorities require a letter from the Australian Government contact the Treaties and Export Section of the Therapeutic Goods Administration on (02) 6270 4321 at least 10 working days prior to departure.

The Schedule of Pharmaceutical Benefits is available from our print on demand vendor, their details and order form are available from the below web link. http://www.pbs.gov.au/html /healthpro/ordercopy The prices for the Pharmaceutical Benefits Book are listed on the order form.

Should an aid be lost or damaged beyond repair, the client is required to pay a $30.00 replacement fee. If two aids are lost or damaged beyond repair, the fee remains at $30.00. A replacement fee was introduced in 2000 to assist in the cost of replacing a hearing aid. The Office of Hearing Services believes that $30.00 is a reasonable charge when compared to the cost of a hearing aid. The most commonly fitted aids cost the Office approximately $400.00 plus a fitting fee to replace. The replacement fee is applied to the provision of all replacement aids. However, the fee will be waived where the: client holds a DVA Gold Repatriation Card; or client holds a DVA White Repatriation Card accepted for hearing loss. The fee may also be waived where the: the aid(s) is lost or damaged by nursing home/ residential or hospital staff, and this is certified by the responsible staff member; the aid(s) has been lost or damaged by Australia Post or another courier; the aid (s) has been lost in a hospital; or the client has dementia Should you wish to apply for the replacement fee to be waived, discuss this with your Hearing Services Provider when lodging the statutory declaration for the lost or damaged aid.

Even when all the doses of a vaccine have been given, not everyone is protected against the disease. Measles, mumps, rubella, tetanus, polio and Hib vaccines protect more than 95% of children who have completed the course. One dose of meningococcal C vaccine at 12 months protects over 90% of children. Three doses of whooping cough (pertussis) vaccine protects about 85% of children who have been immunised, and will reduce the severity of the disease in the other 15% if they do catch whooping cough. The protection levels provided by vaccines differ. For example, if 100 children are vaccinated with MMR, 5-10 of the fully immunised children might still catch measles, mumps or rubella (although the disease will often be milder in immunised children). However, if you do not immunise 100 children with MMR vaccine, and the children are exposed to measles, most of them will catch the disease with a high risk of complications like lung infection (pneumonia) or inflammation of the brain (encephalitis). Booster doses are needed because immunity decreases over time.