Important Information - About Your Policy - Navy Army Air Force - Navy Health
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Private Health Insurance
Important Information
About Your Policy
· ·
Navy Army Air Force
Private Health Insurance • 2 Contents Membership Types 4 Membership Information 5 Australian Government Private Health Insurance Rebate 6 Lifetime Health Cover Loading 8 Medicare Levy Surcharge 9 Benefit Conditions 10 Hospital Benefits and Claiming 11 Extras Benefits and Claiming 14 General Information 16 Health and Wellness Initiatives 19 Terms and Conditions 20
Private Health Insurance • 3
Private Health Insurance • 4
Membership Types
Single membership Single parent family A dependant can take up membership
Cover is for one adult only. Cover is for one adult and dependants. in their own right at any time after
being ineligible to continue under
Couple membership Dependants only their parent’s cover, however some
waiting periods may apply unless
Cover is for the member with a Cover is for dependants only. The
membership is taken up within
spouse/partner. adult listed as the member is not
30 days. The new membership
covered under the policy.
will take effect from the day after
Family membership
they become ineligible on their
Cover is for the member with Military memberships
parent’s membership.
a spouse/partner, plus; A ‘military family’ is the spouse/
For more information please call
• any unmarried children until they partner and/or dependants of the
1300 306 289 or go to
turn 22 years of age or enter into a serving person. However, the serving
navyhealth.com.au
de facto relationship. person will not be listed or covered
by the policy.
• any unmarried children between
the age of 22 and 25 years who are
Young adult membership
undertaking a course of study at
a publicly funded or private Young adult membership is for non-
sector tertiary institution which student dependants over 22 years of
requires a full-time study age. They will remain covered under
workload in Australia. the existing family hospital cover (at
no extra charge) as long as they are
You should advise Navy Health of any covered on their own extras cover.
unborn children before the expected Young adult membership applies
due date (if possible). To ensure no until the dependant turns 25 years of
waiting periods will apply for newborn age, marries or enters into a de facto
children, they must be added within relationship.
two months of birth (and backdated to It’s important to note that a non-
date of birth). student dependant must take up
Please note: a dependant who is no longer any extras cover within 30 days of
eligible for cover under a parent’s membership being ineligible to continue under a
is able to take out membership in their own parent’s membership. Continuity of
right. If the new cover is started within 30 days
hospital cover carried over from a
at an equivalent level, no additional waiting
parent’s membership will be provided
periods will apply.
as long as the parent’s membership is
still current.Private Health Insurance • 5
Membership Information
When does membership When are contributions Cooling off period
commence? payable? Members can choose not to proceed
Your membership commences from Payment of contributions is always in with their Navy Health cover and
your chosen start date. advance. Direct debit payments can request to have any premiums
be made on a fortnightly, monthly, reimbursed. This reimbursement is
How can I change my quarterly, six monthly or yearly basis. on the condition that the member
membership? Partial payments are not accepted. expresses their request to the fund
Any changes to the status of within 30 days of their cover
membership (i.e. level of cover, Discounts commencing, and that no claims have
adding or removing dependants) Members choosing to pay half-yearly been lodged or are pending during the
cannot be undertaken without Navy will receive a 2% discount and annual 30 day cooling off period.
Health receiving advice from the payments will receive a 4% discount.
authorised member or person. The Suspension of membership
If you are an Active Reservist (SERCAT
change cannot be taken as being 3 and above) or hold a current Veteran Navy Health at its absolute discretion
actioned until the member receives Gold or White Card, you are eligible may allow, within a clearly defined
acknowledgement from Navy Health. for a 10% discount on your policy limited set of circumstances,
The earliest effective date of any premiums.* for a member to suspend their
change will be the date notification is membership for an agreed period.
A serving person’s spouse/partner
received by Navy Health. Where the suspension has been
and/or dependants are eligible for
The easiest method of changing approved in writing by Navy Health,
a 10% discount on their policy
details is via Online Member Services members will be advised of the
premiums until the serving person
at navyhealth.com.au/members or call conditions relating to waiting
discharges from the Australian
us on 1300 306 289. periods and pre-existing condition
Defence Force (ADF).
rules which may be applied upon
*Veteran White and Gold Cardholders and
Cover changes reinstatement of membership.
Active Reservists (SERCAT 3-5) must be
Transferring to a higher level of cover covered by the membership for the discount The agreed suspension period is
will result in the member and any to apply. Active Reservists and serving ADF not subject to change without
persons covered having to serve members must pay via direct debit on selected written notification to and written
new waiting periods. Whilst these payment frequencies. Only one discount confirmation from Navy Health.
can be applied to a membership. Proof of
waiting periods are in force, benefits ADF personnel can suspend their
eligibility must be provided for discount to
will still be payable at the previous cover when they are posted overseas.
apply. Discounts will only be applied up to a
level of cover. Higher benefits are not maximum of 10% across the policy. Please visit Members who move into continuous
payable for pre-existing ailments or www.navyhealth.com.au/defence-discounts/ full time service (CFTS) can also
conditions (regardless of whether for full terms and conditions. suspend their cover for the duration of
or not they have been diagnosed) the CFTS.
until a waiting period of 12 months When does membership cease? For more information please go to
has been served. This also applies A membership will cease on a navyhealth.com.au
to Pregnancy & Birth and Assisted date advised and paid to by the
Reproductive Services. member or automatically when
contribution payments are more than
one month in arrears.Private Health Insurance • 6
Australian Government
Private Health
Insurance Rebate
Most Australians The rebate you are eligible for • through a reduced premium; or
depends on your age*, is income- • through your tax return with the
with private health tested and applies to all Navy Health Australian Tax Office (ATO)
insurance currently health insurance covers. The rebate
If you choose to receive your rebate
isn’t applicable to the Lifetime Health
receive a rebate Cover loading portion of membership through your insurer, you will be asked
to nominate the tier you expect to fall
from the Australian payments.
into in order to avoid a tax liability.
Below are the thresholds set by the
Government to help Australian Government. The income You can nominate your tier by
cover the cost of their thresholds will remain at the current contacting Navy Health.
levels until 1 April 2021. More information regarding the
premiums. Australian Government Rebate is
The rebate is indexed each year by
the difference between the Consumer available at navyhealth.com.au/
Price Index (CPI) and the industry knowledge-base-articles/private-
average increase in premiums using a health-insurance-rebate or by
Government calculated formula. phoning 1300 306 289.
If you aren’t sure which rebate tier
Claiming the rebate you should choose, please contact
If you are eligible for the rebate, there your tax agent, financial advisor
are two ways you can claim: or the ATO at www.ato.gov.au/
privatehealthinsurance
Federal Government Rebate*
Income for rebate purposes Under 65 65-69 years 70+ years
years
Single $90,000 or less
Base Tier 24.608% 28.710% 32.812%
Couple/Family $180,000 or less
Single $90,001 – $105,000
Tier 1 16.405% 20.507% 24.608%
Couple/Family $180,001 – $210,000
Single $105,001 – $140,000
Tier 2 8.202% 12.303% 16.405%
Couple/Family $210,001 – $280,000
Single $140,001 or more
Tier 3 0% 0% 0%
Couple/Family $280,001 or more
*The rebate is based on the age of the oldest person on your cover.Private
Private Health
Health Insurance
Insurance • 7Private Health Insurance • 8
Lifetime Health
Cover Loading
Lifetime Health Cover If you take out private hospital cover ADF personnel and Veteran
by 1 July after your 31st birthday and Gold Card holders
(LHC) is a Government maintain that cover, you will not have If you are a member of the Australian
initiative that started to pay LHC. Defence Forces (ADF) your medical
If you decide to take out hospital services are provided by the ADF, so
on 1 July 2000. It was cover at a later date, you’ll pay 2% you are considered to have hospital
designed to encourage more for your hospital premiums for cover. If you joined the ADF prior
every year you’re over 30. to 1 July 2000, your entry age upon
people to take out discharge will be 30. If you joined the
hospital insurance Other things to know ADF on or after 1 July 2000, your entry
about LHC: age is that at which you joined the
earlier in life and to ADF, unless you previously had private
• the maximum LHC loading you can
maintain their cover. have is 70% at 65 years old; health insurance.
• people who were born on or before If you hold a Veterans’ Gold Card you
1 July 1934 are exempt from the are considered to have hospital cover.
loading; If you have held a Gold Card at any
• LHC loadings stay on your cover time since 1 July 2000, and the card
for 10 years. Once you have paid was subsequently withdrawn by the
for 10 continuous years of hospital DVA, you may claim the period you
cover the loading is removed (some held the card as a period with private
conditions apply). health insurance.
To accommodate small breaks in
Lifetime Health Cover your cover the Government allows a
on discharge number of permitted days without
Health care costs of serving members hospital cover. For a full explanation
are met by the Commonwealth of how this works and other LHC
until the date of discharge. This is conditions go to privatehealth.gov.au
regarded as the equivalent of private
health insurance and as such, no
Lifetime Health Cover penalty applies
to members of the ADF when they
separate, providing they take out
hospital cover immediately
following discharge.Private Health Insurance • 9
Medicare
Levy Surcharge
The MLS aims to The Medicare Levy Surcharge (MLS) You may also be subject to the MLS,
is levied on Australian taxpayers who if your taxable income is over the
encourage individuals do not have private hospital cover and threshold and you have a dependent
to take out private earn above a certain income. The who is not currently covered by an
MLS aims to encourage individuals to approved health cover.
hospital cover and take out private hospital cover and
As an ADF serving member, you would
where possible, to use where possible, to use the private
have been exempt from paying the
system to reduce the demand on the
the private system public system.
levy if you were single or only paid 1% if
you had a family. Although as an ADF
to reduce the demand The MLS covers you and your member you may not require health
on the public system. dependants. Your dependants include insurance, if your combined family
your spouse/partner, any of your income is above $180,000, your family
children who are 21 years of age or will need to take out private hospital
under, or any of your student children cover to avoid MLS.
who are under 25 years of age.
If you or your family receive a high
The MLS is calculated at the rate of income, it is advisable to consider
1% to 1.5% of your income for MLS private health insurance to avoid
purposes. It is in addition to the the MLS.
Medicare Levy of 2%, which is paid by
For more information regarding the
most Australian taxpayers.
MLS please go to navyhealth.com.au/
Single parents and couples (including knowledge-base-articles/medicare-
de facto couples) are subjected to levy or the Australian Taxation Office
family tiers. For families with children, website at ato.gov.au
the thresholds are increased by $1500
for each child after the first.
Income for Rebate Purposes
MLS
No Tier Single $90,000 or less
0.0%
No change to rebate or MLS Couple/family $180,000 or less
Single $90,001 – $105,000
Tier 1 1.0%
Couple/family $180,001 – $210,000
Single $105,001 – $140,000
Tier 2 1.25%
Couple/family $210,001 – $280,000
Single $140,001 or more
Tier 3 1.5%
Couple/family $280,001 or more
Medicare Levy Surcharge information correct as of 1 April 2021.Private Health Insurance • 10
Benefit Conditions
For general treatment Benefit year • the procedure does not have an
For general treatment (extras) the assigned Australian Government
(extras) the Navy Navy Health benefit year is 1 July to Medicare Benefits Schedule
Health benefit year is 30 June. For hospital products with an item number;
excess, the benefit period is a rolling • the claim is within a specified
1 July to 30 June. For 12 month period. (i.e. the excess is waiting or replacement period
hospital products with payable once per adult, in full, up to or annual/sub limits have been
the family maximum, in any rolling 12 reached;
an excess, the benefit month period). • providers of in hospital services
period is a rolling 12 submit medical claims two years
When are benefits not payable?
month period. after the date of service, unless
Benefits are not payable when: approved by Medicare Australia
• claims are over two years from the for benefits;
date of service; • the services are performed, or
• claims for the same service exceed the products used are purchased,
two treatments on the same day; outside of Australia;
• the provider is not recognised in a • the membership is in a period of
private practice; suspension or payment arrears;
• the provider is not recognised • the services are considered to be
by Australian Health Practitioner cosmetic surgery (not deemed
Regulation Agency (AHPRA); medically necessary);
• for Natural Therapies, the provider • the extras service provided has an
is not recognised by the Australian assigned Medicare item number;
Regional Health Group (ARHG), • when treatment is provided during
or Exercise and Sports Science an emergency department visit;
Australia (ESSA); • treatment has been already
• if the service forms any part subsidised by any Government
of a payment from Workers’ department.
Compensation, Third Party or
any other liability provision, Navy Overseas benefits
Health reserves the right to seek Navy Health will not pay benefits on
full reimbursement on any benefits any services, treatments or products
paid in these circumstances from received outside of Australia or when
Workers’ Compensation, Third Party purchased from a provider without an
or any other liability provision; Australian Business Number (ABN).Private Health Insurance • 11
Hospital Benefits
and Claiming
Navy Health aims When treated as a private patient Access Gap
in a hospital, members may face Navy Health’s Access Gap scheme aims
to close the gap on extra costs when the treating doctor to minimise the difference between the
out of pocket in charges more than the Medicare Medicare fee and what your Specialist
Benefits Schedule (MBS) allows for the charges. Specialists can choose to take
hospital expenses. service provided. part in Access Gap on a case-by-case
A gap payment is the basis; if they take part you’ll either have
Gap medical no gap or be told exactly what your
difference between The ‘gap’ is defined as the monetary out-of-pocket costs will be. Even if your
the fee charged by variation between the MBS fee and the Specialist elects not to take part, you
doctor’s fee. are legally entitled to know any out-of-
the hospital or doctor pocket cost before your procedure —
If the member receives treatment as
and the benefit paid a private patient in a hospital from a ask your Specialist.
by Navy Health doctor who chooses not to participate
in the Access Gap Scheme, Gap Medical
and Medicare. MBS Fee Gap
benefits will apply (see below).
Under Gap Medical benefits, Medicare
Medicare Fund Patient
will cover 75% of the MBS fee for the
75% 25% 100%
service that has been provided. The
insurer will pay the remaining 25% of
the MBS fee.
If the doctor charges more than
the MBS fee, the member will be
responsible for any ‘gap’ payment.Private Health Insurance • 12
Hospital Benefits
and Claiming
Private and day hospital Known Gap Scheme Prosthetic appliances
— contracted facilities If your chosen Specialist bills with A prosthesis is an artificial substitute
and services a Known Gap through Access Gap, or replacement body part attached
Prior to admission, please check with your out-of-pocket expenses relating or applied to the body to replace a
Navy Health as to whether or not your to your in-hospital treatment will be missing part.
treatment or service is contracted. capped. You won’t be charged any If you are having surgery to implant or
Contracted services relate to hospital additional amounts other than what apply a prosthesis, your private health
fees such as accommodation and you’ve agreed to in your Informed insurer must pay a benefit for it if:
theatre. Financial Consent before your in-
• you have the correct cover for the
Navy Health has been able to hospital treatment.
treatment and the product is on the
negotiate 100% benefits on most Australian Government Prostheses
treatments and services at over 500 No Gap Scheme
List.
private hospitals and day facilities. If your chosen Specialist chooses to
• the insurer will pay the recommended
Product excesses still apply. bill you with no gap, you will not have
minimum benefit as shown on the
Prosthesis items are payable at any out-of-pocket expenses for their
Prostheses List.
100% of the minimum Government in-hospital treatment.
• the Prostheses List will have at least
recommended fee. There is at least The maximum an individual specialist
one no gap prosthesis or device
one prosthesis item available for every can charge under the Access Gap
item for every in hospital procedure
surgery with no out of pocket expense scheme is $500, per admission to
covered on the MBS.
to the patient. Drugs prescribed for hospital, or $800 for obstetrics (as
discharge and drugs not directly a private patient). Specialists can no No benefit is payable where the
associated with the reason for longer charge fees not associated hospital charges for a prosthetic
admission are excluded from contracts with the Medicare item number. appliance or device not listed on the
and are the patient’s responsibility. Prostheses List.
Navy Health’s agreements are
In addition, if a patient chooses to negotiated by the Australian Health
stay in an executive suite, the patient Service Alliance (AHSA).
will be required to pay the difference Please refer to navyhealth.com.au/
between the private room benefit knowledge-base-articles/cover-the-
and the executive suite charge. gap for further information.
There are 2 ways the Access Gap
scheme can work for you; Known
Gap Scheme or No Gap Scheme.
Access
MBS Fee Gap
Gap Fee
Medicare Fund Fund Patient
75% 25% 100% 100%Private Health Insurance • 13
Podiatry surgery Full ambulance cover
Benefits are available only when All Navy Health hospital and extras
Podiatric Surgery is performed in a policies provide full ambulance cover
contracted hospital by an Australian within Australia, provided that the
Government Accredited Podiatrist. service is from a State/Territory
For further information call Online registered ambulance service and
Member Services on 1300 306 289. deemed medically necessary.
Transport services by Patient
Pharmacy Transport vehicles are not ambulance
Any drugs administered in-hospital services and are not covered.
that are not on the pharmaceutical
benefits scheme (PBS); may incur out Hospital claiming
of pocket expenses to be paid by you. Generally hospitals will invoice
Please ensure the hospital provides Navy Health directly.
you with informed financial consent. If you do receive an invoice for
your hospital stay please contact Navy
Exclusions Health on 1300 306 289.
Where excluded services are listed on To search for agreement hospitals and
your policy, no benefits will be paid. specialists in your area, please go to
navyhealth.com.au/providers
Restricted cover
For services that are listed as
restricted on your policy, you can
only be treated as a private patient in
a public hospital. If you are treated
anywhere else such as a private
hospital, you will be significantly out
of pocket.Private Health Insurance • 14
Extras Benefits
and Claiming
You can make claims Preferred optical providers CPAP devices
If a member uses one of Navy Health’s CPAP devices cannot be purchased
for most extras services Preferred Optical Providers, they can more than once in any rolling three
at your provider at the receive an additional benefit (subject year period. The rolling three year
to the annual maximum). To view the replacement period starts from the
time of service. list of preferred optical providers go to first date of purchase.
navyhealth.com.au/optical
The Preferred Optical Provider list is Pharmacy
subject to change without notice. Your extras policy will only cover
pharmacy items that meet the
Natural therapies and following criteria:
recognised providers • not supplied or already covered
Natural therapies include Acupuncture, under the Pharmaceutical benefits
Chinese Herbal Medicine, Myotherapy, scheme (PBS);
Remedial Massage and Exercise
• are fully approved by the
Physiology.
Therapeutic goods administration
Benefits are not payable on any (TGA);
medications, herbal or dietary
• are not experimental drugs or are
preparations, or organised weight
part of a drug trial;
reduction programs.
• prescribed by an Australian
Medically Prescribed registered medical practitioner,
Appliances (MPA) including dentists and nurses;
MPA claims must be accompanied • supplied by a registered Australian
by a referral from a registered Pharmacist and are schedule 4 or 8
practitioner. The following are medicines only;
examples of items that can be • are not vitamins, weight loss drugs,
claimed under the MPA category: contraceptives, herbal medicines,
Nebulisers, Humidifiers, Blood Glucose over the counter pharmacy or non-
Monitors, Heart Rate/Blood Pressure prescription drugs.
Monitors, Support Aids/ Mobility Aids,
Compression Garments, Non-cosmetic
Prostheses (Premium Extras only), and
TENS Machine/ Circulation Boosters.
The MPA category covers the
purchase, hire and repairs to
appliances that are covered under the
category up to the annual limit.Private Health Insurance • 15
Extras Benefits
and Claiming
Electronic claiming Making claims by post
All you need is your Navy Health and email
membership card to use the electronic A completed Navy Health claim form
claiming system. After a consultation, must accompany all claims submitted
your card can be swiped through manually. A copy of receipts forwarded
the electronic claiming facility by for benefits will be held electronically
the service provider. They will enter by Navy Health on your behalf.
the claim details and process the Original receipts will not be returned
transaction on your behalf. to the member. Claim forms can be
Once the transaction has been downloaded from navyhealth.com.au/
authorised by Navy Health knowledge-base-articles/forms
electronically you simply pay
the balance amount. (This is the Benefit payment
difference between the fee charged for Benefit payments not processed
the treatment and the benefit amount at time of service can be direct
paid by Navy Health). deposited into a nominated bank
account (within Australia and
Online Members Services excluding credit cards).
claiming
You can claim your extras services
(excluding Orthodontic, MPAs and
Pharmacy) immediately via Online
Member Services.
To register and for more information
go to navyhealth.com.au/members
Claiming app
Members can claim using our
Navy Health claiming app. This is the
quickest way to submit your claim.
To download go to the App Store or
Google Play Store.Private Health Insurance • 16
General
Information
To find out if you are Waiting periods Pre-existing conditions*
Waiting periods for the selected level A pre-existing condition is where
eligible and how to of cover are detailed in the preceding signs or symptoms of an ailment,
join Navy Health go product fact sheet and need to be illness or condition, in the opinion
read carefully. of a medical practitioner appointed
to navyhealth.com.au/ by Navy Health existed at any time
If you transfer to a higher level of
eligibility cover, new waiting periods will be during the six months preceding the
applied. However, benefits at the day on which you joined the insurer
previous level will still be available or transferred to a higher benefit
whilst the new waiting periods are cover. This is irrespective of whether
being served. your medical practitioner, you and/or
your dependants were aware of the
If you transfer to a hospital product
condition or ailment.
with a lower excess, the previous higher
excess will apply for the first two The pre-existing condition rule also
months or if the condition is deemed to applies when resuming a suspended
be pre-existing. membership and symptoms or signs
developed during the suspension
All persons covered under the policy
period.
are required to complete waiting
periods of the same length The pre-existing condition waiting
as members. period provides protection for existing
members against people joining or
Transferring from another fund upgrading cover only when they
require treatment. This assists Navy
Waiting periods are not applicable if
Health in keeping premiums as low as
you had an equivalent level of cover
possible. Claims and benefits within
and completed all waiting periods with
the first 12 months of joining the
the previous fund.
insurer or increasing to a higher level
The specified waiting periods will of cover are subject to the pre-existing
apply to those aspects of the Navy condition rule.
Health cover not covered previously
*Excludes Psychiatric, Rehabilitation and
by your past fund, and for those
Palliative care.
items specifically nominated within
the products as requiring extended
waiting periods. Whilst the 2, 6 and
12 month waiting periods are being
served, benefits are payable at the
previous level of cover, including any
excesses/co-payments applicable to
your previous level of cover.Private Health Insurance • 17
General Information
Veteran Gold Cardholders Feedback and complaint Navy Health rules and
Members who are, or become handling policy constitution
Veteran Gold Cardholders have the If for any reason you are not satisfied New memberships must be in
option of retaining or cancelling their with the service you receive from accordance with the rules and
cover with Navy Health. Navy Health or feel that it has failed constitution of Navy Health Ltd.
Where a member chooses to cancel to meet your expectations, we Benefits are also paid in accordance
their coverage, they must advise would appreciate your feedback. with these rules.
Navy Health directly. The cover will be We are committed to resolving your
Members can request a copy of the
cancelled from the date Navy Health complaints in a fair and efficient
fund rules. All members are bound by
receives notification, not from the manner and view your feedback as a
the rules of Navy Health Ltd.
date of issue of the card. The person vital opportunity to improve.
holding the Veteran Gold Card may Navy Health provides an accessible,
then re-apply for membership to impartial, free-of-charge complaints
Navy Health without waiting periods handling procedure for members.
or penalties (excluding pre-existing This procedure can be viewed at
conditions ), as they are deemed to navyhealth.com.au or by phoning
have continuity of cover. 1300 306 289.
Any person who has previously held
a Veteran Gold Card is entitled to Private Health Insurance
join Navy Health from the date their Ombudsman
Veteran Gold Card is no longer valid The Private Health Insurance
without serving any waiting periods Ombudsman (PHIO) was set up by the
(excluding pre-existing conditions). Government to deal with complaints
Proof of previous Veteran Gold Card where the member has not been able
status that shows the valid from and to resolve an issue with their insurer.
to dates is required. Whilst we actively encourage all
Where a member chooses to retain members to discuss any such matters
their coverage, benefits will be with our office in the first instance, the
paid on costs incurred after the PHIO will gladly mediate if required.
Department of Veterans’ Affairs The PHIO can be contacted on
(DVA) payment in line with the level 1300 362 072, by email
of cover held, however the benefit phio.info@ombudsman.gov.au
must not exceed the total charge or or you can write to:
the Navy Health benefits and annual Commonwealth Ombudsman
limits and you may still incur an out GPO Box 442, Canberra ACT 2601
of pocket expense.
Where a member with a Veteran Gold
Card has Premium Gold Hospital
coverage, Navy Health will pay the
supplement (top up) benefit for a
private room in a private hospital, as
DVA already cover the cost of a
shared ward.Private Health Insurance • 18
Private Health Insurance • 19
Health and
Wellness Initiatives
Navy Health is Health + Care program Chronic disease
The Health + Care program is management program
continually seeking new supported by several service We offer a wide range of services to
initiatives to improve providers. Navy Health is not involved help manage chronic illnesses such
in the assessment of patients’ eligibility as coronary artery disease, diabetes
your access to quality to uptake these programs. It is and mental health. Through our
health services. important to know that the early Health + Care program, we can offer
discharge and hospital substitute telephonic or face-to-face support
program is NOT available in all (in the comfort of your own home of
hospitals; referrals to the program are course!) with a qualified registered
made by your doctor, hospital staff or nurse, helping you manage your
at the discretion of Navy Health. health better and avoid the need for
We recommend you check with a hospital stay.
your hospital or contact your provider
to discuss what services may be Broader health cover
available to you. Broader health cover is supported by
Call 1300 306 289 for more the Australian Federal Government and
information about early hospital enables private health insurers to pay
discharge or hospital substitute claims for health services that can be
programs that may be suitable for delivered just as effectively at home as
your care. they can in hospital.
Navy Health is continually seeking new Health + Care is an example of broader
initiatives to improve your access to health cover at work, assisting our
quality health services. For up-to- members in achieving and maintaining
date information regarding our good health.
Health + Care program, please visit Our integrated program allows for
navyhealth.com.au/health-care treatment to be provided either in
conjunction with hospital care or as
Online wellness portal a substitute; it may even mean you
Want to get healthier? Our online avoid a hospital stay altogether.
wellness portal is here to help. Start For more information about our
with a comprehensive Health Risk Health + Care program, refer to
Assessment to determine where your navyhealth.com.au/health-care
health priorities need to be. From here,
we’ll help develop a wellness plan and
set tasks and goals to work towards
better health.
You can also upload medical
documents and results here to keep
all your health information in the
one place!
To start your wellness journey
today, simply visit
navyhealth.com.au/health-carePrivate Health Insurance • 20
Terms and Conditions
Definitions • how you may access your personal What is personal information?
The term ‘member’ in this booklet information held by us and correct “Personal information” is information
refers to a ‘policy holder’ as defined in that information where it is or an opinion that identifies you or can
the Navy Health Ltd Rules. incorrect; be reasonably used to identify you. It
• how you may make a complaint includes your name, age, gender and
Privacy Policy about the way we collect, hold, use contact details, as well as your “health
Navy Health Ltd ABN 61 092 or disclose personal information, information”, such as information or an
229 000 (Navy Health/we/us/ and how we will deal with privacy opinion about your health and health
our) are committed to protecting related complaints; services that have been provided
and maintaining the privacy of all • our contact details; to you.
individuals with whom we deal. We • the consequences of not providing “Health information” is part of a sub-
are also committed to complying with personal information; and set of personal information, known
the Privacy Act 1988 (Cth) (Privacy as “sensitive information” for the
• how we use your information for
Act), including the Australian Privacy purposes of the Privacy Act. “Health
direct marketing activities.
Principles contained within that Act, information” is specifically regulated
and other State and Territory Laws It also explains how to contact us if under the state and territory Health
that regulate health information, you have any further queries about Record Laws. In this Privacy Policy, all
such as the Health Records Act 2001 our management of your personal references to “personal information”
(VIC), Health Records and Information information. includes “sensitive information” and
Privacy Act 2002 (NSW) and Health This Privacy Policy applies to all “health information” (unless stated
Records (Privacy and Access) Act individuals whose personal information otherwise).
1997 (ACT) (Health Record Laws), to we have collected or handled,
the extent that they are applicable. including current and past members, What kind of personal
service providers, contractors and information do we collect and
About this Policy? prospective employees. hold?
This Privacy Policy explains how we This Privacy Policy was last updated We only collect personal information
manage the personal information, in June 2020. Navy Health will make about you which is reasonably
which we collect, hold, use and changes to its process and systems necessary for our functions or
disclose. This includes: in relation to how we handle your activities. The types of personal
• the kinds of personal information personal information, and this policy information which we collect and hold
that we collect and hold about you; will be updated to reflect those about you may vary depending on the
changes. nature of our interactions with you.
• how we collect your personal
information; Other terms may also apply to you
• how we hold your personal and the information we hold about
information; you. For example, sometimes we
also provide a privacy collection
• the purposes for collecting,
statement at the time we collect
holding, using and disclosing your
personal information from you, such
personal information;
as when you first sign up as a member
• whether we will (or are likely to) for an insurance policy. This privacy
disclose your personal information collection statement may include
to overseas recipients and the additional terms. If you are employed
countries where such recipients with us, you may have specific privacy
may be located; terms in your employment contract
with us.Private Health Insurance • 21
Members and prospective How do we collect your While this is not an exhaustive list,
members personal information? third parties include:
As an insurance provider, Navy We only collect personal information • health providers i.e. hospitals or
Health collects personal information, about you in a manner that is lawful. medical practitioners;
including health and sensitive Wherever it is possible and practical • other Health Insurers (such as
information. The type of information to do so, we will collect personal where you have requested a
we collect about you includes: information directly from you. For transfer of your health insurance
• your full name; insurance policies that cover more from another fund to us);
• your gender; than one person, such as family or • authorised persons or persons who
couples policies, we collect personal act on your behalf;
• your contact details, including
information about all individuals who
your residential address and email • another insured person on the
are on the policy from the person who
address; insurance policy;
is taking out the policy. For example,
• your date of birth; • government bodies;
where one parent is taking out a
• government related identifiers such family policy, that parent may provide • publicly available sources or
as your Medicare number; us with the details of their partner and networking services (such as
• financial information such as your children. LinkedIn); and
bank details; We may collect this information: • recruitment agencies and referees.
• information about your preferences • in person; Unless we are notified otherwise,
relevant to any marketing activities; • over the telephone; all information, including that of all
• sensitive information such as: persons covered on the insurance
• by mail;
- details about your health and policy, may be disclosed to you or to
• over the internet (including via our
health services provided to you; the person authorised by you to have
website);
and access to your insurance policy.
• by our Navy Health app;
- historical information such as
• by e-mail or fax; or
your prior insurance claims.
• by completion of a form (such as
• Prospective employees and
an application form).
applicants
We may also collect your personal
We collect personal information when information from a third party. This
recruiting people to work with us, such will be limited to circumstances where
as your name, date of birth, gender, it is impracticable or unreasonable for
contact details, qualifications, and work us to collect it directly from you or
and study history (including references you have authorised us to collect
and other information included in a CV the information from them. The
or cover letter as part of the application type of third party who might
process). provide information to us will vary
Before offering you a position, we may depending on the nature of our
collect additional details such as your interaction with you.
tax file number and superannuation
information and other information
necessary to conduct background
checks to determine your suitability
for certain positions.Private Health Insurance • 22
For what purposes do we Can you deal with Navy Health • other organisations as required
collect, hold, use and disclose anonymously? or authorized by law, e.g.: in
your personal information? You may interact with us anonymously an emergency, investigation of
The purposes for which we may or by using a pseudonym if the suspected criminal activity or
collect, hold, use and disclose your interaction is general in nature. where we are authorized to by law;
personal information will depend on However, if the interaction is specific • contractors and service providers,
our relationship with you. Examples of to an account or relates to your such as mailing houses, marketing
some of the purposes are below: personal information we will need agencies, information technology
• to manage and administer our to identify you before we can service and support providers, data
products and services including engage in further discussions and processing and analytics agencies,
private health insurance; correspondence. and website maintenance and
development service providers; and
• to perform the functions and
activities related to our business Consequences for you if your • for members admitted to hospital,
such as assessing your claims and personal information is not our contracted management
paying your benefits; provided to us? service — Australian Health
You may decline to give us your Services Alliance at ahsa.com.au
• to collect rebate entitlements;
personal information when we request
• to collect installments which are
it. However, we may not be able to How do we hold your personal
overdue;
provide you with some or all of the information?
• to manage our relationship with products or services that you request The personal information we collect
you including by contacting you of us. If you have any concerns about about you is kept [on an electronic
about products or services, news, the personal information we have record system in secure databases
competitions or community events requested, please let us know. (including trusted third party storage
which we think may be of interest providers in Australia). Personal
to you; Who do we disclose your information may also be collected
• to research, develop and expand personal information to? in paper-based documents and
our products and services; In order to carry out the above- converted to electronic form for use or
• to identify whether you are suitable mentioned purposes, we may disclose storage (with the original paper-based
for and to contact you about your personal information to persons documents either archived or securely
health management programs and or organisations, such as: destroyed).
services that may be of benefit to • health service providers; We understand the importance of
you; protecting the personal information
• professional advisers;
• to recruit employees and we hold about you. We take
• regulatory bodies; reasonable steps to ensure your
contractors (including volunteers,
internships and work experience) • other Health Insurers; personal information is free from
and other third parties that provide • authorised persons or persons who misuse, interference, loss, unauthorised
services to us; and act on your behalf; access or modification or disclosure,
which include:
• to comply with any applicable laws. • government agencies, allowing
us to comply with statutory & • securing all personal information;
We may also use your personal
legislative reporting requirements • limiting access to personal
information for other purposes
for the collection and submission information only to those that need
explained at the time of collection
of health related data to access; and
or otherwise as set out in this
Commonwealth agencies; • protecting our systems with
Privacy Policy.
appropriate technology solutions.Private Health Insurance • 23
All personal information that is held A dependent child (who is 16 years or We may use your personal information
by Navy Health is secured by the older and in some situations, under the to contact you (including by phone,
following methods: age of 16) may contact Navy Health text message or email) about products
• securing our premises with alarms to request that their claims history be or services which we think may be of
and 24 hour security monitoring. kept private from other persons under interest to you. This may include our
the insurance policy. own, our related body corporate’s or a
• ensuring all systems, servers,
Navy Health may, in its discretion, third party’s products or services with
computers, databases and
decline to disclose the claims history whom we have a formal arrangement.
networks are secured with
password protection and of a person insured under the same In particular, we may contact you
encryption. policy where it cannot be satisfied that about products and services we
such disclosure reflects the current think may be of interest to you after
• ensuring various access levels for
intention of the insured person. In that you cease to hold a private health
staff to limit access to information
circumstance, the Navy Health may insurance policy with us. For example,
and roles.
seek clarification from the insured we might contact you about renewing
• providing our staff with regular person. your old policy or taking out a new
training and feedback pertaining to policy.
It is important to consider the
the Privacy Act.
privacy settings applicable to your You consent to us sending these
• In order to satisfy our legal policy where there are changes in carefully selected marketing materials
obligations, we may need to the relationships amongst persons to you in this manner.
retain your information after the insured under the policy (for example,
relationship has ended. However, as children and young people How can I opt-out of receiving
we will not retain your identifiable mature or if partners separate). marketing material?
personal information longer than In that circumstance, you should You may opt-out of receiving
is reasonably necessary and contact us to change the privacy marketing information from us and our
permitted under relevant Australian settings applicable to your policy or related bodies corporate at any time
privacy laws. We take reasonable discuss whether different insurance by:
steps to destroy or de-identify arrangements are appropriate to your
information that we no longer • calling us on 1300 306 289;
circumstances.
require. • emailing us at
How can I organise additional query@navyhealth.com.au;
How is personal information privacy protections as a victim • ‘ticking the box’ on the relevant
handled for couples and family of family violence or identity form when you apply for one of our
health insurance policies? theft? products or services; or
If you are insured under a health If you are a victim or family violence or • using the unsubscribe function on
insurance policy which covers more identity theft, or have personal safety various communications.
than one person, such as a ‘family’ concerns relating to the personal
or ‘couples’ policy, you should make Please allow five working days for your
information we hold about you, we
yourself aware of the privacy settings request to be actioned by us.
may be able to provide further privacy
applicable to your policy. Information protections for you. Please do not
about the health services received, hesitate to discuss these options with
claims made and benefits paid (claims us by:
history) for each person under the
• calling us on 1300 306 289; or
same health insurance policy is
accessible to the other persons under • emailing us at
the insurance policy. query@navyhealth.com.auPrivate Health Insurance • 24
How does Navy Health interact Navy Health may also use information How can you access and
with you via the internet? collected by cookies to display seek correction of personal
Navy Health’s website, online services, personalised content and advertising information held by us?
interactive applications, email (targeted advertising and online You are entitled to access the personal
messages and advertisements may behavioral advertising), based on an information we hold about you on
use “cookies” and other technologies, individual’s internet usage, and to request.
such as Google Analytics. send marketing materials that Navy
We do not charge a fee to give you
Health thinks will be of interest to the
Navy Health has the following Google access to your personal information,
individual.
Analytics Advertiser Features enabled: but you may be charged for the
You can use your settings to disable reasonable time and expense incurred
• remarketing with Google Analytics
your web browser from accepting in compiling information, depending
• Google Display Network Impression cookies. However, in doing so, you may on the nature and extent of your
Reporting be unable to access certain features or request.
• Google Analytics Demographics content on the Navy Health website.
We will take reasonable steps to
and Interest Reporting
ensure that the personal information
This enables Google Analytics to Are we likely to disclose
we collect, use or disclose is accurate,
collect data about Navy Health your personal information to
complete and up-to-date. You can
Website traffic via Google advertising overseas recipients?
help us to do this by letting us know
cookies and anonymous identifiers, We generally hold your information in
if you notice errors or discrepancies
in addition to data collected through Australia. In certain circumstances, we
in information we hold about you and
a standard Google Analytics may transfer your personal information
letting us know if your personal details
implementation. outside Australia. Technology allows
change.
Navy Health gathers some information for services to be provided by
However, if you consider any personal
automatically and stores it in log files. different service providers including
information we hold about you is
This information includes Internet some that are located overseas. We
inaccurate, out-of-date, incomplete,
Protocol (IP) addresses, browser may use overseas service providers
irrelevant or misleading you are
type and language, Internet service in order to provide our products and
entitled to request correction of the
provider (ISP), referring and exit services or manage our relationship
information.
pages, operating system, date/time with you. The countries in which those
third parties are likely to be based are You can request to access or
stamp and clickstream data. Some of
the United States. seek correction of your personal
the information we collect via cookies
information by:
and online technologies is considered Unless we have your consent, or an
personal information . exception under the Privacy Laws • accessing the Online Member
applies, we will only disclose your Services portal
Navy Health uses this information to
understand and analyse trends, to personal information to overseas • calling us on 1300 306 289;
administer its website, to learn about recipients where we have taken • emailing us at
user behavior on the site, to tailor reasonable steps to ensure the query@navyhealth.com.au; or
email communications and to gather overseas recipient does not breach the
• by mail at PO Box 172, Box Hill,
demographic information about its Australian Privacy Principles in relation
Victoria, 3128
user base as a whole. Navy Health may to your personal information.
use this information in its marketing
and advertising services.Private Health Insurance • 25
When you contact us to request We will also endeavor to resolve Direct debit arrangements
access to and correction of your any concerns or complaints which (a) We will, in accordance with
personal information, we may need you may have to your satisfaction. the terms of the direct debit
to verify your identity by confirming However, if you are unhappy with our request and any other existing
your member number, full name, full response, you can make a complaint agreement, periodically debit
address and date of birth. to the Office of the Australian the nominated account for the
We will give you access to your Information Commissioner (OAIC) in agreed amount(s).
personal information if practicable, Australia.
(b) The debits will occur according
and will take reasonable steps to The contact details for the OAIC: to the frequency you have
amend any personal information about The Office of the Australian nominated i.e. fortnightly,
you which is inaccurate or out of date. Information Commissioner monthly or as agreed. The
We will take reasonable steps to notify GPO Box 5218 amount debited will vary
you of a decision on the request within Sydney NSW 2001 according to the amount
30 days. We may decline your request Phone: 1300 363 992 falling due.
to access or correct your personal Fax: 02 9284 9666 (c) If any drawing falls due on a
information in certain circumstances Website: www.oaic.gov.au non-business day, it will be
permitted by the Privacy Act and Alternatively, you can contact debited from the nominated
Health Record Laws. In such a case, the Victorian Health Complaints account on the prior business day.
we will provide you with written notice Commissioner, NSW Privacy
of the reasons for our decision. Commissioner or ACT Human Rights Your rights
How can you complain about a breach Commission. (a) You can change your direct
of the Australian Privacy Principles debit arrangements by calling us
and how will we deal with your What if I have further on 1300 306 289 or log on to
complaint? questions? Online Member Services at
If you have any questions, concerns If you have any questions about our navyhealth.com.au/members at
or complaints about how we collect Privacy Policy, you may contact our least five business days prior to
or manage your personal information, Privacy Officer whose contact details the next direct debit. Changes
then you may raise that matter with are listed above. If you have questions include altering arrangements,
our Privacy Officer. Our Privacy Officer about the Privacy Act, you may stopping an individual debit or
can be contacted as follows: contact the OAIC. cancelling a direct debit request
• calling us on 1300 306 289; Direct debit service agreement completely.
• emailing us at This agreement (“Direct Debit Service (b) We will give you at least 14 days
privacy@navyhealth.com.au; or Agreement”) outlines the terms notice by telephone or writing
and conditions of the direct debit (including e-mail) of any change
• by mail at: Attention Privacy
arrangements between the person to the terms of the direct debit
Officer, PO Box 172, Box Hill,
signing the direct debit request arrangements, unless otherwise
Victoria, 3128.
(“you”) and Navy Health (“us”). agreed.
We will endeavor to promptly
You agree to be bound by these terms (c) If you believe we have drawn on
respond to your questions, concerns
and conditions upon your execution of your account incorrectly, please
or complaints. In most cases we
the Direct Debit Request. contact us on
will investigate and response to a
1300 306 289 so the matter can
complaint within 30 days of receipt
be resolved. We will make every
of the complaint. If the matter is more
attempt to resolve the dispute
complex or our investigation may take
within five business days.
longer, we will let you know.Private Health Insurance • 26
Your obligations Code of conduct
(a) You must ensure that: Navy Health abides
(i) before completing the direct by the Private
debit request, you check Health Insurance
the account details of your Code of Conduct.
nominated account are By subscribing to
accurate (check against a the code, Navy Health ensures that
recent statement from your members receive clear information
financial institution); and transparency in their dealings with
Navy Health.
(ii) your nominated account can
accept direct debits (your The code ensures Navy Health will:
financial institution can • continue to improve standards
confirm this); of practice and service;
(iii) your nominated account • provide information to members
has sufficient clear funds in clear and plain language;
on the drawing date to allow • ensure the policy documentation
payment to be made in is full and complete;
accordance with the direct
• ensure that Navy Health staff are
debit request and any other
appropriately trained to provide
existing agreement between
clear explanations;
you and us.
• provide members with access
(b) You must advise us immediately
to an internal dispute resolution
if your nominated account is
procedure and advise members
not current.
of their rights to take an issue to
(c) If any drawing is returned or the Private Health Insurance
dishonoured by your financial Ombudsman.
institution, we may, at our
A copy of the code may be provided
discretion, reprocess the
on request or can be viewed at
transaction following receipt
navyhealth.com.au/code-of-conduct
of the notification of return or
dishonour, or request an
alternative form of payment
from you. We may also charge
any dishonour fees back to you.Private Health Insurance • 27
navyhealth.com.au PO Box 172, Box Hill, Victoria 3128
Navy Health Limited
A Registered Private Health Insurer
ABN 61 092 229 000
T 1300 306 289
E query@navyhealth.com.au
Information is current as at April 2021 and is
subject to change. Defence imagery supplied
by Department of Defence.You can also read
