Police Health enjoy the benefits - Quality Health Cover for South Australian Police
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Police
Health
enjoy the benefits
Quality Health Cover
for South Australian Police
©
Why Police Health?
Police Health is Australia's only private health insurer run by police for police.
We are not-for-profit with straightforward health insurance products. All funds
go to ensuring our members receive the best health cover at the best
possible price. It is a unique service exclusive to the police community and
their families.
In South Australia, where Police Health started in 1935, about 90 per cent of
serving officers are members*. This extraordinary support is an indication of
the reputation we enjoy among police ranks.
Member research shows we are one of the highest rating health insurers for
customer satisfaction. And the reason is simple - our policies are easy to
understand, our service is of the highest quality and, most importantly, we
offer value-for-money.
Police Health is conscious that a multitude of private
health insurance products can be confusing.
Therefore, we have only four: Top Hospital and
SureCover Extras, which are combined at a
discounted rate to make Platinum Health, or Platinum
Plus for families with older independent children.
All four are premium quality products with a high level
of health cover.
Police Health is readily available to the policing
communities in South Australia, the Northern Territory,
Queensland, Western Australia and Tasmania.
More information
Please read the information contained in this brochure
carefully and retain it for future reference. It contains
detailed information on our products, why we are the
best health insurance choice for police and how to
become a member.
We welcome all new members so if you have any
questions please contact our office or visit
www.policehealth.com.au. Full contact details are on
the back page of this brochure.
The information contained within this brochure is
provided for information purposes only and is subject
to change without notice.
(*For an explanation of the terms “membership” and “member” as
used in this brochure see page 19.)
© 1
Who can join Police Health?
Police Health is a restricted access health insurer primarily Generous rebates - When you make a claim for extras
for current employees of a State, Territory or Federal with Police Health, our cover tends to be higher. For
police department, service or association. extras we pay 80% of the service fee in most cases, even
though the charge from service providers may vary. If you
Additionally all former employees of South Australia Police
are not with Police Health, you could end up paying
are able to join Police Health, as are former employees of
more. Our dental cover, for instance, is hard to match.
other police services or associations in Australia who
resigned or retired after 1 January 2001. Others eligible Efficient claims system - At Police Health we pride
for membership* include their partners (spouse or ourselves on a rapid and efficient turnaround on claims.
defacto), former partners, dependent children and their Freedom to choose - You can choose your preferred
adult children (as well as partners and dependent hospital, doctor and any other service provider, such as
children of these adult children). your physiotherapist and dentist.
Contact us for clarification if you are not clear on whether Professional advice and friendly service - Police Health
you and your family are eligible to join Police Health. is a quality health insurer managed by industry
professionals. We provide accurate, practical unbiased
Who is covered by my Police Health policy?
advice to ensure the highest level of individual service.
• Single Policy - just yourself.
Our staff are friendly and well trained in providing
• Family Policy - yourself, partner and all your children
excellent customer service.
until they reach 21 years, or 25 if they are full-time
students. Police Health Platinum Plus covers all Easy to understand - We keep it simple. You are not
children until they reach 25. Children who are married bewildered with complex, multiple options and left with
or in a defacto relationship are not covered. niggling questions about the extent of your cover. At
• Single Parent Family Policy - yourself and all your Police Health you only have to choose between quality
children as described above. extras, top hospital or both.
(*For an explanation of the terms “membership” and “member” as
used in this booklet, see page 19.) Quality, value, simplicity
The Police Health difference At Police Health, we make your private health insurance
choices as simple as possible to ensure maximum value.
Essentially, we offer four high quality covers: Top Hospital
Police Health has one objective - looking after the health
and SureCover Extras, which you can have separately or
insurance needs of the police community and their
combined as either Platinum Health or Platinum Plus.
families.
There are several reasons why we offer such a defined
No other health insurance provider in Australia has that
product range. For a start it is less confusing for
single-minded focus.
members and it enables us to keep your costs down.
Our activities are overseen by people who understand Furthermore, we only offer top-of-the-range products,
and care about your requirements. We are managed by which means our members are not caught out with an
a team of health insurance professionals under the inappropriate level of cover.
direction of a board from both police and health
Member feedback has repeatedly shown that police
insurance backgrounds.
prefer to have a comprehensive policy that looks after
There are many other reasons why about 9 out of 10 them and their family through all stages of their lives:
serving police officers in South Australia - the home of • One cover fits all
Police Health - have joined us: • One cover for life
Not-for-profit - There are no shareholders. All premiums The premiums shown in this brochure reflect our
are used to benefit members. endeavour to give you the best in quality at a price that
Value-for-money - Top cover at a great price. Police offers true value. When you compare our premiums and
Health premiums are usually lower than those offered by level of cover with other insurers, it soon becomes
other insurers for similar cover. apparent that Police Health is one of the most competitive.
2 ©
Why private health insurance
There are many compelling reasons why it pays to have private health insurance.
The obvious ones are peace of mind and freedom of choice - knowing that you
can be treated when you want, by the doctor or specialist you prefer and in the
hospital of your choice. There is also a cost consideration - the security of not
being faced with large fees resulting from unexpected treatment. Then there are
the following financial incentives introduced by the Australian Government - three
schemes that make private health insurance an obvious choice.
Government incentives
1 The Australian Government provides a Rebate on private health insurance to
most Australians*. The Rebate is means tested against your income, and is
reduced on a Tier basis. You can choose to receive your Rebate as a reduced
premium, making your health insurance instantly cheaper, or claim any eligible
Rebate when you lodge your tax return.
2 As the government encourages all Australians to take out private health
insurance, it likewise penalises those who do not. The government charges an
additional Medicare Levy Surcharge* if you earn over the set threshold and do
not hold appropriate hospital cover.
3 Government legislation requires health funds to apply a loading to hospital cover
for those who postpone taking out hospital cover until they are older. Avoid the
loadings by simply taking out and maintaining hospital cover by 30 June
following your 31st birthday.*
* Please read more about how these rebates, levies and
loadings may affect you on pages 21 and 22.
Helping you choose
There are resources available to help you choose the best
health insurer and policy to suit your particular requirements.
Standard Information Statements (SIS) are available on all
private health insurance products in Australia. These are
designed to assist you in reviewing and comparing different
health insurance policies.
This is a Federal Government initiative and all health insurers
are required to provide such statements by law. Police Health
SIS are available on request or can be found on our website
www.policehealth.com.au
For further information on SIS and other detailed information
on private health insurance in Australia visit the Federal
Government website www.privatehealth.gov.au
© 3
Top Hospital Hospital Cover
Top Hospital provides cover for treatment in any Access Gap Cover
recognised hospital or day-surgery (public or private) Under Police Health Access Gap Cover you may never
anywhere in Australia. It is designed to give you and your have to pay a doctor's bill. Your doctor can forward all
family complete freedom of choice in your health care. accounts to us and we pay them on your behalf.
Compare the benefits and premiums of Police Health When private patients are admitted to hospital,
Top Hospital - you will find they are comprehensive and Medicare pays a benefit that is 75% of its Schedule Fee
offer excellent value. for medical services such as doctors, radiology and
Choice of hospital pathology. Police Health pays the remaining 25%.
Top Hospital cover does not restrict you to any particular Note: Police Health does not pay benefits for medical services
hospital - full benefits apply in all registered hospitals for where Medicare does not pay a benefit.
recognised services. In the unlikely event that we cease
It is reasonably common for doctors to charge fees
to recognise a hospital for full benefits, Police Health will
over and above the Medicare Benefits Schedule Fee.
advise members likely to be affected. Details of
To help members avoid these additional costs, in the
hospitals not recognised are listed on our website
www.policehealth.com.au majority of cases Police Health is able to pay higher
benefits through our Access Gap Cover scheme.
Choice of doctor
Police Health has no interest in directing you to a Under this scheme, Police Health has arrangements
particular doctor or any other health care provider. Our with more than 25,000 doctors Australia-wide. When
aim is to give you the freedom to make true choices doctors bill under this arrangement we can pay higher
about who treats you and where. benefits to eliminate or at least reduce your
Top Hospital Premiums Oldest Person Under Policy is Under 65years*
Base Tier Tier 1 Tier 2 Tier 3
Payment method (29.04%**) (19.36%**) (9.68%**) (0.0%)
FULL REBATE NO REBATE
Family (& Couples)
65yrs & older!
Fortnightly Direct Debit $117.65 $133.70 $149.75 $165.80 * Premiums based on oldest
Fortnightly Payroll $120.90 $137.40 $153.90 $170.40 person under policy being
under 65yrs, for those 65yrs
or older you may be entitled
Quarterly $788.65 $896.20 $1,003.80 $1,111.40 to a higher Rebate please see
page 21 for more information.
Half Yearly $1,553.65 $1,765.60 $1,977.55 $2,189.50
For premiums that apply to
Yearly $3,060.00 $3,477.40 $3,894.85 $4,312.30 over 65yrs go to
www.policehealth.com.au
Single Parent Family or call 1800 603 603
Fortnightly Direct Debit $104.80 $119.10 $133.40 $147.70 ** Premiums available on
lodging the Australian
Fortnightly Payroll $107.75 $122.45 $137.20 $151.90 Government Rebate on
private health insurance
Quarterly $703.00 $798.90 $894.85 $990.75 application form with Police
Health. See page 21 to
Half Yearly $1,384.95 $1,573.85 $1,762.80 $1,951.75 determine which level of
Rebate applies to you.
Yearly $2,727.70 $3,099.80 $3,471.95 $3,844.05
Important Note: The
Single premiums shown in this table
are based on rates applying
Fortnightly Direct Debit $58.80 $66.85 $74.85 $82.90 to those having an existing
hospital cover with a certified
Fortnightly Payroll $60.45 $68.70 $76.95 $85.20 age of entry of 30 or, who join
hospital insurance by June 30
Quarterly $394.30 $448.10 $501.90 $555.70 following their 31st birthday. If
neither of these apply, contact
Half Yearly $776.80 $882.80 $988.75 $1,094.75 Police Health for the Lifetime
Health Cover premiums that
Yearly $1,530.00 $1,738.70 $1,947.40 $2,156.15 will apply to you.
4 ©
out-of-pocket costs. Also where a gap does exist, members are informed by
their doctor prior to treatment.
Access Gap Cover means our members have even more flexibility when
choosing a doctor, because there is an increased likelihood their fees will be
covered.
While all doctors can be involved in Access Gap Cover, it is up to individual
doctors to participate. You can alert your doctor to the scheme and request that
they take part. If you are unsure if your doctor or specialist has agreed to
participate, please call Police Health or check the list on our website
www.policehealth.com.au
Choosing a prosthesis
Prostheses include screws and plates, intraocular lenses, replacement joints,
cardiac stents, defibrillators and other devices that are surgically implanted
during your stay in hospital. There are often a multitude of brands and types
available for a particular use, all designed to achieve the same result, but they
can vary in cost and comparative benefits.
The Federal Government together with a panel of health specialists issues a
listing for prostheses detailing the benefit that health insurers must pay. While
the surgeon or hospital providing the prothesis can determine what they will
charge for them, it is intended that the government required benefit should
fully cover the cost of at least one of the items available that meet your
surgical requirements.
To make an informed decision ask your doctor the
following questions:
• Which prosthesis will be the best one for you and is
there a gap to pay for it?
• If a gap is payable, is there a gap free option
available?
• What are the costs of the surgery, including the
prosthesis?
Request a written cost estimate if there are any gaps to
pay and contact Police Health to confirm what is covered
and the amount of any gaps you may have to pay.
Hospital 35-day rule
Hospital benefits are payable 365 days a year. However,
if your hospital stay exceeds 35 days you must obtain an
Acute Care Certificate to continue receiving benefits.
If you are not classified as an acute hospital care patient
and your stay exceeds 35 consecutive days, you may
become a "nursing home type patient". In this case a
Government restriction requires that you make a
personal (and uninsurable) contribution to your care. In
our experience this is rare and does not apply where
acute hospital care is required.
© 5
What is covered Police Health Top Hospital
General hospital costs Please refer to page 4; 100% covered for:
• Private or shared room accommodation
• Same day hospitalisation and day surgery
• Intensive/coronary care, etc
Theatre fees/labour ward 100% covered
Drugs supplied 100% covered when related to the reason for admission in hospital and covered under the
agreement with the hospital. Public hospitals generally supply medication without charge.
Surgically implanted
Cover as defined in the Federal Government’s Prostheses List (see page 5).
prostheses
Doctor's fees If your doctor chooses to use the Access Gap Cover schedule of fees, Police Health can cover
(for hospital treatment) up to 100% of the doctor's fee. At a minimum, Police Health will cover the difference between
the Medicare rebate and the Medicare Benefits Schedule (MBS) Fee. (see pages 4, 17)
Hospital at home Police Health has agreements with some hospitals to deliver out-of-hospital care to patients
for services such as wound management, intravenous therapy and post-natal care.
Ambulance 100% covered for emergency transport, clinically required non-emergency transport and
treatment not requiring transport. (see page 16)
Additional health care Aids and appliances - benefits vary (contact Police Health).
services Home Nursing - attractive benefits apply (contact Police Health).
Travel and
Up to $500 per year, per policy. (see page 16)
accommodation cost
Our Top Hospital cover is comprehensive and covers all procedures where Medicare pays a benefit, with no
exclusions or restrictions and no excess to pay when admitted as an in-patient.
Some example services that you are covered for under Top Hospital are listed below; this is not an exhaustive list.
Should you require information about a particular treatment please contact Police Health.
Covered by Covered by
Examples of hospital services Police Health Examples of hospital services Police Health
Top Hospital Top Hospital
Intensive care & operating theatre Pregnancy & birth related services
Heart surgery, bypass, stents Assisted reproductive services (IVF)
Removal of tonsils Gastric banding, stomach surgery
Removal of appendix Dialysis for chronic renal failure
Hernias Back surgery
Chemotherapy and cancer Psychiatric services
Rehabilitation services Cataract and lens replacement (eyes)
Hip and knee reconstruction and Surgically implanted prostheses
joint replacement
6 ©
What is not covered (non exhaustive list*)
• Services incurred before waiting periods have been served. (see page 14)
• Treatment for which Medicare does not pay a benefit, including cosmetic
surgery. (Some benefits may be payable for hospital treatment following this
surgery. Contact Police Health for more details.)
• Services that are provided outside the Commonwealth of Australia.
• Services where an entitlement exists or may exist under any compensation,
sports club or third party insurance.
• A claim for a service that is submitted more than two years after the date
of service.
• Outpatient services unless there is an agreement between Police Health
and the hospital.
• Pharmaceuticals not related to the reason for hospitalisation or not
covered under the agreement with the hospital or provided on discharge.
• Exceptional high cost drugs that may be excluded or limited.
• Prostheses items that are not included on the Federal Government
approved list.
• Charges greater than the benefit defined in the Federal Governments
Prostheses List.
• Personal and take-home items, eg newspapers, toiletries, television,
hairdressing, manicure, etc.
• Treatment provided to a person in a hospital emergency department.
• Aged care and accommodation in an aged care facility.
• If you are in hospital for more than 35 consecutive
days and not classified as an acute care patient, your
benefits will significantly reduce. (see page 5)
* This provides a general description of what is not covered. Should
you require information about a particular treatment or benefit please
contact Police Health.
© 7
SureCover Extras Extras Cover
With Police Health SureCover Extras you are covered are always paid from the current year's Annual Maximum
for an extensive range of health services at highly before your Rollover Benefit is accessed.
competitive premiums.
New members are eligible for Rollover Benefit after just
Few health insurers can match our extras benefits for 12 months (2 years for major dental). The combined
value or the number of services available. Our extras Rollover Benefit and the Annual Maximum are shown as
table is designed exclusively for the benefit of the South the “Rollover Maximum” in the following tables (on pages
Australian police community. 10, 11).
You won’t be left wondering how much your health Limit to services
insurer will repay on your extras claims. For the majority Health insurers have restrictions on frequency of use and
of services provided by recognised providers, Police the way some services are combined. This helps ensure
Health pays a generous 80% of the cost. equity among members.
Equally important, we let you visit the health provider of The benefit structure developed by Police Health means
your choice and in most cases will still provide our high we have fewer restrictions. Our limits on regular services
level of cover. Because of our generous benefits limit such as dental for example are generous by comparison.
(explained later), you can choose your provider and still
For extras services such as physiotherapy, chiropractic
be confident that in most cases you will receive back
80% of their fee. or podiatry, we limit claims to one consultation per
person per day per service type.
Our Annual Maximum - the benefits allowable in any
one calendar year per person are also generous Benefits limit
(exercise physiology also has a family limit). To ensure Health insurers generally calculate an average charge for
even greater security and value, Police Health also services and set their benefit limit based on that amount.
provides Rollover Benefit. Police Health goes further and in the majority of cases
Rollover Benefit recognises charges up to 15% higher than the
In many service areas, any unused Annual Maximum calculated average. This means that when members
benefit that is not claimed during one calendar year can make a claim for extras with Police Health, they tend to
be rolled over to be available the following year. Claims get more back - 80% in the majority of cases.
SureCover Extras Premiums Oldest Person Under Policy is Under 65years*
Base Tier Tier 1 Tier 2 Tier 3
Payment method (29.04%**) (19.36%**) (9.68%**) (0.0%)
FULL REBATE NO REBATE
Family (includes Couples
& Single Parent Families)
65yrs & older!
Fortnightly Direct Debit $62.85 $71.45 $80.00 $88.60
* Premiums based on
Fortnightly Payroll $64.70 $73.50 $82.35 $91.20 oldest person under policy
being under 65yrs, for
Quarterly $422.10 $479.70 $537.30 $594.90 those 65yrs or older you
may be entitled to a higher
Rebate please see page
Half Yearly $831.50 $944.90 $1,058.35 $1,171.80 21 for more information.
Yearly $1,637.75 $1,861.15 $2,084.55 $2,308.00 For premiums that apply to
over 65yrs go to
Single www.policehealth.com.au
or call 1800 603 603
Fortnightly Direct Debit $31.40 $35.70 $40.00 $44.30
** Premiums available on
Fortnightly Payroll $32.35 $36.75 $41.15 $45.60 lodging the Australian
Government Rebate on
Quarterly $211.05 $239.85 $268.65 $297.45 private health insurance
application form with Police
Half Yearly $415.75 $472.45 $529.15 $585.90 Health. See page 21 to
determine which level of
Yearly $818.85 $930.55 $1,042.25 $1,154.00 Rebate applies to you.
8 ©If the service charge is higher than the fee we recognise, the percentage amount
you receive will reduce accordingly.
Our 80% benefit applies to the net amount payable on an account, inclusive of
any discounts the provider might be offering; this may vary where, for the benefit
of our members, Police Health has negotiated specific agreements with
selected providers.
Optical discounts
Police Health has arrangements with OPSM and Laubman & Pank for our
members to receive 20% off all frames*, lenses, contact lenses and treatments.
You can take advantage of these discounts simply by showing your Police
Health Membership Card at any of these outlets throughout Australia. With this
20% discount and our 80% benefit, you can obtain lenses at no cost providing
you are within your Annual Maximum.
Police Health Members can also receive 10% off sunglasses* at these outlets,
Bright Eye’s and Sunglass Hut.
* Based on standard store pricing and excludes Chanel, Bulgari, Oliver Peoples, Paul Smith,
Tag Heuer and Tiffany & Co brands.
Chemist discounts
Police Health has an agreement with National Pharmacies where members with
extras cover receive up to 20% off non-government prescriptions, non-subsidised
PBS prescriptions and all over-the-counter items, including fragrances,
cosmetics, health foods and non-prescription medications.
You can take advantage of these discounts simply by
showing your National Pharmacies card at any of their 36
stores throughout South Australia.
National Pharmacies also make pharmaceutical claiming
easy. When you have your prescriptions filled at any of
their pharmacies, in most cases you will only have to pay
$20 for prescriptions covered by our pharmaceutical
benefits. For further details ask for our Pharmaceutical
Benefits Brochure, or download a copy from our website.
For eligible prescriptions dispensed through other
pharmacies simply lodge your paid pharmacy invoice
with a claim form to claim back any eligible benefits.
Police Health members with SureCover extras, Platinum
Health and Platinum Plus, receive National Pharmacies
membership included with our extras cover.
© 9What is covered SureCover Extras
The following list is an example of the services covered under SureCover Extras with details of our benefit limit and
Annual Maximums, which is based on a calendar year. New members have a waiting period before they can make a
claim for extras benefits and these are marked in the list. Waiting periods may not apply if they have been served
with another insurer prior to joining.
Annual Rollover
Service Type Example of Benefits Maximum Maximum
per person per person*
General Dental Oral exam (2 every calendar year) 80% up to $47.80
(2 months waiting period) Scale and clean (2 every calendar year) 80% up to $101.20
Includes checkups, X-rays, Unlimited N/A
simple extractions, fillings
Filling - adhesive posterior 3 surface 80% up to $165.40
and root canal Mouth Guard (1 every calendar year) 80% up to $158.20
Major Dental Full crown - veneered 80% up to $1,343.20
(12 months waiting period) Complete upper & lower
80% up to $1,472.00
Includes crowns and dentures dentures (1 every 3 yrs) $1,300 $2,600
12 month waiting periods may be waived where it has been served
with previous fund. Rollover Maximum available after 2 years
membership.
Orthodontic Lifetime limit - $3000 80% up to Annual Maximum 1st yr $0
(12 months waiting period) 2nd yr $800
We recognise your time served with other health insurers and N/A
Benefits apply to specialist in many cases new members can go direct to our $1,500 3rd yr $800
orthodontists only Annual Maximum. 4th yr $1,500
Optical Standard single vision lenses 80% up to $109.45
(2 months waiting period) Standard progressive lenses 80% up to $278.40
Contact lenses, disposable - spherical 80% up to $134.40
Contact lenses, rigid 80% up to $249.60
Frames $110.00
$330 $660
At OPSM and Standard single vision lenses 100%
Laubman & Pank: Standard progressive lenses 100%
Contact lenses, disposable - spherical 100%
Contact lenses, rigid 100%
Frames $110.00
Physiotherapy Initial consult 80% up to $69.00 $850
(2 months waiting period) Subsequent consult 80% up to $57.20 Combined $1700
Sub-limit for
Exercise Physiology
Exercise Physiology Initial consult 80% up to $69.00 $400 per person, or N/A
(2 months waiting period) Subsequent consult 80% up to $50.60 $800 per family
Chiropractic Initial consult 80% up to $66.70
(2 months waiting period) Subsequent consult 80% up to $42.80
Naturopathy Initial consult 80% up to $82.80
(2 months waiting period) Subsequent consult 80% up to $55.20
$1,400
Acupuncture Initial consult 80% up to $64.40 $700
(2 months waiting period) Subsequent consult 80% up to $52.90 Combined
Osteopathy Initial consult 80% up to $80.60
(2 months waiting period) Subsequent consult 80% up to $70.80
Complementary Therapies Therapies consult $25.00
(2 months waiting period) Note: While many therapies are covered, some are not. Please refer to N/A
our special Complementary Therapies Brochure for more information.
10 ©Annual Rollover
Service Type Example of Benefits Maximum Maximum
per person per person*
Speech Therapy Initial consult (> 60 mins) 80% up to $126.00
$850 $1,700
(2 months waiting period) Subsequent consult (46 - 60 mins) 80% up to $105.60
Occupational Therapy Initial consult (> 75 mins) 80% up to $147.20
$600 $1,200
(2 months waiting period) Subsequent consult (46 -60 mins) 80% up to $92.00
Eye Therapy Initial consult 80% up to $43.20
$600 $1,200
(2 months waiting period) Subsequent consult (< 30 mins) 80% up to $38.60
Dietary Initial consult 80% up to $101.20
$600 $1,200
(2 months waiting period) Subsequent consult 80% up to $48.40
Podiatry Initial consult 80% up to $63.40
$700 $1,400
(2 months waiting period) Subsequent consult (< 20 mins) 80% up to $53.30
Psychology
Consultation (46-60 mins) 80% up to $150.80 $850 $1,700
(2 months waiting period)
District Nursing
100% $150 $300
(2 months waiting period)
Ambulance Clinically required transport 100%
Unlimited N/A
(2 months waiting period) Treatment no transport required 100%
Pharmaceutical (excludes government subsidised PBS prescriptions)
(2 months waiting period) Per script Up to $50 after you pay first $20
$600 $1,200
Available at any pharmacy Note: While many medicines are covered, some are not.
$20 may increase for dispensings greater than the minimum
standard packaged quantity. Please refer to our special
Pharmaceutical Benefits Brochure for more information.
Health Appliances Hearing aids 80% $1200 per 5 yrs
(12 months waiting period) Nebulisers 80% up to $200 1 unit per 3 yrs
(Doctor's referral required Blood glucose monitors 80% up to $250 1 unit per 3 yrs N/A
on all appliances) Blood coagulation monitor (INR) 80% up to $400 1 unit per 3 yrs
School Accident Additional benefits apply to clinically required services
(2 months waiting period) resulting from an accident whilst at or travelling to or from $500 N/A
school. (Some restrictions apply.) 100%
*Rollover Maximum available after 12 months membership with extras cover, except Major Dental which require
2 years membership.
Note: All the benefits shown here are payable only on services and at health providers recognised by Police Health.
(see page 16 for details)
What is not covered (non exhaustive list**)
• Claims for a service that has exceeded the Annual Maximum & Rollover Maximum.
• The second and subsequent consult with the same profession on the same day.
• Where the service charge exceeds the fee recognised by Police Health, the benefit you receive may be less than
80% of your cost.
• Where the service provider is a partner, dependent or parent of the person being treated. Business partners within
the practice are also excluded.
• Services incurred before a waiting period has been served.
• Services where a Medicare benefit is payable.
• Services that are provided outside the Commonwealth of Australia.
• Services where an entitlement exists or may exist under any compensation, sport club or third party insurance.
• A claim for a service that is submitted more than two years after the date of service.
• Services provided by practitioners not registered or recognised by the fund.
** This provides a general description of what is not covered. Should you require information about a particular treatment or benefit
please contact Police Health.
© 11Platinum Health
This is Police Health's most popular health cover and
the reasons are obvious - it is all-inclusive and is
offered at a discounted premium that provides even
more value.
About 80% of our members choose Platinum Health
because it is the total health package, combining the
security of Top Hospital and the extra protection of
SureCover Extras. In addition partial benefits are
available for corrective laser eye surgery for Platinum
Health Cover which is not available for extras only or
hospital only policies. Furthermore the premium is
lower than having the two products separately and
means all your health needs are covered under one
convenient package.
If you have non-student dependent children who have
turned 21 but not yet 25, please consider the benefits
of Platinum Plus on the following page.
Platinum Health Premiums Oldest Person Under Policy is Under 65years*
Base Tier Tier 1 Tier 2 Tier 3
Payment method (29.04%**) (19.36%**) (9.68%**) (0.0%)
FULL REBATE NO REBATE
Family (& Couples)
65yrs & older!
Fortnightly Direct Debit $177.50 $201.75 $225.95 $250.20
* Premiums based on oldest
Fortnightly Payroll $182.50 $207.40 $232.30 $257.20 person under policy being
under 65yrs, for those 65yrs
Quarterly $1,190.40 $1,352.80 $1,515.20 $1,677.60 or older you may be entitled
to a higher Rebate please see
Half Yearly $2,345.05 $2,664.95 $2,984.90 $3,304.80 page 21 for more information.
For premiums that apply to
Yearly $4,618.70 $5,248.75 $5,878.80 $6,508.90 over 65yrs go to
www.policehealth.com.au
Single Parent Family or call 1800 603 603
Fortnightly Direct Debit $164.70 $187.15 $209.60 $232.10 ** Premiums available on
lodging the Australian
Fortnightly Payroll $169.35 $192.45 $215.55 $238.70 Government Rebate on
private health insurance
Quarterly $1,104.75 $1,255.45 $1,406.15 $1,556.90 application form with Police
Health. See page 21 to
Half Yearly $2,176.35 $2,473.25 $2,770.15 $3,067.05 determine which level of
Rebate applies to you.
Yearly $4,286.45 $4,871.20 $5,455.95 $6,040.70
Important Note: The
Single premiums shown in this table
are based on rates applying
Fortnightly Direct Debit $88.75 $100.85 $112.95 $125.10 to those having an existing
hospital cover with a certified
Fortnightly Payroll $91.25 $103.70 $116.15 $128.60 age of entry of 30 or, who join
hospital insurance by June 30
Quarterly $595.20 $676.40 $757.60 $838.80 following their 31st birthday. If
neither of these apply, contact
Half Yearly $1,172.50 $1,332.50 $1,492.45 $1,652.40 Police Health for the Lifetime
Health Cover premiums that
Yearly $2,309.35 $2,624.35 $2,939.40 $3,254.45 will apply to you.
12 ©Platinum Plus
Platinum Plus provides the same total health package
available in Platinum Health (including the partial benefits
for corrective laser eye surgery) but also includes all your
children until they reach the age of 25, unless they are
married or in a defacto relationship.
This is a true family cover specifically designed to suit
members with older children. It does not matter if they
are employed or unemployed, or living at home or away,
they are still covered under Platinum Plus. All this is
available for just a small increase in your premium.
If the children you wish to cover are aged under 21, or
under 25 and studying full-time, Platinum Health provides
all the cover you need (refer to previous page).
Platinum Plus Premiums Oldest Person Under Policy is Under 65years*
Base Tier Tier 1 Tier 2 Tier 3
Payment method (29.04%**) (19.36%**) (9.68%**) (0.0%)
FULL REBATE NO REBATE
Family (& Couples)
65yrs & older!
Fortnightly Direct Debit $217.90 $247.65 $277.35 $307.10
* Premiums based on oldest
Fortnightly Payroll $224.05 $254.65 $285.20 $315.80 person under policy being
under 65yrs, for those 65yrs
Quarterly $1,461.60 $1,660.95 $1,860.35 $2,059.75 or older you may be entitled
to a higher Rebate please see
page 21 for more information.
Half Yearly $2,879.30 $3,272.10 $3,664.90 $4,057.70
For premiums that apply to
Yearly $5,671.00 $6,444.60 $7,218.20 $7,991.85 over 65yrs go to
www.policehealth.com.au
Single Parent Family or call 1800 603 603
Fortnightly Direct Debit $205.15 $233.10 $261.10 $289.10 ** Premiums available on
lodging the Australian
Fortnightly Payroll $210.95 $239.70 $268.50 $297.30 Government Rebate on
private health insurance
Quarterly $1,375.95 $1,563.65 $1,751.40 $1,939.10 application form with Police
Health. See page 21 to
Half Yearly $2,710.65 $3,080.45 $3,450.20 $3,820.00 determine which level of
Rebate applies to you.
Yearly $5,338.75 $6,067.05 $6,795.35 $7,523.65
Important Note: The
premiums shown in this table
are based on rates applying
to those having an existing
hospital cover with a certified
age of entry of 30 or, who join
hospital insurance by June 30
following their 31st birthday. If
neither of these apply, contact
Police Health for the Lifetime
Health Cover premiums that
will apply to you.
© 13Claiming Information
Making a claim Two-year limit - Claims must be lodged with Police
Lodging claims with Police Health is easy. Hospital bills Health within two years of the date of service. Claims for
are usually sent direct to us by the hospital and we pay services older than two years will not be accepted.
them on your behalf.
Orthodontics - Orthodontics can vary considerably in the
With the majority of extras claims, such as dental and period of treatment, cost and how you are billed. Before
optical, most service providers will process invoices on agreeing to commence orthodontic treatment determine
the spot using eftpos-style electronic claiming facilities. your payment plan with the provider. This may involve an
upfront payment followed by instalments during the
All you have to do is swipe your membership card and
expected treatment period. Ask the provider what options
sign to validate the service. Your claim will be
are available and for a written plan once it’s agreed to.
automatically lodged with Police Health and we will pay
the provider direct, leaving you to pay only the gap. The Should you choose to pay for the total treatment up front,
majority of providers offering on the spot claiming can please be aware Police Health benefits will be spread
be searched for on the Police Health website. over the treatment period and are subject to Annual and
Alternatively give us a call or ask your health service Lifetime Maximum limits and waiting periods. For more
provider to see if they offer this facility. information please call us, or refer to our website.
Please note Police Health does not provide on the spot Please note electronic claiming is not available for
claiming for orthodontic, complementary therapies, Orthodontic services, you will need to submit your claim
speech therapy, occupational therapy, psychology, form to Police Health and we recommend you attach a
dietician, acupuncture and naturopathy. copy of your treatment plan with this claim so we can
If on the spot claiming is not available, simply post, give a detailed outline of the benefits you can expect.
email or fax your account and completed claim form to Waiting periods
Police Health and we will do the rest. Waiting periods are designed to protect the interest of
Claims lodged manually - Payments covering medical our members. Without waiting periods it would be easy
gap or extras services will be made payable to you if for people to simply join at the time they need cover and
you have already paid the account. If you have not paid receive benefits. This would lead to much higher
the account, you will receive a cheque made out to the premiums for all fund members.
health service provider and you must forward this Waiting periods for:
together with your part of the payment. Hospital benefits of Top Hospital, Platinum Health and
Platinum Plus:
Access Gap Cover - Doctors billing under our Access
• 2 months membership for all benefits, excluding
Gap Cover will normally forward their account direct to
accidents.
Police Health. We then claim your Medicare entitlements
• 12 months membership for obstetric treatment.
and pay that, together with your Police Health benefit,
• 12 months membership for pre-existing conditions,
direct to the doctor. Your doctor will inform you of any
excluding psychiatric care, rehabilitation or
out-of-pocket expenses you may need to pay.
palliative care.
PromptPay - If you have already paid the account from • 12 months membership for aids and appliances.
your medical or extras provider, Police Health offers
Extras benefits for SureCover Extras, Platinum Health and
PromptPay to ensure fast payment of your claim. With
Platinum Plus:
PromptPay your benefit is paid direct to your financial
• 2 months membership for all benefits, excluding
institution account as an automatic direct credit. Simply accidents.
tick the appropriate box on the claim form and provide • 12 months membership for major dental (such as
your account details. crowns, bridges, inlays, indirect fillings and dentures),
Email Claims - Email your receipts /accounts with a orthodontic, hearing aids, nebulisers, blood glucose
completed claim form to myclaim@policehealth.com.au & blood pressure monitors, blood coagulation monitor
(Please include your membership number in the subject line). and for pre-existing conditions.
• 12 months membership for Rollover Benefit and
Fax Claims - Fax your receipts /accounts with a access to Rollover Maximum (2 years Major Dental).
completed claim form to 1800 008 554.
14 ©Platinum Health & Platinum Plus
• 3 years membership for corrective laser eye surgery.
For Hospital Substitute Treatment the same waiting periods apply as for
Hospital cover.
Pre-existing conditions - A pre-existing condition is one where signs or
symptoms of your ailment, illness or condition, in the opinion of a medical
practitioner appointed by Police Health (not your own doctor), existed at anytime
during the six months preceding the day on which you purchased your health
insurance or upgraded to a higher level of hospital cover.
The medical practitioner appointed by Police Health must consider any
information regarding signs and symptoms provided by your own treating doctor
or specialist.
If a new member has a pre-existing condition before joining Police Health, they
may need to serve a 12 month waiting period under the terms of our policy
before benefits are payable for the particular condition. This does not apply for
psychiatric care, rehabilitation or palliative care.
New members - Like all private health insurers, Police Health has waiting periods
for people joining our private health insurance who do not have existing cover.
These periods may also apply to people transferring from another
insurer where their cover was lower than Police Health's and to
members upgrading their policy. Naturally, new members do not need
to serve waiting periods for services for which they were eligible prior to
transferring to Police Health.
Transfer from another insurer - New members who were covered by
another insurer at the time of joining will receive continuity of cover.
Credit is even provided for any waiting periods you served with the
previous insurer.
If you are transferring from another insurer and increase your
level of cover, you will be required to serve waiting periods
for new services or higher Annual Maximums, for which you
were not previously covered. This also applies to other
people who transfer to your existing Police Health cover.
Services incurred during the waiting period will, of course,
still be honoured for the lower level of cover. From time to
time waiting periods may be reduced or waived in the case
of special offers by Police Health.
Newborn cover - Mothers with a single hospital policy are
covered for the cost of a birth but not for any treatment for
the baby.
For a baby to be eligible for benefits immediately upon birth,
a parent must have held a family or single parent family
policy for at least two calendar months prior to the baby's
birth, regardless of whether or not the baby is premature.
© 15We recommend that a single member upgrades to a claims they have paid previously. At Police Health, most
family or a single parent family policy as soon as benefits start with our calculated average fee and are
pregnancy is confirmed to ensure a premature baby is then increased by a further 15%. This ensures there are
covered. Doing this also reduces the chance of the 12 few surprises and that the majority of our members will
month waiting period for a pre-existing condition being receive a full 80% rebate on claims.
applied to the baby for a congenital condition. This can
occur when you suspect or are aware of such a condition In determining your claimed benefit, Police Health will
at the time of changing your cover. use the net amount payable of any account inclusive of
discounts the provider might be offering at the time.
We recommend that you add your newborn to your policy
This may vary where, for the benefit of our members,
as soon as you can, but within two months of birth.
Police Health has negotiated specific agreements with
Ambulance selected providers.
No matter which policy you hold, Police Health members
have full ambulance cover when transport is required for Australia-wide coverage
clinical reasons, or if treatment is required with no Members are covered anywhere in Australia but not
transport provided. overseas. Police Health does not provide cover to
insured persons while outside of Australia or for internet
Cover is not provided for ambulance transport where you
or mail order purchases from providers not based in
do not require treatment by the ambulance officers.
Police Health benefits will also not apply if ambulance Australia. It is strongly recommended that people
transportation costs are covered by a third party travelling overseas consider purchasing travel insurance
arrangement, such as an ambulance subscription to cover their emergency needs (see page 20).
scheme or a State/Territory ambulance transportation
Services not recognised by Medicare
scheme. Benefits may be payable, however, for any
Police Health is limited in the benefits it can pay for
ambulance treatment costs not fully covered by those
services that are not recognised by Medicare, including
arrangements or schemes.
some types of cosmetic surgery and sterilisation
Travel and accommodation assistance reversal. If you are intending to undergo this kind of
The Patient Assistance Transport Scheme (PATS), a surgery, please check with us first.
government sponsored scheme operating in South
Australia, provides assistance to a patient who, because Compensation or damages
of their locality, must travel long distances to access If you are eligible for compensation or damages from
specialist medical services. WorkCover or other insurance claims, including
compulsory third party, public liability or an accident,
In addition to the benefits available through PATS, under
certain circumstances Police Health also offers travel and your medical and hospital expenses may be
accommodation benefits to members who need to travel postponed until the third party pays.
more than 200 kilometres from their home to receive
If this does not occur, Police Health may agree to pay
inpatient hospital treatment. Please contact Police Health
your benefits subject to conditions. Under these
prior to admission.
circumstances you will be required to reimburse Police
Recognised health providers Health for any fund benefits you receive for services
Recognised health providers are those who are in private subsequently covered by the other insurance provider.
practice in Australia and recognised by Police Health. We
only pay benefits for services by these providers. If you Any compensation you receive for future medical
wish to ensure that your provider is covered by Police expenses should be consistent with the medical reports
Health please contact us prior to treatment. relating to your claim for compensation. Police Health
may not reimburse costs relating to your illness or injury
Recognised fees
if you accept an offer of compensation which is not
Police Health has agreements with most hospitals and
reasonably consistent with the anticipated future
recognise their fees for rebate.
treatment costs. You should notify Police Health of any
With extras services, generally each health insurer will claim for compensation relating to illness or accident.
calculate their own set of average fees based on the
16 ©Medicare claims
What does Medicare cover?
Certain out-of-hospital medical services are paid by Medicare and are therefore
not covered by private health insurance.
These include visits to or by your doctor, services such as pathology and
radiology when provided as an outpatient, and treatment in a hospital
emergency department as the patient is not admitted. Visits by a paediatrician to
a newborn also fall into this category if the baby has not been admitted to the
hospital as a patient in their own right.
In all these cases, claims should be lodged with Medicare for payment. For
more information on what Medicare covers visit www.medicareaustralia.gov.au
What is the Medicare Benefits Schedule?
This is the level of fees set and recognised by the Commonwealth Department
of Health and Ageing for the payment of Medicare benefits for medical services.
It is important to remember that while benefits are based on this fee schedule
(referred to as Scheduled Fee), medical providers are free to set their fees at any
level.
How much does Medicare pay?
Medicare pays 85% of its Scheduled Fee for medical services provided to
people who have not been admitted to hospital and 75% of the Scheduled Fee
for services provided to people who have been admitted (in-patient).
In the vast majority of cases, Police Health's Access Gap
Cover scheme (see page 4) covers the difference
between the Scheduled Fee and the doctor's charge for
in-patient services*.
Where a doctor chooses not to participate in Access Gap
Cover and charges above the amount in the Medicare
Benefit Schedule, Police Health is only permitted to pay
up to the Scheduled Fee.
*Note: if you are not registered for Medicare benefits, for instance if
you are a non-resident of Australia, you will not receive benefits for
Medicare Services.
What about out-of-pocket costs
In providing its health insurance, Police Health strives to
minimise treatment costs to members. While we have
succeeded in covering most situations, there are some
occasions when members will incur a charge from the
service provider:
• Charges greater than the Scheduled Fee that do not
fall within the Access Gap Cover.
• Charges greater than those recognised for Access
Gap Cover.
• Non in-patient services, including emergency
department fees.
• Visits by a paediatrician to a newborn who has not
been admitted to hospital as a patient in their own right.
© 17Your membership
How to Join • A claim for benefit is made on your health insurance or
Taking out a health insurance policy with Police Health is when dealing with Police Health through one of its
straightforward. There’s an application form attached to communication channels.
the back of this brochure, if you require additional copies Personal information collected includes names,
you can request them from our office or download them addresses, ages, bank account details, telephone
from our website www.policehealth.com.au. numbers, email addresses and sensitive (health)
Once you have decided which policy suits you best, information.
post, email or fax the completed form to Police Health
You should be aware that once you have been accepted
and your policy will begin as soon as we receive the
by Police Health and you are insured under a health
application, or from a future date that you nominate.
insurance policy, Police Health will collect personal
Please contact Police Health if you have any queries.
information on a recurring basis for the duration of your
An information pack with further details about Police health insurance policy. It is necessary for us to collect
Health and your membership will be sent to you a your personal information when you or a responsible
couple of weeks after joining. person on your behalf interact with us, especially when
Membership Card making a claim for health treatment either by post,
All persons covered by your policy who are aged 18 facsimile, through electronic channels or through a third
years or over will receive a Police Health membership party such as a hospital, medical practitioner or other
card. If the card is lost or stolen please notify us service provider who may claim directly from us on
immediately so that it can be cancelled and replaced. your behalf.
Police Health will not accept responsibility or liability for Collection and disclosure of your personal information is
any loss or action resulting from the use or misuse of a required by Police Health, and, depending on the
lost or stolen membership card. information, is required under the Private Health Insurance
Paying your premiums Act 2007. Police Health collects personal information for
A range of payment options are available designed to the purposes described in the Privacy Policy and, in
suit your individual needs and circumstances. Premiums particular to manage the health insurance and
can be automatically paid fortnightly from your SAPOL health-related services it provides.
salary, or by direct debit from your financial institution If we do not receive the necessary information or the
account. Alternatively you can receive a renewal notice information is not accurate or complete, then Police Health
every 3, 6 or 12 months, which can be paid by cheque will not be able to provide you with our services, including:
or BPAY. • Processing your application for a health insurance
Privacy Notice policy and insuring you or other people on the health
Like all health insurers, Police Health is required to collect insurance policy.
personal information. Police Health respects your • Providing services associated with billing and claiming
privacy and treats this information confidentially and of benefits.
stores it securely. • Effectively dealing with your enquiries, issues or
complaints.
Personal information is collected and managed by Police • Providing you with other benefits and services in relation
Health in accordance with the Police Health APP Privacy to your health insurance cover.
Policy and the Australian Privacy Principles. You should
read and be familiar with the Policy, and ensure that other Personal information may also be used in advising you of
persons that are covered by your health insurance policy direct marketing offers such as products or services
also read and are aware of the Privacy Policy. This Notice provided by or in conjunction with Police Health, which we
contains a summary of some important issues, but the consider may be of interest to our members.
Policy has more detail. Police Health may need to disclose personal information
Police Health will collect personal information from you, a to other people insured under the same health insurance
responsible person, or a third party, either directly or policy, government agencies, other health insurers,
indirectly, when: organisations or individuals with whom we contract for
• You apply for membership with Police Health to services, health service providers, financial institutions and
purchase a health insurance policy, and if accepted, your employer. Police Health is not likely to disclose
you are the policy holder (Contributor) of the policy. personal information to overseas recipients.
• You are a dependent (spouse or child) under a health The APP Privacy Policy contains further information on how
insurance policy and the policy holder (Contributor) you may:
holds or has applied to purchase a health insurance • Have reasonable access to and seek correction of your
policy which covers you. personal information.
18 ©• Complain to Police Health about a breach of the Australian Privacy Principles
and how we will deal with such a complaint. Police Health’s contact details
can be found on the back cover of this brochure.
The policy holder (Contributor) or another insured person must only provide
personal information relating to other people on the policy if authorised to do so.
It is important that all persons (currently insured, or who become insured, or
considering joining Police Health) are aware of and understand this Notice and
our Privacy Policy. It is the responsibility of the policy holder (Contributor) to
ensure that every other person covered under the policy is aware of this Notice
and the Privacy Policy. Other people on the policy should be made aware that the
policy holder (Contributor) receives and can view through our On-line Member
Services (OMS) all information relating to their claims for benefits and hence the
policy holder (Contributor) has access to their health information, unless an
individual has requested their claims information be kept private in which case
claims information will not be shown on OMS.
If any insured person aged 18 years or older wishes to ensure that their personal
information is not disclosed to other people on the policy, they should purchase
their own health insurance policy.
A copy of Police Health’s APP Privacy Policy can be obtained from our website
www.policehealth.com.au or by contacting our office.
What membership means
The use of the words "membership" and "member" in the context of this
brochure relates to the policy holder (contributor) and all dependents under the
policy of the Police Health insurance. It does not imply member voting rights as
described in the constitution of Police Health Limited ABN 86 135 221 519.
Conditions of membership
This brochure does not contain all Police Health's conditions
of membership.
A full copy of the Fund Rules is available at our head office at
339 King William Street, Adelaide SA 5000, or send a request
for a copy in writing to our office.
Compliance Policy
Police Health's commitment to compliance is articulated in
its Compliance Policy, which can be viewed at
www.policehealth.com.au
Cooling-off period
If for any reason you are not satisfied, Police Health provides
new members or existing members who change their level of
cover with a cooling-off period. We will refund in full without
penalty any premiums paid for a new policy or increased
premiums paid relating to a cover change provided the
request to cancel the new policy or cover change is received
in writing within 30 days of commencement. The cooling-off
period is void if there have been any benefits paid relating to
the new policy or cover change.
Child dependents ceasing to be covered
Once your children reach an age where they are no longer
protected by your cover, they can sign up to their own Police
Health policy without any waiting period provided they:
• Take out a policy with cover no greater than yours.
• Join from their 21st birthday (25th birthday for Platinum Plus).
© 19You can also read
