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Health Terms and Conditions

 

CUA Health Insurance

TERMS AND CONDITIONS

# The quoted price assumes you live in Queensland and you’ll receive 25.934% Australian Government Rebate for Private Health Insurance. Hospital cover prices are based on no Lifetime Health Cover Loading and an excess of $500 per person per calendar year (excluding dependants).

* First month free is available only to new policy holders who join via Credit Union Australia Limited. ABN: 44 087 650 959 (CUA) directly.

Please read the information carefully and retain for your future reference. If you join CUA Health, confirmation of your cover and policy information will be sent to you. If you change your mind CUA Health provides a cooling off period of 30 days from the start date of your policy. For more information including Code of Conduct and Complaints resolution refer to information for policy holders.

CUA Health insurance is provided by CUA Health Ltd 98 098 685 459 (CHL) which is not an authorised deposit-taking institution. While CUA Health Insurance may be distributed by Credit Union Australia Ltd ABN 44 087 650 959 (CUA), CUA is not liable for this product and does not stand behind CHL.

It’s important to know that we only pay a benefit for services performed by private practitioners in a private practice, provided their associations and services are recognised by us. If you’re unsure if the provider you have selected, or service you require is covered under your policy, please contact CUA Health for confirmation. The items, limits and benefits are provided as a general guide only. Please call us if any further information is required.

When changing health insurers, Extras benefits paid by your old health fund will be counted towards your annual limits in your first year of membership with us.

Benefit limitation periods

During the first 24 months from joining benefits paid for these treatments will be limited to the same amount you would receive in a public hospital for the same treatment. After 24 months from joining you will be eligible for the full benefits under the policy. Benefit Limitation Periods run concurrently with waiting periods when applicable.

Out of Pocket expenses

The benefit we pay towards in-hospital medical services is based on the fees set by the Australian Government under the Medicare Benefits Schedule (MBS). If a service is listed in the MBS and is covered under your hospital cover, Medicare will pay 75% and we will pay 25% of the MBS fee. Where a doctor or specialist charges in excess of the Medicare Schedule fee, you’ll incur an out of pocket expense unless they participate in the Access Gap Cover scheme – see below for more info.

Access gap cover scheme

The Access Gap Cover Scheme will reduce or in many instances eliminate your out-of-pocket expenses for specialist care you receive while in hospital.

Doctors and specialists electing to participate in the Access Gap Cover Scheme can bill CUA Health directly. So, not only does your hospital treatment cost you less, but the billing system is made easier for you too.

Access to a complete list of doctors and specialists participating in the Access Gap Cover Scheme is available here. If your doctor or specialist chooses to use the Scheme, you will either:

  • have no out-of-pocket expenses, or
  • be provided with an estimate of out-of-pocket expenses before your treatment

Your doctor or specialist may choose to use the Scheme on a patient-by-patient basis. Of course, whether or not your doctor or specialist participates in the Access Gap Cover Scheme will not change the relationship you have with him or her, or affect the treatment you receive.

Excess payment

Excess: An upfront amount that you agree to pay towards the cost of hospital treatment, in exchange for lower premiums. For example, if you have Premium Hospital cover with $250 excess, and require hospital treatment you’ll pay $250 per person, per calendar year. This does not apply to dependants listed on the policy.

Agreement hospitals

CUA Health has agreements with the majority of private hospitals and day surgeries. If your hospital or day surgery doesn’t have an agreement with CUA Health, you may be subject to large out-of-pocket expenses, in addition to any excess or co-payment. Please check with your hospital prior to admission. Access to a complete list of agreement hospitals is available here.