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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 25.415% 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).

* The 4% discount is applied to CUA Health premiums paid by direct debit from a CUA transaction account on any policy effective from 4 April 2018. CUA Health reserves the right to amend or remove the discount and any qualifying criteria at any time. We will always provide you with reasonable notice before exercising this right. Full terms and conditions available at cua.com.au/healthdiscount.

** Your needs and financial circumstances have not been taken into account. Terms and conditions are available on application. Other fees and charges may apply. A General Information, Terms & Conditions brochure and Schedule of Fees are available online or from your local CUA branch. You should read both these documents before deciding whether to purchase this product, issued by CUA.

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.

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.

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.

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.