Glossary including MBF Healthcare Cover Guidelines

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Important information for you to know current as at April 2007

Helping you get to know your MBF cover

When you become a member of MBF, you agree to be bound by the MBF By-laws. These explain the full details of your membership, including the rights your membership gives you and the conditions you agree to follow when you become a member. As all MBF members are bound by the MBF By-laws, we encourage every member to read them. Download a copy of the MBF By-laws or visit any MBF Centre to view a copy.

Copies of the By-laws can be viewed at any MBF Centre or by downloading them here.

The information on the MBF website and these MBF Healthcare Cover Guidelines represents a summary of the By-laws and other rules that are likely to affect most members. This will help you understand the way your cover works and the meaning of some of the terms you may encounter.

Your official MBF member magazine, Living Well, will notify you of significant changes to your membership rights and conditions and, for legal purposes, the changes it communicates will be deemed effective notice.

Where you might need extra information

Please note that the information in this document applies to members who are entitled to full Medicare benefits. If you are not entitled to full Medicare benefits please see an MBF Overseas Visitors' Cover or MBF Corporate Overseas Visitors' Cover brochure which can be found on our website.

Of course, if you require any further information about the MBF By-laws, your rights and conditions, how MBF assesses claims or any other aspect of your membership, please visit an MBF Centre, call us on 131 137 or, if you are a Corporate member, call 1300 653 525.

  Accident

An Accident is an event leading to bodily injury caused solely and directly by violent, accidental, external and visible means and resulting solely, directly and independently of any other cause.

   Accident Cover

Where included in your level of MBF extras cover, Accident Cover provides you with benefits up to $2,000 per person ($4,000 per family) per Accident, further limited to $2,000 per person (maximum $4,000 per family) per annum, towards certain medical costs related to an Accident. Benefits are only available for treatment required as a result of an Accident, where the Accident results in urgent hospital attention as soon as practicable after the incident.

Accident Cover is only available to pay any Co-payment or Excess on your MBF hospital cover or, after the payment of any MBF extras benefits, to top up any Limits you have on your extras cover. This benefit is not redeemable as cash. See Compensation from a third party.

Where the Accident results in you requiring a service which is an Excluded Service, under MBF Budget Hospital with exclusions or MBF Standard Hospital with exclusions or MBF HealthSmart, Accident Cover cannot be used to cover the cost of that service or to pay your Excess.

  AutoClaim

MBF AutoClaim is a way for members to make fast, easy, on-the-spot claims for Extras services. It works with one swipe of your MBF Member Card while you're right there, subject to the limits of your cover in your participating healthcare provider's rooms.

It's MBF's link to the automated service provided by HICAPS and IBA HealthClaims. Look for the IBA Health Claims or HICAPS logo when you next visit your healthcare provider.

Ask your healthcare providers if they offer this service. If so, your MBF Member Card is ready to go.

  AutoPay

MBF AutoPay is a direct debit facility from your nominated bank, building society, credit union or credit card account. You can choose from a selection of payment intervals.

We'll give you everything you need to request MBF AutoPay when you join MBF.

 

   Benefit Limitation Period (BLP)

In addition to waiting periods, the MBF HealthLink levels of cover have services with a Benefit Limitation Period (BLP). If a BLP applies to a level of cover, after the relevant waiting periods have been served, benefits will be limited to the default benefit declared by the Federal Minister for Health and Ageing for two calendar years after the waiting period ends. These reduced benefits only apply for the following admissions to private hospitals:

• hip and knee joint replacements, except where they are required as the
  result of an Accident which occurs after membership of MBF commences;
• cataract eye surgery;
• assisted reproductive services;
• dialysis for chronic renal failure;
• bone marrow transplants; and
• all psychiatric conditions (except eating disorders and post natal
  depression).

  Benefits

MBF will only pay benefits where:

• the waiting period for that service has been served;
• services have been rendered in Australia by an MBF Recognised
  Provider (however, limited benefits are payable in Papua New Guinea
  and Norfolk Island);
• a service or treatment is medically necessary and clinically relevant to the person on your membership receiving it;
• a service has actually been rendered to a person on the membership in
  person, eg no benefit for telephone or Internet consultations or written
  reports;
• a charge has been raised by a service provider for services or appliances
  recognised by MBF for benefit purposes;
• you have already paid the provider (if the charges are unpaid, any applicable benefits
  will be made payable directly to the provider);
• the treatment or service is covered by your chosen level of cover;
  you have met all the conditions of your level of cover
• no benefit is payable from another source; and
• for extras services for which you have not made a claim against Medicare for the service.

The amount of benefit will be calculated at the date of service/purchase, on the cost of the treatment or appliance to the member, taking into account any allowances or discounts given by the provider. No benefit paid by MBF can exceed the actual charge of the service or appliance.

Overpayments
If you are overpaid any benefit by MBF, or owe MBF money, MBF may recover (offset) that money from any payment you have made towards your premiums or otherwise, provided that MBF gives you at least one-month's notice.

Hospital cover does not cover you for all treatments
See Hospital Treatment Charges, Doctor's Charges and Excluded Service for more information. Please note: you will not receive benefits for additional charges for luxury suites; services provided which are not of a medical nature (eg continued hospital accommodation for reasons other than medical); experimental treatment; cosmetic surgery; treatments not covered under Medicare (unless specifically covered in a hospital agreement); and some very high cost drugs.

Extras cover benefits
These are normally provided for treatment that is part of a treatment plan recognised by MBF. Examples of where MBF will not provide benefits include: certain dental item numbers; where the number of consultations exceed a certain amount, eg a maximum of one consultation per day per provider for therapies; and certain types of products, eg bandages provided by a physiotherapist and hearing aid batteries. Where an MBF Recognised Provider provides services to an MBF member who is a member of the provider's immediate family, business partner or associate, or members of the family of the business partner or associate, MBF will not pay a benefit for those services unless it has approved, in accordance with its By-laws, an application from the MBF member requesting payment of benefits.

For more information, please refer to the MBF Dental Guidelines, MBF Health Management Aids and Appliances Guidelines, MBF Optical Guidelines and MBF Physiotherapy Guidelines that can be viewed at any MBF Centre

  By-laws and By-law changes

MBF members agree to be bound by any changes in the By-laws. These changes may come into effect on a date prior to the date you are paid up to, however, you are bound to the new rules from their effective date. MBF may make any variation, cancellation or annulment of any of the By-laws at its discretion, subject to the relevant Ministerial approval.

Where practical, MBF will give you 14 days notice of a premium change and between 14 days and two months notice of other changes that significantly reduce benefits. Such alterations may include an increase or reduction in premiums or scale of benefits and includes the right to change conditions of membership, amongst other things.

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  Changes to legislation

Changes to legislation may occur from time to time which may also affect your benefit entitlement or premiums. These changes may affect you immediately from the time the new laws become effective.

  Changes to your circumstances

When your situation changes, it is your responsibility to notify MBF.

This means, for example, a new spouse only be added onto a membership when you notify us to do so. They will then be subject to the usual waiting periods from that date. It is not possible to backdate this notification.

When you change address or contact details, you must also notify MBF to ensure you receive important notices and communications.

  Children's Bonus

The Children's Bonus includes:

• $1,000 per dependant per year special school/sports accident cover (in addition to the usual Accident Cover and applies the same way as extra Accident Cover).

The benefit applies only to members on certain levels of cover and your dependants still at school.

Please note:

MBF will pay the Contributor a benefit towards the cost of essential health care services, except for items covered by Medicare, incurred by a Registered Dependant who has not left school as a result of an Accident at school or whilst travelling to or from school or any associated school activity provided that:

1. the costs are not paid or payable from any other source;

2. the limits of other relevant benefits in MBF FamilyFirst have been exhausted; and

3. the costs of such services for the purpose of determining these benefits shall be limited to the Set Benefit for the respective types of services involved.

  Compensation from a third party

If you have an Accident or are injured (eg in a motor vehicle accident or as a result of your employment) and have a right to receive compensation or damages from a third party, you are not eligible for MBF benefits (including future costs of treatment).

This applies whether or not you pursue the claim and whether or not MBF has made any payment. If you are in this situation, you may apply for provisional benefits which will be paid if you meet MBF's requirements, but these must be paid back if you receive compensation.

  Complaints

MBF has procedures for you to easily voice concerns or to provide us with feedback. Simply talk to any of our consultants who can address a wide range of issues on the spot. If necessary, a qualified team leader is always on hand to discuss your concerns and, if you are not happy with their response,they will pass on your concerns to the Escalated Customer Support team. It is always our first aim to resolve our members' concerns right here at MBF. If you are not satisfied with our response to your concern, you can contact the Private Health Insurance Ombudsman on 1800 640 695. This is an independent, free service to address the concerns of all members of Australian health funds. It is funded by a levy paid by private health insurers.

  Co-payment

A Co-payment is an amount that a member pays towards the cost of Hospital Treatment Charges.. It is payable in addition to any Out-of-pocket Expense you may incur. A Co-payment applies each time you are admitted overnight to an MBF Network Hospital but does not apply to public hospital or to Non-Agreement hospitals admissions. You should check your level of cover to confirm if a Co-payment applies to your level of cover. Please note that from 1 April 2006, if you hold MBF Advantage Hospital cover, no Co-payment is payable for hospital admissions for Dependant Children or Dependant Children registered on your membership under Dependant Extension.

   Complementary therapies

MBF has introduced Complementary therapies on some levels of cover, to help pay for the following: acupuncture, Alexander technique, aromatherapy, Bowen technique, exercise physiology, Feldenkrais, herbalism, homoeopathy, iridology, kinesiology, naturopathy, reflexology, remedial massage and Shiatsu.

  Cosmetic surgery

Benefits are only payable for cosmetic surgery or services where it is required for a medical purpose and Medicare benefits are payable. This also applies to extras services which are cosmetic services, eg tooth bleaching.

  Couple membership

Couple membership includes only the Primary Member and his or her legally married or de facto spouse (living together on a bona fide domestic basis).

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         Dental

In some more complex cases, a general dental procedure may be considered major dental. Simpler 'major dental' procedures may be considered general dental. For orthodontic benefits, the treatment plan must be approved by MBF prior to services being provided. Different dental benefits are payable if the service is provided by a dental prosthetist or orthodontist.

  Dependent Child

A dependant child means:

• any of a Primary Member's or his or her spouse's single children, as notified to MBF, up to the age of 21 years.
• a Student Dependant as defined below.

Student Dependant means any of a Primary Member's or his or her spouse's single children aged 21-24 years inclusive, who are full-time students at a Recognised Tertiary Institution and are fully or partially maintained by you and:

• who are not in receipt of a taxable income from the school, college or university; and/or
• who are not entitled to receive an invalid pension or disability allowance of any amount or other income, providing a total gross annual income of more than $14,000.

You must apply each year to have Student Dependant/s registered on your Family or Single Parent Family membership.

Unless otherwise stated, a child includes adopted, foster, step-children and children over which you are granted guardianship by a court of law. (You will be required to provide evidence that such a child registered on your membership meets this description).

  Dependant Extension

Dependant Extension is available on some levels of Family and Single Parent Family cover for an additional premium and will cover single Dependant Children aged 21-24 years inclusive who are not Student Dependants. You must apply each year to register each Dependant Child on Dependant Extension cover. Contact MBF to find out more details.

  Direct Debit Service Agreement (MBF AutoPay)

MBF will confirm the details of the MBF AutoPay direct debit arrangements prior to the first drawing, and directly debit the account you have nominated. We will make deductions on the nominated day, except for deductions nominated for the 28th, 29th, 30th or 31st, which will occur on the first day of the following month. If the nominated day falls on a weekend or public holiday, deductions will be made on the next business day.

MBF debits all payments in advance and will automatically vary the deduction amount if the premiums change or the level of cover changes. MBF will not give less than 14 days written notice should we vary the deduction amount, except when the previous deduction is dishonoured, when we will deduct the previous period's payment together with the current amount due.

For members who pay premiums at three, six, and 12 monthly intervals, should your financial institution dishonour a drawing, MBF will draw the payment on the nominated day of the following month. MBF will notify you if two or more drawings are returned unpaid by your financial institution and provide you with alternative payment options.

MBF will assist you in the event of a dispute concerning any debit item drawn on the nominated account in compliance with the Industry's Direct Debit Claims Process. MBF will endeavour to resolve disputes with your bank or financial institution within industry-agreed timeframes.

MBF will keep all information pertaining to your nominated account at the financial institution private and confidential. Information can be provided to our or your financial institution to resolve a dispute on your behalf.

Members' rights and responsibilities

Members may:

• request MBF to alter the debit drawing arrangements (frequency, date and level of cover) at any time by contacting MBF; and
• dispute any debit drawing or terminate the deductions at any time by notifying MBF in writing not less than seven days before the next scheduled debit drawing.

All enquiries, disputes, requests for payment changes or cancellation should be directed to MBF.

It is your responsibility that:

• sufficient cleared funds are available in your nominated account on the due date;
• the account you nominate permits direct debiting;
• the authorisation given to draw on the nominated account is identical to the account signing instruction held by the financial institution where the account is based;
• you notify MBF if the nominated account is transferred or closed;
• you pay your MBF membership fees by an alternative method if the direct debit arrangements are cancelled, whether by you or by MBF; and
• your payments are up-to-date, whether a notice is received from MBF or not.

  Direct Credit

With MBF Direct Credit, MBF will deposit your benefit directly into your bank, building society or credit union account, usually within three working days of your claim being assessed and processed.

MBF Direct Credit means you can access funds quickly - no need to wait for cheque clearance. To receive your claims payment by MBF Direct Credit, simply fill in the form, available from any MBF Centre, or call us on 131 137.

  Doctors' Charges

No benefit is payable if the service relates to treatment excluded under your level of cover (see Excluded Service) or you are not entitled to a Medicare benefit for the treatment (eg non resident or cosmetic surgery).

The Medicare Benefits Schedule Fee ("MBS") is the amount determined by the Commonwealth Government for the purpose of paying Medicare benefits.

For in-patient hospital treatment, Medicare will pay 75% of the MBS, and MBF will pay up to 25% of the MBS. If you are treated by a doctor who charges above the MBS this will create an expense not covered by either Medicare or MBF unless MBF has an agreement with the doctor or the MBF Medical Gap Cover Scheme applies (see MBF Medical Gap Scheme). Please note that radiology and pathology services are considered to be Doctors' Charges. MBF does not pay any benefits for services outside of hospitals unless we specify otherwise under your level of cover and we have an agreement with the provider for that treatment or for out-patient treatment.

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     Emergency ambulance transport

Once you have made your payment and your application has been accepted MBF will only pay a benefit for ambulance services where the services are provided by a State or Territory Government. Benefits are only available for emergency or casualty transportation where, in the opinion of a medical officer, a member requires immediate treatment in circumstances where there is serious threat to the member's life or health. Benefits are not payable for transportation from a hospital to your home, nursing home or other hospital; for transportation for on-going medical treatment; or where your State Government provides an ambulance benefit (eg Queensland and Tasmania).

  Excess

An Excess is the amount you agree to pay per person each calendar year each time a person covered by your membership is admitted to hospital. The Excess is paid only once per person per calendar year, to a maximum of twice per membership for Single Parent Family ,Couple or Family memberships.

The Excess payable per person must be fully paid for that calendar year before any MBF benefits are payable for a hospital admission for that person. Any payment made by you for treatment which would not otherwise attract a benefit from MBF i.e., personal items in hospital, will not be taken into account for the purposes of determining if the Excess has been paid in full.

For Singles membership, once the Excess has been paid in full in a calendar year you will not be required to pay any Excess for any further hospital admissions for that calendar year. For Single Parent Family, Couple and Family memberships, once the Excess is paid in full in a calendar year for two people covered by the membership, no further Excess will be payable for any hospital admissions occurring during the same calendar year.

No Excess is payable for hospital admissions for Dependant Children or Dependant Children registered on your membership under Dependant Extension if you hold MBF Advantage Hospital cover (effective 1 April 2006) or MBF HealthLink Advantage cover (effective 1 April 2007).

Please note that reducing your Excess is considered to be upgrading your membership . See 'Upgrading your membership'.

  Excluded Service

An Excluded Service is one where no benefit is payable for any of the doctors' or hospital's charges associated with that admission.

This applies to those members whose level of cover is MBF Choices or MBF Budget Hospital with exclusions, under which benefits are not payable for the following services:

• joint replacement including revisions;
• cataract and eye lens procedures;
• cardiac and cardiac related services;
• renal dialysis for chronic renal failure (for members who joined or transferred to this level of cover on or after 1 April 2006); and
• pregnancy and birth-related services including assisted reproductive services. (Please note most assisted reproductive services are out-patient treatments and are therefore not covered under any level of MBF hospital cover).

Or MBF Standard Hospital with exclusions, under which benefits are not payable for the following services:

• joint replacement including revisions; and
• cataract and eye lens procedures; and
• renal dialysis for chronic renal failure (for members who joined or transferred to this level of cover on or after 1 April 2006).

Or MBF HealthSmart, under which benefits are not payable for the following service:

• pregnancy and birth related services including assisted reproductive services (please note that, most fertility treatments are out-patient procedures and therefore not covered under any level of MBF hospital cover).

  Extended Limits

With some levels of MBF extras cover, eg MBF Premium Extras cover, you have access to MBF's special two year Limits on some services. This means you 'carry forward' some unused Limits into the next year only.

Claims will be deducted from your current year's Limits first. For example, if you have a $300 general dental annual Limit and only claim $100 in year one, you can carry forward $200 into year two.

In year two, you will be able to claim a total of $500. If you then claimed $50 in year two, you will have $250 remaining from your standard annual Limit to carry forward into year three, and be able to claim up to $550 ($300 standard plus $250 carried forward) in that year.

Please note that Extended Limits only apply to services where indicated and don't apply to Accident Cover, hearing aids or the orthodontic lifetime limit.

  Extras Cover

Extras cover helps pay for non-hospital healthcare needs, like going to the dentist, getting new glasses, Emergency Ambulance services, physiotherapy, plus Accident Cover (not covered under MBF Choices) and more. It may also be referred to as ancillary cover.

You can choose extras cover only, or combine extras cover with hospital cover for all round protection.

Medical services provided by a medical practitioner, either in or out of hospital, are not covered by MBF extras cover.

Important note: having extras cover only will not qualify you for the benefits of the Federal Government's Lifetime Health Cover initiative.

 

  Family membership

Family membership includes only the Primary Member and his or her legally married or de facto spouse (living together on a bona fide domestic basis) and any of their Dependant Children or Dependant Children registered on your membership under Dependant Extension. See Dependent Child and Dependent Extension.

  Federal Government Rebate

If all people on your membership are eligible for full Medicare benefits, you are entitled to a Federal Government Rebate on MBF's premiums. If you (and your partner) are aged under 65 years, you are eligible to receive the 30% Federal Government Rebate on your premium. Since 1 April 2005, the Federal Government Rebate on private health insurance increased to 35% for Australians who are aged 65 to 69 years and to 40% for Australians aged 70 years and above.

For members with Couple, Single Parent Family or Family cover that includes a person over 65 years combined with other members who are not, the applicable higher rebate will apply.

There are Savings Provision Entitlements that apply if the person aged over 65 years leaves or cancels the membership. You can choose to receive the rebate as a premium reduction, claim the rebate with your annual tax return or as a cash refund at any Medicare office.

Please call 131 137 or see the Frequent Asked Questions for more information about the Federal Government Rebate.

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  Health management aids and appliances    

Where benefits apply, any health management aids and appliances must be MBF recognised for benefits and be part of a treatment plan recognised by MBF.

Where service limits apply, they apply from the date of purchase.

  Hearing aids  

MBF can help pay for prescribed MBF-approved hearing aid appliances with MBF FamilyFirst, MBF Premium Extras and some other levels of cover, if specified. Excludes batteries and cleaning costs. Waiting Period is three years. Where the cost of all or part of the hearing aid is claimable from another source, no benefit is payable by MBF, eg where the Commonwealth contributes to the cost.

  Hospital Cover  

MBF Hospital Cover can help pay for accommodation and in-patient treatment in a private hospital, or as a private patient in a public hospital where Medicare pays a benefit, providing standard conditions including waiting periods are met, and treatment is not an Excluded Service under your chosen cover.

  Hospital Treatment Charges

Hospital Treatment Charges for eligible in-patient admissions are for accommodation, theatre, labour ward, intensive care, most surgically implanted government approved prostheses (a limited number of government-approved surgically-implanted prostheses will attract a gap which members will be required to pay), most pharmaceuticals that are directly related to the reason for your admission, the PBS patient contribution, physiotherapy and certain other therapies where provided by the hospital. It does not include any Out-of-pocket Expenses.

 

  in2life Partners

MBF in2life Partners offer MBF members all sorts of discounts and special deals from some of Australia's leading retail and lifestyle outlets. There are discounts on sporting goods and sportswear, selected movie tickets, books, CDs, entry to major theme parks and more.

 

  Lifetime Health Cover

The Federal Government has introduced Lifetime Health Cover (LHC) to encourage the uptake of private hospital cover. In general, to avoid the LHC loading, you need to take out hospital cover by the 30 June following your 31st birthday. Otherwise, for every year you delay joining hospital cover, your premiums will increase. In fact, you will pay a 2% higher loading on the base premium for every year you are aged over 30, up to a maximum of 70%. By taking out hospital cover as soon as possible, you can stop the loading from increasing. It will be frozen at the rate that matches your age on the 1 July prior to the date you join (known as the Certified Age at Entry or CAE). As long as you maintain your hospital cover, your loading won't increase each year.

• Paul turned 31 on 7 June 2004. He purchased hospital cover for the first time on 20 June 2004. On 1 July 2003, Paul's CAE was 30, so he does not pay a loading on his premium.
• Kate turned 39 on 6 March 2004. She purchased hospital cover for the first time on 10 June 2004. On 1 July 2003, Kate's CAE was 38. Her loading will be 16%, which is a 2% loading for each year she is aged over 30 before she purchased hospital cover.

What if your hospital cover lapses?
LHC allows those who have locked in their CAE a limited number of days in their lifetime without hospital cover before the loading will be applied or increased. The number of cumulative days without hospital cover allowed before a LHC loading is applied is 1,094 (less than three years).

Members who have:

• have validly suspended their membership in accordance with the MBF By-laws; or
• are overseas (including Norfolk Island) for a continuous period of more than 1 year and who have not returned to Australia for a period of more than 90 days, will not have that time count towards their permitted days without hospital cover.

Are there any exceptions?
Anyone born on or before 1 July 1934 has no LHC loading, except where their partner is born after 1 July 1934.

Other people may have different rules applied for LHC. These include:

• some refugees;
• persons who hold or have held a Veterans' Gold Card after 30/6/99;
• Australian citizens and/or holders of permanent visas who were overseas for the whole of the period between 1/1/00 and 1/7/00 inclusive;
• Australian citizens and holders of permanent visas who were overseas on 1/7/00, or were residents of another country on and after 1/7/00, and have not been back to Australia for a period of more than 90 days;
• Australian citizens and holders of permanent visas who are absent from Australia on the day they turn 31 (provided this is after 1/1/00) and have not since returned to Australia for a period of 90 days or more;

• members of the Australian Defence Force (including their dependants) on continuous full-time service whose health services are provided by the Defence Force;

• a person for whom health services are provided by the Australian Antarctic Division of the Department of Environment and Heritage;

• migrants who became eligible for Medicare benefits after 30/9/99;
• New Zealand citizens who became eligible for Medicare benefits after 30/9/99.

For details regarding Lifetime Health Cover you can visit mbf.com.au, visit one of our Centres or call us on 131 137. Alternatively you can visit the Australian Government Department of Health and Ageing website at http://www.health.gov.au/internet/phimprove/publishing.nsf/content/lifetimecover-lp-1

  Limits

The Limit is the maximum amount you can claim in a service category per person and per calendar year (1 January to 31 December) unless otherwise stated. Per person Limits on services are not transferable to any other members. For certain services, Limits also apply on the number of times that benefits are payable for the same service, e.g. initial consultations.

All Limits apply from the date of service/purchase. Some services have lifetime limits or periodic limits, i.e. orthodontics and hearing aids. Benefits paid for those services on any previous level of cover (including with another Australian registered health fund) will carry forward with you for the purpose of calculating a lifetime limit on your new level of cover.

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  Medication Assistance Service (MAS)

MBF has introduced a new benefit from 1 March 2002 - the Medication Assistance Service (MAS). This means that you can claim for a comprehensive one-on-one consultation with an MBF MemberCare pharmacist about your medications. It usually takes about 20-30 minutes and may also involve follow-up at a later stage.

This service is available to all members with extras cover from existing pharmaceutical limits and is subject to normal membership conditions such as waiting periods. MBF will pay a benefit of up to $40, and members will be entitled to one service per calendar year.

It is designed to give you an opportunity to ask lots of questions about your medications. MAS may be particularly useful if you have recently commenced new medications, if you have any specific concerns about your medications, or simply want to have a better understanding of how they work.

If you are using a medication aid or appliance such as inhaler/nebuliser/blood glucose monitor, it could be a good time to check your technique. Depending on your pharmacist, you may need to make an appointment.

  MBF Dental Guidelines

MBF Dental Guidelines are available for viewing at MBF Centres.

  MBF Living Well Programs      

The MBF Living Well Program (available on selected hospital and package covers) helps cover selected health related programs from approved MBF Recognised Providers such as:

• Nicotine Replacement Therapy - Patches, gums and inhalers.
• First Aid Courses - Once you've completed a course, you can claim for part of the cost, as long as it is given by a Government accredited provider such as Red Cross, QLD Ambulance or St John Ambulance Australia.
• Weight management programs - Fees only. Programs include Jenny Craig, Weight Watchers and SureSlim. No benefit is payable for food, books or videos.
• Gym membership fees - MBF will only pay a benefit for gym membership where the gym program is provided by an approved gym provider and a claim is submitted with a special approval form (available from MBF) that is signed by your GP or an MBF Recognised Provider confirming that the gym program is intended to prevent or relieve a specific health condition/s. Please note that GP consultations are not covered by MBF. Benefits are only payable after a month of gym membership and exclude casual visits, aquatic membership and personal trainers.

• Yoga courses - MBF will only pay a benefit for yoga classes where the yoga program is provided by an approved yoga provider and a claim is submitted with a special approval form (available from MBF) that is signed by your GP or an MBF Recognised Provider confirming that the yoga program is intended to prevent or relieve a specific health condition/s. Please note that GP consultations are not covered by MBF. Benefits are only payable for a program or a minimum of eight-class pass. Benefits are payable on completion of the course and will be paid for yoga classes such as (but not limited to) Hatha, Ashtanga, Ivengar, Bikrams and Ki. Casual courses are excluded.

• Pilates - MBF will only pay a benefit for Pilates where the program is provided by an approved provider and a claim is submitted with a special approval form (available from MBF) that is signed by your GP or an MBF Recognised Provider confirming that the Pilates program is intended to prevent or relieve a specific health condition/s. Please note that GP consultations are not covered by MBF.

Members who also hold MBF hospital cover can access benefits for the following:

• Asthma Foundation membership fees - Provided you are registered as a member of the MBF Asthma Management Program (AMP). Be aware that, as a member of the AMP, you are entitled to a 12 months free Asthma Foundation membership, therefore benefits are only payable for subsequent years of registration as a Asthma Foundation member.
• Diabetes Australia membership fees - Provided you are registered as a member of the MBF Diabetes Management Program (DMP). Be aware that as a member of the DMP you are entitled to a 12 months free Diabetes Australia membership, therefore benefits are only payable for subsequent years of registration as a Diabetes Australia member.

  MBF Network Hospitals

MBF has agreements with selected private hospitals and day hospitals, that have been approved for in-patient hospital benefits by the Commonwealth Government. These agreements may vary or be terminated from time-to-time and benefit entitlements may change. A list of current MBF Network Hospitals is available at any MBF Centre, at mbf.com.au or in Living Well magazine. Please be aware that in MBF Network Hospitals, some Out-of-pocket Expenses may still be payable, especially for sundry items like newspapers, faxes and non-local telephone calls. See Hospital Treatment Charges and Out-of-pocket Expenses.

  MBF Recognised Provider

An MBF Recognised Provider is a person in private practice who is registered under the relevant state or federal regulation (where applicable) and who also meets MBF's documented recognition criteria. Benefits are only payable for services rendered by MBF Recognised Providers whose services or appliances attract a benefit from MBF.

  Medical Gap Scheme    

The MBF Medical Gap Cover Scheme allows patients with MBF hospital cover to eliminate or reduce selected out-of-pocket expenses for medical gap payments for in-patient hospital treatments covered under your chosen level of hospital cover. See Doctor's Charges.

MBF does not pay an amount charged by your doctor above the Medicare Benefits Schedule Fee unless there is an agreement in place between your doctor and MBF or your doctor uses MBF's Medical Gap Scheme. In the absence of any agreement or if a doctor does not use the MBF Medical Gap Scheme, you will be responsible for any additional charges.

Doctors are independent of MBF and, as a result, we cannot guarantee a participating medical gap doctor in every area or that every participating doctor will treat every patient under the scheme.

No benefits are payable for Doctors' Charges if the service relates to an Excluded Service or surgical podiatry.

Please note that you should ask your doctor to explain the costs of your hospital admission including any prostheses gap amount, their own fees, any fees that other doctors involved in the admission (such as assistant surgeons, anaesthetists, radiologists and pathologists) might charge, and any other expenses involved. If there are any gaps for you to pay, ask for a written cost estimate. This is known as 'informed financial consent'.

  Medicare

Medicare is the Federal Government's health cover scheme for all Australians. Some limited benefits also apply to some visitors. Some aspects of your private health cover work in relation to Medicare, in particular to the Medicare Benefits Schedule fee.

Many doctors' charges are higher than the Medicare Benefits Schedule fee, resulting in what's known as a 'medical gap'.

  Medicare Benefits Schedule Fee

The Medicare Benefits Schedule Fee is the amount determined by the Commonwealth Government for the purpose of paying Medicare benefits.

It is not necessarily the amount that a doctor will charge, but it is the basis from which the Medicare benefit is determined. For hospital or day surgery treatment, Medicare will pay 75% of the Medicare Benefits Schedule Fee, and MBF will pay up to 25% of the Medicare Benefits Schedule Fee.

MBF will only pay medical costs above this where MBF has an agreement with the Doctor. This is medical gap cover.

MBF does not pay any benefits for services outside of hospitals or day surgeries.

 Minimum benefits

The Minimum Benefit is the amount determined by the Minister from time to time, also known as Ministerial default benefits. They are not sufficient to cover treatment in a private hospital. These benefits are sufficient only to cover your stay in a shared room of a public hospital. No benefit is paid for theatre charges raised for these services.

 

  Non-Agreement Hospitals

MBF cannot guarantee the amount that you will be covered for for admissions to non-Agreement Hospitals. Please call MBF on 131 137 to confirm your likely benefits.

  Nursing Home Type Patient (NHTP)

Patients requiring longer-term hospitalisation of more than 35 days may be regarded as Nursing Home Type Patients (NHTP). In the absence of a valid Acute Care Certificate, NHTP will be required to make a personal contribution towards hospital charges, which may be significant. To prove that you are not a NHTP, MBF will need a valid Acute Care Certificate (MBF may refer to the Acute Care Advisory Committee for a ruling on its validity). NHTP receive only limited benefits from MBF. These benefits are significantly lower than what some hospitals charge NHTP. An Excess applies to benefits payable. MBF does not cover respite care.

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  Obstetrics and new born infants cover

See Pregnancy and birth-related services.

  Optical  

Where benefits apply, they are only payable where the appliance/s are designed and manufactured with the sole purpose of correcting a refractive error or to cause image enhancement on the retina of the eye due to change of focal length caused by that appliance.

  Out-of-pocket Expenses

Certain charges are not covered by MBF when you are admitted to hospital. For example, MBF does not cover: medical fees above the Medicare Benefits Schedule Fee unless MBF Medical Gap Cover applies; the patient contribution on the PBS drugs that are not intrinsic to your hospital treatment; additional charges for luxury suites; services by providers which are not covered by a hospital agreement; experimental treatment and some high cost drugs; and some personal and take-home items (e.g. toiletries, newspapers, STD and mobile phone calls). In addition, a limited number of government-approved surgically implanted prostheses will attract a gap which members will be required to pay. MBF can advise you of your likely benefits, but you should find out from the hospital and your doctor what your Out-of-pocket Expenses may be.

  Out-patient Treatment

Out-patient treatment is not covered by MBF unless we have a specific agreement with the hospital for a service or we specify otherwise under your level of cover and we have an agreement with the provider for that treatment. Out-patient treatment includes:

• procedures that do not clinically require formal admission to a hospital, eg could be performed in a doctor's surgery;
• emergency room treatment;
• consultation with your specialist before a labour admission;
• most fertility treatment; and
• services where Medicare doesn't pay your doctor's fee at the in-patient hospital benefit rate, eg a pediatrician check-up of a non-admitted newborn baby in hospital.

Medicare publishes lists of procedures that should not be in-patient services. To confirm whether your treatment is in-patient or out-patient, call MBF on 131 137 with the relevant Medicare item number and the name of your hospital. Your doctor or hospital should also know if your service clinically requires in-patient care.

 

  Partner Authority

The Primary Member has the option to give their partner, as nominated on the application form, authority to have the same authority as the Primary Member in relation to the membership. This authority enables the partner to make claims on behalf of all people covered by the membership, to make changes to or enquiries about:

• personal details, eg address, phone number;
• level of cover;
• payment method;
• adding people to, or deleting people from the membership;
• cancelling the membership and requesting a refund of contributions; and to access the personal information of all people covered by the membership.

The Primary Member must tick the box on the application form at the time of joining or contact MBF for a Partner Authority form at any time. This information is recorded. MBF will confirm Partner Authority before quoting details or processing any changes requested by the partner. Without Partner Authority a partner is only permitted to sign for and receive claim benefits for themselves.

The Partner Authority can be revoked by the Primary Member anytime by notifying MBF in writing.

  Payments and membership

Premiums must be paid in advance. An adjustment to your payment and/or date paid through may be required following a premium increase, change to your level of cover or scale of cover, change to the MBF By-laws or change to Legislation (see MBF By-laws). You will not be entitled to make a claim for any services provided after the date to which your membership has been paid. If, for any reason, payments fall behind by two months and one day, your membership will be ceased. Members who re-join after two months have elapsed will have to serve the normal waiting periods. A person may not contribute to similar services with more than one fund, contribute to more than one level of a similar service with MBF or contribute to any MBF cover unless they are eligible to be in Australia under Australian law.

For Tasmanian registered members effective from 1 January 2005; South Australian, West Australian, Queensland and Northern Territory registered members, effective early 2006; and New South Wales, ACT and Victorianregistered members effective from mid 2006:

You must make payments for the entire 'billed through date' period. If you make a payment that is less than the 'billed through date' period, benefits will not be payable until the entire amount for the 'billed through date' period has been received by MBF. Your 'billed through date' means the period corresponding with the 'frequency of payment' chosen by you. Your 'frequency of payment' is the period for which you choose to pay your premiums from the available options for your level of cover.

  Password Reminder

The Password Reminder is a statement, word or question to help remind you of what your password is for Member Self Service. We will show the Password Reminder upon request should you forget what your password is for Member Self Service. It should not be the same as your password, a derivation of your password or make obvious to other's what your Password is for Member Self Service.

An example: if your Password is ORANGE, your Password Reminder could be colour. It should not be EGNARO.

  Pharmaceutical  

For most prescribed non-PBS listed drugs where prescribed specifically for the treatment of an ailment or illness.
Note: MBF HealthSmart provides cover for preventive travel-related pharmacy only (eg: anti-malarial drugs and vaccinations due to overseas travel and available by prescription only, which are not covered by the Government's Pharmaceutical Benefits Scheme).

  Pharmaceutical Benefits Scheme (PBS)

The Pharmaceutical Benefits Scheme (PBS) is the national pharmaceutical scheme funded by the Commonwealth Government where patients make a contribution to the cost of the subsidised drug. MBF will not provide benefits for drugs that are named on any PBS list, even where they are prescribed in a different quantity and whether or not you obtain a PBS benefit. However, MBF may, on special application, provide benefits for PBS Authority or Restricted drugs, but only if prescribed for illnesses which do not meet the PBS Authority or Restricted requirements and therefore are rejected under the PBS before being prescribed. MBF will only provide benefits for drugs listed on the Australian Register of Therapeutic Goods administered by the TGA (or specially recognised by MBF) and which by law require a prescription and are so prescribed. Contraceptives and anabolic steroids are not covered unless prescribed for an illness. MBF will pay a benefit for the PBS patient contribution where the drug is intrinsic to hospital treatment covered by MBF.

  Podiatric surgery

Benefits are not payable under any level of MBF hospital cover for all Doctors' Charges for in-patient treatments provided by a podiatrist, this includes the fees raised by the podiatrist. Hospital Treatment Charges for in-patient treatments provided by an accredited podiatric surgeon are covered under most levels of MBF hospital cover, except MBF Budget Hospital with exclusions and MBF Standard Hospital with exclusions. Members with an appropriate level of MBF extras cover may be entitled to some benefits for the podiatrist's fees, please check your level of MBF extras cover. Hospital Treatment Charges for in-patient treatments provided by an Accredited podiatric surgeon are limited to minimum benefits under MBF Choices.

  Pre-existing ailment

A pre-existing ailment is one where signs or symptoms of your ailment, illness or condition, in the opinion of a medical practitioner appointed by MBF (not your own doctor), existed at any time during the six months preceding the day on which you purchased your hospital insurance or upgraded to a higher level of hospital cover.

The only person authorised to decide that an ailment is pre-existing is the medical practitioner appointed by MBF. This medical practitioner must, however, consider any information regarding signs or symptoms provided by your treating medical practitioner(s).

If the ailment, illness or condition is considered pre-existing: new members must wait 12 months for any hospital benefits; members Transferring/upgrading to a higher hospital cover must wait 12 months to receive the higher hospital benefits. Existing members with at least 12 months membership in total across their old and new cover are entitled to the lower benefits on their old cover. Some examples of treatments for conditions that would normally be considered to be pre-existing include sterilisation, infertility treatments, vasectomy, surgical extraction of wisdom teeth, or where you have consulted your doctor for a particular condition prior to joining or upgrading.

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  Pregnancy and birth-related services

When will my baby incur charges?
A baby will only be admitted and therefore require cover as an in-patient in hospital in the following circumstances:

• if the baby is in a recognised neo-natal intensive care unit;
• if the baby is still in hospital more than nine days after the birth; and
• if the baby is the second or subsequent baby of a multiple birth, eg a twin.

If your baby is admitted as a patient and covered on an MBF membership, an Excess or Co-payment is payable for your baby (where applicable). Please note that from 1 April 2006 no Excess or Co-payment is payable for hospital admissions for Dependant Children or Dependant Children registered on your membership under Dependant Extension if you hold MBF Advantage Hospital cover. From 1 April 2007 no Excess is payable for hospital admissions for Dependant Children or Dependant Children registered on your membership under Dependant Extension if you hold MBF HealthLink Advantage Hospital cover.

	Singles, Couples , Single Parent Families, and Families MBF Budget Hospital, MBF Choices or MBF HealthSmart^ cover	Singles MBF Standard, MBF Advantage or MBF Premium Hospital Cover	Couples, Single Parent Families, and Families MBF Standard, MBF Advantage or MBF Premium Hospital Cover
Cover for Pregnancy-related services		*	*
Cover for birth (mother only)		*	*

If you would like cover for these services you should choose an appropriate cover option at least 12 months prior to the birth.

* 12 month waiting period applies, even if premature.

^ MBF Choices and MBF HealthSmart is only available for singles and couples.

  Primary Member

The Primary Member is the person who has legal responsibility for the membership and for ensuring that the premiums are kept up-to-date. This person will have the right to add or remove others from the membership and obtain information about claims made on the membership.

   Privacy Statement

Why does MBF Health collect personal information?

We collect your personal information (personal information is as defined in the Privacy Act 1998 (Cth) and includes sensitive information, eg health information) so that we can provide you with health insurance and related services, and so that we can continue to operate an efficient and sustainable business. This information is collected and used only accordance with the National Privacy Principles, other applicable privacy laws, this Privacy Statement and the MBF Information Handling Policy.

In some circumstances, the collection, use, disclosure and access of personal information is governed by specific legislation. Where there is a specific legislation, this will generally govern how we use the information despite the provisions of the Privacy Act. For example, legislation such as the National Health Act 1953 and the Private Health Insurance Incentives Act 1998 require us to collect certain information about you.

How does MBF Health collect personal information?

To provide the best products and services to suit your needs, we collect information from you when you:

• complete an application form for one of our products;
• contact us in person, by phone or online; or
• lodge a claim.

Though we try to collect information about you directly from you, sometimes we might also collect information about you from another person or entity. For example, if we wish to perform risk assessment on our membership base, census, survey and statistical type data from external providers. Further examples include:

• you are covered by Couples or Family cover and we collect information from another person on the membership;
• you go to hospital and we will collect information directly from the hospital;
• you go to an MBF Recognised Provider and we collect information from the provider;
• you are a corporate member and we collect information from your employer and/or a broker. This information may include details such as your payroll number; and
• we may collect information about you from an MBF Recognised Provider or other medical providers or professional experts in order to assess your claim and conduct investigations in relation to potential fraudulent activity.

Couple, Single Parent Family and Family health insurance membership

Information about spouses, partners, Dependant Children and Dependant Children registered under Dependant Extension on health insurance memberships is collected from the Primary Member or with the authorisation of the Primary Member. For example, we collect this information when the Primary Member completes an application form or when a claim is made.

We collect information on spouses, partners, Dependent Children and Dependant Children registered under Dependant Extension on the membership with the consent of the Primary Member. If you are over 16 years of age when the Primary Member provides information about you or lodges a claim on your behalf, we assume they have your consent to give us all the information necessary to process the claim. The reverse of this is that, if you are the Primary Member and you provide us with information about a spouse, partner, Dependant Child or Dependant Child registered under Dependant Extension on the membership, we assume that you have that person's permission to give us the information and that you have told them you have given the information to us. All information collected during the course of the membership is also available to the Primary Member.

The Primary Member is responsible for maintaining the policy and paying premiums. So, we will disclose information to them about benefit Limits and treatment for all persons covered by the policy. If you are over 18 years old and you do not wish your personal or treatment information to be disclosed to the Primary Member or any other authorised person, you should take out your own health insurance membership with MBF.

How does MBF use and disclose my information?

We use your personal information to provide, manage and administer your health membership and related services to you, to evaluate and pay claims and to operate an efficient and sustainable business in the interest of its members.

As part of these processes, we may collect, use and disclose your information to:

• process your application;
• process payments, withdrawals and redemptions;
• investigate and assess any claim;
• contact you about matters relating to you, your health insurance or our other services (these services may change from time to time);
• answer your enquires;
• meet internal functions such as administration, accounting and information technology systems;
• practice effective risk management and prevent fraud;
• monitor, price and evaluate products and services;
• conduct marketing, research and statistical analysis;
• resolve complaints;
• report to and obtain information from regulatory authorities;
• auditors and other service providers we may appoint to ensure the integrity of our operations;
• any person acting on your behalf, including your financial adviser, executor, trustee and attorney;
• help you improve your health and wellbeing and advise you of programs available to assist you;
• conduct customer surveys; and
• conduct Health Management Programs.
• We may need to disclose your information to others to provide you with health insurance and related services and to operate an efficient and sustainable business. Some circumstance where we may do this include:
• where another organisation helps us process transactions, store data, access data or provide services to you in order for them to perform their role;
• where a hospital or provider is helping us administer a claim for you; and
• where we are required under law to disclose your information to someone else or to a government authority.

It is our policy that, where member information is disclosed to our contractors and service providers they must agree to be bound by the Privacy Act. We do not sell personal information to anyone.

We may share your personal information on a confidential basis to our related entities so that they can offer you products and services. You have a right to ask these organisations for access to information they hold about you.

In the course of providing you with our products and services some of the organisations to which we may disclose your personal information (including companies in the Bupa Australia Group and State and Government agencies) are located outside New South Wales in other States or Territories in Australia. MBF may send your personal information to them, including electronically transmitting data. When we do so, we require them to handle your personal information in the same way we do. We will do everything reasonable to ensure your personal information is kept secure from unauthorised access or disclosure.

Receiving marketing material

From time to time the MBF Group will provide you with information about products and services from our group of companies or other affiliate organisations that we consider of potential benefit to you and your family.

If we use your personal information for direct marketing of products and services from other members of our group of companies or other affiliate organisations, we will give you the opportunity to "opt-out" of receiving any further marketing correspondence. You can opt-out at any time from receiving marketing information from the MBF Group or affiliated organisations by calling us toll free Monday - Friday on 1800 240 345 (8.00am to 7.00pm AEST).

Want more information?

If you would like to know more about the MBF Group's information handling practices, visit the MBF Information Handling Policy on our website or call MBF on 131 137.

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  Private Patients' Hospital Charter

The Federal Government has produced a statement called the Private Patients' Hospital Charter. Copies of the Charter are available to members and members of the public at any MBF Centre, where you will also find a copy on display.

  Proof of identity and/or age

MBF may ask you to provide proof of identity and/or age when joining MBF, changing your level of cover or in relation to any other transaction with the Fund.

  Prostheses

Prostheses are designed to replace a part of the body, or to make a part of the body work more efficiently.

For the purposes of claiming under MBF hospital cover prostheses include pacemakers, defibrillators, cardiac stents, hip, knee and other joint replacements, intraocular lenses and other devices that are surgically implanted during and admission to hospital for a valid medical reason.

  Public hospital charges

Public hospital charges are charges made by public hospitals for private patients for hospital services. These are determined by the relevant State Minister and may vary from time to time. Higher charges may be made by a hospital if you are not entitled to full Medicare benefits.

 

  Recognised Tertiary Institution

Includes a TAFE College, University, College of Advanced Education or Business College.

  Registration Code

This is a code one of our staff may have given you or may appear on a promotional piece from MBF. If you have not been provided with a registration code, leave this space blank.

 

  Savings Provision Entitlement

For information on the Savings Provision Entitlement please see the Frequently Asked Questions.

  School

A school does not include a TAFE College, University, College of Advanced Education or Business College.

  Set Benefit  

A Set Benefit is the specific amount you can claim for a particular service within a category of MBF extras cover. Refer to the MBF Premium and Set Benefits Guide for some examples of Set Benefits.

  Single membership

Single membership includes only the Primary Member.

  Single Parent Family membership

Single Parent Family membership includes only the Primary Member and any of his or her Dependant Children and Dependant Children registered on your membership under Dependant Extension. See Dependent Child and Dependant Extension.

  Special Benefits

Special Benefits apply to MBF Premium Hospital cover only and include:

• accommodation in hospital for parent/s, spouse or next of kin - maximum $60 a night (increased by $30.00);
• meals for parents/s, spouse or next of kin - maximum $30 per day (increased by $20.00); and
• home services directly relating to and following the admission, including post-natal care, lactation nursing, physiotherapy, occupational therapy or speech pathology - up to $60 per visit (increased by $20.00).

For the services listed above, you can claim up to $100 per member for each day hospitalised, to the limits set out below. Special Benefits are not redeemable for cash.

• Under 2 years continuous membership - up to $300 per annum (3 days)
• 2 years to less than 5 years continuous membership - up to $500 per annum (5 days)
• 5 years to less than 10 years continuous membership - up to $1,000 per annum (10 days)
• 10 years to less than 15 years continuous membership - up to $1,500 per annum (15 days)
• 15 years and over continuous membership - up to $2,000 per annum (20 days).

  Student Dependant

If you have any children aged 21-24, who are full-time students and who are fully or partially maintained by you, and:

• who are not in receipt of a taxable income from the school, college or university; and/or
• who are not entitled to receive an invalid pension or disability allowance of any amount or other income, providing a total gross annual income of more than $14,000.

Call MBF on 131 137 to find out more.

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  Suspension of Membership

If you are planning to travel overseas for two calendar months or more, it may be possible for you to suspend your membership. Your application for you to suspend your membership must be made before your date of departure. Certain other criteria must also be met before you can suspend your membership. For more information and full details, please visit 'frequently asked questions' on our website.

 

  Tax Advantages

The Federal Government will ask you to pay an additional 1% Medicare levy if you have a taxable income and reportable fringe benefits of more than $73,000 a year for a single and $146,000 a year for couples and families with one child (threshold increases by $1,500 for each additional child) and don't have appropriate hospital cover for you, your partner and all your dependents. This means that your Medicare levy could increase from 1.5% to 2.5% of your taxable income. You can avoid this additional levy simply by taking out MBF hospital cover with $0, $250 or $500 Excess. Please note: that MBF applies the Excess once per person to a maximum of twice per membership, in a calendar year. Taking out any MBF hospital cover with $1,000 Excess will not enable you to avoid the additional 1% Medicare levy.

  Termination

MBF may terminate a person's membership immediately if, in the opinion of MBF, the person has deliberately given false information or has falsely obtained or attempted to obtain a benefit to which they are not entitled under the MBF By-laws. In such a case, MBF reserves the right to prosecute any involved parties. Membership will automatically terminate if your membership payments are two months and one day in arrears. Subject to legislation, MBF also has the right to terminate membership without cause by giving two months notice in writing and refunding any contribution paid by the member for the period after termination of membership.

  Time limit on claims

No benefits will be paid if claims are lodged after two years from the date of service, treatment or purchase. MBF recommends claims are lodged within 12 months.

  Transferring from another fund/MBF membership

If you transfer from another Australian registered health fund or are covered by another MBF membership, you will have continuity of membership for the same level of benefit entitlement for services provided by and common to both funds/levels of MBF cover, provided that you have already served the relevant waiting periods and transferred within two months of ceasing membership of the previous fund or rejoin MBF within 2 months of cancelling your previous MBF membership. Please note that delays might incur Lifetime Health Cover (LHC) penalties.

If you transfer to MBF or rejoin MBF more than 2 months after you have ceased your membership with the previous fund/MBF, you will have to serve all the waiting periods applicable to your new level of cover even if you have served some of them in whole or in part with your previous fund/MBF.

If you transfer to a level of MBF cover that provides benefits not covered by your previous fund or cover, you must serve the relevant waiting periods for the additional benefits.

Where Limits apply, including lifetime limits, any benefits paid by your previous fund are treated as if MBF had paid them.

  Transfer to MBF

If you'd like to transfer to MBF from another fund just select your current provider from the menu on the application form. The only thing you need to do is to cancel any automatic payment authority you may have with your existing fund and we'll do the rest. When you transfer to MBF, we'll honour any Waiting Periods that you have served with your previous fund for services common to both levels of cover.

  Treatment information

In some cases, either before or after payment of a benefit, MBF will ask you to provide information about your treatment, including confirmation that it relates to a diagnosed medical condition and that it is a course of treatment recognised by MBF. You agree to assist MBF in obtaining this information from your provider including copies of clinical records as requested by MBF that relate to MBF benefits or your membership.

 

  Upgrading your membership

If moving from one level of cover to a higher level or if moving from a higher to a lower Excess in the same cover, benefits under the new level of cover, that were not covered under the original level of cover or Excess, are payable at the original level of cover or Excess entitlement, until you have satisfied the waiting periods. Where Limits apply, any benefits already paid will be taken into account.

 

  Waiting periods

Before you can claim under your cover, you must have been in that level of cover for a certain length of time, known as the waiting period. No benefits are payable for any treatment for a service received while you are serving the waiting period for that service. Waiting periods apply in addition to Benefit Limitation Periods (where applicable). Waiting periods are based on calendar months.

The following is a summary of waiting periods normally applicable to members who are new to private health insurance or who are upgrading their level of cover. Some of the terms used are defined in these MBF Healthcare Cover Guidelines. Please note that you should check your level of cover first to ensure that benefits are available, as not all levels of cover provide the benefits listed here:

• pre-existing ailment - 12 months
• pregnancy and birth-related services - 12 months
• major dental - 12 months
• health management aids and appliances - 12 months (except for fully handcrafted surgical shoes - 5 years)
• optical appliances - 6 months
• MBF Living Well Programs - 6 months
• hearing aids - 3 years
• other conditions - 2 months
• hospital treatment for Accidents which occur after joining and would normally have a 2 month waiting period, will have no waiting period.

Further information

For further information regarding MBF products and services, simply visit your local MBF Centre or call 131 137 or, if you are a Corporate member, call 1300 653 525.

MBF Australia Limited
ABN 81 000 057 590
A registered health benefits organisation

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