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While Police Health cover is simpler than most other private funds, we're frequently asked these questions: Who
can join?
You can join
Police Health if you are:
Once you've
joined you can remain a member, or rejoin, even after you've left
police employment.
The Scheduled
Fee is the level of fees set and recognised by the Commonwealth
Department of Health and Aged Care for the payment of Medicare benefits
for medical services.
Medicare pays 85% of the Scheduled Fee for all medical services other than those provided to people while admitted to hospital (inpatients) and 75% of the Scheduled Fee for services provided to hospital inpatients. In the vast majority of cases, Police Health's Access Gap Cover scheme covers the difference between the Scheduled Fee and the doctor's charge. Where a doctor chooses not to participate in this scheme with Police Health, we're only permitted to pay up to the Scheduled Fee.
No. Police
Health has no interest in directing you to a particular doctor or
any other health care provider. Our aim is to give you the freedom
to make true choices about who treats you and where.
Your family membership covers you, your spouse or partner, and your children until they're 21 years of age or, if they're full-time students, until they're 25. In addition to this, non student children can be covered under your membership until their 25th birthday if you choose Platinum Plus. If your child is married or in a defacto relationship, they are unable to be covered by your membership. Single parent family membership covers you and your children as described above. If you take out single membership it will cover you only.
Once your children
reach an age where they're no longer protected by your cover (as
detailed above), they can take out their own Police Health membership
without any waiting period provided they:
Or, if they've
been covered as a student dependent, provided they:
In all these
circumstances, your children have 2 months in which to join with
their contributions being calculated from the date they ceased to
be an eligible dependent.
Yes. And we'll make it as simple as possible for you. If you're still covered by another fund at the time you join, you and your dependents will receive continuity of cover. We'll even give you credit for any waiting periods you've already served with your previous fund. If you’re transferring from another fund and increase the level of your cover, you’ll be required to serve the waiting periods for that higher level of cover. This also applies when other persons transfer to your existing Police Health cover. Naturally we’ll still honour your eligibility for the lower cover during your waiting period. From time to time waiting periods may be reduced or waived in the case of special offers by Police Health.
Like all private health funds, Police Health has waiting periods for people who are commencing private health insurance. These may also apply to people who transfer from another insurer to Police Health, but only for any higher level of cover selected. Waiting periods also apply to our members when upgrading their cover. The purpose of these, of course, is to protect our existing members. The waiting periods are: Hospital benefits of Top Hospital, Platinum Health and Platinum Plus:
Extras benefits for SureCover Extras, Platinum Health and Platinum Plus:
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 Police Health (not your own doctor), existed at any time during
the 6 months preceding the day on which you purchased your hospital
insurance or upgraded to a higher level of hospital cover.
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Yes. Police Health protects you anywhere in Australia. Although members that relocate to another state must notify Police health within one month of such move. You will be required to pay the contribution rates that apply in that state and territory.
No, Police Health is prohibited from providing cover to insured persons while outside Australia. It is strongly recommended persons travelling overseas purchase travel insurance to cover emergency needs when overseas.
The Patient Assistance Travel Scheme (PATS), a government sponsored scheme operating in Western Australia, provides assistance to a patient who because of their locality must travel greater distances to access specialist services. In addition to the benefits available under PATS, Police Health also offers travel and daily accommodation benefits to members under certain circumstances, who need to travel more than 200 kilometres from their home to receive in-patient hospital treatment. Please contact Police Health prior to admission.
Not normally. Hospital benefits are payable 365 days a year. However, if you've been in hospital for 35 consecutive days we may determine you as being a "nursing home type patient". A Government restriction requires you to make a personal (and uninsurable) contribution to your care, and the hospital charges may be significantly higher than the Police Health benefit. But be reassured, in our experience this is rare and it doesn't apply where acute hospital care is necessary. Police Health does have some benefit restrictions for services that are not recognised by Medicare such as some services for cosmetic surgery and sterilisation reversal. If you're intending to undergo this kind of surgery, please check with us first. If you're eligible for compensation or damages from other sources like Workcover, compulsory third party insurance, liability, accident insurance and so on, your medical and hospital expenses will often be postponed until the third party pays. If this isn't possible, benefits will be paid subject to conditions. Under these circumstances you will be required to pay back to Police Health, fund benefits received for services subsequently covered by the other insurance.
Recognised Providers are health providers who are in private practice in Australia and recognised by Police Health. We only pay benefits for services by these providers.
Police Health
has agreements with most hospitals, recognising
their fees for full rebate. It is the recognition of fees described above that determines the maximum benefit we will pay for a particular service. In determining your benefit, Police Health will use the net amount payable of any account inclusive of any discounts the provider might be offering at the time. This may vary where, for the benefit of our members, Police Health has negotiated specific agreements with selected providers.
Single hospital membership for mothers covers the cost of the birth of the baby but doesn't cover any costs incurred by the baby. For a baby to be eligible for benefits immediately upon birth, the mother must have contributed to a family or a single parent family membership for at least 2 calendar months prior to the infant's birth, regardless of whether or not the infant is premature. We recommend that a single membership be upgraded to a family or single parent family membership as soon as pregnancy is confirmed to ensure a premature baby is covered. Please note that where it is known or suspected that your baby may have developed a congenital condition during the pregnancy, no benefits are payable unless you have held continuous family or single parent family cover for at least 12 months prior to the baby's birth. We request that you add your newborn to your membership within 14 days of baby's birth date.
Annual Limit refers to the maximum benefit allowable in any one calendar year per person.
This website does not contain all Police Health benefit details or conditions of membership. A full copy of the Fund rules are available at 339 King William Street, Adelaide SA. Or alternatively we can provide a copy to any adult covered by a Police Health policy following their written request. |
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