Changes that may impact you

Change to cover for speech processor replacements

After careful consideration, from 1 July 2022 claims for speech processor replacements or upgrades will no longer be paid as a goodwill gesture under your Hospital cover.

While this decision aligns to health insurance industry practice and our fund rules, it also ensures that the cover we provide remains clinically appropriate and affordable for all members, keeping future premium increases lower.

You may want to discuss your future options with your health care provider. You can also consider whether Extras cover is right for you, or review your current level of Extras cover. Replacements and upgrades of speech processors are covered on some of our Extras options .

Changes to how claims are processed on your health cover

We have incorrectly paid some claims that fall into one or more of the categories below in the last two years. From 1 July 2022, we will improve the accuracy of claim processing and any future claims that fall under these rules will not be paid.

Below are some examples of how we’ll change the way claims on your cover are processed:

Dental claim (Australian Dental Association Schedule)

Members are unable to claim for dental services on a tooth that has been billed previously as an extraction.

Medical claim (Medicare Benefits Schedule (MBS) )

Some medical services can only be claimed once in a 12-month period, as outlined by the MBS. Claims for the same services will be declined if a benefit has already been paid in the 12 months to-date.

Hospital claim (The contracts we have in place with hospital providers)

A hospital cannot bill a service that is not in-line with their contract with us. An example would be where a member claims an admission related to Rehabilitation at a hospital that is not contracted to provide that service

For more information, examples and an outline of all claim categories that will be affected, please go here.

Please note: Any past claims that were incorrectly paid will not be affected. This change only applies to claims from 1 July 2022.