Singles and Couples Combined Cover

When you’re young and healthy, sometimes health insurance can be the furthest thing from your mind. But there are lots of benefits that come from having health insurance – like potential tax savings, benefits for things like optical, dental and physiotherapy, not to mention cover just in case something happens and you need to go to hospital. So we’ve put together a combined product for singles and couples aged 35 and under that focuses on the things you really want to be covered for.

Singles and Couples Combined cover covers you for the hospital services you’re more likely to use, and leaves out ones that you might not need yet, like hip replacements or renal dialysis, while still giving you the security of hospital cover at any hospital in our network.

Singles and Couples Combined cover has some excluded and restricted benefits, but is designed to give you access to only what you need. Under our Singles and Couples Combined cover product, you get the same access to our hospital network, and your approved hospital charges will be fully covered once the agreed excess has been deducted. You can choose from a $250 or $500 excess for a single or couples membership.

If you do not have ancillary (Extras) cover and exercise physiology, for example, is required in hospital as part of your treatment, then you will not be covered for these services if they are invoiced separately by the provider. This is also the case for any allied services not covered under this policy.

View and print a full product summary for Singles and Couples Combined cover.

Hospital and doctors' benefits

 Hospital and doctors' benefits for included services
Choice of doctor/hospital
Private hospital accommodation
Public hospital accommodation as a private patient (shared room)
Theatre fees
Surgically implanted prosthesis benefits
(Some surgically implanted prostheses may be for an excluded benefit, therefore no benefit would be payable in this circumstance; for example, hip replacement)
Intensive care
In-hospital rehabilitation treatments
Plastic and reconstructive surgery (if medically necessary)
Medical Gap
Doctor's charges in hospital where each doctor chooses to opt in to Queensland Country Access Gap Scheme
Radiography and pathology services charges ordered by your doctor in hospital. 100% cover where the practitioner participates in the Queensland Country Access Gap Scheme.
Most pharmaceuticals related directly to your admission

 

Examples of covered services

The following are examples of in-hospital services that are covered under our Singles and Couples Combined cover. Covered services include, but are not limited to:

Included servicesExamples of in-hospital treatments we will pay benefits towards
Appendix treatment
Accidents
Removal of teeth
Knee, shoulder and hip investigations
Removal of tonsils
Hernia surgery
Digestive disorders
Colonoscopies
Kidney stone and gall stone removal
Knee & ankle arthroscopy and reconstructions
Shoulder arthroscopy and reconstructions

 

Restricted benefits

If a service is covered as a restricted benefit, this means you will be covered with your choice of doctor for shared ward accommodation in a public hospital only. If you go to a private hospital for a specific service which has restricted benefits, it is likely to result in large out-of-pocket expenses. Restricted benefits are an amount set by the Government and are generally not enough to cover accommodation costs in a private hospital. No benefit is paid towards the cost of theatre charges raised for these services.

Restricted servicesIn-hospital treatments
RestrictedIn-hospital psychiatric treatments
RestrictedCardiothoracic procedures e.g. open heart surgery
RestrictedMajor eye surgery - cataract and eye lenses procedures
RestrictedObstetric related services - birth and pregnancy related services
RestrictedAssisted reproductive services - for example IVF
RestrictedGastric banding and obesity surgery
RestrictedRenal dialysis - for chronic renal failure

 

Excluded benefits

An excluded service means you will not be covered in a public or private hospital and will not receive a payment from Queensland Country for that service. If you think you may need any of the procedures outlined above as an excluded service, you may like to consider taking out a higher level of hospital cover.

Excluded servicesIn-hospital treatments
ExcludedJoint replacements
ExcludedCosmetic surgery (hospital treatment for which Medicare pays no benefit)

 

Extras cover

The table below outlines the benefits paid under your cover.

Type of serviceWaiting periodSub-limit
Per person, per policy benefit limits apply unless otherwise specified (per Membership year)
What we'll pay
Dental   
General dental
Diagnostic


Preventative


Simple extraction

Restorative

General services
2 months$500 per person up to $1,000 per policy
Periodic oral exam - $34
X-rays - $23

Scale & clean - $56
Fluoride treatment - $17

Simple extraction - $79

One surface composite filling - $68

Occlusal splint - $225

Mouthguard - $113
Major dental
Surgical extractions #
12 months
Surgical extraction - $135
Periodontics


Endodontic

Crowns and bridges #

Orthodontics



 
12 months$500 per person up to $1000 per policyTreatment of acute periodontal infection (per visit) - $38

Filling of one root canal - $128

Full veneered crown - $500

Braces for upper & lower teeth, including removal plus fitting of retainer - $500
Lifetime limit $1,000 per person
Benefits are paid at 70% of cost
Optical
Single and multi-focal lenses and frames2 months$210 per person, up to $420 per policySingle vision lenses & frames - $210
Repair to frames - $210
Contact lenses - $210
Physiotherapy   
Initial consultation

Subsequent consultation

Group therapy
2 months$400 per person up to $800 per policy
$80 sub-limit applies to Group Therapy
$42

$32

$8
Therapies   
Acupuncture*
Initial and subsequent consultation
2 months$300 per therapy/
$500 per person up to $1,000 per policy

$30
Chiropractic
Initial and subsequent consultation

X-rays
2 months
$30

$50
Remedial Massage Therapy*/Bowen Therapy*/Myotherapy*
Initial and subsequent consultation
2 months

$30
Osteopathy
Initial consultation

Subsequent consultation
2 months
$30

$30
Naturopathy*/Homeopathy*
Initial and subsequent consultation
2 months
$30
Dietician
Initial consultation

Subsequent consultation
2 months
$55

$35
Podiatry
Initial and subsequent consultation

Approved appliances (orthotics)


Minor procedures
 
2 months
$30

85% of cost
(up to sub-limit)

75% of cost (up to sub-limit)
Other services   
Pharmaceutical ##2 months$150 per person up to $300 per policyUp to $30 per script
Healthy living2 months$125 per person up to $250 per policyBenefits up to the person/policy limit are available for:
Your choice of quit smoking programs
Your choice of weight management programs
Participate in other approved health management programs** including gym membership and personal training programs.
Skin checks through mole mapping
Consultation fees for metabolic dieticians and nutritionists when providing assistance with weight management

* Benefits are payable for services rendered by Australian Regional Health Group approved providers registered with Queensland Country Health Fund, as well as Bowen Therapists that are registered with the Bowen Association of Australia (BAA) or Bowen Therapists Federationn of Australia (BTFA).
** To comply with private health insurance legislation you must have been referred by your health care professional to participate in a health management program to address, improve or prevent a specific or medical condition. A Health Management Program Benefit Approval Form must accompany claim for these benefits.
^ There are specific requirements to claim for exercise physiology.
# Benefits paid on dental item numbers only, unless hospital cover is held and all waits have been served for any inpatient services.
## The Pharmaceutical Benefits Scheme (PBS) is a national pharmaceutical scheme funded by the Federal Government where patients contribute to the cost of prescribed drugs.

 

Understanding excesses

When you choose private hospital cover, you can choose the level of excess you want to pay. An excess is the amount you agree to pay towards the cost of your hospital treatment on admission, in exchange for lower premiums. The higher the level of excess, the lower your premium will be, as you agree to pay a larger sum towards your hospital costs.

At Queensland Country, the maximum excess that applies per person within any one membership year is $250 or $500, depending on the chosen excess option, regardless of the number of times you’re admitted to hospital.

Under our Singles and Couples Combined cover, you can choose from an excess of $250 or $500.

Excess OptionsMaximum excess per Membership year
 SingleCouple/Family
$250$250$500
$500$500$1000

You’ll only pay the excess once per individual, to a maximum of two excess payments for a couple, within your membership year. This means a maximum of $500 on a $250 excess option, or $1,000 for a $500 excess option.

Your chosen excess applies to the full cost of hospitalisation at a public, private or day hospital facility. Once the excess has been paid, we take care of the rest, so you can enjoy the full benefits of your private health insurance.

Pharmaceuticals

Queensland Country doesn't cover pharmaceutical prescriptions covered by the Pharmaceutical Benefits Scheme or for contraceptives and items normally available without prescriptions.

We’ll pay benefits as outlined in the Extras table up to the claim limit for this category, with consideration to the maximum individual script benefit limit. The benefit amount per script is calculated by deducting the PBS general patient contribution amount from the purchase price (up to script benefit limit). This is conditional on the pharmaceutical prescription being listed in the MIMs Schedule as S4 or S8 and being dispensed in quantities in accordance with this schedule. We also pay for compound pharmacy scripts, as long as one of the ingredients meet this criteria.

The PBS contribution amount is reviewed annually by the Government and changes every year on 1 January. As at 1 January 2017, the PBS contribution is set at $38.80.

It’s important to note that a doctor's letter may be required for some pharmacy items.

Other important information

There are some important things you need to know about your cover. Visit the links below to find out more.

 

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