320 Plan Schedule of Benefits
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This Schedule of Benefits needs to be read in conjunction with the Product Disclosure Statement (PDS). Capitalised terms in this Schedule have the meaning given in the PDS.
Plan 320 - 100% In-Hospital and Out-Patient Medical Benefits plus Extras, and 100% Obstetrics and Newborn Infants Expenses
Schedule of Benefits
SECTION 1.1 - IN-HOSPITAL (IN-PATIENT) EXPENSES for INJURY and SICKNESS
Up to 100% Expenses
In-Hospital (In-Patient) Expensesincurred as a result of sustaining Injury or Sickness and paid
by You or on Your behalf to a Medical Practitioner, registered nurse or registered physiotherapist
or hospital for medical, surgical, x-ray, hospital, nursing or other medical
treatment as shown below, including prescribed medicines, drugs and medical supplies within
Australia.
Private Accommodation
Shared Private Ward
General Ward
Theatre Fees
Intensive Care
Procedure Room
Anaesthetic Services
Same Day Surgery
Specialist Medical Care in Hospital
Dental Reconstruction (following trauma)
Prostheses (Surgically implanted)
Special Surgical Dressings, Supplies and Procedures
Physiotherapy in Hospital
Drugs and Medicines in Hospital
Specialist Nursing
X-rays
Pathology
Medical and Surgical Supplies
Blood Transfusions
All Medical, Surgical and Ancillary services and other In-Hospital services approved by IMAN/AHP
Parent Hospital Accommodation Charges
SECTION 1.2 - IN-HOSPITAL (IN-PATIENT) EXPENSES for REHABILITATION PROGRAMMES following Hospitalisation
Up to 100% Expenses
SECTION 1.3 - OUT-PATIENT CONTINUING TREATMENT following Hospitalisation
Up to 100% Expenses
SECTION 1.4 - IN-HOSPITAL (IN-PATIENT) CASH BENEFITS
Cash in Hospital of $200 per day when hospitalised for more than five days (excluding Dependents). Annual limit 180 days in hospital.
SECTION 2 - OUT- PATIENT MEDICAL EXPENSES for INJURY and SICKNESS
Up to 100% Expenses
Out-Patient Medical Expenses incurred as a result of sustaining Injury or Sickness and paid by
You or on Your behalf to a Medical Practitioner or hospital for medical, surgical, x-ray, pathology,
hospital, nursing or other medical treatment as shown below, including the cost of drugs and
supplies administered as part of the treatment.
Primary and Specialist Medical Practitioner Outpatient Medical Care for Injury and Sickness
Medical Practitioner visits to office, hotel or residence
Visits to Medical Practitioners - General Practitioners and Specialist Medical Practitioners
Hospital Emergency Room visits
Sports Medicine
Pathology for Injury and Sickness
Diagnostic Testing
Tests and Procedures
Pathology Tests
Laboratory Tests
Blood Tests
Medical Practitioner-ordered Outpatient Medical Services for Injury and Sickness
Plastic Surgery (reconstruction after accident)
Chemotherapy
Radiation Therapy
X-rays
Lithotripsy
Other Medical Tests, operations, treatments and specialist procedures as approved by IMAN/AHP
Artificial Aids
Blood Glucose Meter
Nebuliser
SECTION 3 - ELECTIVE SURGERY EXPENSES
In-Hospital (In-Patient) Expenses and Same Day Surgery Expenses for Elective Surgery up to a maximum of $A2000 per person per annum in total for non-critical surgery determined as elective by a Medical Practitioner appointed by us.
SECTION 4 - PSYCHIATRIC SERVICES
$A2000 per annum in total
Please note: Expenses for counselling, testing, and any other services provided by psychologists and others are NOT payable .
Benefits are only payable for one on one consultations - group sessions are excluded.
SECTION 5 - PHARMACEUTICAL - MEDICAL PRACTITIONER - PRESCRIBED DRUGS AND MEDICINES
Benefits are subject to specified annual limits:
Single $A1000 maximum per annum in total
Family $A2000 maximum per annum in total
Medical Practitioner-prescribed drugs and medicines, as listed under the Australian Government's Pharmaceutical Benefits Scheme, due to Injury or Sickness whilst in Australia. Medicines which are not listed on the Australian Government's Pharmaceutical Benefits Scheme are not claimable. Benefits are on a pro-rata basis for membership periods of less than 12 months.
SECTION 6 - PHYSIOTHERAPY, OSTEOPATHY AND CHIROPRACTIC SERVICES
Benefits are subject to specified annual limits:
Single $A1000 maximum per annum in total
Family $A2000 maximum per annum in total
Treatment by a registered Physiotherapist, Osteopath and Chiropractor, due to Injury or Sickness whilst in Australia. Benefits are on a pro-rata basis for membership periods of less than 12 months. Benefits are only payable for one on one consultations - group sessions are excluded.
SECTION 7 - AMBULANCE EXPENSES, MEDICAL REPATRIATION TO HOME COUNTRY, FUNERAL EXPENSES
Up to 100% Expenses
Road and Air Ambulance services within Australia.
Medical Repatriation to home country when this is deemed medically necessary by a
Medical Practitioner appointed by Us. Medical Repatriation includes the cost of air fares, onboard stretcher, accompanying aero-medical specialists and nursing staff, and ambulance transport in your home country.
Funeral Expenses in Australia or the cost of returning your body or ashes to your home country.
SECTION 8 - INSURANCE AND LIABILITY SURCHARGE
Insurance and Liability Expenses levied by Medical Practitioners and Hospitals in Australia, up to a maximum of $A20,000 per annum in total.
SECTION 9 - EXTRAS MEDICAL EXPENSES
Benefits are subject to specified annual limits:
Single, $A1000 maximum per annum in total
Family $A2000 maximum per annum in total
Benefits are on a pro-rata basis for membership periods of less than 12 months.
Dental - Consultation, X-rays, Scaling and Cleaning, Removal of Plaque, Application of Fluoride, Composite Fillings, Extractions, Orthodontics, Endodontics and Periodontics, Oral Surgery, Wisdom Teeth removal, Crowns and Bridgework, Dentures
Rehabilitation and Occupational Therapy
Podiatry
Home Nursing and Home Care
Preventative and Diagnostic Pathology and Radiology
X-rays and Laboratory examinations ordered by providers of Extras Cover Services
Eyeglass Lenses and Eye examinations by an Optometrist.
Please note: Eyeglass frames, and Sunglass Lenses and Frames are NOT covered.
Dermabrasion performed by a Registered Practitioner referred by a Medical Specialist.
Elective Pathology and Preventative Care - Including Diagnostic Pathology and Radiology
Diagnostic investigations e.g. sleep apnoea testing
Radiology including CT and MRI Scans, but excluding CT full body scans
Periodic Health Check-ups and Innoculations including Cardiology Stress Testing
Immunisations and Innoculations including Hepatitis, Pathology and Blood Tests including Tropical Screening
Please note: Medical examinations, x-rays, inoculations, or other such treatments for the purposes of obtaining, renewing or extending a visa for entry to Australia, or for the purpose of obtaining Permanent Residency status in Australia, or for the purpose of travelling overseas are NOT covered.
Dietetics
Speech Therapy
Hearing Aids
Acupuncture
Naturopath
Prosthesis and Appliances
Traditional Chinese or Alternative Medical Therapy
SECTION 10 - OBSTETRICS AND NEWBORN INFANTS EXPENSES
100% Expenses without excess or co-payment
Obstetrics and new born infant related Expenses including prenatal, childbirth or the complications thereof and Medical, Hospital and Extras Medical expenses of the new-born infant are payable after 12 months continuous membership under a Family Plan (i.e. no claims are payable in the first 12 months of membership).
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