Before you start, you must understand the essential 'rules' that apply to private health cover. If you have any questions at all about what the terms and conditions mean or how they might affect you, please call us on 1300 362 155.

Before you go into hospital

To ensure that the full cost of your hospital accommodation is covered, Latrobe has agreements with participating private hospitals and day procedure centres throughout Australia. Non-participating private hospitals may charge more for their services and you might not be fully covered for these costs. You have full cover for treatment as a private patient in any Australian public hospital and you can exercise some choice over the specialists who will care for you. Always contact Latrobe before going to hospital for specific advice and information about your benefits.

Glossary, terms and conditions of membership

Accident
An occurrence causing a physical injury or bodily condition, resulting from the application of unintentional external force and requiring immediate treatment. Accident doesn't include illness; operational procedures; the effects of alcohol, drugs of addiction or non-prescribed drugs; pregnancy; aggravation of an existing physical injury or condition.

Admission (to hospital)
Refers to a period of time in hospital for which accommodation charges are raised. It doesn't include treatment at an emergency centre of a hospital.

Approved service providers
To be eligible for benefits, services must be covered by your selected table and provided in Australia by a provider approved by Latrobe for the particular service being claimed. Latrobe reserves the right to withdraw approval of a provider without notice. Before receiving treatment, contact Latrobe to confirm that your provider is approved. The approval and registration of any ancillary, dental, medical or hospital provider for the payment of benefits does not constitute a recommendation by Latrobe, nor do we represent that their services will or may be of benefit to members. Latrobe accepts no responsibility for the outcome of any advice, service, product or treatment given to members by an approved provider.

Calendar year
A calendar year starts on 1 January and ends on 31 December annually.

Certified age at entry (CAE)
Under the Lifetime Health Cover scheme all adult members are assigned a CAE when first taking private hospital cover. The CAE determines what loading, if any, is applied to the base cost of your private hospital cover. It may or may not be your actual age.

Claim time limit
If claims for ancillary benefits are not made within two years of the date of service, benefits are not payable. We recommend that you submit all claims as soon as practical after the service is provided.

Compensation from other sources
You are not entitled to claim benefits if compensation and/or damages can be claimed from another source. For example: WorkCover, Transport Accident Commission, public liability or travel insurance, or private legal action. In circumstances of financial hardship Latrobe may be able to assist you. Contact us if you may be affected.

Default benefits and other limited benefits
Default benefits are set and periodically reviewed by the government. They are the minimum level of benefits health funds must pay for valid claims for treatment provided in a shared ward in public hospitals. Latrobe pays default benefits for specified procedures during relevant benefit limitation periods. Other limited benefits are paid for treatment in a non-participating private hospital; treatment not covered by Medicare; nursing home type patients.

Dental surgery
You are covered for the hospital costs associated with dental surgery in a participating private hospital or a public hospital, but not for the dentist's fees. You can claim a benefit for the dental fees if you have an appropriate Extras table. If you are planning dental surgery, you are strongly urged to contact Latrobe to confirm the scope of your cover.

Dependents
This term includes:

• Your partner including married, de facto and same-sex partners;
• Your unmarried children under the age of 18. Unmarried means not living in a domestic relationship with a partner, including de facto or same-sex relationships;
• Your unmarried children who are full-time student dependants under the age of 25;

On Family Care covers, dependants also includes unmarried children under the age of 25, who are no longer full-time student dependants, who may be living away from home and/or earning their own income.

Financial membership
Membership fees must always be paid at least one payment period in advance. If your membership is in arrears for 60 days, it is automatically cancelled. Accounts and/or reminder notices are sent if you pay at a branch or agency, Australia Post, credit card or B-Pay. Accounts are not sent if you choose weekly or fortnightly payments, if you participate in a payroll deduction plan, or pay by direct debit.

Initial consultation
This means the first consultation with a service provider that is extended for purposes other than providing a treatment, usually to obtain a full medical history or discuss treatment options. An initial consultation does not mean the first consultation with the provider when a standard consultation fee is charged.

Membership year
A 12-month period commencing on the day you join Latrobe, or change to a particular table, and renewed annually.

Newborn baby cover
A single membership covers only the person who applies for a health membership. A newborn baby is not covered under your single membership. If you are planning a baby, please contact Latrobe for advice.

Overseas benefits
Medicare has reciprocal arrangements with some countries, but benefits are limited and you could be in dire financial trouble if you need overseas medical or hospital treatment. Latrobe pays a limited benefit under some Extras covers for unforeseen treatment and funeral expenses. You are strongly advised to take out travel insurance. Members are eligible for substantial discounts on travel insurance purchased through Latrobe.

Participating private hospitals
Latrobe has contracts with participating private hospitals Australia wide. This guarantees the cost of your hospital care will be covered in accordance with the information we have provided to you. For a current list of contracted hospitals, follow this link www.arhg.com.au/contracted.asp or call 1300 362 155.

Pharmaceutical Benefits Scheme (PBS)
The PBS is a federal government scheme to subsidise the cost of certain drugs. You pay a contribution towards the cost of each new prescription, which the government reviews from time to time. Prescriptions covered by the PBS are not eligible for benefits under any Latrobe Extras cover.

Pre-existing ailments
This is any ailment, illness or condition where the signs or symptoms were, in the opinion of a Latrobe appointed medical practitioner, in existence during the 6 months prior to the day you joined or upgraded your cover. Latrobe's medical practitioner takes into account information provided by your own practitioner who treated the condition, when forming an opinion as to whether or not your condition is pre-existing. No benefits are paid for the treatment of a pre-existing condition during the first 12 months of starting a new cover. Please go to Upgrade of Cover and Waiting Periods for important related information.

Rules
Latrobe's rules govern all matters to do with your membership and the operation of the fund, and the federal government approves these rules to ensure they are fair and comply with all relevant legislation. When you apply for a Latrobe membership, you agree to abide by the rules, which you can view by appointment at any branch office. Latrobe's rules may change from time to time. You will always receive written advice before any new rule is introduced, if it might reduce your membership conditions or benefits.

Student dependants
To qualify under family cover as a student dependant, your child must attend full-time study at a Latrobe recognised educational institution. For continued cover, you must complete and return the Student Dependent Registration form that is sent to you every year. The registration form also recommends alternative health cover solutions, if your child no longer qualifies.

Suspended membership
When planning overseas travel, you can apply to suspend your membership. During suspension you do not make any membership payments, and services normally covered are not eligible for claim benefits. If you have not completed all relevant waiting or benefit limitation periods, the balance must be served after your membership is unsuspended. Latrobe may consider a suspension period in the event of financial hardship. Conditions for suspension vary according to your circumstances; suspension may not be a suitable option if you qualify to pay the Medicare Levy Surcharge. Please call Latrobe for advice.

Third party and partner authority
You must tick the appropriate box on your application for a couples or family membership if you want your partner to have equal authority to enquire about or make changes to any aspect of your membership. This includes authority to cancel the membership and request a refund of contributions. If you do not tick the equal authority box, a partner is only permitted to sign for and receive claim benefits. This information is recorded on your membership.

Due to privacy laws, we must have your written authority if you want another person to have control or access to your membership (for example in the event of absence overseas, illness or incapacity, speech, hearing or language difficulties). Please tick the appropriate box on the application or call Latrobe on 1300 362 155 for a Third Party Authority to be sent to you.

Transferring from another fund
You receive continuity of cover for the entitlements you had with your previous fund when:

1. You transfer within 30 days of expiry with the other fund, and
2. You have served the required waiting periods with the other fund. (If you've served part but not all of the waiting periods, you must serve the remaining period with Latrobe before you are eligible to claim), and
3. The cover you take with Latrobe is not an upgrade of the cover you had with the other fund.

When you transfer to Latrobe and also upgrade your cover, you are entitled to the lower benefits paid by the previous fund or Latrobe's closest approximate table, until relevant waiting periods are completed.

Upgrade of cover
This is any change in cover that entitles you to receive higher benefits. Higher benefits include a higher rebate for a particular service, cover for services not included in your previous level of cover, changing to a hospital cover with a lower, or no, excess.

Waiting periods
You are covered immediately for treatment required as a result of an accident that occurs after you join Latrobe. For all other treatments or services, you must serve a waiting period. This is a specified time you must wait after joining before you can claim benefits under your hospital or extras cover. These waiting periods apply to new members starting private health cover and to existing members upgrading their cover.

12 months pre-existing conditions, major dental and orthodontic treatment, optical, blood glucose monitors, compressor pumps and nebulisers, hearing aids, C-PAP machines, non-surgically implanted prostheses
9 months pregnancy related conditions
3 months general dental treatment, mouthguards
2 months all other services

Private Health Insurance Ombudsman

We value your membership and have in place an established and successful system to resolve complaints or disputes that might occasionally arise.

In the unlikely event that your complaint cannot be amicably resolved, you can contact the Private Health Insurance Ombudsman. The Ombudsman provides free and independent services to handle unresolved issues between members and their health fund. Contact details are:

Level 7, 362 Kent Street 
Sydney NSW 2000
Complaints Hotline: 1800 640 695
Facsimile: (02) 8235 8778

Deaf, hearing or speech impaired - via the National Relay Service
Telephone: 13 25 44

Unable to speak English - via the Translating and Interpreting Service
Telephone: 13 14 50.

Latrobe strongly recommends all members read their policy document as information contained in this website is a summary only. Conditions and benefits will apply as per the policy document.