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When it comes to your health, you want to know that you and your loved ones will be able to get the care you need whenever you need it. While the Medicare system goes some of the way to ensuring that you get the medical treatment you need, for the ultimate peace of mind you need to take out private health insurance.
Private health cover can cover your treatment in a private hospital, allow you to choose your doctor or specialist, and also help you meet the costs associated with a wide range of general treatments like optical, dental and physio.
If you’re looking for private health cover for yourself or for the entire family, RT Health Fund is a not-for-profit fund owned by its members. Established more than 126 years ago, RT Health Fund offers four levels of hospital cover and three levels of extras cover to suit your cover needs and budget.
Choosing the right cover
RT Health Fund provides four hospital cover options that offer an increasing range of benefits and an increasing premium cost for the higher level of cover: Public Hospital, First Start Hospital, Smart Hospital, Step Up Hospital and Premium Hospital. These can be purchased as standalone cover or you can choose to mix and match them with one of the three extras cover options: Value Extras, Smart Extras and Premium Extras.
Do I need health insurance?
If you’re weighing up whether or not you need health insurance cover, all you need to do is take the Australian Government’s Lifetime Health Cover Scheme into account. Under the scheme, you’ll be charged a premium loading for every year after you turn 31 that you do not have some form of private health cover in place. In other words, the sooner you take out cover the cheaper it will be.
With this in mind, you’ll have to decide on the right cover option for you – and the right cover can differ greatly from one person to the next. For example, someone in their mid 50s with a history of health problems is going to need very different cover to a young, fit and healthy applicant. Consider what you need cover for and how much you want to spend before you choose a fund.
RT Health Insurance Levels of Cover
RT Health Fund offers the following hospital cover options:
- This policy covers up to 100% of the cost of treatment in the private or public hospital of your choice, the doctor of your choice, implanted prostheses and in-hospital pharmaceuticals, ambulance attendance and transportation. Available with an optional excess, Premium Hospital also offers additional benefits like a hospital substitution program, a pregnancy support program and a disease prevention and management program.
- This mid-level cover option provides comprehensive protection and lets you choose your doctor and receive treatment in the public or private hospital of your choice. However, it features more restrictions and exclusions than Premium Hospital Cover, with things like joint replacements, psychiatric treatment and discharge pharmaceuticals not fully covered.
Step Up Hospital
- As the name implies, this is a step up from the First Start Hospital plan, and is a slightly more comprehensive cover. It covers you for a wider range of treatments in a public hospital or partnered private hospital (including benefits for some treatments only if you are a private patient in a public hospital). It still excludes certain procedures from cover including kidney dialysis, spinal surgery, and others.
First Start Hospital
- This hospital cover is designed for young and healthy people with no specific health concerns. Available with a $250 or $500 excess, it covers you for some treatments of a public hospital or partnered private hospital and lets you choose your doctor. Procedures excluded from cover include major eye surgery, spinal surgery, and others.
- As the name suggests, this option only covers you for treatment in a public hospital, not a private hospital. However, you can receive treatment from the doctor of your choice and receive up to 100% of hospital costs. Ambulance attendance and transportation is also covered.
Extras available from RT Health
There are three levels of extras cover, that can be purchased alongside hospital or as standalone products.
- This is RT Health Fund’s top-level extras cover option and it provides cover for general and major dental, orthodontics, optical, physiotherapy, chiropractic, occupational therapy, orthoptics, dietetics, audiology, podiatry, speech therapy, psychology, pharmaceuticals, vaccines, alternative therapies, home nursing, hearing aids, health aids and more.
- This mid-level policy option covers the same general treatments as a Premium Extras policy but does not provide as generous benefit limits. It also excludes orthodontics cover, creating a combination between a broad range of cover and affordability.
- This entry-level extras cover option excludes a number of treatment types and features lower benefit limits. However, it still provides cover for general dental, optical, physio, chiropractic, occupational therapy, orthoptics, dietetics, alternative therapies, vaccines, pharmaceuticals, health aids and hearing aids.
Are there any additional benefits?
- No excess for dependent children. RT Health Fund hospital cover members will never have to pay an excess for their dependent children.
- Affordable cover. Sole parent cover is available to make health insurance more affordable for single parent families.
- Cover your kids up to the age of 25. If any of your kids are unmarried and full-time students, they can stay covered under your RT family policy until they reach 25 years of age.
- Optical and dental discounts. Fund members can access a range of discounted products and services at the fund’s new optical practices in Surry Hills and Newcastle. A range of dental and eyewear discounts are also available.
- Free health management programs. RT Health Fund members can take advantage of two free health management programs. Hospital at Home offers hospital-equivalent care to you at home, while health4life helps you make healthy lifestyle changes to prevent chronic disease.
What isn't covered?
Your RT Health Fund claim will not be paid if:
- It is for a treatment excluded from your level of cover. For example, Smart Hospital excludes cover for joint replacement procedures
- It is for services received more than two years prior to submitting your claim
- It is for a service for which Medicare does not offer a benefit
- It is for cosmetic surgery that is not medically necessary
- If you are admitted to a private hospital with which RT Health Fund does not have a contract
- It is for hospital or medical costs incurred for outpatient treatment
- It is for private hospital emergency department fees
- It is for treatment received overseas
- It is for discharge pharmaceuticals
- It is for hospital costs not related to the reason for your admission, for example TV hire and phone calls
- You have Smart Hospital or Value Hospital cover and you receive treatment in a private hospital which you are only covered for in a public hospital
- It is for treatment provided in a non-hospital facility, for example a nursing home.
Am I eligible to join?RT Health Fund is a restricted membership fund that offers cover to employees in the transport and energy industries and their families. In order to be eligible to become a member of RT Health Fund you will need to be a current or former employee of a:
- Land, sea or air transport company
- Government body that administers the air, land or sea transport industries
- Energy generation or delivery company
- Contract company that provides any of the above services
Current and former members of Railways Credit Union Limited can also join, while you can also join if you are related to an eligible person. This means you must be their parent, sibling, brother- or sister-in-law, partner or former partner, child, grandchild, son- or daughter-in-law, or niece or nephew.
Does RT Health Insurance have an excess?
Depending on the level of hospital cover you take out, you may be required to pay an excess when you are admitted to hospital. The excess is the amount you pay to contribute to your hospital costs and allows you to enjoy lower premiums. Under Premium Hospital, you can choose to pay an optional excess or no excess at all. Both Smart Hospital and Value Hospital come with an excess that you’ll need to pay when you’re admitted to hospital, and the amount you have to pay will be detailed in your policy schedule.
I need to make a claim ... what do I do?
If you receive treatment in a private hospital, in most cases the hospital’s bills will be sent directly to your health fund. However, you may receive bills from the different doctors who treat you, and you’ll need to take them to a Medicare office and fill out a two-way claim form. Medicare will then forward your claim on to RT Health Fund to cover the 25% gap that Medicare does not pay.
When you need to make an extras claim, many providers will offer on-the-spot electronic claiming that simply requires you to swipe your membership card. Where this option is not available you will have to download a claim form from the RT Health website, fill it out and submit it to the health fund.
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If you’re eligible to become a member of RT Health Fund, consider the benefits and features it offers when choosing private health cover. Comparing the products offered by a range of funds is the best* way to ensure that you get the cover you need for you and your family.