RT Health Fund Review

RT health insurance: Our verdict

RT is good if:

• You want a not-for-profit health fund.
• You're a rail, transport or energy worker or family member.

RT is not great if:

• You're happy with a bare bones policy and don't mind that it's a not-for-profit health fund.

_{Review by our insurance and innovations editor Gary Rose Hunter}

What types of health insurance does RT offer?

Hospital Coverage

Hospital

• Gold Optimum Hospital. No exclusions or restrictions; this policy covers up to 100% of the cost of treatment in the private or public hospital of your choice, and covers you for all 38 clinical categories.
• Silver Plus Assure Hospital. Comprehensive cover that suits most people's needs. It doesn't cover you for procedures such as weight loss surgery, pregnancy, or assisted reproductive services so it's more affordable than Gold Optimum.
• Bronze Plus Essential Hospital. Suited to the young and healthy, exclusions include joint replacement procedures and their revisions, kidney dialysis, spinal surgery and major eye surgery.
• Bronze Plus Clasic Hospital. For those without any specific health issues or concerns. Available with a $350 or $700 excess, First Start covers you for some treatments of a public hospital or partnered private hospital and lets you choose your doctor.
• Basic Plus Public Hospital. RT Basic Plus Public Hospital offers restricted benefits at a basic level of cover.

Extras coverage

Extras

There are three levels of extras cover, that can be purchased alongside hospital or as standalone products.

• Premium Extras. This is RT Health'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.
• Smart Extras. 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.
• Value Extras. 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.

Ambulance coverage

Ambulance

All RT hospital policies can cover ambulance attendance and transportation depending on where you live. Residents of VIC, SA, WA, TAS, NT can get up to $5,000 per person per year for emergency ambulance attendance or transportation. RT Ambulance cover only applies where the state government scheme does not.

RT health frequently asked questions

• Are there any additional benefits?

  • No excess for dependent children. RT Health 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 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 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 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.

• How do I make a claim?

  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 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.

  You can also submit a claim via the RT health insurance app. You can download the app from the Apple Store or Google Play Store.

• How do I know which hospitals I will be fully covered in?

  RT Health has agreements in place with the vast majority of private hospitals and day surgeries in Australia. You can view a list of agreement hospitals on the RT website.

• I want to transfer from another health fund to RT – will I need to serve waiting periods again?

  No, Australian law makes it possible for you to switch health funds without having to re-serve any waiting periods. As long as you join RT less than two months after leaving your previous fund, any waiting periods you've already served will be recognised.

• Does RT offer gap cover?

  Yes, all of the hospital cover options from RT Health come with rt health Medicover, which allows you to reduce your out-of-pocket hospital expenses or even avoid them altogether.

• My partner works for an energy generation company – am I eligible to join?

  Yes, family members of people who work in the energy and transport industries are eligible to join RT Health.