Q&A about OVHC – Australia

Medicare covers areas of medical, hospital and pharmaceutical costs, but does not cover private hospital costs, dental, optical and similar services. Medicare does not provide cover for emergency ambulance assistance or for transport to hospitals.

It is very important that you have a good understanding of the Australian health care system so that you will be able to access the best and most effective treatment for you.

• In-hospital medical treatment

• Prescription medicines

• Surgically implanted prostheses

• Emergency ambulance transport

• Medical repatriation (only if authorised by AGA)

• Out of hospital medical treatment (Visitors Plus only)

Australia has a public health insurance system, known as Medicare, and a public hospital system, however, overseas visitors are generally not eligible for Medicare coverage or free treatment in public hospitals*. This means that overseas visitors who need hospital or medical treatment while they are in Australia will have to pay for these services, and the costs can potentially be significant – in most cases hospital treatment will cost more than $1,500 per day.

Visa requirement

If your visa is subject to Visa Condition 8501, you must maintain adequate arrangements for health insurance while you are in Australia. Your visa conditions can be checked on the website of the Australian Government Department of Immigration and Border Protection (DIBP). Allianz Global Assistance’s OVHC cover meets all DIBP requirements and will satisfy Visa Condition 8501.

You can choose to pay by regular fortnightly, monthly, quarterly, six-monthly or annual installments via automatic payment (direct debit) from your chosen credit card or bank account.

You will continue to be a member and have continuous cover while you continue to pay your premiums.

• Single – covering only the overseas visitor.
• Dual family – covering the overseas visitor, and either one adult spouse or recognised de facto partner or one or more children or step-children under the age of 18 years who are not married.
• Multi-family – covering the overseas visitor and more than one dependant, which can only include one adult spouse or recognised de facto partner and one or more dependent children.

• Services provided by physiotherapists, osteopaths, chiropractors, naturopaths or any other ancillary services.
• Medications, drugs or other treatments not prescribed by a doctor and not included in the PBS.
• Any costs associated with dental treatment, unless the services provided meet the requirements of the Medicare Benefits Schedule.
• Optical charges.
• The co-payment payable by you under Australian law or as a result of the provider charging in excess of the Medicare Benefits Schedule Fee.
• Service fees charged by a doctor or hospital which are not included in the benefits covered under your policy.

General exclusions

Benefits are not payable:

• For services and treatment rendered as part of an assisted reproductive program, including but not limited to in-vitro fertilisation.
• For bone marrow and organ transplants.
• For treatment rendered outside of Australia, whether or not in connection with a course of study and including treatment necessary en route to or from Australia.
• For treatment arranged in advance of the dependant’s or overseas visitor’s arrival in Australia.
• For treatment rendered to a dependant or overseas visitor in the first 12 months, other than psychiatric, rehabilitative or palliative care, where the treatment is for a pre-existing condition.
• For treatment rendered to a dependant or overseas visitor in the first 2 months where that treatment is psychiatric, rehabilitative or palliative care and is for a pre-existing condition.
• For treatment rendered to a dependant or overseas visitor in the first 12 months, where the treatment is for a pregnancy-related condition.
• For transportation of a dependant or overseas visitor into Australia in any circumstance, or for transportation out of Australia except in the circumstances and to the extent covered by our ‘Medical Repatriation Benefit’.
• For services and treatment which are covered by compensation, damages or provisions of any kind.
• For elective cosmetic surgery.

For the purposes of these exclusions, the start date for calculating the relevant period of 12 months or 2 months, and whether or not the condition is a pre-existing condition, will be determined in accordance with the ‘waiting periods’ section of the OVHC policy document.

You cannot claim for costs arising during the applicable waiting period if such costs arise from a pre-existing condition or a pregnancy-related condition.

The waiting period is calculated as 12 months (or, for psychiatric, rehabilitative or palliative care, 2 months) commencing from:

• The date you or your dependant (as the case may be) arrived in Australia; or
• The date your eligible visa was granted,

whichever the later date is.

If you are switching to Allianz Global Assistance from a similar policy held with another insurer, and there has not been a gap in your coverage of more than 30 days, we will count the time you were covered under your previous policy towards any waiting period which applies to your coverage with us – see the section ‘Other Important Matters’ on page 12 of the OVHC policy document.

If you have previously held OVHC or OSHC with us and:

• You voluntarily terminated your policy and 30 days have since elapsed during which you did not hold health insurance; or
• Your policy was lawfully canceled by us,

New waiting periods will commence upon commencement of any new policy you take out with us after that time.

In forming this opinion, the medical practitioner must have regard to any information in relation to the ailment, illness or condition provided to that medical practitioner by the medical practitioner who treated the ailment, illness or condition.

This includes an ailment, illness or condition that was present but had not been diagnosed by a medical practitioner at the time of your arrival in Australia or the date your eligible visa was granted, whichever is the later date.

Some medical providers may charge a ‘gap’ fee at the time of service, but the rest of the bill will be taken care of by Allianz Global Assistance OVHC. This means you do not need to make a claim. You can easily find your closest direct-billing medical provider here on the website using our Find a Doctor page.

Please note: there are no benefits payable for services provided by a direct-billing medical provider for OVHC Budget Visitors – Hospital Only policies. These benefits are only payable on OVHC Visitors Plus policies.

If you are not in a medical emergency situation, the first point of contact is a general practitioner (GP), medical practitioner or local health/medical centre. You can access many services at your local health centre. Some of the services available are:

• General medicine and simple diagnostic screenings.
• Assessment and treatment of health problems and injuries.
• First aid services as needed.
• Women’s and men’s health.
• Referrals to specialist services.

In most cases, it is necessary for you to make an appointment to see your doctor.

Accident and emergency treatment

Many hospitals have a 24-hour Accident and Emergency department. Accident and Emergency departments should only be accessed in the case of emergency situations. When you visit an accident and emergency department, a nurse will assess you and if your illness or injury is not deemed as an emergency, you may need to wait a long time to see a doctor.

Hospital treatment

If you have been admitted for emergency treatment, contact Allianz Global Assistance immediately on 1800 814 781. If you have been referred to hospital for a non-emergency admission, contact the claims department on 1300 727 193 prior to admission. You will need to provide Allianz Global Assistance with the details of your treatment and hospital stay. We will then be able to confirm your cover and assist you with making arrangements for payment to the hospital.

Public admission

Generally, OVHC covers the total cost of your stay and treatment as an in-patient in a shared ward of a public hospital. As a public patient, your doctors will be nominated by the hospital. After your hospital discharge, your care will be carried out in either the outpatient clinic, by one of the hospital’s specialists in his/her private rooms or you will be referred to your local general practitioner.

Private admission

You can choose to be treated in a private hospital. Through our relationship with Peoplecare Health Limited, we have agreements in place with most private hospitals in Australia. These hospitals (known as Agreement Hospitals) ensure that an agreed schedule of fees (including in-patient accommodation, theatre, and special unit accommodation fees as appropriate) is charged by the hospital and paid by Allianz Global Assistance on a member’s behalf. You may incur out-of-pocket costs for private hospital expenses.

There are some private hospitals that are not Agreement Hospitals. In these cases, we may not cover the full cost of your hospitalisation. However, if you call us before you go into hospital we’ll be able to provide you with an estimate of your out-of-pocket expenses. Members who choose a non-agreement hospital may incur out-of-pocket expenses for hospital-related services.

• You paid your premium and did not come to Australia.
• You paid your premium on the basis of an extended stay but the extension of authorised stay was not granted by the Department of Immigration and Border Protection.
• You have been granted permanent residence in Australia.
• You can provide proof of other OVHC cover provided by another organisation which includes the period covered by the organisation.

Please note:

• Refunds are calculated on a monthly pro rata basis, with a minimum refund of one month.
• A minimum cover period of 3 months is payable if cover is cancelled whilst in Australia. Any amount that we retain on these grounds is treated as a fee for processing your refund.
• There is no minimum cover period payable if cover is cancelled prior to arrival in Australia.