Frank Health Insurance

Frank hates complicated legal speak. But Frank wants to make sure you know exactly what you're getting.

So here's the legal stuff, in all its glory.

Please select:

Privacy Statement for Members
Your personal information
How we might contact you
Disclosure of information
Use of our website
Contact us
Website terms of use
Acceptance of terms
Liability
User obligations
Material posted by users
Intellectual property
Third party websites and content
Privacy
Indemnity
Termination of membership
Changes to this site
Governing law
How to contact us
New membership join process
Online claiming process
Other important information
Product information

Privacy Statement for Members

GMHBA Limited (ABN 98 004 417 092) complies with the Privacy Act 1988 (Cth) to ensure that your personal information in protected.

References to "we", "us" and "our" are references to GMHBA Limited.

This Privacy Statement explains how we collect personal information through this website, how we use and disclose that personal information and how to contact us if you have any further queries about our management of your personal information.This Statement should be read in conjunction with our Website Terms of Use statement.

Your personal information

We collect personal information on this website to assist us in providing services to you. The type of personal information we collect about you depends on how you use this website. For example, personal information is collected when you:

• log in to the member area;
• complete the "Chat now" webchat request form;
• complete the "Sign Up" form to sign up for health insurance with Frank;
• post a blog comment;
• complete an email query form; or
• register or subscribe for, or contribute content to, any other services available through the website from time to time.

We may also keep records of any emails or other correspondence that you send via the website.

We may collect your personal information directly from you or from third parties such as from the policy holder of your membership.

If you do not provide us with the personal information requested of you, we may be unable to respond to your request or provide you with the relevant service (except in cases where the provision of that information is optional).

We will use the personal information provided to us through this website for the purposes for which it was provided (for example, to respond to your request or process your application for health insurance). We may also use your personal information for any other purposes explained at the time of collection or that are required or authorised by or under applicable law (including, without limitation, the Privacy Act 1988 (Cth)).

If you use our webchatting service or otherwise enquire about our products and services via this website, we may use your personal information to contact you for the purposes of providing you with further information about our products and services and to follow up whether you have an interest in acquiring products or services from us. You can let us know at any time if you no longer wish to be contacted for these purposes. Your permission will remain current until you advise us otherwise.

In addition, if you have Frank health insurance, we will use your personal information to provide you with private health insurance cover, including to:

• manage our ongoing relationship with you;
• process and audit claims;
• develop products and services;
• resolve any legal and/or commercial complaints or issues; and
• assess your suitability for, and provide you with information about, other products or services that we think may be of interest to you. If you do not want to receive information about these products or services, please let us know. Your permission will remain current until you advise us otherwise.

How we might contact you

We may contact you in a variety of ways, including by post, email, SMS, telephone call or facsimile.

We will not send you any commercial electronic messages such as SMSs or emails unless this is permitted by the Spam Act 2003 (for example, if we have your express or inferred consent to do so). In addition, we will not call you on a number listed on the Do Not Call Register unless this is permitted under the Do Not Call Register Act 2006 (Cth) and related instruments (for example, if we have your express or inferred consent to do so). If you do not wish us to call you on a particular number, please let us know.

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Disclosure of information

We may disclose your personal information to persons or organisations to carry out the purposes described in this Statement such as our service providers, legal and other advisors, health service providers (such as participating private hospitals), government authorities, payment systems operators and financial institutions and, if you have a corporate insurance product, your employer. In some circumstances, these third parties may disclose personal information they collected from you to us. We will hold and use all personal information we collect from third parties about you for the purposes described in this Statement.

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Use of our website

(a) Mailing lists

Users of our website can subscribe to mailing lists provided by us if they so choose. We will not sell or pass on this information on to any third parties except as outlined in this Statement. You can unsubscribe from this list at any time by sending an email to: frank@frankhealthinsurance.com.au with the word "unsubscribe" in the subject line.

(b) Cookies

A "cookie" is a file sent by a web server to your internet browser and stored on your computer. It contains data that websites use to identify you as a unique user.

Our website uses cookies to store information on your computer. This information is used to enhance our website service and to provide information relevant to you such as premium rates for the state in which you reside.

We will not disclose the contents of any cookie to any third party, except that we may disclose such information to any service providers we engage to assist us to establish and operate our online services.

Most internet browsers are set to accept cookies. If you prefer not to receive them, you can adjust your browser to reject cookies, or to notify you when they are being used. There are also software products available that can manage cookies for you. However, rejecting cookies can limit the functionality of the website.

(c) General information about use

Frank uses a third party service to collect general information about the use of our website. This anonymous information is aggregated and will not disclose personally identifiable information about any user of our website.

(d) Other websites

Our website may contain links to other websites on the internet that are not associated with or controlled by us. We do not have any responsibility for the policies of these sites so you will need to review these sites directly to ascertain their privacy practices.

Changes to this Privacy Statement

We may change this Privacy Statement from time to time.

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Contact us

We will allow you to access and correct personal information we hold about you as required by law.

Should you have any concerns, questions or comments on a privacy matter or would like to access your personal information, we encourage you to email us at: frank@frankhealthinsurance.com.au

If you have a privacy concern that cannot be resolved, we encourage you to contact our Privacy Officer on ph:1300 437 265 or by writing to:

Privacy Officer
Frank Health Insurance
PO Box 761
Geelong VIC 3220

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Website terms of use

This website and the services offered through this website ("Site") are provided by GMHBA Limited trading as Frank Health Insurance ("GMHBA").

References to "we", "us" and "our" are references to GMHBA.

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Acceptance of terms

Your use of this Site is governed by these Terms of Use, as updated by us from time to time. Please read these Terms of Use carefully before using this Site as they contain important information, including warranty disclaimers and limitations of liability.

You acknowledge and accept that by using this Site, you agree to be bound by these Terms of Use as updated by us from time to time, whether you are a 'Visitor' (which means that you simply browse our Site) or a 'Member' (which means that you have joined our health fund). The term 'User' refers to a Visitor or a Member.

If you do not agree with any of the terms contained in these Terms of Use, do not use this Site.

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Liability

This Site is intended solely for use by Australian residents and holders of valid Australian visas who are eligible to purchase our health insurance products. The materials on this Site have been prepared for general information purposes only. While we have taken reasonable care in compiling this Site, we are not responsible for any action taken by any person or organisation, wherever they are based, as a result, direct or otherwise, of information contained in or accessed through this Site whether such information is provided by us or by a third party. Nothing on this Site should be construed as the giving of advice or the making of any recommendation. This Site should not be relied upon in any way.

The information on this Site may not always be complete and up to date. To the extent permitted by law, we make no warranties, representations or give any undertakings whether express or implied about any of the content on this Site including (without limitation), the timeliness, currency, accuracy, completeness or fitness for any particular purpose of such content or that the results which may be obtained from the use of the Site will be error free or reliable. You agree that your access and use of this Site and its content is at your sole discretion and risk.

To the extent permitted by law, we and any party involved in creating, producing or delivering this Site will not, in any circumstance, be liable for any damages, loss (whether direct or consequential), costs or expenses of any kind arising out of, or referable to, the completeness, timeliness, currency, suitability or accuracy of anything on this Site, or the inability to use this Site, whether caused by our negligence or otherwise.

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User obligations

If you are a Member and have been issued with a username and password to access your online portal on this Site ("Online Portal Rights"), you acknowledge that your Online Portal Rights are personal to you and you must therefore not share your Online Portal Rights with any other person. You agree to keep the username and password secure and confidential and you agree to:

• (a) notify us immediately upon becoming aware of any unauthorised disclosure or use of your username and/or password; and
• (b) be liable for any loss or damage resulting from such unauthorised use or disclosure.

As a User of this Site, you undertake:

• (a) to use this Site only in accordance with these Terms of Use;
• (b) not to knowingly or recklessly contravene, in the course of using this Site, the provisions of any legal or regulatory requirements of any competent authority having jurisdiction over you or over any activity you undertake;
• (c) not to use this Site to make unauthorised attempts to access any of our systems or third party networks;
• (d) not to use this Site to conduct any business or activity or solicit the performance of any activity that is prohibited by law;
• (e) not to use this Site for the transmission or posting of any material such as data, text, software, images, audio and video, including links to that material ("Material") which:
• (i) is defamatory, offensive, or of an abusive, obscene or menacing nature; or
• (ii) infringes third party rights; or
• (iii) is misleading or deceptive;
• (f) not to use this Site for the purpose of causing annoyance or inconvenience to any third party including to other Users;
• (g) not to use this Site to:
• (i) transmit, directly or indirectly, commercial electronic messages (as that term is defined in the Spam Act 2003 (Cth)) which are unsolicited ("Spam") or bulk communications that include Spam; or
• (ii) harvest information about our Users for the purpose of sending, or to facilitate the sending of, Spam;
• (h) to inform us immediately of any claim or action against you for any use of this Site and, on request from us, to immediately cease the act complained of; and
  (i) to inform us immediately of any changes affecting your details stored in your online portal (such as your address). It is your obligation to ensure that your details stored in your online portal are kept up to date.

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Material posted by users

Some of the services offered through this Site may allow you to submit, upload, post or transmit Material that may be accessed and viewed by others, including the internet audience in general. By submitting, posting or uploading Material you represent and warrant that you have rights to and are legally entitled to post that material on the internet.

You acknowledge that anything you post onto the Site may appear elsewhere on the internet and/or remain on the internet after you have ended your Online Portal Rights and you accept that while we provide various privacy controls, we cannot guarantee that your Material will not appear elsewhere, be copied, downloaded or used otherwise. If you are concerned about posting any personal and/or private content, you are advised to not use these services.

You are solely responsible for:

• (i) the Material that you post, provide or transmit on or through the Site;
• (ii) any Material that you transmit to other Users; and
• (iii) your interaction with other Users.

We have not assumed, and do not assume, any obligation to monitor any Material posted on our Site. However, you acknowledge and agree that we reserve the right to review, reprint, modify, distribute, remove or delete any Material posted on our Site.

We do not control the Material posted by other Users and as such do not guarantee the accuracy, integrity or quality of such Material.

The opinions expressed by Users on the Site reflect solely the opinions of the individuals who submitted such opinions, and do not reflect our opinions. We are not responsible for the accuracy or reliability of information provided by Users. Any reliance on or use of any Material posted by other Users is at your own risk. Under no circumstances will we, or our employees, officers, directors, shareholders, agents, representatives or affiliates, be liable for any loss or damage caused by your reliance on or use of any Material posted by Users on our Site.

By using our Site you understand and agree that you may be exposed to Material posted by other Users that may be offensive, indecent or objectionable. We will use reasonable efforts to remove any such Material from our Site should you notify us by email at frank@frankhealthinsurance.com.au. You acknowledge and agree that we are not liable for either the opinions or the behaviour of other Users, including any Material posted and any defamatory statements or offensive conduct.

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Intellectual property

Your copyright

We do not claim ownership of any Material that you may post on the Site. However, you agree that by posting any Material on the Site, you grant us, our affiliates and distributors, a royalty free, perpetual right to use, reproduce, modify, adapt, publish, translate, create derivative works from, distribute, publicly perform and display such content worldwide in any medium.

You may not post, provide, transmit, modify, distribute, or reproduce in any way any copyrighted material, trademarks or other proprietary information belonging to others on or through our Site without obtaining the prior written consent of the owner of such proprietary rights.

Our copyright

The copyright in this Site, including, without limitation, in all documents, files, text, images, graphics, devices and code contained in it and in this Site's general "look and feel" is owned, controlled or licensed by or to us. You are authorised to copy and print extracts or documents from this Site (except for any third party owned content which has been identified as such) for your non-commercial use only or to use such extracts or documents as permitted by the Copyright Act 1968 (Cth), provided any such copy, print or other use retains all copyright or other proprietary notices and any disclaimer contained within them. Other than as specifically mentioned above, reproduction of part or all of the content of this Site in any form, including framing, creating any derivative works based on this Site or its content, incorporation into other Sites, electronic retrieval systems or publications is prohibited. No links to this Site may be included in any other Site without our prior written permission.

We cannot guarantee that you have any right to use third party owned content which is available on this Site and you must obtain permission from the third party owner before using or downloading such content. Content which is copyright protected may not be changed (except as permitted by the Copyright Act 1968 (Cth)) nor may any author attribution notice or copyright notice appearing on such content be altered without first obtaining the appropriate consents.

Except for the limited permission set out above, nothing on this Site should be construed as granting any other right or licence.

Our trade marks

All product names referred to on this Site are our trade marks, except for those trade marks indicated as owned by other companies and all rights are reserved.

Our logos and trade marks may not be used or reproduced without our prior written consent.

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Third party websites and content

This Site may contain third party owned content (e.g. articles or data feeds) and may also include hypertext links to third party owned websites. We provide such third party content and links as a courtesy to Users (and subject to the terms set out above under the heading Copyright). We have no control over any third party owned websites or content referred to, accessed by, or otherwise available on this Site and, therefore, we do not endorse, sponsor, recommend or otherwise accept any responsibility for such third party websites or content, or for the availability of such websites. In particular (but without limitation), we do not accept any liability arising out of any allegation that use or other exploitation of any third party owned content (whether published on this Site or any other website) infringes the intellectual property rights of any person or any liability arising out of the use of or reliance on any information or opinion contained on or in, or an omission from, such third party website or content.

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Privacy

All personal information submitted to us through the Site will be dealt with in accordance with the terms of our Privacy Statement for Members which can be accessed above.

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Indemnity

You agree to defend, indemnify and hold us (including our directors, officers and employees) harmless from any and all liability, cost and expense, including reasonable legal fees, relating to:

• (a) any breach of these Terms of Use by you; or
• (b) to the extent permitted by law, your use of this Site;or
• (c) your violation of any rights (including intellectual property rights) of a third party.

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Termination of membership

We may, in our sole discretion, terminate or suspend your Online Portal Rights immediately without notice for any reason, including (without limitation) if you breach any of these Terms of Use. We may also, in our sole discretion and at any time, remove any Material or information that you have posted on our Site or cease the provision of this Site, or any part of it, with or without notice to you.

You may terminate your Online Portal Rights by sending an email to frank@frankhealthinsurance.com.au from your email address. However, you acknowledge and agree that even if you have terminated your Online Portal Rights, you will continue to be bound by these Terms of Use for as long as you continue to use our Site.

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Changes to this site

We reserve the right to change any part of this Site or these Terms of Use at any time without notice. Any changes to these terms and conditions shall take effect from the next time you access this Site. You are responsible for checking these Terms of Use regularly for changes. Notwithstanding the above, we are not obliged to keep this Site up to date, or to correct any inaccuracy on the Site that may become apparent at a later time.

We may, in our sole discretion, terminate or suspend your access to all or any part of this Site for any reason.

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Governing law

These terms and conditions are governed by and must be construed according to the law applying in Victoria. By visiting and using this Site, you unconditionally submit to the jurisdiction of the courts in Victoria.

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How to contact us

You can contact us by sending an e-mail to frank@frankhealthinsurance.com.au.

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New membership join process

Acknowledgement

In these terms, "you" or "your" refers to GMHBA Limited, and "I" or "my" refers to you as the Policy Holder.

By typing “yes” I acknowledge and declare that:

1. I have read and accept your terms and conditions of membership (as outlined in the Other Important Information);
2. I understand the conditions relating to pre-existing conditions/illnesses and waiting
3. I have read and accept your Privacy Statement for Members and I consent to the use and disclosure of my personal information in accordance with this policy;
4. The information I have provided to you via this online application for membership is true and correct;
5. The information in this online application for membership is provided with the consent of the individual(s) to whom it relates. I confirm that I have the authority to act on behalf of the individual(s) named in this online application and I have brought your Privacy Statement for Members to their attention;
6. I will make all claims under this policy and will ensure that each claim includes the sensitive information of a spouse/partner or dependant aged 16 years and over only with their consent;
7. I understand that my application for membership at the payment of benefits may be declined if any of the information I have provided to you is false;
8. I understand that you have the right to accept or refuse my application for membership and upon acceptance of my application for membership I will have engaged you to provide health insurance to me in accordance with my chosen level of cover;
9. I understand that cover does not commence until payment is received;
10. I am responsible for this policy and I will communicate to all current and future individuals covered by it, the information contained in your terms and conditions of membership, the existence of the Fund Rules, and the fact that those terms, conditions and rules apply to all of your members; and
11. I understand that you have the right to amend your terms and conditions of membership and your Privacy Statement for Members.

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Online claiming process

Declaration by the Policy Holder

In these terms, "you" or "your" refers to GMHBA Limited, and "I" or "my" refers to you as the Policy Holder.

By typing “Yes” I make a claim for services provided and I declare that:

1. I have paid for or am liable to pay for the expenses associated with this claim;
2. I have no entitlement to claim compensation for the expenses detailed in this claim from a third party including TAC, or WorkSafe;
3. The information provided in this claim is made with the consent of the individual(s) to whom it relates and I have the authority to act on behalf of the individual(s) named in this claim;
4. I have read and accept your Privacy Statement for Members (as amended from time to time) and have brought the Privacy Statement for Members to the attention of the individual(s) named in this claim;
5. I consent to the use and disclosure of the personal information of the individual(s) named in this claim in accordance with the Privacy Statement for Members and the terms and conditions of membership (detailed in Other Important Information) and I have the authority of the individual(s) named in this claim to provide such consent;
6. The services were not for the purposes of health screening, superannuation or life insurance entry or a health examination requested by an employer of the individual(s) the subject of the claim;
7. I authorise any medical practitioner, hospital or other health service provider to give you full and complete details of all or any medical treatment, hospitalisation, injury, disease, diagnosis, or other personal information (including sensitive information and health information) about me, my spouse/partner or my dependants for the purpose of assessing this claim. I have the consent of the individual(s) named in this claim to give this authority of their behalf; and
8. All information supplied with this claim is true and correct.
9. I acknowledge your terms and conditions of membership (detailed in the Other Important Information) in making this claim, and confirm that you may deduct monies for unpaid premiums or over payment from any monies due to me.

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Other important information

Introduction

Frank Health Insurance is a business of GMHBA Limited. In this section, references to "Frank" or "Frank Health Insurance" are references to GMHBA Limited trading as Frank Health Insurance.

Application for membership with Frank

When you sign up for health insurance with Frank it’s important that you provide us with all the information requested to allow us to maintain an accurate record of your membership. It is also important that the information you provide is true and correct. Frank will consider your membership void if you provide false or incorrect information on your membership application. If your membership is terminated, then premiums received in advance for coverage beyond the termination date will be refunded.

You can make changes to your membership anytime.

Frank uses the terms ‘member’, 'spouse/partner' and ‘dependant’ to define the people covered by a membership. Only the person nominated as the ‘member’ can authorise changes to the membership unless the member has previously authorised the spouse/partner to make such changes. Similarly, correspondence issued by Frank will be addressed to the member and it is the member’s responsibility to notify Frank of any change of address by maintaining the address records in the member area. The completion of the application process and the payment of any premium constitutes an acceptance of any conditions laid down in the regulations of the fund, including the Fund Rules and any fund policies, in force at that time or as they may be amended from time to time. A copy of the Fund Rules can be accessed on request by emailing Frank at frank@frankhealthinsurance.com.au, but be prepared – the Fund Rules are comparable in size to a telephone directory, and you will need to print it yourself.

Frank reserves the right to refuse admission to membership of any level of health insurance.

In the event of any member or person named on the member’s membership is convicted in a court of law of assault or similar offence against a staff member related to that staff member’s performance of their duties, has obtained or attempted to obtain an improper advantage, for themselves or for any other member or is convicted in a court of law of fraud against Frank, the Board may in its discretion, declare the member’s membership void. The status of the member’s membership will be assessed with any outstanding claims being honoured and any premiums shall be refunded. Any other rights accrued to the member will be forfeited.

Membership card

When you sign up with Frank Health Insurance, you’ll receive a membership card that identifies you as a member. The card shows your membership number and who is covered. Frank’s contact details are listed on the back of the card. Have your membership card on hand when you arrange admission to hospital, visit a participating provider or when you call Frank with any questions.

A new card may be issued when you make changes to your membership. Please note that an existing card will become invalid whenever a new membership card is issued. Keep your card safe and please advise Frank if your card is lost or stolen.

Communications from Frank by webmail

Frank understands that paperwork is time-consuming, tedious, and bad for trees. On the other hand, Frank understands that members want to be able to access information relevant to their membership easily and quickly.

Frank will provide you with a great deal of information upon joining, including your:

• Membership certificate
• The Standard Information Statement (SIS) for the product/s you have bought
• A detailed description of the coverage provided by the products you have bought
• Other Important Information relating to your coverage and your membership

Frank understands that you will need this material one day, which may be years after you join, so Frank will be communicating with members via a secure Webmail. Webmail is contained within the Member Area and is accessible only with your Member Number and password. The information that Frank sends you this way can be viewed in screen, copied to your hard drive or printed out. Information sent to you via Webmail can be personally sensitive so Frank recommends that you guard your password carefully.

As well as the material listed above, Frank will send to your Webmail account your:

• Annual Rate change letter
• Annual Tax Statement and LHC statement
• Records of services provided and claims paid
• Any other notifications relevant to your membership

You will be asked to consent to receiving communications electronically during the sign-up process. This is the only way that Frank can communicate with you, and acceptance of this is a condition of membership. Receiving these notifications by snail mail is not an option.

Check your cover

Please contact Frank to check what you’re going to get back before having treatment or going into hospital. Frank has a range of health insurance options at different levels.

Arrears

Frank members are responsible for ensuring their accounts have sufficient funds available on their nominated direct debit date. Membership will cease when premiums fall into arrears of more than 2 months after the premium due date. To claim benefits a member must be financial at the time of incurring the expense for the service or treatment.

Liabilities of members to Frank

A member can be liable to Frank for unpaid premiums and for overpayments. Overpayments can be made by Frank to a member, either through an error in completing a claim, or an error in processing a claim. If an overpayment is made, the member is liable to repay the amount of the overpayments to Frank on demand. If a member is liable to Frank for unpaid premiums or overpayments then Frank has the right to deduct the amount of that liability from any monies due by Frank to the member on any account.

Audits

Frank undertakes audit activities in order to protect members’ assets and contain costs. From time to time, in the general interest of members, a Frank representative may contact you with a request for assistance to monitor costs – whether relating to benefits paid or charges raised by health care providers. Your co-operation with such requests is critical to our cost containment efforts, and will be treated in a completely confidential manner.

Refunds

You may cancel your Frank Health Insurance cover from:

• the date you notify Frank in writing of the cancellation (a transfer certificate will be provided to the insured person within 14 days of request); or
• your next direct debit date,

whichever is the earlier.

If you cancel your Frank Health Insurance cover within 30 days of joining, you will receive a full refund of any premiums received by Frank, provided you have not made a claim.

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Product information

When to contact Frank

If you have less than 12 months membership on your current hospital cover, make sure you contact us before you are admitted to hospital and find out whether the pre-existing condition waiting period applies to you. We need about 5 working days to make the pre-existing condition assessment, subject to the timely receipt of information from your treating medical practitioner/s. Make sure you allow for this time frame when you agree to a hospital admission date. If you proceed with the admission without confirming benefit entitlements and we subsequently determine your condition to be pre-existing, you’ll have to pay all outstanding hospital charges and medical charges not covered by Medicare.

Waiting periods

Waiting periods exist to protect members from claims made by those who join Frank or increase their level of cover because they have a condition or illness that may require treatment.

Waiting periods will apply to:

• New memberships (previously uninsured);
• Additions to a membership (unless the addition/s has already served all waiting periods with Frank or another insurer) except newborns and adopted and permanent foster children where the family membership has been in existence for at least 2 months, and where the addition/s has already served all waiting periods and benefit limitation periods with Frank or another insurer,
• Existing Frank memberships, and transfers to Frank from another insurer where:
• the level of cover and/or benefit entitlement is upgraded or increased;
• any hospital or extras service was not covered by the previous insurer and/or;
• the waiting periods have not been completed.

Where a member is transferring from another product or from another health insurer, waiting periods for hospital treatment that was not covered under the old policy are :

• 24 months – Benefit Limitation Periods apply to gastric banding, psychiatric or renal dialysis (where offered in the cover after your other waiting periods have been served).
• 12 months - obstetric or pre-existing condition (other than for psychiatric, rehabilitation or palliative care).
• 2 months - Psychiatric, rehabilitation or palliative care.
• 2 months - Any other benefit for hospital treatment.

Where a member is transferring from another product or from another health insurer, waiting periods for extras that were not covered under the old policy are:

• 12 months - Major dental (including root canals), podiatric surgery and orthotics (where offered in the cover)
• 6 months - Optical benefits.
• 2 months - Any other extras benefit

The above waiting periods also apply to previously uninsured members.

For treatment that was covered under the old policy, at the same or higher level than the new policy, waiting periods are no longer than the balance of any unexpired waiting period for the benefit that applied to the person under the policy.

For treatment that was covered under the old policy but at a lower level, the member is entitled to the lower benefits on their old cover during the waiting period.

Existing members with at least 12 months membership in total across their old and new cover are entitled to the lower benefits on their old cover during the waiting period.

Benefit Limitation Periods

Benefit Limitation Periods are important - they stop people from taking advantage of Frank’s generous nature. Benefit Limitation Periods are a restriction on what Frank will pay for a hospital treatment for a period of time. It begins the date you join Frank or switch covers. It means Frank pays public hospital benefits in a shared room, so long as you have served all other waiting periods, but then you’ll be back to normal. A benefit limitation period of 24 months applies to:

• Best Hospital cover for gastric banding, psychiatric or renal dialysis; and
• Better Hospital cover for psychiatric.

Emergency admissions

In an emergency, we may not have time to determine if you are affected by the pre-existing condition rule before your admission. Consequently if you have less than 12 months membership on your current hospital cover you might have to pay for some or all of the hospital and medical charges if:

• you are admitted to hospital and you choose to be treated as a private patient; and
• we later determine that your condition was pre-existing.

Pre-existing conditions (PEC)

A pre-existing condition is one where signs or symptoms of your ailment, illness or condition, in the opinion of a medical practitioner appointed by Frank (not your own doctor), existed at any time during the six months preceding the day on which you purchased your hospital insurance or upgraded to a higher level of hospital cover and/or benefit entitlement.

The only person authorised to decide that a condition is pre-existing is the medical practitioner appointed by Frank. However, the medical practitioner appointed by Frank must consider any information regarding signs and symptoms provided by your treating medical practitioner/s.

The pre-existing condition rule still applies even if your ailment, illness or condition was not diagnosed prior to joining the hospital cover. The only test is whether or not, in the 6 months prior to joining your current hospital cover signs and symptoms:

• were evident to you; or
• would have been evident to a reasonable general practitioner if a general practitioner had been consulted.

Waiting periods – PEC

A special waiting period applies to obtain benefits for hospital treatment for new members who have pre-existing conditions. The waiting period also applies to existing members who have recently upgraded their level of hospital cover. If the ailment, illness or condition is considered pre-existing:

• new members must wait 12 months for any hospital benefits (other than psychiatric, rehabilitation and palliative care)
• members transferring/upgrading to a higher hospital cover must wait 12 months to get the higher hospital benefits (other than psychiatric, rehabilitation and palliative care).
• 24 months – Benefit Limitation Periods apply to gastric banding, psychiatric or renal dialysis (where offered in the cover after your other waiting periods have been served).

Existing members with at least 12 months membership in total across their old and new cover are entitled to the lower benefits on their old cover.

Planning a child

If you are preparing to start a family and your hospital cover does not include obstetrics, you will need to ensure you upgrade your hospital cover to include obstetrics at least 12 months before you have a child to ensure all waiting periods have been served.

If all goes well, a new born baby is not admitted as a patient in hospital, but if you have complications and your baby requires any accommodation or medical attention, you will not be covered for accommodation or medical services unless your child has served the waiting period. So, if you are currently on a singles membership, you will need to change to a family membership at least 2 months before your baby is born. Frank recommends that you change to family membership three months before your baby is due, (you can add an unborn child as an additional person) in case your baby arrives prematurely.

Excess - Hospital only

An excess is deducted from the benefit paid by Frank, but not always the entire excess applicable for the policy. For example, if Frank’s full benefit for a hospital stay was $5,000 and the member has a $500 excess on their hospital cover, the benefit would reduce by the amount of the excess and an adjusted benefit of $4,500 would be paid. Where one member on a couples, family or single parent excess cover is admitted to hospital they will only pay a maximum amount per person as opposed to the maximum amount per membership. This is usually half the maximum annual excess per policy.

When Frank says ‘year’ Frank means calendar year (Jan 1 to Dec 31).

Exclusions

You cannot claim for the following:

• Benefits are only payable on itemised and original account/s. Account/s which have been altered in any way will not be accepted. Providers are required to re-issue any account/s or endorse any alterations.
• Natural remedies (includes Modifast & Optifast).
• Food supplements.
• Dental procedures carried out and charged direct to the member/dependant by a dental mechanic, other than an advanced dental technician.
• A range of dental procedures when provided on the same day e.g. a filling on a tooth that has been removed.
• Dental procedures where a limit on the number you can have has been exceeded.
• Dental procedures unless tooth identifications (ID) are supplied by the provider.
• Services/treatment for which the member and/or dependant has a right to claim damages or compensation from any other person or body.
• Treatment where the member and/or dependant is eligible for free treatment under any Commonwealth or State Government Act.
• Services/treatment rendered more than 12 months prior to the date of claiming.
• Where more than one consultation and/or treatment type per day has been claimed regardless of provider within the group of chiropractor (excluding x-ray), naturopath, homeopath and osteopath.
• Where more than one consultation and/or treatment type per day has been claimed regardless of provider within the group of physiotherapy, myotherapy and if eligible, remedial massage.
• Services/treatment which is not covered by your membership and/or is rendered while the membership is in arrears or is suspended.
• Services/treatment rendered by a practitioner not in private practice and/or not recognised by bodies approved by Frank.
• Hiring of equipment (unless otherwise stated).
• Services not rendered face to face (e.g. remotely over the phone).
• Foot orthotics provided by a physiotherapist or chiropractor.
• Additional medical gap benefits where the medical service is rendered by a medical practitioner employed full-time in the public sector.
• Benefits for lifestyle related services that primarily take the form of sport, recreation or entertainment.
• Benefits, payable under a hospital or extras cover shall not exceed the fees and/or charges raised for any treatment and/or services covered for benefits under the relevant cover, after taking into account benefits paid from any other source.
• Benefits for services on treatment received overseas.

Restrictions

Benefits may not be paid or may be paid at a lower level where:

• you have already claimed the maximum allowable benefits during a specified period.
• you have transferred to a Frank extras cover from an extras cover by a different insurer and have previously claimed for the service/ treatment.
• the health care account has been incompletely, incorrectly or inappropriately itemised.
• you have an excess to pay on your chosen level of cover.
• Frank believes that a patient, following a review of the case (on the basis of information provided by the hospital either internally or using an agreed independent source), is not receiving acute care after 35 days continuous hospitalisation. If this is the case, Frank benefits will be reduced to Nursing Home Type Patients benefits and will be paid in accordance with the default benefit determined by the Department of Health & Ageing. All Nursing Home Type Patients are required to pay part of the cost of hospital accommodation.
• the service/s is subject to a waiting period or other limit which has not been served/met.
• surgery is performed in hospital by a registered podiatrist/podiatric surgeon. Contact Frank for details.
• no MBS item number is provided by the GP/specialist e.g. cosmetic surgery.
• professional services are provided to the provider or members of the provider’s family or to a provider’s business partner’s family members or any other people not independent from the practice. Family members include: wife/husband, brother/sister, children, parents, grandparents, grandchildren. If this is the case, only wholesale material costs involved in the provision of the service are subject to benefits.
• the claim is for cosmetic surgery. Limited benefits may apply on hospital covers for cosmetic surgery, depending on the medical justification for the surgery.
• the claim is for additional medical gap benefits, where the medical service is rendered by a medical practitioner employed full-time in the public sector.

Suspensions

You can suspend your Frank cover for periods of overseas travel provided you:

• have at least 12 months continuous unsuspended cover with Frank prior to departure; and
• plan to be overseas for at least 2 months; and
• have paid premiums to the date of departure; and
• apply for suspension of your cover prior to departure.

You’ll be required to resume your suspended cover within 2 months of returning to Australia and premiums must be paid from the date of re-entry. Your passport, boarding pass or a statutory declaration may be required to be presented to Frank as proof of travel.

A 3 year maximum cover suspension period for overseas travel applies. Only the balance of outstanding waiting periods need to be served upon resumption of your membership.

Note also that your Certified Age of Entry (CAE), for the purposes of calculating Lifetime Health Cover (LHC) loading, may be affected by periods of absence of 3 years or longer. See the LHC section for details.

Dependants

1. Child and student dependants are covered up until they turn 21 years of age. They have 2 months to organise health insurance from this date, but their new membership will start from the date they turned 21. They won’t have to serve waiting periods when transferring to an equivalent or lower level of insurance.

2. Previously insured with another insurer
Student dependants whose parents are members of another registered health insurer and were previously insured with their parents may sign up with Frank within 2 months of ceasing to be a dependant, on a level of cover equal to or less than that held by their parents, without serving waiting periods. An acceptable transfer certificate and claims history must be received

3. Previously uninsured
Previously uninsured dependants may sign up with Frank and receive immediate Basic Hospital cover benefits, except for any pre-existing condition/illness (other than for psychiatric, rehabilitation and palliative care) and maternity cases for which a waiting period of 12 months will apply. All waiting periods must be served for extras benefits and hospital benefits which are higher than those available from the Basic Hospital cover.

Participating providers

A participating provider is a health care provider, with whom Frank has entered into an agreement relating to direct billing and/or fees and benefits. These agreements aim to maximise your cover and minimise your out-of-pocket costs. Details of participating private hospitals can be obtained from the website, by clicking this link: http://www.frankhealthinsurance.com.au/documents/list-of-participating-hospitals-may.pdf.

a) Participating private hospitals

1. Best Hospital cover

• Members who have taken out Frank’s Best Hospital cover, who are admitted to a participating private hospital and have served all waiting periods are entitled to cover for accommodation, theatre, delivery suite, intensive and coronary care and other agreed hospital charges - less any excess (if applicable). Best Hospital cover has a 24 month benefit limitation period for the following services: gastric banding, psychiatric and renal dialysis. These services attract public hospital benefits in a shared room. Members should present their Frank membership card when attending a participating private hospital.
• Public hospitals: Frank’s Best Hospital cover provides cover for hospital accommodation costs when you are admitted to a private or shared room (subject to bed availability) as a private patient in a recognised public hospital.

2. Better Hospital cover

• Members who have taken out Frank’s Better Hospital cover, who are admitted to a participating private hospital and have served all waiting periods, will be covered for accommodation intensive and coronary care and other agreed hospital charges - less any excess (if applicable). Better Hospital Cover has benefit exclusions for the following services: obstetrics, IVF and related services, joint replacement, renal dialysis, gastric banding, cosmetic surgery and cataract surgery.

These excluded services do not attract any benefits. Better Hospital cover has a 24 month benefit limitation period for psychiatric services. This attracts a public hospital benefit in a shared room. Members should present their Frank membership card when attending a participating private hospital.

• Public hospitals: Frank’s Better Hospital cover provides cover for hospital accommodation costs when you are admitted to a private or shared room (subject to bed availability) as a private patient in a recognised public hospital. Excluded services do not attract any benefits

Limited benefits may apply to cosmetic surgery and high cost drugs. Drugs purchased outside of the hospital are not included.

b) Non-participating hospitals

Fixed benefits are payable for hospitalisation in non-participating private hospitals. Please contact Frank on 1300 4 FRANK (37265) for further details as treatment in a non-participating private hospital will result in out-of-pocket expenses.

Limited benefits may apply to cosmetic surgery and high cost drugs. Drugs purchased outside of the hospital are not included.

c) Basic hospital

Members with Basic Hospital cover, who are admitted to a public hospital and have served all waiting periods are covered for accommodation costs for a shared room.

Please Note: Benefits for a private room in a public hospital or for treatment in a private hospital when using Basic Hospital cover will result in significant out-of-pocket expenses. For further information on private patient benefits on Basic Hospital cover, please call on 1300 4 FRANK (37265).

Overseas travel

Frank Health Insurance does not provide benefits for services or treatment received overseas.

Frank advises that you take out travel insurance for the set period of your travel and that it’s suitable to the destinations you’re visiting.

Extras services purchased over the internet

Benefits will be paid for optical services purchased over the internet from Australian providers where a script is provided. Benefits for services on treatment received overseas are excluded.

Benefit replacement rule

A benefit replacement rule applies to dentures covered by Frank’s extras covers. The rule requires that after you claim for such an item, you must wait a specified period of time before you can lodge another claim for the same type of item.

Customer Satisfaction and Private Health Information

Code of Conduct

Frank Health Insurance is brought to you by GMHBA Limited, proud to be a compliant member of the Private Health Insurance Code of Conduct.

The Private Health Insurance Code of Conduct is designed to help you by providing clear information and transparency in your relationships with health insurers.

The Code covers four main areas of conduct in private health insurance ensuring:

• You receive the correct information on private health insurance from appropriately trained staff;
• You are aware of the internal and external dispute resolution procedures with Frank Health Insurance;
• Policy documentation contains all the information you require to make a fully informed decision about your purchase and all communications between you and Frank Health Insurance are conducted in a way that ensures appropriate information flows between the parties; and
• All information between you and Frank is protected in accordance with national and state privacy principles.

You can download the Code at www.privatehealth.com.au/codeofconduct/documents.php.

Community Rating

Frank Health Insurance is required to comply with Community Rating.

Community Rating means Frank will not discriminate between members on the basis of their health or any other reason described below - basically equal opportunity for private health insurance.

When making decisions in relation to members, Frank will disregard the following:

1. The suffering by the member of a chronic disease, illness or any other medical condition.
2. The gender, race, sexual orientation or religious belief of a person.
3. The age of a member, except in relation to Lifetime Health Cover loadings.
4. Any other characteristic of a person (including but not just matters such as occupation or leisure pursuits) that are likely to result in an increased need for extras or hospital treatment.
5. The frequency with which a person needs extras or hospital treatment.
6. The amount, or extent, of the benefits to which a member becomes, or has become, entitled during a period.

Privacy

We value the relationship between Frank and our members. An important part of this relationship is our commitment to protecting the personal information entrusted to us by our members. This commitment is documented in our Privacy Statement for Members.

Complaints or concerns

Frank thinks that honesty is the best policy. Frank wants you to share what is on your mind. So Frank can help resolve it.

Just so you know what to expect of Frank this is the process for dealing with complaints:

1. Make a Complaint
You can make a complaint in whichever is your preferred method. Writing an email is Frank’s preferred method to fully understand the complaint before coming up with a resolution, so please email frank@frankhealthinsurance.com.au Or if you prefer, visit frankhealthinsurance.com.au and WebChat about it, or call 1 300 4 FRANK (37265). You will receive an acknowledgement response within 24 hours. If the matter is of a more difficult nature and will take some time to resolve, Frank will keep you informed of the ongoing progress.

2. Unhappy with the resolution of the initial complaint
If after receiving Team Franks response you are still unhappy, you can request that it be brought to the Team Frank Business Manager's attention. They will then again review the complaint, possibly contacting you for further information, if needed, and get back to you with a response within 5 working days.

3. Free independent advice is available from the Private Health Insurance Ombudsman. You can contact the Ombudsman on freecall 1800 640 695 or Level 22, 580 George Street, Sydney NSW 2000.

Insure? Not sure?

If you need more information about private health insurance please refer to the Private Health Insurance Administration Council (PHIAC) guide “Insure? Not sure?” which can be downloaded from http://www.phiac.gov.au/for-consumers/insure-not-sure/

State of the health funds report

The Private Health Insurance Ombudsman publishes an annual State of the Health Funds Report. This independent report compares service and productivity of private health insurers.

Download the report from www.phio.org.au

Standard Information Statements

A Standard Information Statement (SIS) is available for every product of Frank.

Upon joining, the SIS/s for the Frank products which you have purchased will be sent to your Frank Webmail, and you will receive a notification stating that the SISs are available in your Webmail.

An up to date SIS will be forwarded to your Webmail at least once per year from where it can be read or printed.

Recommendation or endorsement

Frank does not offer health or medical services or advice. Frank does not recommend or endorse any medical practitioner, dentist, therapist, hospital, health or medical service provider, treatment, therapy or the use of any appliance or prosthetic. Frank does not endorse or make any representation whatsoever as to the appropriateness or effectiveness of any service or goods for which a benefit is paid. Members should make and rely on their own enquiries and seek any assurance or warranties directly from the provider of the service or product.

Medicare Levy Surcharge

The Medicare Levy Surcharge (MLS) is a surcharge on individuals and families on higher incomes who don’t have eligible private patient hospital cover (eligible cover). The surcharge is 1% of taxable income in addition to the normal 1.5% Medicare Levy. People may have to pay the Medicare levy surcharge if they or any of their dependants do not have eligible cover and they are:

• A single person - without dependent children - with a taxable income (including any reportable fringe benefits of $1,000 or more) greater than $80,000.
• A family - including a couple and single parent - with a combined taxable income (including any reportable fringe benefits of $1,000 or more) greater than $160,000 (increasing by $1,500 per dependent child, after the first child).

Contact your tax adviser for further details about the Medicare levy surcharge.

Federal Government Rebate

If you have health insurance and all people covered by the membership have full Medicare eligibility, you are eligible for the Federal Government 30% rebate on private health insurance. The rebate is 30% for people aged up to 64 years, 35% if one or more people covered on the membership are aged 65 to 69 and 40% if one or more people covered are aged 70 or more.

You can claim the rebate as a reduction to your premiums, as a tax rebate when you lodge your annual tax return or as a direct payment from the Government through any Medicare office.

The easiest way for you to claim the rebate is to complete the application form for the Federal Government Rebate during the application process with Frank. Frank will then deduct the rebate from your premiums.

Lifetime Health Cover Loading

The Federal Government introduced the Lifetime Health Cover (LHC) initiative on the 1st of July 2000. From this date, anyone who joins a hospital cover of a registered health fund will be given a Certified Age at Entry (CAE ) status - which represents their age when they first joined a hospital cover after the 1st of July 2000.

If you joined a hospital cover before this date you are assigned a CAE of 30 and you’ll pay the base rate (the lowest premium) for your hospital cover. The premiums returned on the Quick Quote are quoted at base rates. If you joined after this date and are aged 31 or over, and therefore have a CAE of over 30, you’ll pay a 2% loading for each year your CAE is above 30 to a maximum loading of 70%. Where you have had to pay a LHC loading, and have done so for a continuous period of 10 years, the loading will no longer apply on the day after the last day of the 10 year period. If you’re over the age of 30, the sooner you take out hospital cover, the less you’ll pay later.

In summary, the Federal Government’s LHC loading applies if you were aged 31 or over on the 1st of July just passed and are taking out hospital cover for the first time. Under LHC, in addition to the rates on the Quick Quote, a 2% loading is applied for each year you are aged over 30 when you join. The Federal Government rebates apply to your total premiums, including any LHC loading.

Lifetime health cover applies to hospital cover and does not apply to extras.

Periods of absence

As members may need to discontinue their hospital cover membership for brief periods, lifetime health cover allows a period or periods of absence through a member’s lifetime without affecting their CAE. However, after a total of two years absence, their CAE will increase by one year for each additional full year of absence. Members will need to re-serve waiting periods when they return to Frank.

Membership suspension

Approved periods of suspension, which will not affect a member’s CAE are explained under ‘Suspensions’ in the Product Information section.

All about Claiming

Damages or compensation

Where you or your dependants have a right to claim damages or compensation from any other person or body, you are required to pursue that entitlement prior to lodging a claim for benefits with Frank. A claim should only be lodged with Frank if action at law is unsuccessful. A letter of denial is required. This includes WorkCare, TAC, public liability and third party claims.

Claiming procedure

How to claim with Frank:

1. Hospital claims - are paid from Frank direct to the hospital. You will need to present your membership card upon admission, and you will not need to contact Frank in most cases. For claims paid direct to the hospital on your behalf, you will receive a statement of benefit for your records.

2. Extras Claims - When you have Frank extras cover you can use your Frank membership card to claim electronically on the spot when this facility is available at your health care provider. After the service has been provided, your membership card will be swiped through the terminal, your claim details entered and your claim will usually be processed electronically within seconds. Once your claim is authorised by Frank, you simply pay any difference between the full fee for the treatment and the amount paid by Frank. If there is an unexpected rejection of your claim at the point of service, your provider should contact Frank on 1300 4 FRANK (37265) to clarify the issue at the time of the service taking place.

3. If your service provider does not have an electronic terminal, you will need to pay your account with your service provider in full. Once the services have been paid for, you can claim your benefit from Frank on-line through the Member Services area on the website. To support your claim, you will need to submit a scanned copy of your original receipt by email to frank@frankhealthinsurance.com.au. Alternatively, after you have submitted your claim on-line, you can send Frank the original receipt by snail mail to: Frank Health Insurance Claims PO Box 69. Geelong, VIC, 3220.

4. In some situations you may not be able to claim on-line, and you will need to submit your claim via snail mail. You will need to submit your claim via snail mail if the service occurred more than 6 months before the date of claiming, or the service was for orthodontic treatment.

To submit a claim by snail mail, Frank needs the following information:

• A completed claim form; and
• The fully itemised health care account/s, and the original receipt/s. Photocopies/facsimiles of accounts and/or receipts cannot be accepted.

An orthodontic treatment plan certificate, completed by the treating orthodontist/dentist, is also required before orthodontic benefits will be paid. You can obtain an orthodontic treatment plan certificate by calling our customer service centre on 1300 4 FRANK (37265). For the purpose of benefit payments, orthodontic treatment is regarded as commencing on the date the appliance is originally fitted. Limits apply every calendar year.

This paperwork should be sent to: Frank Health Insurance Claims PO Box 69. Geelong, VIC, 3220.

Frank reserves the right to take the following actions against any member or persons where improper, fraudulent or indiscretion occurs whilst making claims from Frank.

Actions that may be taken are:

• Suspension of electronic claiming for the period of time determined by Frank depending on the severity of the incident
• Restitution (voluntary or negotiated)
• Prosecution

Paid accounts/ bills

Benefits for paid accounts will be deposited directly into the members’ previously nominated bank account.

Unpaid accounts (other than hospital accounts)

Claims for unpaid accounts will not be paid.

Medical benefits

Medical benefits cover your fees payable to surgeons, anaesthetists and other professionals who may bill you separately from your hospital bills.

Claims for medical benefits can only be paid after your claim for medical services has been assessed by Medicare (except in the case of claims made through our medical gap cover) and your claim for hospital benefits has been assessed and paid. Our benefits are not payable for services rendered when the patient is not a hospital inpatient.

Important Information prior to signing up

Transferring from another health insurer

You can transfer your health insurance from another health insurer to Frank without serving any new waiting periods provided that you:

• have served all waiting periods with your previous health insurer; and
• transfer to any equivalent or lower level of cover within 30 days of your membership ceasing with your previous health insurer.

Frank recommends that your cover starts immediately after your previous cover ends. If your new cover with Frank provides higher benefits or benefits for services not covered by your previous health insurer, you’ll be regarded as a new member for those higher benefits, and/or additional services, and will be required to serve the waiting periods - but only for the higher benefits/additional services.

If you transfer to Frank from another health insurer before completing the waiting periods with your previous health insurer, you’ll need to serve the balance of the waiting periods with Frank (see below under the heading ‘waiting periods’).

When you transfer to Frank your benefit entitlements may be adjusted by benefits already paid by your previous health insurer. Under lifetime health cover, continuity of a member’s/partner’s certified age at entry (CAE) is possible when transferring from another Australian registered private health insurer.

Membership for non-residents of Australia

Frank hospital covers are designed for people who have full Medicare eligibility. These covers will not meet the cost of public or private hospital treatment, medical treatment or diagnostic services for people who do not have full Medicare eligibility. People who do not have full Medicare eligibility should contact Frank on 1300 4 FRANK(37265) to discuss appropriate health insurance arrangements.

Migrants

Frank congratulates you on migrating to Australia and hopes that it all works out for you. Again, you will want to be eligible for Medicare before you sign up to any of Frank’s products.

Migrants who sign up with Frank within 2 months of arriving in Australia shall receive the following concessions:

• No 2 month waiting period for any level of hospital cover.
• No 12 month waiting period for pre-existing conditions/illnesses will apply to Basic Hospital cover.

All other waiting periods for hospital and extras will apply. Proof of residency may be required by Frank. Lifetime health cover regulations also apply to migrants. Contact Frank for details.

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