안녕하세요
항상 '멜번의 하늘'에서 거주지를 정하는 것부터 렌트를 하는 방법에 이르기까지 많은 정보를 배우고 있습니다.
저희가 예상하는 거주지 인근에 "로얄 칠드런스 병원(멜번)" 이 있어서 여러분들의 평도 좋고 병원도 8개월된 아이에게 적합할 것 같아서 딸아이가 아플시 병원을 이용할 예정입니다.
저는 현재 비자를 발급받았고 비자 신청시 IMAN 보험사에 동반 3인가족 기준으로 6개월에 120여만원가량의 보험에 가입해두었습니다. 물론 국내 보험사에 여행자 보험으로 가족 3인 모두 각각 3000만원한도로 보장되는 해외방문자보험에도 가입해두고 갈 생각입니다. 보험발효시점은 2014.9월 경이고 해당보험사에 응급상황이나 일반적인 경우 병원 진료에 대해문의를 해본결과
1. 아이가 고열이나 응급으로 아플시에 혜택을 받을 수 있을지 문의를 하니
답변: 아주 응급의 경우에 한해 보장을 받을 수 있다
라는 답변을 해왔습니다.
보험사가 말하는 아주 응급의 경우가 일반적으로 아이들이 한밤에 고열이거나 힘들어하는 경우에도 해당하는지 궁금하고
만일, 평소에 아이가 아플때 "로얄칠드런스 병원"에서 진료를 받기위해서는 미리 예약을하고 몇일을 기다린 후에 진료를 받아야 하는지 문의드려 봅니다. 아니면 평상시 낮에도 아이가 아프면 한국처럼 병원에 찾아가도 되는지? 아님 예약을 하고 당일 진료가 불가능한지 궁금합니다.
혹시 로얄 칠드런스 병원에 다니시는 분들이 있으시다면 여쭤봅니다.
보험상품은 Value Plus Visitors Cover 입니다.
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Insurance benefits at least equivalent to:
a) Public hospital - admitted patient treatment, a benefit equal to the State and Territory health authority
gazetted rates for ineligible patients for:
1. overnight and day only hospital accommodation (all costs including: all theatre, intensive care, labour
wards, ward drugs);
2. emergency department fees that lead to an admission;
3. admitted patient care and post-operative services that are a continuation of care associated with an
early discharge from hospital.
Note: For the purpose of clarity this includes all admitted treatments covered by the Medicare Benefit Schedule.
b) Surgically implanted prostheses - no gap prostheses and gap permitted prostheses as listed in the Private
Health Insurance (Prostheses) Rules 2007: Benefit at least equal to 100% of the minimum benefit amount listed.
c) Pharmacy - all PBS listed drugs that are prescribed according to the PBS approved indications, that are
administered during and form part of an admitted episode of care - a benefit equal to the PBS listed price in
excess of the patient contribution.
Note: For the purpose of clarity, this definition is intended to include the cost of PBS listed drugs administered
post discharge - if they form part of the admitted episode of care.
d) Medical services - admitted medical services with an MBS item number- 100% of the Medicare Benefits
Schedule fee, or less if the patient is charged less.
e) Ambulance services - 100% of the charge, which is not otherwise covered by third party arrangements, for
transport by ambulance provided by, or under an arrangement with, a government approved ambulance service
when medically necessary for admission to hospital, emergency treatment on-site, or inter-hospital transfer for
emergency treatment.
Note: For the purpose of clarity, this definition is intended to include inter-hospital transfers that are necessary
because the original admitting hospital does not have the required clinical facilities. It does not extend to
transfers due to patient preferences.
Other minimum health insurance policy features
f) Informed Financial Consent - Insurers will make available membership eligibility checking to hospitals to
enable the provision of informed financial consent to members on admission.
g) Waiting periods - To comply with the minimum level of health insurance, the only waiting periods that maybe
imposed are:
1. 12 months for pregnancy related conditions;
2. 12 months for pre-existing conditions applied in a way that is consistent with Section 75-15 of the
Private Health Insurance Act 2007;
3. 2 months for psychiatric, rehabilitation and palliative care regardless of whether or not the condition
is pre-existing.
CertV_0114
h) Excluded treatments - To comply with the minimum level of health insurance, the only admitted patient
treatments that may be excluded are:
1. assisted reproductive treatments;
2. elective cosmetic treatments; and
3. bone marrow and organ transplants.
Insurance policies may also exclude the following:
1. Treatment rendered outside of Australia including treatment necessary en route to or from Australia;
2. Treatment arranged in advance of the insured's arrival in Australia;
3. Services and treatment which are covered by compensation and damages provisions of any kind.
Note: Insurers are not required to exclude these treatments. A decision to cover them is at the discretion of
the insurer.
i) Global annual benefit limits - To comply with the minimum level of health insurance per person, per annum,
the benefit must not be less than $1 million dollars.
j) Portability - To comply with the minimum level of health insurance, when determining waiting periods,
insurers must recognise previous length of membership on a policy held with another Australian insurer that
meets the minimum standards. That is:
1. When transferring between Australian based insurers where the customer has been a member of the
previous fund for greater than 12 months, waiting periods of no greater than 12 months will apply to the
higher level of benefits.
2. When transferring between Australian based insurers where the customer has been a member of the
previous fund for less than 12 months, any unserved waiting periods will need to be completed
with the new fund and if increasing the level of cover or benefits, additional waiting periods of no greater
than 12 months will apply to the higher level of benefits. These waiting periods are served concurrently.
To comply with the minimum level of health insurance an insurer must agree to:
1. Grant a member who seeks to transfer between Australian based insurers, continuity of cover for up to 30
days from the date they leave the previous insurer; and
2. provide members, who terminate their policy, with a clearance certificate, approved by the Department of
Immigration and Citizenship, within 14 days of the date of termination or the date of notification of the
termination, whichever is the later.
k) Buy out clauses - To comply with the minimum level of health insurance, a policy must not contain a buy
out clause that has the effect of terminating the insurer's liabilities in exchange for a pre-determined lump
sum payment.
I) Arrears - To comply with the minimum level of health insurance an insurer will allow for acceptance of
premiums for 60 days from the last financial date of membership without terminating the membership. Insurers
are not obligated to pay for treatments received during any arrears period until and unless the arrears are paid
for the relevant period.
Benefits
Benefits are payable for in-hospital medical, ambulance, repatriation and funeral expenses. For more
information please refer to your IMAN Working Visitor Health Cover. All covers comply with the Department of
Immigration and Border Protection (DIBP) health benefit requirements (visa condition 8501) for 457 and other
400 series visas.
Waiting Periods
Sometimes you have to wait before you can claim money for services covered under your IMAN policy, this is
called a waiting period. Waiting periods apply from the date your policy commences. For a list of waiting periods
please refer to your Working Visitor Health Cover brochure.
Term of IMAN Policy
The term of your IMAN policy is the period which the IMAN health cover is in effect and continues until the health
cover is cancelled. The term commences on the day shown on this Confirmation of Health Cover certificate.
The commencement date cannot be prior to your arrival in Australia.