Your A to Z membership guide

At RT Health, we’re all about making things simple for our members. That’s why we’ve put together this simple, easy to understand membership guide.

Our A to Z guide provides detailed info on your membership, types of membership, how to make a claim, making payments … and a lot more! It’s worth taking a look through this information as part of your intro to RT Health.

It’s in an easy-to-read format. Just pick the topic you’d like to know more about from the list to the left and you’ll be directed to the information you need. Simple!

And, it will always be here if you need to come back to it.

If you’ve just joined us, it’s good to read your Cover Guide for the cover(s) you’ve selected in conjunction with the A to Z guide. The you’ll have the full picture on what’s available from your membership and from RT Health.

We know sometimes private health insurance can get complicated.

That’s why we’ve also compiled Private Health Insurance Explained – a handy information hub for RT Health members.

It’s a convenient and easy way to get information about private health insurance (and how you can use your RT Health membership). All at your fingertips, any time you need it.

There’s some straightforward explanations about private health insurance topics you’ll need to know about when you have private cover. It’s all about making it clearer and easier for you.

Whether you need to know more about waiting periods, informed financial consent … or what to do when you’re going to hospital or having a baby. There’s loads of info here for you to read, search or bookmark. 

And, it’s all available 24/7. Whenever you need it.

Happy reading!

Remember, we’re always here if you need us. Just give our friendly Member Care team a call (or send them an email). They’re available every Monday to Friday from 8.30am to 5 pm (AEDT/AEST) to take your call on 1300 886 123.

Or, you can get in touch via email if you’d prefer. Just drop them a line to help@rthealthfund.com.au

They’ll be happy to help.

Joining the RT Health family

Here’s what you need to know about joining and transferring to RT Health, including our 30-day cooling off period.

Who can join?

If you’re an Australian resident (and you have full access to Medicare), we can welcome you into the RT Health family. If you aren’t eligible, or partly eligible, for Medicare you aren’t able to take up private health insurance in Australia. You’ll need to take out Overseas Visitor cover.

Since we merged with HCF in 2021, we’re an open fund. This means we’re not restricted by your employment or other interest groups.

While we’re committed to the rail, transport and energy industries, we’re open to all Aussie residents from all walks of life.

Switching from another fund?

We’d be pleased to welcome you!

It’s an important part of our private health cover system that you’re able to switch insurers as you like without re-serving waiting periods. We’ve make it easy for you by outlining these below.

There are a few things that are important to know when you’re switching private health insurers and we’ve outlined them below.

- Continuity of cover. It’s part of the legislation of private health insurance that you can transfer between Australian health funds with ‘portability’ or ‘continuity of cover’. This means you won’t have to re-serve any waiting periods already served with a previous fund. That means when you join RT Health, we’ll recognise any waiting periods (or part of a waiting period) if you join us within two months of leaving another fund.

- Levels of cover and your waiting periods. The level of cover you’ve selected is important when it comes to knowing if you’ll need to serve a waiting period once you join RT Health. If you’ve joined us on a higher level of cover than you were on with your previous fund, you’ll still need to serve the waiting period for the higher cover with us.

- Your excess. Transferring from a cover with a higher excess to one with a lower excess (for example, from a $700 excess to a $350 excess) works the same as an upgrade to your cover. You may have to pay your previous higher excess until you’ve served the waiting period for the new, lower excess.

- Your Extras. We’ll also look at some of the Extras claims you’ve made with your previous fund when working out your annual limits and entitlements. Sometimes, within your first 12 months of membership with us, the amounts you’ve already claimed with your previous fund may be deducted from your annual limits. But don’t worry, our annual limits refresh on 1 January each year. It’s important you know that if you’ve already claimed on ‘lifetime limit’ with your previous fund, this amount will be permanently deducted from any lifetime limit available under your new RT Health cover.

- Private health cover overseas. We’re not able to recognize any health cover held overseas, or any ‘overseas visitor’ or ‘overseas visitor’ cover provided by another Australian fund when providing continuity of your cover. If you’re just starting out with health cover in Australia for the first time, or after a period of being overseas without having an Australian health cover, all waiting periods will apply.

We make switching easy - transfer certificates

A transfer certificate (also known as a clearance certificate) is a document provided when you move from one Australian health fund to another. It contains all the information we need about your previous membership, including the length of your membership, your level of cover, any Lifetime Health Cover loading as well as claims information.

When you join RT Health, you’ll authorise for us to contact your previous fund to cancel your cover with them.

While transfer certificates should be provided within 14 days, there are sometimes administrative delays. This can mean we’re not able to recognise waiting periods already served, and that we are unable to establish whether a Lifetime Health Cover (LHC) loading applies to your membership.

Sometimes it can be quicker and easier for you to contact your previous fund to ask for a transfer certificate. This will also help make sure that your previous fund doesn’t take any further payments on your membership.

Until we receive a transfer certificate, we can’t process any claims on your new RT Health membership.

We’ll use the information provided in your transfer certificate to confirm your membership details – including advice on the Lifetime Health Cover loading and anything that may not have been mentioned in your application to join.

Do you have an excess? What you need to know

An excess is the pre-set amount you pay if you're admitted to hospital for planned treatment. Generally, the higher your excess, the lower your premiums will be, and vice versa.

All RT Health Hospital covers include an excess.

If you’re admitted to hospital, you’ll be asked by the hospital before or at the time you go in to be treated and you’ll make the payment directly to the hospital.

About your excess:

- You’ll only need to pay only one hospital excess amount per person per calendar year. 

- You won’t pay hospital excess for dependent children (under the age of 22).

- Depending on your level of cover, you won’t pay an excess, or you’ll only pay a reduced excess, on same-day hospital admission (when you don’t stay overnight at hospital).

- If your Hospital cover does have day admission excess, and you have multiple day admissions in a calendar year, you’ll only pay up to the maximum of the full hospital excess amount, no matter how many admissions you have.

Changed your mind? Our 30-day cooling off period

We want you to be happy at RT Health. That’s why we offer a risk-free 30-day cooling off period. If we’re not the fund for you, and as long as you haven’t made a claim, we’ll refund your premiums.

All of the usual waiting periods (outlined above) apply during your cooling off period.

Your new RT Health membership

There are a few things it’s good to know about when you become part of the RT Health family – from your new membership card(s) and keeping your details up to date through to authority on your membership . 

We’ve outlined them here for you.

Your membership card

When you join RT Health, we’ll send you your membership card (and one for every adult on the membership).

Your membership card displays your RT Health membership number and will list the people covered. You should check this when you first receive it (and whenever you receive a replacement card), to ensure your details are correct and that everyone you want covered is listed.

Your RT Health card lets you to make on-the-spot claims through HICAPS and iSOFT, and you’ll be asked to show it if you’re admitted to hospital.

Keep your card safe! You don’t want anyone else making claims. If your card is lost or stolen, let us know as soon as you can so we can cancel it and issue a new one for you.

Principal member

When you complete your application, we’ll ask you to nominate one person and the ‘principal member.’ They will be the person responsible for the membership and who we will communicate with about all membership information.

If you’re the principal member, you’re responsible for:

- ensuring that all information included on your application is true and correct           

- ensuring your membership payments are made and up to date

- abiding by all fund rules

- letting us know about any change of contact details or circumstances that affect any of the people covered by your membership.

Authorities

You’re able to organise for other people to have authority on your membership.

Partner authority: Initially, the principal member is the only person who can change your membership, submit claims and receive benefit payments. We make it easy for you to extend this authority to your partner. By completing a simple ‘partner authority, you’re can make sure your partner or spouse (as long as they’re listed on your membership) ifs able to access and administer our membership.

You can organise your ‘partner authority’ when you or at any time contacting our member services team, or by simply ticking the ‘partner authority’ box on the membership in your online Member Services portal.

To set up your partner authority online, or check if you already have one in place, visit our online Member Services portal.

Legal authority: We recognise the authority of a third party to make claims and changes to a membership where a general or enduring power of attorney is in place.

However, we don’t recognise a ‘guardianship’ as authority to deal with someone else’s membership. (While guardianship allows the guardian to make many decisions about someone’s living arrangements and medical treatment, it does not usually extend to making financial decisions).

Third party authority: The principal member can nominate someone who is not covered by the membership to make changes, ask about claims and generally manage the membership on his or her behalf by completing a ‘third party authority’ form.

Making changes to your membership 

Changes in life happen all the time. We get it. But, it’s important that you keep us in the loop when it comes to some of life’s bigger moments. That way we can make sure we’re doing everything we can to help you make the most out of your RT Health cover..

We’ve outlined a few for you here.

Changes in membership: If there’s a change to the people covered by your membership, please just let us know. That way, we can make sure your cover remains valid for everyone on your membership.

Changing your contact details: Keeping you informed about your cover and other great things across the RT Heath community is important to us. Just let us know if you’ve changed your address, phone number or email address. That way, we’ll be able to get important information to you when you need it. And, we’ll be able to make sure your claim payments find their way to you quickly and easily.

Moving interstate?: The price of your cover varies between states, so an interstate move can either increase or decrease the cost of your health cover.

Ambulance cover arrangements also differ significantly between states, so it’s important you give us a heads up if you’re on the move.

When we make a change: From time to time, we make changes to our covers. We do this to ensure all members are getting great value from their cover with RT Health. If there’s a change to legislation, or a change to our Fund Rules or to your cover we’ll let you know in writing (you’ll get an email or letter from us).

Saying goodbye to RT Health?: If you’re looking to cancel your membership, we’d be sad to see you go. Membership cancellations must be requested by the principal member, and specify the date of cancellation. We can’t backdate a cancellation, so we’ll make them from the date we receive them. (This doesn’t apply during your cooling off period).

Because membership contributions are paid in advance, we’ll refund you any amount you’ve paid ahead of the date you cancel your cover.

Any adult or dependent child who is 18 or older can remove themselves from the membership without approval from the principal member. They can’t suspend themselves from the membership.

Can we cancel your membership?: There are some situations when we’ll need to cancel your membership. These include:

- when your payments are 90 days behind

- If you provide false or misleading information in any correspondence or claims (you’ve engaged in fraudulent activity)

- if you’ve acted in a manner detrimental to the fund

- if you’ve received, obtained, or attempted to receive or obtain, any advantage you’re not entitled to under our Fund Rules, or

- if you’ve obtained your membership by misrepresentation or mistake

Claiming on your membership

 We’ve put together this short guide with some things you need to know about claiming benefits on your RT Health membership.

There’s also some great info about ways to submit your claim here: rt health | Managing Your Cover | Make a Claim (rthealthfund.com.au)

There are a few rules around what we’ll pay benefits for, how long you have to submit your claims and when we’re not able to pay your claims.

We’ve outlined them for you here.

Overseas products and services: Your RT Health cover doesn’t include benefits for products, services or treatments purchased from or provided outside of Australia (this applies whether you buy them in person, by mail or online).

There’s a time limit for submitting claims: You have up to two years from the date of purchase, service or treatment to submit your claim. We’re not able to pay benefits if you submit your claim after two years.

Waiting periods: We’re not able to pay benefits on products, services or treatments you receive or purchase during any waiting periods.

Compensation claims: We can’t pay benefits for products, services or treatments you need as a result of an incident for which you are entitled to claim compensation or damages from a third party.

Sometimes, you’re able to submit an ex-gratia payment, which may help you to cover the upfront costs. If granted, we pay the initial costs and you agree to repay the sum once the third party claim is resolved.

In this situation, it is possible to ask us to pay the claims to cover the upfront costs provided you provide us with all information to enable us to recover these costs from the third party. If we’re not able to recover these costs from the third party, we’ll look to recover them directly from you.

Incorrect payments: If we pay a benefit by mistake, we’ll work with you to recover any amount mistakenly paid.

Fraudulent claims: It’s important to us that our approach to member benefits is fair – for everyone. That’s why we’re serious about our approach to fraudulent claims. When we evaluate our products and pricing each year, we take many things into account, but the volume and cost of claims are among the key drivers of how much your health cover costs. Fraudulent claiming drives the cost of health cover up for all members.

Fraudulent claims can come from many different sources, including health service providers and members. If you become aware of (or suspect that you may have been exposed to) fraudulent claiming, please let us know.

Paying your membership 

Keeping your payments up to date

When we welcomed you into the RT Health family, we let you know that your membership payments should always be paid in advance. This helps us ensure that you’re covered, not atter what happens (especially when you’re admitted to hospital).

It also helps you be sure that you’re able to claim on the spot at providers at offer HICAPS and iSOFT payments.

For example, if you pay monthly you’ll pay a month’s premium ahead on each payment date. The same with weekly and fortnightly payments.

The only exception is members who pay via salary deduction.

If your payments fall behind, we’re not able to pay benefits for any product, service or treatment received until you’re back up to date again.

If your membership remains unpaid after 90 days, we’ll end your membership with us and you won’t be covered any longer.

Ways of paying your membership

There are plenty of options available when it comes to making your membership payments.

Direct debit: Direct debit is the simple and easy way to make sure you make your payments to us. You can pay your membership via direct debit from a bank, building society or credit union account, or with your MasterCard or Visa. If you choose to pay by direct debit, there are a few things to remember:

- You can choose to pay weekly, fortnightly, monthly, quarterly, half-yearly or yearly payment frequencies.

- Weekly payments are deducted each Friday.

- Fortnightly payments are deducted on alternate Fridays (depending on which fortnight you choose).

- Monthly payments are deducted on the 6th of each month (or the next working day, if the 6th falls on a weekend or public holiday).

- We offer Direct Debit Any Day for monthly direct debit payments. You can choose which day you’d like your payment to be taken. You can read  more about it here: rt health | Direct Debit Any Day (rthealthfund.com.au)

- If you’re paying by credit card and your card is lost or stolen, please let us know immediately, so we can stop payments and set up a new debit with your replacement card for you.

- If the credit card you’re paying with expires, payments will fail and you’ll generally get a dishonour fee from your bank.

- If you’d like to change or cancel a direct debit, we’ll need to know at least 7 business days before your next debit is due to occur. This gives us time to process your request.

- If your direct debit payment is unsuccessful for two consecutive times, we’ll remove you from the direct debit process. You’ll need to complete a new direct debit authority so we can process future direct debit payments.

Paying online: 

We make it easy for you to pay online- 24/7 when it suits you. You can make your payments via your online Member Services portal. It’s quick and easy.

For more info on making your payments, visit our handy Private Health Insurance Explained information hub.

Suspending your membership 

No one wants to be paying for something they’re not able to use. Likewise, we know that when things get tough, you need some time to get back on your feet.

That’s why we offer our members two opportunities to suspend their RT Health membership.

Your memberships can be suspended for two reasons:

1. If you’re travelling overseas (for work or a holiday)
2. If you’re experiencing financial hardship.

You can suspend your RT Health cover for up to two years (maximum) when travelling overseas. The minimum period of suspension is 28 days.

Suspended Hospital cover does not count toward your number of ‘absent days’ for Lifetime Health Cover (LHC) purposes, but it may result in you being liable to pay the Medicare Levy Surcharge (MLS).

We recommend that you speak to your accountant, tax agent or the Australian Taxation Office if you need further advice about how suspending your membership may impact you.

The following apply all membership suspensions:

- The principal member is the only person with authority to request a membership suspension.

- If you’re travelling overseas on holidays, your health cover can be suspended for any period from a minimum of 28 days to a maximum of two years.

- You must be overseas for the entire duration of your membership suspension. (For example, it is not possible to suspend your membership for 28 days if you are going to be overseas for any period less than 28 days).

- A membership suspension applies to the entire membership and each person covered. This means you aren’t able to suspend one person’s cover while continuing cover for other people named on the membership and you’re not able to suspend your membership if all people covered by it are not travelling overseas.

- You aren’t able to suspend just the Hospital or just the Extras part of your membership;

- You must have held your RT Health membership at least 12 months before requesting a suspension.

- Your membership must be paid up to the date of your departure before we’re able to suspend it.

- Any contributions you’ve paid in advance of the date of your departure will be credited to your membership once it’s reactivated.

- Suspension requests should be submitted at least two weeks before you leave Australia (we’re not able to backdate a membership suspension).

- There must be a minimum of six months between the end of one period of suspension and the beginning of another. The ‘beginning’ of any period of suspension is the first full day you are out of the country.

Reactivating your membership:

So we can reactivate your membership and get you back on track, we ask you provide proof of travel for each person covered by the membership (within 30 days of returning to Australia):

- If you travelled for less than three months, you can provide boarding passes for flights out of and into Australia, or a stamped passport showing dates of departure and return. We’ll reinstate your cover from the date of your return to Australia.

- If you travelled for three months or more, we ask you provide us with a Certificate of Movement from the Department of Immigration and Citizenship.

- Members travelling by sea for any length of time can provide copies of cruise boarding cards and cruise itinerary.

We’re not able to accept travel itineraries or e-tickets as proof of travel.

If you can’t provide proof of travel for each person covered, we’ll need to reassess your suspension and you may need to pay any outstanding contributions for the period of suspension.

- Following a period of suspension, your membership will become active again when the membership has been reactivated and contribution payments have recommenced. Where contributions have been made in advance, your membership must still be reactivated before claims can be made. Your cover will be reinstated from the date of your return to Australia.

- You may need to pay the Medicare Levy Surcharge (MLS) while your membership is suspended if your income exceeds the Medicare Levy Surcharge thresholds. You should discuss this with your accountant or tax advisor.