If you're sick or injured

For information relating to policies purchased prior to 7 December 2017, please check the PDS provided with your purchase. You can contact us if you need this sent to you again.
For policies purchased from 7 December 2017:
If you're sick or injured overseas
With a TID policy, The Works and the Annual Multi Trip plans offer up to an unlimited dollar amount of cover for up to 12 months for emergency medical expenses incurred overseas (Section 1) due to a unforeseen sudden illness or serious injury you experience. Of course, medical cover is subject to all policy terms, conditions and exclusions.
 
Under The Basics plan, the single limit is up to $5,000,000 and $10,000,000 for a family. There is limited cover for claims relating to existing medical conditions experienced by you, anyone on your policy and close relatives at home in Australia or New Zealand who are not travelling with you. So, please refer to the Existing Medical Conditions section in the PDS for more information.
 
Before you go, check with your GP and smartraveller.gov.au to find out if there are any vaccinations required for your destination, and if your destination country requires proof of vaccination against specific disease as a condition of entry. Many vaccinations need to be administered well in advance of your departure.
 
The following is a summary of cover under Sections 1, 2, 3, 5 and 7 in the PDS and should be used as a guide only, as every claim is assessed on its individual circumstances. Full terms, conditions, limitations and exclusions are available in the PDS.
 

What’s covered?

  • Visits to a GP or other registered medical practitioner
  • Ambulance by road or air and treatment by paramedics
  • Any prescribed medication while on your trip
  • Hospital or outpatient fees
  • Any prescribed treatment in hospital such as physiotherapy, anaesthetics and medication
  • Out of pocket costs, where you are hospitalised for more than 48 hours you are entitled to $50/day, up to the applicable benefit limit, for any out of pocket costs.
  • Where medically necessary and approved by our emergency assistance team, we’ll arrange for a close relative or friend to be with you while you are hospitalised and to escort you home in the place of a medical escort. This includes the costs of flying someone from Australia to be with you.
  • Repatriation to Australia, including a medical escort and air ambulance if medically necessary and pre-approved by us.
  • Reimbursement of your original airline ticket home (less any refunds due to you) when you need to be repatriated to Australia with a medical escort. To qualify for this benefit (Section 7, Return Airfare) you will need to have been hospitalised for more than 25% of your trip or, at the time we brought you back, you had more than 5 days or 25% of the length of your trip to go (whichever is greater).
  • Where you can no longer continue on your trip, the policy will cover you for reimbursement of non-refundable, pre-paid transport or accommodation arrangements (Section 2, Cancellation costs).
  • Once you’re fit to travel, we will cover the costs of additional travel and accommodation expenses to get you on the road again (Section 3, Additional Expenses).
 

What you will need to do:

  • Where you have been hospitalised or expect your medical expenses to be more than $2,000, please contact our emergency assistance team to arrange for a guarantee of payment to the hospital or medical facility, where possible;
  • Obtain copies of your medical reports and clinical notes from your treating doctor detailing the diagnosis and treatment; copies of hospital admission and discharge papers; copies of all tests and results;
  • Keep receipts for medication, doctors’ fees, hospital services;
  • Keep any costs to a minimum.
 

About Reciprocal Health Care Agreements

The Australian government has Reciprocal Health Care Agreements with New Zealand, the United Kingdom; the Republic of Ireland, Sweden, the Netherlands, Finland, Italy, Belgium, Malta, Slovenia and Norway. These agreements mean: Australian residents can get help with the cost of essential medical treatment when visiting these countries. More information is available from the Department of Human Services website.
 

What's not covered?

  • Medical expenses in Australia even if the illness or injury was sustained overseas and we paid for the overseas medical expenses. Under the Private Health Insurance Act 2007 we are prevented from covering medical expenses in Australia.
  • Private hospital treatment when public-funded treatment was available.
  • You travel even though you know you are unfit to travel or have been advised against travel by a medical professional.
  • Travelling to obtain medical or dental treatment.
  • A claim related to a metastatic or terminal prognosis made prior to the issue of the Certificate of Insurance.
  • Pregnancy after 26 weeks gestation for single pregnancies and 19 weeks gestation for a multiple pregnancy.
  • Any claims where you have not taken the appropriate vaccinations, malaria prophylaxis and hygiene measures according to the World Health Organisation (who.int).
  • Any claim which is recoverable through workers compensation, transport accident laws or by any government sponsored fund, plan or medical benefit scheme.
  • Any claim due to an act of war (whether war is declared or not), rebellion, revolution, insurrection or taking of power by the military.
  • Any claim due to: a nuclear reaction or contamination from nuclear weapons or radioactivity; biological and/or chemical materials, substances or compounds used to directly or indirectly harm or destroy human life.
  • A loss that arises because you did not follow advice in the mass media of a government or other official body’s warning: against travel to a particular country or parts of a country; or of a strike, riot, bad weather, civil commotion or contagious disease; or of a likely or actual epidemic or pandemic; or of a threat of an epidemic or pandemic that requires the closure of a country’s borders; or of an epidemic or pandemic that results in you being quarantined; and you did not take the appropriate action to avoid or minimise any potential claim under your policy.
  • You are injured doing an activity that is excluded from our policy.
  • You are injured while doing a snow sport or activity and you haven’t purchased the Snow Sports and Activities option for an additional premium.
  • A loss arising from your, any of your travelling party’s or a close relative’s intentional exposure to a needless risk or not taking reasonable care, except in an attempt to save human life.
  • Elective or cosmetic surgery that is not medically necessary (and any complications that arise from surgery); gastric banding and gastric bypass surgery (and their complications); elective pregnancy terminations.
  • If you, your close relative or a member of your travelling party: commits suicide, attempts to commit suicide or deliberately injures himself or herself; is under the influence of, or is addicted to, intoxicating liquor or a drug, except a drug taken in accordance with the advice of a registered medical practitioner.
  • Any medical procedures in relation to an implantable cardioverter-defibrillator (ICD), also known as an automated implantable cardioverter-defibrillator (AICD) insertion during your trip.
  • The cost of medication in use at the time the trip began or for maintaining a course of treatment you were on prior to the trip.
  • Existing medical conditions except as specified under Existing Medical Conditions.
  • Any claims in relation to sexually transmitted disease.
  • Any claims in relation to mental illness as defined by DSM-IV including (but not limited to) dementia, anxiety, depression or other nervous condition; behavioural diagnoses such as autism; eating disorders; a drug or alcohol addiction.
  • Any government prohibition, regulation or intervention.
 
 Full policy terms, conditions, limitations and exclusions are available in the PDS.



This article was written by Travel Insurance Direct.
This article was written by Travel Insurance Direct.
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