Definitions

Australian Unity’s Health Fund Rules defines the below terms as follows:

Ancillary: Means any benefits in respect of dental, medical and other ancillary services, including where a General Treatment item number is referable.

Member: The policy holder, their partner or their dependant that is registered with the fund.

Private Practice: A professional practice (whether sole, partnership or group) that operates on an independent and self-supporting basis. This means that its accommodation, facilities and/or services are not provided or subsidised by another party, such as a Public Hospital or publicly funded facility.

Recognised: In respect of a person, organisation, hospital, facility, treatment or procedure, means a person, organisation, hospital, facility, treatment or procedure which has been recognised or approved by the Company for the purpose only of payment of benefits.

For an ancillary provider to be recognised for the payment of benefits for services to Australian Unity members, the provider must meet the Recognised Provider Requirements in clause 1 of these Terms and Conditions.

1. Recognition Requirements

All ancillary providers must comply with the registration criteria outlined in the Private Health Insurance (Accreditation) Rules 2011.

In the interests of protecting the safety of Australian Unity’s members and attracting high quality service providers, Australian Unity also requires that all ancillary providers meet the following requirements:

1.1 Appropriate full membership with an Australian Unity recognised association or registration with the appropriate AHPRA board/association.

     1.1.1 This includes individual providers maintenance of a current first aid certificate, relevant insurance and a minimum of 20 hours Continuing Professional Education hours each year.

1.2 Appropriate accredited professional qualifications facilitated through a registered training organisation

1.3 Providers must be in private practice

 

Our full recognition requirements for Natural Therapy and Allied Health providers can be found on our website.

2. Receipting and record keeping criteria

Providers must follow the receipting requirements of Australian Unity when processing member receipts. These requirements are;

2.1 A clear and accurate description of the treatment performed.

2.2 Item numbers (where possible)

2.3 A minimum of three identifiers present on the account/receipt to identify the provider. Identifiers must include the provider’s name & practice location and any one of; provider number, phone number, practice name, association number or ABN.

2.4 Receipts should be on formal letterhead or formally stamped.

2.5 Patient records are accurate and appropriately detailed

2.6 The provider must be willing to submit these to Australian Unity upon request

2.7 Patient records are retained for a minimum of two years, or any longer period required where set out in current legislation.

3. Information Requests

When necessary, Australian Unity may make enquiries regarding proof of a provider’s registrations, membership or qualifications with third parties.
Upon written request by Australian Unity, recognised providers must:

3.1 Provide Australian Unity with documentation confirming registration, accreditation, association membership, qualifications and compliance with Australian Unity’s recognition requirements as set out in clause 1 of these Terms and Conditions;

3.2 Comply with all Australian Unity requests for documentation in a timely manner; and

3.3 Ensure requested information supplied is accurate and without any misrepresentation.

4. Provider conduct

Recognised providers will:

4.1 Not use Australian Unity logos or trademarks or nor imply any association from or endorsement with Australian Unity, without express written authorisation.

4.2 Not be paid benefits if they provide Australian Unity members with any goods sourced directly outside of Australia without first receiving those goods in Australia and inspecting them for safety, quality and all applicable Australian Standards.

4.3 Comply with all laws and regulations applicable to the provider’s services, including, but not limited to, the Competition and Consumer Act 2010, the Privacy Act 1988 and State and Territory fair trading law;

4.4 Comply with any audits Australian Unity conducts in accordance with clause 3 in an honest manner, providing all relevant documentation upon reasonable request; and

4.5 Not be paid benefits by Australian Unity for treatment provided to themselves as an individual (or Member) or to a practitioner’s spouse, defacto partner or dependents; or business partner, or the spouse.

5. Deregistration Policy

Australian Unity may deregister a provider from being Recognised at any time if the provider has materially breached any of these provider terms and conditions or otherwise breached the provider terms and conditions and failed to remedy that breach within 30 days of receiving notice from Australian Unity.

Further information on Australian Unity’s Deregistration Policy can be found on our website.

Australian Unity may suspend a provider's HICAPS number if Australian Unity believes (acting reasonably) that the provider has breached any of these provider terms and conditions and is investigating the breach.

6. Changes to these terms and conditions

Australian Unity may update or change any of these terms and conditions by giving you notice through the Australian Unity website or by written notice in the event of a detrimental change. You should regularly check these terms and conditions as published on the Australian Unity website.