<<Date>> <<Primary_Applicant_Title>> <<Primary_Applicant_GivenName>> <<Primary_Applicant_FamilyName>> <<Primary_Applicant_AddressLine1>> <<Primary_Applicant_AddressLine2>> <<SUBU B>> <<STAT!>> <<P"ST#"D!

>> Dear <<Primary_Applicant_Title>> <<Primary_Applicant_GivenName>> <<Primary_Applicant_FamilyName>>$ "n %e&al' (' <<)ns*rer_B*siness_Name>>$ ) certi'y t&at t&e '(ll(+in, pers(n-s. Primary Applicant/ <<Primary_Applicant_GivenName>> <<Primary_Applicant_FamilyName>> <<Primary_Applicant_D"B>> Sec(ndary Applicant -1./ <<Sec(ndary_Applicant_GivenName_1>> <<Sec(ndary_Applicant_FamilyName_1>> <<Sec(ndary_Applicant_D"B_1>> Sec(ndary Applicant -2./<<Sec(ndary_Applicant_GivenName_2>> <<Sec(ndary_Applicant_FamilyName_2>> <<Sec(ndary_Applicant_D"B_2>> Sec(ndary Applicant -0./ <<Sec(ndary_Applicant_GivenName_0>> <<Sec(ndary_Applicant_FamilyName_0>> <<Sec(ndary_Applicant_D"B_0>> Sec(ndary Applicant -1./ <<Sec(ndary_Applicant_GivenName_1>> <<Sec(ndary_Applicant_FamilyName_1>> <<Sec(ndary_Applicant_D"B_1>> Sec(ndary Applicant -2./ <<Sec(ndary_Applicant_GivenName_2>> <<Sec(ndary_Applicant_FamilyName_2>> <<Sec(ndary_Applicant_D"B_2>> is3are$ (r +ill immediately *p(n t&eir arrival in A*stralia %e$ c(vered %y <<4ealt&_(r_Travel>> ins*rance t&at is at least as c(mpre&ensive as t&e minim*m level (' ins*rance re5*ired %y t&e A*stralian Department (' )mmi,rati(n and #iti6ens&ip set (*t at Attac&ment A7 T&e ins*rance pr(d*ct s*pplied %y <<)ns*rer_B*siness_Name>> is <<)ns*rer_Pr(d*ct_Name>> and +ill %e pr(vided '(r t&e peri(d <<)ns*rance_start_date>> 8 <<)ns*rance_'inis&_date>> s*%9ect t( t&e '(ll(+in, e:cepti(ns/ <<)ns*rance_!:cepti(n>>
By pr(vidin, t&is letter t( Department (' )mmi,rati(n and #iti6ens&ip y(* are als( a,reein, t&at <<)ns*rer_B*siness_Name>> may n(ti'y Department (' )mmi,rati(n and #iti6ens&ip i' y(* cancel$ (r 'ail t( rene+$ y(*r &ealt& ins*rance p(licy$ (r i' y(*r &ealt& ins*rance p(licy is terminated7 At Attac&ment B$ +e &ave prepared a letter +&ic& y(* may si,n and pr(vide t( y(*r empl(yer i' y(* +is&$ +&ic& a*t&(rises y(*r sp(ns(r t( ma;e re,*lar ded*cti(ns 'r(m y(*r +a,es '(r &ealt& ins*rance premi*ms t( <<)ns*rer_B*siness_Name>>7

)' y(* &ave any 5*esti(ns a%(*t y(*r &ealt& ins*rance c(ver$ please c(ntact <<)ns*rer_#(ntact_Name>> %y emailin, <<)ns*rer_#(ntact_!mail_Address>> (r %y telep&(nin, <<)ns*rer_#(ntact_P&(ne_N*m%er>>7 <<Name_)ns*rer_ epresentative>> Si,nat*re (' pers(n representin, <<)ns*rer_B*siness_Name>>

Attachment A Insurance benefits at least equivalent to: a. Public hospital < admitted patient treatment$ a %ene'it e5*al t( t&e State and Territ(ry &ealt& a*t&(rity ,a6etted rates '(r ineli,i%le patients '(r/ (verni,&t and day (nly &(spital acc(mm(dati(n -all c(sts incl*din,/ all t&eatre$ intensive care$ la%(*r +ards$ +ard dr*,s.= emer,ency department 'ees t&at lead t( an admissi(n= admitted patient care and p(st (perative services t&at are a c(ntin*ati(n (' care ass(ciated +it& an early disc&ar,e 'r(m &(spital7
N(te/ '(r t&e p*rp(se (' clarity t&is incl*des all admitted treatments c(vered %y t&e >edicare Bene'it Sc&ed*le7

%. Surgically implanted prostheses < n( ,ap pr(st&eses and ,ap permitted pr(st&eses as listed in t&e Private 4ealt& )ns*rance -Pr(st&eses. *les 2??@/ Bene'it at least e5*al t( 1??A (' minim*m %ene'it am(*nt listed7 c. Pharmacy < all PBS listed dr*,s t&at are prescri%ed acc(rdin, t( t&e PBS appr(ved indicati(ns$ t&at are administered d*rin, and '(rm part (' an admitted epis(de (' care 8 a %ene'it e5*al t( t&e PBS listed price in e:cess (' t&e patient c(ntri%*ti(n7
N(te/ F(r t&e p*rp(se (' clarity$ t&is de'initi(n is intended t( incl*de t&e c(st (' PBS listed dr*,s administered p(st disc&ar,e < i' t&ey '(rm part (' t&e admitted epis(de (' care7

d. Medical services < admitted medical services +it& an >BS item n*m%er < 1??A (' t&e >edicare Bene'its Sc&ed*le 'ee$ (r less i' t&e patient is c&ar,ed less7 e. Ambulance services < 1??A (' t&e c&ar,e$ t&at is n(t (t&er+ise c(vered %y t&ird party arran,ements$ '(r transp(rt %y am%*lance pr(vided %y$ (r *nder an arran,ement +it&$ a ,(vernment appr(ved am%*lance service +&en medically necessary '(r admissi(n t( &(spital$ emer,ency treatment (n8site$ (r inter8&(spital trans'er '(r emer,ency treatment7
N(te/ F(r t&e p*rp(se (' clarity$ t&is de'initi(n is intended t( incl*de inter8&(spital trans'ers t&at are necessary %eca*se t&e (ri,inal admittin, &(spital d(es n(t &ave t&e re5*ired clinical 'acilities7 )t d(es n(t e:tend t( trans'ers d*e t( patient pre'erences7

Other minimum health insurance policy features '. Informed Financial Consent )ns*rers +ill ma;e availa%le mem%ers&ip eli,i%ility c&ec;in, t( &(spitals t( ena%le t&e pr(visi(n (' in'(rmed 'inancial c(nsent t( mem%ers (n admissi(n7 ,. aiting periods T( c(mply +it& t&e minim*m level (' &ealt& ins*rance$ t&e (nly +aitin, peri(ds t&at may%e imp(sed are/ 12 m(nt&s '(r pre,nancy related c(nditi(ns= 12 m(nt&s '(r pre8e:istin, c(nditi(ns applied in a +ay t&at is c(nsistent +it& Secti(n @2812 (' t&e Private Health Insurance Act 20077 2 m(nt&s '(r psyc&iatric$ re&a%ilitati(n and palliative care$ re,ardless (' +&et&er (r n(t t&e c(nditi(n is a pre8e:istin,7

&. !"cluded treatments T( c(mply +it& t&e minim*m level (' &ealt& ins*rance$ t&e (nly admitted patient treatments t&at may %e e:cl*ded are/ Assisted repr(d*ctive treatments= !lective c(smetic treatments= B(ne marr(+ and (r,an transplants= )ns*rance p(licies may als( e:cl*de t&e '(ll(+in,/ Treatment rendered (*tside (' A*stralia incl*din, treatment necessary en r(*te t( (r 'r(m A*stralia= Treatment arran,ed in advance (' t&e ins*redBs arrival in A*stralia= Services and treatment +&ic& are c(vered %y c(mpensati(n and dama,es pr(visi(ns (' any ;ind
N(te/ ins*rers are n(t re5*ired t( e:cl*de t&ese treatments7 A decisi(n t( c(ver t&em is at t&e discreti(n (' t&e ins*rer7

i. #lobal annual benefit limits T( c(mply +it& t&e minim*m level (' &ealt& ins*rance$ t&e per pers(n per ann*m$ %ene'it m*st n(t %e less t&an C1 milli(n d(llars7 9. Portability T( c(mply +it& t&e minim*m level (' &ealt& ins*rance$ +&en determinin, +aitin, peri(ds$ ins*rers m*st rec(,nise previ(*s len,t& (' mem%ers&ip (n a p(licy &eld +it& an(t&er A*stralian ins*rer t&at meets t&e minim*m standards7 T&at is/ D&en trans'errin, %et+een A*stralian %ased ins*rers +&ere t&e c*st(mer &as %een a mem%er (' t&e previ(*s '*nd '(r ,reater t&an 12 m(nt&s$ +aitin, peri(ds (' n( ,reater t&an 12 m(nt&s +ill apply t( t&e &i,&er level (' %ene'its7 D&en trans'errin, %et+een A*stralian %ased ins*rers +&ere t&e c*st(mer &as %een a mem%er (' t&e previ(*s '*nd '(r less t&an 12 m(nt&s$ any *nserved +aitin, peri(ds +ill need t( %e c(mpleted +it& t&e ne+ '*nd and i' increasin, t&e level (' c(ver (r %ene'its$ additi(nal +aitin, peri(ds (' n( ,reater t&an 12 m(nt&s +ill apply t( t&e &i,&er level (' %ene'its7 T&ese +aitin, peri(ds are served c(nc*rrently7 T( c(mply +it& t&e minim*m level (' &ealt& ins*rance an ins*rer m*st a,ree t(/ ,rant a mem%er +&( see;s t( trans'er %et+een A*stralian %ased ins*rers$ c(ntin*ity (' c(ver '(r *p t( 0? days 'r(m t&e date t&ey leave t&e previ(*s ins*rer= and pr(vide mem%ers$ +&( terminate t&eir p(licy$ +it& a clearance certi'icate$ appr(ved %y t&e Department (' )mmi,rati(n and #iti6ens&ip$ +it&in 11 days (' t&e date (' terminati(n (r t&e date (' n(ti'icati(n (' t&e terminati(n$ +&ic&ever is t&e later7 ;. $uy out clauses T( c(mply +it& t&e minim*m level (' &ealt& ins*rance$ a p(licy m*st n(t c(ntain a %*y (*t cla*se t&at &as t&e e''ect (' terminatin, t&e ins*rers lia%ilities in e:c&an,e '(r a pre8determined l*mp s*m payment7 l. Arrears

T( c(mply +it& t&e minim*m level (' &ealt& ins*rance an ins*rer +ill all(+ '(r acceptance (' premi*ms '(r E? days 'r(m t&e last 'inancial date (' mem%ers&ip +it&(*t terminatin, t&e mem%ers&ip7 )ns*rers are n(t (%li,ated t( pay '(r treatments received d*rin, any arrears peri(d *ntil and *nless t&e arrears are paid '(r t&e relevant peri(d7Attachment $ <<Date>> <<Sp(ns(r_Title>> <<Sp(ns(r_GivenName>> <<Sp(ns(r_FamilyName>> <<Sp(ns(r_B*siness_Name>> <<Sp(ns(r_AddressLine1>> <<Sp(ns(r_AddressLine2>> <<Sp(ns(r_SUBU B>> <<Sp(ns(r_STAT!>> <<Sp(ns(r_P"ST#"D!>> ) a*t&(rise <<Sp(ns(r_B*siness_Name>> t( ded*ct <<Am(*nt_Ded*cted>> per <<Fre5*ency_Ded*cted>> 'r(m my +a,es '(r &ealt& ins*rance premi*ms t( %e paid t( <<)ns*rer_B*siness_Name>> and '(r it t( %e paid int( t&e '(ll(+in, acc(*nt (n my %e&al'/ <<)ns*rer_Acc(*nt_Name>> <<)ns*rer_Acc(*nt_N*m%er>> <<Primary_Applicant_Title>> <<Primary_Applicant_GivenName>> <<Primary_Applicant_FamilyName>>

Si,nat*re (' Primary Applicant/ <<Date>>