Terms and Conditions for QLD and NSW TUH Preferred Dental Providers
Conditions of application to become a QUEENSLAND TEACHERS’ UNION HEALTH FUND LTD (TUH) Preferred Provider
An authorised representative of a dental practice(preferably the principal) may apply for the practice to become a TUH Preferred Provider (which includes both Teachers' Union Health Fund and Union Health). If the application is accepted all dentists practicing from the practice location who meet the conditions specified in clause 1.4 and elsewhere in this document will be considered Preferred Providers unless specifically excluded. Dentists should be specifically excluded on the TUH Preferred Provider Application Form.
Where dentists are specifically excluded from the TUH Preferred Provider Application it is the responsibility of the dental practice to advise the member that the dentist is excluded from this agreement and ensure Informed Financial Consent is provided to the member prior to the commencement of treatment.
The dental practice must apply separately for each location at which it wishes to be a TUH Preferred Provider. TUH reserves the right to accept an application from the dental practice in respect of one location but not another.
For a dentist at the practice to become a TUH Preferred Provider he or she must (on application, and ongoing for so long as they remain a TUH Preferred Provider):
be a qualified dentist, registered or licensed to practice in a State or Territory of Australia;
have a current provider number allocated by Medicare Australia for the location at which he or she proposes to participate in the Network;
be fully registered with the Australian Health Practitioner Regulation Agency (AHPRA);
at all times, maintain the ethical and professional standards reasonably required of a dental practitioner; and
be the principal of a private dental practice or be employed by, or contracted to, a private dental practice.
The dental practice must have a commitment to minimal intervention in restorative dentistry and a focus on preventive dentistry.
A dental practice may apply to participate as a Preferred Provider by completing the application form and submitting it to TUH for assessment.
Assessment of requests to become a TUH Preferred Provider
TUH may accept or refuse an application to become a Preferred Provider at its absolute discretion.
In deciding whether to accept or refuse an application TUH will take into account matters relevant to the viability and effectiveness of the TUH Preferred Provider Network, including:
any restriction on the size of the TUH Preferred Provider network;
the geographical distribution of TUH members;
the number of dentists participating in the TUH Preferred Provider network in the same geographical area as the applicant; and
the results of any relevant TUH member satisfaction surveys and claims history audits.
The dental practice must hold a current radiation possession licence and at least one person in the practice must hold a current radiation licence.
The application must provide:
the name of each dentist at the practice;
their AHPRA and Medicare provider numbers;
any restrictions imposed on their practice;
the name of the radiation safety officer; and
the practices radiation possession licence number.
Practice accreditation endorsed by the Australian Dental Association (ADA) e.g. the Quality Innovation Performance (QIP)accreditation will be regarded favourably.
In considering applications TUH may undertake audits related to the dental practice and request a copy of the practices fee schedule to satisfy itself that the dental practice would be a suitable TUH Preferred Provider.
Conditions of participation as a TUH Preferred Provider
As part of ongoing participation as a TUH Preferred Provider, a dental practice must:
continue to meet the conditions to become a Preferred Provider;
abide by the TUH Fund Rules insofar as these are applicable to medical practitioners or providers;
maintain public liability insurance with a sum insured of at least $10 million which covers it against claims of personal injury or property damage that a third party suffers (or claims to have suffered) as a result of its business activities;
ensure that every dentist employed within the practice maintains professional indemnity insurance with a sum insured of at least $10million which covers any provision of dental services at the practice address provided;
practice within the legal and ethical standards expected in contemporary Australian dental practice and in accordance with Australian Safety and Quality Goals for healthcare;
provide TUH members with quality dental services, including advice and information, and otherwise comply with relevant guidelines and policies published by the ADA from time to time, including the following policy statements:
Principles of Ethical Dental Practice; and
Infection control
give TUH permission to publish:
the fact that the dentists a Preferred Provider; and
the contact details for the dental practice;
on our website or in any other manner TUH decides.
The Preferred Provider will charge TUH members no more than the current Department of Veterans Affairs (DVA) Dentists and Dental Specialists'; fees for item numbers in all of the following - Category 000Diagnostic Services, Category 100 Preventive Services, Category 200Periodontics, Category 300 Oral Surgery, Category 400 Endodontics and Category500 Restorative Services.
The Preferred Provider may charge TUH members their standard practice fee for Category 600 Crown and Bridge, Category 700 Prosthodontics, Category 800 Orthodontics, Category 900 General Services and in any Category where there is no stated fee.
TUH members on products Gold Ultimate Choice, Gold Easy Choice, Silver+ Active Choice, Bronze+ Young Choice, Comprehensive Extras, Mid Range Extras, Family Extras, Healthy Options Extras , Everyday Extras and Basic Extras attending a Preferred Provider should not experience out-of-pocket expenses for items 011, 012, 013, 022, 074, 111, 113, 114,115, and 121. [Note: TUH benefits are the same as the DVA fees for these items].
The Preferred Provider must keep records necessary to show compliance with these Terms and Conditions. Without limiting this obligation, a Preferred Provider must retain for 2 years from the date of a professional service the invoice / receipt signed by the TUH member verifying that the service has been provided.
The Preferred Provider must provide TUH with any records or other information TUH may reasonably require to verify that a professional service has been rendered.
The Preferred Provider must provide TUH with any information it may reasonably require to confirm that all Preferred Providers are complying with these Terms and Conditions.
The Preferred Provider practice must notify TUH within 5 business days of any change to its address details as they appear in the application form.
The Preferred Provider practice must display promotional materials about the TUH Preferred Provider network provided to the practice by TUH and refrain from using any other promotional materials about the network or TUH unless the Preferred Provider has the prior written approval of TUH.
The Preferred Provider dental practice is required to notify TUH in a timely manner of:
the details specified in clause 2.4 for new dentists who commence at the practice;
details of dentists who leave the practice.
any above-mentioned changes via the web-based form on the TUH Provider portal.
In the event that the Preferred Provider dental practice is sold the practice must notify TUH within 10 business days. TUH may, at its absolute discretion, terminate the preferred provider agreement or transfer it to the new owner.
The Preferred Provider dental practice must notify TUH within 5 business days of any issues that may affect a dentists registration including the imposition of disciplinary sanctions, restrictions, suspensions, or other conditions which may affect their ability to meet these Terms and Conditions.
Processing Claims
TUH has the capacity to receive claims electronically through HICAPS or Healthpoint systems unless there is a technical issue at any point in time.
Whether claims are submitted electronically or manually, an invoice from the Preferred Provider must include:
the patients name for manual claims and patient ID code for electronic claims;
the date of service;
a description of each service rendered;
item numbers;
relevant tooth identification numbers;
the dentists name, address and provider number;
the fee for the service;
any discount applied to the fee; and
the net amount required to be paid by the patient.
Claims will be processed in accordance with the TUH Health Fund Benefit Rules.
TUH will monitor claiming patterns and charges applied at its discretion. The TUH member will be responsible for the payment of any amount between the fee charged and the level of benefit paid ('out of pocket expenses').
General Matters
Where a dental practice enters into an agreement with TUH to become a Preferred Provider, that agreement consists solely of:
these Terms and Conditions;
any General Treatment Terms and Conditions which maybe made available by TUH from time to time, to the extent that these are reasonable. The Preferred Provider may (acting reasonably), dispute the introduction of, or amendment to the General Treatment Terms and Conditions and, if the dispute cannot be resolved, may terminate the agreement in accordance with clause 7.1 of these Terms and Conditions;
the application to join the Preferred Provider network submitted by the dental practice to TUH, in the form determined by TUH; and
the letter from TUH to the dental practice notifying it that TUH has accepted its application to become a Preferred Provider with the names of the recognised providers.
Where there is any inconsistency between any of the documents listed at 5.1 then these Terms and Conditions prevail.
An agreement referred to in clause 5.1 is governed by the law of the State of Queensland and is subject to the exclusive jurisdiction of the State of Queensland.
TUH makes no guarantee, representation or warranty that by becoming a Preferred Provider a dental practice will receive increased business from TUH members.
A dentist or dental practice does not become an agent of TUH by becoming a Preferred Provider.
TUH is not liable to any person for any loss, damage or injury incurred as a result of a dentist providing treatment or failing to provide treatment to a TUH member.
By becoming a TUH Preferred Provider a dentist and dental practice agrees to indemnify TUH against all expenses, losses, damages and costs that TUH may incur as a result of:
any breach of these Terms and Conditions by the dentist; or
any loss or damage to any property or injury to or death of any person caused by any negligent act or omission or wilful misconduct of the dentist or his or her partners, employees or contractors.
TUH indemnifies the Preferred Provider against all expenses, losses and costs that the Preferred Provider may incur as a result of TUH's breach of these Terms and Conditions.
TUH may not give directions to a dentist or otherwise attempt to influence a dentists decision about the appropriate treatment for a TUH member, although it may require information about treatment given to a TUH member as described in clause 3.
TUH may contact a member to discuss any claimed treatment provided and/or ask the member to have a clinical examination if there are questions raised to which the practice is unable to provide an explanation that satisfies TUH.
Changes to the Terms and Conditions
TUH may amend these Terms and Conditions at any time by giving the Preferred Provider notice in writing at least 28 days before the amendment is due to come into effect. The Preferred Provider may (acting reasonably), dispute the introduction of, or amendment to the General Treatment Terms and Conditions and, if the dispute cannot be resolved, may terminate the agreement in accordance with clause 7.1 of these Terms and Conditions;
If a Preferred Provider wishes to amend these Terms and Conditions, its principal must make a written proposal to TUH, which TUH may accept or refuse at its absolute discretion.
If TUH accepts an amendment proposal from a Preferred Provider, then the amendment comes into effect from a date nominated by TUH.
Leaving the Network
The participation of a dentist/dental practice in the TUH Preferred Provider network may be terminated by the dentist/dental practice or TUH at any time by giving 28 days; written notice to the other party.
TUH is not required to give 28 days; written notice if:
TUH reasonably finds that any or all dentists at the dental practice has failed to observe relevant ADA policy statements or guidelines;
TUH reasonably finds that any or all dentists at the dental practice consistently fail to meet clauses 3.2, 3.3 or 3.4 of these Terms and Conditions; or
any or all dentists at the dental practice no longer meets the conditions in clause 1.4; or
the dental practice is sold.
and the termination of the dental practices participation takes effect from the day on which TUH gives written notice to the dental practice.
After termination has taken effect, the dental practice:
must remove any promotional materials about the Preferred Provider network from display; and
must take any other steps necessary to ensure that it does not represent to any person that it continues to participate as a TUH Preferred Provider.
Resolving Disputes
If any dispute arises between TUH and a dentist or the dental practice in relation to the Preferred Provider network, then both parties should, in good faith, try to resolve any disputes informally in the first instance.
Notices
Any notice to TUH in accordance with these terms and conditions should be in writing and signed on behalf of the practice by an authorised party and sent by email to providers@tuh.com.au.
Terms and Conditions for NDC Australia Pty Ltd TUH Preferred Dental Providers
Conditions of application to become a QUEENSLAND TEACHERS’ UNION HEALTH FUND LTD (TUH) Preferred Provider
An authorised representative of a dental practice (preferably the principal) may apply for the practice to become a TUH Preferred Provider. If the application is accepted all dentists at the practice who meet the conditions specified in clause 1.3 and elsewhere in this document will be considered Preferred Providers unless specifically excluded. Providers should be specifically excluded on the TUH Preferred Provider Application Form.
Where providers are specifically excluded from the TUH Preferred Provider Application it is the responsibility of the dental practice to advise the member that the dentist is excluded from this agreement and ensure Informed Financial Consent is provided to the member prior to the commencement of treatment.
The dental practice must apply separately for each location at which it wishes to be a TUH Preferred Provider. TUH reserves the right to accept an application from the dental practice in respect of one location but not another.
For a dentist at the practice to become a TUH Preferred Provider he or she must (on application, and ongoing for so long as they remain a TUH Preferred Provider):
be a qualified dentist, registered or licensed to practice in a State or Territory of Australia;
have a current provider number allocated by Medicare Australia for the location at which he or she proposes to participate in the Network;
be fully registered with the Australian Health Practitioner Regulation Agency (AHPRA);
at all times, maintain the ethical and professional standards reasonably required of a dental practitioner; and
be the principal of a private dental practice or be employed by a private dental practice.
The dental practice must have a commitment to minimal intervention in restorative dentistry and a focus on preventive dentistry.
A dental practice may apply to participate as a Preferred Provider by completing the application form and submitting it to TUH for assessment.
Assessment of requests to become a TUH Preferred Provider
TUH may accept or refuse an application to become a Preferred Provider at its absolute discretion.
In deciding whether to accept or refuse an application TUH will take into account matters relevant to the viability and effectiveness of the TUH Preferred Provider Network, including:
any restriction on the size of the TUH Preferred Provider network;
the geographical distribution of TUH members;
the number of dentists participating in the TUH Preferred Provider network in the same geographical area as the applicant; and
the results of any relevant TUH member satisfaction surveys and claims history audits.
The dental practice must hold a current Possession licence, Premises Compliance Certificate and Radiation Safety Officer Certificate. Practices and individuals must adhere to the to the Radiation Safety Act 1999 and the Radiation Safety Regulation 2010. All clinicians must comply with the Code of Practice for Radiation Protection in Dentistry (2005) published by ARPANSA. https://www.arpansa.gov.au/sites/default/files/legacy/pubs/rps/rps10.pdf
The application must provide:
the name of each dentist at the practice;
their AHPRA and Medicare provider numbers;
any restrictions imposed on their practice;
the name of the radiation safety officer; and
the practices radiation possession licence number.
Practice accreditation endorsed by the Australian Dental Association (ADA) e.g. the Quality Innovation Performance (QIP) accreditation will be regarded favourably.
In considering applications TUH may undertake desk audits related to the dental practice and request a copy of the practices fee schedule to satisfy itself that the dental practice would be a suitable TUH Preferred Provider.
Conditions of participation as a TUH Preferred Provider
As part of ongoing participation as a TUH Preferred Provider, a dental practice must:
continue to meet the conditions to become a Preferred Provider;
abide by the TUH Fund Rules insofar as these are applicable to medical practitioners or providers;
maintain public liability insurance with a sum insured of at least $10 million which covers it against claims of personal injury or property damage that a third party suffers (or claims to have suffered) as a result of its business activities;
ensure that every dentist employed within the practice maintains professional indemnity insurance with a sum insured of at least $10 million which covers any provision of dental services at the practice address provided;
practice within the legal and ethical standards expected in contemporary Australian dental practice and in accordance with Standards 1 – 6 of the National Safety and Quality Health Service Standards.
provide TUH members with quality dental services, including advice and information, and otherwise comply with relevant guidelines and policies published by the ADA from time to time, including the following policy statements:
Principles of Ethical Dental Practice; and
Infection Control.
give TUH permission to publish:
the fact that the dentist is a Preferred Provider; and
the contact details for the dental practice;
on our website or in any other manner TUH decides.
The practice will charge TUH members no more than the current Department of Veterans Affairs (DVA) Dentists and Dental Specialists’ fees for item numbers in all of the following - Category 000 Diagnostic Services, Category 100 Preventive Services, Category 200 Periodontics, Category 300 Oral Surgery, Category 400 Endodontics and Category 500 Restorative Services.
The practice may charge TUH members their standard practice fee for Category 600 Crown and Bridge, Category 700 Prosthodontics, Category 800 Orthodontics, Category 900 General Services and in any Category where there is no stated fee.
TUH members with a financial extras policy attending your practice should not experience out-of-pocket expenses for items 011, 012, 013, 022, 074, 111, 113, 114, 115, and 121. [Note: TUH benefits are the same as the DVA fees for these items].
The practice must keep records necessary to show compliance with these Terms and Conditions. Without limiting this obligation, a dentist must retain for 2 years from the date of a professional service the invoice / receipt signed by the TUH member verifying that the service has been provided.
The practice must provide TUH with any records or other information TUH may reasonably require to verify that a professional service has been rendered.
The practice must provide TUH with any information it may reasonably require to confirm that all Preferred Providers are complying with these Terms and Conditions.
The practice must notify TUH within 5 business days of any change to its address details as they appear in the application form.
The practice must display promotional materials about the TUH Preferred Provider network provided to the practice by TUH and refrain from using any other promotional materials about the network or TUH unless the dentist has the prior written approval of TUH.
The dental practice is required to notify TUH in a timely manner via the web-based form on the TUH Provider portal of:
the details specified in clause 2.4 for new dentists who commence at the practice;
details of dentists who leave the practice.
In the event that the dental practice is sold the practice must notify TUH within 10 business days. TUH may, at its absolute discretion, terminate the preferred provider agreement or transfer it to the new owner.
The dental practice must notify TUH within 5 business days of any issues that may affect a dentists registration including the imposition of disciplinary sanctions, restrictions, suspensions, or other conditions which may affect their ability to meet these Terms and Conditions.
Processing claims
TUH has the capacity to receive claims electronically through HICAPS or iSoft systems unless there is a technical issue at any point in time.
Whether claims are submitted electronically or manually, an invoice from the dentist must include:
the patient’s name for manual claims and patient ID code for electronic claims;
the date of service;
a description of each service rendered;
item numbers;
relevant tooth identification numbers;
the dentists name, address and provider number;
the fee for the service;
any discount applied to the fee; and
the net amount required to be paid by the patient.
Claims will be processed in accordance with the TUH Health Fund Benefit Rules.
TUH will monitor claiming patterns and charges applied at its discretion. The TUH member will be responsible for the payment of any amount between the fee charged and the level of benefit paid (‘out of pocket expenses’).
General Matters
Where a dental practice enters into an agreement with TUH to become a Preferred Provider, that agreement consists solely of:
these Terms and Conditions;
any General Treatment Terms and Conditions which may be made available by TUH from time to time;
the application to join the Preferred Provider network submitted by the dental practice to TUH, in the form determined by TUH; and
the letter from TUH to the dental practice notifying it that TUH has accepted its application to become a Preferred Provider with the names of the recognised providers.
Where there is any inconsistency between any of the documents listed at 5.1 then these Terms and Conditions prevail.
An agreement referred to in clause 5.1 is governed by the law of the State of Queensland and is subject to the exclusive jurisdiction of the State of Queensland.
TUH makes no guarantee, representation or warranty that by becoming a Preferred Provider a dental practice will receive increased business from TUH members.
A dentist or dental practice does not become an agent of TUH by becoming a Preferred Provider.
TUH is not liable to any person for any loss, damage or injury incurred as a result of a dentist providing treatment or failing to provide treatment to a TUH member.
By becoming a TUH Preferred Provider a dentist and dental practice agrees to indemnify TUH against all expenses, losses, damages and costs that TUH may incur as a result of:
any breach of these Terms and Conditions by the dentist; or
any loss or damage to any property or injury to or death of any person caused by any negligent act or omission or wilful misconduct of the dentist or his or her partners, employees or contractors.
TUH may not give directions to a dentist or otherwise attempt to influence a dentists decision about the appropriate treatment for a TUH member, although it may require information about treatment given to a TUH member as described in clause 3.
TUH may contact a member to discuss any claimed treatment provided and/or ask the member to have a clinical examination if there are questions raised to which the practice is unable to provide an explanation that satisfies TUH.
Preferred Provider Agreements will be issued for a maximum period of two years with the option of a two-year extension at TUHs sole discretion. TUH will provide confirmation by letter that an extension has been granted. An agreement or extension will only be valid when the agreement or extension letter is returned to TUH no later than 2 months after issue and is signed.
Preferred Provider Agreements will have a common expiry date of 31st December.
Changes to the Terms and Conditions
TUH may amend these Terms and Conditions at any time by giving the dental practice notice in writing at least 28 days before the amendment is due to come into effect.
If a dental practice wishes to amend these Terms and Conditions, its principal must make a written proposal to TUH, which TUH may accept or refuse at its absolute discretion.
If TUH accepts an amendment proposal from a dental practice, then the amendment comes into effect from a date nominated by TUH.
Leaving the Network
The participation of a dentist/dental practice in the TUH Preferred Provider network may be terminated by the dentist/dental practice or TUH at any time by giving 28 days’ written notice to the other party.
TUH is not required to give 28 days’ written notice if:
TUH reasonably finds that any or all dentists at the dental practice has failed to observe relevant ADA policy statements or guidelines; or
any or all dentists at the dental practice no longer meets the conditions in clause 1.3; or
the dental practice is sold.
and the termination of the dental practices participation takes effect from the day on which TUH gives written notice to the dental practice.
After termination has taken effect, the dental practice:
must remove any promotional materials about the Preferred Provider network from display; and
must take any other steps necessary to ensure that it does not represent to any person that it continues to participate as a TUH Preferred Provider.
Resolving disputes
If any dispute arises between TUH and a dentist or the dental practice in relation to the Preferred Provider network, then both parties should, in good faith, try to resolve any disputes informally in the first instance.
Notices
Any notice to TUH in accordance with these terms and conditions should be in writing and signed on behalf of the practice by an authorised party and sent by email to providers@tuh.com.au
Terms and Conditions for North West Physiotherapy/ TUH Preferred Providers
TUH’s Physiotherapy and Podiatry preferred provider networks are designed to give TUH / Union Health members access to affordable treatments while retaining clinical independence.
Conditions of application to become a QUEENSLAND TEACHERS’ UNION HEALTH FUND LTD (TUH) Preferred Provider
An authorised representative of the company (preferably the Director) may apply for the North West Physiotherapy – Everton Park Pty Ltd (the Company) and its Related Body Corporate including but not limited to the following entities: North West Physiotherapy – Everton Park Pty Ltd to become a TUH Preferred Provider. If the application is accepted all providers at Company owned practices who meet the conditions specified in clause 1.3 and elsewhere in this document will be considered Preferred Providers unless specifically excluded. Providers should be specifically excluded on the TUH Preferred Provider Application Form.
Where providers are specifically excluded from the TUH Preferred Provider Application it is the responsibility of the Company to advise the member that the provider is excluded from this agreement and ensure Informed Financial Consent is provided to the member prior to the commencement of treatment.
The Company must list each location at which it wishes to be a TUH Preferred Provider. This list of locations may be provided as a complete list for example as an excel file or similar and may be updated by the Company from time to time as additional practices join the North West Physiotherapy – Everton Park Pty Ltd. The list will contain all required fields regarding the provider and practice details.
For a provider at the practice to become a TUH Preferred Provider he or she must (on application, and ongoing for so long as they remain a TUH Preferred Provider):
Maintain appropriate qualifications to practice;
have a current provider number allocated by the relevant regulator the location at which they participate in the Network;
be fully registered with the Australian Health Practitioner Regulation Agency (AHPRA);
at all times, maintain the ethical and professional standards reasonably required; and
remain an employee or contractor of a practice owned by the North West Physiotherapy – Everton Park Pty Ltd.
Assessment of requests to become a TUH Preferred Provider
TUH may accept or refuse an application to become a Preferred Provider at its absolute discretion.
In deciding whether to accept or refuse an application TUH will take into account matters relevant to the viability and effectiveness of the TUH Preferred Provider Network, including:
any restriction on the size of the TUH Preferred Provider network;
the geographical distribution of TUH members;
the number of providers participating in the TUH Preferred Provider network in the same geographical area as the applicant; and
the results of any relevant TUH member satisfaction surveys and claims history audits.
The application must provide:
the name of each provider at the practice;
their AHPRA and Medicare provider numbers; and
any restrictions imposed on their practice.
Conditions of participation as a TUH Preferred Provider
As part of ongoing participation as a TUH Preferred Provider, the company must:
continue to meet the conditions to become a Preferred Provider;
abide by the TUH Fund Rules insofar as these are applicable to medical practitioners or providers;
maintain public liability insurance with a sum insured of at least $10 million which covers it against claims of personal injury or property damage that a third party suffers (or claims to have suffered) as a result of its business activities;
ensure that every provider covered by the agreement maintains professional indemnity insurance with a sum insured of at least $10 million which covers any provision of clinical services at the practice address provided;
practice within the legal and ethical standards expected in contemporary Australian health practice and in accordance with Australian Safety and Quality Goals for healthcare;
provide TUH members with quality services, including advice and information; and
give TUH permission to publish:
the fact that the provider is a Preferred Provider; and
the contact details for the provider on our website or in any other manner TUH decides.
The company will charge TUH members aged 17 years and under (up until the day before their 18th birthday) no more than $90 for initial physiotherapy services and comprehensive podiatry services. In return, TUH will pay a benefit of $90 for these services.
The company will provide TUH members with the following exclusive offers:
Physiotherapy
10% off initial and standard consultations (excluding the offer in 3.2); and
Podiatry
10% off initial consultations (excluding the offer in 3.2).
The company must keep records necessary to show compliance with these Terms and Conditions. Without limiting this obligation, a provider must retain for 2 years from the date of a professional service the invoice / receipt signed by the TUH member verifying that the service has been provided.
The company must provide TUH with any records or other information TUH may reasonably require to verify that a professional service has been rendered.
The company must provide TUH with any information it may reasonably require to confirm that all Preferred Providers are complying with these Terms and Conditions.
The company must notify TUH within 5 business days of any change to its address details as they appear in the application form.
The company is required to notify TUH in a timely manner of:
the details specified in clause 2.4 for new providers who commence at the company;
details of providers who leave the company.
In the event that the company is sold, the company must notify TUH within 10 business days. TUH may, at its absolute discretion, terminate the preferred provider agreement or transfer it to the new owner.
The company must notify TUH within 5 business days of any issues that may affect a provider’s registration including the imposition of disciplinary sanctions, restrictions, suspensions, or other conditions which may affect their ability to meet these Terms and Conditions.
In consultation with the Company, TUH may provide public notice and information of a company’s participation in the preferred provider network through point of service material to be placed in a noticeable position at the company’s premises.
Processing claims
TUH has the capacity to receive claims electronically through HICAPS or iSoft systems unless there is a technical issue at any point in time.
Whether claims are submitted electronically or manually, an invoice from the provider must include:
the patient’s name for manual claims and patient ID code for electronic claims;
the date of service;
a description of each service rendered;
item numbers;
the provider’s name, address and provider number;
the fee for the service; and
the net amount required to be paid by the patient.
Claims will be processed in accordance with the TUH Health Fund Benefit Rules. TUH pay benefits to our members in accordance with their level of cover and our policy terms and conditions. Conditions that may affect a member’s eligibility to receive benefits include, but are not restricted to: waiting periods; annual limits; compensation payable by another party and premium payments in arrears.
TUH will monitor claiming patterns and charges applied at its discretion. The TUH member will be responsible for the payment of any amount between the fee charged and the level of benefit paid (‘out of pocket expenses’).
General matters
Where a company enters into an agreement with TUH to become a Preferred Provider, that agreement consists solely of:
these Terms and Conditions;
any General Treatment Terms and Conditions which may be made available by TUH from time to time;
the application to join the Preferred Provider network submitted by the company to TUH, in the form determined by TUH; and
the letter from TUH to the company notifying it that TUH has accepted its application to become a Preferred Provider with the names of the recognised providers.
Where there is any inconsistency between any of the documents listed at 5.1 then these Terms and Conditions prevail.
An agreement referred to in clause 5.1 is governed by the law of the State of Queensland and is subject to the exclusive jurisdiction of the State of Queensland.
TUH makes no guarantee, representation or warranty that by becoming a Preferred Provider a practice will receive increased business from TUH members.
A practice does not become an agent of TUH by becoming a Preferred Provider.
TUH is not liable to any person for any loss, damage or injury incurred as a result of a preferred provider providing treatment or failing to provide treatment to a TUH member.
By becoming a TUH Preferred Provider a practice agrees to indemnify TUH against all expenses, losses, damages and costs that TUH may incur as a result of:
any breach of these Terms and Conditions by the provider; or
any loss or damage to any property or injury to or death of any person caused by any negligent act or omission or wilful misconduct of the practitioner or his or her partners, employees or contractors,
except to the extent that any such expenses, losses, damages and costs are caused or contributed to by TUH.
TUH may not give directions to a provider or otherwise attempt to influence a provider’s decision about the appropriate treatment for a TUH member, although it may require information about treatment given to a TUH member as described in clause 3.
TUH may contact a member to discuss any claimed treatment provided and/or ask the member to have a clinical examination if there are questions raised to which the company is unable to provide an explanation that satisfies TUH.
Preferred Provider Agreements will be issued for a maximum period of two years with the option of a two year extension at TUHs sole discretion. An agreement will only be valid when it is returned to TUH no later than 2 months after issue and is signed.
Preferred Provider Agreements will have a common expiry date of 31st December.
Changes to the terms and conditions
TUH may amend these Terms and Conditions at any time by giving the company notice in writing at least 28 days before the amendment is due to come into effect.
If the company wishes to amend these Terms and Conditions, its Director/Principal must make a written proposal to TUH, which TUH may accept or refuse at its absolute discretion.
If TUH accepts an amendment proposal from the company, then the amendment comes into effect from a date nominated by TUH.
Leaving the network
The participation of a company in the TUH Preferred Provider network may be terminated by the company or TUH at any time by giving three months’ written notice to the other party.
TUH may terminate the agreement in writing immediately if:
TUH reasonably finds that any or all providers at the company have failed to observe relevant regulatory body policy statements or guidelines; or
any or all providers at the company no longer meets the conditions in clause 1.4;
the company’s access to electronic claiming systems such as HICAPS is terminated;
In TUH’s reasonable opinion, the company’s conduct may adversely impact our goodwill, reputation or business; or
the company is sold.
and the termination of the company’s participation takes effect from the day on which TUH gives written notice to the company.
After termination has taken effect, the company:
must remove any promotional materials about the Preferred Provider network from display; and
must take any other steps necessary to ensure that it does not represent to any person that it continues to participate as a TUH Preferred Provider.
Resolving disputes
If any dispute arises between TUH and a provider or the company in relation to the Preferred Provider network, then both parties should, in good faith, try to resolve any disputes informally in the first instance.
Notices
Any notice to TUH in accordance with these terms and conditions should be in writing and signed on behalf of the company by an authorised party and sent by email to providers@tuh.com.au
Terms and Conditions for Healthia/ TUH Preferred Providers
TUH’s Physiotherapy and Podiatry preferred provider networks are designed to give TUH / Union Health members access to affordable treatments while retaining clinical independence.
Conditions of application to become a QUEENSLAND TEACHERS’ UNION HEALTH FUND LTD (TUH) Preferred Provider
An authorised representative of the company (preferably the Director) may apply for the Healthia Limited (the Company) and its Related Body Corporate, limited to the following entities: My FootDr (Aust) Limited, Allsports (Aust) Limited and BIM Physiotherapy Group Holding Pty Ltd (the Healthia Group) to become a TUH Preferred Provider. If the application is accepted all providers at Company owned practices who meet the conditions specified in clause 1.3 and elsewhere in this document will be considered Preferred Providers unless specifically excluded. Providers should be specifically excluded on the TUH Preferred Provider Application Form.
Where providers are specifically excluded from the TUH Preferred Provider Application it is the responsibility of the Company to advise the member that the provider is excluded from this agreement and ensure Informed Financial Consent is provided to the member prior to the commencement of treatment.
The Company must list each location at which it wishes to be a TUH Preferred Provider. This list of locations may be provided as a complete list for example as an excel file or similar and may be updated by the Company from time to time as additional practices join the Healthia Group. The list will contain all required fields regarding the provider and practice details.
For a provider at the practice to become a TUH Preferred Provider he or she must (on application, and ongoing for so long as they remain a TUH Preferred Provider):
Maintain appropriate qualifications to practice;
have a current provider number allocated by the relevant regulator the location at which they participate in the Network;
be fully registered with the Australian Health Practitioner Regulation Agency (AHPRA);
at all times, maintain the ethical and professional standards reasonably required; and
remain an employee or contractor of a practice owned by the Healthia Group.
Assessment of requests to become a TUH Preferred Provider
TUH may accept or refuse an application to become a Preferred Provider at its absolute discretion.
In deciding whether to accept or refuse an application TUH will take into account matters relevant to the viability and effectiveness of the TUH Preferred Provider Network, including:
any restriction on the size of the TUH Preferred Provider network;
the geographical distribution of TUH members;
the number of providers participating in the TUH Preferred Provider network in the same geographical area as the applicant; and
the results of any relevant TUH member satisfaction surveys and claims history audits.
The application must provide:
the name of each provider at the practice;
their AHPRA and Medicare provider numbers; and
any restrictions imposed on their practice.
Conditions of participation as a TUH Preferred Provider
As part of ongoing participation as a TUH Preferred Provider, the company must:
continue to meet the conditions to become a Preferred Provider;
abide by the TUH Fund Rules insofar as these are applicable to medical practitioners or providers;
maintain public liability insurance with a sum insured of at least $10 million which covers it against claims of personal injury or property damage that a third party suffers (or claims to have suffered) as a result of its business activities;
ensure that every provider covered by the agreement maintains professional indemnity insurance with a sum insured of at least $10 million which covers any provision of clinical services at the practice address provided;
practice within the legal and ethical standards expected in contemporary Australian health practice and in accordance with Australian Safety and Quality Goals for healthcare;
provide TUH members with quality services, including advice and information; and
give TUH permission to publish:
the fact that the provider is a Preferred Provider; and
the contact details for the provider on our website or in any other manner TUH decides.
The company will charge TUH members aged 17 years and under (up until the day before their 18th birthday) no more than $90 for initial physiotherapy services and comprehensive podiatry services. In return, TUH will pay a benefit of $90 for these services.
The company will provide TUH members with the following exclusive offers:
Physiotherapy
10% off initial and standard consultations (excluding the offer in 3.2)
Podiatry
10% off initial consultations (excluding the offer in 3.2); and
eComm retail footwear store: $20 voucher for every purchase over $100 for all members.
The company must keep records necessary to show compliance with these Terms and Conditions. Without limiting this obligation, a provider must retain for 2 years from the date of a professional service the invoice / receipt signed by the TUH member verifying that the service has been provided.
The company must provide TUH with any records or other information TUH may reasonably require to verify that a professional service has been rendered.
The company must provide TUH with any information it may reasonably require to confirm that all Preferred Providers are complying with these Terms and Conditions.
The company must notify TUH within 5 business days of any change to its address details as they appear in the application form.
The company is required to notify TUH in a timely manner of:
the details specified in clause 2.4 for new providers who commence at the company;
details of providers who leave the company.
In the event that the company is sold, the company must notify TUH within 10 business days. TUH may, at its absolute discretion, terminate the preferred provider agreement or transfer it to the new owner.
The company must notify TUH within 5 business days of any issues that may affect a provider’s registration including the imposition of disciplinary sanctions, restrictions, suspensions, or other conditions which may affect their ability to meet these Terms and Conditions.
In consultation with the Company, TUH may provide public notice and information of a company’s participation in the preferred provider network through point of service material to be placed in a noticeable position at the company’s premises.
Processing claims
TUH has the capacity to receive claims electronically through HICAPS or Healthpoint systems unless there is a technical issue at any point in time.
Whether claims are submitted electronically or manually, an invoice from the provider must include:
the patient’s name for manual claims and patient ID code for electronic claims;
the date of service;
a description of each service rendered;
item numbers;
the provider’s name, address and provider number;
the fee for the service; and
the net amount required to be paid by the patient.
Claims will be processed in accordance with the TUH Health Fund Benefit Rules. TUH pay benefits to our members in accordance with their level of cover and our policy terms and conditions. Conditions that may affect a member’s eligibility to receive benefits include, but are not restricted to: waiting periods; annual limits; compensation payable by another party and premium payments in arrears.
TUH will monitor claiming patterns and charges applied at its discretion. The TUH member will be responsible for the payment of any amount between the fee charged and the level of benefit paid (‘out of pocket expenses’).
General matters
Where a company enters into an agreement with TUH to become a Preferred Provider, that agreement consists solely of:
these Terms and Conditions;
any General Treatment Terms and Conditions which may be made available by TUH from time to time , to the extent that these are reasonable. The Preferred Provider may (acting reasonably), dispute the introduction of, or amendment to the General Treatment Terms and Conditions and, if the dispute cannot be resolved, may terminate the agreement in accordance with clause 7.1 of these Terms and Conditions;
the application to join the Preferred Provider network submitted by the company to TUH, in the form determined by TUH; and
the letter from TUH to the company notifying it that TUH has accepted its application to become a Preferred Provider with the names of the recognised providers.
Where there is any inconsistency between any of the documents listed at 5.1 then these Terms and Conditions prevail.
An agreement referred to in clause 5.1 is governed by the law of the State of Queensland and is subject to the exclusive jurisdiction of the State of Queensland.
TUH makes no guarantee, representation or warranty that by becoming a Preferred Provider a practice will receive increased business from TUH members.
A practice does not become an agent of TUH by becoming a Preferred Provider.
TUH is not liable to any person for any loss, damage or injury incurred as a result of a preferred provider providing treatment or failing to provide treatment to a TUH member.
By becoming a TUH Preferred Provider a practice agrees to indemnify TUH against all expenses, losses, damages and costs that TUH may incur as a result of:
any breach of these Terms and Conditions by the provider; or
any loss or damage to any property or injury to or death of any person caused by any negligent act or omission or wilful misconduct of the practitioner or his or her partners, employees or contractors,
except to the extent that any such expenses, losses, damages and costs are caused or contributed to by TUH.
TUH indemnifies the Preferred Provider against all expenses, losses and costs that the Preferred Provider may incur as a result of TUH’s breach of these Terms and Conditions.
TUH may not give directions to a provider or otherwise attempt to influence a provider’s decision about the appropriate treatment for a TUH member, although it may require information about treatment given to a TUH member as described in clause 3.
TUH may contact a member to discuss any claimed treatment provided and/or ask the member to have a clinical examination if there are questions raised to which the company is unable to provide an explanation that satisfies TUH.
Preferred Provider Agreements will be issued for a maximum period of two years with the option of a two year extension at TUHs sole discretion. An agreement will only be valid when it is returned to TUH no later than 2 months after issue and is signed.
Preferred Provider Agreements will have a common expiry date of 31st December.
Changes to the terms and conditions
TUH may amend these Terms and Conditions at any time by giving the Company notice in writing at least 28 days before the amendment is due to come into effect. The Company may (acting reasonably), dispute the introduction of, or amendment to the General Treatment Terms and Conditions and, if the dispute cannot be resolved, may terminate the agreement in accordance with clause 7.1 of these Terms and Conditions.
If the Company wishes to amend these Terms and Conditions, its Director/Principal must make a written proposal to TUH, which TUH may accept or refuse at its absolute discretion.
If TUH accepts an amendment proposal from the Company, then the amendment comes into effect from a date nominated by TUH.
Leaving the network
The participation of a company in the TUH Preferred Provider network may be terminated by the company or TUH at any time by giving three months’ written notice to the other party.
TUH may terminate the agreement in writing immediately if:
TUH reasonably finds that any or all providers at the company have failed to observe relevant regulatory body policy statements or guidelines; or
any or all providers at the company no longer meets the conditions in clause 1.4;
the company’s access to electronic claiming systems such as HICAPS is terminated;
In TUH’s reasonable opinion, the company’s conduct may adversely impact our goodwill, reputation or business; or
the company is sold.
and the termination of the company’s participation takes effect from the day on which TUH gives written notice to the company.
After termination has taken effect, the company:
must remove any promotional materials about the Preferred Provider network from display; and
must take any other steps necessary to ensure that it does not represent to any person that it continues to participate as a TUH Preferred Provider.
Resolving disputes
If any dispute arises between TUH and a provider or the company in relation to the Preferred Provider network, then both parties should, in good faith, try to resolve any disputes informally in the first instance.
Notices
Any notice to TUH in accordance with these terms and conditions should be in writing and signed on behalf of the company by an authorised party and sent by email to providers@tuh.com.au.
