ÁñÁ«ÊÓƵÏÂÔØ

The following definitions apply throughout the Business Rules:

ÁñÁ«ÊÓƵÏÂÔØ Victoria (AV) manages the AV ÁñÁ«ÊÓƵÏÂÔØ Scheme and provides AV Services either directly or through contracted third parties.

ÁñÁ«ÊÓƵÏÂÔØ/AV Services

1. Includes ambulance treatment, transport, referral service or alternative care provided by AV resources or those resources contracted to provide services for and on behalf of AV for medical or surgical cases; and
2. Excludes any services provided by the Royal Flying Doctor Service (RFDS) unless transport is deemed Clinically Necessary and pre-approved by AV or the result of an emergency case; and
3. Must be deemed Clinically Necessary, with the exception of Emergency Cases; and
4. In all cases AV will transport patients to/from the nearest and most appropriate medical facility.

Australia Refers to all States and Territories of Australia and its Territorial waters.

AV’s Operational Boundaries means the areas that AV operates within (all of Victoria and certain areas of South Australia and New South Wales). Please refer to AV’s website for a list of towns or call the AV ÁñÁ«ÊÓƵÏÂÔØ Service Centre on 1300 366 141.

Clinically Necessary means the patient or the Member require active clinical monitoring/care or clinical supervision during transport that is provided by a paramedic, health professional or qualified patient transport officer or attendant. Authorisation must be provided by a Health Professional who can make an informed decision about whether there is a genuine clinical need for a patient to be transported by ambulance instead of any other way.

Continuity of Benefits means Members’ who renew their ÁñÁ«ÊÓƵÏÂÔØ within thirty (30) days post their renewal date may receive continuous ÁñÁ«ÊÓƵÏÂÔØ. If continuous
ÁñÁ«ÊÓƵÏÂÔØ applies then payment will be allocated from their due renewal date, with no loss of benefits.

Cover Note is an interim twenty one (21) day confirmation of the ÁñÁ«ÊÓƵÏÂÔØ valid until the expiry date shown on the Cover Note; Subject to payment being received by AV within the Cover Note period.

Dependants – in respect of a Member includes the following:

• The Member’s partner, including legal or de-facto partners, whether of the opposite or same sex, and residing with the Member within AV’s Operational Boundaries;
• All dependent children (under the age of 17 years) of the Member and/or their partner, whether the
  natural child of the Member and/or their partner, or adopted, or a foster child, or any child in respect of which the Member and/or their partner is responsible for the primary care of that child;
• Dependent students of the Member and/or their partner engaged in full-time study at a secondary or tertiary education institution, provided that they are single and dependent upon the Member and are under the age of 25;
• Exchange students may be covered on their host’s Family ÁñÁ«ÊÓƵÏÂÔØ if approved by AV. If AV accepts the child as a Dependant, they will be covered on a Family ÁñÁ«ÊÓƵÏÂÔØ.

Notes:

1. Dependants must be eligible and listed on a Family ÁñÁ«ÊÓƵÏÂÔØ to receive Member benefits.
2. Those Dependants awaiting placement at tertiary institutions will continue to be covered by their parent/guardian’s ÁñÁ«ÊÓƵÏÂÔØ up to 31 March of the year for which they have applied for placement. After this date proof of full time student status must be provided to receive ÁñÁ«ÊÓƵÏÂÔØ benefits in the event of having used AV’s services.
3. Where a Dependant student aged 17 to 24 years old requires transport by ambulance, an invoice may be issued and proof of full time student status will be required for invoice settlement.

Emergency Cases means cases that originate from a triple zero (000) call and are prioritised as an emergency case by the relevant authority.

Family ÁñÁ«ÊÓƵÏÂÔØ refers to a ÁñÁ«ÊÓƵÏÂÔØ for a Primary Member and their Dependant(s).

Financial Member is a Member who has paid for ÁñÁ«ÊÓƵÏÂÔØ for a period in advance.

Health Professional means a health professional who can authorise whether ambulance transportation is Clinically Necessary. This includes:

• A registered medical practitioner;
• An AV paramedic;
• Authorised employee of Triple Zero Victoria; or
• A registered division 1 nurse

Member is any person who paid for a ÁñÁ«ÊÓƵÏÂÔØ for a ÁñÁ«ÊÓƵÏÂÔØ Period.

Member Benefits Members receive ambulance treatment, transport and services at no additional cost to the Member for Emergency Cases and Clinically Necessary Non-Emergency Cases except where exclusions and exceptions apply, including those exemptions set out under Section 2.4 and Section 3.0 of these Business Rules
In all cases transport is provided to the nearest, most appropriate medical facility. In Victoria, AV Services must be provided by AV or those resources contracted to AV to be included as a Member Benefit.

ÁñÁ«ÊÓƵÏÂÔØ can be in the form of a Single ÁñÁ«ÊÓƵÏÂÔØ or Family ÁñÁ«ÊÓƵÏÂÔØ.

ÁñÁ«ÊÓƵÏÂÔØ Commencement Date is the Members start date for the ÁñÁ«ÊÓƵÏÂÔØ as set out under Clause 3.1.1.

ÁñÁ«ÊÓƵÏÂÔØ Fee is the relevant payment required by AV that entitles a person to either a Single or Family ÁñÁ«ÊÓƵÏÂÔØ. Due to the variety of payment channels available the ÁñÁ«ÊÓƵÏÂÔØ Fee may not be received by AV on the same day it is paid however, the Fee will be applied effective to the date it was paid once received, based on the date information provided by the relevant financial or payment institution. As such AV recommends that Members please allow up to three (3) business days for your payment to be applied by AV. In the situation where a payment is not received by AV, proof of payment will be requested in order to locate the payment.

ÁñÁ«ÊÓƵÏÂÔØ Period is the period of time expressed under Clause 3.1.3 that the Member has paid for ÁñÁ«ÊÓƵÏÂÔØ. If payment for a ÁñÁ«ÊÓƵÏÂÔØ is not received for a full quarter, one, three, or five year period, AV will pro-rata this payment to provide ÁñÁ«ÊÓƵÏÂÔØ for the pro-rata period.

New Member is a person who takes out AV ÁñÁ«ÊÓƵÏÂÔØ for the first time.

Non-Emergency Cases means cases designated by AV as requiring a Non-Emergency response and that is deemed Clinically Necessary.

Non-Emergency Patient Transport means Clinically Necessary non-emergency patient transport provided by ÁñÁ«ÊÓƵÏÂÔØ Victoria or by a contracted service provider on behalf of ÁñÁ«ÊÓƵÏÂÔØ Victoria.

Pre-Existing Ailment is any ailment, illness or condition of which the signs or symptoms were, in the opinion of a medical practitioner, in existence during the six (6) months prior to the day of joining. Pregnancy is not a preexisting condition for the purpose of this definition.

Qualifying Period is the period of time before ÁñÁ«ÊÓƵÏÂÔØ Benefits for pre-existing and non-emergency cases are provided (Refer to Clause 3.2 Qualifying Period).

Reinstated Members means Members who cease to be Financial Members and who subsequently renew their ÁñÁ«ÊÓƵÏÂÔØ.

Renew/Renewing/Renewal means the payment of the ÁñÁ«ÊÓƵÏÂÔØ Renewal fee as noted on the ÁñÁ«ÊÓƵÏÂÔØ renewal form by the due date, provided funds are not dishonoured (Refer Clause 5.1 Funds and Dishonour Fees).

Single Member means a Member with no Dependants.

Single ÁñÁ«ÊÓƵÏÂÔØ this provides Member benefits for one individual only.