Search FAQ Questions

Cancelling your cover

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How can I cancel my membership?

HCF requires the Policyholder to provide notice in writing if you want to cancel your membership. Any premiums paid in advance of the effective cancellation date will be refunded in full, provided you haven’t made a claim after your cancellation date.

If you want to cancel your cover, we’d like to discuss your reasons with us first, and hopefully find alternatives that won’t affect your lifetime health cover status, so please call us on 13 13 34.


Changing cover

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If I change my level of cover, what should I be aware of?
  • For a lower level of cover, you will be entitled to the benefits of your new level of cover immediately.
  • When you change to a higher level of cover, you will only be entitled to the benefits from your old level of cover until you serve the necessary waiting periods for the higher benefit entitlements. For example, if your old cover had a benefit limit of $500/yr and your new cover has a benefit limit of $800/yr with a waiting period of 6 months, you would not be able to access the extra $300/yr for this benefit until you have served 6 months on the new level of cover.
  • Waiting periods will also apply upon upgrading for services you were previously not covered for. To confirm waiting periods that may apply, refer to your policy information, or by calling HCF on 13 13 34.

Changing details

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How do I change my personal details?

Log into our member section where you can change your address, phone numbers, and email address. Alternatively call HCF on 13 13 34, email service@hcf.com.au or visit one of our branches.

How HCF collects, uses, discloses, and keeps secure your personal information is described in the HCF Privacy Policy.

How do I change who is covered on my membership?

Call HCF on 13 13 34, email service@hcf.com.au or visit one of our branches.

I recently married, how do I change my surname on my membership?

Congratulations!

Step 1: change your name with Medicare
Step 2: send us a copy of your marriage certificate, with a covering letter, to GPO BOX 4242, Sydney, NSW, 2001
Step 3: we will re-order a new card

You will receive your card in approximately 5 working days.

All current membership cards will no longer be valid once your order has been successfully processed - which is:

  • 8pm (AEST) Tuesday - if you ordered your card between 5pm (AEST) Saturday and 8pm (AEST) Tuesday (not from the date of request)
  • 8pm (AEST) Thursday – if you ordered your card between 5pm (AEST) Tuesday and 8pm (AEST) Thursday (not from the date of request)
  • 5pm (AEST) Saturday - if you ordered your card between 8pm (AEST) Thursday and 5pm (AEST) Saturday (not from the date of request)


Claiming

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What do I need to know before I claim?
  • Make sure your contributions are paid up to the date of service
  • You must have served the relevant waiting period – for example there is a twelve month waiting period before you can claim for a pre-existing condition
  • You can't lodge a claim before the service has been provided
  • Claims must be lodged within 2 years of the date of service
  • The Policyholder's or nominated partner's signature must appear on the claim form
  • An HCF recognised health practitioner must provide the service
  • Claims for artificial appliances approved by HCF may need a letter of authorisation from the practitioner, stating the condition being treated. If you would like to claim for an artificial appliance please call us on 13 13 34 to find out if you need a letter from your practitioner
  • Submit original accounts (not photocopies) detailing the date of service, the item number, the description of service and the cost
  • Claims relating to school accident cover must be made within 12 months of the date of the accident.
Hospital claims

Knowing what you're entitled to claim for when in hospital can become very confusing. That's why we try to make it as clear as possible for you. Please log into our member section or call 13 13 34 to find out what you're entitled to under your current policy.

If you are admitted into a participating private hospital, the hospital will send a bill to HCF on your behalf. All you need to do is read the claim form carefully, answer the questions and sign it before being discharged.

Also non-participating private hospitals and public hospitals will send bills to HCF on member's behalf.

If your policy requires you to pay an excess or you have restricted cover, you will need to pay your excess and any gap payment directly to the hospital.This usually occurs at the time of departure, however, check with your hospital to make sure.

Please check with the hospital whether you have to pay this upon admission or if they bill you.

Doctor and Specialist claims during hospital admission

If your doctor or specialist treated you under the HCF Medicover agreement, they will send the bills directly to HCF.

If your doctor or specialist sends the bills to you, please take it to Medicare and complete a Medicare Two-Way form and drop into an HCF branch and complete a Medicare claim form and an HCF claim form.

Did your doctor or specialist treat you under the HCF Medicover agreement?

  • Yes - Then there's no need to visit Medicare. They will send the bill directly to HCF.
  • No - Just take your bill to either Medicare or HCF and complete a Medicare Two Way form and a Medicare form.
Extras claims

Here are the ways to claim payments for extras:

1. On the spot

This is your most convenient way to claim for some services such as visiting your optometrist, dentist(claims for orthodontic treatment must be submitted by mail or at a branch), physiotherapist, chiropractor, osteopath, speech pathologist, occupational therapist, dietician or podiatrist. Using our electronic claims and payment system, you just need to pay the difference between the cost and benefit once the claim is approved electronically.

2. Photo claiming with the HCF app

Download the HCF app to your personal device to submit a claim with a photo of your receipt.

3. Claim by post

You can pick up a claim form from any branch, download one or call Self Service on 13 13 34 and we’ll post or email one to you.

Then just:

  • Complete and sign the claim form and, attach the original receipts (the receipts must have the name and address of the provider printed or stamped on them, not handwritten)
  • Post the form to HCF at GPO BOX 4242, Sydney, NSW, 2001
  • We will post you a cheque, or credit your nominated bank account if the receipt you’ve attached shows that you’ve paid the provider. If there is no receipt attached to the claim form, and only an account, a cheque will be drawn to the person or organisation that provided the service.
  • We'll also send you statement for your records.

4. Claim in person

You can make a claim at any HCF branch by presenting your membership card and original receipts. The name and address of the health care provider must be printed or stamped on the receipt, not handwritten. We will credit to your nominated bank account, and give you a statement for your records.

5. Claim online

You can claim online for popular Extras like general dental, dietetics, occupational therapy, podiatry, podiatry, homeopathy, speech pathology, remedial massage, naturopathy and physiotherapy.

To claim these online follow these steps:

  • If you are a first time user of the HCF Member Section, please select the ‘Register now’ link on the login page.
  • If you currently have access to the HCF Member Section, you will need to log in and select the 'Make an online claim' link.

When you have completed your online claim, please ensure that you post the original receipts, otherwise future claims may be delayed.

Ambulance claims

Medicare doesn’t cover the cost of an ambulance and these services can be very expensive.

HCF hospital and extras products include cover for State Government emergency ambulance services. Plus, on selected levels of cover, you may also be able to claim up to $5,000 per person, per year for non-emergency, medically necessary State Government ambulance transport i.e. where your doctor requests ambulance transport because your condition requires medical monitoring and support in transit.

Ambulance transport is to the nearest appropriate hospital able to provide the level of care you need. There is a waiting period of one day for emergency ambulance cover, 2 months for non-emergency ambulance cover and 12 months for pre-existing ailments or conditions.

NSW and ACT members

If you live in New South Wales or Australian Capital Territory, a levy is included in the hospital component of your private health cover. This levy entitles you to free ambulance transport under the State Government ambulance transport schemes. So, if you receive an invoice for ambulance transport, just send it to us; we will endorse the account and send it to the appropriate ambulance transport scheme for settlement. Members with pension or social security entitlements in NSW or the ACT just need to complete that section on the back of the ambulance account and return it to the ambulance service.

If you fall outside the state based arrangement for ambulance services and aren’t otherwise covered, you can claim under your HCF product for State Government provided emergency ambulance services.

QLD and TAS members

If you live in Queensland or Tasmania, you’re covered under your state ambulance service scheme. If you fall outside your state based arrangement and aren’t otherwise covered for emergency ambulance services, you can claim under your HCF product for State Government provided emergency ambulance services.

VIC, SA, NT and WA members

If you live in Victoria, South Australia, the Northern Territory or Western Australia and you don’t have an ambulance subscription with your state ambulance service and aren’t otherwise covered (including under other state based arrangement e.g. where the State Government has made a provision for free ambulance services for aged pensioners) you can claim under your HCF product for State Government provided emergency ambulance services.

Online claims

How do I make an online claim?
Log into online member services and select ‘Make an online claim’.

What can I claim online for?
You can claim online for:

  • Diagnostic Dental
  • Preventative Dental
  • Periodontic Dental
  • Extractions
  • Physiotherapy
  • Speech Pathology
  • Occupational Therapy
  • Podiatry/Chiropody
  • Dietetics
  • Naturopathy
  • Homoeopathy
  • Remedial Massage
  • Pharmaceutical (non-PBS, limited items available)
  • Artificial Appliances
  • Peak Flow Meter
How do I claim for doctor and specialists’ medical accounts when I have been in hospital?

You will need to take your account to Medicare and complete a Medicare Two Way claim form. For more information and to download a Two Way claim form, go to http://www.humanservices.gov.au

Where can I find information on More for you program providers?

You can search for recognised ancillary (extras) providers in your local area by logging into member section the member section and following the links to Find a Health Professional. Here you can search for specialist doctors, More for Muscles program physiotherapists, More for Backs program chiropractors or osteopaths, More for Teeth program dentists, More for Eyes program optical providers, More for Feet program podiatrists and online optical providers.

Alternatively you can call HCF on 13 13 34.


Dependants

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Does my health insurance cover my children?

As long as they are listed on your policy, your children are automatically covered under your family cover until the day before they turn 22. If they are full-time students, simply register them as Student dependants, and they'll be covered for no extra cost until the day before they turn 25 or cease full time study (whichever comes first).

What is Extended Family Cover?

If your children aren't full-time students, you can also continue to cover them until they turn 25 with Extended Family cover on selected levels of HCF cover. As long as they're not married or in a de facto relationship, you can take out this cover for a surcharge of about 25% of your existing premium - even if your children are living away from home.

I have just finished school, and am starting my first job. Does my families' health insurance cover me?

If you're under 22 years of age, you don't need to do anything. You're covered under your family's membership.

If you're between 22 and 25 years, you can continue to be covered under "Extended Family Cover". It simply requires an extra cost of 25% on top of your family's current membership.

I am still living at home but just finished studying at university full time - what do I need to know?

If you are under 25 years, you can be covered under "Extended Family cover" at an additional cost of 25% of the existing premium on your families' membership.

I am still studying at university - do I need health insurance?

If you are single, aged less than 25 years and studying full time, you can continue to be covered under your parent's family membership as a student dependant.


Excess

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What is an excess?

An excess is the amount you nominate to pay if you are admitted to hospital. Depending on your level of hospital cover, you can reduce your premium by opting for a higher excess or pay a bit more to get a lower excess. An excess is the amount you nominate to pay if you’re admitted to hospital.

You can also save more if you need to claim because:

  • You won’t pay a hospital excess for dependent children.
  • You pay only one hospital excess amount per person per calendar year if an excess is applicable.

Exclusions

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What is an exclusion?

If you need treatment for any procedures listed as an Exclusion in your hospital cover, you won't receive any benefits from us and you may have significant out-of-pocket expenses. Make sure you have reviewed the Exclusions list before purchasing your cover.


Health Management Programs

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What are HCF Health Management Programs?

Click here to find out more about HCF Health Management Programs.

How can I claim a Health Management Program benefit?

Before you start any program, please check with us so that you don’t incur any expenses that aren’t covered. A summary of the different programs and requirements can be found here.

Then submit your receipts (see requirements below) together with the appropriate claim form:

  • Exercise and gym programs claim form
  • Healthy Weight for Life program please complete claim form
  • For all other health management programs please complete the standard HCF claim form.

HCF only accepts receipts that include the following details:

  • The full name of the member participating in the program
  • The type of program
  • Who is providing the program
  • Where the program takes place (address)
  • Start and completion dates
  • Cost of program (must be paid in full)

Joining

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How can I join HCF?

You can join:

  • Choose the cover that's right for you, and then complete the online application form. You will even have the option to make your first payment online.
  • Mail your completed application form to HCF, GPO BOX 4242, Sydney, NSW, 2001
  • Contact an HCF representative.
How do I choose a cover that suits my needs?

At HCF, we are dedicated to helping members choose the right cover. If you would like assistance with choosing your health cover you can:

  • Use the various tools available on the HCF website
  • Contact an HCF representative.
  • Visit a branch
When does my cover start?

Your cover will start as soon as you have paid us all premiums due at the time that you apply, and have fully completed our application process. Waiting periods may apply so make sure you check out how this affects your membership before you join.

Does HCF offer a free trial?

Yes. You will receive a 100% refund on your Hospital and Extras cover if you change your mind and choose to cancel your policy within 30 days, and you haven't made a claim.

Will I get a membership card?

Yes. Upon joining, all HCF members receive a membership card that lists the membership number and the names of those covered. You will receive your card within 10 working days of joining. You can use your membership card to make 'on the spot' claims at branches or through HICAPS.


Loyalty benefits

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What are loyalty benefits and how do they work?

Your loyalty is rewarded and limits accrue on many of our extras according to your level of cover, and the number of years you have been on this level of cover. You can get more information on any available loyalty benefits by referring to your product summary (available for download in the member section) or by calling us on 13 13 34.

Please note that when you upgrade your cover you may need to serve waiting periods before you can take advantage of the increased benefit and limits.


Membership Card

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How can I order a replacement membership card?

Log in to the member section and follow the links to “Reorder Membership Card” to submit your request for new a new card. Your new card will arrive in approximately 5 working days.

Please note:

  • For security purposes, all current membership cards will no longer be valid once your order has been successfully processed
  • The minimum selection is 1 card for single or single parent membership, and 2 cards for a family membership.
  • The maximum number of cards you can select is based on the number of people covered on your membership.

If you have any questions please call 13 13 34 or contact us.


Payment

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How do I pay for my membership?

Ezipay (direct debit from a bank, building society or credit union account)

We can arrange for your bank, building society or credit union to make your payments automatically by direct debit from your nominated account. Simply download the payment authority form and return it to HCF.

Ezipay (credit card)

Arrange for your bank, building society or credit union to make your payments automatically by direct debit from your credit card. Download payment authority form

You can choose any direct debit date with the exception of the 28th, 29th, 30th and 31st day of a month, and you can pay your premiums yearly, half yearly, quarterly or monthly.

We will advise you if your payment is not made, and what you need to do to keep your membership up to date. Please note: If your account becomes overdrawn, some financial institutions may charge you a fee.

We guarantee to abide by the Direct Debit Customer Service Agreement so that we can maintain a trusting relationship with you.

Payroll deduction

Payroll deduction is an automatic payment from your wages or salary. If your employer participates under an HCF Payroll Scheme, you can arrange to have your contributions paid directly from your salary or wages.

If you're not sure whether your company has such a scheme, just ask your Human Resource or Payroll team, or give us a call on 13 13 34.

Online

You can make a secure payment with your credit card online. Just log in to the member section and select Make a Payment.

By phone

We accept American Express, MasterCard and VISA. Just call 13 13 34.

By mail

You can mail a cheque to us at: HCF, GPO BOX 4242, Sydney, NSW, 2001
Note: Please remember to write your membership number on the back of your cheque, and we can't accept cash through the mail.

How do I use BPAY?

BPAY

With BPAY, you can make your HCF payments any time over the phone, or via internet banking.

How do I change my bank details?

If you would like to change your bank details for direct debit (Ezipay), please log into the member section and follow the links to Change Ezipay Details. Alternatively you can call HCF on 13 13 34.

To change your banking details for the direct credit of benefits, please call HCF on 13 13 34.


Pre-existing ailments or conditions

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What are pre-existing ailments or conditions?

A pre-existing ailment or condition is an ailment or illness or a condition where the signs or symptoms existed during the six months before joining HCF or upgrading to a higher level of cover, even though a diagnosis may not have been made.

If there is any doubt as to whether an ailment or condition is pre-existing, a medical practitioner appointed by HCF will examine information provided by your doctor, together with other relevant claim details.


Pregnancy

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What are 'pregnancy and birth related' services?

These are services that are directly related to the hospitalisation for pregnancy and childbirth. They include things like complications of pregnancy, delivery itself and prenatal and postnatal care of the mother.

What sort of cover do I need if I want to have children, and cover the birth?

You need to ensure you are on an appropriate level of cover at least 12 months prior to giving birth, as a 12 month waiting period applies to pregnancy and birth related services. Appropriate cover means a hospital cover that does not exclude benefit for pregnancy and birth related services.

To confirm if your are covered for pregnancy and birth-related services, please refer to your policy information, or call HCF on 13 13 34.

We are having a baby – when do I need to add my baby to my membership so he or she is covered?

If you’re on a single or couples membership, it’s important to call to tell us your expected due date as soon as possible. We’ll transfer you to a family membership from the expected date of birth. This will ensure your baby is covered and won’t have to serve any waiting periods. If you don’t tell us your expected due date, you still have two (2) months to transfer to a family membership from the date your baby was born and your baby will be covered from this date.


Privacy

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How do I know my privacy is protected?

HCF is committed to protecting your privacy. How HCF collects, uses, discloses, and keeps secure your personal information is described in the HCF Privacy Policy.


Travel

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I am travelling interstate - does my private health insurance cover me outside my state?

Yes - you're covered throughout Australia. On selected levels of cover, HCF members who live in isolated and rural communities can claim travel benefits where specialist medical and hospital treatment is not available locally. If you're intending to move interstate permanently, please give us a call on 13 13 34 to change your contact details.

Does my private health insurance cover me if I'm sick when travelling overseas?

No - your HCF cover is only effective in Australia.

We recommend taking out travel insurance whenever you travel overseas. As an HCF member, you're entitled to a discount of up to 20% on HCF Travel Insurance. HCF Travel Insurance is issued by QBE Insurance (Australia) Limited.

Should I suspend my policy while overseas?

When you travel overseas, it's wise to carry travel insurance if medical or emergency assistance is required. Remember, your HCF hospital, extras or more protection insurance only applies when you're in Australia.

If all members on the HCF policy are overseas for more than 30 days, you may be able to suspend your policy for this period.

Think seriously before you suspend or cancel your HCF policy as individuals and families who do not have adequate private patient hospital cover may be liable to pay additional Medicare Levy Surcharge (MLS). If you are unsure, give us a call on 13 13 34 and we can go through your options with you.

Suspending your policy also means you won't be eligible for free travel insurance, if it's included on your cover.

What if I cancel or suspend my policy for the period I am away overseas?

If you do that, then you are considered to be without private hospital cover for that period. Accordingly, you may be liable for the MLS if your taxable income exceeds the relevant threshold.

If you suspend your cover, the period of suspension will not count towards any waiting periods or towards benefits that accrue based on a length of membership. If you cancel completely and don’t have cover with another private health insurer in Australia, you will need to re-serve all waiting periods.

Do I have to suspend or cancel my health insurance policy when I go overseas for a period of time?

There is nothing in the tax legislation that requires you to suspend or cancel your policy if you go overseas. It is your choice but there may be MLS implications if you do suspend or cancel your policy.

Won't the premium payments I save by suspending or cancelling my policy be enough to pay my MLS liability?

Not necessarily. You should contact your accountant or tax agent for advice.

What if I take out travel insurance for the period I am overseas and suspend or cancel my private patient hospital cover?

Travel insurance is not private patient hospital cover for MLS purposes. Hence, you are considered to have no private patient hospital cover during the period of suspension or cancellation.

If you have cancelled the policy, you will not be deemed to have had continuous membership and will need to re-serve all waiting periods.

What if I take out medical insurance with an overseas fund for the period overseas but cancel my cover in Australia during this period?

Private patient hospital cover does not include cover provided by an overseas fund. Hence, you are considered to have no private patient hospital cover during the period of suspension or cancellation.

What if I cancel or suspend cover for myself but retain the cover for my family?

Individuals on a policy cannot be suspended. In family situations, this means everyone on your policy must be suspended. You and your dependants need to have private patient hospital cover to avoid paying the MLS. Cancelling or suspending cover for yourself will mean that you and your spouse may each still be liable for the MLS if your taxable income exceeds the relevant threshold.

What if I take out travel insurance for the period you are overseas as well as maintain my private patient hospital cover?

By maintaining your private patient hospital cover in Australia, you will not be liable for MLS for that period overseas.


Suspending your cover

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How do I suspend my membership?

You can apply to suspend your membership if you’re travelling overseas, receiving a Newstart Allowance or Sickness Allowance from Centrelink, or for a reason approved by HCF. Please note that all individuals on the suspended policy won’t be covered for the period of suspension. Suspension is at HCF’s absolute discretion.

To discuss suspending your membership, please call 13 13 34.

What conditions apply to suspending my membership?
  • The minimum period of suspension is 30 days
  • The maximum period of suspension is 2 years, after which time the membership will lapse
  • No benefits are payable to a member during the period of suspension
  • The period of suspension doesn't count towards waiting periods and loyalty benefits will not increase (e.g. orthodontic limit)
  • The additional Medicare Levy Surcharge may be payable for the period of suspension, depending on your annual taxable income
  • A member wishing to suspend their cover for travel reasons, must advise HCF before leaving Australia
  • Active and financial membership must be held for more than six months before suspension and at least six months between suspensions
  • A membership cannot be suspended more than once in a 12 month period
  • Cash Assist options and life insurance policies cannot be suspended. To maintain the cover provided, please call 13 13 34 to arrange for the premiums to be paid while your health cover is suspended

Only health products can be suspended. You can’t suspend if you’re on Overseas Visitor cover or on a Life product.

I am currently suspended, how do I resume my cover?

Your policy must be resumed within 30 days of no longer receiving a Newstart Allowance or Sickness Allowance from Centrelink, or within 30 days of your return to Australia.

An Application to Resume Membership and Payment Authority Form (if applicable) must be completed and submitted to us, together with proof that benefits were being received (i.e. a letter from Centrelink or current employer) or proof of departure and arrival into Australia.


Wisdom teeth

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I need to have my wisdom teeth removed. Am I covered?

Your hospital cover will contribute towards the costs incurred in hospital if you are being admitted for the wisdom teeth extraction in a hospital. Extras cover contributes towards the costs of wisdom teeth extraction in the dentist’s chair or in hospital, subject to your level of cover. You must serve the 12 month waiting period before you are covered for this procedure. The benefit for the dental surgeon is taken from the annual limits of your extras product and makes a contribution only and you will have an out of pocket expense.

You can contact Member Services on 13 13 34 for more information.


Complaints

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What should I do if I have a complaint?

If there's a problem with your membership or cover, please contact HCF directly so we can assist in resolving it as quickly as possible.

Ombudsman

If your complaint isn’t dealt with satisfactorily, you can also contact the relevant Ombudsman

  • independent bodies formed to help resolve complaints and provide advice and information.

If your complaint is about Health Insurance:

Private Health Insurance Ombudsman

Call: 1300 362 072 (option 4 for private health insurance)

Visit: ombudsman.gov.au

Email: phio.info@ombudsman.gov.au

Online: ombudsman.gov.au/making-a-complaint/contact-us

Write: Private Health Insurance Ombudsman, Commonwealth Ombudsman, GPO Box 442, Canberra, ACT, 2601

If your complaint is about Life Insurance, Pet Insurance or Travel Insurance:

Financial Ombudsman Service Australia

Call: 1800 367 287

Visit: fos.org.au

Email: info@fos.org.au

Write: Financial Ombudsman Service Limited, GPO Box 3, Melbourne, VIC, 3001

HCF also supports the Private Patients Hospital Charter, which outlines what members can expect from doctors, hospitals and health funds. Copies of the Charter are available by phoning 13 13 34.


Australian Government Rebate on private health insurance

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How can I claim the Australian Government Rebate?

You can claim the Australian Government Rebate as a reduction on your premium paid to HCF (this requires a completed Australian Government Rebate Application form), or as a rebate through your annual tax return.

What happens if I nominate an incorrect tier?

When you lodge your income tax return, the ATO will determine the amount of your private health insurance rebate entitlement, which may result in a refund or a liability.

There is no penalty for miscalculating your ‘income’ and claiming the incorrect private health insurance rebate.

Do I need to let my health fund know what my income is in order to determine my rebate tier?

No. You do not have to, and should not report your income to your health fund; you just need to nominate your tier.

If my income falls into Tier 1, 2 or 3, can I continue to claim any of the rebate amounts through reduced premiums?

Yes, you can receive any rebate amount you select. When you submit your tax return, the ATO will determine whether you have claimed a rebate more than you are entitled to and will seek reimbursement in your tax assessment.

What happens if any member of a family passes away?

If any member of a family dies, family thresholds will continue to apply for the financial year in which the payment was made. If a dependent child dies, any increase in the thresholds due to that child will apply for the financial year in which the payment was made.

How does the rebate affect employer-purchased cover?

Where employers fully or partially subsidise private health insurance as an employee benefit, this is a private arrangement between employer and employee. Employees (i.e. the adults covered by the policy) can still nominate a rebate tier and make up the difference if required.

Who is entitled to the rebate for dependent child only policies?

The parents are income tested and are entitled to the rebate. When the dependent child has two parents, who are not married on the last day of the financial year, the parent who paid the premium is income tested and entitled to the rebate.

What happens if my income or my family’s income changes from one tier to another during financial year? What will be the effect of that change on private health insurance rebate & medicare levy surcharge?

There is no penalty for changing tiers during the financial year.

If you have claimed too much private health insurance rebate, as a premium reduction or through Medicare, the ATO may recover the amount as a tax liability. This liability will be listed on your notice of assessment.

If you have not received your full rebate entitlement, the ATO will calculate the rebate you are due and refund this to you as a tax offset when you lodge your tax return. The tax offset will be listed on your notice of assessment.

Is the rebate applicable to the Lifetime Health Cover (LHC) loading on private health insurance?

No, From 1 July 2013, the private health insurance rebate has been removed from the LHC loading. which means that the LHC loading component of your health insurance premium is no longer eligible for the rebate despite you being eligible for a rebate overall.

For more information, please visit the ATO website.


What is private health insurance?

Private health insurance is about having choice and access, and being in control of your situation. It's the only affordable way to choose your own hospital, your own doctor and your own timeframe. Just as extras cover is the only option if you want to pay less for dental, physiotherapy, optical, chiropractic and all the other every day health services not covered by Medicare.

Currently almost 10.5 million Australians (45.7%) have private health cover.

What are the benefits of HCF Private Health Insurance?

Doctor of your choice

You get to choose your doctor, which means peace of mind.

Avoid waiting lists

You can access the HCF network of Participating Private or Public hospitals.

If you need an urgent operation or medical treatment, you won't need to go on a waiting list. Our hospital cover will quickly get you into a private hospital so you can spend your time getting better, not waiting for surgery and a bed.

Our generous benefit limits for extras like dental, optical, chiropractic and physiotherapy services will keep more money in your pocket and help you to achieve a better level of health.

Take advantage of government incentives

You can avoid having to pay the Lifetime Health Cover loading if you take out cover before you turn 31. Loading adds an additional 2% to the cost of your hospital premiums for every year after you turn 31.

In addition, the Australian Government Rebate may subsidises your premium to help make your private health cover more affordable. Full details

Reduce your tax

Reduce your tax by taking out private hospital cover and not having to pay the Medicare Levy Surcharge (extra tax). Go to www.ato.gov.au for full details.

What should I know before purchasing health insurance?

The Private Health Insurance Ombudsman produces an annual State of the Health Funds Report to assist consumers in assessing the relative performance and service delivery of each of the health funds. This report can be accessed at www.phio.org.au. The Ombudsman can also be reached on 1800 640 695, or by writing to Suite 2202, 580 George St, Sydney NSW 2000

What is the private health insurance Code of Conduct?

HCF supports the Private Health Insurance Code of Conduct ensuring:

  • You will receive correct information on private health insurance
  • You are aware of the internal and external dispute resolution procedures
  • You can make an informed decision about your purchase through informative policy documentation
  • You are protected in accordance with privacy principles

A full copy of the code is available at www.privatehealth.com.au/codeofconduct

What is the Private Patients Hospital Charter?

HCF supports the Private Patients Hospital Charter, which outlines what members can expect from doctors, hospitals and their health fund. Copies of the Charter are available by phoning 13 13 34 or at www.phiac.gov.au

What are HCF's Fund Rules?

You can read all about our rules in this download


Lifetime health cover

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What is Lifetime Health Cover, and how can I avoid the loading?

According to the Lifetime Health Cover initiative those who take out Hospital cover before the age of 31 and keep it can maintain lower premiums. From 1 July following your 31st birthday, you will pay 2% more for each year you don't have hospital cover. If you're already over 31, take out hospital cover as early as possible to avoid paying any extra.


Medicare

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What is Medicare?

Medicare is Australia's public health system. It covers all Australian citizens and permanent residents. Medicare is partly funded by a levy on taxable income. It covers public hospital treatment and doctor services.

Why is Medicare not enough?

You'll often find public hospitals have long waiting lists - especially for non-urgent operations. In addition, as a Medicare patient you cannot choose the doctor you want. A doctor chosen by the public hospital you attend will treat you. Medicare does not cover ambulance costs.

What does Medicare cover?

While Medicare is acknowledged as one of the world's best public health systems, it only covers things like:

  • Treatment at general and specialist practitioners
  • Treatment at public hospitals
  • A portion of the cost of medical treatment in private hospitals by surgeons, anaesthetists and other specialists
What does private health insurance cover me for that Medicare does not?
  • Hospital insurance covers you for hospital accommodation and theatre fees at private hospitals and emergency ambulance travel
  • Extras covers you for day-to-day health services, such as dental treatments, glasses and contact lenses, physiotherapy, natural therapies and so on

Medicare levy surcharge

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Avoid paying additional Medicare Levy Surcharge

If you are single and earn more than $90,000 or a family or couple earning more than $180,000 a year (increasing by $1,500 for each dependent child after the first) in this financial year, you could avoid any additional Medicare Levy Surcharge simply by having HCF hospital cover. For advice about how this may affect you, please contact your financial adviser.

Income thresholds for the 2015-16, 2016-17 and 2017-18 financial years

Income

Type of member

No Tier

Tier 1

Tier 2

Tier 3

Singles

< or = $90,000

$90,001 - $105,000

$105,001 - $140,000

> or = $140,001

Families

< or = $180,000

$180,001 - $210,000

$210,001 - $280,000

> or = $280,001

Medicare Levy Surcharge

All ages

0.0%

1.0%

1.25%

1.5%


Pharmaceutical Benefits Scheme (PBS)

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What is the Pharmaceutical Benefits Scheme (PBS)?

The Pharmaceutical Benefits Scheme (PBS) makes subsidised prescription medicines available to Australian residents and requires a PBS co-payment to be paid towards each item.

You can claim up to $50 per script towards HCF approved pharmacy items that your doctor prescribes, after an HCF co-payment that is equivalent to the current PBS co-payment for general patients is paid. For more information please check the current HCF Member Guide.


Savings Provision Entitlement

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What is Savings Provision Entitlement?

There are circumstances where you may be entitled to an increased Government Rebate. The Savings Provision Entitlement ensures that people remaining on a policy that has been eligible for the 35% or 40% Government Rebate do not have their rebate amount reduced when the person aged 65 years or over leaves or cancels the policy.

The Savings Provision Entitlement only applies when the person 65 years or over leaves or cancels the policy after 1 April 2005. Anyone who is aged under 18 or a full-time student under the age of 25 at the time the person leaves the membership cannot inherit the 35% or 40% Rebate.


Tax statements

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When will I get my Private Health Insurance tax statement?

Your statement may be mailed or emailed to you during the first two weeks of July. Statements will also be available in the member section from 6 July, simply login to view.

What do I have to do to get my statement?

If you are an existing member, or have held private health insurance with HCF during the last financial year, we will contact you with your tax statement details. You will either receive notification via SMS, email or post depending on your selected communication preference.

Can I get a statement earlier?

Tax statements include details of all payments processed by HCF up to and including 30 June. This means that we cannot begin processing them until after that date. However, we endeavour to get statements out to all members as quickly as possible. From 6 July your statement will be available in the member portal.

Why do I need the Private Health Insurance Statement?

You may need this to complete your tax return. Your private health insurance statement will have details of the number of days you have been covered by an appropriate level of patient hospital cover during the last financial year. If you did not have an appropriate level of private patient hospital cover for the full financial year and you fall within certain income brackets, you may be liable for the Medicare Levy Surcharge.

Your statement will also outline premium reductions you have received due to the Australian Government's Rebate on private health insurance as well as details of any additional rebate you may be able to claim as part of your tax return.

If you have any questions about the Australian Government Rebate on private health insurance, please call the Australian Taxation Office helpline on 132 861.

Will I receive anything else along with my Private Health Insurance Statement?

If you are an existing member, you will also get an Annual Policy Summary. This provides a summary of your current Lifetime Health Cover status as well as an overview of your current level of cover. You may also receive a Standard Information Statement.

Do I need my Annual Policy Summary or Standard Information Statement to complete my tax return?

No. The summary of cover is for your personal records only.

What information do I need in order to complete my tax return?

You may need the details included in the table below (found in your Private Health Insurance Statement) in order to complete your tax return.


The Gap

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Understanding the Gap

HCF has an extensive network of service providers and private hospitals throughout Australia, where specific charges have been negotiated for your benefit.

Medical Gap

The Australian Government subsidises medical services listed on the Medicare Benefit Schedule (MBS). However, when a doctor charges a fee higher than the MBS, it's referred to as the 'medical gap'. HCF has negotiated 'no gap' services with thousands of doctors across Australia, so ask your doctor if they are able to participate in our no-gap scheme. This will help minimise your of out-of-pocket expenses for doctors and specialists fees in hospital. Always ask your doctor to detail their charges (and any out-of-pocket expenses) before going to hospital.

Participating Hospital

An HCF participating hospital is a private hospital where specific charges have been negotiated by HCF for accommodation and other services, so you will not have any additional charges for these services. Any excess and conditions relating to your hospital cover will still apply in any HCF participating hospital. However, you may still have to pay for doctor's bills if the doctor does not participate in a Gap scheme.

Medicover no-gap

Many doctors who charge above the MBS fee are now participating in HCF's no medical gap arrangements. This means you will not have to pay any gaps for the in-hospital medical services they provide for you which could save you thousands of dollars. The easiest way to find out if you can benefit from this arrangement is to ask your doctor(s) in advance whether they participate in the HCF no medical gap arrangement.

As an HCF member you also have the right to choose the doctor who treats you. HCF provides details of the doctors who participate in our no gap arrangements. If you choose a doctor who doesn't participate in the no medical gap arrangement, then there may be a medical gap payment that you may have to pay for.

Log in to the HCF Member section and refer to ‘Find a Health Professional’ for a listing of providers who are registered under Medicover arrangements.


Member section

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I've forgotten my password - how do I log into my account?

Go to online member services of the website and click on the 'Forgot password?' link Follow the prompts to reset your password. If you are having difficulties, please call us on 13 13 34.

Can I make a payment online?

Yes, you can make one-off credit card payments online. Log into online member services and select 'Make a Payment'. Making a payment online is totally secure. Please note that making a payment online will not change your regular method payment.

How do I register for online member services?

Go to online member services of the website and click on the 'Register now' link. Follow the prompts to set your password and security questions. If you are having difficulties, please call us on 13 13 34.

How do I change my password or security questions and answers?

Log into online member services and click on the 'Security settings' link. Follow the prompts to reset your password or change your security questions or answers. If you are having difficulties, please call us on 13 13 34.


Pet insurance

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Why should I get pet insurance?

HCF pet insurance gives you comfort when it comes to looking after the other member of your family. It can help provide financial assistance to cover up to 80% of eligible vet expenses. It’s important that you read the Combined Product Disclosure Statement (PDS) and Financial Services Guide (FSG) before you make a decision to buy or continue to hold this product. You can get a copy by calling 1800 631 681 or downloading it from the Useful Documents section of the website. Remember, this information is general in nature and does not take into account your personal objectives, financial situation or needs. You also need to be aware that certain limits and exclusions apply.

Are full medical records needed to apply for HCF pet insurance?

No, you don’t need to submit veterinary records when you apply for HCF pet insurance. We will ask you a few simple questions about any illnesses and injuries your pet may have had prior to your application. This information is important and forms part of your legal duty of disclosure when you make an application for insurance cover.

Can all types of pets be insured?

HCF pet insurance is only available for cats and dogs. We are unable to provide cover for some animals such as, security dogs or racing Greyhounds or any dog which is not lawfully allowed to be kept.

How old does my pet need to be to get HCF pet insurance?

You can apply for Standard or Comprehensive Cover if your dog or cat is between 8 weeks of age and 9 years of age. There is no upper age limit for Basic Cover. Once your pet is covered with HCF pet insurance you will be able to cover your pet for life simply by renewing your cover annually and paying premiums when they are due.

What if I have more than one pet?

Each pet has its own policy with its own individual choice of cover and excess option.

How can I pay my premiums?

You may pay your premiums either by credit card or direct debit and you can choose to pay fortnightly, monthly or annually.

Are there any restrictions on the vet that I use for my pet?

No, there are no restrictions. You can use any vet that is licensed to legally practice as a veterinarian in Australia.

Are hereditary and congenital defects covered?

Yes, subject to the terms and conditions of the policy, and only for expenses related to symptoms or clinical signs of the hereditary and congenital defects that first arise after you have taken out the policy.

Are there things that are not covered by HCF pet insurance?

Yes, there are some exclusions and limits to cover, which we apply to help ensure that the premiums are great value. Some examples of exclusions are: pregnancy, elective procedures, pet foods, grooming and pre-existing conditions that showed symptoms or clinical signs before you took out your HCF pet insurance policy.

Please read the Combined Product Disclosure Statement and Financial Services Guide for a comprehensive list and full explanation of policy exclusions and limits.

Can I change the level of cover for my pet after it is insured?

Yes, it is possible to change the level of cover during a policy term as long as you have not made a claim against the policy. If you have made a claim, then the level of cover can be changed at the time that the policy is renewed and the next policy term commences. However, you cannot upgrade your pet’s cover after its 9th birthday.

How do I renew my HCF pet insurance policy?

For your convenience and to ensure continuity of cover for your pet, provided you continue to pay the premium, we will automatically renew your policy each year after sending you a renewal notice. Your renewal notice will specify any changes to your cover or the price you must pay.

Can I cancel my pet’s policy at any time?

Yes, you may cancel your policy by notifying the administrator of HCF Pet Insurance, PetSure (Australia) Pty Ltd (“PetSure”). You can do this by telephone on 1800 630 681, by email petinsurance@hcf.com.au or in writing to HCF Pet Insurance, Locked Bag 9021, Castle Hill NSW 1765.

If you have not made a claim under the policy and you have paid the annual premium in full, you will be refunded the portion of the premium that relates to the remainder of the policy period less any amount we are unable to refund. There will not be any refund if you have chosen the monthly or fortnightly payment options.

If you have made a claim under the policy, and you have chosen to pay premiums annually, no refund is provided if you cancel your policy. If you are paying monthly or fortnightly, any remaining premium still has to be paid for the remainder of the policy period.

How soon can I use my pet’s policy?

You can use your policy as soon as your application has been accepted. The policy will start at 23h59 on the date of acceptance and from this time you can claim for an accidental injury that occurred after 23h59 on the commencement date. There is a 30 day waiting period for illness condition claims when you have Standard or Comprehensive Cover. There is also a 6 month waiting period that applies for cruciate ligament injuries and conditions irrespective of your cover level.

By completing a Cruciate Ligament Exam Form you may apply to have this 6 month waiting period waived.

How do I make a claim?

Simply complete a HCF pet insurance Claim Form. You are required to submit your claim within 90 days of your pet receiving treatment. The vet must complete a small section of the claim form and sign it, so take along a printed claim form when visiting your vet.

It’s important to note if you’re lodging your first claim you’ll need to attach a complete veterinary history for your pet. Once you’ve provided this information, there’s no need for you to submit it again. Once we receive the documentation we need, your claim will be processed without delay and payment will be made to the policyholder by cheque or directly into a nominated account. Aside from your first claim, in many cases your claim can be processed directly without veterinary records being required. However, in some cases veterinary records may be requested to assist in understanding some aspects of your claim to ensure it is processed correctly and fairly. Sometimes this can result in a delay in payment of claims.

Does HCF pet insurance provide cover for Third Party Liability?

No. HCF pet insurance policies do not include cover for Third Party Liability. Your domestic contents insurance would normally provide third party liability cover for your pet. We suggest you contact your contents insurer for details of your cover.


Cash Back Cover

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What is the waiting period on accidents?

There is no waiting period on accidents for Cash Back Cover.

Am I covered if the accident occurs overseas?

No, Cash Back Cover only covers accidents that occur in Australia.

Can I claim more than once on a Cash Back policy?

Yes, you can claim multiple times on your Cash Back policy, up to $20,000 for singles and $40,000 for family policies.

What is your definition of accidents?

An accident is an external violent visible event occurring during the period of insurance, and which results directly or independently of all other causes in injury.

Am I covered if I am a New Zealand citizen?

New Zealand citizens are covered provided you are permanently residing in Australia.


Kids' Accident Cover

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What is the maximum payment under Kids Accident Cover?

$100,000 is the maximum payable for Kids Accident Cover.

Is racing covered and what is your definition of racing?

Racing is not covered under Kids' Accident Cover. Racing is defined as 'any speed contest involving the use of a powered vehicle or device or any form of organised speed contest'.

What happens to the policy when my child turns 17?

The policy ends on your child's 17th birthday but call 13 13 34 and for information on replacement policies.


Income Assist Insurance

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Am I covered if I was made redundant?

No, unfortunately redundancy is not covered under Income Assist Insurance.

I have two jobs and work more than 21 hours on each job. Will I be covered for both jobs if I become sick and unable to work?

You can only be covered for one job. You will have to decide which of the two jobs you would like to be covered for.

Can I apply for Income Assist if I’m self-employed?

Yes you can as long as you have been self-employed for at least 12 months

Can I apply on behalf of my child, who is a dependent on my health cover?

Cover is only available for those aged 18 to 54. The person being insured must be the one applying for cover.

Is depression and anxiety covered under Income Assist Insurance?

We will not pay a benefit if the insured person suffers from any mental illness including anxiety, stress, depression, psychoses, neuroses, physical fatigue, personality disorder, addiction, psychiatric disorder or any associated disease or disorder. HCF Life will not accept a claim based on that condition unless the insured person receives a workers' compensation payment as a result of the same condition.


Critical Illness Cover

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What is Critical Illness Cover?

Critical Illness Cover pays cash up to $25,000 or $50,000, depending on your level of cover, should you suffer from any one of the critical illnesses specified in the Benefits table.

Who is covered under my Family Critical Illness Cover and how much is the benefit amount for each person covered under the policy?

Family Cover covers ALL the people listed in your HCF Family Health membership. The maximum benefit amount of $25,000 or $50,000 is payable to each of them.

What happens to our Family Critical Illness Cover when either myself or my partner turn 65?

Cover ceases on the 65th birthday of the insured person named on the Policy Schedule, although cover may cease for other family members if they reach the age of 65 prior to this date.

What is the waiting period for Cancer?

The waiting period is 90 days from the date the cover commences.


Smart Term Insurance

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Am I covered outside of Australia?

Yes, you are insured anywhere in the world.

Can I nominate a beneficiary for my Smart Term Insurance policy?

HCF Life does not take nomination of beneficiaries and the proceeds of your policy will be paid based on your last will and testament.

Can I still apply for Smart Term Insurance if I already have a life insurance policy with another insurance company?

Yes, HCF Life will pay the sum insured on your Smart Term Insurance policy even if you have other life insurance policies.

Why does my premium increase every 5 years instead of annually just like other insurers?

Smart Term is priced in 5 year bands, meaning you won’t have any age related premium increases on your policy, which allows you to better budget over the long term.

What is a pre-existing condition and why is it excluded in the Smart Term Insurance policy?

A pre-existing condition means a condition that the insured person had either at the time or any time before the policy was entered into. Smart Term is a 'risk' insurance policy – this means cover can only be offered when there is a genuine risk of a person suffering a condition in the future. It would be impossible to offer a competitive premium if cover was issued to people with existing serious illnesses.


Personal Accident Insurance

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What is Personal Accident Insurance?

Personal Accident Insurance pays up to $5,000 or $10,000 depending on your level of cover if you suffer one of the injuries listed in the table of benefits.

Who is eligible to apply for this policy?

Anyone who is a permanent resident of Australia and aged between 55 and 74.

When does my cover begin?

Your cover starts within 24 hours of the cover commencement date.

Does the premium increases with age?

No, your premium stays the same.

What happens to my policy when I turn 80 years old?

The level of cover and each benefit payable as a result of an accident occurring after your 80th birthday will be halved.


Bounceback Cover

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Who is eligible to apply for this policy?

Bounceback Cover is available to Australian Permanent Residents aged 16-30.

What age does my policy cease?

You can keep your Bounceback Cover up until the age of 65.

I have a pre-existing illness, can I have this cover?

You can take out a Bounceback Cover policy if you have a pre-existing illness, however we do not pay benefits for pre-existing injuries or illnesses for the life of the policy.


Cover type

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What is a cover?

The type and level of health insurance you take out. There are two types of covers: hospital & extras. The level of health insurance differs depending on the services for which you want to be covered and you wish to pay.

What is Hospital cover?

Private hospital cover helps reduce the costs associated with treatment in hospital (e.g. doctors fees, accommodation, operating theatre, intensive care, and pharmaceuticals in hospital). Having private hospital cover also allows you to choose your own doctor (such as your own obstetrician), and choose when you have treatment for elective surgery.

All HCF hospital covers allow you to claim for the following expenses:

  • Overnight and same day accommodation charges, less your excess (if applicable)
  • Operating theatre and critical care fees
  • Intensive care and Neo-natal intensive care
  • Prostheses for covered services (up to the amount on the Government Approved Appliances List)
  • Emergency ambulance cover

All HCF hospital covers exclude:

  • Medical and associated hospital benefits for which there is no Commonwealth Medical Benefits Schedule item number or when the medical services are not approved for payment by Medicare
  • Private room accommodation for same-day procedures
  • Experimental treatments
  • Experimental and high cost non-PBS drugs
  • Procedures normally performed in a doctor's surgery or as an outpatient
  • Private hospital emergency room fees
  • Respite care
  • Nursing home-type patients are limited to benefits set by the Commonwealth Department of Health
  • Special nursing like your own private nurse
  • Luxury room surcharge
  • Donated blood and blood products and blood collection and storage
  • PBS pharmaceutical benefits in non-participating hospitals
  • Pharmaceuticals (including PBS pharmaceuticals benefits) and other sundry supplies not directly associated with the reason for admission
  • Take home items, e.g. crutches, toothbrushes and drugs
  • Personal convenience items, e.g. phone calls, newspapers, magazines and beauty salon services etc
  • Massage and aromatherapy services
  • Some services provided while in hospital by non-hospital providers
  • Benefits where a Service is an Excluded Service for the payment of Benefits in a Hospital, and any other Services including medical, diagnostic, Prosthesis and pharmacy received at the same time, except when Accident Safeguard applies.
  • The gap on government approved gap-permitted Prostheses items.
  • Benefits greater than Minimum Benefits if a Service is listed as a Minimum Benefit Service in the Product Information. For some Hospital Covers, this may not apply when a Member receives Treatment as the result of an Accident. For other Hospital Covers, this is regardless of whether or not Treatment is required as a result of an Accident.
  • Any Exclusions under your cover. For some Hospital Covers, this may not apply when a Member receives Treatment as the result of an Accident. For other Hospital Covers, this is regardless of whether or not Treatment is required as a result of an Accident
What is Extras cover?

Extras cover helps reduce the out-of-pocket expenses associated with managing or improving your health. Examples of 'Extras' services include dental, optical, physiotherapy and chiropractic. You can claim towards the following expenses depending on your level of cover:

  • Diagnostic and preventative dental
  • Restorative dental (fillings), oral surgery, endodontic services
  • Orthodontics
  • Dentures, crowns and bridges
  • Optical
  • Chiropractic, physiotherapy and osteopathy
  • Occupational, speech pathology
  • Pharmaceutical (HCF approved - non-PBS)
  • School accident cover
  • Natural therapies: homeopathy, naturopathy, acupuncture and massage
  • HCF approved artificial aids
  • Hearing aids
  • HCF approved Health Management Programs

Conditions applying to Extras cover

  • HCF does not pay a benefit greater than the charge levied to the patient.
  • Artificial Aids and Hearing Aids: Depending on the aid or appliance you require, benefits do not necessarily renew every year. Please check with us before you incur any costs.
  • There are other conditions that apply to Extras cover, please see your Member Guide

All Extras covers exclude:

  • Psychological and developmental assessments. Where psychology is included in your cover, psychology treatment is only payable when your GP has prescribed a mental health plan under Medicare and your psychology entitlements from Medicare for that year are exhausted
  • Goods and services while a hospital patient except for eligible oral surgery
  • Pharmacy items that aren’t on our approved pharmacy list e.g. items listed on the PBS, items prescribed without an illness, items that are available without a prescription, or items that are not TGA approved
  • Goods or services that had not been provided at time of claim e.g. pre-payment
  • Fees for completing claim forms and/or reports
  • Goods and/or services received overseas or purchased from overseas including items sourced over the internet
  • Where no specific health condition is being treated or in the absence of symptoms, illness or injury
  • Routine health checks, screening and mass immunisations
  • More than one therapy service performed by the same provider in any one day
  • Co-payments and gaps for government funded health services e.g. the co-payment for PBS items
  • Where a provider is not in an independent private practice
  • More than one of the following therapies received on the same day (physiotherapy, chiropractic and osteopathy
  • Any Exclusions under your cover
  • Add-ons for optical such as high index material, coatings and tinting
What is Ambulance cover?

Did you know that Medicare does not cover you for the cost of using an ambulance? If you have an accident you could be up for a very expensive ride, especially if you live in a rural or remote area.

Fortunately, you can take out HCF Ambulance cover. It provides full cover for emergency ambulance services with State Government services where you require hospital or on-the-spot treatment in Australia.

Some levels of cover also include State Government non-emergency ambulance services.This is payable your doctor requests ambulance transport because your condition requires monitoring and support in transit (up to $5000 per person per calendar year).

Please note: Ambulance cover is not available to residents of Western Australia, Tasmania and Queensland. Pre-existing conditions will not be covered for 12 months, otherwise a 1-day waiting period applies for emergency and 2 months for non-emergency cover.

Who does my membership cover?

Please make certain you understand who is covered under your policy. Review your policy at least once a year to identify changes in your circumstances that could affect your health cover needs. If your family situation changes, let us know so that we can suggest appropriate adjustments to your cover.

Family cover

The Policy holder, their Partner and dependants listed on the policy. Only the Policy holder can determine who is covered under a membership.

Cover for your dependants

The children listed on your membership are automatically covered at no extra cost under your family cover until the day before they turn 22.

If your children are full-time students, simply register them as Student dependants at the start of each academic year, and they will be covered for no extra cost until the day before they turn 25 or cease full time study (whichever comes first).

If your children are not full-time students, you can also continue to cover them until they turn 25 with Extended Family Cover, available on certain levels of HCF cover. Otherwise, your grown children will need to take out their own cover.

All new dependants must serve waiting periods, unless they are transferring from another membership or another private health insurer where they have already completed the relevant waiting periods. In this case they will need to request an Interfund Transfer Certificate from their previous fund, which is provided to HCF when joining.

Single Parent Family cover

The Policy holder and their dependants listed on the policy.

Single parent families receive a reduction (approximately 20% of the family rate) on their hospital and Extras cover. This reduction in premium is only available on certain levels of HCF cover.

Couples cover

The Policy holder and their Partner listed on the policy.

Singles cover

The Policy holder only

What's not covered or included?

There are a number of situations where HCF health insurance does not cover you:

  • Where there are Exclusions on your policy
  • Claims made two years or more after the date of service
  • When you or your dependants have the right to recover the costs from a third party other than us, including an authority, another insurer (like motor vehicle or workers compensation), or under an employee benefit scheme
  • Treatment for pre-existing ailments or conditions within waiting periods
  • Goods and services received during any period where your payment is in arrears, your membership is suspended or you're within waiting periods
  • Treatment that we deem inappropriate or not reasonable, after receiving independent medical or clinical advice
  • Any service where the treatment does not meet the standards in the Private Health Insurance Accreditation Rules 2011 or as amended
  • Services that aren't delivered face to face, like online or telephone consultations, unless you're participating in one of our chronic disease management or health improvement programs like My Health Guardian
  • Goods or services supplied by a provider not recognised by us
  • Goods or services provided outside Australia, which don't meet the requirements under the Private Health Insurance Act (2007)
  • Claims that don't meet our criteria

In addition, HCF hospital cover does not include:

  • Medical and associated hospital benefits for which there is no Commonwealth Medical Benefits Schedule item number or when the medical services are not approved for payment by Medicare
  • Private room accommodation for same-day procedures
  • Experimental treatments
  • Experimental and high cost non-PBS drugs
  • Procedures normally performed in the doctor's surgery or as an outpatient
  • Private hospital emergency room fees
  • Respite care
  • Nursing home-type patients are limited to benefits set by the Commonwealth Department of Health and Ageing
  • Special nursing like your own private nurse
  • Luxury room surcharge
  • Donated blood and blood products and donated blood collection and storage
  • PBS pharmaceutical benefits in non-participating private hospitals
  • Pharmaceuticals (including PBS pharmaceuticals benefits) and other sundry supplies not directly associated with the reason for admission
  • Take home items e.g. crutches, toothbrushes and drugs
  • Personal convenience items e.g. phone calls, newspapers, magazines and beauty salon services
  • Massage and aromatherapy services
  • Some services provided while in hospital by non-hospital providers
  • Benefits where a Service is an Excluded Service for the payment of Benefits in a Hospital, and any other Services including medical, diagnostic, Prosthesis and pharmacy received at the same time, except when Accident Safeguard applies.
  • The gap on government approved Prostheses in non-participating private hospitals
  • The gap on government approved gap-permitted Prostheses items
  • Benefits greater than Minimum Benefits if a Service is listed as a Minimum Benefit Service in the Product Information. For some Hospital Covers, this may not apply when a Member receives Treatment as the result of an Accident. For other Hospital Covers, this is regardless of whether or not Treatment is required as a result of an Accident.

In addition, HCF extras cover does not include:

  • Psychological and developmental assessments. Where psychology is included in your cover, psychology treatment is only payable when your GP has prescribed a mental health plan under Medicare and your psychology entitlements from Medicare for that year are exhausted
  • Goods and services while a hospital patient except for eligible oral surgery
  • Pharmacy items that aren't on our approved pharmacy list e.g. items listed on the PBS, items prescribed without an illness, items that are available without a prescription, or items that are not TGA approved
  • Goods or services that had not been provided at time of claim e.g. pre-payment
  • Fees for completing claim forms and/or reports
  • Goods and/or services received overseas or purchased from overseas including items sourced over the internet
  • Where no specific health condition is being treated or in the absence of symptoms, illness or injury
  • Routine health checks, screening and mass immunisations
  • More than one therapy service performed by the same provider in any one day
  • Co-payments and gaps for government funded health services e.g. the co-payment for PBS items
  • Where a provider is not in an independent private practice
  • Add-ons for optical such as high index material, coatings and tinting

Going to hospital

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How do I find a recognised provider or participating hospital?

Log in to the member section of the HCF website and search for your closest Health Professional (e.g. Doctors or specialists) by selecting your state.

What is a 'participating hospital'?

Our 'participating hospitals' include most private hospitals, and all public hospitals throughout Australia. You're fully covered (except for any excess and conditions relating to your hospital cover which still apply) in every one of them for the following in-hospital expenses:

  • Overnight and same-day accommodation
  • Operating theatre and critical care fees
  • Supplied pharmaceuticals directly associated with the reason for admission (including the Pharmaceutical Benefit Scheme benefits)
  • Allied services such as physiotherapy, occupational therapy and dietetics
  • Surgically implanted Government recognised Prostheses
  • Emergency Ambulance Cover
What is a 'non-participating private hospital'?

A private hospital that we don't have an agreement with. If you go to a non-participating private hospital, you could face significant personal expense.

What is the difference between public and private hospitals?

Public hospitals

Pro's Con's
If you go into a public hospital as a public patient, you are totally covered under Medicare. You have little or no say over who treats you, or when
If you go into a public hospital as a private patient, your HCF hospital cover will pay for some of the costs associated with your treatment and you get to choose your doctor. You still have little or no control over where or when you get treated

Private hospitals

If you are admitted into a private hospital, Medicare will cover a portion of your medical treatment costs, but they will not cover you for your accommodation and theatre expenses. The only way to cover yourself for those bills - which generally can be quite expensive - is with HCF hospital cover.

Our hospital cover contributes to the portion of treatment costs not covered by Medicare:

  • The Government sets a dollar amount for types of in-hospital medical treatment, known as the "Schedule Fee"
    Medicare pays 75% of the Schedule Fee
    HCF Private Hospital Cover pays the remaining 25%
  • Some doctors and specialists charge more than the Schedule Fee. The difference between the two is the "gap", which is normally up to you to pay, but if your doctor or specialist is recognised by HCF, they agree with us to charge you either no gap or a maximum gap.

Before surgery:

1. Check that your HCF product covers you.

2. If your surgery requires a Prosthesis, ask your doctor which Prosthesis will be the best one for you and which no-gap Prosthesis are available. If the doctor recommends a Prosthesis for which a gap is payable, ask why this one is being recommended. You will only have to pay part of the Prosthesis cost if you agree to have one of these devices.

3. Ask the doctor to explain the costs of the surgery including any medical gap, the Prosthesis gap payment (if any) and any other expenses involved. If there are any gaps for you to pay ask for a written cost estimate.

4. Then either call HCF on 13 13 34 or log into the member section of the website to access the Prosthesis List online, with the Prosthesis code to confirm if your surgery will result in any gap payments.


Prostheses

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What are Prostheses?

Prostheses are items used in surgery to augment or replace a part of the body e.g. pacemakers or joint replacement devices. Government approved, non-cosmetic Prostheses that have been surgically implanted, are covered by HCF. Ask your doctor which Prostheses is best for you and whether a no-gap option is available.


Minimum Benefits

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What are Minimum Benefits?

For procedures identified as Minimum Benefits, we will pay the rate set out by the Commonwealth as the minimum shared room benefit, and benefits for Government approved Prostheses List items, if applicable.

In a private hospital: These benefits would not be adequate to cover all hospital costs and are likely to result in large out-of-pocket expenses.

In a public hospital: In the event these benefits are less than what your chosen public hospital charges, you may have out-of-pocket expenses to pay.


Insulin Pump

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I am about to commence insulin pump therapy, am I able to claim a benefit?

The following benefits apply for the first time in your life when you start using an insulin pump. When your insulin pump therapy is commenced in an outpatient setting, HCF will pay 100% of the highest costing insulin pump on the Federal Government Prosthesis List (currently up to $9,500) when we receive a completed insulin pump claim form.

If admission to hospital is required for commencement of pump therapy, HCF will provide a benefit, provided the Type C certification is completed in accordance with the legislation. Please note that education is not a valid reason for hospitalisation. At times HCF may require additional information to verify the reasons for hospitalisation.

If you are already using, or have previously used, an insulin pump then benefits may apply under “replacement” insulin pumps. See below.

Am I eligible to claim for a replacement insulin pump?

If you have been on Top Plus, Top Hospital, Fit & Free, or Healthmate Ultimate, Premium or Ultimate hospital cover continuously over a 5 year period you will be eligible to claim a benefit of 100% of the highest costing insulin pump on the Federal Government Prostheses List (currently up to $9,500) - you will have no out of pocket expense.

If you have maintained any other level of hospital cover during the previous 5 year period, you will be eligible to claim up to half of that amount (currently up to $4,750) provided that the cover does not have an Exclusion for insulin pump treatments.

The replacement cycle does not reflect the manufacturer’s warranty period, but rather the reasonable life expectancy of an insulin pump. If you wish to replace your insulin pump in less than 5 years, a pro-rata benefit may be offered depending on your individual circumstances, and provided the pump is not under warranty. Please note that HCF does not replace damaged, lost or stolen pumps. HCF also does not pay for consumables for insulin pumps, which are available through the National Diabetes Services Scheme.

How do you claim for a replacement insulin pump

The new application process is streamlined by a standardised replacement insulin pump claim form.


Switching funds

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How do I switch to HCF?

Switching to HCF is easy. Choose the cover that works for you, then complete your application and Interfund Transfer.

You can also switch at any HCF branch or by calling 13 13 34.

If you held an equivalent level of cover with your previous fund, and join HCF within 30 days of leaving, you won't have to re-serve any waiting periods.

Once we have the details of your previous fund, we'll ask them to send us an Interfund Clearance Certificate. If they send it to you, please forward it to: HCF GPO BOX 4242, Sydney, NSW, 2001.

If you are switching and wish to upgrade your cover, you will need to serve the necessary waiting periods for the higher benefit entitlements.


Waiting periods

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What are waiting periods?

Waiting periods must be served before benefits are paid. They apply to:

  • New members.
  • Existing HCF members who upgrade to a higher level of cover or reduce excess payable. In this case, you need to serve the necessary waiting period for the higher benefit entitlement.
  • Members who switch from another fund who have not already completed the required waiting period for equivalent benefits.
  • New dependants, unless they switch from another fund where they have completed the required waiting period for equivalent benefits.
  • Hearing aid benefits for members switching from another health fund, irrespective of the previous cover held.
  • Treatment of a pre-existing ailment.
  • Members who cancel their policy for a period of time and then rejoin HCF without having cover with another insurer during the gap period

Waiting periods vary according to the type of treatment or service and are as follows:

Hospital waiting periods
Palliative care 2 months
Psychiatric treatment#
Rehabilitation services
Pre-existing ailments or conditions 12 months
Pregnancy & birth related services
All other hospital services 2 months
Extras waiting periods
Health management programs 2 months
Artificial appliances (e.g. CPAP machine, blood glucose monitors) 12 months
Dental bleaching, bridges and crowns
Dentures
Endodontics
Hearing aids
Occlusal therapy
Oral surgery
Orthodontics
Periodontics
Pre-existing ailments & conditions
Prosthodontics
Veneers
School Accident benefit 2 - 12 months
All other extras services 2 months
Ambulance waiting periods
Emergency ambulance (where not for pre-existing ailments) 1 day
Medically necessary non-emergency ambulance (where not for pre-existing ailments) 2 months
Pre-existing ailments 12 months

If you joined during an HCF waiver offer, waiting periods are only waived for extras with waiting periods equal to or less than the waiver. All other waiting periods in excess of the waiver apply.

Waivers are only available to new members taking both hospital and extras cover. All hospital services (including the same day excess) and ambulance services are excluded from the waiver offer.

#From 1 April 2018, members who have held a hospital cover for at least 2 months and upgrade to Ultimate Hospital to receive psychiatric treatment as covered services may not be required to serve the waiting period for psychiatric treatment. This exemption can only be accessed once in a member's lifetime.

HCF Life Insurance products are issued by HCF Life Insurance Company Pty Limited (ABN 37 001 831 250, AFSL 236 806). Before you apply, you should read the relevant Product Disclosure Statement and Financial Services Guide, available by clicking the link on each product above, and consider if the relevant cover is appropriate for your objectives, financial situation or needs, as the information we have provided does not take these into account.