Guide to cover _ you need - peace of mind when - Health Care Insurance
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guide to
cover _
peace of
mind when
you need
it most
Version 1.0.1 DECEMBER 2020
CONTACT US Call: 1800 804 950
DIRECTLY Email: enquiries@hciltd.com.au
Visit our website: hciltd.com.au
Fax: 03 6432 1160
Mail: PO Box 931, Burnie TAS 7320
Or, come into our office:
25 Cattley Street, Burnie TAS 7320
contents
Why should I have private
health cover? 3
Health cover for you
4
Hospital Care
6
Hospital Waits
10
I need to go into hospital
12
Levels of excess
14
Lifetime Health
Cover Loading 15
Our Extras Products
16
Extras Levels of Cover
17
Premier Extras
18
Healthy Extras
22
Active Life Extras
24
Extras Waiting Periods
25
Packaged Cover
26
How to Claim
28
Best Doctors
30
Smile.com.au
32
Important Info
34
Useful links and
glossary items 37
1
happy _
healthy &
worry free HCI gives you the confidence and
flexible coverage to be your best self.
Happy, healthy and worry free.
At HCI we are committed to
providing you with access to the
health care services that best suit
you and your family, it’s that simple.
We are here to ensure that private
health insurance is easy to
understand and delivers both
comprehensive and affordable
health care.
2
Tasmania's
oldest
Health Fund!
As a member owned and not-for-profit insurer, We are here to help you face to face, over the
we consider your needs first - we are here for phone, via our online claiming app and via email.
the peace of mind of our members. Let us work with you to guide you through the
process of selecting the cover you need.
We pride ourselves on our coverage for wellness
initiatives including dental, optical, physio, chiro, In this booklet you will find all the information
antenatal education and much more. you need to make an informed decision about
your cover including the Federal Government
We have been supporting our local communities
insurance rebates and incentives. The information
since 1939. HCI has experienced first hand the
detailed herein is subject to change from time to
trials and tribulations our members have faced.
time and we will notify you of any changes to
As one of Australia’s oldest health funds we are
your policy as and when they occur.
proud to say we have been there for
generations of families.
Why should I have
private health cover?
Reduce Benefits on
Choice waiting periods more services
With private health you For non-emergency Depending on your level of
can choose your doctor, treatment, average extras cover you can claim
the hospital you want waiting times are lower benefits on most extras
to be treated in and a as a private patient. services like massage, optical,
private room if available. dental and more.
Save money 1. The Medicare Levy Surcharge (MLS):
High income earners can avoid the MLS altogether by taking
If you take out private
out the appropriate level of hospital cover. See page 35 for
hospital insurance you
more information on the MLS.
may be able to save
money on:
2. The Lifetime Health Cover loading (LHC):
By taking out hospital cover before you turn 31 you can avoid
paying the LHC. See page 15 for more information on LHC.
3
health
cover
for you _
Choose the right health cover mix
for you with HCI. We try to keep
it really simple with our Singles,
Couples, Single Parent and Family
cover options, it’s health care
designed with you in mind.
Gold Hospital with
Premier Extras equals
complete peace of
mind with your HCI.
4
Choose who
will be covered:
Single Couples Single Parent Extended Family Extended
health care health care health care for Single health care for Family
for team me for me and me and my kids Parent me, my partner health care for
my partner (up to age 25 if full health care for and all our kids me, my partner
time student) me and my kids (up to age 25 if full and all our kids
(aged 23 & 24) time student) (aged 23 & 24)
hospital extras packaged
cover cover cover
GOLD HOSPITAL PREMIER EXTRAS GOLD HOSPITAL OR
HCI offers comprehensive hospital Available when packaged with HCI’s SILVER PLUS HOSPITAL
cover with a range of excess options. Gold and Silver Plus Hospital. WITH PREMIER EXTRAS
It’s that simple.
HEALTHY EXTRAS For more details go to pages 26-27.
SILVER PLUS HOSPITAL Provides wide-ranging cover on
a broad range of extras services.
Or, You Choose!
Quality cover without pregnancy,
giving you access to a range of ACTIVE LIFE EXTRAS
treatments and care, while saving
Extras cover that doesn’t break the budget.
you more.
For the full breakdown of services Choose to combine Gold Hospital,
BRONZE HOSPITAL covered and annual limits see Silver Plus Hospital or Bronze
An exclusionary cover that won't pages 16-25. Hospital with Healthy Extras or
break the budget. Ideal for those just Active Life Extras.
starting out.
For the full breakdown go to
pages 6-7.
Note: Premier Extras is only available to purchase when packaged
with either Gold Hospital or Silver Plus Hospital.
5
Private hospital insurance with
HCI enables you to take more control over
how, where and by whom you are treated.
HCI is part of the Australian Health Service Alliance
(AHSA). Through the AHSA our members have access to
hospital
a wide range of doctors and hospitals Australia wide.
HCI knows that choice is important to our members;
knowing when you will be treated, by which doctor,
care _
and especially, where you will be treated.
HCI provides access to more than 500 private hospitals
and 30,000 doctors across Australia.
Visit hciltd.com.au/search-doctor
to find a doctor near you.
GOLD SILVER PLUS BRONZE
HOSPITAL HOSPITAL HOSPITAL
EXCESS OPTIONS EXCESS OPTIONS EXCESS OPTIONS
NIL $250 $500 $750 $250 $500 $750 $750
HCI’s Gold Hospital cover HCI’s Silver Plus Hospital HCI’s Bronze Hospital cover
ensures you can have total cover has all the benefits is an exclusionary product
confidence in your hospital of Gold Hospital with that won’t break the
cover. pregnancy and some other budget.
Gold Hospital does not have any infrequent procedures This product is ideal for those who
exclusions or limitations when it removed. want lower costs and only need
comes to the necessary treatment. cover for a select group of services.
If your family is complete or you
As long as you have served the You may still be able to access
are childfree and not planning
relevant waiting periods and the the public system for any services
a family in the near future this
service is eligible for a Medicare that are not covered. If you’re just
product is for you. You’ll still
benefit HCI has you covered. starting out, this might be the
be covered in the event of an
cover for you!
unexpected accident or illnesses
Be confident that you with access to the best possible It should be noted whilst Gold
are fully covered with treatment and care. Hospital cover is comprehensive,
the Bronze Hospital cover does
HCI's Gold Hospital. Please note Silver Plus Hospital
does have some exclusions and
have exclusions and limitations.
restrictions (see page 7 for details). If you are going into hospital,
please check with HCI first to
If you are going into hospital,
ensure your are covered.
please check with HCI first to
ensure you are covered.
+ COMBINE WITH YOUR CHOICE OF EXTRAS
COVER TO CREATE YOUR UNIQUE PACKAGE
6GOLD HOSPITAL, SILVER PLUS HOSPITAL SILVER
AND BRONZE INCLUDED (AND EXCLUDED) GOLD PLUS BRONZE
PROCEDURES: HOSPITAL HOSPITAL HOSPITAL
Rehabilitation ✔ ✔ (R) ✔ (R)
Hospital psychiatric services ✔ ✔ (R) ✔ (R)
Palliative care ✔ ✔ (R) ✔
Brain and nervous system ✔ ✔ ✔
Eye (not cataracts) ✔ ✔ ✔
Ear, nose and throat ✔ ✔ ✔
Tonsils, adenoids and grommets ✔ ✔ ✔
Bone, joint and muscle ✔ ✔ ✔
Joint reconstructions ✔ ✔ ✔
Kidney and bladder ✔ ✔ ✔
Male reproductive system ✔ ✔ ✔
Digestive system ✔ ✔ ✔
Hernia and appendix ✔ ✔ ✔
Gastrointestinal endoscopy ✔ ✔ ✔
Gynaecology ✔ ✔ ✔
Miscarriage and termination of pregnancy ✔ ✔ ✔
Chemotherapy, radiotherapy and immunotherapy for cancer ✔ ✔ ✔
Pain management ✔ ✔ ✔
Skin ✔ ✔ ✔
Breast surgery (medically necessary) ✔ ✔ ✔
Diabetes management (excluding insulin pumps) ✔ ✔ ✔
Heart and vascular system ✔ ✔ ✘
Lung and chest ✔ ✔ ✘
Blood ✔ ✔ ✘
Back, neck and spine ✔ ✔ ✘
Plastic and reconstructive surgery (medically necessary) ✔ ✔ ✘*
Dental surgery ✔ ✔ ✘
Podiatry surgery (provided by a registered podiatric surgeon) ✔ ✔ ✘
Implantation of hearing devices ✔ ✔ ✘
Cataracts ✔ ✔ ✘
Joint replacements ✔ ✔ ✘
Dialysis for chronic kidney failure ✔ ✔ ✘
Pregnancy and birth ✔ ✘ ✘
Assisted reproductive services ✔ ✘ ✘
Weight loss surgery ✔ ✘ ✘
Insulin pumps ✔ ✘ ✘
Pain management with device ✔ ✘ ✘
Sleep studies ✔ ✘ ✘
(R) T
his is a Restricted Service. A Restricted Service means you do * For Bronze Hospital, plastic surgery which
have some cover however only a 'default' or minimum benefit is medically necessary and related to the
can be paid, therefore you may incur large out of pocket costs. treatment of a skin-related condition is
For further information, please refer to the Glossary on page 37. covered under the “Skin” clinical category.
7HCI provides access
to more than
HCI has you covered
with up to
30,000 100%
across Australia hospital accommodation costs
WHAT’S COVERED*: WHAT’S NOT COVERED:
Up to 100% of hospital accommodation costs Cosmetic Surgery.
and theatre fees in all contracted hospitals and
day surgery facilities in Australia. Extra services beyond the hospital
treatment plan.
Up to 100% of the cost of surgically
implanted prostheses (as listed by the Personal expenses like phone calls,
Federal Government). newspapers and TV rental.
Private room accommodation (if available). Hospital benefits where the
professional service performed is not
Up to 100% of the cost of most hospital eligible for Medicare benefits.
prescriptions relating to the admission.
(Subject to hospital agreement details). Pharmaceutical items supplied or
prescribed on discharge.
Dental theatre costs for surgical tooth
extraction by an oral surgeon. Medical Gap.
100% of the cost of the difference between Surgically Implanted Prosthesis Gap.
the Medicare refund and the Commonwealth
Medical Benefit Scheme (CMBS) fee for medical Medical treatment provided in
services provided during a hospital admission. doctors’ rooms out of hospital.
Up to 100% of the cost of medical services * Coverage applies to eligible services only.
provided during a hospital admission where See table on page 7 for inclusions and exclusions.
the doctor charges above the Commonwealth
Medical Benefit Scheme (CMBS) fee and
chooses to use Access Gap Cover.
8Thinking about
starting a family?
Or want to build your confidence and
knowledge as a new parent?
Health Care Insurance is excited to
partner with Nourish Baby.
THE NOURISH BABY PROGRAM IS SUITABLE FOR
HEALTH CARE INSURANCE MEMBERS WITH GOLD
HOSPITAL COVER WHO ARE:
- Planning to have a baby in the near future;
- Are already pregnant;
- Have a newborn baby;
- Or have a toddler.
WHAT’S INCLUDED IN THE PROGRAM:
Access To Nourish Baby Online
Nourish Baby Online is an online antenatal and early parenting education platform, providing
informative courses to support you every step of the way. The online courses are fun and easy to
follow, featuring engaging videos, interactive, learning activities and knowledge checks.
The online courses cover the following topics:
- Pregnancy health and fitness
- Antenatal and postnatal pelvic health
- Feeding from birth up to age 3
- Emotional health and wellbeing
- Parenting and relationships
- Baby and toddler growth and development
- Sleep and settling from birth up to age of 3
Telephone support
Delivered by infant and toddler sleep experts Safe Sleep Space.
Following the birth of your baby, members receive two x 20 minute
phone consultations at approximately 3 weeks and 3 months of age.
Learn more: https://hciltd.com.au/nourish
9hospital
waits _
HCI will always inform you of
any waiting periods that apply
to your policy.
HCI does not apply waiting periods
to accidents. Psychiatric and
rehabilitation services only require
a two month waiting period.
New and existing members of HCI
WHO HAS Transferring from another
may be able to upgrade from a
WAITING PERIODS? fund: If you switch to HCI from
policy that has restricted benefits on another health fund and within 2
psychiatric hospital services to a New members: If you are taking months of ceasing your
policy with full cover for psychiatric out private health insurance for membership with your previous
hospital services. the first time you will be required fund, join a similar level of cover
to serve full waiting periods with HCI you will receive the
This upgrade can be done without
before services can be claimed. same level of benefits and incur
serving the standard two month
This includes people joining as no new waiting periods.
wait. This upgrade can only be used
dependants on an existing
once in a person’s lifetime, regardless If you transfer to a level of HCI
member’s policy who have not
of whether you have transferred cover that provides benefits for
been financial members of a
between insurers. services not previously covered by
health fund within the previous
two months. your previous health fund you will
need to serve waiting periods for
Existing members: If you are the additional services not
upgrading to a higher level of
NO new wait times
previously covered or the higher
cover you will need to serve level of benefits.#
waiting periods on the higher
when you level of benefits.*
switch
to HCI from * Members who are serving waiting periods on higher levels of
benefit will receive the same annual limits as their previous
health fund until waits have been served. For example,
another health fund* if you received a $500 annual limit on a service with your
previous fund and HCI offer a higher limit for that service,
* On an equal or lower level of cover
HCI will still honour your previous fund’s limit until
you have served waits on the higher benefit.
If you have used all of a benefit limit with your previous
#
health fund that benefit usage will transfer over to HCI.
Where the benefit limit has been used HCI benefits may be
reduced. HCI benefits are on a calendar year cycle.
10PRE-EXISTING CONDITION OBSTETRICS
WAITING PERIODS Obstetrics and birth related services
A pre-existing condition is any ailment, are covered under HCI's Gold Hospital.
illness or condition you have had at A 12 month waiting period applies
anytime in the last 6 months. This can be to all pregnancy and birth related
either identified and diagnosed or services including IVF and assisted
unidentified and undiagnosed. reproductive services.
The pre-existing condition waiting periods Check with HCI before proceeding with IVF
apply to new members and existing policy or similar treatments to confirm what
holders upgrading their policy. services you will be required to pay for and
that you have completed any required
An independent medical practitioner waiting periods. Only an admission to
appointed by HCI will form an opinion as hospital can be covered under private
to whether any signs or symptoms existed hospital insurance.
at any time during the six months prior to
taking out hospital cover, or, upgrading to Always check with the hospital, HCI and your
a higher level of cover. doctor before proceeding with a hospital
booking to ensure you will be covered and to
If you are planning to go into hospital and discuss what costs you may incur.
have had less than twelve months hospital
cover with HCI please contact us
beforehand so we can determine whether
MAKING YOUR POLICY
the pre-existing waiting period applies. BABY READY
If a condition is deemed pre-existing by an If you already have a single parent or family
independent medical practitioner benefits policy there will be no waiting periods for
are not payable in the first 12 months of a the baby provided your policy contributions
membership. This means that, in the are up to date and the new child is added to
opinion of an independent medical your plan within 2 months of their birth.
practitioner (not your doctor), any signs If your policy covers just you or just you and
or symptoms of a condition did exist a partner, you will need to contact us to
in the six months prior to taking out upgrade to a single parent or family policy
hospital cover or upgrading to a higher from the birth date.
level of cover.
waiting periods
WAITING
SERVICES PERIOD
HOSPITAL TREATMENT OR
HOSPITAL SUBSTITUTE
Pre-existing conditions 12 months
Obstetrics (pregnancy related services) 12 months
IVF and assisted reproduction technology 12 months
Sterilisation including reversal 12 months
Psychiatric care, rehabilitation or
2 months
palliative care
All other hospital treatment services 2 months
11I need to
go into
hospital _
Under the Commonwealth Medical Benefits ACCESS GAP
Schedule (CMBS) fees are determined and
accordingly split between HCI and Medicare. In the event you need specialist care in hospital your
Between HCI and Medicare we cover 100% of the doctor can use HCI’s Access Gap Cover. Access Gap
CMBS. Prior to treatment it is imperative to is a simple billing system that aims to eliminate
discuss with your doctor if there will be any out out-of-pocket expenses all together, or, reduce them
of pocket expenses. If your doctor charges over considerably. Through Access Gap your doctor can
the CMBS fee HCI cannot cover these expenses. let you know exactly what you have to pay prior
to treatment.
HCI has agreements with more than 500 private
hospitals and day stay surgery hospital facilities Doctors can choose to opt in or out of Access Gap on
around Australia. For a comprehensive list of our a patient by patient basis. They may choose to use
contracted hospitals in your local area visit: Access Gap for one patient but not for another.
hciltd.com.au/search-hospital Doctor’s may not be publicly listed on the AHSA as
It’s important to remember that as an Australian being Access Gap doctors but can still be
resident, Medicare covers public hospital participating in the scheme. It is worth asking your
treatment and emergency patients will normally doctor if they will treat you through Access Gap.
go to a public hospital with Intensive Care Units. To find an Access Gap doctor near you visit:
www.ahsa.com.au/web/doctors/information/
doctor_search
Remember to ask your doctor:
Will I have any out-of-pocket expenses?
Please provide a formal quote of these costs.
Will you treat me under the Access Gap Cover?
Will any assisting doctors also use the Access
Gap Cover and if so, how can I obtain a quote
for their services?
Search for doctors at:
hciltd.com.au/search-doctor
12your Hospital
Gap Checklist _
Ask your treating
doctor or specialist:
How much is your fee?
W
ill your fee be covered under my private health
insurance or will I have to pay a gap out of my
own pocket?
If I have to pay a gap, how much will that be?
What if I can't afford to pay this gap?
Which other doctors and medical staff will be
involved in my treatment?
How can I get information about their fees
and if they will be covered by my private
health insurance?
How will I know how much I have to pay out of
my own pocket all up?
Will I receive just one bill?
Am I having a surgically implanted device or
prosthesis? Will the cost of this be covered by my
health fund or will I have to pay a gap?
What is the Medicare Benefits Schedule item
number for the procedure I am to have?
Ask your health fund:
D
oes my policy cover me for this procedure
or service?
GAP COVER AND SURGICALLY
Under my policy, do I have to pay an excess?
IMPLANTED PROSTHESES
W
ill I have to pay extra for my hospital
Surgically implanted prostheses are sometimes
accommodation, my doctors fees and those of
required during a medical procedure, such as a any one else involved with my treatment, or is it
replacement lens for a cataract surgery, an covered under my policy?
artificial hip joint, a pacemaker, or a heart valve.
If I have to pay extra, when and to whom do
For medical procedures covered by Medicare, I pay it?
HCI fully cover the cost of at least one prosthesis
– this is referred to as a ‘no gap’ prostheses.
There are however some items listed on the Ask your hospital:
Prostheses Schedule that are not, or only
D
oes this hospital have an agreement with my
partially covered. Please review the list with private health fund?
your doctor prior to surgery.
Will I have a gap to pay for my hospital
accommodation?
What else do I have to pay for out of my own
pocket during my time in hospital?
13HOSPITAL COVER
EXCESS OPTIONS
You can choose to not pay an excess
under a policy for Gold Hospital
cover. Having a hospital excess
however will reduce your premium,
the greater the excess the lower the
premium. There is no excess for
dependent children under the age of
18 years. The excess per adult is the
maximum payable per person in any
calendar year.
If a person covered is under the age
of 18 but not a dependant on a
single or couple policy they will be
required to pay the excess.
APPLICATION OF HOSPITAL
PER ADULT EXCESS
TREATMENT EXCESS
OVERNIGHT SILVER
ADMISSIONS GOLD Note the maximum annual excess
GOLD GOLD GOLD PLUS BRONZE
HOSPITAL per policy for all categories except
HOSPITAL HOSPITAL HOSPITAL HOSPITAL HOSPITAL
NIL single person policies is double the
$250 $500 $750 $250 / $500 $750
EXCESS per adult excess.
/ $750
The excess is payable when admitted
Single N/A YES YES YES YES YES
to hospital overnight.
The excess is payable for each person
Couples N/A YES YES YES YES YES
admitted to hospital overnight.
The excess is payable for each of the
Family N/A YES YES YES YES YES first two adults admitted to hospital
overnight.
E
xtended
The excess is payable for each of the
N/A YES YES YES YES YES first two adults admitted to hospital
Family overnight.
The excess is payable for each of the
Single
N/A N/A YES YES YES YES first two adults admitted to hospital
Parent overnight.
Extended The excess is payable for each of the
Single N/A N/A YES YES YES YES first two adults admitted to hospital
overnight.
Parent
SAME DAY
ADMISSIONS
For Gold Hospital $250 and $500
products HCI will waive the excess
WAIVER OF EXCESS for same day procedures. For Silver
FOR SAME DAY N/A YES YES NO NO NO Plus Hospital $250, $500, $750 and
ADMISSIONS Bronze Hospital $750 products, the
full excess is payable for both same
day and overnight admissions.
14lifetime
health cover Lifetime Health Cover Loading (LHC) is a
government initiative that started on July 1st
2000. It is a financial loading that can be payable
loading _ in addition to your private health insurance
hospital cover premiums. One of the benefits to
joining HCI earlier in life is minimising or
eliminating the LHC all together, compared to
someone who takes out hospital cover later in life.
If you take out hospital cover by July 1st following
your 31st birthday you will not have to pay LHC.
If you take out hospital cover after this date you
may be required to pay a 2% loading for every
year you are over 30. For example, if you wait until
you are 40 to take out hospital cover you could be
paying an extra 20% on your base premium
hospital rate.
If you are a new migrant to Australia, and are aged
31 or over, you will not have to pay an LHC loading
if you purchase hospital cover within 12 months of
being registered for full Medicare benefits. If you
delay purchasing hospital cover for more than 12
months after your registration, you will have to
pay the 2% more for each year you are aged over
30 when you purchase your hospital cover.
Any LHC loading that you pay will be removed
from your hospital cover premium after you have
held hospital cover for 10 continuous years.
However, if you cancel your hospital cover after
the LHC loading has been removed, you may
become liable to pay an LHC loading again
in the future.
Visit www.ato.gov.au/Individuals/Medicare-
levy/Private-health-insurance-rebate/Lifetime-
health-cover/ to find our more information about
LHC and www.privatehealth.gov.au/dynamic/
lifetimehealthcover.aspx to calculate your level
of LHC.
PERMITTED DAYS WITHOUT
HOSPITAL COVER:
You are able to stop your hospital cover
for a total of 1094 days in your lifetime
without it effecting your certified entry
age. However, after the 1094 days of
absence you may be subject to the LHC.
15our extras
products _
PREMIER
EXTRAS
Premier Extras is only available
when packaged with Gold Hospital
or Silver Plus Hospital cover as a
Premier Extras Package.
pages 18-21
HEALTHY
EXTRAS
Healthy Extras is your gateway to
living your best life. pages 22-23
ACTIVE LIFE
Active Life Extras is designed
to give you cover for what
you need right now. page 24
16Extras levels of cover
PREMIER HEALTHY ACTIVE
SERVICES EXTRAS EXTRAS LIFE
Acupuncture ✔ ✔ ✔
Ambulance ✔ ✔ ✘
Audiology (Hearing Tests) ✔ ✔ ✘
Chiropractic ✔ ✔ ✔
Dental – General ✔ ✔ ✔
Dental – Major
(excl. Orthodontics)
✔ ✔ ✔
Dental – Orthodontics ✔ ✔ ✘
Diabetes Education ✔ ✔ ✘
Diabetes Australia
✔ ✘ ✘
Claiming made easy
Membership
Dietetics ✔ ✔ ✘
so you can enjoy
Eye Therapy (Orthoptics) ✔ ✔ ✘
Funeral*
(eligible members only)
✔ ✘ ✘
the more important Health Screening Checks ✔ ✔ ✘
things in life. Hearing Aids
Home Nursing
✔
✔
✔
✔
✘
✘
Hydrotherapy ✔ ✔ ✘
Laser Eye Surgery ✔ ✘ ✘
Medical Appliances ✔ ✔ ✘
Natural Therapy
(incl. Remedial Massage) ✔ ✔ ✔
See separate table below
Non-surgical Prostheses ✔ ✔ ✘
Occupational Therapy ✔ ✔ ✘
Optical ✔ ✔ ✔
Orthotics ✔ ✔ ✘
Osteopathy ✔ ✔ ✔
Pharmacy ✔ ✔ ✘
Physiotherapy ✔ ✔ ✔
Podiatry / Chiropody ✔ ✔ ✘
NATURAL THERAPY INCLUDES:
Psychology ✔ ✔ ✘
Chinese medicine (Consultation only)
Quit Smoking Programs ✔ ✔ ✘
Chiropractor
Speech Therapy ✔ ✔ ✘
Remedial Massage
Surgical Footwear ✔ ✔ ✘
Myotherapy
Travel and Accommodation ✔ ✘ ✘
Osteopathy
Weight Loss Programs ✔ ✔ ✘
* Funeral cover special conditions are on page 23
Note: P
remier Extras is only available to purchase when packaged
with either Gold Hospital or Silver Plus Hospital.
17premier
extras _ SERVICES EXTRAS LEVEL
OF COVER
AMBULANCE
For emergency transport provided by a registered Cost
ambulance provider within Australia
ALTERNATIVE THERAPIES GROUP ANNUAL LIMIT $500
Premier Extras is only
Chiropractic
available when packaged with - Consultations $33
- X-Rays $65
Gold Hospital or Silver Plus
Hospital cover as a Premier Osteopathy
- Consultations $33
Extras Package. It provides
Acupuncture
comprehensive extras cover - Consultations $33
with an extensive range of Remedial Massage, Chinese medicine and Myotherapy
services. - Consultations $33
Gold Hospital or Silver Plus Hospital is DENTAL TREATMENT
ideal for those who want the comfort of Benefits are paid according to the Australian Dental Association item num-
knowing their hospital cover has them ber used. Benefits are payable at 90% of cost to a set maximum per item.
covered for all life’s unexpected twists For an itemised quote please contact us.
and turns with an extras cover to match.
GENERAL DENTAL ANNUAL LIMIT $1,500
If you’re just starting out, starting a
The maximum number of services in which a benefit
family or retired, Gold Hospital or Silver will be paid on items 011-015 in total is 2 per year and
Plus Hospital with the Premier Extra 016-017 in total 2 per year
Package is able to grow with you and Item 011 - comprehensive oral examination $40
Item 121 - topical application of remineralisation agent $22
your needs. Item 311 - removal of a tooth $105
Item 511 - metallic filling 1 surface $104
MAJOR DENTAL $1,500
Crowns and Bridgework up to $1,000
Periodontics up to $700
Implants up to $1,000
Dentures (benefits are payable every 2 years) up to $1,200
Orthodontics
- Lifetime Limit $2,700
- Annual Limit per person up to $900
HEARING TESTS AND APPLIANCES
Hearing Aids
Appliance limit every 3 years with a benefit payable of
90% of cost for:
- Single hearing aid up to $1,200
- Bilateral hearing aid up to $2,000
- Repairs (per year) up to $120
Annual limits and services per
person, per calendar year. Audiology (hearing tests)
- Annual Limit $200
- Initial Consultation $50
- Subsequent Consultations $40
18SERVICES EXTRAS LEVEL
OF COVER
OPTICAL
Annual Limit for supply of glasses $250
- Contact lenses 90% of the
cost up to
$250
Annual Limit for repairs to glasses $50
LASER EYE SURGERY (LASIK AND ASLA EYE SURGERY)
For laser eye surgery performed in a registered day surgery facility. Annual
maximum benefit entitlements per person increase with each completed
year of membership, as follows:
1 year Nil
2 years 90% of cost up to $500
3 years 90% of cost up to $1,000
4 + years 90% of cost up to $1,500
LIFE CHOICES ANNUAL LIMIT $350
Quit Smoking Programs 90% of cost
Programs must be approved by the Fund. up to $150
Weight Loss Programs 90% of cost
Programs must be approved by the Fund. up to $150
Diabetes Education
- Annual Limit $200
- Consultation $20
Diabetes Australia Membership $36
Health Screening Checks
For health checks that are not eligible for Medicare
benefits. Screening services must be approved by the Fund.
- Annual Limit $100
- Per Service 90% of cost
up to $250
MEDICAL APPLIANCES* (LIMIT FOR SAME APPLIANCE EVERY 3 YEARS)
Medical Appliances* 90% of cost
Prescribed by a specialist or doctor, including tens machine, up to $500
nebuliser, glucose monitor, blood pressure monitor.
Non-surgical Prostheses* 90% of cost
Items prescribed by a specialist or doctor, including up to $200
breast prosthesis and surgical stockings.
CPAP machine* 90% of cost
Your doctor will first diagnose your requirement and up to $700
determine your eligibility to insure the therapy is right
for you.
OTHER THERAPIES ANNUAL LIMIT $1,000 * When making medical botox or medical
Podiatry / Chiropody appliance claims members are required to
- Annual Limit $300 supply a letter from their treating medical
- Initial Consultation $30
- Subsequent Consultations $27
practitioner indicating the medical condition
- Nail surgery (excludes inpatient services) $100 requiring treatment. For all pharmacy claims
please ensure an official pharmacy receipt
Orthotics (custom made) Annual Limit $200
is provided to HCI. The official pharmacy
Orthotic Casting Annual Limit $100 receipt will have the name of the patient,
Eye Therapy (Orthoptics) script number, prescribing doctor information,
- Annual Limit $375 cost, name of medication and dispensed
- Initial Consultation $30 date on it. Your pharmacist who should be
- Subsequent Consultations $25
- Group Session $10 able to provide this to you upon request.
19premier
extras
cont _ SERVICES EXTRAS LEVEL
OF COVER
OTHER THERAPIES ANNUAL LIMIT $1,000
Speech Therapy
- Annual Limit $375
- Initial Consultation $50
- Subsequent Consultations $30
- Group Session $10
Dietetics
- Annual Limit $200
- Initial Consultation $35
- Subsequent Consultations $30
Occupational Therapy
PLEASE NOTE: - Annual Limit $375
- Initial Consultation $40
There is an annual limit - Subsequent Consultations $30
- Group Session $10
imposed on the dollar amount
that can be claimed per service HOME NURSING
per year. Expenses beyond the For a visit by a home nursing provider approved by the
set annual limit are exempt Fund. Visit/treatment must be prescribed by a doctor.
from cover. - Annual Limit $500
- Per Visit $25
PHARMACY $1,000
* When making medical botox
or medical appliance claims Per Script $100
members are required to 100% less the applicable co-payment amount. The An Annual Limit
applicable co-payment is equivalent to the maximum of $600 applies
supply a letter from their cost for a pharmaceutical benefit item for a general for prescriptions
treating medical practitioner patient under the pharmaceutical benefits scheme as for the following
indicating the medical condition determined by the Federal Government each year. conditions:
weight loss,
requiring treatment. For all Benefits are excluded for items that can be obtained
without a prescription, contraceptives, anabolic baldness and
pharmacy claims please ensure male erectile
steroids and drugs not approved in Australia.
an official pharmacy receipt is dysfunction
provided to HCI. The official Medical Botox* (For treatment of a medical condition $600
pharmacy receipt will have only) – 100% of cost up to annual limit.
the name of the patient, script
PHYSIOTHERAPY GROUP ANNUAL LIMIT $750
number, prescribing doctor
information, cost, name of Physiotherapy
- Annual Limit $700
medication and dispensed - Consultation $33
date on it. Your pharmacist - Group Session $15
who should be able to provide
Hydrotherapy
this to you upon request. - Annual Limit $300
- Consultation / Treatment $15
Annual limits and services per PSYCHOLOGY $250
person, per calendar year.
Initial Consultation $60
Subsequent Consultations $50
Group Session $20
20SERVICES EXTRAS LEVEL
OF COVER
SURGICAL FOOTWEAR & CUSTOM MADE SUPPORT
APPLIANCES
For surgical footwear and custom made support 90% of cost
appliances prescribed by a specialist or doctor and up to $1,000
individually made by a provider approved by the Fund.
FUNERAL (ELIGIBLE MEMBERS ONLY)**
This benefit is only payable to members who $1,150
had entitlement under the Rules in force prior to
1st April 2007. A benefit is payable to eligible members
following the death of a member or dependent
(refer to waiting period).
TRAVEL AND ACCOMMODATION#
Benefits payable when attending a medical specialist
or hospital more than 50kms from normal place of ** Members who make a change to their policy,
residence within home state. (e.g changing excess level or level of cover) will
lose their funeral benefit as Federal Government
Accommodation - per night $50
Legislation as of 1st April 2007 prohibits health
Travel - per km 15 cents funds from offering this entitlement.
Travel and Accommodation
- Maximum Per Trip per person $125 #
For HCI to pay a benefit on travel and
- Annual Limit per person $300 accommodation, members must have a Gold
- Annual Limit per family $800 Hospital and Premier Extras.
21SERVICES EXTRAS LEVEL
OF COVER
healthy
AMBULANCE
For emergency transport provided by a registered Cost
ambulance provider within Australia
extras _ ALTERNATIVE THERAPIES GROUP ANNUAL LIMIT
Chiropractic / Osteopathic
- Initial service
- Subsequent services
$500
$33
$25
Acupuncture
- Consultations $25
Remedial Massage, Chinese Medicine and Myotherapy
- Consultations $27
Healthy Extras is your
DENTAL TREATMENT
gateway to living your best
Benefits are paid according to the Australian Dental Association item
life. This extensive extras cover number used. Benefits are payable at 90% of cost to a set maximum per
leaves little room for concern. item. For an itemised quote please contact us.
It will help you live the life $1,000
you want, meeting your day to GENERAL DENTAL ANNUAL LIMIT (INCLUDING
ENDODONTICS)
day needs, and will have you
The maximum number of services in which a benefit
back up and running through will be paid on items 011-015 in total is 2 per year and
life’s unforeseen situations. 016-017 in total 2 per year
Item 011 - comprehensive oral examination $25
You can combine Healthy Extras with Item 121 - topical application of remineralisation agent $14
Item 311 - removal of a tooth $70
Silver Plus Hospital or Bronze Hospital
Item 511 - metallic filling 1 surface $68
for a more comprehensive cover, complete Endodontics $500
with a range of excess options, you will With Healthy Extras cover, you can also
have satisfaction of knowing you’re receive NO GAP on annual check up and cleans
in the smile.com.au dental network!
putting your best foot forward.
MAJOR DENTAL $1,500
Crowns and Bridgework $700
Periodontics $500
Implants $700
Dentures (benefits are payable every 2 years) $800
Orthodontics
- Lifetime Limit $1,800
- Annual Limit per person $600
PSYCHOLOGY $250
PLEASE NOTE: Initial Consultation $60
Subsequent Consultations $50
There is an annual limit
Group Session $20
imposed on the dollar amount
that can be claimed per service HEARING TESTS AND APPLIANCES
per year. Expenses beyond the Hearing Aids
set annual limit are exempt Appliance limit every 3 years with a benefit payable
from cover. of 90% of cost for:
- Single hearing aid up to $800
- Bilateral hearing aid up to $1,600
- Repairs (per year) up to $120
Annual limits and services per
person, per calendar year. Audiology (hearing tests)
- Annual Limit $200
- Initial Consultation $33
- Subsequent Consultations $30
22SERVICES EXTRAS LEVEL
OF COVER
SERVICES EXTRAS LEVEL
OF COVER
PHARMACY $700 PHYSIOTHERAPY GROUP
$700
ANNUAL LIMIT
Per Script $75
Physiotherapy
100% less the applicable co-payment amount. The
- Annual Limit $700
applicable co-payment is equivalent to the maximum
- Initial Services $60
cost for a pharmaceutical benefit item for a general
- Subsequent Services $25
patient under the pharmaceutical benefits scheme as
- Group Session $15
determined by the Federal Government each year.
Benefits are excluded for items that can be obtained Hydrotherapy
without a prescription, contraceptives, anabolic - Annual Limit $100
steroids and drugs not approved in Australia. - Consultation / Treatment $15
Medical Botox* (For treatment of a medical condition
only) – 100% of cost up to annual limit. OTHER THERAPIES ANNUAL LIMIT $1,000
Podiatry / Chiropody
OPTICAL - Annual Limit $300
Annual Limit for supply of glasses and contact lenses $200 - Initial Consultation $30
- Single Vision $200 - Subsequent Consultations $25
- Bifocal $200 - Nail surgery (excludes inpatient $100
- Multifocal $200 services)
- Contact lenses 90% of the
Orthotics (custom made) $200
cost up to $200
Annual Limit
LIFE CHOICES ANNUAL LIMIT $300 Eye Therapy (Orthoptics)
- Annual Limit $200
Quit Smoking Programs 90% of cost
- Initial Consultation $30
Programs must be approved by the Fund. up to $100
- Subsequent Consultations $25
Weight Loss Programs 90% of cost - Group Session $15
Programs must be approved by the Fund. up to $100
Speech Therapy
Diabetes Education - Annual Limit $400
- Annual Limit $200 - Initial Consultation $33
- Consultation $20 - Subsequent Consultations $25
- Group Session $15
Health Screening Checks
For health checks that are not eligible for Medicare Dietetics
benefits. Screening services must be approved by the Fund. - Annual Limit $200
- Annual Limit $100 - Initial Consultation $33
- Per Service 90% of cost - Subsequent Consultations $30
up to $100
Occupational Therapy
HOME NURSING $500 - Annual Limit $375
- Initial Consultation $33
For a visit by a home nursing provider approved by the - Subsequent Consultations $30
Fund. Visit/treatment must be prescribed by a doctor. - Group Session $15
- Annual Limit $500
- Per Visit $20
MEDICAL APPLIANCES / SURGICAL FOOTWEAR* $1,000
* When making medical botox or medical
3 year limit for appliances (TENS machines, blood 90% of cost appliance claims members are required to
glucose monitors, nebulisers, blood pressure up to $300
monitors)* except sleep apnoea appliances
supply a letter from their treating medical
practitioner indicating the medical condition
3 year limit for sleep apnoea appliances* 90% of cost requiring treatment. For all pharmacy claims
up to $500
please ensure an official pharmacy receipt
Surgical Footwear 90% of cost is provided to HCI. The official pharmacy
up to $1000
receipt will have the name of the patient,
Medical Braces 90% of cost script number, prescribing doctor information,
up to $500
cost, name of medication and dispensed
Non Surgical Prostheses 90% of cost date on it. Your pharmacist who should be
up to $150 able to provide this to you upon request.
23active life
extras _
SERVICES EXTRAS LEVEL
OF COVER
ALTERNATIVE THERAPIES GROUP
$400
ANNUAL LIMIT
Active Life Extras is designed
Chiropractic
to give you cover for what you - Consultations $22
need right now. Active Life - X-Rays $30
Extras is a budget friendly Osteopathy
- Consultations $22
extras cover that allows you to
Acupuncture
be covered for the essentials - Consultations $22
without breaking the bank.
Remedial Massage, Chinese Medicine and Myotherapy
Active Life Extras will be the support you - Consultations $22
need to kick start, or maintain, your best
DENTAL TREATMENT $500
possible self.
Benefits are paid according to the Australian Dental (GENERAL &
You can combine Active Life Extras with Association item number used. Benefits are payable at MAJOR
90% of cost to a set maximum per item. For an itemised DENTAL
Gold, Silver Plus or Bronze Hospital for a COMBINED)
quote please contact us.
more comprehensive cover, complete with a
range of excess options, you will have the GENERAL DENTAL ANNUAL LIMIT
security of hospital cover with the benefits
The maximum number of services in which a benefit
of Active Life Extras.
will be paid on items 011-015 in total is 2 per year and
016-017 in total 2 per year
Item 011 - comprehensive oral examination $27
Item 121 - topical application of remineralisation agent $13
Item 311 - removal of a tooth $70
Item 511 - metallic filling 1 surface $57
MAJOR DENTAL
Crowns and Bridgework up to $500
Periodontics up to $500
Implants up to $500
PLEASE NOTE:
OPTICAL $220
There is an annual limit
imposed on the dollar amount Annual Limit for supply of glasses and contact lenses $220
- Single Vision $170
that can be claimed per service - Bifocal $190
per year. Expenses beyond the - Multifocal $220
set annual limit are exempt - Contact lenses 90% of the
cost up to
from cover.
Annual Limit for repairs to glasses $180
Annual limits and services per $50
person, per calendar year.
Annual limits and services per PHYSIOTHERAPY GROUP ANNUAL LIMIT $400
person, per calendar year. Physiotherapy
- Annual Limit $400
- Consultation $22
- Group Session $10
24Extras waiting periods
SERVICES WAITING PERIOD
Acupuncture 2 months
Ambulance 2 months
Audiology (Hearing Tests) 2 months
Chiropractic 2 months
Dental – General 6 months
Dental – Major (excl. Orthodontics) 12 months
Dental – Orthodontics 12 months
Diabetes Education 2 months
Diabetes Australia Membership 2 months
Dietetics 2 months
Eye Therapy (Orthoptics) 2 months
Funeral* (eligible members only) 120 months
Health Screening Checks 2 months
Hearing Aids 24 months
Home Nursing 2 months
Hydrotherapy 2 months
Laser Eye Surgery 12 months
Medical Appliances 12 months
Remedial Massage, Chinese 2 months
Medicine & Myotherapy
Non-surgical Prostheses 12 months
Occupational Therapy 2 months
Optical 6 months
Orthotics 2 months
Osteopathy 2 months
Pharmacy 2 months
Physiotherapy 2 months
Podiatry / Chiropody 2 months
Psychology 2 months
Quit Smoking Programs 2 months
Speech Therapy 2 months
Surgical Footwear 2 months
Travel and Accommodation 6 months
Weight Loss Programs 2 months
* Funeral cover special conditions are on page 23.
25packaged
cover _
Package
Single Couples
your cover health care
for team me
health care
for me and
so you have my partner
everything
to suit your
needs.
+
26Single Parent Extended Family Extended
health care for Single health care for Family
me and my kids Parent me, my partner health care for
(up to age 25 if full health care for and all our kids me, my partner
time student) me and my kids (up to age 25 if full and all our kids
(aged 23 & 24) time student) (aged 23 & 24)
GOLD HOSPITAL WITH
PREMIER EXTRAS
Our highest level of cover. Be confident that you are fully covered.
Or, You Choose!
Choose to combine Gold Hospital, Silver Plus Hospital or Bronze Hospital
with Healthy Extras or Active Life Extras.
Note: Premier Extras is only available to purchase when packaged with either
Gold Hospital or Silver Plus Hospital.
27how to
claim _
We offer a range of claiming options that are fast, easy-to-use and
even paperless. In most cases, Extras claims are processed the same
day they’re received.
HICAPS electronic claiming (HICAPS) has streamlined extras claiming so
you can be refunded on the spot. Based on your level of extras cover,
benefits will be paid to the provider instantly and you will just need to
pay the difference.
HOSPITAL AND MEDICAL CLAIMS
Hospital claims:
Generally, when you are discharged from hospital, the hospital staff
will forward the account for your hospital treatment directly to HCI.
Check this before you leave.
Medical claims for treatment received
whilst in hospital:
If you receive bills from your doctor for medical treatment you
received whilst in hospital, you must lodge your medical claims at a
Medicare office first, before submitting with us.
Visit: www.humanservices.gov.au/individuals/forms/ms014 to find
out more information.
You cannot claim your out-of-pocket expenses and HCI does not pay
benefits for medical treatment provided to you out of hospital.
If you have paid the account, your benefit can be paid electronically
into your bank account. You will receive a separate notification as to
the payment details. Or, if you have not paid the account, a cheque
will be made payable to the practitioner who provided the treatment.
28Claiming made easy
HCI Smartphone Claiming App
Download the HCI Claiming App
to send us your claim straight
from your mobile or tablet.
Email – with a completed claim form*
Email your claim form and receipt to us at:
enquiries@hciltd.com.au
Fax
Fax your claim form and receipt to 03 6432 1160
Mail
Post your claim form and receipt to
PO Box 931, Burnie TAS 7320
*To download claim form, visit: hciltd.com.au/downloads
It’s important to remember:
All accounts and receipts must include the full
name of the person receiving the service, the
date, provider details, the appropriate item
number and a full description of the services/
PAYING FOR YOUR PREMIUMS products being claimed and the cost.
Paying your premiums is easy, you choose the
payment method that works for you: All services/products must be provided by
practitioners who are operating in private
Direct Debit Online via our website practice and who are approved by HCI.
Payroll Deduction Cheque Claims must be lodged within two years of the
date of service.
BPAY Credit Card
Benefit payments are calculated on the date
Over the Phone In person services/products are provided.
Note: To pay your premiums through payroll Claims posted, faxed or emailed must have
deduction there must be a minimum of four people a completed claim form attached, with a
in your work place paying through payroll. handwritten signature.
29best
doctors _
Health Care Insurance (HCI)
has partnered with Best
Doctors to give all HCI
members peace of mind
and a clear way forward
in their times of need.
30HCI’s Best Doctors provides access to a second opinion
from the world’s leading medical specialists. If a HCI
member has received a diagnosis or treatment for an
illness, injury, or mental health condition, HCI’s Best
Doctors can arrange for a top expert to conduct an
in-depth review of your case.
It’s a confidential service that complements the care
your own doctor is providing. With HCI’s Best Doctors,
you can be sure you have the right diagnosis and
treatment plan. And you can be confident you’re
making the right decisions about your health.
HCI’s Best Doctors offers an array of services
including Expert Medical Opinion, Doctor Online™,
Find an Expert™ and Mental Health Navigator.
Find out more about HCI’s Best Doctors services on
their member portal. On the portal you'll find
online services that enable you to ask a GP a
question, check a symptom and learn more about
medical conditions. For more information, go to:
www.askbestdoctors.com
31healthy.
smiles.
everyday _
Health Care Insurance
(HCI) has partnered with
smile.com.au to make quality
dental care more affordable for
our members across Australia.
If you have extras cover, you are now
automatically entitled to save 15 – 40% off
all dental treatments when you visit a
smile.com.au approved dentist.
Of course your usual HCI benefit is still
payable. The lower up front costs means
your out of pocket costs are also lower!
And for those with Healthy Extras cover,
in addition to the savings, you can receive
No Gap on annual check up and cleans!
Now that’s something
to smile about!
32here’s how
it works
1. B
ook an appointment
with a smile.com.au
approved dentist
2. S
how your card to
receive the savings
3. C
laim as you would usually
There are 2000+ quality approved dentists
across Australia! Find your nearest by following:
www.smile.com.au/health-funds/hci
33important
info _
SUSPENDING MEMBERSHIP PRIVATE HEALTH COMPENSATION AND DAMAGES
Members may apply for suspension of INFORMATION STATEMENTS HCI does not pay benefits for services or
their membership if they have held Private Health Information Statements treatment where you are entitled to
private health insurance cover for at least provide a brief summary of your level of receive compensation or damages from
12 months and paid all contributions due cover to help you review your existing another source. Where an accident or
as of the application date. policy and compare other health funds. illness is caused by the actions of another
HCI is required by law to issue you with party, HCI expects that you will pursue a
Suspension of membership can be
a Private Health Information Statement claim for compensation or damages from
approved on two grounds:
when you first join and thereafter at the party concerned. HCI may, however,
• T
he member’s absence from Australia your request. make provisional payments where
for 28 days and up to two years. compensation or damages are claimable
For more information about Private
• T
he member’s financial hardship by you, provided you agree to repay such
Health Information Statements you
for 1 to 6 months. payments from your final settlement.
can phone on 1800 804 950 or visit
Periods of suspension of hospital cover hciltd.com.au If you become involved in circumstances
do not count towards the cumulative where compensation or damages may
You can view each health fund’s Private
absence allowed by Lifetime Health be claimable by you, please call us on
Health Information Statements by visiting
Cover legislation. 1800 804 950 to seek clarification of
privatehealth.gov.au
your benefit entitlements.
If a member reinstates membership
within 30 days of the period suspension RECOGNISED/APPROVED
TREATMENT PROVIDERS 30 DAY MONEY BACK GUARANTEE
ending and pays contributions from the
HCI can only pay benefits to members Our 30 day money back guarantee
end of the suspension period, there will
that use providers who are recognised lets you cancel your membership within
be no new waiting periods to be served.
and approved by HCI. Recognition of 30 days with a full refund of any
For details of what information you will providers by HCI is subject to change contributions you have paid. Your 30
need to provide in your application for without notice. day cooling-off period starts as soon as
suspension of membership, call us on you join. However, your cooling off period
1800 804 950. If you are not sure about a provider’s is no longer available if a claim under
approved status with HCI, call us on your policy has been made during the
CEASING MEMBERSHIP 1800 804 950 to check before cooling-off period.
If you choose to cease your hospital arranging treatment.
PAYMENT DEFAULT
cover, your future hospital health cover Should your contributions fall more than
premiums will be subject to the Lifetime SERVICES PROVIDED BY
FAMILY MEMBERS two months in arrears, your membership
Health Cover provisions dealing with may be ceased. Acceptance of arrears
periods of absence. Unless a member has received prior
approval from the General Manager, payments after two months is not
Please note that high income earners will HCI will not pay benefits for services or automatic, so please talk to us if you
be subject to the Medicare Levy goods provided to a person covered by a need time to pay. It should be noted that
Surcharge (MLS) during a period of membership where those services or benefits are not payable for treatment
suspended hospital cover. goods are supplied by a family member. if your contributions are in arrears.
OVERSEAS TREATMENT BENEFIT LIMITATION PERIODS
HCI will not pay a benefit for services, Some private health insurers will apply
treatment or appliances provided or Benefit Limitation Periods (BLP) for certain
purchased overseas. HCI will only pay a types of treatments and hospital policies.
benefit towards services, treatment and BLP are periods applied after your waiting
appliances by approved providers and/or period has already been served and a lower
suppliers registered within Australia only. benefit is paid than the normal benefit.
HCI does not apply BLP for members.
34FEDERAL GOVERNMENT INCENTIVES
TO GET PRIVATE HEALTH CARE:
FEEDBACK
At HCI we value your opinion and if a product PRIVATE HEALTH For convenience and certainty that you
or service does not meet your expectations, INSURANCE REBATE receive your full rebate entitlement,
we want to know about it. Talk to us - our The federal government private health we recommend you register to have
team is here to listen. We want your feedback insurance rebate helps make private your rebate taken off the contributions
and aim to solve any questions or concerns health insurance more affordable. The you pay to HCI.
on the spot. You can call us on 1800 804 950 rebate applies to hospital and general
or alternatively you can write to us at treatment policies. Since 2012 this MEDICARE LEVY
enquiries@hciltd.com.au or PO Box 931, rebate is income tested. SURCHARGE (MLS)
Burnie TAS 7320. The MLS of up to 1.5% is paid in
The income thresholds are indexed
addition to the 2% Medicare Levy
In managing your complaints HCI will seek to: every financial year. For more
that is deducted from your taxable
• Resolve your matter at first point of call. information on the income threshold
income in Australia. With private
please refer to our health cover
• Keep you informed of the process. hospital cover you are exempt from
premiums, our website hciltd.com.au or
the MLS 1.5% surcharge.
• Investigate your complaint and respond alternatively you can visit the Australia
to you within 5 business days. Taxation Office website ato.com.au The MLS applies if you do not have an
• P
rovide you with a final response within appropriate level of hospital cover and
The level of rebate you may be entitled
45 days. your annual adjustable taxable income
to also depends on the age of the
exceeds the limit set by the Federal
OBTAIN AN EXTERNAL REVIEW oldest person covered by your policy.
Government for single, single parent,
If despite everyone’s best efforts we are The rebate increases when you turn 65
couple and family memberships.
unable to resolve your concerns with our and again at age 70.
For more information visit our website
senior manager, you may wish to have the You can claim your rebate in one of two hciltd.com.au
matter investigated by an independent ways: as a reduction in your
person. The Private Health Insurance contributions; or as an income tax
Ombudsman (PHIO) handles complaints offset on your income tax return.
for Private Health Insurance consumers
and can be contacted by:
Complaints Hotline: 1300 362 072
www.ombudsman.gov.au
For general information about private health
insurance, see www.privatehealth.gov.au
PRIVATE HEALTH
INSURANCE INDUSTRY
CODE OF CONDUCT
HCI is a signatory to the
Private Health Insurance
Industry Code of Conduct.
The code was developed by the industry
and is designed to set benchmarks of
standards of service to members to be
achieved by all Private Health Insurers.
A copy of the code is available at
privatehealthcareaustralia.org.au/
codeofconduct
PRIVACY STATEMENT
HCI respects your privacy and is committed
to keeping your personal information safe
through compliance with the Privacy Act 1988 HCI will do everything possible to ensure that your
and the Notifiable Data Breaches (NDB) privacy is not breached. However, if you believe we
scheme under Part IIIC of the Privacy Act. have breached your privacy, you may write to:
HCI collects information that is necessary HCI Privacy Officer
to assist the fund to meet your health PO Box 931, Burnie TAS 7320
insurance needs. We will endeavour to resolve the matter amicably
If you wish to obtain more with you. However, if you consider we have not
information about HCI’s resolved the matter to your satisfaction, you may
Privacy Policy, please contact contact the Privacy Commissioner’s Office at:
our Privacy Officer on The Director of Compliance
1800 804 950 or refer to our Office of the Privacy Commissioner
website at hciltd.com.au GPO Box 5218, Sydney NSW 2001
35HCI is your ticket to being well, being
covered and being well covered.
Unlock the key
to peace of mind
with HCI.
36useful glossary
links _ items _
Access gap cover A scheme offered by HCI in HCI Health Care Insurance Ltd.
For HCI: hciltd.com.au partnership with AHSA to allow members more
Lifetime Health Cover A private health
choice and minimise medical gaps. The Access
insurance initiative introduced by the
Gap Cover scheme gives members more clarity
Download claim forms, rates, brochures Australian Government in July 2000 for
with private hospital cover to help reduce out-
the purpose of encouraging Australians to
and much more: hciltd.com.au/ of-pocket expenses (medical gap) for in-hospital
take out private health insurance earlier
admissions. Doctors can opt-in or opt-out of
downloads in life and continue to hold their cover.
the Access Gap Cover scheme at any time.
Medical gap Also known as ‘out-of-
Accident An unforeseen event or incident
pocket’ is any amount above the listed
To obtain a quote: which results in an injury and requires
Medicare Benefit Schedule Fee or Access
hciltd.com.au/get-a-quote immediate treatment or medical attention.
Gap Schedule. We encourage you to
Admission Treatment or medical attention contact your health provider to find out
as a Private Patient in a registered if you will have to pay medical gap.
Search for providers: public, private or day Hospital where a
Medicare Benefit Schedule (MBS)
hciltd.com.au/provider-search member has been admitted by a medical
Medicare contributes a set amount for
practitioner and declared an inpatient.
each treatment or procedure, as laid out
Treatment in the emergency room of a
in the Australian Government’s MBS.
To view our products: Private Hospital is not an Admission.
This schedule of Medicare services is
hciltd.com.au/types-of-cover Agreement hospital A hospital with subsidised by the Australian Government.
which we have negotiated a contract Your doctor may choose to charge more
to minimise out-of-pocket expenses than the MBS fee so you may have to
Private Health Care Australia: for most Hospital related expenses. pay additional out-of-pocket expenses.
www.privatehealthcareaustralia. Australian Health Services Alliance Member A person who is a member of
org.au (AHSA) A third party contracted by HCI in accordance with its constitution.
HCI to negotiate fees and benefits with
Medicare Levy Surcharge (MLS) A levy
hospitals and medical providers.
on your taxable income of up to 1.5%
Australian Health Service Alliance: Benefit(s) An amount that is paid depending on your level of income. MLS
www.ahsa.com.au/web to the member or the provider for applies if you do not hold an appropriate
approved services or treatment level of hospital cover and your taxable
as outlined in the brochure. adjustable income exceeds the limit
Department of Health: Calendar year is 1 January to 31 December. set by the Federal Government.
www.health.gov.au Claim A request for the entitlement and Partner A person who lives with the policy
payment of benefits in accordance with fund holder in a marital or de facto relationship.
rules and the product the member holds. Policy The contract between you and
LHC calculator: www. Health Care Insurance Ltd which provides
Certified entry age is the age at
privatehealth.gov.au/dynamic/ which you took up hospital cover. you with private health insurance cover
lifetimehealthcover.aspx in exchange for a contribution.
Compensation Means legally entitled to,
Pre-existing conditions Illness or
likely to receive, or had received payment
by way of compensation, damages or ailment A pre-existing ailment, illness or
LHC information: www.ato.gov.au/ other benefits for expenses. For example condition is one where the signs or symptoms
Individuals/Medicare-levy/Private- workers compensation, motor vehicle existed during the six months before joining
HCI (or upgrading to a higher level of cover).
health-insurance-rebate/Lifetime- accident claims where an entitlement
has been received from another party. Private Health Insurance rebate
health-cover/ A rebate amount from the Australian
Commonwealth Medical Benefit Scheme
(CMBS) is a list of Medicare services that are Government to help cover the cost of
private health insurance for consumers.
Medicare: www.humanservices.gov. subsidised by the Australian Government.
au/individuals/medicare Contribution(s) An amount of money Private Health Insurance Statement
a member is required to pay to us to A separate document that provides you with
receive private health insurance cover. a summary of your health insurance cover.
Claiming through Medicare: www. Dependants - Dependant children Restricted Services Hospital claims
humanservices.gov.au/individuals/ • A person who is not the member
that are limited to a default/minimum
benefit. The default benefit is the minimum
forms/ms014 or member's partner
dollar amount that is set by the Australian
• Your children under 23 years of Government for accommodation as a
age including step children, legally private patient in a shared room in a public
Australian Government website for adopted children, foster children hospital. HCI cannot pay towards the cost
all things related to Private Health and grandchildren (supporting legal of intensive care or theatre fees in a private
Insurance: www.privatehealth.gov.au guardianship document required) hospital or private day center, therefore
• Full-time students who are enrolled in you may incur large out of pocket costs.
an Australian a school, college or tertiary Same Day admission An admission in
Private Health Insurance Ombudsman: institution up until their 25th birthday. a registered hospital or registered day
www.ombudsman.gov.au • Are not married or living in a hospital where you are discharged on
de facto relationship the same date as you were admitted.
Exclusions Services and treatments Waiting period(s) A period of time set by
Australian Prudential Regulation HCI in accordance with the Private Health
that you are not covered by your
Authority (APRA): www.apra.gov.au health insurance cover. Insurance Act 2007 by which you and
anyone else who is insured under the policy
Excess If you are going into hospital for must continuously be covered by before
the first time that calendar year, you may anyone insured can receive a paid benefit.
have to pay an excess. An excess is the
amount you have agreed to pay towards You The person or persons covered
a claim on your hospital insurance. by the policy.
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