Health insurance that puts you first
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Health insurance
that puts you first
ntil 2014 -
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Health Insurance
Australia
2009 - 2014
April 2015
1
Why having health cover
makes good sense
Value for money
HCF members have peace of mind knowing you:
No matter what you pay, you’ll get better value with HCF.
• can choose your own doctor All our hospital and extras products are specially designed to give
• can claim back on extras, including dental you great cover at a reasonable price, whatever your needs.
• avoid public hospital waiting lists for
elective surgery
Pay nothing on a range of extras
• have access to emergency ambulance HCF EXTRAS COVER
cover if you need it. HCF includes 100% back on certain claims on selected extras at
participating providers (and subject to your limits). The higher your
extras cover, the more services you can claim 100% back on.
Higher limits the longer you're with us
Your loyalty is rewarded when you’re with HCF. Depending on your level
you
When you’re with HCF,
of cover, your extras claim limits increase for every year you’re a member,
up to a maximum limit. It’s another way we want you to stay happy.
it’s all about Create your own cover
You should be able to decide the best cover for your needs, so with HCF
you can create a customised hospital and extras package. If you only
want hospital cover, or just need extras, you can do that too.
Free health and wellbeing programs
HCF knows how important your health and wellbeing is, so we provide
a range of quality health programs to you at no extra cost. See page 18
for more details.
Make extras claims via our mobile app
As Australia’s largest not-for-profit health fund, everything we
We’ve taken the hassle out of claiming - just send us a photo of your receipt
do is focused on your needs. We take pride in delivering high using the HCF app. No more waiting in queues - you can claim wherever
quality service, having won major customer service awards. you are, whenever you want. It’s that easy.
And we’re careful with your money. In 2014, we returned
93 cents in every dollar back to our members (against the
industry average of 87 cents). HCF's 30 Day Guarantee
We want you to be happy with your health cover and the choice you’ve
made. So we’ll give you a 100% refund up to 30 days after you’ve
joined, as long as you haven’t made a claim in that period.
2
It's easy to get a great package
that suits your needs To make choosing your health cover easier,
we've created a selection of packages to
suit your life stage, budget & usage.
Boost your package with
Which best describes you? Suggested hospital & extras Cash Assist Covers
Basic Hospital & Bronze Plus Extras Cash Back Cover
under
Young singles & couples Pays $5,000 if you suffer an
under
30 yrs
30 yrs Young Starter Package accident requiring surgery
Cover for the essentials without blowing within 6 months or suffer a listed
your budget Mid Hospital & Silver Extras serious medical condition.
Premium Hospital & Silver Extras Income Assist Insurance
Planning a family Pays 75% of your monthly ?
Premium Hospital & Gold Extras income (up to a max $6,000)
Cover for when you’re having kids
for 12 months if you are unable to
? Premium Hospital & Platinum Extras work for more than 30 days.
Basic Hospital & Silver Extras
Family with kids Kids' Accident Cover
Pays up to $100,000 if your child
Mid Hospital & Gold Extras
Cover for every type of family (under 17) is accidentally injured.
Only 90 cents per child per week.
Premium Hospital & Platinum Extras
Mid Hospital & Silver Extras
No kids, no worries Medical Trauma
Pays a specified sum, up to
Mid Plus Hospital & Gold Extras Over
Cover for singles & couples without kids
30 yrs
Over $50,000, if you suffer one of
30 yrs
the 40 listed serious medical conditions.
Premium Hospital & Platinum Extras
Premium Hospital & Silver Extras Smart Term Insurance
Complete peace of mind Pays up to $500,000 in the
event of death or terminal
Premium Hospital & Gold Extras
Cover for anyone wanting complete illness. Benefit is doubled if death
peace of mind is due to accident. Early payment of
Premium Hospital & Platinum Extras $10,000 to cover funeral expenses.
Stand-alone cover Choose a stand-alone hospital or extras cover.
Plus it's easy to add additional cover if you need to.
For more details on our health cover
packages see overleaf. For all Cash
Quality cover when you need it Assist Covers, see page 16.
5
You can also create the cover that’s
just right Young Starter Package
Designed for young
for you
singles & couples getting
health cover for the first
time.
• Includes basic hospital
and extras
• Saves you tax if you’re
a high income earner
• 100% back on up to
2 dental checks per
Because different people have different health cover needs, HCF lets you year at participating
customise your hospital and extras cover. Just select one of the 4 hospital providers (subject to
covers below and your preferred extras option. Or if you only want a your annual limits).
hospital cover, or just need extras, the choice is yours.
Choose your hospital cover Choose your extras cover
Premium Platinum
Top level extras
Premium hospital Gold with the highest
cover for those who
Mid Plus prefer complete OR
coverage for
therapies and
Quality extras
peace of mind. Silver cover for a wide services.
Comprehensive range of services • 100% back on
hospital cover for • No excess for
Mid healthy singles & accidents
Affordable mid and therapies.
Bronze Plus level extras cover • 100% back on up to 2 dental
checks per year*
couples not requiring • No excess for kids for a range of
up to 2 dental • 100% back on
Affordable hospital cover for pregnancy • Only one excess for Basic extras cover services and checks per year*
therapies. initial physio,
Basic cover for some (must be taken with same day hospital Bronze for dental, optical
and selected • 100% back on chiro, osteo,
common procedures. extras). admissions • 100% back on initial physio,
Cost effective, therapies. podiatry consult*
• No excess for • Pregnancy, heart up to 2 dental chiro, osteo,
Basic hospital cover • No excess for entry-level extras • 100% back on • No gap eyewear
accidents surgery, joint cover that’s checks per year.* podiatry consult*
designed for the healthy accidents 1 dental check and free digital
• No excess for kids replacement surgery competitively • No gap eyewear • No gap eyewear
& budget conscious. • Heart and joint per year* retinal imaging
• Heart surgery, joint & more priced. and free digital and free digital
replacement surgery • A step up from eye check at
• No excess for investigations & more • Free access to a great • Basic extras retinal imaging retinal imaging
& more Bronze extras, eye check at eye check at participating
accidents • Free access to a great range of health and cover for dental with higher
• Free access to a great participating participating More for Eyes
• No excess for kids range of health and wellbeing programs. and selected limits plus optical providers.*
• Joint investigations wellbeing programs. range of health and More for Eyes More for Eyes
wellbeing programs. therapies. optical benefits.
& more. optical providers.* optical providers.*
*at participating providers and subject to your annual limits.
Check out our Cash Assist Covers for accident
and illness on page 16.
100% BACKHCF EXTRAS COVER
HCF lets you claim back up to 100% of the cost of certain
services at participating More for You providers
(depending on which cover you take out).
6 7
Hospital benefits summary Budget friendly
Basic
Young Starter Package
Mid-range
Mid
Mid Plus
Highest cover
Premium
Hospital waiting periods
Palliative care
Singles & Couples only Singles & Couples only Psychiatric services 2 months
Excess (per person per calendar year) $250, $500 $250, $500 $250, $500 $250, $500 Nil, $250, $500 Rehabilitation services
Pre-existing ailments or conditions
No excess for kids NA NA 12 months
Pregnancy & birth related services
No excess for accident related treatment
All other hospital services 2 months
For same day hospital admissions, pay only one excess per policy, per year
No No Extras waiting periods
Available as hospital cover only (without extras) Yes (Available with Young Starter Yes (Available with Silver or Gold Yes
Health Management Programs 6 months
extras only) extras only)
Examples of what’s covered - Includes accommodation, operating theatre, intensive care, Government approved prostheses, pharmaceuticals# and physiotherapy, as part of your covered admission at a participating private hospital Artificial appliances (e.g. low vision aids, blood glucose monitors)
Foot orthotics
Emergency Ambulance
Pre-existing ailments & conditions
Accident related treatment after joining
Dental bleaching
Removal of tonsils, adenoids, appendix
Crowns and Bridges
Surgical treatment of a hernia
Indirect fillings
Removal of kidney stones & gall stones Dentures
Digestive disorder procedures (e.g. bowel surgery) 12 months
Endodontics
Cancer related services (e.g. chemotherapy) Occlusal therapy
Heart surgery including diagnostic & therapeutic cardiac procedures Oral surgery
Spinal surgery (excluding surgery related to spinal scoliosis) Orthodontics
Surgery related to spinal scoliosis Periodontics
Cochlear implant surgery & bone anchored hearing devices* Prosthodontics
Insulin pump treatments† Veneers
Care involving dialysis for chronic renal failure Hearing aids 24 months
Rehabilitation services All other extras services 2 months
Psychiatric services
Ambulance waiting periods
Gastric banding & obesity surgery
Emergency ambulance
Assisted reproductive services (e.g. IVF, GIFT) 1 day
(where not for pre-existing ailments)
Pregnancy & birth related services
Pre-existing ailments 12 months
Joint investigations & reconstructions
Waiting periods vary according to the type of treatment or service. See page 20 of the Member Guide
Joint replacements (e.g. hip replacements, knee replacements)
for more information.
Cataract & other lens related surgery
Covered.
Sterilisation
Minimum Benefits. See page 24 for definition.
Elective cosmetic surgery Exclusions. See page 25 for definition.
# Excluding experimental and high-cost non-PBS drugs. See page 25 for more information.
Podiatric surgery by an accredited podiatrist * Includes associated speech and sound processors including upgrades.
† Certified type C procedures and certified overnight type C procedures for the treatment of diabetes.
All other in-hospital services where a Medicare benefit is payable Reduced or no benefits may apply. See hcf.com.au/insulinpumps or page 15 of the Member Guide for details.
8 10
Extras benefits summary Bronze Bronze Plus Young Starter Package Silver Gold Platinum
100% BACK
No gap dental check through HCF’s More for Teeth provider network 1 check-up per year 2 check-ups per year 2 check-ups per year 2 check-ups per year 2 check-ups per year
(Not available in NT & Tas)
No gap eyewear and free digital retinal imaging eye check through
HCF's More for Eyes provider network
HCF EXTRAS COVER
At participating providers, subject to your cover and annual limits Get your initial physiotherapy, podiatry, chiropractic and osteopathy
consultation no gap through HCF's More for Muscles, More for Feet
To find out more, visit hcf.com.au/100back and More for Backs provider network
Bronze Bronze Plus Young Starter Package Silver Gold Platinum
Services Details Waiting Periods Annual limits, per person per calender year, unless otherwise specified (set benefits apply per service or item)
Diagnostic & preventative dental (service limits apply e.g. maximum 1 or 2 scale No annual limit No annual limit
& clean per person per year, depending on cover) $350 per person $400 per person (service limits apply) (service limits apply)
Max. $700 per policy Max. $800 per policy
General Dental Direct fillings (1-2 surfaces) 2 months
Direct fillings (3 or more surfaces) $500 $500
Extractions
Oral Surgery (including wisdom teeth removal) $600 - $1,000 $900 - $1,300
Indirect fillings
Periodontics, Endodontics
Major Dental Implants, Veneers, Crowns, Bridges 12 months
Dentures (every 3 years)
$700 ($350 for other dentists) $800 ($400 for other dentists)
Orthodontics - Orthodontist / other dentists Lifetime limit $2,100 or $1,050 Lifetime limit $2,400 or $1,200
for other dentists for other dentists
$100 per person
Optical Glasses and contact lenses 2 months
Max. $200 per policy
$150 $150 $200 $250
$100 per person $120 per person
Physiotherapy (group & classes covered under Health Management) Max. $200 per policy Max. $240 per policy $200 $200
$300 - $500 $500 - $900
Exercise physiology (group & classes covered under Health Management)
Occupational therapy
Psychology (after Medicare entitlement exhausted)
Chiropractic
Osteopathy
$250 - $500
Remedial massage and Myotherapy 2 months Combined with $80 per person $200 - $400
Therapies (12 months for foot orthotics) physiotherapy limit Max. $160 per policy
$150 $150
Acupuncture, Chinese herbal medicine (CHM) consultation
Naturopathy / Nutrition consultation Sublimit $200 per therapy Sublimit $200 per therapy
(except for Chiro and Osteo) (except for Chiro and Osteo)
Alexander technique
Podiatry (including foot orthotics)
$200 - $400 $250 - $500
Dietetics
Audiology (loyalty limits do not apply (loyalty limits do not apply
to foot orthotics) to foot orthotics)
Speech pathology
Travel & accommodation (200km round trip) Up to $200 per policy Up to $250 per policy
HCF approved pharmacy after PBS equivalent co-pay 2 months
$180 $280
HCF approved vaccines & immunisations after PBS equivalent co-pay $100 $100
Artificial aids (e.g. low vision aids, blood glucose monitors) 12 months Up to $150 per policy Up to $200 per policy
Other Hearing aids (claimable once every 5 years) 24 months $600 - $1,600 $800 - $1,800
$150 per person $200 per person
Health Management Programs (e.g. exercise classes, weight management) 6 months
Max. $300 per policy Max. $400 per policy
NSW/ACT 1 day No annual limit No annual limit No annual limit No annual limit No annual limit No annual limit
Emergency ambulance (see page 26 for details and limits) 1 per person 1 per person 1 per person 1 per person 1 per person 1 per person
VIC/NT/WA/SA 1 day
2 per policy 2 per policy 2 per policy 2 per policy 2 per policy 2 per policy
13
Loyalty benefits. See page 14 for details.
Loyalty
benefits
Higher limits the longer you're with us
We're all about giving back to our members. Depending on your level of cover, the longer you're an
HCF member the more you can claim on selected extras, up to a maximum limit. And the higher your
level of cover, the more you'll be able to claim.
Please note that when you upgrade your cover, you’ll need to serve waiting periods before you can
take advantage of the increased benefits and limits.
Gold Extras Platinum Extras
Service category Total loyalty limits, per service category
Year 1 $600 Year 1 $900
Fillings, extractions, oral surgery, Year 2 $650 Year 2 $950
periodontics, endodontics, implants, Year 3 $700 Year 3 $1,000
veneers, crowns, bridges and dentures Year 4 $800 Year 4 $1,100
(dentures claimable every 3 years) Year 5 $900 Year 5 $1,200
Year 6+ $1,000 Year 6+ $1,300
Year 1 $300 Year 1 $500
Year 2 $325 Year 2 $550
Physiotherapy, exercise physiology, Year 3 $350 Year 3 $600
occupational therapy, psychology Year 4 $400 Year 4 $700
Year 5 $450 Year 5 $800
Year 6+ $500 Year 6+ $900
Chiropractic, osteopathy, remedial Year 1 $200 Year 1 $250
massage, myotherapy, acupuncture, CHM Year 2 $225 Year 2 $275
consultation, naturopathy or nutrition Year 3 $250 Year 3 $300
consultation, alexander technique
Year 4 $300 Year 4 $350
Note sublimit of $200 per year applies for Year 5 $350 Year 5 $400
each therapy, except for Chiro and Osteo Year 6+ $400 Year 6+ $500
Year 1 $200 Year 1 $250
Year 2 $225 Year 2 $275
Podiatry (not including foot orthodics) Year 3 $250 Year 3 $300
dietetics, audiology, speech pathology Year 4 $300 Year 4 $350
Year 5 $350 Year 5 $400
Year 6+ $400 Year 6+ $500
Under 2 years Nil Under 2 years Nil
Year 2-5 $600 Year 2-5 $800
Hearing aids Year 6-9 $800 Year 6-9 $1,100
(claimable once every 5 years) Year 10-14 $1,000 Year 10-14 $1,400
Year 15-19 $1,200 Year 15+ $1,800
Year 20+ $1,600
14Cash Assist
covers
For that extra peace of mind, HCF offers a range of low cost options that provide
cash assistance to help you recover from an unexpected accident or illness.
Kids’ Accident Cover Permanent Disability Income Assist Personal Accident
Up to $100,000 cover Benefit Plus Insurance Insurance
Only 90 cents per week per child Up to $100,000 cover Up to $6,000 per month Up to $50,000 cover
$1 per week for singles From $1.65 per week From $3.15 per week
Affordable cover which pays up to $2 per week for families
$100,000 if your child (under 17) is Pays 75% of your monthly income (up to Designed for those aged 55 and over,
accidentally injured. Low cost cover which provides up to a max $6,000) for 12 months if you are this cover pays cash if you suffer one of
• Specified sum paid for injuries $100,000 protection in the event you are unable to work for more than 30 days. the listed injuries such as burns, fractures
• Cover against accidents permanently disabled due to an accident. and dislocations.
• Cover against accident and illness
• Cover 24 hours a day anywhere • Single and family cover options • Additional benefits paid for child care • Choice of $25,000 or $50,000 cover
in Australia • Up to $10,000 is paid for each child expenses and bed confinement • Lump sum cash benefit
• Paid regardless of any other benefits • Pays your HCF Health Insurance • Premiums may be tax deductible • No pre-existing conditions exclusions
premium if on claim (up to $1,000 • Protection for your biggest asset - • Pays a benefit in the event of
for singles, $2,000 for families) your income accidental death
• Cover against accidents
• Specified sum paid for injuries
Cash Back Cover $
$5,000 Benefit For more information on Cash Assist
Smart Term Insurance
$2 per week for singles
Up to $500,000 cover
covers visit hcf.com.au/cashassist
$4 per week for families
Medical Trauma From $3.45 per week The Product Disclosure Statement and Financial Services
Guide for Cash Back Cover, Kids' Accident Cover and
Pays $5,000 if you suffer an accident Up to $50,000 cover Permanent Disability Benefit Plus, is available on pages
requiring surgery within 6 months or From $2.50 per week Pays cash in the event of death or 28-31. For more information on Smart Term Insurance,
Income Assist Insurance, Medical Trauma and Personal
suffer a listed serious medical condition. terminal illness. Accident Insurance please visit hcf.com.au, call 13 13 34,
• Cover for illnesses such as heart attack, Pays cash if you suffer one of over 40 • Nine benefit levels to choose from, or visit your local branch. Cooling off period applies.
cancer and stroke listed serious medical conditions. ranging from $100,000 to $500,000
• Single and family cover options • Choice of $25,000 or $50,000 cover • Benefit doubled if death is caused by
• Make multiple claims up to a total of • Lump sum cash benefit an accident
$20,000 for singles and $40,000 • Cover for serious illnesses such as • Early payment of $10,000 to cover
for families heart attack, cancer and stroke funeral expenses (applies to death
(90 day waiting period applies) by accident in the first 3 years and
thereafter for all conditions)
• Single and family cover options
• Easy to apply - no blood tests or medicals
16 17great health
Get access to
Benefits for
programs
programs with your
HCF cover to improve
your health
Your HCF membership includes easy-to-use health and wellbeing management HEALTH MANAGEMENT
tools and support for a range of specific health conditions. PROGRAMS
On eligible extras covers, you can
claim on a range HCF approved Health
Management Programs to help you
HELPING YOU LEAD A WELL-BEING PLUS GET MEDICAL ADVICE FROM lead a fit and healthy life.
HEALTHIER AND HAPPY LIFE MOBILE APP WORLD-LEADING SPECIALISTS
Programs include:
• Weight management
To help keep you motivated • Healthy Weight for Life
and on target to achieve • Exercise and gym membership fees
your health goals, you If you or someone on your family
Our unique program, My Health Guardian, for specific health problems
can track your health and membership had a serious illness, wouldn’t
helps you create an easy and effective (doctor’s referral required)
wellbeing wherever you it be reassuring knowing you could access a
wellbeing plan. Whether you want to lose • Childbirth education
are with the My Health world-leading medical expert to review your
weight, have more energy or just feel Guardian mobile app, • Lactation consultant
case? My Global Specialist is an innovative • Learn to swim
healthier, this innovative service helps 'Well-being Plus'. medical information service available to
you take the necessary steps towards a • Stress management and quit smoking.
Visit hcf.com.au/ members on selected levels of cover.
healthy, happy life. mobile-apps for A six month waiting period and
You’ll have access to a global network
information on how to use the app. conditions apply to claims for Health
My Health Guardian is provided at no cost of 50,000 medical experts to review
Available for iPhone and Android. Management Programs.
to members aged 18 years and over with your medical records and report on your
hospital or extras cover. diagnosis and treatment plan and answer Visit hcf.com.au/healthmanagement
any questions you have. This service is for details.
Getting started? available through Best Doctors, the world’s
We recommend you see how you or HEALTHY
HEALTHYWEIGHT
WEIGHTFOR
FORLIFE
LIFE leading resource for specialist medical
a family member can benefit. advice, founded by doctors from the
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and wellbeing of participants Wellbeing programs from time to time.
Please consult our website for the most up
Visit
Visithcf.com.au/hwfl
hcf.com.au/hwflforfor
more information.
more to date information about these programs.
18 19Sometimes in life
a little help
is all you need
Travel Pet
Insurance Insurance More at Home is a community care service, providing quality home support to those who need a
helping hand. Everyone has different needs, which is why our services are tailored to your personal
Members get 10% off Our members also get 10% needs and preferences, ensuring we provide you with the perfect ‘fit’.
HCF Travel Insurance off HCF Pet Insurance We'll give you access to a compassionate professional who can assist you with domestic and/or
When you travel overseas, Australian health If your dog or cat is suddenly or unexpectedly personal care. We’ll help with housework, shopping, meal preparation, getting you ready in the
cover doesn’t protect you. injured or becomes ill, pet insurance can help morning and providing transport - if needed. Our nursing services may also assist you with your
HCF travel insurance provides: pay for veterinary expenses. medical needs following surgery and are available on a continuous basis.
• Worldwide emergency assistance • Choice of two comprehensive covers More at Home is currently available in Northern and Western Sydney and is anticipated to be
• A range of benefits for overseas medical and • Up to 80% of covered veterinary expenses available in other areas in the future. This paid service is managed by Manchester Unity, a HCF
hospital expenses (less an annual excess that you choose). subsidiary with 65 years of experience providing high quality aged care services for Australians.
• Legal assistance To find out more, visit moreathome.com.au or call 1300 550 124.
• Compensation for journey delays or lost luggage Visit hcf.com.au/petinsurance for more
• Plus more. information.
Visit hcf.com.au/travel for more information. We recommend that you consider the Pet
Insurance Product Disclosure Statement and
We recommend that you read the Travel Financial Services Guide which is available by
Insurance Product Disclosure Statement and calling 1800 630 681 or visiting
Financial Services Guide which is available by
hcf.com.au/petinsurance before deciding to
calling 13 13 34 or visiting hcf.com.au/travel before
buy or continue to hold this product.
deciding to buy or continue to hold this product.
HCF Pet Insurance is issued by The Hollard Insurance
The HCF Travel Insurance Policy is issued by QBE Insurance Company Pty Ltd, ABN 78 090 584 473,
(Australia) Limited ABN 78 003 191 035, AFSL 239 545. AFSL 241 436.
Get free overseas travel insurance with Premium or Mid Plus Hospital,
or Young Starter. For more information see hcf.com.au/bonustravel
The Hospitals Contribution Fund of Australia Limited (HCF) has obtained overseas travel insurance under a Master
Policy issued by AIG Australia Limited (AIG), ABN 93 004 727 753, AFSL 381 686. It is intended that this overseas
travel insurance cover will remain in place while you remain a Premium, Mid Plus Hospital, or Young Starter policy
holder; however we reserve the right to remove or alter the cover by giving you 30 days notice. The terms, conditions and
exclusions of the overseas travel insurance are specified in the Premium, Mid Plus Hospital, or Young Starter overseas
travel insurance ‘Conditions of Use’ and may be amended from time to time. The ‘Conditions of Use’ document must be
reviewed to make sure that the overseas travel insurance meets your needs. The ‘Conditions of Use’ document is available at
hcf.com.au/bonustravel or by calling 13 13 34.
20 21Rebates, surcharges If you don’t have eligible private hospital cover
and you fall into these income thresholds then
and incentives you will be charged an additional surcharge on
your Medicare levy when your tax return is
Changes to private health legislation can assessed.
affect your choice of health cover, so it's
important to understand how to maximise To view this year's income thresholds and
your entitlements and avoid unnecessary Medicare Levy Surcharge information,
expenses. go to privatehealth.gov.au/healthinsurance/
incentivessurcharges
Australian Government Rebate
on Private Health Insurance Lifetime Health Cover
To help make private health cover more Lifetime Health Cover (LHC) is a Government
affordable, the Australian Government provides initiative designed to encourage people to
a rebate on your health insurance premium. take out hospital insurance earlier in life and
The rebate is available to people with hospital, maintain their cover.
extras or ambulance cover, and who are In some cases, you may be exempt or fit into
registered with Medicare. The rebate is income a special circumstances category.
tested, so your entitlement may change
If you do not have a product that includes
depending on your income and also your age.
hospital cover with an Australian registered
You can elect to take the rebate either as: health fund on 1 July following your 31st
print
• A reduced premium birthday and then decide to take out hospital
OR cover later in life, you will pay a 2% loading on
• A tax offset credit in your annual tax return. top of your premium for every year you are
The fine
aged over 30.
When calculating your income you need to
For example, if you take out hospital cover at
include taxable income, fringe benefits,
age 40 you will pay 20% more than someone
reportable superannuation contributions,
who first took out hospital cover at age 30.
net financial investment losses and more.
You may incur additional tax payments if you The maximum loading is 70%. Once you have
nominate the incorrect rebate tier. paid a LHC loading for 10 continuous years, the
loading is removed as long as you retain your
We can provide you with general information on
hospital cover.
these thresholds. However, for personal advice
specific to your circumstances, please consult For members transferring from another fund,
your accountant, financial advisor or if your LHC loading differs to what was advised,
the ATO at ato.gov.au or 13 28 65. upon receipt of the transfer certificate, your
premiums may change accordingly.
See privatehealth.gov.au/healthinsurance/
The Australian Government Rebate does not
incentivessurcharges for the list of rebate apply to the LHC component of private
percentages.
health insurance. This means if you are eligible
Important things you need to know when Medicare Levy Surcharge to receive the rebate and also have a LHC
loading, the rebate will not apply to the LHC
deciding on private health insurance. The Medicare Levy Surcharge is an portion of your health insurance.
Australian Government initiative designed
You can use the Lifetime Health Cover
to encourage high-income earners to take
calculators to find out if you need to pay the
responsibility for their health care. It applies
LHC loading by visiting privatehealth.gov.au
to people earning above this year's income
and looking for Lifetime Health Cover.
threshold where they don’t have eligible private
hospital cover. For more information, visit hcf.com.au or
call us on 13 13 34.
You can avoid having to pay this simply by
having eligible HCF hospital cover.
22 23
23Things you need What happens if I choose to be a private patient
in a Public Hospital?
If your child is born prematurely and you have
not held appropriate membership for at least
• Treatment for pre-existing ailments or
conditions within waiting periods
to know We pay Commonwealth Minimum Benefit for 2 months, your child will not be covered for • Goods and services received during any
period where your payment is in arrears, your
procedures that occur during the initial 2 month
Pre-existing ailments a shared room and a higher rate for a single
waiting period. Waiting periods for pre-existing membership is suspended or you’re within
private room. You will need to confirm with
or conditions the hospital if they will be charging you any conditions may also apply. waiting periods
• Treatment that we deem inappropriate or
A pre-existing ailment, illness or condition out-of-pocket expenses. The hospital has the Your children are covered under your family
not reasonable, after receiving independent
is one where the signs or symptoms existed responsibility to explain to you any out-of-pocket cover until the day before they turn 22, provided
medical or clinical advice
during the six months before joining HCF expenses and obtain written informed financial they aren’t married or in a de-facto relationship.
• Experimental treatments
or upgrading to a higher level of cover, even consent (IFC), prior to admission. If your children are full-time students aged • Any service where the treatment does not
though a diagnosis may not have been made. between 22-24, aren’t married or in a de-facto meet the standards in the Private Health
What happens if I choose to go to a relationship and are primarily reliant on you Insurance Accreditation Rules 2011 or as
If there’s any doubt that an ailment or condition Non-participating Private Hospital? for maintenance and support, you can register amended
is pre-existing, a medical practitioner appointed
We pay Commonwealth Minimum Benefit them as student dependants, and they will • Services that aren’t delivered face to face,
by HCF will examine information provided by continue to be covered for no extra cost until like online or telephone consultations, unless
towards accommodation and prostheses.
your doctor, together with other relevant claim the day before they turn 25. you’re participating in one of our chronic
Out-of-pocket expenses may apply to
details. disease management or health improvement
accommodation, theatre, labour ward fees and If your children aren’t full-time students, you
prostheses. You need to obtain a quote from the can also continue to cover them until they turn programs like My Health Guardian
Hospital cover in-patient services hospital. The hospital has the responsibility to • Goods or services supplied by a provider not
25 with extended family cover, provided they
Hospital benefits are payable when you’re recognised by us
explain to you any out-of-pocket expenses and aren’t married or in a de-facto relationship.
admitted to hospital for treatment. These are • Goods or services provided outside Australia,
obtain written informed financial consent, You can take out this cover for a surcharge on top
called ‘in-patient’ services, and only in-patient which don’t meet the requirements under the
prior to admission. of your existing premium if you have Basic, Mid or
services are covered by your hospital cover. Private Health Insurance Act (2007)
Premium cover.
What is informed financial consent (IFC)? • Claims that don’t meet our criteria.
HCF has agreements with over 440 private
IFC is the provision of cost information to Insulin Pumps In addition, our hospital cover
hospitals around the country. For a full list of
patients, including notification of likely out-of-
participating private hospitals, visit
pocket expenses (gaps), by all relevant service
For information about insulin pump doesn’t include:
initialisation, replacement pumps and your
hcf.com.au/participatinghospitals • M edical and associated hospital benefits for
providers, in writing, prior to admission to benefit entitlement, please refer to the Member
which there is no Commonwealth Medical
Minimum Benefits hospital or treatment. Guide or hcf.com.au/insulinpumps
Benefits Schedule item number or when
Some procedures are paid at Minimum Who can be covered? Exclusions the medical services are not approved for
Benefits, depending on the hospital cover you payment by Medicare
Prior to taking out health insurance, we If you need treatment for any procedures listed
• Private room accommodation for same-day
select. Minimum Benefits is the rate set out encourage you to understand who can be as an Exclusion in your hospital cover, you won’t
procedures
by the Commonwealth Minister for Health as covered under your policy. Our staff will be receive any benefits from us and you may have • Experimental and high cost non-PBS drugs
the minimum benefit for a shared room and happy to explain who can be covered and significant out-of-pocket expenses. Make sure • Procedures normally performed in the
benefits for Government approved Prostheses answer any questions you have. you have reviewed the excluded services on doctor’s surgery or as an outpatient
List items. your selected hospital cover to ensure this cover • Private hospital emergency room fees
Alternatively, you can read more about who is appropriate for your needs. • Respite care
In a private hospital: These benefits would not
can be covered in the HCF Member Guide or • Nursing home-type patients are limited to
be adequate to cover all hospital costs and
are likely to result in significant out-of-pocket
by visiting hcf.com.au/faqs, and looking under What’s not covered benefits set by the Commonwealth
‘Who does my membership cover?’ There are a number of situations where our Department of Health
expenses.
health insurance doesn’t cover you: • Special nursing, like your own private nurse
In a public hospital: As a private patient in a Cover for your children • Luxury room surcharge
public hospital, in the event these benefits are (dependants) • Where there are Exclusions on your policy
• Donated blood and blood products and
less than what your chosen public hospital • Claims made two years or more after the
If you’re pregnant and on a single or couple donated blood collection and storage
charges, you may have out-of-pocket expenses date of service
membership, make sure you upgrade to a family • PBS pharmaceutical benefits in non-
• When you or your dependants have the right
to pay. participating private hospitals
or single parent membership at least 2 months to recover the costs from a third party other
• Pharmaceuticals (including PBS
prior to the birth of your child (ideally, as soon than us, including an authority, another insurer
pharmaceuticals benefits) and other sundry
as pregnancy is confirmed) to ensure your child (like motor vehicle or workers compensation),
supplies not directly associated with the
is covered. or under an employee benefit scheme
reason for admission
24 25
25• T ake home items e.g. crutches, toothbrushes Management - Individual Allied Health • Y
ou’re protected in accordance with the • Assess your insurance, health and related
and drugs Services privacy principles. lifestyle needs
• Personal convenience items e.g. phone calls, • Where a provider is not in an independent For a full copy of the code, visit
• Investigate fraudulent or improper claims and
newspapers, magazines and beauty salon private practice assess risks
privatehealth.com.au/codeofconduct
services • More than one of the following therapies • Research and develop products, services and
• Massage and aromatherapy services received on the same day (physiotherapy, Private Patients Hospital Charter benefits that may better serve your needs
• Some services provided while in hospital by chiropractic and osteopathy). • Assess your possible interest in and tell you
non-hospital providers We also support the Private Patients Hospital about such products and services
• Where a service is not covered for the Emergency ambulance (extras only) Charter, which outlines what members can expect • Administer our business and deal with
payment of benefits in a hospital, any from doctors, hospitals and their health fund. complaints.
For residents of NSW & ACT, you are covered for
associated items (e.g. medical gap, For a copy, call 13 13 34 or visit the Private
State Government emergency ambulance services The types of organisations and individuals we
prostheses, pharmacy) are also not covered in NSW and ACT where you require treatment Health Insurance section for consumers at
• The gap on Government approved prostheses disclose personal information to include:
for an emergency. In all other states, we cover you health.gov.au
in non-participating private hospitals • Third party organisations who deliver services
for one State Government provided emergency
• The gap on Government approved gap- ambulance service per person (and two per policy) Have a complaint? on our behalf or to us, some of whom may be
permitted prostheses items. per year, except where you are otherwise covered located overseas
If there's a problem with your membership,
e.g. through your State Ambulance arrangements. • Health service providers, to improve their
In addition, our extras cover No benefits are claimable for residents of
contact HCF directly so we can assist in resolving
ability to provide you with health services
it as quickly as possible. If necessary, an Internal
doesn’t include: Queensland and Tasmania.
Dispute Resolution Officer will be appointed to • Research companies contracted to us to ask
• P sychological and developmental your opinion on improving our service, benefits
assessments. Where psychology is included
Please Note independently review the issue.
or product offerings
This is not a comprehensive list of items not
in your cover, psychology treatment is only covered under hospital or extras cover. Private Health Insurance • Other insurers or reinsurers, including other
payable when your GP has prescribed a Please call 13 13 34 to check what you’re covered Ombudsman health insurers if you have moved your
mental health plan under Medicare and your for prior to going to hospital or for treatment. insurance to or from HCF
psychology entitlements from Medicare for If your complaint isn’t dealt with satisfactorily,
This brochure should be read in conjunction you can also contact the Private Health • Government, including law enforcement
that year are exhausted with the HCF Member Guide, a copy of which is Insurance Ombudsman, an independent body agencies
• Goods and services while a hospital patient, available on the HCF website or at HCF branches.
except for eligible oral surgery formed to help resolve complaints and provide • Related HCF companies
• Pharmacy items that aren’t on our approved Changes to products and pricing advice and information. • The named Policyholder who has your
pharmacy list e.g. items listed on the PBS, To contact the Ombudsman: authority
Please read and retain this brochure for future
items prescribed without an illness, items that Call: 1800 640 695 • Any other authorised individual.
are available without a prescription, items for reference. We however, reserve the right to
make changes to prices, product specifications Visit: phio.org.au If you do not provide the personal information
reproductive medicine, sexual performance, Write: Private Health Insurance Ombudsman
items for weight loss, or items that are not and other conditions relating to the products we request, we may not be able to provide you
contained in this brochure. Please contact us Suite 2, Level 22, 580 George St Sydney with our products or services, including health
TGA approved
prior to purchasing any products to make sure NSW 2000 insurance.
• Goods or services that had not been provided
that you have the latest information available.
at time of claim e.g. pre-payment
• Fees for completing claim forms and/or reports Our privacy statement You can ask us at any time to stop direct
• Goods and/or services received overseas or How your rights are HCF is committed to best practice privacy
marketing to you by emailing
service@hcf.com.au or calling 13 13 34.
purchased from overseas, including items
sourced over the internet protected protection.
We collect your personal information including For more information about the personal
• Where no specific health condition is being information we collect and how we handle it,
treated or in the absence of symptoms,
Private Health Insurance sensitive information such as health information
how to access and correct your information or
illness or injury Code of Conduct from you and/or the Policyholder who is
to make a complaint and how we will respond
We support the Private Health responsible for your policy and/or from other
• Routine health checks, screening and mass to complaints, please read our Privacy Policy.
immunisations Insurance Code of Conduct by ensuring: third parties detailed in our Privacy Policy,
• More than one therapy service performed by so we can: To view the HCF Privacy Policy:
• Y ou receive correct information about private
the same provider in any one day health insurance • Comply with applicable laws • Visit hcf.com.au/privacy
• Co-payments and gaps for Government • You’re aware of the internal and external • Manage our relationship with you • Visit your local branch.
funded health services e.g. the co-payment dispute resolution procedures • Record your treatment
for PBS items, or services where you receive • You can make an informed decision about • Provide health or other insurance, related All new Policyholders should ensure that all
a rebate from Medicare such as the Child your purchase through informative products and services to you (including members on the policy are made aware of the
Dental Benefit Schedule, or Chronic Disease policy documentation through third parties) HCF Privacy Policy.
• Manage and pay claims and benefits
26 27
27Cash Assist Kids’ Accident Cover Benefits Permanent Disability Benefit Plus Premiums
Combined Product Disclosure Statement Only $4.30 for singles or $8.65 for families Premiums may only increase if this applies to
Benefits
and Financial Services Guide Impairments $100,000 per month. all policy holders for the product, and we will
Maximum
Pays you up to $100,000 in the event you provide one month’s notice to you.
Product Disclosure Statement Broken or fractured bones
Skull or any person covered by your membership Your premium will also include any stamp duty
This is a Product Disclosure Statement for • Compound or depressed fracture $2,000 has an accident which results in one of the charged by your State Government, as well as
Cash Assist insurance products sold by HCF • Hairline fracture $1,000 disablements listed in the below table. any taxes that may be levied by State and
Spine
and issued by HCF Life Insurance Company Federal Governments.
• Fractured vertebrae $2,000 Up to $100,000 is paid for you and your spouse,
Pty Limited. • Chipped vertebrae $400
and up to $10,000 is paid for each of your children.
Neck $2,000 Additional information
Cash Assist options are available to permanent Hip, pelvis or jaw $1,500 A maximum of $100,000 for singles and $200,000
for families is payable during the life of the policy. Select any of these options on your HCF
Australian residents aged between 16-60 with Leg, ankle or knee
• Compound (open) $1,000 application and you will promptly receive a
the exception of Kids’ Accident Cover which is • Simple (closed) $500 The disablement must occur within six months Policy Document with full details on your
available for children under 17. Shoulder or cheekbone $600 of the date of the accident. benefits.
Arm, elbow or wrist
Cash Back Cover • Compound (open) $500 Plus, your HCF contributions will be paid up to A copy is available upon request. Your cover is
• Simple (closed) $250
Only $8.65 per month for singles or Ribs $500
$1,000 for singles and $2,000 for families if you automatic once we receive your application and
$17.30 per month for families. Nose or collarbone $400 are unable to work due to accident, sickness or payment instructions.
Pays you $5,000 if you or any person covered
Foot (other than toe) $200 involuntary unemployment.
Hand (other than finger or thumb) $200 Taxation
by your membership suffers an accident that Burns When cover ceases
requires surgery in an operating theatre within • Second degree $400
Usually, premiums aren’t tax deductible and
six months of the date of the accident. • Third degree $650 Cash Assist policies expire when the total benefits are paid free of personal tax. This is a
Wounds (requiring more than 3 stitches) amount payable has been paid or when your general statement based on present laws and
You also receive $5,000 for malignant cancer, • Per Stitch $10 premiums fall two months in arrears. their interpretation. Individual circumstances
chronic kidney failure, heart disease requiring Internal injuries With the exception of Kids’ Accident Cover, may vary and you should consult a professional
bypass surgery, heart attack, stroke, or any • Rupture of internal chest or abdominal organ $500 where benefits expire at age 17, all Cash Assist tax adviser in relation to your individual
disease requiring a major organ transplant. Permanent disabilities policies cover up to age 65. circumstances.
• Total & permanent paralysis of all limbs $100,000
A maximum of $20,000 is payable for single • Total & permanent paralysis of both legs $50,000 30 Day Guarantee
cover and $40,000 for family cover if you or & the lower part of the body
• Permanent loss of all sight in both eyes $50,000 When you receive your policy document from
your family have a number of accidents or • Permanent loss of all sight in one eye $3,000 us, you have 30 days to check whether the
illnesses during the life of the policy. • Permanent & total loss of use of both $30,000
policy meets your needs. Within this time, you
hands or both feet
Kids’ Accident Cover • Permanent & total loss of use of one hand $3,000 may cancel your policy in writing and receive
or one foot a full refund of any money paid, provided you
Only $3.90 per child per month. • Permanent loss of all hearing in both ears $50,000 have not made a claim.
Pays up to $100,000 if your child (under 17) is • Permanent loss of all hearing in one ear $3,000
• Permanent & total loss of use of one $500
accidentally injured, 24 hours a day, anywhere thumb of either hand
in Australia, provided the accident results in Permanent Disability Benefit Plus Benefits
impairment immediately or permanent disability
Disablement Benefit
within six months. The sum is paid regardless
Contributor Or Spouse Other Persons
of any liability or damages claimed and covers
impairments detailed in the table opposite and • Total & permanent paralysis of all limbs $100,000 $10,000
• Total & permanent paralysis of both legs & the lower part of the body $100,000 $10,000
on page 29. • Permanent loss of all sight in both eyes $100,000 $10,000
• Permanent loss of all sight in one eye $50,000 $5,000
• Permanent & total loss of use of both hands or both feet $100,000 $10,000
• Permanent & total loss of use of one hand or one foot $50,000 $5,000
• Permanent loss of all hearing in both ears $100,000 $10,000
• Permanent loss of all hearing in one ear $50,000 $5,000
• Permanent & total loss of use of one thumb of either hand $40,000 $4,000
28 29Exclusions Protecting your rights Our staff members receive an incentive,
Financial Services Guide depending on the number of Cash Assist option
For all these Cash Assist covers, benefits are If you have a complaint about your policy,
This Financial Services Guide (FSG) relates to the policies they sell. This will not exceed 20% of
not paid for: please contact our Service Team on services provided by HCF (we, us or our) in relation the first year’s premium.
• Pre-existing conditions 13 13 34 and we will attempt to resolve it to the Cash Assist options issued by HCF Life
• Events on or before the first day of cover promptly. If you are dissatisfied with our Insurance Company Pty Limited (HCF Life). Both HCF and HCF Life are each responsible
• Events that occur outside Australia response, you can contact the Financial for the entire contents of this combined FSG
• Professional sport, military service, racing Ombudsman Service. This is an independent This guide is designed to assist you in deciding and PDS.
or private aviation body that is available to you free of charge. whether to use any of the services offered
by us relating to the HCF Life products as set We hold Professional Indemnity insurance that
• War, hostility, civil commotion, terrorism complies with the compensation requirements
The Service’s address is: out in this FSG. It contains information about
or insurrection of section 912B of the Corporations Act.
The Financial Ombudsman Service, remuneration paid to us and our staff for the
• Events resulting from intentional self-injury, This includes cover for claims in relation to the
GPO Box 3, Melbourne VIC 3001. services offered and how complaints against
illegal acts and drugs or alcohol. conduct of representatives and employees
Telephone: 1300 780 808. us in relation to these services are dealt with.
For each of these products, benefits are not If we offer or arrange to issue you with any who no longer work for us, but who did at the
paid for certain additional events. These events HCF Life Insurance Company Pty of these products, we will provide you with a time of the relevant conduct.
are marked with a cross in the table below. Limited Product Disclosure Statement (PDS) relating Should you have a complaint about any of the
to that product. This sets out the significant services we offer in relation to the HCF Life
In addition to these exclusions, the ABN 37 001 831 250, AFSL 236 806 features of the product and will assist you in products in this FSG, or a complaint about a
contributions component of the Permanent 403 George Street, Sydney NSW 2000 comparing and making informed decisions product itself, please contact us on 13 13 34 or
Disability Benefit Plus benefits is not paid for: Telephone: 13 13 34 Dated: 8 January 2015 about the product. service@hcf.com.au and we will endeavour
• T he first 30 days you’re not working We provide general advice about the suitability to resolve it as quickly as possible. If we have
• Pregnancy, childbirth, infertility, contraceptive of these products for the needs of members. not resolved your complaint within 45 days or
procedures and related conditions This means we don’t take into account you’re not satisfied with our response, you can
• AIDS individual objectives, financial situations or contact the Financial Ombudsman Service on
• Events resulting from intentional self-injury, needs. You should, before acting on that advice, 1300 780 808 or by post at GPO Box 3,
illegal acts and drugs or alcohol consider the appropriateness of the advice, Melbourne VIC 3001. This is an independent
• Events that occur outside Australia or within having regard to your objectives, financial body available to you free of charge.
the first two months of cover situation or needs. Please read the PDS before
• Pre-existing conditions in the first 12 months deciding to purchase any of these products. The Hospitals Contribution Fund
of cover We are licensed to provide general advice
of Australia Limited
• Unemployment in the first 12 months with about, and arrange the issue of, life and general ABN 68 000 026 746, AFSL 241 414
your employer. insurance products. HCF Life is a wholly owned 403 George Street, Sydney NSW 2000
subsidiary of ours. When we issue you with a Telephone: 13 13 34 Dated: 8 January 2015
policy for a Cash Assist option, we do so under
a binder that authorises us to enter into that
Kids' Permanent contract of insurance on behalf of HCF Life.
Cash Back
Event/Reason For Claim Accident Disability HCF Life receives the premiums paid for the
Cover
Cover Benefit Plus Cash Assist options. We receive monthly
commissions from HCF Life in relation to the
Condition within first two months of cover
Cash Assist options: 40% of the first year’s
Conditions covered by workers compensation, premium, plus an additional commission of
third party insurance or social security benefits
80% of HCF Life’s underwriting profit each
Surgery for diagnostic purposes or not in an financial year, calculated as premiums less
operating theatre
claims and expenses.
AIDS
Intentional act by adult person living with child
Event resulting in death within seven days
30 31
31Branch, Dental and Eyecare Switching to HCF is easy
Centre Locations The thought of changing health funds can seem complicated, so we’ve made joining HCF
stress-free. To switch, all you need to do is:
1. Create the HCF cover that’s right for you
2. Complete your application along with the interfund transfer section
3. Leave the rest to us.
ACT NSW George Street We’ll even contact your former health fund for you, and you can start enjoying the benefits of HCF
Sydney CBD HCF Dental and cover with no additional waiting periods for equivalent levels of cover (excludes hearing aids).
Belconnen Albury Grafton Eyecare Centres
Canberra Armidale Griffith Blacktown
Woden Bankstown Dental: (02) 9852 2100
Hornsby Eyecare: (02) 9672 9500
Bathurst
Index
Hurstville
QLD Bega
Bondi Junction
Lismore Dental: (02) 9386 2222
Brisbane Blacktown Liverpool Eyecare: (02) 9386 2333
Carindale* Bondi Junction Maitland Brookvale
Chermside* Bowral Miranda Dental: (02) 9907 5600
Robina* Brookvale Eyecare: (02) 9907 5100 Benefits of private health insurance 2
North Ryde
Burwood Chatswood HCF Member Benefits 3
North Sydney*
SA Campbelltown Dental: (02) 8448 0144 Suggested cover packages 4
Nowra Eyecare: (02) 8448 0111
Adelaide Castle Hill Orange Create the cover that's right for you 6
Hurstville
Marion* Charlestown Parramatta Hospital benefits summary 8
Dental: (02) 8567 3244
Chatswood Penrith Eyecare: (02) 8558 9800 Extras benefits summary 11
VIC Coffs Harbour Port Macquarie Parramatta Loyalty Benefits 14
Chadstone* Deniliquin Tamworth Dental: (02) 9685 1255
Cash Assist covers 16
Dubbo Eyecare: (02) 9685 0655
Doncaster* Tweed Heads Access to health programs 18
Melbourne Eastgardens Wagga Wagga Sydney
Dental: (02) 9290 0555 Travel and Pet Insurance 20
Southland* Erina Wollongong Eyecare: (02) 9290 0199 More at Home 21
The Fine Print 22
Rebates, surcharges and incentives 23
Find your local branch online
Things you need to know 24
Changes to products and pricing 26
hcf.com.au/branches
How your rights are protected 26
Our privacy statement 27
Cash Assist Combined Product Disclosure
Statement and Financial Services Guide 28 HCF Mobile App
* Please note, these branches do not accept cash or cheque payments for premiums.
On-the-spot claims are paid via direct credit to your bank account. Branch, Dental and Eyecare Centre locations 32 Get access to HCF on the
go. Available for iPhone
How to join 34 and Android.
32You can also read
