UNCOMMON CARE IS OUR BOTTOM LINE - MEMBER GUIDE JUNE 2021 - HCF
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UNCOMMON CARE IS OUR BOTTOM LINE MEMBER GUIDE JUNE 2021
LET US BE WELCOME
YOUR GUIDE TO HCF
This is your Member Guide. Keep it handy for advice on how to claim, plan a hospital Thanks for choosing us. As Australia’s largest not-for-profit health fund, we define
treatment, update your details and access member perks every day. success differently. Like showing you, and our 1.7 million members, a level of care
that’s uncommon.
USE YOUR COVER #1 IN TRUST 100% BACK ON
04 How to get started
06 How to prep for hospital treatment
08 How to claim on extras
4 When it comes to health,
you can count on us.
We were recognised as
Australia’s most trusted
POPULAR EXTRAS
Pay $0 on 1 or 2 dental check-ups
a year and a first visit to a physio,
chiro or osteo with 16,000
health fund by Roy Morgan extras providers who
Net Trust survey for participate in our
3 years in a row*. No-Gap network^. BACK ON
COVER EXPLAINED
10
– POPULAR
EXTRAS
10 Make sense of waiting periods
12 Make sense of gaps
15 Make sense of tax time and incentives
MORE MONEY BACK WE’RE HERE FOR YOU
For every dollar our members Proudly owned and run
pay in premiums, we’ve paid by Aussies, we’re here
MEMBER PERKS
16
out more benefits than the to help you with
16 Access added value industry average over the award-winning local
17 Access loyalty rewards last five years+. call centres and branches
18 Access health and wellbeing support across the country.
20 Access Recover Cover
22
MEMBER ADMIN KNOW YOUR OUT-OF- LOYALTY REWARDS
22 Manage your policy
24 Manage your payments
POCKET COSTS You don’t have to be unwell to
With our large hospital get great value from your cover with
network and a search tool our range of exclusive HCF Thank You
that helps you find the loyalty offers and rewards.
right specialist at the right We can help you save money
on essentials like groceries
25
IMPORTANT INFO price, we’re helping you
or on well-deserved
keep your out-of-pocket
25 Good to know treats and experiences#.
costs down.
32 Insurance lingo
38 Your rights and privacy
* Roy Morgan Net Trust Survey 2018, 2019 and 2020.
^ 100% back from providers in our No-Gap network is available on selected covers. Waiting periods and annual limits apply.
See hcf.com.au/100back
+
90% compared to 86% across the industry. Calculated based on the average of the past 5 years, sourced from APRA,
This guide is for all HCF health insurance policies except Overseas Visitors Health Cover members Statistics: Private Health Insurance Operations Report 2016-20, June 2020.
2 who should refer to the Overseas Visitors Health Cover Member Guide. 3
#
Eligibility criteria applies. You can access HCF Thank You offers after you’ve been a member for a week, and if your premiums
are up to date. Excludes Ambulance Only and Overseas Visitors Health Cover.
HOW TO
USE YOUR COVER
GET STARTED
Connect with us to make the most of your membership.
REGISTER FOR ONLINE GET THE HCF MAKE THE MOST
MEMBER SERVICES MEMBER APP OF MEMBER PERKS
Manage your membership, see your Download the My Membership app to Access our range of health and
cover details, get HCF Thank You rewards claim for extras, get a benefit estimate, wellbeing programs (pages 18-19).
and more at hcf.com.au/members manage your details and more. And after you’ve been a member
or through the HCF My Membership app. for a week you can cash in on
Available for Apple
our exclusive range of loyalty
and Android.
offers (page 17).
WE’RE HERE FOR YOU GIVE US A BUZZ POP IN FOR A VISIT
WE PROMISE TO: Chat to our uncommonly caring Visit one of our branches
team members on 13 13 34: across the country with
• be helpful, courteous and professional
they’re all in Australia and questions, to make a claim
• explain our answers and actions clearly known for their award-winning or just to have a chat.
• work through your options with you customer service. hcf.com.au/branches
• let you know of, and clearly explain, any
changes to your policy and premiums
• provide straightforward, relevant
information on claims and your membership.
Ask us about our Member Service Charter DROP US AN EMAIL SEND US A LETTER
or go to hcf.com.au/membercharter
Write to us at Mail your forms or questions
service@myhcf.com.au and to HCF, GPO BOX 4242,
we’ll do our best to reply Sydney, NSW 2001. We’ll aim
NEED A FORM? within 3 business days. to reply within 5 business days
You can download HCF forms at once we get your letter.
hcf.com.au/forms
4 5
HOW TO PREP FOR HANDY TOOL FOR HOSPITAL PREP
USE YOUR COVER
Take some of the stress out of surgery with our Preparing
HOSPITAL TREATMENT for Hospital tool. Learn how a procedure works, what you
can expect in hospital and what aftercare you might need.
You can also get an idea of costs and hear from other HCF
members who’ve had the same procedure.
What you need to know and do, before you head to hospital.
hcf.com.au/preparing-for-hospital
1 CHOOSE YOUR MEDICAL
SPECIALIST (DOCTOR) 2 CONTACT US TO MAKE
SURE YOU’RE GOOD TO GO 3 TALK TO YOUR HOSPITAL AND
MEDICAL SPECIALISTS
Search for a doctor, surgeon or other medical Call 13 13 34, email service@myhcf.com.au, It’s important to understand the procedure or
specialist at hcf.com.au/findaprovider or visit one of our branches (find one at treatment you’re having and how much it’ll cost.
hcf.com.au/branches)
Our network is made up of over 39,000 ASK YOUR DOCTOR: ASK YOUR HOSPITAL:
medical professionals across Australia who’ve ASK US: What type of treatment or procedure will I have? Are you an HCF participating
agreed to participate in the No Gap or Does my policy cover me for this? private hospital?
Known Gap arrangement for HCF members What are the item numbers for the procedure
Have I served the relevant waiting periods? or treatment? Will I have a gap or excess to pay for
(see this explained on pages 12-13).
How much will you charge me? any hospital accommodation?
Will I need to pay any charges on top?
If so, how much? Will you participate in HCF’s No Gap or Known Will all my hospital costs be covered
Gap arrangement? by HCF?
Will I need to pay any more for my hospital
accommodation, doctors’ fees or the Will I have to pay a gap? If so, how much will it be? Will I have any other out-of-pocket costs
fees of anyone else involved in my treatment during my time in hospital?
or recovery? If I have to pay a gap, when will I have to pay it?
If I have to pay a gap or any out-of-pocket
What if I can’t afford the gap? costs, when do I have to pay them?
Which other medical staff will be involved in my
treatment or recovery? How can I find out their fees?
What will my total costs for treatment be?
How do I prepare for this procedure?
TREATMENT IN YOUR OWN HOME INFORMED FINANCIAL CONSENT
We give eligible members access to a wider range of treatment options, at no extra You have a right to Informed Financial Consent (IFC) before
cost, in the comfort and security of your own home*. You can get quality care for any hospital treatment. This means you should see an
treatments at home like chemo, IV antibiotics, complex wound care and rehab estimate of your hospital and medical costs, including any
(for hip or knee replacement), instead of receiving them in hospital. Talk to your gaps, in writing before you agree to treatment. Ask your
treatment team to find out what treatment-at-home options are available. doctors and hospital for a breakdown of your expected
costs or speak to us on 13 13 34 for help or guidance.
hcf.com.au/home-treatment
*A
vailable with HCF-contracted providers, subject to your
6 7
location and your hospital cover. Waiting periods apply.
HOW TO
USE YOUR COVER
CLAIM ON EXTRAS
Extras are treatments like dental, optical and physio that make your everyday healthier.
Here’s how to make the most of them.
1 CHECK WHAT
YOU CAN CLAIM 2 FIND A PROVIDER
IN OUR NETWORK 3 MAKE YOUR
CLAIM
Download the My Membership app, log in to You can only claim for services from providers
online member services at hcf.com.au/members recognised by HCF. Use our search tool at
or call 13 13 34 to check you’re eligible for the hcf.com.au/findaprovider to be confident you’re
extras you want to claim, that your chosen choosing from one of the 16,000 provider locations
provider is recognised by HCF, that your in our No-Gap network.
payments are up to date, and that you’ve AT YOUR PROVIDER WITH THE APP IN BRANCH VIA POST
served your waiting periods. GET 100% BACK ON SELECTED EXTRAS The easiest way to Download the Take your membership Download a claim
Depending on your cover and annual limits, claim is by swiping your My Membership app card and original form from hcf.com.
you could get 100% back at extras providers membership card when at hcf.com.au/mobile- receipts to any HCF au/forms, pick one up
in our No-Gap network*, including: visiting a recognised apps. Available for branch. We’ll pay the from an HCF branch,
provider. Apple and Android. claim into your chosen or call us on 13 13 34
CLAIM ON TELEHEALTH bank account. and we’ll post or email
SERVICES 1 or 2 dental check-ups a year. hcf.com.au/branches one to you. Then send
We’ve extended the time you can claim for it back to us.
a range of telehealth services. You can claim
for extras like physio, dietetics, birthing GOOD TO KNOW
classes, occupational therapy and speech A pair of prescription glasses from a • Claims must be lodged within 2 years of the date
pathology from HCF recognised providers selected range^ and free digital retinal
imaging with your eye test.
of the treatment (or 12 months from the accident VISIT OUR HCF DENTAL
until 31 December 2021#. for School Accident benefit).
AND EYCARE CENTRES
• The policyholder or partner listed on the policy
#
epends on level of extras cover. Waiting periods
D must sign the claim form or electronic claims Our network of HCF Dental and Eyecare
and annual limits apply. receipt. A Dependant aged 18 years or over who centres gives members easy access to high
A first visit to a physio+. holds an HCF membership card can also claim and quality, affordable healthcare. Depending on
sign for the services they’ve been provided. your level of cover, you can also get 100%
• Make sure you give us all the required info we back on a dental check-up and a pair or
need to process your claim, either on the claim prescription glasses and sunglasses from
A first visit to a chiro and osteo+. form, or when claiming through the app or online a selected range when you visit any of our
member services. centres*. For locations and to find out more
• HCF won’t pay for any costs of receiving or see hcf.com.au/locations/hcf-centres
sending in claim information.
A first visit to a podiatrist+. • We can only pay claims when you’ve given us a
receipt from the provider and a signed claim form.
• Make sure you’ve given us your bank details for
direct credit so we can pay your claims.
• If your hospital or doctors’ bills are unpaid, we’ll
pay your benefit directly to the provider.
* 100% back from providers in our No-Gap network is available
on selected covers. Waiting periods and annual limits apply.
See hcf.com.au/100back
^ Add-ons like coating and high index material aren’t included.
8 +
First visit is for new and eligible health conditions and flare-ups 9
where no treatment has been given in the previous 90 days.
MAKE SENSE OF WHEN DO WAITING
PERIODS APPLY?
QUICK GUIDE TO WAITING PERIODS
that apply to services covered by your policy
COVER EXPLAINED
WAITING PERIODS Waiting periods apply when you:
• join HCF
• rejoin after a break in cover
HOSPITAL
Pre-existing conditions or ailments
Pregnancy and birth 12 months
A waiting period is the time you have to wait before you can start • upgrade your cover or reduce your excess.
Chronic Disease Management Programs
claiming on some services and procedures.
SWITCHING HEALTH FUNDS Palliative care
If you’ve switched from another health fund, Rehabilitation
you may not need to serve waiting periods, if: Hospital psychiatric services*
2 months
• your HCF cover includes the same level of benefits All other hospital services, including
and services as your previous cover; and accident-related treatment
• you’ve served the equivalent waiting periods with SAME-DAY HOSPITAL TREATMENT
your previous fund. EXCESS WAIVER
To avoid serving waiting periods again when (available on some covers)
switching between funds, you’ll need to have All hospital services (where not for
2 months
switched from another Australian registered health pre-existing conditions)
insurer or an international health insurer belonging Pre-existing conditions or ailments 12 months
to the International Federation of Health Plans, EXTRAS
and to have joined within 1 month of ending your
Artificial appliances (e.g. low vision aids, 12–24
previous membership. These rules also apply blood glucose monitors) months
if you’ve switched from another HCF product.
Pre-existing ailments and conditions
Unfortunately when you switch funds, you can’t
transfer over any loyalty rewards, including Foot orthotics
increased limits. Hearing aids
12 months
If you joined HCF during a special offer, some waiting Dental bleaching, crowns and bridges,
periods might be waived. Get in touch with us to indirect fillings, dentures, endodontics,
occlusal therapy, oral surgery,
check which waiting periods may apply. orthodontics, periodontics,
prosthodontics and dental veneers
WHAT’S A PRE-EXISTING School Accident Benefit
2–12
CONDITION? months
All other extras services 2 months
If you had signs or symptoms of a condition,
illness or ailment during the 6 months before or on AMBULANCE
the day you joined HCF (or in the 6 months before Emergency ambulance 1 day
you upgraded to a higher level of HCF cover or
Non-emergency ambulance 2 months
reduced your excess) this means the condition was
‘pre-existing’, even if no diagnosis was made
* Members who have held a hospital cover for at least
before your cover started.
2 months and upgrade to receive hospital benefits
HCF will have a medical expert look at information (or a higher level of hospital benefits) for hospital
from your doctor, and any other relevant claim psychiatric services may elect to be exempted from
HAVING A BABY? the 2 month waiting period for hospital psychiatric
details, to decide whether or not your condition was
If you’re pregnant and on a single membership, be sure to call us services that usually applies to members when they
pre-existing. If it was, a 12 month waiting period upgrade their hospital cover. Members who have
within 2 months of your bub’s arrival to upgrade to family or single will apply to services related to that condition held a hospital cover for less than 2 months may
parent cover. The family or single parent membership must start from your policy start date. This rule applies to all elect to serve a reduced waiting period of 2 months
from the day your baby’s born. Waiting periods will apply to your new members, members upgrading their cover or minus the length of time that the member held
baby if your newborn is added to your policy 2 months (or more) hospital cover. This exemption or reduction can
reducing their excess, and to other adult dependants only be accessed once in a member’s lifetime.
after your baby’s date of birth. and children you’ve added to a policy. If you upgrade,
you only serve waiting periods for any new services
that you weren’t covered for previously, or a reduced
excess if you’ve chosen to lower it.
10 11
MAKE SENSE MEDICAL GAPS
COVER EXPLAINED
You’ll be charged a fee for each medical The MBS portion of your provider’s fee will
OF GAPS service you get in hospital. Each fee is set
by the specialist who delivers the service
(e.g. your surgeon). The specialist can
be partly covered (75%) by Medicare and your
HCF hospital cover will pay for the remaining
25% (for eligible services).
Understand the costs of your hospital treatment to avoid unexpected bills. choose to charge you a fee known as the
Any fee that your specialist charges which is
Medicare Benefits Schedule (MBS) fee,
more than the MBS fee may not be covered by
or a lower or higher fee for their service.
HCF. This is a medical gap you might have to pay.
It’s entirely up to them.
WHAT TYPES OF COSTS HOW TO FIND A
WILL I BE CHARGED? PARTICIPATING HOSPITAL YOU’LL PAY YOU’LL PAY UP YOUR SPECIALIST
For a hospital admission and treatment, Find an HCF participating hospital at NO GAP TO $500 GAP SETS THE GAP
you’ll be charged 2 types of costs: hcf.com.au/participatinghospitals This specialist This specialist chooses This specialist chooses
We’ve got a large network of participating chooses to be an HCF to be an HCF Known not to participate in an
1. Hospital costs are charges for things like your
private hospitals and day surgeries to help you No Gap provider. Gap provider. HCF arrangement.
room fees, operating theatres, and prostheses in
private hospitals. avoid or reduce any hospital gap.
2. Medical costs are charges for services like
doctors’, anaesthetists’ and surgeons’ fees, and $0 GAP MAX $500 GAP $ UNKNOWN GAP
inpatient diagnostic services like X-rays, scans and
blood tests. Your hospital cover will pay for part or
all of these costs, depending on your level of cover, MBS FEE MBS FEE MBS FEE
FULLY PAID FULLY PAID FULLY PAID
the hospital you choose, and the doctors who BY HCF AND BY HCF AND BY HCF AND
treat you. MEDICARE MEDICARE MEDICARE
Any cost your insurance doesn’t cover
is called a gap (or an ‘out-of-pocket’ cost).
This is money you’ll have to pay.
HOSPITAL GAPS
HCF PARTICIPATING PRIVATE NON-PARTICIPATING PRIVATE HOW TO SAVE WITH A NO GAP
HOSPITAL HOSPITAL OR RESTRICTED SERVICES OR KNOWN GAP SPECIALIST
You can choose from our list of more than 39,000
specialists and doctors at hcf.com.au/findaprovider
GAP These specialists are more likely to charge HCF members
COVERED
BY HCF either No Gap ($0), or a Known Gap (a maximum of $500)
COVERED when treating you in an HCF participating hospital.
If your specialist isn’t on the list, ask them if they would
Private hospitals charge for accommodation If you’re admitted to a non-participating private consider applying to participate in HCF’s No Gap or
(your bed), operating theatres, prostheses and other hospital, if you choose to be a private patient in Known Gap arrangement. Your specialist should always
hospital-related services. If you’re admitted to an a public hospital, or if you’re being treated for a let you know if you’ll have to pay a gap, and if you do,
HCF participating private hospital, these costs will be Restricted Service on your level of cover, HCF how much it will be. Make sure you get this information
covered by HCF for services included in your cover will only pay Minimum Benefits (see page 25 from each of your treating specialists (e.g. both your
(other than Restricted Services). for details) to the hospital. This means you might surgeon and your anaesthetist). A doctor can choose to
have to pay the difference between what the participate on a member-by-member basis.
A note on excess: Remember, if you’ve chosen a hospital charges and the Minimum Benefit – See How To Prep for Hospital Treatment (pages 6-7) for more.
product with an excess, you’ll only have to pay it once this is known as the hospital gap.
per calendar year when you’re admitted to hospital.
13
WHAT’S THE DIFFERENCE? INPATIENT OR OUTPATIENT
MAKE SENSE OF TAX
COVER EXPLAINED
ADMITTED TIME & INCENTIVES
ADMITTED
ADMITTED
JOHN SMITH
JOHN SMITH
JOHN SMITH
WE COVER INPATIENT SERVICES WE DON’T COVER OUTPATIENT SERVICES NAVIGATING YOUR TAX RETURN
If you’re admitted to hospital, either as a If you need treatment outside of hospital, or have We’ll create a Private Health Insurance Tax Statement for you every July.
day or overnight patient, you’re considered treatment in hospital but don’t get officially admitted, You can access it by logging in to online member services at hcf.com.au/members
an inpatient. The services you receive while you’re considered an outpatient. Hospital cover
you’re an inpatient (from when you’re officially generally doesn’t pay benefits for outpatient services. You’ll need to include details from the statement on your tax return, including:
admitted to when you’re officially discharged) • the premiums you paid in the last financial year
will be covered by HCF, depending on your The most common outpatient services are:
• the number of days you had the right private hospital cover (if less than
level of cover and the hospital you’re in. • consultations with a specialist or regular doctor 365 you may need to pay the Medicare Levy Surcharge – see below).
(even if it’s at a hospital)
• blood tests or X-rays when not provided as If you lodge your tax return online with the Australian Taxation Office’s
part of a hospital admission myTax service or through a registered tax agent, your HCF Tax Statement
• going to an outpatient clinic details should be auto-populated in myTax.
• going to an emergency department.
WHEN IT’S TIME TO CLAIM MORE REASONS TO HAVE PRIVATE HEALTH INSURANCE
Hospital fees: When it’s time for you to leave Medical fees: If your doctor or specialist treated you The Australian Government has a few private health insurance initiatives it’s worth knowing about:
hospital, read the claim form carefully, answer the under an HCF No Gap or Known Gap arrangement,
questions and sign. The hospital will then send they’ll send your bills directly to us. If your doctor or
specialist sends a bill to you, take it to Medicare and MEDICARE LEVY SURCHARGE LIFETIME HEALTH
us a bill to pay on your behalf. If you need to pay
complete a Medicare Two-way claim form, or visit If you earn above a certain income, and don’t have COVER LOADING
an excess or have restricted cover, you’ll need to
pay the excess and any gap payment directly to an HCF branch. Speak to us on 13 13 34 if you have hospital cover, you might have to pay a Medicare I f you don’t have hospital cover with an
the hospital. This usually happens when you’re any questions. Levy Surcharge. You can avoid paying this by Australian registered health fund on 1 July
discharged, but check with your hospital. having eligible HCF hospital cover. Talk to us about following your 31st birthday, and then
your cover options on 13 13 34. decide to take out hospital cover later
in life, you might have to pay a Lifetime
RIVATE HEALTH
P Health Cover loading of 2% on top of
INSURANCE REBATE your premium for every year you’re aged
I f you have hospital, extras or ambulance cover over 30. Over time, this can really add up.
GOOD TO KNOW: PROSTHESES WHAT ABOUT EXTRAS GAPS?
and are registered with Medicare, you might The maximum loading is 70% and once
Prostheses are items used in surgery to augment If you have extras cover, we’ll pay up qualify for the Australian Government Private you’ve paid the loading for 10 continuous
or replace a part of the body, like pacemakers, to a set amount for extras services, Health Insurance Rebate. The rebate is income years, the loading is removed.
stents or joint replacement devices. Government- like dental or optical. The amount we’ll tested, so your entitlement may change depending
approved prostheses that have been surgically pay varies depending on your level of cover on your income and your age. You can take the
implanted are covered by your HCF hospital and your annual limits. You’ll need to pay rebate as a reduced premium or a tax offset credit
cover, ask your doctor which prosthesis is the difference between what your extras in your annual tax return.
best for you. The government’s Prosthesis List provider charges and the benefits we pay:
can be found in the Private Health Insurance this is an extras gap. See pages 8-9 on
(Prostheses) Rules at health.gov.au how to claim extras.
Need help? Use the ATO Personal Infoline 13 28 61, visit privatehealth.gov.au,
speak to your tax professional, or call us on 13 13 34.
15
ACCESS ACCESS TO
ADDED VALUE LOYALTY REWARDS
MEMBER PERKS
Our Uncommon Care means more than great value health cover. Get more from your cover through HCF Thank You, available after you’ve been a
Make the most of these member perks. member for a week*. The longer you’re with us, the more ways we say thank you.
Log in to hcf.com.au/members to save.
HCF THANK YOU OPAL HCF THANK YOU EMERALD HCF THANK YOU RUBY HCF THANK YOU DIAMOND
MEMBERS CAN SAVE UP TO
15% ON PET INSURANCE
HCF pet insurance can reimburse you up
to 80% on eligible vet bills for your dog or 0-4 YEARS 5-14 YEARS 15-24 YEARS 25 OR MORE
cat, bringing peace of mind to your whole WITH HCF WITH HCF WITH HCF YEARS WITH HCF
fur-family.
hcf.com.au/petinsurance
YOU COULD SAVE ON AVERAGE OVER $1,000 A YEAR^
CLOTHING & ENTERTAINMENT GROCERIES
FOOTWEAR Up to 50% off Event and Village Save on Woolworths
INVOLUNTARY FREE MAGAZINE 5% or more discount on e-Gift Cinemas. 5% discount on e-Gift and Coles e-Gift Cards
UNEMPLOYMENT Be inspired to eat, work and play healthier cards at Target, Big W, Kmart, cards at JB Hi-Fi, Harvey Norman,
ASSISTANCE with our member magazine, Health Agenda. Myer, Footlocker, Nine West Amazon and more
Packed with expert advice, interviews and and more
If you become involuntarily unemployed,
we’ll pay your HCF health insurance insights – simply subscribe and we’ll pop it
premiums for up to 6 months (183 days). in the post. PETROL
Conditions and waiting periods apply*. hcf.com.au/subscribe 5% discount on
Caltex e-Gift Cards
hcf.com.au/unemployment-
assistance
FITNESS RESTAURANTS
20% off all 12 and 18 month & CAFES
gym memberships at 10% discount on
Fitness First and Goodlife MALL Good Food e-Gift Cards
Health Clubs
* Available to all members who’ve had hospital cover for at least 12 months. Excludes extras only, Ambulance Only and Overseas Visitors Health Cover. CAFE
All HCF members are eligible for at least 10% discount on HCF Pet Insurance. HCF Ruby and Diamond members get 15% discount. Existing HCF Pet Insurance
policies will have the relevant discount automatically applied at renewal. HCF Pet Insurance is issued by the insurer The Hollard Insurance Company Pty Ltd
(ABN 78 090 584 473; AFSL 241436) (Hollard); is promoted and distributed by The Hospitals Contribution Fund of Australia Limited (ABN 68 000 026 746;
AFSL 241414) (HCF); and administered by PetSure (Australia) Pty Ltd (ABN 95 075 949 923; AFSL 420183) (PetSure). HCF Pet Insurance is not part of HCF’s
health insurance business. Please read the Product Disclosure Statement (PDS) and do not assume that pet insurance and health insurance are similar.
Any advice provided is general only, and does not take into account your individual objectives, financial situation or needs. Please consider the PDS at
hcf.com.au/petinsurance to decide if the product is right for you. HCF may receive a commission of up to 17% of the premium for promoting HCF Pet Insurance
policies. This commission is used by HCF to cover costs associated with the marketing and distribution of this product to you and may include any referral fees * Eligibility criteria applies. You can access HCF Thank You offers after you’ve been a member for a week,
to people or organisations that refer new customers to HCF. HCF sales agents are paid a salary or wages but do not receive a commission or other payments and if your premiums are up to date. Excludes Ambulance Only and Overseas Visitors Health Cover.
17
attributable to the sale of HCF Pet Insurance. ^ ABS data from 2015/16 based on average household spend who buys discounted e-Gift cards.
ACCESS TO HEALTH & LEADING THE WAY IN MENTAL HEALTH CARE
We’ve gone above and beyond to develop an holistic mental health and wellbeing program with quick and
WELLBEING PROGRAMS
MEMBER PERKS
easy access to a range of options to suit your needs, and the freedom to choose which is right for you.
hcf.com.au/mental-support
We want you to be your healthiest self and make the most of
THIS WAY UP CALM KID CENTRAL
our health and wellbeing programs.
You can access a range of online courses We offer free access for eligible
through THIS WAY UP, a not-for-profit members** to Calm Kid Central,
online hub developed by experienced an online educational and support
HOSPITAL TREATMENTS HEALTHY WEIGHT FOR psychiatrists and clinical psychologists, program helping kids aged 4–11 manage
AT HOME LIFE PROGRAM to help you understand and improve their big feelings and emotional challenges.
We offer a wide range of treatment Carrying extra weight can take its mental challenges like stress, insomnia, The program provides confidential access
options in the comfort, convenience toll at any stage and age. That’s why worry, anxiety and depression#. to an experienced child psychologist who
and security of your own home such as we’ve partnered with Prima Health can answer your questions within 48 hours,
chemo, rehab after knee or hip surgery, Solutions, to give you free access to GP2U & PSYCH2U as well as tools and resources to help you
IV antibiotics and complex wound care, our Healthy Weight for Life program You can speak with a GP2U and support your child.
for eligible members*. So you can get to help you improve your quality PSYCH2U expert online to access a
quality care at home, when you need it. of life. The program is available to range of services including getting WOEBOT
members who are overweight and sick notes and referrals, treatment for You can download and access the Woebot
hcf.com.au/home-treatment
have Type 2 diabetes, a chronic anxiety, depression and stress. app - a mental health chatbot developed by
CH M
PERSONAL HEALTH COACH heart condition, joint pain (requiring Stanford University psychologists to help
HELLO SUNDAY
COA GRA
PRO
surgery), osteoarthritis or are at risk of learn about yourself, boost your mood and
If you have diabetes or a heart-related developing chronic conditions. MORNING manage your state of mind#.
condition, you could be eligible for 6 You must have had an eligible hospital
free phone coaching sessions through Hello Sunday Morning’s Daybreak app
product for 12 months and meet the connects you anonymously with an PSYCH2U VIDEO COUNSELLING
the COACH Program® to help you program’s eligibility criteria.
achieve and maintain your health online peer community and health Eligible members with HCF Hospital
goals. You must have had eligible hcf.com.au/hwfl coaches to help you change your Gold cover for at least 12 months can
hospital cover for 12 months. relationship with alcohol. HCF members access a comprehensive mental health
HEALTHY FAMILIES FOR get a higher level of access to Daybreak’s support program that provides customised
hcf.com.au/coach LIFE PROGRAM clinical team, as well as extra help, care through online, telehealth and chronic
In partnership with Prima Heath resources and support programs that disease management programs.
FREE SECOND may be available with your cover.
OPINION SERVICE Solutions, our Healthy Families for Life
program is designed to encourage kids
Lean on our network of Aussie-based to develop positive nutritional habits
medical specialists to get a free for growth and development and
second opinion on a health condition reduce the risk of chronic conditions
you’re worried about. You must have in their future. Eligibility criteria apply^. HEALTH MANAGEMENT ANTENATAL AND
had HCF hospital cover for 12 months PROGRAMS POSTNATAL SUPPORT^^
and a specialist consultation to use hcf.com.au/healthyfamilies
We’re always looking for new ways to Claim on a range of programs and
this service. Excludes Accident Only help you to be your healthiest self. services for support through pregnancy
Basic cover, conditions apply. SNUG HEALTH APP
Our Health Management Programs^^ and after birth, including childbirth
We’ve partnered with Snug Health are designed to do just that and are education classes (including access
hcf.com.au/secondopinion Log in
to help you manage the health and created with your needs in mind. to Birth Beat’s online courses),
wellbeing of the whole family, simply
Depending on your limits, level of cover breastfeeding consultations, and
and seamlessly with a free customised
and eligibility, you can claim for: antenatal and postnatal group physio.
Snug subscription trial+.
You might also be able to claim on
hcf.com.au/snughealth • learn to swim lessons pregnancy compression garments
• bowel cancer screening and breastfeeding support from the
* Available with HCF contracted providers, subject to member location and hospital cover. Waiting periods apply. You must have a suitable home to be treated in.
^ All HCF members with any HCF health insurance product (excluding Overseas Visitors Health Cover) are eligible to access the Healthy Families for Life online • weight management programs Australian Breastfeeding Association.
resources and online/phone assessment from the care support team. Other conditions apply for additional support, see hcf.com.au/healthyfamilies • exercise classes and gym memberships. A 2 month waiting period applies.
+ All HCF members above the age of 14, who hold any HCF health insurance product (excluding Overseas Visitors Health Cover) are eligible for a customised Snug
subscription trial at no cost until 21 March 2022. Other conditions apply, see hcf.com.au/snughealth
# This service
* B eforeisyou
not affiliated
start any or associated with HCF in any way.
Health Management You should
Program, makewith
check your own enquiries
us that you’reto determine
on whether this service is suitable for you. If you hcf.com.au/hmp hcf.com.au/family
decide to use this service, it’ll be on the basis that HCF won’t be responsible, and you won’t hold HCF responsible, for any liability that may arise from that use.
eligible
** To access Calmcover and the
Kid Central provider
you must of the
have had program
hospital or extrasiscover
recognised by us.
for 12 months, excludes Accident Only cover and Overseas Visitors Health Cover. 19
^^ A 2 month waiting period applies and depends on annual limits. Before you start any Health Management Program check with us that you’re on eligible cover
and the provider of the program is recognised by us.RECOVER COVER
THAT’S UNCOMMON CARE
MEMBER PERKS
The road to recovery is different for everyone. That’s why our unique range of
7 flexible insurance products give you cash – so you can get back to your best at
your own pace. We call it Recover Cover.
WHICH RECOVER COVER IS RIGHT FOR YOU? Please note this information is a summary only. Read the PDS and Policy Document
for full details of cover, limitations, exclusions and definitions.
CASH BACK CRITICAL ILLNESS INCOME ASSIST SMART TERM KIDS’ ACCIDENT BOUNCEBACK PERSONAL ACCIDENT
COVER COVER INSURANCE INSURANCE COVER COVER INSURANCE
Apply if you’re aged Apply if you’re aged Apply if you’re aged Apply if you’re aged Apply for kids under 17. Apply if you’re aged 16-30. Apply if you’re aged
16–60. Expires at 65. 18–54. Expires at 65. 18–54. Expires at 65. 18–54. Expires at 70. Expires when they turn 17. Expires at 65. 55–74. Expires at 85.
Get $5,000 for accidents Get up to $50,000^, Get up to 75% of your Get up to $500,000, Get handy cash to help Get up to $100,000 Get cash for particular
needing surgery, or for depending on your level income+ (up to $6,000 based on the level your child recover if you need surgery after injuries, including certain
a number of serious of cover, for serious per month for up to 12 of cover you choose, from a range of common an accident^, or for a range fractures and burns,
illnesses*. Use your cash illnesses like specified months) if you can’t work if you’re diagnosed with injuries if they have an of illnesses, including if you have an accident
to help with the costs heart attacks, cancers or for more than 30 days a terminal illness or pass accident in Australia*. specified cancers, heart in Australia and depending
of recovery: taxis to strokes*. A fast payment because of an illness or away, or up to $1m if Quick help with the costs conditions, burns and on your level of cover,
the doctor, extra rehab, can ease the unexpected injury*. We’ll help you you die as a result of an of splints, treatments, fractures*. From Ubers up to $50,000^ for
hospital parking, financial strain of serious stay afloat while you accident*. A fast therapies, or just to keep to acupuncture, or a accidental death*.
babysitters, or help if illness – and you choose take the time you need payment that leaves the house running while little extra time off work, Provides financial help
you need time off work. how you use it. to recover. one less worry for your your child gets better. it’s yours to use as to recover from accidents
loved ones. you choose. big and small.
$2.50 FROM FROM FROM ONLY FROM FROM
PER WEEK FOR $2.30 $1.65 $3.45 90c $7.00 $3.20
SINGLES PER WEEK PER WEEK PER WEEK PER CHILD, PER WEEK PER WEEK PER WEEK
$5 per week for families for singles aged 18-34 on for 18-29 yr old non-smoker for 18-40 yr old non-smoker for 16-34 yr olds for singles on $25,000
$25,000 cover level male accountant, normal male on $100,000 cover level cover level
BMI, $1,500 monthly benefit
* Subject to exclusions and limitations - please refer to the PDS and the Policy Document for further information.
^ Sub-limits apply. Please read the PDS.
+ Payment is subject to offsets including any amounts payable from your employer or superannuation fund.
Please consider each Combined Product Disclosure Statement (PDS), Policy Document and Financial Services Guide available by
We’ll help you find the right Recover Cover
calling 13 13 34 or visiting hcf.com.au/lifeinfo, and consider your financial situation, objectives, and needs before deciding on these
products as any advice provided does not take these into account. These covers are issued by our own HCF Life Insurance Company
Pty Ltd. ABN 37 001 831 250, AFSL 236 806 (HCF Life). HCF Life is a wholly owned subsidiary of The Hospitals Contribution Fund
of Australia Limited ABN 68 000 026 746, AFSL 241 414 (HCF). The premiums for the life insurance products are paid to HCF Life.
1800 560 855 Visit a branch hcf.com.au/recover-cover
HCF receives commission from HCF Life for their sale of up to 40% of the first year’s premium plus an additional commission of 80%
of HCF Life’s underwriting profit each year calculated as premiums less claims and expenses. HCF’s staff may receive an incentive
20 depending on the annual premium of these products which they sell. This will not exceed 15% of the first year’s premium. 21MANAGE CANCEL YOUR COVER
If you want to cancel your HCF membership,
As an existing member you’ve also got
30 days to change your mind about the level
MEMBER ADMIN
YOUR POLICY
of cover you’ve chosen, and your premiums
you’ll need to tell us in writing. Any premiums
and claims may be adjusted.
paid after the effective cancellation date will
be refunded in full, if you haven’t made a claim
after the cancellation date.
TERMINATING YOUR
Here’s what you need to know about updating your details, MEMBERSHIP
changing your level of cover or suspending your policy. If you don’t keep your hospital cover from
HCF won’t terminate the membership of any
age 31, the government’s Lifetime Health Cover
member on the grounds of their health. But we
(LHC) loading may apply (see page 15). If you
may terminate a membership if:
want to cancel your cover, call us on 13 13 34
CHANGE YOUR DETAILS You should know:
first. We may be able to give you options that (a) anyone included in the membership has
If your contact details change, please tell us. • the minimum period of suspension is 30 days won’t affect your LHC status. committed or has attempted to commit fraud
Go to: hcf.com.au/members • the maximum period of suspension is 2 years, (b) t he application for membership is incomplete
Phone: 13 13 34 after that your membership will lapse COMMUNICATION ABOUT or incorrect
Email: service@myhcf.com.au • you won’t be able to claim during the period YOUR COVER (c) the member has a membership with another
Write to: HCF, GPO Box 4242, Sydney NSW 2001 of suspension We’ll let you know important information health fund
Visit: an HCF branch, see locations at • if you want to suspend your cover for travel about our current and new covers and services, (d) t he membership is in arrears of more than
hcf.com.au/branches reasons you must tell us before leaving Australia including changes to our services and/or offers 2 months
• active and financial membership must be held to participate in any programs we develop,
YOUR MEMBERSHIP CARD for more than 6 months before suspension and by email, phone, SMS or mail.
(e) any member included in the membership has,
at least 6 months between suspensions in the opinion of HCF, behaved inappropriately
As a new member, you’ll get a membership
toward HCF staff, providers or other members.
card in the mail soon after you join. If you lose • the period of suspension doesn’t count towards FUND RULES
your card, log in to online member services at your waiting periods and your loyalty benefits All members on a policy should be aware of and HCF will give written notice of termination to
hcf.com.au/members, visit a branch or call won’t increase abide by the Fund Rules, which are rules that the policyholder and will refund any premiums
13 13 34 to get a new one. • you may have to pay the additional Medicare apply to your HCF membership. You can find paid in advance, as at the date of termination.
Levy Surcharge for the period of suspension, these at hcf.com.au/fundrules. HCF reserves
CHANGE YOUR LEVEL OF COVER depending on your annual taxable income. the right to amend, delete or add to these RECOVERY OF MONIES
To change to a different level of cover, call 13 13 34, Overseas Visitors Health Cover and HCF Life rules at any time, subject to the Private Health If HCF makes a payment to a member in error,
visit a branch or send a message through policies can’t be suspended. To stay covered Insurance Act 2007 and its rules. we can lawfully recover the benefit paid from
hcf.com.au/contact-us with your Life policies while your health policy that member within 24 months of making the
The transfer will take place on the date we get is suspended, call 13 13 34. YOUR 30 DAY GUARANTEE payment. The amount can be recovered if it’s
your application or a later date of your choice. We want you to be happy with your health been paid directly to the member or to a third
If your new cover gives you new or higher benefits RESUME YOUR COVER cover and the choice you’ve made. If you change party (like a hospital) for goods or services
or a lower excess, then waiting periods – including your mind and cancel your HCF policy within provided to the member. We reserve the right
You must restart your policy within 30 days of no to recover any money obtained fraudulently or
the pre-existing condition rule – may apply. longer receiving a Newstart Allowance or Sickness 30 days of joining, we’ll give you a 100% refund,
Remember that changing to a different level of as long as you haven’t made a claim in that time. in error, or by other means in line with our rules.
Allowance from Centrelink, or within 30 days of If a refund is provided to a member in error,
cover or cancelling your hospital cover might also your return to Australia. It’ll take effect from the
affect your Lifetime Health Cover and Medicare we have the right to recover the payment.
date you arrive back in Australia.
Levy Surcharge status (see page 15).
To restart your membership, send a Resume My
Membership Form and Payment Authority Form
SUSPEND YOUR COVER (if necessary) to us. You’ll also need proof that you
In some circumstances, it’s possible to suspend were receiving benefits (i.e. a letter from Centrelink
your membership. These include if you’re travelling or current employer) or proof of your travel in and
overseas, receiving a Newstart Allowance or out of Australia.
Sickness Allowance from Centrelink, or for another
reason approved by HCF. If your application for hcf.com.au/forms
suspension is approved, all members on your policy
won’t be covered during the period of suspension.
Suspension is at HCF’s absolute discretion.
22 23MANAGE YOUR GOOD TO
IMPORTANT INFO
PAYMENTS KNOW
No probs. There are many ways to pay. Get the lowdown on your cover and steer clear of unexpected costs.
Always contact us before going to hospital.
CHANGE HOW YOU PAY US FALLING BEHIND ON PAYMENTS Where a term is written with capitals in this a hospital that isn’t in the HCF network.
section, look for its definition in the Insurance If Minimum Benefits are in place, you’re likely
• Log in to online member services at Your premiums must be paid in advance. If your
Lingo section on pages 32-37. to have large additional costs, known as ‘gaps’
hcf.com.au/members premiums are more than 2 months in arrears,
(see page 12). Minimum Benefits are set by
• Call us on 13 13 34 your membership will automatically be cancelled.
If you decide to rejoin, the normal waiting periods MORE ABOUT HOSPITAL AND the Commonwealth Minister for Health.
• Visit an HCF branch.
apply, including the pre-existing conditions rule MEDICAL CLAIMS If you do have Restricted Services under your
(see page 11). Lifetime Health Cover loading may Depending on your level of cover and which cover, HCF will pay:
HANDY WAYS TO PAY also apply (see page 15). hospital you go to, you might be able to claim • the Minimum Benefit for a shared room
1. Direct debit via your credit card or bank account. for the following hospital-related expenses: • Minimum Benefits for government-approved
2. Phone 13 14 39 for self-service and to pay DIRECT DEBIT PAYMENTS • Emergency Ambulance Transportation Prostheses List items for the Restricted Services.
by credit card 24 hours a day. The Direct Debit Customer Service Agreement (not including transfers between hospitals)
3. Log in to online member services at applies when you pay your premiums by direct This means you might have to pay large gaps in
• overnight and same-day accommodation a private hospital or if you choose to be a private
hcf.com.au/members to pay by credit card debit. You can find this agreement at hcf.com.au charges (including critical care), less any
or set up direct debit. patient in a public hospital. When Accident
excess that applies Safeguard applies, the Benefits payable for
4. Go to hcf.com.au/bpay for details on paying
CHANGE YOUR DIRECT DEBIT DETAILS
• operating theatre and labour ward charges, Excluded Services or Restricted Services will
by BPAY. To cancel your direct debit, change how often less your excess if it applies. You can’t claim if be those applicable to a service covered on an
you pay, or defer your debits, let us know in person only Minimum Benefits are payable or a service
5. Visit your nearest branch to pay by credit card. unrestricted basis. Accident Safeguard excludes
at a branch, by calling 13 13 34 or by emailing is listed as Service Not Included
6. Payroll deduction through your employer Elective Cosmetic Surgery and podiatric surgery
membermaintenance@myhcf.com.au no later
(if your employer has an arrangement with HCF). • pharmaceuticals you’re given in hospital that are by a registered podiatric surgeon.
than 2 business days before your next debit.
directly associated with your reason for admission
Minimum Benefits differ in private
You can update your direct debit details and that you take in hospital (doesn’t include
and public hospitals:
by logging in to online member services at experimental and high cost non-PBS drugs)
hcf.com.au/members • allied health and therapy services like In a Participating Private Hospital:
physiotherapy, occupational therapy, speech Where a service is a Restricted Service,
pathology and dietetics provided while you’re Minimum Benefits won’t cover all hospital costs
admitted to a Participating Hospital (you can’t and you could have gaps to pay.
claim for these services under your extras cover In a private Non-participating Hospital:
while you’re in hospital) We only pay Minimum Benefits for all services,
• surgically implanted prostheses and human including those that are covered or restricted.
tissue items that are on the government-approved Minimum Benefits won’t cover all hospital costs
Prostheses List (you can’t claim for Services and you might have to pay significant gaps.
Not Included) It’s important to ask the hospital what costs
• medical charges (see page 13 for more). you’re likely to have before you’re treated.
In a public hospital:
WHAT’S RESTRICTED COVER? If you choose to be a private patient in a public
Restricted Cover is where certain services are hospital, we only pay Minimum Benefits for all
listed as Restricted Services under a hospital services, including those that are covered or
product and where Minimum Benefits apply. restricted. You might have to pay large gaps if
Minimum Benefits are less than what your chosen
Minimum Benefits are reduced benefits that we
public hospital charges, or if they don’t cover all
pay for Restricted Services (you don’t have full
hospital costs.
24 cover for a hospital procedure), or when you go to 25WHAT ARE ‘SERVICES The items listed below aren’t a complete list of to any higher level Benefits or lower excess • PBS pharmaceutical benefits in private
what isn’t covered, so always call 13 13 34 to under their New Policy) Non-Participating Hospitals
NOT INCLUDED’?
IMPORTANT INFO
check your cover before you go to hospital or • if a service is listed as a Service Not Included • experimental drugs, high cost non-PBS
If you choose a hospital cover where some have a treatment. (we define these services as Excluded Services drugs and Therapeutic Goods Administration
treatments are listed as Services Not Included
Some items not covered by our hospital or extras in our Fund Rules and on page 34) in the Product (TGA)-approved drugs used for a purpose
(we define these services as Excluded Services in
cover include: Information. For some Hospital Covers, a Service other than that for which they were approved
our Fund Rules and on page 34), then we won’t pay
Not Included might not apply when a Member • experimental treatment or other treatment
any hospital, medical or other benefits for those • Elective Cosmetic Surgery receives treatment as the result of an Accident that does not fall within a clinical category
treatments, except if you have Accident Safeguard • emergency room fees (see hcf.com.au/accident-safeguard). under the Private Health Insurance
as part of your cover. • Ambulance Transportation between hospitals For other Hospital Covers, the service is not (Complying Product) Rules that is covered
Services Not Included in a private hospital (emergency or non-emergency) included regardless of whether or not treatment by the product
means you’re responsible for all hospital charges • services supplied by a provider not recognised is required as a result of an Accident. • benefits where a service is a Service Not
related to those services, which could be large. by HCF Included (we define these services as
Our hospital cover doesn’t include the following,
Services Not Included in a public hospital • claims made 2 years or more after date unless we’re required to pay benefits under the Excluded Services in our Fund Rules and on
means if you choose to be a private patient in a of service Private Health Insurance Act: page 34) for the payment of Benefits in
public hospital, you’re responsible for all hospital • treatment that HCF deems to be inappropriate a Hospital, and any other services directly
charges related to those services, which could or not reasonable, after receiving independent • doctors consultations performed in a doctor’s related to those services, including medical,
be large. You can choose to be treated as a public medical or clinical advice (subject to HCF’s surgery, medical centre, clinic, or as an outpatient diagnostic, prosthesis and pharmacy
patient to avoid these charges. obligation to pay Benefits under the Private • hospital benefits relating to procedures received at the same time, except when
Health Insurance Act) (and other associated goods and services) Accident Safeguard applies
TRAVEL AND • claims that do not meet HCF’s criteria as set that do not require a hospital admission • benefits greater than Minimum Benefits
ACCOMMODATION out in the Fund Rules (except certified Type C procedures) if a service is listed as a Restricted Cover
• services that are not delivered face-to-face in • private room accommodation for in the Product Information. For some
You can claim travel costs if this benefit is included
a clinical setting; such as online or telephone Same-Day procedures Hospital Covers, Minimum Benefits
in your level of cover.
consultations, unless a member is participating • luxury room surcharge might not apply when a Member receives
Your travel for medical specialists (eligible extras in a Chronic Disease management Program or • massage and aromatherapy services treatment as the result of an Accident
cover only) and/or hospital treatment (eligible Health Management Program, or the service (see hcf.com.au/accident-safeguard).
• select services provided while in Hospital by
hospital or extras cover) must be within Australia is an extras service and HCF has authorised For other Hospital Covers, Minimum Benefits
non-hospital providers
and greater than a 200km round trip for treatment the recognised Provider to deliver that extras apply regardless of whether or not treatment
that isn’t available locally. You can’t claim on both • take home items including crutches,
service in another manner (such as online or is required as a result of an Accident.
hospital and extras cover for the same hospital toothbrushes and drugs
by telephone conversation) In addition, extras benefits are not payable for:
admission. • personal convenience items including the
• services provided outside Australia which cost of phone calls, newspapers, magazines
You can claim towards accommodation costs do not meet the requirements under the • psychological and developmental assessments
and beauty salon services
for the patient and carer (if medically necessary) Private Health Insurance Act • psychology treatment (where included under
• respite care
including the night before and after the hospital • any service where the treatment does not meet a Policy) unless a mental health plan has been
admission, if this is included in your level of cover. • special nursing prescribed under Medicare entitlements and
the standards in the Private Health Insurance
Terms and conditions apply. (Accreditation) Rules • benefits for Nursing Home Type Patients except these entitlements have been used up for the
as required under Private Health Insurance Act calendar year
Go to hcf.com.au/travel-accommodation • when a member has the right to recover
the costs from a third party other than HCF, • hospital benefits (including Medical Benefits) • add-ons for optical such as a high index
to find out more.
including an authority, another insurer or under for services in respect of which the item is not material, coatings and tinting
To claim, fill out and send us an ‘HCF Application approved for payment by Medicare • services received overseas or purchased
an employee benefit scheme
to Claim Travel and Accommodation Expenses’ • donated blood and blood products from overseas including items sourced over
form, available at hcf.com.au/forms, from any • services received during any period where
payment is in arrears, the Policy is not financial, • donated blood collection and storage the internet
HCF branch or by calling 13 13 34.
the Policy is suspended or within a Waiting Period • the gap on government-approved gap-permitted • routine health checks, screening and
Prostheses items mass immunisations
WHAT’S NOT COVERED BY • treatment for Pre-Existing Conditions
• pharmaceuticals (including PBS
(other than for hospital psychiatric services, • where a provider is not in an independent
MY HEALTH INSURANCE? rehabilitation or palliative care) within the pharmaceuticals benefits) and other sundry Private Practice
There are some situations where your health 12 month Waiting Period (the Pre-Existing supplies not directly associated with the reason • more than one therapy service performed by
insurance doesn’t cover you, unless we’re required Condition Waiting Period applies to new for admission the same provider in any one day
to pay benefits under the Private Health Insurance Act. Members and Members upgrading their Policy
26 27• services while a hospital patient except for If your doctor or allied health professional ORTHODONTICS to the current standard Pharmaceutical Benefits
eligible oral surgery prescribes a certain surgical or medical aid or Orthodontics is a specialty of dentistry that Scheme (PBS) co-payment for general patients.
IMPORTANT INFO
• pharmacy items that do not meet HCF’s appliance, call us on 13 13 34 to find out if you deals with the diagnosis, prevention and
definition of a Pharmaceutical Item (see page can claim for it. We’ll tell you: PSYCHOLOGY
treatment of problems with alignment of the
35 for definition) • if the appliance is covered teeth and jaws. Orthodontic benefits have a On some levels of cover you can claim for
• services that had not been provided at time of claim lifetime limit and an annual limit, depending on consultations with an HCF-recognised
• if any service limits apply
• fees for completing claim forms and/or reports your level of cover. psychologist, but we’ll only pay benefits for
• what supporting information we need patients who:
• where no specific health condition is being from your doctor/specialist/allied health You’ll get lower benefits and your overall limit will
treated or in the absence of symptoms, professional to help you make a claim. be lower if a dentist other than an orthodontist • have been referred by their GP, or
illness or injury (except some Chronic Disease treats you. Always check with us on 13 13 34 • are on a GP mental health plan through
Management Programs) Different waiting periods apply, depending on Medicare, or
before undertaking any orthodontic work.
your level of cover.
• co-payments and gaps for government-funded • are referred directly by a psychiatrist or
Orthodontic treatment might involve:
health services including the co-payment for HEALTH MANAGEMENT PROGRAMS paediatrician, or
PBS items • custom-made appliances, e.g. to change the • once the Medicare entitlements for the
Some HCF extras covers include Health jaw shape
• any service specifically excluded by law calendar year are used up.
Management Programs, where you can claim
including Alexander Technique, Aromatherapy, • braces or aligners to straighten teeth
towards programs like swimming lessons, weight This benefit acts as a safety net after Medicare
Bowen Therapy, Beteyko, Feldenkrais, Western • the fitting of a retainer to keep the position of
management programs, exercise programs and can’t be paid in any other circumstances.
Herbalism, Homeopathy, Iridology, Kinesiology, teeth once braces are removed.
(see below) and childbirth education.
Naturopathy, Pilates, Reflexology, Rolfing,
Before you start any Health Management Orthodontic treatment can include the upper or SCHOOL ACCIDENT BENEFIT
Shiatsu, Tai Chi and Yoga.
Program, please check with us that you’re eligible. lower jaw and teeth, or both. If your level of cover includes School Accident
Benefit, you might be able to claim more
MORE INFO ABOUT The providers of the program must be recognised The benefit you’ll get back depends on your level
extras benefits if your child has an Accident in,
by HCF and claims must include original receipts
EXTRAS CLAIMS with provider details, the type of program, the
of cover, and annual and lifetime limits; how
or travelling to or from, school and you can’t
long you’ve had that level of cover; whether your
RECOGNISED PROVIDERS program location, and start and end dates. treatment is provided by an orthodontist or general recover the costs from another source. You can
dentist and what type of treatment you have. only claim to help top up services included in
To meet our obligations and to ensure our members EXERCISE PROGRAMS & GYMS your extras cover. This benefit doesn’t include
get quality care, HCF has recognition requirements Depending on your cover, you might be able to medical or hospital services. Claims must include
that providers must meet. If a provider doesn’t To claim the cost of an exercise program, you
claim more if you need more than 1 orthodontic a detailed description of the Accident from the
meet HCF’s requirements or on the rare occasion must fill in and send us an ‘Exercise and gym
appliance. For example, we pay higher benefits school and be submitted within 12 months of
a provider is de-listed, you can’t claim benefits for benefits authorisation and claim form’, available at
for braces on your upper and lower teeth than the Accident. School Accident Benefit applies to
services from them. Natural therapy providers must any HCF branch, hcf.com.au/forms or by calling
braces for your upper teeth only. children up to secondary school, depending on
have continuous membership with an association 13 13 34. This form must include your doctor’s or
specialist’s confirmation of your specific health We won’t pay a benefit before the treatment any waiting periods for the extras service being
that HCF recognises. To find out if your provider is claimed, and the annual limit.
condition that the program addresses. takes place, even if you choose to pay for your
recognised by HCF, call us on 13 13 34.
orthodontic treatment in advance or with a
Your physiotherapist or exercise physiologist can
payment plan. The benefits for braces or aligners INSULIN PUMPS
ARTIFICIAL APPLIANCES complete the form if you’re claiming for a class
can only be paid once the braces or aligners Here’s some important info for HCF members
Some extras covers include benefits for certain held by a physiotherapist or exercise physiologist. who have Type 1 Diabetes and might need,
are in place. For details on how to claim for
artificial appliances, like CPAP machines or You can’t claim for recreational or competitive or already have, an insulin pump and have cover for
your treatment see page 8. We won’t pay for
blood glucose monitors – which must always sports or activities. insulin pumps. When an insulin pump is supplied
direct-to-consumer clear teeth aligners or related
meet HCF’s definition of an Artificial Appliance in an outpatient setting, you must have served
HEARING AIDS services, because they’re not being given in
(see page 33) and be on our approved list. any relevant waiting periods (12 months for new
person by a recognised dentist or orthodontist.
You may only be able to claim appliances when Some extras covers include benefits for hearing aids members or upgrades), have your premiums paid up
specified health professionals prescribe them (see definition on page 34). Your hearing aid limits PHARMACY to date, and be on an eligible hospital cover to claim.
for particular health conditions, and if you can renew every 3 years from the date you get them, not
You might be able to claim for a range of non- Initial insulin pumps
provide a letter from the professional to support every year. Depending on your cover, limits increase
PBS listed drugs, if your level of cover includes These benefits apply for the first time in your
your claim. For some particular appliances, the longer you have your cover. Please check your
pharmacy benefits. See the definition of an eligible life when you start using an insulin pump. If your
only a specified supplier can provide them. cover details by logging in to online member services
Pharmaceutical Item on page 35. The range of insulin pump therapy begins in an outpatient
hcf.com.au/members or call us on 13 13 34.
claimable drugs changes each month so, to be setting, HCF will pay a benefit equal to the
sure, call us on 13 13 34 to check. Before any minimum amount on the government-approved
benefit is paid, we take a co-payment equivalent Prostheses List.
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