UNCOMMON CARE THAT MAKES COMMON SENSE - MEMBER GUIDE MARCH 2020 - HCF
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UNCOMMON CARE THAT MAKES COMMON SENSE MEMBER GUIDE MARCH 2020
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 your health fund. We’re committed to showing you, and all
treatment, update your details and access member perks every day. our 1.6 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 voted Australia’s
POPULAR EXTRAS
Pay $0 on 1 or 2 dental
check-ups a year and
most trusted health fund a first visit to a physio,
by Roy Morgan Net chiro or osteo with 19,000
Trust survey the last extras providers in our
2 years running.
COVER EXPLAINED network. Depends on BACK ON
10
POPULAR
your level of cover and EXTRAS
10 Make sense of waiting periods annual limits.
12 Make sense of gaps
15 Make sense of tax time and incentives
MORE MONEY BACK WE’RE HERE FOR YOU
For every dollar members Run by Aussies, for Aussies –
MEMBER PERKS
16
paid in premiums over those born here and
16 Access added value the last 5 years, we’ve those who’ve decided
17 Access loyalty rewards given them back more to call Australia home.
18 Access health and wellbeing support in benefits than the We’re here to help you
20 Access Recover Cover industry average. with award-winning local
call centres and branches
across the country.
MEMBER ADMIN
22 Manage your policy
24 Manage your payments
22 KNOW YOUR OUT-OF-
POCKET COSTS
LOYALTY REWARDS
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 loyalty offers
that helps you find the and rewards. We can help you
save money on essentials like
IMPORTANT INFO
25
right specialist at the right
price, we’re helping you groceries or on well-deserved
25 Good to know treats and experiences*.
keep your out-of-pocket
32 Insurance lingo
costs down.
38 Your rights and privacy
This guide is for all HCF health insurance policies except Overseas Visitors Health Cover members *E
ligibility criteria applies. You can access HCF Thank You offers after you’ve been a member for a month, and if
2 who should refer to the Overseas Visitors Health Cover Member Guide. your premiums are up to date. Excludes Ambulance Only and Overseas Health Visitors Cover. 3
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 members-only
cover details, get HCF Thank You rewards claim for extras, get a benefit estimate, health and wellbeing programs
and more at hcf.com.au/members manage your details and more. (page 18). And after you’ve been
or through the member app. a member for a month you can
Available for Apple
cash in on our exclusive range
and Android.
of loyalty 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@hcf.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
USE YOUR COVER
HOSPITAL TREATMENT
What you need to know and do, before you head to 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@hcf.com.au, or It’s important to understand the procedure or
specialist at hcf.com.au/findaprovider visit one of our branches. treatment you’re having and how much it’ll cost.
Our network is made up of over 35,000 ASK US: ASK YOUR DOCTOR: ASK YOUR HOSPITAL:
medical professionals across Australia who’ve Does my policy cover me for this? What
type of treatment or procedure will I have? Are
you an HCF participating
agreed to participate in the No Gap or private hospital?
Known Gap arrangement for HCF members Have
I served the relevant waiting periods? What
are the item numbers for the procedure
or treatment? Will
I have a gap or excess to pay for
(see this explained on pages 12-13). Will
I need to pay any charges on top?
How
much will you charge me? any hospital accommodation?
If so, how much?
Will
you participate in HCF’s No Gap or Known Will
all my hospital costs be covered
Will
I need to pay any more for my hospital
Gap arrangement? by HCF?
accommodation, doctors’ fees or the fees of
anyone else involved in my treatment? Will
I have to pay a gap? If so, how much will it be? Will
I have any other out-of-pocket costs
during my time in hospital?
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? How can I find out their fees?
What
will my total costs for treatment be?
Am
I having a surgically-implanted prosthesis
and will I need to pay a gap on this?
How
do I prepare for this procedure?
HANDY TOOL FOR HOSPITAL PREP INFORMED FINANCIAL CONSENT
Take the stress out of surgery with our Preparing for You have a right to Informed Financial Consent (IFC) before any
Hospital website. Learn how a procedure works, what you hospital treatment. This means you should see an estimate of your
can expect in hospital and what aftercare you might need. hospital and medical costs, including any gaps, in writing before you
You can also get an idea of costs and hear from other HCF agree to treatment. Ask your doctors and hospital for a breakdown
members who’ve had the same procedure. of your expected costs or speak to us on 13 13 34 for help.
hcf.com.au/preparing-for-hospital
6 7
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 Use our search tool at hcf.com.au/findaprovider
online member services at hcf.com.au/members to be confident you’re choosing from one of the
or call 13 13 34 to check you’re eligible for the 19,000 provider locations in our No Gap network.
extras you want to claim, that your payments You can only claim for services from providers
are up to date, and that you’ve served your recognised by HCF.
waiting periods.
GET 100% BACK ON SELECTED EXTRAS
Depending on your cover and annual limits, you AT YOUR WITH IN VIA
can get 100% back at extras providers in our PROVIDER THE APP BRANCH POST
network, including:
The easiest way to Download the Take your membership Download a claim
claim is by swiping My Membership app card and original form from hcf.com.
A pair of prescription glasses from a
your membership at hcf.com.au/mobile- receipts to any HCF au/forms, pick one up
selected range* and free digital retinal
card when visiting a apps. Available for branch. We’ll pay the from an HCF branch,
imaging with your eye test through our
recognised provider. Apple and Android. claim into your chosen or call us on 13 13 34
network
bank account. and we’ll post or email
hcf.com.au/branches one to you. Then send
it back!
A first visit to a physio in
our network^
GOOD TO KNOW
A first visit to a chiro and osteo
• Claims must be lodged within 2 years of the date of the treatment
in our network^
(or 12 months from the accident for School Accident benefit).
• The policyholder or partner listed on the policy must sign the claim form or
electronic claims receipt. A Dependant aged 18 years or over who holds an HCF
A first visit to a podiatrist in
membership card can also claim and sign for the services they’ve been provided.
our network^
• Make sure you give us all the required info we need to process your claim, either
on the claim form, or when claiming through the app or online member services.
100% back or reduced cost on high • HCF won’t pay for any costs of receiving or sending in claim information.
quality hearing aids and access to • We can only pay claims when you’ve given us an itemised account and
free online tools to better understand receipt from the provider and a signed claim form.
your hearing ability through our • If your hospital or doctors’ bills are unpaid, we’ll pay your benefit directly
network provider to the provider.
* 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
COVER EXPLAINED
that apply to services covered by your policy
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
2 months
you may not need to serve waiting periods, if: Hospital psychiatric services*
• your HCF cover includes the same level of benefits All other hospital services, including
accident-related treatment
and services as your previous cover; and
• you’ve served the equivalent waiting periods with SAME-DAY HOSPITAL TREATMENT
EXCESS WAIVER
your previous fund.
(available on some covers)
To avoid serving waiting periods again when All hospital services (where not for
2 months
switching between funds, you’ll need to have pre-existing conditions)
switched from another Australian registered health Pre-existing conditions or ailments 12 months
insurer or an international health insurer belonging
EXTRAS
to the International Federation of Health Plans,
and to have joined within 1 month of ending your Artificial appliances (e.g. low vision aids, 12–24
blood glucose monitors) months
previous membership. These rules also apply
Pre-existing ailments and conditions
if you’ve switched from another HCF product.
Unfortunately when you switch funds, you can’t Foot orthotics
transfer over any loyalty rewards, including Hearing aids
increased limits. 12 months
Dental bleaching, crowns and bridges,
If you joined HCF during a special offer, some waiting indirect fillings, dentures, endodontics,
occlusal therapy, oral surgery,
periods might be waived. Get in touch with us to orthodontics, periodontics,
check which waiting periods may apply. prosthodontics and dental veneers
2–12
School Accident Benefit
WHAT’S A PRE-EXISTING months
CONDITION? All other extras services 2 months
If you had signs or symptoms of a condition, AMBULANCE
illness or ailment during the 6 months before or on Emergency ambulance 1 day
the day you joined HCF (or in the 6 months before
Non-emergency ambulance 2 months
you upgraded to a higher level of HCF cover or
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
2 months and upgrade to receive hospital benefits
before your cover started. (or a higher level of hospital benefits) for hospital
HAVING A BABY? psychiatric services may elect to be exempted from
HCF will have a medical expert look at information
If you’re pregnant and on a single membership, be sure to call us from your doctor, and any other relevant claim
the 2 month waiting period for hospital psychiatric
within 2 months of your bub’s arrival to upgrade to family or single services that usually applies to members when they
details, to decide whether or not your condition was upgrade their hospital cover. Members who have
parent cover. We’ll make sure they’re insured from day 1. If your pre-existing. If it was, a 12 month waiting period held a hospital cover for less than 2 months may
baby isn’t added to your policy within this timeframe, they won’t will apply to services related to that condition. elect to serve a reduced waiting period of 2 months
be covered for procedures that happen in the 2 month waiting This rule applies to all new members, members minus the length of time that the member held
period. The family or single parent membership starts from the upgrading their cover or reducing their excess,
hospital cover. This exemption or reduction can
day your baby’s born. only be accessed once in a member’s lifetime.
and to other adult dependants and children you’ve
added to a policy.
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 PUBLIC HOSPITAL OR KNOWN GAP SPECIALIST
You can choose from our list of more than 35,000
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 Tax Statement for you every July. You can access
day or overnight patient, you’re considered treatment in hospital but don’t get officially admitted, it by logging into 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 pays to know 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 LIFETIME HEALTH COVER
us a bill to pay on your behalf. If you need to pay
an excess or have restricted cover, you’ll need to complete a Medicare Two-way claim form, or visit I f you earn above a certain income, and don’t have I f you don’t have hospital cover with an
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 Australian registered health fund on 1 July
the hospital. This usually happens when you’re any questions. Levy Surcharge. You can avoid paying this by following your 31st birthday, and then
discharged, but check with your hospital. having eligible HCF hospital cover. Talk to us about decide to take out hospital cover later
your cover options on 13 13 34. in life, you might have to pay a Lifetime
Health Cover loading of 2% on top of
RIVATE HEALTH
P your premium for every year you’re aged
GOOD TO KNOW: PROSTHESES WHAT ABOUT EXTRAS GAPS? INSURANCE REBATE over 30. Over time, this can really add up.
Prostheses are items used in surgery to If you have extras cover, we’ll pay up I f you have hospital, extras or ambulance cover The maximum loading is 70% and once
augment or replace a part of the body, like to a set amount for extras services and are registered with Medicare, you might you’ve paid the loading for 10 continuous
pacemakers, stents or joint replacement (like dental or optical), depending on your qualify for the Australian Government Private years, the loading is removed.
devices. Government-approved prostheses that annual limits. The amount we’ll pay also Health Insurance Rebate. The rebate is income
have been surgically implanted are covered by varies depending on your level of cover tested, so your entitlement may change depending
your HCF hospital cover. But if a government- and your annual limits. You’ll need to pay on your income and your age. You can take the
approved gap-permitted prosthesis item is used, the difference between what your extras rebate as a reduced premium or a tax offset credit
you might have to pay a gap. Ask your doctor provider charges and the benefits we pay: in your annual tax return.
which prosthesis is best for you and if a no-gap this is an extras gap. See pages 8-9 on
option is available. The government’s Prosthesis how to claim extras.
List can be found in the Private Health Insurance
(Prostheses) Rules at health.gov.au Need help? Use the ATO Personal Infoline 13 28 61, privatehealth.gov.au,
speak to your tax professional, or call us on 13 13 34.
15
ACCESS ACCESS
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
Make the most of these member opportunities. a member for a month*. The longer you’re with us, the more ways we thank you.
Log in to hcf.com.au/members to save.
MEMBERS CAN SAVE UP EMBERS CAN SAVE 25%
M
TO 15% ON PET INSURANCE ON TRAVEL INSURANCE ~
HCF pet insurance can reimburse you Travel with the confidence that
up to 80% on eligible vet bills for your Aussie-based nurses and call centre staff 0-4 YEARS 5-9 YEARS 10-24 YEARS 25 OR MORE
dog or cat, bringing peace of mind will be there 24/7 if you need help*. WITH HCF WITH HCF WITH HCF YEARS WITH HCF
to your whole fur-family. hcf.com.au/travel
hcf.com.au/petinsurance
YOU COULD SAVE ON AVERAGE OVER $1,000 A YEAR^
INVOLUNTARY COMPLIMENTARY CLOTHING & ENTERTAINMENT GROCERIES
UNEMPLOYMENT OVERSEAS TRAVEL FOOTWEAR Up to 50% off Event and Village Save on Woolworths
ASSISTANCE INSURANCE 5% or more discount at Cinemas. 10% or more discount and Coles e-Gift Cards
If you become involuntarily unemployed, Enjoy up to 90 days complimentary Target, Big W, Kmart, Myer, on Ticketmaster, Village Roadshow
we’ll pay your HCF health insurance overseas travel insurance on some levels David Jones and more Theme Parks, Adrenaline and more
premiums for up to 6 months (183 days). of cover. Insurance is issued by AIG and
Conditions and waiting periods apply#. conditions apply. See page 31 for
a list of eligible covers. PETROL
hcf.com.au/unemployment-
assistance hcf.com.au/bonustravel 5% discount on
Caltex e-Gift Cards
FITNESS RESTAURANTS
15% off 12 month Blue & CAFES
and Platinum Goodlife 10% discount on
#
Available to all members who’ve had hospital cover for at least 12 months. Excludes extras only, Ambulance Only and Overseas Visitors Health Cover.
Gym Memberships MALL Good Food Gift Cards
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. Please note that HCF Pet Insurance is general insurance issued and underwritten by
The Hollard Insurance Company Pty Ltd ABN 78 090 584 473 AFSL 241436, and is not part of The Hospitals Contribution Fund of Australia Limited’s (HCF)
health insurance business. Please read the PDS and do not assume that pet insurance and health insurance are similar. HCF Pet Insurance is distributed and
promoted by HCF ABN 68 000 026 746 AFSL 241414 and administered by Petsure (Australia) Pty Ltd ABN 95 075 949 923 AFSL 420183. Consider the PDS
at hcf.com.au/petinsurance before making any decisions about this product. Terms, conditions, waiting periods and exclusions apply. Any advice provided is
general only. We do not provide any advice based on any consideration of your objectives, financial situation or needs.
CAFE
Travel insurance is issued and managed by AWP Australia Pty Ltd ABN 52 097 227 177 AFSL 245631 trading as Allianz Global Assistance as agent for the
insurer Allianz Australia Insurance Limited ABN 15 000 122 850 AFSL 234708 (Allianz). The Hospitals Contribution Fund of Australia Ltd ABN 68 000 026
746 AFSL 241414 (HCF) arranges this insurance as agent for Allianz. You should consider your financial situation, objectives and needs before deciding on the
product as any advice provided does not take these into account. Terms, conditions, limits and exclusions apply. Before making a decision, please consider
the Product Disclosure Statement available at hcf.com.au/travel. If you purchase this insurance, HCF will receive a commission that is a percentage of the
premium. Ask us in branch, or phone us on 13 13 34, for details before we provide you with any services. *Sub-limits apply to particular kinds of losses or
claims. You do not have cover under certain sections while travelling in Australia. Please refer to the Product Disclosure Statement at hcf.com.au/travel for
full details.~25% discount is the total member discount on offer for the product, based on standard premium rates. It applies automatically to premiums for * Eligibility criteria applies. You can access HCF Thank You offers after you’ve been a member for a month,
all plans including policy add-ons. Cannot be used in conjunction with or in addition to any other discounts. Minimum premiums may apply and be subject to and if your premiums are up to date. Excludes Ambulance Only and Overseas Health Visitors Cover.
rounding and only apply to the extent any minimum premium is not reached. 17
^ ABS data from 2015/16 based on average household spend who buys discounted e-Gift cards.
ACCESS HEALTH &
WELLBEING SUPPORT
MEMBER PERKS
We want you to be your healthiest self and make the most of
our members-only health and wellbeing programs.
H
COAC RAM
PROG
PERSONAL HEALTHY WEIGHT BOWEL CANCER FREE MAGAZINE
HEALTH COACH FOR LIFE PROGRAMS SCREENING* Be inspired to eat, work and play
If you have diabetes or a heart- Our free Healthy Weight for Life programs If you’re outside of the free testing healthier with our member magazine,
related condition, and have had help improve your quality of life if you’re ages for the National Bowel Cancer Health Agenda. Packed with expert
eligible hospital cover for at least overweight and have Type 2 diabetes, Screening Program, you might still advice, interviews and insights – simply
12 months, you could be eligible a chronic heart condition or osteoarthritis. be eligible to claim towards the subscribe and we’ll pop it in the post.
for 6 free phone coaching sessions You must have had an eligible hospital bowel cancer screening kit under
hcf.com.au/subscribe
through the COACH Program®. product for 12 months. We also support your extras cover. A 2 month waiting
Achieve and maintain your health eligible members who are overweight and period applies. EXERCISE CLASSES AND
goals and have more helpful at risk of developing chronic conditions. GYM MEMBERSHIPS*
hcf.com.au/hmp
conversations with your doctor. hcf.com.au/hwfl If you have a specific medical condition
hcf.com.au/coach BABY SLEEP APP and your doctor has prescribed an
CLAIM ON WEIGHT
Z
Z
Z
Take control of your baby’s sleep exercise program, you may be able to
A GP AT YOUR FINGERTIPS MANAGEMENT PROGRAMS* cycle with the SleepWellBaby app. In claim benefits towards the program
Save time in the waiting room by To help you achieve a healthy weight, partnership with Tresillian and Sleepfit, on eligible extras products. A 2 month
having a video consultation with a you may be able to claim on eligible HCF is giving members a discount on waiting period applies.
GP in the comfort of your home or extras products towards dietitian-led the app to help you and your baby get
hcf.com.au/hmp
office. We’ve partnered with online HCF-approved weight management a better night’s sleep.
service GP2U so HCF members get a programs. A 2 month waiting LEARN TO SWIM LESSONS*
hcf.com.au/sleepwellbaby
discount on GP2U’s standard rates. period applies.
You may be able to claim for swimming
hcf.com.au/gp2u hcf.com.au/hmp ANTENATAL AND lessons run by swim schools that are:
POSTNATAL SUPPORT* ASSA members, AUSTSWIM (Gold
FREE SECOND FREE HEART HEALTH CHECKS Claim on a range of programs and Silver level) or Swim Australia
OPINION SERVICE The Victor Chang Cardiac Research and services for support through swim centres. Squad training or
Lean on our network of Aussie-based Institute conducts free roving heart pregnancy and after birth, including recreational swimming isn’t covered,
medical specialists to get a free health checks for HCF members aged 18 childbirth education classes (face- and you’ll need to be on an eligible
second opinion on a health condition and over with extras cover at selected to-face, as well as access to Birth extras product for at least 2 months
you’re worried about. You must have HCF branches. It only takes 10 minutes Beat’s online courses), breastfeeding before diving in.
had hospital cover for 12 months and you can get your results right away. consultations, and antenatal and
hcf.com.au/hmp
and a specialist consultation to use hcf.com.au/victorchang postnatal group physio. You might
this service. Excludes Accident Only also be able to claim on pregnancy
Basic cover, conditions apply. compression garments and
breastfeeding support from the
hcf.com.au/secondopinion
Australian Breastfeeding Association.
A 2 month waiting period applies.
hcf.com.au/family
* Before you start any Health Management Program, check with us that you’re on
* Before you start any Health Management Program, check with us that you’re on eligible
18 eligible cover and the provider of the program is recognised by us. 19
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 everybody. 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?
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*, depending on your level income^ (up to $6,000 based on the level your child recover if you need surgery after injuries, including certain
or for a number of serious of cover, for serious per month for up to 12 of cover you choose, from common injuriesō an accidentø, or for a range fractures and burns,
illnesses. Use your cash specified illnesses like months) if you can’t work if you’re diagnosed with if they have an accident‡ 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 in Australia. Quick help cancers, certain heart in Australia and depending
of recovery: taxis to strokes. A fast payment because of an illness or away, and up to $1m if with the costs of splints, conditions, burns and on your level of cover,
the doctor, extra rehab, can ease the unexpected injury+. We’ll help you you die in an accident**. treatments, therapies, fractures∞. From Ubers up to $50,000 for
hospital parking, financial strain of serious stay afloat while you A fast payment that or just to keep the house to acupuncture, or a accidental death**.
babysitters, or help if illness – and you choose take the time you need leaves one less worry running while your child little extra time off work, Financial help to recover
you need time off work. how you use it. to recover. for your loved ones. gets better. it’s yours to use as from accidents big
you choose. and small.
$2.00 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
$4 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
* Surgery must be necessary as a result of the accident and within 6 months of the accident.
^ Payment is subject to offsets including any amounts payable from your employer or superannuation fund.
+ Injury must be caused by an external violent event.
# Life expectancy of less than 6 months.
** Death must be due to violent, external and visible means solely and directly caused by an accident. Please read the PDS.
Ō Bodily injury caused by an Accident which results in an Impairment immediately, or in a Permanent Disability within 6 months of the Accident. We’ll help you find the right Recover Cover
‡ An externally caused unexpected, unintended and unforeseen event.
Ø Sub-limits apply. Certain heart conditions, cancers, burns and fractures are not covered. Please read the PDS.
∞ Injuries must be as a result of an external violent visible event.
Please consider each Product Disclosure Statement (PDS) and Financial Services Guide available by calling 13 13 34 or visiting hcf.com.au/life-insurance,
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. 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%
20 of HCF Life’s underwriting profit each year calculated as premiums less claims and expenses. HCF’s staff may receive an incentive depending on the annual 21
premium of these products which they sell. This will not exceed 15% of the first year’s premium.MANAGE 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.
TERMINATE 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) a nyone 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@hcf.com.au • you won’t be able to claim during the period YOUR COVER (c) t he 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: a branch • if you want to suspend your cover for travel about our current and new covers and services, (d) the membership is in arrears of more than
reasons you must tell us before leaving Australia including changes to our services and/or offers 2 months
YOUR MEMBERSHIP CARD • active and financial membership must be held to participate in any programs we develop,
for more than 6 months before suspension and (e) a ny member included in the membership has,
As a new member, you’ll get a membership by email, phone, SMS or mail.
at least 6 months between suspensions in the opinion of HCF, behaved inappropriately
card in the mail soon after you join. If you lose
toward HCF staff, providers or other members.
your card, log in to online member services at • the period of suspension doesn’t count towards FUND RULES
hcf.com.au/members, visit a branch or call 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
13 13 34 to get a new one. won’t increase abide by the Fund Rules, which are rules that the policyholder and will refund any premiums
• 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.
CHANGE YOUR LEVEL OF COVER Levy Surcharge for the period of suspension, these at hcf.com.au/fundrules. HCF reserves
To change to a different level of cover, call 13 13 34, depending on your annual taxable income. the right to amend, delete or add to these RECOVERY OF MONIES
visit a branch or send a message through 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,
hcf.com.au/contact-us policies can’t be suspended. To stay covered Insurance Act 2007 and its rules. we can lawfully recover the benefit paid from
The transfer will take place on the date we get with your Life policies while your health policy that member within 24 months of making the
your application, or a later date of your choice. is suspended, call 13 13 34. YOUR 30 DAY GUARANTEE payment. The amount can be recovered if it’s
If your new cover gives you new or higher benefits We want you to be happy with your health been paid directly to the member or to a third
or a lower excess, then waiting periods – including RESUME YOUR COVER cover and the choice you’ve made. If you change party (like a hospital) for goods or services
the pre-existing condition rule – may apply. 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
Remember that changing to a different level of longer receiving a Newstart Allowance or Sickness 30 days of joining, we’ll give you a 100% refund,
cover or cancelling your hospital cover might also 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,
affect your Lifetime Health Cover and Medicare your return to Australia. It’ll take effect from the
Levy Surcharge status (see page 15). we have the right to recover the payment.
date you arrive back in Australia.
To restart your membership, send a Resume My
SUSPEND YOUR COVER Membership Form and Payment Authority Form
In some circumstances, it’s possible to suspend (if necessary) to us. You’ll also need proof that you
your membership. These include if you’re travelling were receiving benefits (i.e. a letter from Centrelink
overseas, receiving a Newstart Allowance or or current employer) or proof of your travel in and
Sickness Allowance from Centrelink, or for another out of Australia.
reason approved by HCF. If your application for
suspension is approved, all members on your policy hcf.com.au/forms
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; and
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 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@hcf.com.au no later than
(if your employer has an arrangement with HCF). • pharmaceuticals you’re given in hospital that are by a registered podiatric surgeon.
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 • if a service is listed as a Service Not Included • experimental drugs, high cost non-PBS
what isn’t covered, so always call 13 13 34 to (we define these services as Excluded Services drugs and Therapeutic Goods Administration
NOT INCLUDED’?
IMPORTANT INFO
check your cover before you go to hospital or in our Fund Rules and on page 34) in the Product (TGA)-approved drugs used for a purpose
If you choose a hospital cover where some have a treatment. Information. For some Hospital Covers, a Service other than that for which they were approved
treatments are listed as Services Not Included Not Included might not apply when a Member
Some items not covered by our hospital or extras • experimental treatment or other treatment
(we define these services as Excluded Services in receives treatment as the result of an Accident
cover include: that does not fall within a clinical category
our Fund Rules and on page 34), then we won’t pay (see hcf.com.au/accident-safeguard). under the Private Health Insurance
a benefit for those treatments and any services • Elective Cosmetic Surgery For other Hospital Covers, the service is not (Complying Product) Rules that is covered
associated with those treatments, except if you • emergency room fees included regardless of whether or not treatment by the product
have Accident Safeguard as part of your cover. • Ambulance Transportation between hospitals is required as a result of an Accident. • benefits where a service is a Service Not
Services Not Included in a private hospital (emergency or non-emergency) Included (we define these services as
Our hospital cover doesn’t include the following,
means you’re responsible for all hospital charges • services supplied by a provider not recognised Excluded Services in our Fund Rules and on
unless we’re required to pay benefits under the
related to those services, which could be large. by HCF page 34) for the payment of Benefits in
Private Health Insurance Act:
Services Not Included in a public hospital • claims made 2 years or more after date a Hospital, and any other services directly
means if you choose to be a private patient in a of service • doctors consultations performed in a doctor’s related to those services, including medical,
public hospital, you’re responsible for all hospital • treatment that HCF deems to be inappropriate surgery, medical centre, clinic, or as an outpatient diagnostic, prosthesis and pharmacy
charges related to those services, which could or not reasonable, after receiving independent • hospital benefits relating to procedures received at the same time, except when
be large. You can choose to be treated as a public medical or clinical advice (and other associated goods and services) Accident Safeguard applies
patient to avoid these charges. • claims that do not meet HCF’s criteria as set that do not require a hospital admission • benefits greater than Minimum Benefits
out in the Fund Rules (except certified Type C procedures) if a service is listed as a Restricted Cover
TRAVEL AND • services that are not delivered face to face in • private room accommodation for in the Product Information. For some
ACCOMMODATION a clinical setting; such as online or telephone Same-Day procedures Hospital Covers, Minimum Benefits
consultations, unless a member is participating • luxury room surcharge might not apply when a Member receives
You can claim travel costs if this benefit is included treatment as the result of an Accident
in your level of cover. in a Chronic Disease management Program or • massage and aromatherapy services
Health Management Program, or the service • select services provided while in Hospital by (see hcf.com.au/accident-safeguard).
Your travel for medical specialists (eligible extras is an extras service and HCF has authorised non-hospital providers For other Hospital Covers, Minimum Benefits
cover only) and/or hospital treatment (eligible the recognised Provider to deliver that extras apply regardless of whether or not treatment
• take home items including crutches,
hospital or extras cover) must be within Australia service in another manner (such as online or is required as a result of an Accident.
toothbrushes and drugs
and greater than a 200km round trip for treatment by telephone conversation) • personal convenience items including the In addition, extras benefits are not payable for:
that isn’t available locally. You can’t claim on both
• services provided outside Australia which cost of phone calls, newspapers, magazines
hospital and extras cover for the same hospital • psychological and developmental assessments
do not meet the requirements under the and beauty salon services
admission. • psychology treatment (where included under
Private Health Insurance Act • respite care
You can claim towards accommodation costs • any service where the treatment does not meet a Policy) unless a mental health plan has been
• special nursing prescribed under Medicare entitlements and
for the patient and carer (if medically necessary) the standards in the Private Health Insurance
including the night before and after the hospital • benefits for Nursing Home Type Patients except these entitlements have been used up for the
(Accreditation) Rules
admission, if this is included in your level of cover. as required under Private Health Insurance Act calendar year
• when a member has the right to recover
Terms and conditions apply. • hospital benefits (including Medical Benefits) • add-ons for optical such as a high index
the costs from a third party other than HCF,
for services in respect of which the item is not material, coatings and tinting
Go to hcf.com.au/travel-accommodation including an authority, another insurer or under
approved for payment by Medicare • services received overseas or purchased
to find out more. an employee benefit scheme
• donated blood and blood products from overseas including items sourced over
To claim, fill out and send us an ‘HCF Application • services received during any period where
payment is in arrears, the Policy is not financial, • donated blood collection and storage the internet
to Claim Travel and Accommodation Expenses’ • the gap on government-approved gap-permitted • routine health checks, screening and
form, available at hcf.com.au/forms, from any the Policy is suspended or within a Waiting Period
• treatment for Pre-Existing Conditions Prostheses items mass immunisations
HCF branch or by calling 13 13 34.
(other than for hospital psychiatric services, • pharmaceuticals (including PBS • where a provider is not in an independent
pharmaceuticals benefits) and other sundry Private Practice
WHAT’S NOT COVERED BY rehabilitation or palliative care) within the
supplies not directly associated with the reason
12 month Waiting Period (the Pre-Existing • more than one therapy service performed by
MY INSURANCE? Condition Waiting Period applies to new for admission the same provider in any one day
There are a few situations where your health Members and Members upgrading their Policy • PBS pharmaceutical benefits in private • services while a hospital patient except for
insurance doesn’t cover you, unless we’re required to any higher level Benefits or lower excess Non-Participating Hospitals eligible oral surgery
to pay benefits under the Private Health Insurance Act. under their New Policy)
26 27• pharmacy items that do not meet HCF’s If your doctor or allied health professional ORTHODONTICS PSYCHOLOGY
definition of a Pharmaceutical Item (see page prescribes a certain surgical or medical aid or Orthodontics is a specialty of dentistry that On some levels of cover you can claim for
IMPORTANT INFO
35 for definition) appliance, call us on 13 13 34 to find out if you deals with the diagnosis, prevention and consultations with an HCF-recognised
• services that had not been provided at time of claim can claim for it. We’ll tell you: treatment of problems with alignment of the psychologist, but we’ll only pay benefits for
• fees for completing claim forms and/or reports • if the appliance is covered teeth and jaws. Orthodontic benefits have a patients who:
• where no specific health condition is being • if any service limits apply, and lifetime limit and an annual limit, depending on • have been referred by their GP, or
treated or in the absence of symptoms, • what supporting information we need your level of cover.
• are on a GP mental health plan through
illness or injury (except some Chronic Disease from your doctor/specialist/allied health You’ll get lower benefits and your overall limit will Medicare, or
Management Programs) professional to help you make a claim. be lower if a dentist other than an orthodontist • are referred directly by a psychiatrist or
• co-payments and gaps for government-funded treats you. Always check with us on 13 13 34
Different waiting periods apply, depending on paediatrician, or
health services including the co-payment for before undertaking any orthodontic work.
PBS items your level of cover. • once the Medicare entitlements for the
Orthodontic treatment might involve: calendar year are used up.
• any service specifically excluded by law HEALTH MANAGEMENT PROGRAMS
including Alexander Technique, Aromatherapy, • custom-made appliances, e.g. to change the This benefit acts as a safety net after Medicare
Bowen Therapy, Beteyko, Feldenkrais, Western Some HCF extras covers include Health jaw shape and can’t be paid in any other circumstances.
Herbalism, Homeopathy, Iridology, Kinesiology, Management Programs, where you can claim
• braces or aligners to straighten teeth
Naturopathy, Pilates, Reflexology, Rolfing, towards programs like swimming lessons, weight SCHOOL ACCIDENT BENEFIT
• the fitting of a retainer to keep the position of
Shiatsu, Tai Chi and Yoga. management programs, exercise programs
teeth once braces are removed. If your level of cover includes School Accident
(see below) and childbirth education.
Benefit, you might be able to claim more
Orthodontic treatment can include the upper or
MORE INFO ABOUT Before you start any Health Management
lower jaw and teeth, or both.
extras benefits if your child has an Accident in,
EXTRAS CLAIMS Program, please check with us that you’re eligible. or travelling to or from, school and you can’t
The providers of the program must be recognised The benefit you’ll get back depends on your recover the costs from another source. You can
RECOGNISED PROVIDERS by HCF and claims must include original receipts level of cover and annual limits; how long you’ve only claim to help top up services included in
To meet our obligations and to ensure our members with provider details, the type of program, the had that level of cover; whether your treatment your extras cover. This benefit doesn’t include
get quality care, HCF has recognition requirements program location, and start and end dates. is provided by an orthodontist or general dentist medical or hospital services. Claims must include
that providers must meet. If a provider doesn’t and what type of treatment you have. a detailed description of the Accident from the
meet HCF’s requirements or on the rare occasion
EXERCISE PROGRAMS & GYMS school and be submitted within 12 months of
Depending on your cover, you might be able to
a provider is de-listed, you can’t claim benefits for To claim the cost of an exercise program, you the Accident. School Accident Benefit applies to
claim more if you need more than 1 orthodontic
services from them. Natural therapy providers must must fill in and send us an ‘Exercise and gym children up to secondary school, depending on
appliance. For example, we pay higher benefits
have continuous membership with an association benefits authorisation and claim form’, available at any waiting periods for the extras service being
for braces on your upper and lower teeth than
that HCF recognises. To find out if your provider is any HCF branch, hcf.com.au/forms or by calling claimed, and the annual limit.
braces for your upper teeth only.
recognised by HCF, call us on 13 13 34. 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 INSULIN PUMPS
ARTIFICIAL APPLIANCES condition that the program addresses. takes place, even if you choose to pay for your Here’s some important info for HCF members
Some extras covers include benefits for certain orthodontic treatment in advance or with a who have Type 1 Diabetes and might need,
Your physiotherapist or exercise physiologist can
artificial appliances, like CPAP machines or payment plan. The benefits for braces or aligners or already have, an insulin pump and have cover for
complete the form if you’re claiming for a class
blood glucose monitors – which must always can only be paid once the braces or aligners insulin pumps. When an insulin pump is supplied
held by a physiotherapist or exercise physiologist.
meet HCF’s definition of an Artificial Appliance are in place. For details on how to claim for in an outpatient setting, you must have served
You can’t claim for recreational or competitive
(see page 33) and be on our approved list. your treatment see page 8. We won’t pay for any relevant waiting periods (12 months for new
sports or activities.
direct-to-consumer clear teeth aligners or related members or upgrades), have your premiums paid up
You may only be able to claim appliances when services, because they’re not being given in
specified health professionals prescribe them
HEARING AIDS to date, and be on an eligible hospital cover to claim.
person by a recognised dentist or orthodontist.
for particular health conditions, and if you can Some extras covers include benefits for hearing aids. Initial insulin pumps
provide a letter from the professional to support Your hearing aid limits renew every 3 years from the PHARMACY These benefits apply for the first time in your
your claim. For some particular appliances, date you get them, not every year. Depending on life when you start using an insulin pump. If your
You might be able to claim for a range of non-
only a specified supplier can provide them. your cover, limits increase the longer you have your insulin pump therapy begins in an outpatient
PBS listed drugs, if your level of cover includes
cover. Please check your cover details by logging setting, HCF will pay a benefit equal to the
pharmacy benefits. See the definition of an eligible
into online member services hcf.com.au/members minimum amount on the government-approved
Pharmaceutical Item on page 35. The range of
or call us on 13 13 34. Prostheses List.
claimable drugs changes each month so, to be
sure, call us on 13 13 34 to check. Before any
benefit is paid, we take a co-payment equivalent
to the current standard Pharmaceutical Benefits
28 Scheme (PBS) co-payment for general patients. 29You can also read
