Say hello to
HCF Corporate
September 2014
Contents
BENEFITS OF PRIVATE HEALTH INSURANCE
4
HEALTH INSURANCE OPTIONS
5
Choosing your level of cover
Top Hospital
Healthmate Ultimate
Healthmate Advanced
Healthmate Essentials
Healthcover Plus Extras
6
7
8
9
10
11
HOSPITAL COVER
12
Your hospital cover
Private hospital services
What hospital charges are covered?
Having a baby
13
14
16
18
EXTRAS COVER
19
Extras benefits & limits Extras services 20
24
ADDITIONAL MEMBER BENEFITS
My Health Guardian
My Home Doctor
My Global Specialist
Health Dollars Loyalty Rewards
Involuntary Unemployment
OTHER PRODUCTS AND OFFERS
Our other products and offers for members
Manage your health cover online
Cash Assist Covers
Cash Assist Covers – Combined Product Disclosure Statement
Financial Services Guide
IMPORTANT INFORMATION
Things you need to know
Rebates, surcharges and incentives
Our privacy statement
HOW TO JOIN
2
28
29
30
30
30
31
32
33
34
36
38
42
43
44
49
51
52
How HCF
gives you more
MORE BENEFITS
MORE COVER
• We’re Australia’s largest not-for-profit
health fund
• 91.6 cents in the dollar were returned as member
benefits in the 2013 financial year, compared to
only 86.4 cents for the average health fund
• 5 time winner (2009 - 2013) of Canstar’s top
outstanding value award, so you’re assured of
getting more value
• Australia’s best customer service – HCF won the
2013 ‘Best of the Best’ award from the Customer
Service Institute of Australia (CSIA)
• With our ‘member first’ attitude, branches
across Australia, plus a call centre open 7 days
a week, we’re there for you – HCF also won
CSIA’s 2013 ‘Easiest health fund to do business
with’ award.
• Heart cover is included in all HCF Corporate
hospital products
• Access a range of fully covered services for your
teeth, eyes, muscles, back and feet through over
9,500 providers with our More for You programs
• 7 Sydney HCF Dental Centres, exclusively
for members, offering a range of fully
covered services
• 7 Sydney HCF Eyecare Centres, with reduced
member pricing for contacts, frames, lenses
and sunglasses.
MORE SAVINGS
• No hospital excess for dependent children
or for treatment as a result of an accident
• You’ll only pay one hospital excess amount
per person per calendar year, (if an excess
is applicable)
• Enjoy the best no-gap medical coverage of any
health fund in Australia (PHIO report 2013)
• Get a 10% discount on pet and travel insurance.
MORE THAN HEALTH
INSURANCE
• Look after your health and wellbeing easily
with our My Health Guardian program
• Eligible members in selected areas can access
our afterhours My Home Doctor service
• Victor Chang heart health checks are available
with HCF extras cover at no cost and at
scheduled times, in selected branches
• Regular health news updates, magazines,
exclusive member offers, competitions and more
• Low cost covers from HCF Life that provide
financial relief from illness or accidents.
HCF’S LOYALTY BENEFITS.
MORE REWARDS THE
LONGER YOU STAY WITH US.
The HCF Corporate Health Dollars Loyalty
Rewards program lets you reduce your
hospital excess or claim more back on extras
services such as dental and optical.
See pages 30-31 for more information.
3
Benefits of private
health insurance
MORE CHOICE, MORE CONTROL
MEDICARE LEVY SURCHARGE
Private health insurance is all about peace of
mind and choice – your choice of doctor at a
conveniently located hospital or day hospital
facility. If you need hospital treatment, your
private hospital cover will help safeguard you
and your family against high costs and the
lengthy waiting lists – having you back on the
road to recovery faster.
The Medicare Levy Surcharge is an Australian
Government initiative designed to encourage
high income earners to take responsibility for
their health care. It applies to those singles
earning a taxable income $90,001 and over
per year for singles and $180,001 and over
for couples/families.
LIFETIME HEALTH COVER
Lifetime Health Cover is an Australian
Government initiative designed to encourage
life-long membership of private health insurance.
People who take out hospital cover early in
life will be charged lower contribution rates
throughout their life, relative to people who
take out hospital cover later.
Health Insurance
Options
For information on how the Medicare levy
applies to you please refer to page 50.
All information contained in this brochure
assumes that you are a permanent resident of
Australia with full Medicare eligibility. If you
are not, please let us know so we can provide
you with complete information about the
appropriate cover.
For more information on how the Lifetime Health
Cover applies to you please refer to page 50.
AUSTRALIAN GOVERNMENT
REBATE ON PRIVATE HEALTH
INSURANCE
The Australian Government provides an income
tested rebate to help make private health cover
more affordable.
While most people will receive the full rebate,
income testing will reduce the rebate for
singles earning $90,001 and over per year and
couples/families earning $180,001 and over
combined per year.
For information on how the rebate applies to you
please refer to page 49.
4
5
Choosing your
level of cover
Top Hospital
The products featured in this brochure are
part of the HCF Corporate products range
The following table is designed to assist you when choosing your health insurance by looking at
the type of cover you need and your life stage.
When choosing your level of cover, we recommend you consider a range of other factors not
incorporated in this table, including your family’s medical history, any pre-existing conditions
and the hospital and extras cover needs of each person covered on the membership.
Recommended
level of cover
Life stage
Coverage
Top Hospital
You have a maturing family or are looking for the maximum protection
and flexibility in your hospital cover, with the choice of adding an
extras cover for total peace of mind (see page 7).
High level
hospital cover
Healthmate
Ultimate
You’re a single, couple or family looking for a value for money hospital
and extras cover, offering the ideal pregnancy package to see you
through the birth of your children (see page 8).
Medium – high
level hospital and
extras cover
Healthmate
Advanced
You’re looking for comprehensive hospital and extras cover with
generous benefits, and not planning a family or any more children
(see page 9).
Medium level
hospital and
extras cover
Healthmate
Essentials
You’re a young, active single, or couple not planning a family and
looking for basic, affordable hospital and extras cover for the things
you need (see page 10).
Low level hospital
and extras cover
Healthcover
Plus Extras
(extras only)
You want quality extras cover for services like dental, optical, physio
and chiro or you are looking to add an extras cover to your Top
Hospital cover. Healthcover Plus Extras also includes benefits to help
you stay fit and healthy (see page 11).
Medium – high
level extras cover
For those who want the very best
in private hospital cover
Top Hospital is our top level of private hospital
cover in the HCF Corporate range, giving you
maximum protection and choice, with complete
peace of mind. You are covered for your own
private room with ensuite (where available) at
any of our contracted hospitals, along with all
the additional charges such as theatre fees and
government approved surgical prostheses.
ADD EXTRAS COVER FOR
TOTAL PEACE OF MIND
For a total health care package we recommend
that you add Healthcover Plus Extras cover, which
pays benefits for a range of costly extras services,
such as dental and optical (see pages 20-27).
A RANGE OF
ADDITIONAL BENEFITS
Adding an extras cover will also give you access
to a range of additional member benefits that
help you to maintain good health. These easyto-use health and wellbeing management tools
include exclusive home care and support for a
number of specific health conditions. For more
information, including details on the
My Health Guardian, My Home Doctor and
My Global Specalist services, see pages 29-31.
Importantly, Top Hospital and Healthcover Plus
Extras give you access to Health Dollars – our
loyalty program – which can be used to reduce
your personal expense when claiming extras
benefits or reduce your hospital excess
(see page 30).
Hospital
Participating private and public hospitals included.
Extras
Top Hospital can be taken with or without extras cover. See page 11 for our Healthcover
Plus Extras level of cover.
Ambulance
Included.
Excess
Singles: $250 per person to a maximum of $250 per calendar year.
Couples/Families: $250 per person to a maximum of $500 per policy per calendar year.
Note: Whilst this table indicates a recommended level of cover for each life stage, it is provided as a general guide only.
State Government emergency ambulance cover is included in all of our hospital covers except for QLD and TAS residents who are covered
by their State Government ambulance service.
6
You won’t pay any excess for accidents or dependent children. You also won’t pay an excess
for same day treatment after serving the relevant waiting periods. A 12 month waiting period
applies for pre-existing conditions, and a 2 month waiting period for all other procedures.
7
Healthmate
Ultimate
Healthmate
Advanced
The ultimate cover for planning your family
A healthy step forward that won’t
break your budget
Whether you’re single, a couple planning a family
or a young family after cover for the things that
really matter, Healthmate Ultimate is the right
cover for you.
Healthmate Ultimate provides you with quality
private hospital cover, as well as cover for many
of the expensive extras, like dental (including
crowns, bridges and orthodontics), optical and
physiotherapy to name just a few. See pages 20-27
for details. Our loyalty rewards program can also
help you reduce your personal expenses when
claiming extras or to reduce your hospital excess.
PLANNING A BABY
Of course, if you’re planning for a baby
(see page 18), affordable private health
cover is a must, and Healthmate Ultimate
is the complete package.
Healthmate Ultimate also provides cover for
ante-natal classes and hospital services to
treat post-natal depression if required.
YOUR PREMIUMS
REMAIN AFFORDABLE
To keep your premiums affordable, Healthmate
Ultimate includes an excess. Some services on
Healthmate Ultimate attract Minimal Benefits
and exclusions and these are listed on pages
14-15. Having Minimal Benefits and exclusions
on services you are unlikely to need means
you’ll save money on your premiums. All in all,
Healthmate Ultimate is the perfect health cover
for anyone planning to start a family.
Hospital
Participating private and public hospitals included.
Extras
Included.
Ambulance
Included.
Excess
Singles: $250 per person to a maximum of $250 per calendar year.
Couples/Families: $250 per person to a maximum of $500 per policy per calendar year.
You won’t pay any excess for accidents or dependent children.
If you’re looking for a comprehensive cover and
you aren’t planning a family or any more children,
Healthmate Advanced is the right choice for you.
Healthmate Advanced gives you quality hospital
and extras cover and a range of added benefits
that will keep you healthy. With Healthmate
Advanced you can rest easy, knowing you have
the security of private hospital cover. You’ll also
be covered for a great range of extras services like
dental, optical, physiotherapy and chiropractic.
See pages 20-27 for more information.
A MORE AFFORDABLE
CHOICE OF COVER
While Healthmate Advanced covers you for most
hospital treatments that you are likely to need at
your stage of life, some hospital services receive
Minimal Benefits, like pregnancy and birth related
services. However you can still enjoy the benefits
of being a private patient in a shared room, in a
public hospital – which means you choose who
treats you.
Gastric banding and obesity surgery is excluded,
see pages 14-15 for more details.
To make your cover even more affordable, an excess
has been included with Healthmate Advanced.
WE HAVE YOU COVERED
WITH A GREAT RANGE
OF EXTRA BENEFITS
Healthmate Advanced includes a great range of
additional member benefits, so you are always
getting value for your money. You’ll have access
to our loyalty reward program that you can use
to reduce your personal expense when claiming
extras or to reduce your hospital excess. To help
you stay fit and healthy, you’ll have access to
HCF approved health management programs.
See page 26 for more details.
Hospital
Participating private and public hospitals included.
Extras
Included.
Ambulance
Included.
Excess
Singles: $250 per person to a maximum of $250 per calendar year.
Couples/Families: $250 per person to a maximum of $500 per policy per calendar year.
You won’t pay any excess for accidents or dependent children.
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9
Healthmate
Essentials
Healthcover
Plus Extras
Your first step into private health cover
Quality cover for the things you really need
If you’re a young, active single or couple and
looking for your first step into private health
cover then consider Healthmate Essentials.
Healthmate Essentials is a great value package
ideal for young people looking for basic hospital
and extras cover.
COVER TO SUIT YOUR BUDGET
With so many other things on your shopping list,
you don’t need expensive health cover. To make
Healthmate Essentials more affordable, some
services you are less likely to need attract
Minimal Benefits and exclusions. See pages 14-15
for more details.
Even though some services are restricted, you’re
still covered for services you may need like knee
reconstructions or getting your appendix out.
STAYING HEALTHY IS EASY
With Healthmate Essentials you have access to
a range of extras services to help you stay fit and
healthy. Extras services can be costly and most of
them are not covered by Medicare.
Healthmate Essentials provides cover for things
like contact lenses, dental check-ups or visits to
the physio. See pages 20-27 for a detailed list.
If you’re planning a trip overseas, Healthmate
Essentials pays benefits on some travel
vaccinations, so you can look after your health
wherever you are in the world.
IF YOUR JOB FALLS THROUGH,
YOUR HEALTH COVER
DOESN’T HAVE TO
To give you that little bit of extra support,
we’ll take care of your Healthmate Essentials
contributions for up to 12 months if you are
retrenched from work, through no fault of your
own. See page 31 for more details.
Hospital
Participating private and public hospitals included.
Extras
Included.
Ambulance
Included.
Excess
Singles: $250 per person to a maximum of $250 per calendar year.
Healthcover Plus Extras will give you quality cover
on extras services that aren’t covered by Medicare.
Plus, you’re covered for State government
emergency ambulance road and air services.
A WIDE RANGE OF BENEFITS
Healthcover Plus Extras gives you quality cover
for an extensive range of services such as:
• Dental (including crowns, bridges
and dentures)
• Orthodontics
• Optical
• Physiotherapy
• Chiropractic
• Osteopathy
• Speech pathology
• Recognised natural therapies
• HCF approved health management programs
(see page 26 for more details).
Hospital
Not included.
Extras
Included.
Ambulance
Included.
Excess
N/A.
As an added bonus, benefits for crowns,
bridges, indirect restorations and orthodontics
increase the longer you are a member. For a
detailed list of extras benefits and limits see
pages 20-27.
GREAT BENEFITS
TO KEEP YOU HEALTHY
To help you and your family stay on top
of your health, included with Healthcover
Plus Extras is a great range of additional
member benefits. This includes benefits for
approved health and weight loss programs.
For more details see pages 26.
TAILOR YOUR HEALTH COVER
TO MEET YOUR NEEDS
This cover can be taken on its own or paired
with Top Hospital to help put your mind at ease.
See Top Hospital on page 7 for more details.
Couples: $250 per person to a maximum of $500 per policy per calendar year.
You won’t pay any excess for accident related treatment.
Note: This cover is not available for family policies.
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11
Your hospital cover
WHY DO I NEED
HOSPITAL COVER?
Hospital cover is important for two main reasons.
It gives you the freedom to access private
hospital care when and where you need it within
Australia. And it gives you the peace of mind of
knowing that you and your family are protected
from unforeseen medical costs that could cause
financial hardship.
Hospital cover provides benefits for two types
of services provided to admitted patients in
hospital. Some services are billed by the hospital
and are referred to as hospital benefits.
Other services are billed by doctors who treat
you in hospital and are referred to as medical
benefits. All HCF hospital covers provide you
with access to different types of hospital
treatment but you are not covered for medical
services provided outside a hospital.
AM I COVERED FOR
AMBULANCE SERVICES?
With every HCF hospital or extras cover
you have benefits for State Government
ambulance services:
• Cover for State Government emergency
ambulance services to transport you to the
nearest hospital that can provide the care
you need, or to treat you on the spot
• Up to $5,000 per person per calendar year
for non-emergency, but medically necessary
State Government ambulance services where
the treating doctor requests the ambulance
because your condition requires that level of
monitoring and support in transit.
12
Hospital Cover
Ambulance costs are not claimable if they
are covered elsewhere. e.g. by your State
Government (TAS and QLD), by a third party
(such as another insurance policy) through
other funding arrangements (such as a levy)
or for transfers between hospitals where the
hospitals are liable.
HOW IS THE EXCESS APPLIED?
For more information about the excesses
available on each level of cover, see pages 7-10.
BONUS ON TOP
HOSPITAL COVER
You won’t pay an excess for same day
hospital treatment after serving the relevant
waiting periods. See page 7 for more details.
WHAT ABOUT
WAITING PERIODS?
Generally, all health funds require new members,
and existing members upgrading their level of
cover or reducing their excess, to wait before
benefit payments are made at the level that
applies to their new cover.
A 12 month waiting period is applied to some
treatments and conditions, including pre-existing
ailments, illnesses or conditions, and pregnancy
and birth-related services. Other waiting periods
are listed on page 44.
13
Private hospital
services
Participating private hospitals and public hospitals
Excess per calendar year
Prior to any hospital admission please call HCF on 13 13 34 to confirm that your procedure
is covered. For other circumstances where you may not be covered see page 44-47.
Top Hospital
Healthmate Ultimate
Healthmate Advanced
Healthmate Essentials
$250 per person to
a maximum of $500
per family policy.
$250 per person to
a maximum of $500
per family policy.
$250 per person to
a maximum of $500
per family policy.
$250 per person to
a maximum of $500
per couple.
Accommodation
Operating theatre
Intensive care
Coronary care
Physiotherapy
Pharmaceuticals*
Excluded
Excluded
Pregnancy and birth related services
Excluded
Minimal Benefits
Minimal Benefits
Psychiatric services
Minimal Benefits
Minimal Benefits
Gastric banding and obesity surgery
Government approved prostheses
Minimal Benefits
Minimal Benefits
Hip and knee joint replacement surgery
Minimal Benefits
Minimal Benefits
Minimal Benefits
Cataract and other lens related surgery
Minimal Benefits
Minimal Benefits
Minimal Benefits
Dialysis for chronic renal failure
Minimal Benefits
Minimal Benefits
Minimal Benefits
Minimal Benefits
Minimal Benefits
Minimal Benefits
Minimal Benefits
Minimal Benefits
Minimal Benefits
Minimal Benefits
Minimal Benefits
Assisted reproductive services (e.g. IVF, GIFT, etc)
Elective cosmetic surgery
Surgery by accredited podiatric surgeon
Emergency ambulance
Apart from the services listed above as Minimal
Benefits and exclusions, you are covered for all
other conditions or surgical procedures provided
you have served the required waiting periods.
Having Minimal Benefits reduces the cost of
hospital cover, but you should carefully consider
your current and future health needs when
selecting your level of cover. For example, you
are required to serve waiting periods if you
upgrade to a level of cover where the service
is not a Minimal Benefit.
What do we mean by ‘Minimal Benefits’?
If you choose a product which has Minimal
Benefits for some procedures (such as pregnancy
and birth-related services), then you’ll be covered
in a public hospital shared room, but your private
hospital costs won’t be fully covered. This means
you may face significant personal expenses if you
have any of these procedures in a private hospital.
For procedures attracting Minimal Benefits
in a private hospital, HCF would:
• Pay a small amount towards your
accommodation;
• Pay for prostheses, if required (cover for
government approved prosthesis list items);
and
• Not pay operating theatre expenses, or labour
ward charges.
In addition, there are some services where
doctor’s charges are not payable (for example,
elective cosmetic surgery and surgery by an
accredited podiatric surgeon). For these, HCF
will only pay a very small amount towards the
total cost of the procedure (and no doctor’s
charges). This applies to services which do
not attract a benefit from Medicare.
Exclusions
If you need treatment for any procedures listed
as an Exclusion in your hospital cover, you won’t
receive any benefits from us and you may have
significant out-of-pocket expenses. Make sure
you have reviewed the excluded services on your
selected hospital cover listed in the table above.
* Excluding experimental and high cost non-PBS drugs.
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15
What hospital charges
are covered?
We’ll cover hospital charges related to your admission provided the service or treatment is not excluded
on the cover you have chosen. The table below provides a guide as to how we pay, depending on the type
of hospital you choose.
Hospital Charge
Participating
Private Hospitals
Non-Participating
Private Hospitals
Public Hospitals
• Accommodation (single
room if available)
100% of most services
are covered, excluding
services with Minimal
Benefits or where an
excess is payable.
HCF has agreements
with most private
hospitals and day
surgeries, but at the
few private hospitals
or day surgeries where
we do not have an
agreement, Minimal
Benefits apply and
you are likely to have
high personal expenses
in relation to all
hospital charges.
If you choose to be
treated as a private
patient in a public
hospital, you are fully
covered for all hospital
charges for services
without Minimal
Benefits in a shared
ward, excluding any
excess payable.
• Theatre fees for covered
services
• Labour ward*
• Intensive care for covered
services
• Most required
pharmaceuticals for your
treatment
HCF has agreements
with more than 400
private hospitals and day
surgeries throughout
Australia.
See our website
hcf.com.au
• Therapies provided by the
for a list of contracted
hospital
• Emergency ambulance cover private hospitals or
call 13 13 34.
• Same day admission.
* Not covered on Healthmate Advanced or Healthmate Essentials.
MEDICAL CHARGE
Private hospital cover pays the difference
between the Medicare benefit and the
Medicare Schedule Fee for medical services
received as a private patient in hospital.
A benefit is payable by Medicare for most
services received as a hospital in-patient.
No health fund benefit is payable for
out-patient medical services or where
Medicare has not paid a benefit.
CLOSING THE ‘GAP’
If your doctor charges above the Schedule
Fee, the difference between the cost and
your benefit (known as the ‘Gap’) is payable
by you. This may be reduced or eliminated
altogether if your doctor has agreed to take
part in our medical gap scheme.
WHAT ARE YOU NOT
COVERED FOR?
If your hospital cover has services with
Minimal Benefits you will be covered for
shared ward accommodation costs as a
private patient in a public hospital, but only
Minimal Benefits apply for treatment in
a private hospital or private day hospital.
Please note that in most cases this will
leave you with a personal expense.
16
PARTICIPATING
PRIVATE HOSPITALS
These are private hospitals and day
surgeries where we have an agreement
with the hospital to secure the maximum
level of cover for our members.
INFORMED
FINANCIAL CONSENT
Before you agree to treatment, doctors
should provide you with information so
that you can give your Informed Financial
Consent. Before you are admitted into
hospital, ask your doctor if they, and other
doctors who will be treating you, participate
in our medical gap scheme. Also, elect to
have your treatment in an HCF participating
hospital. A list of these can be found at
hcf.com.au
PROSTHESIS
Our benefits meet the cost of the
government approved surgically implanted
prostheses. If your surgeon chooses a
prosthesis that is not fully covered, you
are likely to incur personal expense.
Your surgeon should advise you of this
before your operation.
17
Having a baby
Extras Cover
If you’re considering having a baby, there are
a few important things to take into account
ARE YOU ON THE RIGHT
LEVEL OF COVER?
All of the hospital covers in this brochure provide
shared ward coverage in a public hospital but if
you are considering having a baby in a private
hospital then Healthmate Ultimate or Top
Hospital needs to be your choice of cover.
Healthmate Ultimate and Top Hospital cover
pregnancy and birth related services, such
as assisted reproductive services, infertility
investigations and infertility treatments
performed in hospital. You will also have access
to a range of benefits and programs ensuring that
you have everything you need to get you through
your pregnancy.
DO WAITING PERIODS APPLY
IF YOU ARE TRANSFERRING
FROM ANOTHER FUND?
If you are new to a product that covers pregnancy
and birth related services, you have to serve
the waiting periods outlined on page 44 to
be covered for this service. However, if you
have already served the waiting periods for
preganancy and birth related services on an
equivalent level of cover at another health fund,
we will recognise those waiting periods you
have already served as long as you transfer to
HCF within 30 days from the end date with the
previous fund.
The services related to pregnancy and childbirth
have a waiting period of 12 months.
WILL YOUR BABY BE COVERED?
To ensure that your baby is covered at birth,
it’s important to upgrade to family cover at
least two months prior to the birth to ensure
the baby is covered.
We strongly advise that you transfer to a
family membership when you are considering
starting a family.
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19
Extras benefits
& limits
The following table shows you the annual limits of
our extras covers and benefits payable on some
commonly used extras services. All services are
subject to individual item benefit limits.
Type of Service
Note: Where initial consultations are shown, lower
benefits apply for subsequent consultations.
Annual limit per person
Annual limit per person
(Individual benefits listed as examples)
(Individual benefits listed as examples)
Healthmate Advanced
Healthmate Essentials*
Waiting Periods
Optical
Healthcover Plus Extras
$210
$200
$180
$180
2 months
Single sighted glasses (frames and lenses)
$177
$175
$155
$155
Service limits apply
Service limits apply
Preventative & diagnostic dental
Healthmate Ultimate
Service limits apply
Service limits apply
Periodic oral exam 012 (2 per person, per year)
$26
$24
$22
$22
Scale and clean 111 (2 per person, per year)
$27
$25
$25
$25
$22/$18
$20/$15
$20/$15
$20/$15
$22
$22
$22
$20
$400
$400
$400
$400
$75
$75
$65
$63
Single film x-rays (initial / subsequent)
Fluoride treatment 121 (1 per person per year)
General dental
Metallic filling, one surface, direct 511
Tooth coloured filling, one surface, direct 551
$250
$225
$210
$750/$1,000 after 5 years
$700
$600
Full crown: Non-Metallic
$625
$600
$600
Bridge Pontic: Indirect
$570
$570
$570
Periodontics, endodontics, occlusal therapy
& oral surgery
$500
$400
$400
Crowns, bridges, indirect restorations (1)
Orthodontic
$300(8)
After 5 years we pay up to (orthodontist
or dentist)
(3)
$400 or $300
$400 or $300
$400 or $300
$2,200 or $1,800 per lifetime
$1,800 or $1,500 per lifetime
$1,200 or $900 per lifetime
$185
12 months
Foot Orthotics (3)
$120
$120
$100(4)
Exercise Physiology (5)
$350
$350
$350
$350(9)
$30
$30
$30
$25
12 months
Subsequent visits
$25
$25
$25
$20
Chiropractic (5) (6)
$350
$350
$350
$350(9)
First 4 visits
$35
$35
$35
$30
Subsequent visits
$24
$22
$22
$20
20
12 months
12 months
After 12 months we pay up to (orthodontist
or dentist)
First visit
2 months
12 months
(2)
Orthopaedic Shoes
2 months
2 months
2 months
21
Extras benefits
& limits (cont.)
Type of Service
Annual limit per person
Annual limit per person
(Individual benefits listed as examples)
(Individual benefits listed as examples)
Healthmate Advanced
Healthmate Essentials*
Waiting Periods
Osteopathy (5) (6)
Healthcover Plus Extras
$350
Healthmate Ultimate
$350
$350
$350(9)
2 months
First 2 visits
$42
$40
$37
$30
Subsequent visits
$34
$32
$30
$20
Physiotherapy (6) (7)
$750
$700
$600
$350 (9)
First 2 visits
$40
$35
$35
$32
Subsequent visits
$29
$28
$27
$25
After 14 visits
$22
$22
$22
$10
Occupational therapy (7)
$750
$700
$600
First 2 visits
$49
$44
$41
Dietetics (7)
$750
$700
$600
First 2 visits
$45
$40
$35
$250
$200
$150
$30 - $36
$28 - $33
$25 - $30
Speech pathology (7)
$750
$700
$600
First 4 visits
$49
$45
$42
Orthoptic therapy (7)
$750
$700
$600
First 2 visits
$40
$35
$35
Natural therapies (1): acupuncture, remedial
massage, naturopathy and more
$300
$300
$250
Podiatry
Consultation
2 months
2 months
2 months
2 months
2 months
$150 (12)
Initial consultation
$35
$35
$35
$30
Subsequent consultation
$20
$20
$20
$20
Pharmaceutical prescriptions (10)
$700
$600
$600
$300
Psychology (11)
$300
$300
$300
Consultation
HCF approved health management programs
- refer to page 26 for more details
*Limits are applicable per person for singles and couples.
Cover is not available on family memberships.
(1) Limit shown is the overall limit for all services in this group.
(2)Orthodontic limits are lifetime limits which include benefits
paid in previous years from any extras cover.
(3) Combined limit for orthopaedic shoes and foot orthotics.
(4)Combined limit for foot and sports orthotics on
Healthmate Advanced.
$45
$45
$45
$150 per person,
$300 per policy
$150 per person,
$300 per policy
$100 per person,
$200 per policy
(5)The limit shown is a combined limit for chiropractic, exercise
physiology and osteopathy services. Excludes Healthmate
Essentials which has a different combined limit, see (9).
(6)You cannot claim for more than one therapy received on the
same day for physiotherapy, chiropractic and osteopathy.
(7)Limit shown is a combined limit for physiotherapy,
occupational therapy, dietetics, speech pathology and
orthoptic therapy services. Excludes Healthmate Essentials
which has a different combined limit, see (9).
2 months
(8)$300 limit is for oral surgery only. Other services not covered
under this product.
(9)Limit shown is a combined limit for physiotherapy,
chiropractic, exercise physiology and osteopathy.
Up to $50 per script for HCF approved items. A co-payment
(10)
equivalent to the standard PBS prescription charge for general
patients is deducted per script before benefits are calculated.
2 months
2 months
2 months
6 months
(11)Claimable only when you have been prescribed a Mental
Health Plan by your GP and your Medicare entitlement is
exhausted for the calendar year.
(12) Limited range of therapies are covered on Healthmate
Essentials. See pages 25 for full list.
Please note: Only one therapy service performed by the same provider in any one day can be claimed.
22
23
Extras services
OPTICAL
Benefits are payable per person per calendar
year, up to the maximum indicated. Individual
limits apply to both lenses and frames. If you are
making an optical claim, your prescription details
must be provided when claiming benefits.
More for Eyes program
This program gives you a range of fully covered
glasses and access to free digital retinal
photography through our participating optical
providers across Australia and seven HCF
Eyecare Centres in Sydney. It’s available with
selected extras cover and subject to available limits.
For more details on the program, including
a list of participating providers, please visit
hcf.com.au/more-for-eyes or call 13 13 14.
HCF Eyecare Centres are independently owned
and operated by Eyecare Holdings Pty Limited
ACN 054 365 196.
DENTAL
Benefits are payable up to the amounts shown
in the table on pages 20-21, note that individual
items benefit limits also apply. We refer to the
item numbers supplied by your dentist when
paying benefits.
Diagnostic Dental includes items and services
such as examinations, consultations and x-rays.
Preventative Dental includes items and services
such as the removal of plaque, fluoride application
and the provision of a mouthguard.
General Dental includes items and services such
as simple extractions and simple fillings.
Periodontics, Endodontics & Oral Surgery:
benefits are payable upon completion of services.
Not all services are covered on all products.
Crowns, Bridges & Indirect restorations:*
benefits depend upon the type of treatment.
Note: After 5 years of membership on Healthcover
Plus Extras your benefit limit increases to $1,000.
Not all services are covered on all products.
Orthodontics: benefit limits accrue for each year
of membership, up to the maximum payable.
Up to half of the accrued limit is claimable when
the treatment commences and the remaining
accrued limit when the treatment is completed.
So we will need a treatment plan and quotation from
your Orthodontist when the treatment begins and
confirmation of completion at the time it is finalised.
Orthodontic limits are lifetime limits which include
benefits paid in previous years from any extras
cover. Not all services are covered on all products.
More for Teeth program
Available in Sydney through HCF Dental Centres
and across Australia (except NT and TAS)
through participating dental providers. It is
available with all extras covers and subject to
available limits.
To learn more about the program, or to find
participating dentists in your area, please visit
hcf.com.au/more-for-teeth or call 13 13 14.
THERAPIES
More for Muscles program
This program gives you one fully covered initial
consultation a year for a new health condition,
or flare up of an existing condition, through our
participating physiotherapists across Australia.
It’s available with all extras covers and subject to
available limits.
For more information on the program, including
a list of participating physiotherapists, please
visit hcf.com.au/more-for-muscles or call 13 13 14.
More for Backs program
This program gives you one fully covered initial
consultation a year for eligible musculoskeletal
conditions; whether for a new health condition
or flare up of an existing condition, through our
participating chiropractors and osteopaths
across Australia. It’s available with all extras
covers and subject to available limits.
For more information on the program, including
a list of participating providers, please visit
hcf.com.au/more-for-backs or call 13 13 14.
More for Feet program
NATURAL THERAPIES
We pay benefits for a range of natural therapies.
Please contact us on 13 13 34 to find out if your
therapist is recognised for benefit purposes.
See below for benefits are payable for.
Acupuncture
Traditional
Chinese medicine
consultations
Remedial massage/
myotherapy
Kinesiology*
Nutrition consultations
Homeopathy*
Naturopathy
consultations
Reflexology*
Western herbal
medicine
consultations*
Shiatsu*
Aromatherapy*
Sports Therapy*
Note:
Only one natural therapy service can be claimed per day from the
same provider.
* These services are not available on Healthmate Essentials.
This program gives you one fully covered initial
consultation a year for a new health condition,
or flare up of an existing condition, through our
participating podiatry providers across Australia.
It’s available with selected extras covers and
subject to available limits.
For more information on the program, including
a list of participating podiatrists, please visit
hcf.com.au/more-for-feet or call 13 13 14.
* Restorations made outside the mouth.
24
25
ORTHOPAEDIC SHOES
& FOOT ORTHOTICS
Benefits are payable for custom made
orthopaedic shoes and foot orthotics when
prescribed by a podiatrist, orthopaedic surgeon,
rheumatologist or rehabilitation specialist, and
supplied by a recognised provider. Limits apply
per person per calendar year. Not all services
are covered on all products.
PHARMACY
Benefits are payable for prescription medicines
when they are dispensed by a pharmacist in an
independent private practice. A co-payment
equivalent to the standard Pharmaceutical
Benefits Scheme (PBS) prescription charge for
general patients is deducted per script before
benefits are calculated.
HCF does not pay towards:
• Items listed under the government PBS
in any form, brand or strength
• Items available without a prescription
• Items prescribed outside of illness or
disease, or for reproductive medicine
e.g. contraception
• Items that are not on the HCF approved
pharmacy list.
To find out if your prescription is eligible for
a benefit, please call us on 13 13 34. For more
detailed information about pharmaceutical
benefits please refer to the HCF Member Guide.
PSYCHOLOGY
AIDS & APPLIANCES
If you are covered for psychology you are only
eligible for psychology benefits from HCF once you
have been referred for a mental health plan by your
GP through Medicare and your entitlements from
Medicare have been exhausted.
When you combine Top Hospital with Healthcover Plus Extras, we will assist with the purchase or hire
of a range of aids and appliances certified by your doctor as being helpful to the management of your
medical condition. See below for more examples.
HCF APPROVED HEALTH
MANAGEMENT PROGRAMS
Our approved health management programs offer
a benefit for a range of services to help prevent or
manage specific health and medical conditions.
The programs are available to members with extras
cover, excluding Healthmate Essentials, who have
served the 6 month waiting period.
Programs include:
• Weight management programs
• Exercise and gym membership for a specific
health problem (Doctor’s referral required)
• Childbirth education*
• Lactation consultation*
• Quit smoking
• Stress management
• Faecal occult blood test (FOBT).
More information can be found by visiting
the FAQ’s section of our website hcf.com.au.
Before you start any program, please contact
us on 13 13 34 to ensure your particular program
is eligible for a benefit (annual limits apply).
Category A
After 2 years of membership
Category B
After 1 year of membership
Wheelchair
Glucose monitor
CPAP machine (purchase)
TENS machine
Callipers
Blood pressure monitor
SIDS monitor (purchase)
Lymphoedema garments
Oxygen concentrator
Mammary prosthesis
Hearing Aids
Wig (for approved medical condition)
Nebuliser
Annual limits:
Healthcover Plus Extras
Annual limit
Single
$1,000 total ($250 sub-limit for category B items)
Couple/Family
$2,000 total ($500 sub-limit for category B items)
The maximum you can claim on aids and appliances is the annual limit on your chosen level of cover.
Individual benefit amounts apply to each item under both categories.
MORE FOR HEARING PROGRAM
This program provides free online tools to help you better understand your hearing ability.
Depending on your level of cover we’ll significantly reduce out-of-pocket costs for high-quality
hearing aids from Blamey Saunders Hears, our participating hearing aid provider.
More for information on the program visit hcf.com.au/more-for-hearing or call 13 13 34.
* These services are only available on Top Hospital with Healthcover Plus Extras or Healthmate Ultimate.
26
27
Your additional
member benefits
Healthcover Plus
Extras only
Top Hospital Only
Healthmate Essentials
Healthmate Advanced
Healthmate Ultimate
Added Member Benefits
Top Hospital with
Healthcover Plus Extras
Depending on your level of cover, you are eligible for a range of member benefits to care for your health.
The table below is a summary of benefits available.
Waiting
Periods
My Health Guardian
1 day
My Home Doctor*
1 day
My Global Specialist*
1 day
Health Dollars Loyalty Rewards
12 months
Involuntary Unemployment Benefit
2 months
Aids & appliances
1 to 2 years
*R
efer to sections overleaf.
WELL-BEING PLUS MOBILE APP
My Health Guardian is our unique online health
and wellbeing management program, that lets
you create an easy and effective wellbeing plan.
It’s like having your own health coach 24/7.
My Health Guardian can help you achieve your
health goals with a wide range of innovative
online planning and monitoring tools. There is
also a disease management program available to
eligible members with a chronic condition.
28
Additional
Member Benefits
To help keep you motivated and on target to
achieve your health goals, you can track your
health and wellbeing wherever you are with
the My Health Guardian mobile app,
‘Well-being Plus’.
We recommend you see how you or a family
member can benefit. To find out what My Health
Guardian can do for you, take the virtual tour
at hcf.com.au/mhg
It’s a fully covered service for members aged
18 years and over with hospital or extras cover.
29
If you or someone on your family membership
had a serious illness, wouldn’t it be reassuring
to know that you could access a world-leading
medical expert to review your case?
My Global Specialist is a specialist medical
information service. It is available to members
on our highest level of hospital cover, Top Plus
with nil excess, with either Multicover or Super
Multicover Extras.
You will have access to a global network of
50,000 medical experts to review your medical
records and provide you with a report on your
diagnosis and treatment plan.
We have engaged Best Doctors, the world’s
leading resource for specialist medical advice
founded by doctors from the Harvard Medical
School in 1989, to provide this innovative new
service. Please visit hcf.com.au/mgs or contact
us for more information.
30
You’ll also receive ongoing nursing care with a
registered nurse if you need it. This paid service is
managed by Manchester Unity, a HCF subsidiary
with 65 years of experience providing high quality
aged care services for Australians.
To find out more visit moreathome.com.au
or call 1300 550 124.
HEALTH DOLLARS
LOYALTY REWARDS
One of the unique benefits of the HCF Corporate
range is our Health Dollars Loyalty Rewards.
This loyalty rewards program allows you to
reduce your excess if you are going to hospital
or reduce your personal expense when you make
a claim for extras services such as dental and
optical. You choose how and when your Health
Dollars are best used, suiting your individual
health care needs.
The amount of Health Dollars you receive each
year depends on your time with us; the longer
you are a member, the more Health Dollars
you receive. Each year your Health Dollars are
renewed on your renewal date, which put simply,
is the anniversary of the date you joined our
health fund on an eligible level of cover.
Healthmate Essentials
To see if your area is covered, contact us or visit
hcf.com.au/mhd
More at Home gives you access to a
compassionate professional who will assist you
with domestic and/or personal care. They’ll help
with housework, shopping and meal preparation
or even just getting ready in the morning and
providing transport if needed.
Healthmate Advanced
Coverage spans most of Sydney, Melbourne,
Geelong, Adelaide and South East Queensland,
and is constantly expanding.
More at Home is a community care service
available in Northern and Western Sydney,
providing home support to those who need
a helping hand on either a regular basis or
once off.
Healthmate Ultimate
My Home Doctor is a convenient, after hours
home doctor service for eligible members in
selected areas. The service is provided at no cost
to you if you have hospital cover. Think of the
peace of mind having access to such a service.
Whether it’s having your distressed young child
seen by a doctor in the middle of the night, or
simply helping you get treatment sooner when
you feel sick.
The following table shows the Health Dollars that apply to each level of cover per year for Single or
Family membership.
Top Hospital with
Healthcover Plus Extras
OUR NEW SERVICE
N/A
N/A
N/A
N/A
– Single Membership
$100
$75
$50
N/A
– Couple/Family Membership
$200
$150
$100
N/A
– Single Membership
$150
$100
$100
N/A
– Couple/Family Membership
$300
$200
$200
N/A
– Single Membership
$200
$150
$125
N/A
– Couple/Family Membership
$400
$300
$250
N/A
Loyalty Rewards Years of Membership
First year of cover
Waiting
Periods
As at 1st anniversary of cover or 2nd year
As at 2nd anniversary of cover or 3rd year
12 months
Following 3rd anniversary of cover and ongoing
To claim your Health Dollars simply fill out the
Health Dollars section of an HCF claim form.
Please note that when you make an extras claim,
you will be required to pay the first $50 each year
in order to claim Health Dollars.
No payment amount is required for hospital
excess claims. Rewards not used within the year
do not get accrued into the next year.
Health Dollars can only be claimed on services
covered under your HCF policy or product.
INVOLUNTARY
UNEMPLOYMENT
While we hope you will never need to take
advantage of these initiatives, we’re sure they
will add to your overall peace of mind.
Conditions apply:
• A no claim period of 29 days applies to
each claim and claims must be made
within three months
• There is a waiting period of 2 months
for new or upgrading members
• Terminations due to unsuitability to work,
unsatisfactory work performance, misconduct
or voluntary redundancy are not eligible.
If you have been in permanent full time
employment for the last six months, and you are
retrenched through no fault of your own, we will
take care of your HCF health fund contributions
for up to 12 months, or until you find another job.
31
Other products
and offers for members
At HCF, we have a range of other products on
offer to give you the total peace of mind you need
10% DISCOUNT
ON PET INSURANCE
HCF PET INSURANCE
If your dog or cat is suddenly or unexpectedly
injured or becomes ill, pet insurance can help
pay for veterinary expenses.
• Choice of two comprehensive covers
• Up to 80% of covered veterinary expenses
(less an annual excess that you choose).
Visit hcf.com.au/petinsurance for
more information.
HCF Pet Insurance is issued by
The Hollard Insurance Company Pty Ltd
ABN 78 090 584 473, AFSL 241 436.
We recommend that you consider the
Product Disclosure Statement and
Financial Services Guide, which is available
by calling 1800 630 681 or by visiting
hcf.com.au/petinsurance before deciding
to buy or continue to hold this product.
32
Other
Products and Offers
10% DISCOUNT
ON TRAVEL INSURANCE
WHEN YOU TRAVEL OVERSEAS,
AUSTRALIAN HEALTH COVER
DOESN’T PROTECT YOU.
As our member, you get 10% off our international
travel insurance. It provides:
• Worldwide emergency assistance
• A range of benefits for overseas medical
and hospital expenses
• Legal assistance
• Compensation for journey delays or lost
luggage
• Plus more.
Visit hcf.com.au/travel for more information.
We recommend that you read the Travel
Insurance Product Disclosure Statement and
Financial Services Guide which is available by
calling 13 13 34 or visiting hcf.com.au/travel
before deciding to buy or continue to hold
this product.
The HCF Travel Insurance Policy is issued
by QBE Insurance (Australia) Limited
ABN 78 003 191 035, AFSL 239 545.
33
Manage your
health cover
online
We encourage all of our members
to visit our website hcf.com.au
Here you will find a range of member services to
help you manage your health cover needs quickly
and easily, including an email service if you need
an answer for something that we haven’t covered
in this brochure.
We are always looking at new ways to provide
you with better products and services.
This is made easier if you let us know your
email address, by registering online.
Registering is easy - simply go to
hcf.com.au/members and click on the
‘First time users’ link.
We’d love to be able to communicate with
all our members online – it’s easier for you
and better for the environment. So we are
continually updating and improving our
website. Keep coming back to check out
the changes we are making.
We provide a variety of online services to help
you get the most from your membership:
• Online claims for extras services
• Make a payment securely online
• View and change your membership and
cover details
• View your extras claims history
• Sign up to receive your HCF ATO statement
policy summary and rate notifications
electronically
• Sign up for other member notifications
including reminder and arrears notices and
reminders via SMS
• Prostheses items list including price, benefits
and gap information.
34
35
Cash Assist Covers
Financial cover for accidents and illnesses
NOW THAT YOU’VE SELECTED THE RIGHT HOSPITAL AND EXTRAS
OPTIONS, YOU SHOULD THINK ABOUT TOPPING UP YOUR COVER
WITH ONE OR MORE OF THESE CASH ASSIST COVERS.
Kids’ Accident
Up to $100,000 cover
Only 90 cents per week per child
Affordable cover which pays up to
$100,000 if your child (under 17) is
accidently injured.
• Specified sum paid for injuries
• Cover against accidents
• Cover 24 hours a day anywhere in
Australia
• Paid regardless of any other benefits
$
Cash Back Cover
$2,500 Benefit
$1 per week for singles
$2 per week for families
Pays $2,500 if you suffer an accident
requiring surgery within 6 months or suffer
a listed serious medical condition.
• Cover for illnesses such as heart attack,
cancer and stroke
• Single and family cover options
• Make multiple claims up to a total of
$10,000 for singles and $20,000
for families
• Cover against accidents and illness
36
Permanent Disability
Benefit Plus
Up to $100,000 cover
$1 per week for singles
$2 per week for families
Low cost cover which provides up to
$100,000 protection in the event you are
permanently disabled due to an accident.
• Single and family cover options
• Up to $10,000 is paid for each of your children
• Pays your HCF Health Insurance premium
if on claim (up to $1000 for singles,
$2000 for families)
• Cover against accidents
• Specified sum paid for injuries
Smart Term Insurance
Up to $300,000 cover
From $3.45 per week
Pays the sum insured in the event of
death or terminal illness.
• Five benefit levels to choose from, ranging
from $100,000 to $300,000
• Lump sum cash benefit
• Benefit doubled if death is caused by
an accident
• Easy to apply- no blood tests or medicals
COMBINED PRODUCT DISCLOSURE STATEMENT AND
FINANCIAL SERVICES GUIDE
These products are issued by HCF Life Insurance Company Pty Ltd ABN 37 001 831 250, AFSL 236 806. Please
read the Product Disclosure Statement before you apply and consider whether this cover is appropriate for your
objectives, financial situation or needs, as the information we have provided does not take these into account.
The Product Disclosure Statement and Financial Services Guide for Cash Back Cover, Kids Accident Cover and
Permanent Disability Benefit Plus, is available on pages 38-42. For more information on Smart Term Insurance,
Income Assist Insurance, Medical Trauma and Personal Accident Insurance please visit hcf.com.au, call 13 13 34,
or visit your local branch.
COOLING OFF PERIOD
When you receive your policy document from us, you have 30 days to check whether the policy meets your
needs. Within this time, you may cancel your policy in writing and receieve a full refund of any money paid
provided you have not made a claim.
Personal Accident
Insurance
Income Assist Insurance
Up to $6,000 per month
From $1.65 per week
Pays 75% of your monthly income (up to
a max $6,000) for 12 months if you are
unable to work for more than 30 days.
• Cover against accident and illness
• Additional benefits paid for child care
expenses and bed confinement
• Premiums may be tax deductible
• Protection for your biggest asset your income
Up to $50,000 cover
From $3.15 per week
Designed for those aged 55 and over this
cover pays a specific cash benefit if you
suffer one of the listed injuries such as
burns, fractures and dislocations.
•
•
•
•
Choice of $25,000 or $50,000 cover
Lump sum cash benefit
No Pre-Existing conditions exclusions
Pays a benefit in the event of
accidental death
Medical Trauma
Up to $50,000 cover
From $2.50 per week
Pays a specified sum if you suffer one of
over 40 listed serious medical conditions.
• Choice of $25,000 or $50,000 cover
• Lump sum cash benefit
• Cover for serious illnesses such as heart
attack, cancer and stroke
• Single and family cover options
• 90 day waiting period applies for heart
attack, cancer and stroke
For more information on
Cash Assist Covers visit
hcf.com.au/cashassist
37
Cash Assist
KIDS’ ACCIDENT COVER BENEFITS
Combined Product Disclosure Statement
and Financial Services Guide
Impairments
Benefits
$100,000
Maximum
Permanent disabilities
Total and permanent paralysis of all limbs
$100,000
Total and permanent paralysis of both legs and
the lower part of the body
$50,000
Permanent loss of all sight in both eyes
$50,000
Permanent loss of all sight in one eye
Now that you’ve selected the right hospital and
extras options, you should think about topping up
your cover with one or more of these Cash Assist
covers. They offer you cash assistance to help
you and your family recover from accidents and
illnesses. You can choose an option that protects
your kids, too.
Product Disclosure
Statement
KIDS’ ACCIDENT COVER BENEFITS
Impairments
Broken or fractured bones
Skull
– compound or depressed fracture
– hairline fracture
Spine
– fractured vertebrae
– chipped vertebrae
Benefits
$100,000
Maximum
$2,000
$1,000
$2,000
$400
Neck
$2,000
Hip, pelvis or jaw
$1,500
Leg, ankle or knee
– compound (open)
– simple (closed)
$1,000
$500
KIDS’ ACCIDENT COVER (KAC)
Ribs
$500
Nose or collarbone
$400
Foot other than toe
$200
Hand (other than finger
or thumb)
$200
Kids’ Accident Cover pays up to $100,000 if your
child (under 17) is accidentally injured, 24 hours a
day, anywhere in Australia provided the accident
results in impairment immediately or permanent
disability within six months. The sum is paid
regardless of any liability or damages claim and
covers impairments detailed in the table
opposite and on page 39.
38
Shoulder or cheekbone
$600
Arm, elbow or wrist
– compound (open)
– simple (closed)
$500
$250
Burns
– second degree
– third degree
Wounds requiring more
than three stitches
– per stitch
Internal injuries
Rupture of internal chest
or abdominal organ
Permanent and total loss of use of both hands
or both feet
Permanent and total loss of use of one hand
or one foot
Permanent loss of all hearing in both ears
Permanent loss of all hearing in one ear
The low cost financial benefits offered in this
Product Disclosure Statement are available to
permanent Australian residents aged 16-60,
with the exception of Kids’ Accident Cover which
is available for children under the age of 17.
These products are sold by HCF and issued by
HCF Life Insurance Company Pty Limited.
Only $3.90 per child per month.
$3,000
$400
$650
$10
$500
$30,000
$3,000
$50,000
$3,000
Permanent and total loss of use of one thumb
of either hand
$500
CASH BACK COVER (CBC)
Only $4.30 for singles OR $8.65 for
families per month.
Cash Back Cover pays you a cash
benefit of $2,500 if you or any person
covered by your membership suffers
an accident that requires surgery in an
operating theatre within six months
of the date of the accident. You also
receive $2,500 for malignant cancer,
chronic kidney failure, heart disease
requiring bypass surgery, heart attack,
stroke, or any disease requiring a major
organ transplant.
A maximum of $10,000 is payable for
single cover and $20,000 for family
cover if you have a number of accidents
or illnesses during the life of the policy.
PERMANENT DISABILITY BENEFIT
PLUS BENEFITS
Benefit
PERMANENT DISABILITY
BENEFIT PLUS (PDBP)
Contributor
or spouse
Other
Persons
Only $4.30 for singles OR $8.65 for
families per month.
Total and permanent paralysis
of all limbs
$100,000
$10,000
Total and permanent paralysis
of both legs and the lower part
of the body
$100,000
$10,000
Permanent loss of all sight of
both eyes
$100,000
$10,000
Permanent loss of all sight of
one eye
$50,000
$5,000
Permanent and total loss of use
of both hands or both feet
$100,000
$10,000
Permanent and total loss of use
of one hand or one foot
$50,000
$5,000
Permanent loss of all hearing in
both ears
$100,000
$10,000
Permanent loss of all hearing
in one ear
$50,000
$5,000
Permanent and total loss of use
of one thumb of either hand
$40,000
$4,000
Disablement
Permanent Disability Benefit Plus pays
you a cash benefit up to $100,000
for you and your spouse, and up to
$10,000 for each of your children, in
the event you or any person covered
by your membership has an accident
which results in one of the disablements
listed in the table below. A maximum
of $100,000 for singles and $200,000
for families is payable during the life
of the policy. The disablement must
occur within six months of the date of
the accident, and this product provides
valuable benefits when covers such as
motor vehicle or workers compensation
don’t apply. Plus your HCF contributions
will be paid up to $1,000 for singles and
$2,000 for families if you are unable
to work due to accident, sickness or
involuntary unemployment.
39
WHAT YOU NEED TO KNOW
ABOUT CASH ASSIST
Exclusions and waiting periods
Benefits are not paid for claim events
(e.g. accidents, disablements, impairments) as
described in the table below. Where the table is
marked ‘ ’, this means that a claim would not be
paid in this event.
The benefit for payment of your HCF contributions
insurance (contributions component of Permanent
Disability Benefit Plus) will not be paid for:
• the first 30 days you are not working
• pregnancy, childbirth, infertility, contraceptive
procedures and related conditions
• AIDS
• events resulting from intentional self injury,
illegal acts and drugs or alcohol
• events that occur outside Australia or within the
first two months of cover
• pre-existing conditions in the first 12 months
of cover
• unemployment in the first 12 months with
your employer.
When cover ceases
Additional information
Protecting your rights
Select any of these options on the application form
and you will promptly receive a policy document
with full details on your benefits.
If you have a complaint about your policy, please
contact our Policy Service Team on 13 13 34 and
we will attempt to resolve it promptly. If you are
dissatisfied with our response, you can contact
the Financial Ombudsman Service. This is an
independent body that is available to you free
of charge.
These policies expire when the total benefit
amount has been paid or when your premiums
fall two months in arrears or on your death.
With the exception of Kids’ Accident Cover
where benefits expire at age 17, policies provide
cover up to age 65.
A copy is also available upon request. Your cover
is automatic once we receive your application and
payment instructions. You have 30 days to review
your policy. Should it not meet your needs, simply
advise us in writing to cancel the policy and you
will receive a full refund, provided you have not
made a claim.
Premiums
Taxation
Premiums may only increase if this applies to all
policyholders for the product and we will provide
one month’s notice to you. Your premium will also
include any stamp duty charged by your state
government as well as any taxes that may be
levied by state and federal governments.
Usually, premiums are not tax deductible and
benefits are paid free of personal tax. This is a
general statement based on present laws and their
interpretation. Individual circumstances may vary
and you should consult a professional tax adviser
in relation to your individual circumstances.
The Service’s address is:
The Financial Ombudsman Service,
GPO Box 3, Melbourne VIC 3001.
The phone number is 1300 780 808.
HCF Life Insurance
Company Pty Limited.
ABN 37 001 831 250. AFSL 236 806.
403 George Street, Sydney NSW 2000
Telephone: 13 13 34
Dated: 1 July 2014
EXCLUSIONS
Reason for claim
KAC
CBC
PDBP
Conditions covered by workers compensation or third
party insurance or social security benefits
Surgery for diagnostic purposes or not in an
operating theatre
Event resulting from drugs or alcohol
AIDS
War, hostility, civil commotion, terrorism or insurrection
Pre-existing conditions
Intentional self injury
Conditions within first 2 months of cover
Event resulting from illegal act
Intentional Act by adult person living with child
Death within 7 days of the event, or within 7 days
of removal of life support
Professional sport, military service, racing
or private aviation
Event on or before the first day of cover
Events that occur outside Australia
40
41
Financial Services
Guide
This Financial Services Guide (FSG) relates
to the services provided by HCF in relation
to the Cash Assist products issued by HCF
Life Insurance Company Pty Limited
(HCF Life).
It is designed to assist you in deciding
whether to use any of the services offered
by HCF in this FSG. It contains information
about remuneration paid to HCF and its staff
for the services offered and how complaints
against HCF in relation to these services are
dealt with.
If HCF offers or arranges to issue you any
of these products we will provide you with
a Product Disclosure Statement relating
to that product where required. This sets
out the significant features of the product
and will assist you to compare and make
informed decisions about the product.
HCF provides general advice about the suitability
of these products for the needs of members.
This means we do not take account of individual
objectives, financial situation or needs.
You should, before acting on that advice, consider
the appropriateness of the advice, having regard
to your objectives, financial situation or needs.
Please read the Product Disclosure Statement
before deciding to purchase any of these
products.
HCF is licensed to provide general advice
about, and arrange the issue of, life and general
insurance products. HCF Life is a wholly owned
subsidiary of HCF. When HCF issues you with a
policy, we do so under a binder that authorises us
to enter into that contract of insurance on behalf
of HCF Life.
42
HCF Life receives the premiums paid for these
products. HCF receives commission monthly
from HCF Life of 40% of the first year’s premium
plus an additional commission of 80% of
HCF Life’s underwriting profit each financial
year calculated as premiums less claims and
expenses.
HCF’s staff receive an incentive depending on
the number of products they sell. This will not
exceed 20% of the first year’s premium. HCF is a
not-for-profit organisation and all of the income it
receives is applied for the benefit of its members.
HCF and HCF Life are each responsible for
the entire contents of this Combined Financial
Services Guide and Product Disclosure Statement.
HCF holds professional indemnity insurance that
complies with the compensation requirements
of Section 912B of the Corporations Act.
This includes cover for claims in relation to the
conduct of representatives and employees who
no longer work for HCF but who did at the time of
the relevant conduct.
Should you have a complaint about any of the
services HCF offer in this FSG please contact us
on 13 13 34 and we will endeavour to resolve it as
quickly as possible. If we have not resolved your
complaint within 45 days or you are not satisfied
with our response, you can contact The Financial
Ombudsman Service on 1300 780 808 or by
post at GPO Box 3, Melbourne VIC 3001.
This is an independent body available to you free
of charge. HCF’s contact details are shown on the
back cover of this brochure.
The Hospitals Contribution Fund
of Australia Limited
ABN 68 000 026 746.
AFSL No. 241 414.
403 George Street Sydney.
Telephone 13 13 34
Dated: 26 March 2012
43
42
Important
Information
43
Things you
need to know
While it may not be the most exciting part of the
brochure, it is the most important. So please take
time to read through it. If you have any questions,
you can call us on 13 13 34 or email
[email protected] and we will be happy
to assist you.
WAITING PERIODS
Waiting periods must be served before benefits
are paid. They apply to:
• New members
• Existing HCF members who upgrade to a higher
level of cover or reduce their excess payable.
In this case, you need to serve the necessary
waiting period for the higher benefit entitlement
• Members who switch from another fund who
have not already completed the required
waiting period for equivalent benefits
• Hearing aid benefits for members switching
from another fund, irrespective of the
previous cover held
• New dependents, unless they switch from
another fund where they have completed the
required waiting period for equivalent benefits
• Treatment of a pre–existing ailment.
PRE–EXISTING AILMENTS
OR CONDITIONS
A pre–existing ailment or condition is an ailment
or illness or a condition where the signs or
symptoms existed any time during the six months
before a member joined or upgraded to a higher
level of cover, even though a diagnosis may not
have been made.
Waiting periods vary according to the type of
treatment or service and are as follows:
Hospital waiting periods
2 months
sychiatric, rehabilitation and
P
palliative care.
All other treatments except where
there’s a longer waiting period.
12 months
reatments for pre–existing ailments
T
excluding psychiatric, rehabilitation
and palliative care (see below).
Pregnancy and birth–related
services.
Extras waiting periods
2 months
All services except those below.
6 months
Health management programs.
12 months
rowns, bridges, dentures,
C
endodontics, occlusal therapy*,
oral surgery, periodontal,
prosthodontics, dental
bleaching, veneers, indirect
restorations and orthodontics.
Foot orthotics and orthopaedic
shoes. Some artificial appliances
and pre–existing ailments.
2 years
ome artificial appliances, including
S
hearing aids and repairs.
Ambulance waiting periods
1 day
2 months
mergency ambulance, except
E
where related to a pre-existing
ailment or condition as a 12 month
waiting period applies.
Medically necessary non-emergency
ambulance (where not for pre-existing
ailments).
If there is any doubt as to whether an ailment or
condition is pre–existing, a medical practitioner
appointed by HCF will examine information
provided by your doctor, together with other
relevant claim details.
WHO CAN BE COVERED?
Prior to taking out health insurance, please
make sure you understand who can be covered
under your policy.
Detailed information of who can be covered
under your policy can be found in the HCF
Member Guide or at hcf.com.au. Follow the link to
the FAQ’s section and look under ‘who does my
membership cover’.
Cover for your dependents
Your children can be covered for a small
additional fee under your family cover until the
day before they turn 22.
If your children are between the ages of 22 and
24 and are full-time students, un-married and not
in a de facto relationship and are primarily reliant
on you for maintenance and support, they can
also be covered until the day before they turn 25.
HOSPITAL COVER
In–hospital services
Hospital benefits are payable when you’re
admitted to hospital for treatment. These are
called ‘in–patient’ services, and only in-patient
services are covered by your hospital cover.
Minimal Benefits
If you choose a product which has Minimal
Benefits for some procedures (such as pregnancy
and birth-related services), then you’ll be covered
in a public hospital shared room, but your private
hospital costs won’t be fully covered.
This means you may face significant personal
expenses if you have any of these procedures
in a private hospital.
For procedures attracting Minimal Benefits
in a private hospital, HCF would:
• Pay a small amount towards your
accommodation
• Pay for prostheses, if required (cover for
government approved prostheses list items)
• Not pay operating theatre expenses, or labour
ward charges.
In addition, there are some services where
doctor’s charges are not payable (for example,
elective cosmetic surgery and surgery by an
accredited podiatric surgeon). For these, HCF will
only pay a very small amount towards the total
cost of the procedure (and no doctor’s charges).
This applies to services which do not attract a
benefit from Medicare.
Exclusions
If you need treatment for any procedures listed
as an Exclusion in your hospital cover, you won’t
receive any benefits from us and you may have
significant out-of-pocket expenses. Make sure
you have reviewed the excluded services on
your selected hospital cover on pages 14-15, and
general Exclusions on the following page before
purchasing your cover.
Insulin Pumps
For information about insulin pump initialisation,
replacement pumps and your benefit entitlement
please refer to the Member Guide or
hcf.com.au/insulinpumps
*Correcting grinding or biting on surface of teeth.
44
45
EXTRAS COVER
Conditions applying to extras cover
• HCF does not pay a benefit greater than the
charge levied to the claimant
• Artificial Aids and Hearing Aid:
Depending on the aid or appliance you require,
benefits do not necessarily renew every year.
Please check with us before you incur any costs.
HCF health insurance
does not cover:
• Claims made two years or more after
date of service
• When you or your dependents have the right
to recover the costs from a third party other
than us, including an authority, another insurer
(eg. motor vehicle or workers compensation),
or under an employee benefit scheme
• Treatment for pre–existing ailments
or conditions
• Goods and services received during any
period where your payment is in arrears, your
membership is suspended or you are within
waiting periods
• Treatment that we deem inappropriate or
not reasonable after receiving independent
medical or clinical advice
• Any service where the treatment does not
meet the standards in the Private Health
Insurance Accreditation Rules 2011 or
as amended
• Services that are not delivered face to
face, such as online or telephone
consultations, unless you are participating
in one of our chronic disease management
or health improvement programs such as
My Health Guardian
46
• Goods and services supplied by a provider
not recognised by us
• Goods or services provided outside Australia
which don’t meet the requirements under the
Private Health Insurance Act 2007
• Claims that don’t meet our criteria.
In addition, HCF hospital cover
does not include:
• Medical and associated hospital benefits for
procedures where there is no Commonwealth
Benefits Schedule item number or where the
medical service is not approved for payment
by Medicare
• Private room accommodation for
same–day procedures
• Experimental treatments
• Experimental and high cost non–PBS drugs
• Procedures normally performed in the doctor’s
surgery or as an outpatient
• Private hospital emergency room fees
• Respite care
• Nursing home–type patients are limited
to benefits set by the Commonwealth
Department of Health
• Special nursing i.e. your own private nurse
• Luxury room surcharge
• Claims that do not meet our criteria
• Donated blood and blood products and
donated blood collection and storage.
In addition, HCF hospital cover
does not include:
• PBS pharmaceutical benefits in
non–participating private hospitals
• Pharmaceuticals (including PBS
pharmaceuticals benefits) and other sundry
supplies not directly associated with the
reason for admission
• Take home items e.g. crutches, toothbrushes
and drugs
• Personal convenience items e.g. phone calls,
newspapers, magazines and beauty salon
services
• Massage and aromatherapy services
• Some services provided while in hospital
by non–hospital providers
• Where a service is excluded from the payment
of benefits in a hospital, any associated items
(e.g. medical gap, prosthesis, pharmacy) are
also excluded
• The gap on government approved prostheses
in non-participating private hospitals
• The gap on government approved
gap–permitted prostheses items.
•
In addition, HCF extras cover
does not include:
•
• Psychological and developmental
assessments. Where psychology is included
in your cover, psychology treatment is only
payable when your GP has prescribed a
Mental Health Plan and your Medicare
entitlements are exhausted for that
calendar year
• Goods and services while a hospital patient
except for eligible oral surgery
• Pharmacy items that are not on our Approved
Pharmacy list eg. items listed on the PBS,
•
•
•
•
•
•
•
items prescribed without an illness, items that
are available without a prescription, or items
that are not TGA approved
Goods or services that had not been provided
at time of claim eg. pre–payment
Fees for completing claim forms and/
or reports
Goods and/or services received overseas or
purchased from overseas including items
sourced over the internet
Where no specific health condition is being
treated or in the absence of symptoms,
illness or injury
Routine health checks, screening and
mass immunisations
More than one therapy service performed
by the same provider in any one day
Co–payments and gaps for government
funded health services e.g. the co–payment
for PBS items, or services where you receive
a rebate from Medicare such as the Child
Dental Benefit Schedule, or Chronic Disease
Management - Individual Allied Health
Services
Where a provider is not in an independent
private practice
More than one of the following therapies
received on the same day (physiotherapy,
chiropractic and osteopathy).
This is not a comprehensive
list of hospital or extras cover
exclusions. Please call 13 13 34
to check what you are covered
for prior to going to hospital or
for treatment.
47
PRIVATE HEALTH INSURANCE
CODE OF CONDUCT
HCF supports the Private
Health Insurance Code of
Conduct by ensuring:
• You receive correct information on private
health insurance
• You are aware of the internal and
external dispute resolution procedures
• You can make an informed decision
about your purchase through informative
policy documentation
• You are protected in accordance with the
privacy principles.
A full copy of the code is available at
privatehealth.com.au/codeofconduct.php
Private Patients Hospital Charter
HCF also supports the Private Patients Hospital
Charter, which outlines what members can
expect from doctors, hospitals and their health
fund. Copies of the Charter are available by
phoning 13 13 34 or visiting the Private Health
Insurance section for consumers at health.gov.au
In case of a complaint
Should any problem arise concerning your
HCF membership, contact us directly so that
it can be resolved as quickly as possible.
An Internal Dispute Resolution officer has been
appointed to independently review complaints.
If your complaint is not dealt with satisfactorily,
members can also contact the Private Health
Insurance Ombudsman, an independent body
formed to help resolve complaints and provide
advice and information.
The Ombudsman can be reached by calling
1800 640 695, by going to their website
phio.org.au or by writing to the
Private Health Insurance Ombudsman,
Suite 2, Level 22, 580 George St, Sydney
NSW 2000.
Rebates, surcharges
and incentives
AUSTRALIAN GOVERNMENT
REBATE ON PRIVATE HEALTH
INSURANCE
You can use the table below as a guide to
nominating your rebate tier. When calculating your
income you need to include taxable income, fringe
benefits, reportable superannuation contributions,
net financial investment losses and more.
To help make private health cover more
affordable, the Australian Government provides
a rebate on your health insurance premium.
The rebate is available to people with hospital,
extras or ambulance cover, and who are
registered with Medicare. The rebate is income
tested, so your entitlement may change
depending on your income and also your age.
We can provide you with general information
about these thresholds and the rebate tiers.
However for personal advice specific to your
circumstances, please consult your accountant,
financial advisor or the ATO at ato.gov.au or
13 28 65.
You can elect to take the rebate either as:
• A reduced premium
OR
• A tax offset credit in your annual tax return.
Income thresholds for the 2014/15 income tax year
Income
No tier
Tier 1
Tier 2
Tier 3
Singles
$90,000
or less
$90,001 –
$105,000
$105,001 –
$140,000
$140,001
or more
Families*
$180,000
or less
$180,001 –
$210,000
$210,001 –
$280,000
$280,001
or more
Under 65
29.040%
19.360%
9.680%
0%
Age^
Rebate
65 – 69
33.880%
24.200%
14.520%
0%
Over 70
38.720%
29.040%
19.360%
0%
All ages
0.0%
1.0%
Medicare levy surcharge
1.25%
1.5%
Thresholds effective from 1 July 2014. Rebate amounts listed are effective from 1 April 2014 to 31 March 2015.
*Note: Single parents and couples (including de facto couples) are subject to the family tiers. For families with
children, the thresholds are increased by $1,500 for each child after the first.
48
49
2014 GOVERNMENT
REBATE CHANGE
In April this year, the Australian Government
changed how your rebate is calculated.
The private health insurance rebate will be
adjusted on 1 April each year. This change will
apply to all Australian private health funds.
See table on previous page for the list of
rebate percentages.
MEDICARE SURCHARGE
The Medicare Levy Surcharge is an
Australian Government initiative designed
to encourage high-income earners to take
responsibility for their health care. It applies to
people earning a taxable income of $90,001 or
more per year for singles and $180,001 and over
for couples and families where they don’t have
eligible private hospital cover.
You can avoid having to pay this simply by having
eligible HCF hospital cover. If you don’t have
eligible private hospital cover and you fall into
these income thresholds then you will be charged
up to an additional 1.5% surcharge on your
Medicare levy when your tax return is assessed.
Please refer to the ‘Medicare Levy Surcharge’
section of the table opposite to see what your
surcharge may be.
LIFETIME HEALTH COVER
Lifetime Health Cover (LHC) is a Government
initiative designed to encourage people to
take out hospital insurance earlier in life and
maintain their cover.
In some cases you may be exempt or fit into
a special circumstances category.
If you do not have a product that includes hospital
cover with an Australian registered health fund
on 1 July following your 31st birthday and then
decide to take out hospital cover later in life, you
will pay a 2% loading on top of your premium for
every year you are aged over 30.
For example, if you take out hospital cover at age
40 you will pay 20% more than someone who
first took out hospital cover at age 30.
The maximum loading is 70%. Once you have
paid a LHC loading for 10 continuous years, the
loading is removed as long as you retain your
hospital cover.
The Australian Government Rebate no longer
applies to the LHC component of private
health insurance.
This means if you are eligible to receive the rebate
and also have a LHC loading, the rebate will not
apply to the LHC portion of your health insurance.
You can use the Lifetime Health Cover
calculators to find out if you need to pay
the LHC loading by visiting
privatehealth.gov.au and looking for
Lifetime Health Cover.
For more information visit hcf.com.au or
call us on 13 13 34.
Our privacy statement
We collect your personal information including
sensitive information such as health information
from you and/or the policyholder who is
responsible for your policy and/or from other third
parties detailed in our Privacy Policy, so we can:
• Comply with applicable laws
• Manage our relationship with you
• Record your treatment
• Provide health or other insurance, related
products and services to you (including through
third parties)
• Manage and pay claims and benefits
• Assess your insurance, health and related
lifestyle needs
• Investigate fraudulent or improper claims and
assess risks
• Research and develop products, services and
benefits that may better serve your needs
• Assess your possible interest in and tell you
about such products and services
• Administer our business and deal with
complaints.
The types of organisations and individuals we
disclose personal information to include:
• Third party organisations who deliver services
on our behalf or to us, some of whom may be
located overseas
• Health service providers to improve their ability
to provide you with health services
• Research companies contracted to us to ask
your opinion on improving our service, benefits
or product offerings
• Other insurers or reinsurers including other
health insurers if you have moved your insurance
to or from HCF
• Government including law enforcement agencies
• Related HCF companies
• The named policy holder who has your authority
• Any other authorised individual.
If you do not provide the personal information
we request, we may not be able to provide you
with our products or services, including health
insurance.
You can ask us at any time to stop direct
marketing to you by emailing [email protected]
or calling 13 13 34.
For more information about the personal
information we collect and how we handle it,
how to access and correct your information or
to make a complaint and how we will respond
to complaints, please read our Privacy Policy.
To view the HCF Privacy Policy:
• Visit hcf.com.au/privacy
• Visit your local branch.
All new policyholders should ensure that all
members on the policy are made aware of the
HCF Privacy Policy.
CHANGES TO PRODUCTS AND PRICING
Please read and retain this brochure for future reference. We however, reserve the right to make
changes to prices, product specifications and other conditions relating to the products contained
in this brochure. Please contact us prior to purchasing any products to make sure that you have the
latest information available.
50
51
How to join
Call 13 13 34
8am to 8pm Monday to Friday
9am to 5pm on weekends (AEST)
Email [email protected]
Ask one of our sales representatives to come to your workplace
Visit hcf.com.au/corporate-plans
Want more from your current fund?
Then switch to HCF. Making the move couldn’t be simpler.
We’ll contact your former health fund for you so you can start enjoying the benefits of
HCF cover with no additional waiting periods for equivalent levels of cover (excludes hearing aids).
Just call 13 13 34 to find out how.
ntil 2014 15
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Va
Re
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The Hospitals Contribution
Fund of Australia Limited.
ABN 68 000 026 746
Head Office: 403 George Street,
Sydney NSW 2000
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