HEALTH COVER THAT S NOT FOR PROFIT JUNE 2018

Transcription

1 HEALTH COVER THAT S NOT FOR PROFIT JUNE 2018

2 2 WHY PRIVATE HEALTH INSURANCE IS RIGHT FOR YOU Everyone has their own personal reasons for choosing private health insurance. It could be for the peace of mind of knowing that you re covered, or it might make sense financially. Here s some of the great benefits of private health insurance. CHOOSE YOUR HOSPITAL AND YOUR SPECIALIST Private health insurance gives you choices you can decide who treats you and where you re treated. REDUCE WAITING TIMES Cut down on the time you need to wait for surgery. PRIVATE HOSPITAL ROOM Better access to a private room so you can recover in peace. CLAIM ON EXTRAS LIKE DENTAL AND OPTICAL Depending on your cover, you can claim on extras such as dental, optical, physio, chiro, and more that are important to your health and wellbeing. SAVE MONEY BY MAKING THE MOST OF AUSTRALIAN GOVERNMENT INCENTIVES By taking out private health insurance, you may be able to save money by: reducing the cost of your cover due to the Australian Government Rebate avoiding the Medicare levy surcharge at tax time avoiding the Lifetime Health Cover loading if you take out hospital cover before your 31st birthday, and maintain it. GET GREAT VALUE WITH AUSTRALIA S LARGEST NOT FOR PROFIT HEALTH FUND We believe that your health is not-for-profit. With more than 1.5 million lives covered, you can feel confident in choosing us as your health partner. No wonder more people are joining not-for-profit health funds. HERE ARE JUST SOME OF THINGS WE DO AT HCF TO GIVE BETTER VALUE WE GIVE YOU MORE BACK For every dollar our members pay in premiums, we ve paid out more benefits than the industry average over the past 5 years. FIND A PARTICIPATING NO-GAP DOCTOR Search for a no-gap or reduced gap specialist through our partnership with Healthshare, saving you out-of-pocket costs. WE RE HERE FOR YOU Speak to our Australian call centre, come and chat to us at one of our many branches around Australia, or visit a dentist at one of our dental centres. You can also get a free heart health check at select locations. See page 17 for more information. PEACE OF MIND IN AN ACCIDENT If you re injured in an accident and attend a hospital emergency department within 24 hours, you can get the benefits of our top level hospital cover for up to 90 days. Conditions apply. See hcf.com.au/ accident-safeguard GREAT MEDICAL GAP COVERAGE We ve got one of the best arrangements in the country for hospital medical treatment to help reduce your out-of-pocket expenses. HCF THANK YOU As an HCF member, you ll get access to a great range of exclusive offers and rewards. And the longer you stay with us the more ways we say thank you. Excludes Ambulance Only members, see hcf.com.au/thankyou for more. GREAT VALUE FOR FAMILIES You won t pay an excess for kids no matter how many times they go to hospital. And whether you have one or more children, the cost of your family cover remains the same. Excludes Accident Only cover. 100% BACK Receive 1 or 2 no-gap dental check-ups and claim 100% back on an initial consult with a physio, chiro or osteo when you use our network of more than 10,000 participating extras providers. Subject to your cover and annual limits, see pages 14 and 15 for more information. 3

3 LET US HELP YOU CHOOSE THE COVER THAT S RIGHT FOR YOU NEED SOME HELP SELECTING? PAGE 6 PAGE 8 SUGGESTIONS BY LIFE STAGE SELECT A PACKAGE HCF offers a range of health cover to suit your needs. You might already know what type of cover you want, or you might like to receive suggestions based on your life stage, needs and budget. You may select a package, or pick and choose the hospitals and extras cover which suits you best. Use our quick reference guide to make your selection easy. LET S MAKE A START READY TO MAKE A SELECTION? CHOOSE YOUR HOSPITAL AND/OR EXTRAS PAGE 10 PAGES 12 & 14 Not sure and need help? We ll assist you to find the solution that suits you. 4 5

4 HEALTH COVER TO SUIT YOUR LIFE STAGE In our experience with new members, we ve found that a useful approach is to start with the stage you re at in life. While not exhaustive of all personal circumstances, life stages provide a good indication of what you ll likely need, or don t need, from your cover. We don t like to put people in a box. If choosing based on a life stage isn t right for you, please go to the next pages to choose the cover or package that best meets your needs. Just want ambulance cover? Head to hcf.com.au/ambulance to find out more. Not sure and need help? We ll assist you to find the solution that suits you. HOW WOULD YOU DESCRIBE YOURSELF OR YOUR LIFE STAGE? WHAT TYPE OF COVER IS IMPORTANT TO YOU? SUGGESTED HOSPITAL & EXTRAS YOUNG SINGLES & COUPLES Not planning a family PLANNING KIDS A single or couple starting or growing a family FAMILY WITH KIDS With no plans to have more kids SINGLES & COUPLES No kids, not planning a family, or kids have left home Top cover for peace of mind Mid level cover Budget conscious Top cover for peace of mind Mid level cover Budget conscious Top cover for peace of mind Mid level cover Budget conscious Top cover for peace of mind Mid level cover Budget conscious Premium Hospital and Gold Extras Mid Hospital and Silver Plus Extras Basic Hospital and Bronze Extras Young Starter Package Premium Hospital and Platinum Extras My Family Plus Package My Family Package Premium Hospital and Platinum Extras My Family Plus Package Basic Hospital and Silver Plus Extras Premium Hospital and Platinum Extras Mid-Plus Hospital and Gold Extras Mid Hospital and Silver Plus Extras Basic Hospital and Bronze Plus Extras 6 7

5 DISCOVER OUR CONVENIENT PACKAGES PLANNING A FAMILY If you re planning to have kids, or adding to a growing family, HCF s My Family or My Family Plus packages have you covered for the journey ahead. We offer a wide range of services and treatments for before, during and after your pregnancy. These packages include breastfeeding consultations, childbirth education classes, pregnancy compression garments, pelvic floor physio, and breastfeeding support services provided by the Australian Breastfeeding Association. YOUNG STARTER MY FAMILY MY FAMILY PLUS 8 Our Young Starter Package is designed for young singles and couples getting health cover for the first time. Here are some of ways you ll receive value. Includes hospital and extras cover May save you money on the Medicare Levy Surcharge if you re a high income earner 100% back on up to 2 dental checks per year, at participating providers and subject to your annual limits 100% back on certain prescription glasses^ and a FREE digital retinal image with your eye test at participating providers and subject to annual limits. ^ Excludes add-on such as high index material, coatings and tinting. The My Family package is ideal for when you re planning a family, as it covers you for pregnancy and birth-related services (after a 12 month waiting period), as well as dental, optical and natural therapies. Private hospital cover for pregnancy and birth-related services Hospital and extras package with antenatal and postnatal support Accident Safeguard receive the benefits of our top level of hospital cover for 90 days if you re in an accident No excess for kids or for accident related treatment A flexible extras limit that lets you claim on the included services you need the most, with an additional limit for optical HCF-approved learn to swim and weight management programs 100% back* on: up to 2 dental checks per year, scale and cleans and a fluoride treatment certain prescription glasses^ and a FREE digital retinal image with your eye test. * At participating providers, subject to your cover and annual limits. Exclusions apply. To find out more, visit hcf.com.au/100back ^ Excludes add-ons such as high index material, coatings and tinting. ** Applies to children attending school, up to and including year 12. Subject to waiting periods, annual limits and other conditions. See hcf.com.au/school-accident To be eligible, must attend a hospital emergency department within 24 hrs. Top hospital coverage applies for up to 90 days of the Accident. Other conditions apply. See hcf.com.au/accident-safeguard If you re growing your family and would like all the benefits of My Family, along with more family-friendly extras services including orthodontics, speech therapy, occupational therapy and more, then My Family Plus is a great option. Private hospital cover for pregnancy and birth-related services Hospital and extras package with antenatal and postnatal support Accident Safeguard receive the benefits of our top level of hospital cover for 90 days if you re in an accident No excess for kids or for accident related treatment A flexible extras limit that lets you claim on the included services you need the most, with an additional limit for optical HCF-approved learn to swim and weight management programs 100% back* on: up to 2 dental checks per year, scale and cleans and a fluoride treatment certain prescription glasses^ and a FREE digital retinal image with your eye test an initial physio, chiro and osteo consult an initial podiatry consultation Added family-friendly extras services including orthodontics, speech therapy, podiatry and foot orthotics, School Accident Benefit** and occupational therapy.

6 CHOOSE THE RIGHT COVER HOSPITAL EXTRAS HOSPITAL ONLY OR EXTRAS ONLY You can create your own package by mixing and matching different covers. The first question you need to ask yourself is: Do I want to combine hospital and extras covers? Or do I need only hospital or only extras? Enjoy the flexibility to choose what works for you. To help you design what s right for you, outlined below are the key features of each cover, from the basic options all the way to the most comprehensive. In the following pages, you ll also find more detailed information on the hospital covers benefits and extras covers limits. HOSPITAL BASIC Budget conscious and healthy? Basic hospital cover is for you. MID Think you may need a common procedure? Our Mid cover is an affordable option. MID PLUS Not planning a baby, but want comprehensive cover? Choose our Mid plus option. PREMIUM Want our top level of cover for peace of mind? Premium has you covered. Includes: Choose $250 or $500 excess Procedures like joint investigations, digestive disorder procedures, removal of tonsils or appendix Free access to a great range of health and wellbeing programs No excess for kids or Accident related treatment Also: Heart surgery Sterilisation and reversals Also: Joint replacement surgery Dialysis for chronic renal failure Not sure and need help? We ll assist you to find the solution that suits you. Also: Pregnancy & birth related services Assisted reproductive services e.g. IVF Choose Nil, $250 or $500 excess No excess for same day admissions EXTRAS BRONZE Want general dental and selected therapies at a budget-friendly, entrylevel rate? Try Bronze. BRONZE PLUS Want to step up your general dental and selected therapies? Add higher limits and optical cover with Bronze Plus. SILVER PLUS Think you might need major dental, and higher limits on a wider range of treatments and services? Consider Silver Plus. GOLD Want quality comprehensive extras? Gold includes orthodontics, Health Management Programs, School Accident Benefit** and more. PLATINUM Our premium option, providing the highest limits and benefits for all included extras services. Includes: 100% back # on 1 dental check per year Also: Higher limits Cover for optical Also: 100% back # on: 2 dental checks per year Certain glasses & lenses^ Free digital retinal imaging with your eye test Also: 100% back # on an initial physio, chiro, osteo and podiatry consult* Higher limits, which increase the longer you re with us, up to a maximum amount Also: Our highest limits and benefits 10 See pages for a detailed list of what s covered. # At participating providers and subject to your annual limits. * One initial consult for a new health condition or flare up where no treatment has been provided in the previous 3 months. ^ Excludes add-ons such as high index material, coatings and tinting. ** Applies to children attending school, up to and including year 12. Subject to waiting periods, annual limits and other conditions. See hcf.com.au/school-accident 11

7 HOSPITAL BENEFITS SUMMARY YOUNG STARTER PACKAGE Singles & Couples only Choose your excess (per person per calendar year) No excess for kids $250 or $500 WAITING PERIODS HOSPITAL MY FAMILY PACKAGE MY FAMILY PLUS PACKAGE BASIC MID MID PLUS PREMIUM $250 or $500 $250 or $500 $250 or $500 $250 or $500 $250 or $500 Nil or $250 or $500 N/A No excess for Accident related treatment Palliative care Psychiatric treatment Rehabilitation services 2 months Pre-existing ailments or conditions Pregnancy and birth related services 12 months All other hospital services 2 months AMBULANCE No excess for same day treatment Available as hospital cover only (without extras) No No No Yes Yes Yes Examples of what s covered Includes accommodation, operating theatre, intensive care, Government approved Prostheses, pharmaceuticals# and physiotherapy, as part of your covered admission at a participating private hospital Emergency Ambulance Accident related treatment after joining (Accident Safeguard Excluded Services or Minimum Benefit Services listed in this table will be treated as Covered Services in the event of an Accident. Excludes podiatric surgery by an accredited podiatrist. Conditions apply. Visit hcf.com.au/accident-safeguard) Removal of tonsils, adenoids, appendix Yes Emergency ambulance 1 day Waiting periods vary according to the type of treatment or service. Members who have held a hospital cover for at least 2 months and upgrade to Premium Hospital to receive psychiatric treatment as a Covered Service may not be required to serve the waiting period for psychiatric treatment. This exemption can only be accessed once in a member s lifetime. MINIMUM BENEFITS Heart surgery including diagnostic and therapeutic cardiac procedures From time to time, the Commonwealth Minister for Health sets out a rate for Minimum Benefits. These Minimum Benefits may apply to some procedures under some hospital cover. If this is the case under your cover, HCF will pay the Minimum Benefit for a shared room and benefits for Government approved Prostheses List items. When Accident Safeguard applies, you ll receive the same Benefits as those for Covered Services. Spinal surgery Minimum Benefits differ in private and public hospitals: Cochlear implant surgery and bone anchored hearing devices* Private hospital: Minimum Benefits wouldn t cover all the hospital costs and there could be significant out-of-pocket expenses for you to pay. Surgical treatment of a hernia Removal of kidney stones and gall stones Digestive disorder procedures (e.g. bowel surgery) Cancer related services (e.g. chemotherapy) Insulin pump treatments Public hospital: If you elect to be a private patient in a public hospital, you may have to pay out-of-pocket expenses if Minimum Benefits are less than what your chosen public hospital charges or don t cover all hospital costs. Care involving dialysis for chronic renal failure Rehabilitation services Psychiatric treatment Gastric banding and obesity surgery Assisted reproductive services (e.g. IVF, GIFT) Pregnancy and birth related services EXCLUDED SERVICES If you choose a hospital cover where some procedures are excluded then nil benefits apply for the episode of care, except in the case of Accident Safeguard. If multiple procedures are provided in a single episode of care and one procedure is excluded then nil benefits apply for the entire episode of care. Joint investigations and reconstructions Hip and knee joint replacement surgery All other joint replacement surgeries (e.g. shoulder replacements, elbow replacements) Cataract and other lens related surgery Excluded Services differ in private and public hospitals: Sterilisation and sterilisation reversals Private hospital: You are responsible for all hospital charges and could have significant out-of-pocket expenses. Podiatric surgery by an accredited podiatrist All other in-hospital services where a Medicare benefit is payable Covered Services Minimum Benefits Excluded Services Covered for certified Type C procedures and certified overnight Type C procedures for the treatment of diabetes. Reduced or no benefits may apply. See hcf.com.au/insulinpumps to find out if you re covered. 12 * Includes associated speech and sound processors (including upgrades). # Excluding experimental and high-cost non-pbs drugs. See page 24 for more information. Public hospital: If you elect to be a private patient in a public hospital, you are responsible for all hospital charges and could have significant out-of-pocket expenses. Please note: Other service exclusions apply. For more information on excluded services read page 24.

8 EXTRAS LIMITS SUMMARY CATEGORY SERVICE MY MY FAMILY MY MY FAMILY PLUS PLUS YOUNG LIMITS LIMITS # LIMITS LIMITS # STARTER ($800 ($800 combined ($1,200 ($1,200 combined BRONZE BRONZE PLUS PLUS SILVER PLUS PLUS GOLD GOLD PLATINUM LIMITS LIMITS # limit limit + $200 + $200 optical) optical) limit limit + $250 + $250 optical) optical) LIMITS LIMITS # LIMITS LIMITS # LIMITS LIMITS # LIMITS LIMITS # LIMITS LIMITS # WAITING PERIODS OPTICAL Spectacle frames frames Glasses & & $100 $100 per person person Spectacle lenses lenses pair^ pair^ 2 2 months $150 $150 $200 $200 $250 $250 contact lenses lenses Max Max $200 $200 per per policy policy $200 $200 $250 $250 $275 $275 Contact lenses lenses pair pair Examinations $350 $350 per person person $400 $400 per person person No No annual annual limit limit No No annual annual limit limit Diagnostic & & Single Single film film x-rays x-rays service service limits limits apply apply Max Max $700 $700 per per Max Max $800 $800 per per Max Max 2 check 2 check ups, ups, 2 2 Max Max 2 check 2 check ups, ups, 2 2 Preventative Removal of of plaque/calculus $500 policy Max 1 check policy Max 1 check scale and clean, and 1 scale and clean, and 1 $500 policy Max 1 check policy Max 1 check scale and clean, and 1 scale and clean, and 1 GENERAL up, up, 1 scale 1 scale and and up, up, 1 scale 1 scale and and fluoride fluoride treatment per per fluoride fluoride treatment per per DENTAL Application of fluoride of fluoride 2 2 months Max Max 2 check 2 check ups, ups, clean, clean, and and 1 fluoride 1 fluoride clean, clean, and and 1 fluoride 1 fluoride person, person, per year year person, person, per year year 2 scale 2 scale and and clean, clean, Tooth Tooth extractionssimple Simple extractions treatment per per treatment per per $650 $650 and and 1 fluoride 1 fluoride person, person, per year year person, person, per year year Direct Direct fillings fillings (1-2 (1-2 surfaces) treatment per per $800 Max 2 check direct $800 combined Max 2 check Fillings direct Direct Direct fillings fillings (3 or (3 more more surfaces) person, person, per year year limit limit per person, person, ups, ups, 2 scale 2 scale per per year, year, for for all all and and clean, clean, Fillings indirect Indirect fillings fillings services covered and and 1 fluoride 1 fluoride Oral Oral surgery Surgical extractions except except optical optical treatment Year Year 1 $800 1 $800 Year Year 1 $1,000 1 $1,000 per person, person, Periodontics Treatment of tissue of tissue surrounding teeth teeth Year Year 2 $950 2 $950 Year Year 2 $1,150 2 $1,150 per per year year Year Year 3+ $1, $1,100 Year Year 3+ $1, $1,300 Endodontics Treatment of root of root canals canals Crowns & & bridgesplacing Placing of crowns of crowns and and bridges bridges MAJOR $1,200 and/or (partial and 12 $1,200 combined DENTAL Dentures and/or components (partial and complete). 12 months limit limit per person, person, Dentures Limits Limits renew renew every every 3 years 3 years from from the the date date you you received them them per per year, year, for for all all (excluding My My Family Family & My & My Family Family Plus) Plus) covered services except except optical optical $700 $700 ($350 ($350 for for other other $800 $800 ($400 ($400 for for other other Orthodontics Correction of teeth of teeth and and jaws jaws by an by an orthodontist other or other dentist dentist dentists) Lifetime Lifetime limit limit dentists) Lifetime Lifetime limit limit $2,100 $2,100 with with sub-limit of of $2,400 $2,400 with with sub-limit of of $2,100 $2,100 life-time $1,050 $1,050 for other for other dentists dentists $1,200 $1,200 for other for other dentists dentists limit limit for for orthodontics $150 $150 combined limit limit Physiotherapy (group (group and/or and/or classes classes are are covered under under $200 $200 per person person with with a a sub-limit with with services services below below Health Health Management Program) With With combined $200 of $1,050 for Max $300 per policy Max $400 per policy Year 1 $350 Year 1 $600 $200 of $1,050 for Max $300 per policy Max $400 per policy Year 1 $350 Year 1 $600 $350 $350 Year Year 2 $450 2 $450 Year Year 2 $750 2 $750 limit limit other other dentists Exercise physiology (group (group and/or and/or classes classes are are covered Year Year 3+ $ $550 Year Year 3+ $ $900 under under Health Health Management) Occupational therapy Year Year 1 $350 1 $350 Year Year 1 $600 1 $600 Psychology (after (after Medicare entitlement is used is used up) up) Year Year 2 $450 2 $450 Year Year 3+ $ $550 Year Year 2 $750 2 $750 Year Year 3+ $ $900 Year Year 1 $250 1 $250 Chiropractic/Osteopathy 2 2 months Year Year 2 $350 2 $350 Initial/ (12 THERAPIES Initial/ (12 months With With combined Combined $100 $100 per per Year Year 3+ $ $450 Subsequent Remedial massage and/or and/or Myotherapy for for foot foot limit $150 with person $150 Year 1 $250 orthotics) $150 limit with person and/or herbal physiotherapy $150 Year 1 $250 Acupuncture and/or Chinese herbal medicine consultation Max Max $200 $200 Year Year 2 $350 2 $350 limit limit per per policy policy Year Year 3+ $ $450 Naturopathy and/or and/or Nutrition consultation Sub-limit $200 $200 per per therapy service service type type Year Year 1 $300 1 $300 Year Year 2 $400 2 $400 Year Year 3+ $ $500 Year Year 1 $300 1 $300 Year Year 2 $400 2 $400 Year Year 3+ $ $500 Sub-limit $250 $250 per per therapy service service type type Podiatry (including foot foot orthotics). Note: Note: foot foot orthotics annual annual limit limit on Gold on Gold and and Platinum Extras Extras is capped is capped at Year at Year 1 1 Year Year 1 $200 1 $200 Year Year 1 $250 1 $250 Audiology Year Year 2 $250 $250 Year Year 2 $300 2 $300 Speech Speech pathology Year Year 3+ $ $400 Year Year 3+ $ $500 Dietetics HCF HCF approved pharmacy After After PBS PBS equivalent co-payment subtracted With With combined limit With HCF 2 limit With combined HCF approved 2 months limit limit $180 $180 $280 $280 vaccines & & Immunisations After After PBS PBS equivalent co-payment subtracted $100 $100 $100 $100 Artificial aids aids & & appliances HCF HCF approved (e.g. (e.g. low low vision vision aids, aids, blood blood glucose monitors) months Max Max $150 $150 per per policy policy Max Max $200 $200 per per policy policy Hearing aids aids Benefits accrue accrue over over time time and and renew renew every every 3 years 3 years from from the the date date you you received them them months $600 $600 $1,600 $1,600 $800 $800 $1,800 $1,800 OTHER HCF HCF approved $50 $50 per person person (e.g. (e.g. exercise exercise classes, classes, group group physiotherapy and and group group exercise exercise physiology Health Max $100 $150 per person $200 per person Health Max $100 $150 person $200 person classes, classes, weight weight management, learn learn to swim, to swim, antenatal/postnatal services services classes and 2 With per policy Max $300 per policy Max $400 per policy Management including childbirth education classes and breastfeeding consultations) Programs 2 months With combined per policy Max $300 per policy Max $400 per policy limit limit Additional HCF HCF approved antenatal/postnatal services - - With With combined Pregnancy compression garments, breastfeeding support support services services provided provided by by limit limit the the Australian Breastfeeding Association 14 School School Accident Helps Helps pay pay out-of-pocket extras extras expenses for for extras extras in your in your cover cover Benefit (per (per eligible eligible child). child). See See hcf.com.au/school-accident months $150 $150 $200 $200 GET 100% BACK ON SELECTED EXTRAS Subject to your cover and annual limits, you can get 100% back at participating providers. These include: Dental check-ups through More for Teeth providers. Prescription glasses^ and free digital retinal imaging with your eye test through More for Eyes providers. An initial physio, chiro and osteo consult through More for Muscles and More for Backs providers*. An initial podiatry consult through More for Feet providers*. ^ Excludes add-ons such as high index material, coatings and tinting. * One initial consult for a new health condition or flare up where no treatment has been provided. LIMITS # Annual limits, per person, per calendar year, unless otherwise specified (set benefits apply per service item). WAITING PERIODS EXTRAS Artificial aids and appliances (e.g. low vision aids, blood glucose monitors) Major dental Foot orthotics Hearing aids Orthodontics Pre-existing ailments and conditions School Accident Benefit All other extras services Excluded Services 12 months 2 12 months 2 months

9 HEALTH & WELLBEING PROGRAMS We want you to get the most out of life. We offer a range of health support and wellbeing programs and services to help you make a positive change and be your healthiest self. FIND A PARTICIPATING NO-GAP DOCTOR We re the first private health insurer to partner with Healthshare to help you and your GP find a specialist that will charge no-gap or a reduced gap. Available free to all Australian GPs, our members and non-members, the tool can help you access the right information on the Healthshare website to make a better-informed health decision and minimise your out-of-pocket costs. hcf.com.au/findaprovider PREPARE FOR YOUR HOSPITAL VISIT When you need to go to hospital, understanding more about your procedure can provide welcome peace of mind. Our online resource will help you understand how it works, how to prepare, what questions to ask, what to expect in hospital, what aftercare you may need and an idea of average costs using our cost indicator tool. hcf.com.au/preparing-for-hospital A GP AT YOUR FINGERTIPS We ve partnered with online GP service GP2U which allows you to book and receive a GP consultation via mobile or desktop. Online GP consultations can t be claimed from Medicare or private health funds, but as an HCF member you can save up to 20% on GP2U s standard rates. hcf.com.au/gp2u DISCOVER OUR ANTENATAL AND POSTNATAL SERVICES On eligible covers, you may be able to claim for a range of programs and services to guide and support you through pregnancy and after birth. A 2 month waiting period applies. Programs and services include: Childbirth education classes faceto-face in hospital, as well as access to Birth Beat s online courses Breastfeeding consultations Antenatal and postnatal group physio. You may also claim benefits back on: Pregnancy compression garments Breastfeeding support services provided by the Australian Breastfeeding Association hcf.com.au/family MANAGE YOUR WEIGHT FOR CHRONIC CONDITIONS Our free Healthy Weight For Life programs help improve your quality of life if you re overweight and have Type 2 diabetes, a chronic heart condition or osteoarthritis. You must have held an eligible hospital product for 12 months. hcf.com.au/hwfl FREE VICTOR CHANG HEART HEALTH CHECKS The Victor Chang Cardiac Research Institute conducts roving free heart health checks for HCF members aged 18 and over with extras cover at selected HCF branches. hcf.com.au/victorchang EXERCISE CLASSES AND GYM MEMBERSHIP FEES If you have a specific medical condition and your doctor has prescribed an exercise program, you may be able to claim benefits towards it on eligible extras products. A 2 month waiting period applies. hcf.com.au/healthmanagement CLAIM ON WEIGHT MANAGEMENT PROGRAMS To help you achieve a healthy weight, you may be able to claim on eligible extras products towards dietitian-led HCF approved weight management programs. A 2 month waiting period applies. hcf.com.au/healthmanagement LEARN TO SWIM COURSES You may be able to claim for swimming lessons run by swim schools that are: ASSA members, AUSTSWIM (Gold and Silver level) or Swim Australia swim centres. Squad training or recreational swimming is not covered. You must have held an eligible extras product for at least 2 months. hcf.com.au/healthmanagement BOWEL CANCER SCREENING If you re outside of the free testing ages through the National Bowel Cancer Screening Program, you may be eligible to claim towards the bowel cancer screening kit under your extras cover. A 2 month waiting period applies. hcf.com.au/healthmanagement 16 17

10 MORE FOR OUR MEMBERS We offer more than just great health cover. As an HCF member you have access to a fantastic range of additional benefits, rewards and offers. TRAVEL INSURANCE Going on holidays? Take advantage of our discounted rates on travel insurance. PET INSURANCE Help protect your fur babies with discounted rates on pet insurance. INVOLUNTARY UNEMPLOYMENT ASSISTANCE We ll pay your HCF health insurance premiums if you become involuntarily unemployed. Available to eligible Policyholders with hospital cover, up to a maximum period of 183 days. Excludes extras only, Ambulance Only and Overseas Visitors Health Cover. Conditions and waiting periods apply. To find out more go to hcf.com.au/ unemployment-assistance FREE SUBSCRIPTION TO HEALTH AGENDA MAGAZINE Health Agenda is a quarterly magazine empowering our members to make healthier choices. It s packed with insightful articles on nutrition, fitness, technology, and physical and mental health. Members receive the magazine for free simply enter your details at hcf.com.au/subscribe and we ll pop it in the post. While you re there, update your address so we can keep you informed on monthly offers, competitions and health information. SAVE UP TO 20% ON HCF TRAVEL INSURANCE Choose from international budget, comprehensive or annual plans that cover medical and dental expenses, delays, lost luggage and more. Staying closer to home? We also offer cover for Australian domestic travel. Visit hcf.com.au/travel to find out more. SAVE UP TO 15% ON HCF PET INSURANCE If you have a cat or dog, HCF pet insurance can help with vet bills, providing up to 80% back. Visit hcf.com.au/petinsurance to find out more. GREAT OFFERS AND REWARDS WITH HCF THANK YOU Choosing a health fund is a big commitment, so we want to give you something back. To say thank you for your loyalty, you ll get access to a great range of exclusive offers and rewards. And the longer you stay with us, the more ways we can say thank you. For more details visit hcf.com.au/thankyou All HCF members are eligible for at least 10% discount on HCF Travel Insurance. HCF Emerald members get 15% discount, and Ruby and Diamond members get 20% discount. HCF Travel Insurance is issued by QBE Insurance (Australia) Ltd ABN AFSL This product is not available directly from QBE. Any advice here does not take into account your objectives, financial situation or needs. Consider the PDS at hcf.com.au/travel before making any decisions about this product. Terms and conditions apply. 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 AFSL , 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 AFSL and administered by Petsure (Australia) Pty Ltd ABN AFSL Consider the PDS at hcf.com.au/petinsurance before making any decisions about this product. Terms, conditions, waiting periods and exclusions apply. 19

11 CASH ASSIST FOR THE UNEXPECTED A range of low-cost life insurance products that help pay for the things that your health insurance may not. FOR KIDS FOR UNDER 30S FOR ADULTS AND FAMILIES KIDS ACCIDENT COVER Pays a lump sum if your insured child gets accidentally injured #. Available for children aged 0 17 Pays a benefit of up to $100,000 Covers many common fractures and breaks Easy to apply no medical questions or examinations No waiting periods Make multiple claims up to a maximum of $100,000 per child Costs only 90 cents per week per child. BOUNCEBACK COVER Protection for young people against common accidents and illnesses. You can apply if you re aged Pays a benefit of up to $100,000 Easy to apply no medical questions or examinations Covers surgery for illnesses like tonsillitis and appendicitis Covers many common fractures and breaks Make multiple claims up to a maximum of $100k Costs $7 per week^ Waiting period: 90 days for all covered cancers and heart conditions. INCOME ASSIST INSURANCE Pays you a monthly benefit if you can t work due to sickness or injury. You can apply if you re aged Pays up to 75% of your average monthly income (maximum of $6,000 per month) Pays a monthly income for up to 12 months Available to those working 21 hours or more per week + Additional benefits for expenses incurred on child care and care during bed confinement Cost depends on age, gender and occupation Waiting period: First 30 days of each period you are unable to work. SMART TERM INSURANCE Pays a lump sum to your loved ones to help them with the financial costs if you were to suffer a terminal illness or were no longer around. You can apply if you re aged Choose up to $500,000 cover Early payment if you re diagnosed with a terminal illness Advance payment of $10,000 to cover funeral expenses ~ Easy to apply no medical questions or examinations Cost depends on age, gender, smoking status and choice of benefit amount. FOR ADULTS AND FAMILIES CASH BACK COVER Pays a lump sum if insured person suffers from any of the 6 major illnesses or an accident that needs surgery in an operating theatre. You can apply if you re aged Pays a $5,000 lump sum for covered accidents and illnesses Covers illnesses such as heart attack, stroke and certain cancers Easy to apply no medical questions or examinations Make multiple claims up to $20,000 for singles and $40,000 for families $2 per week for singles and $4 per week for families Waiting period: 2 months for all covered illnesses. CRITICAL ILLNESS COVER Pays a lump sum if you re diagnosed with specified illnesses. You can apply if you re aged Choice of $25,000 and $50,000 levels of cover Includes cover for illnesses such as heart attack, stroke and certain cancers Easy to apply no medical questions or examinations Costs from $2.30 per week for singles and $4.60 per week for families Waiting period: 90 days for all covered illnesses. FOR OVER 55 PERSONAL ACCIDENT INSURANCE Covers over 55s for specified injuries or death as a result of an accident. You can apply if you re aged Choice of $25,000 and $50,000 levels of cover* Easy to apply no medical questions or examinations Covers a range of specified fractures, dislocations and burns Costs from only $3.20 per week for singles and $6.40 per week for couples. For more information on these products: Please note: all covers exclude pre-existing conditions. # Accident should result in immediate impairment or permanent disability within 6 months. ^ Premium will be $1 per day until you reach the age of 35, after which premiums will be based on your age. + Should have been employed for the past 12 months with the same employer or in the same occupation. * Level of cover and benefit payable for each specified injury and accidental death will be halved for accidents occurring after you reach age 80. ~ Funeral advancement benefit is only payable on accidental death for the first 3 years and for death from any cause after 3 years. 20 Please consider each Product Disclosure Statement and Financial Services Guide available by calling 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 , AFSL (HCF Life). HCF Life is a wholly owned subsidiary of The Hospitals Contribution Fund of Australia Limited ABN , AFSL (HCF). The premiums for the life insurance products are paid to HCF Life. HCF receives commission from HCF Life for their sale of 40% of the first year s premium plus an additional commission of 80% of HCF Life s underwriting profit each year calculated as premiums less claims and expenses. HCF s staff receive an incentive depending on the annual premium of these products which they sell. This will not exceed 20% of the first year s premium. GO TO hcf.com.au/life-insurance 21

12 IMPORTANT THINGS YOU NEED TO KNOW ABOUT HEALTH COVER Information to help you make the right choice, pay lower premiums and avoid unnecessary costs. REBATES, SURCHARGES AND INCENTIVES Private health legislation can affect your choice of health cover, so here s some useful information on how to get your maximum entitlements and avoid unnecessary expenses. AUSTRALIAN GOVERNMENT REBATE ON PRIVATE HEALTH INSURANCE 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 your age. You can take the rebate as: A reduced premium OR A tax offset credit in your annual tax return. When calculating your income be sure to include taxable income, fringe benefits, reportable superannuation contributions, net financial investment losses and more. You may have to pay additional tax if you nominate an incorrect rebate tier. We can provide you with general information on these thresholds, for personal advice specific to your circumstances you should consult your accountant, financial advisor or the ATO at ato.gov.au or See privatehealth.gov.au/healthinsurance/ incentivessurcharges for the list of rebate percentages. MEDICARE LEVY SURCHARGE The Medicare Levy Surcharge is an Australian Government initiative designed to encourage high-income earners to be responsible for their health care. It only applies if you ll earn above this year s income threshold and don t have eligible private hospital cover. You can avoid paying this by having eligible HCF hospital cover. If you don t have eligible private hospital cover and fall into these income thresholds, you ll be charged an additional surcharge on your Medicare levy when your tax return is assessed. To view this year s income thresholds and Medicare Levy Surcharge information, go to privatehealth.gov.au/healthinsurance/ incentivessurcharges LIFETIME HEALTH COVER Lifetime Health Cover (LHC) is a government initiative that encourages 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 don t have 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 could 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 could 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. For members who have switched from another fund, if your LHC loading differs to what was listed in the transfer certificate, your premiums may change accordingly. The Australian Government Rebate does not apply to the LHC component of private health insurance. This means if you are eligible for the rebate and also have a LHC loading, the rebate won t apply to the LHC portion of your health insurance. To find out if you need to pay the LHC loading, you can use the Lifetime Health Cover calculators at privatehealth.gov.au (and search for Lifetime Health Cover). For more information, visit hcf.com.au or call us on PRE-EXISTING AILMENTS OR CONDITIONS A pre-existing ailment, illness or condition is one where the signs or symptoms existed during the six months before joining HCF (or upgrading to a higher level of cover), even though a diagnosis may not have been made. If there s any doubt that an ailment or condition is pre-existing, an HCF-appointed medical practitioner will examine information provided by your doctor, and any other relevant claim details. WHO CAN BE COVERED? Before taking out health insurance, you should understand who can be covered under your policy. You can find out more by visiting hcf.com.au/faqs, and searching for Who does my membership cover? HOSPITAL COVER FOR IN-PATIENT 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. HOSPITAL GAP Private hospitals charge for accommodation, operating theatres, Prostheses and other hospitalrelated services. HCF has agreements with the majority of private hospitals and day surgeries (known as participating private hospitals) across Australia. This means you won t pay additional costs for services covered under your policy and under our agreement with the participating private hospital (except Minimum Benefit services). This is subject to any excess you have on your policy, medical gaps (see below) and the conditions relating to your hospital cover. HCF hospital will only cover in-patient services (from when you re officially admitted to hospital to when you re officially discharged), however they don t cover outpatient services before or after your hospital admission. If you re at a non-participating private hospital or a private patient in a public hospital or received Minimum Benefit services, Minimum Benefits will apply and you may incur significant additional expenses, in addition to your excess and medical gaps. Minimum Benefits means the minimum default Benefit level payable by HCF for Hospital Treatment as determined under the Private Health Insurance Act and rules made under it from time to time. To check if your planned hospital admission will be in a participating private hospital, please visit hcf.com.au/participatinghospitals, drop into a HCF branch or call us on Please note: these agreements are updated from time to time and subject to change. MEDICAL GAP Medical services provided while you are admitted to hospital (like doctors, anaesthetists and surgeons fees, and diagnostic services such as x-rays, scans and blood tests) are charged separately from hospital services. Medicare covers 75% of the Medicare Benefits Schedule (MBS) fee for these charges and HCF covers the remaining 25% (for eligible services). However, many providers charge more than the MBS fee, so you may face additional out-of-pocket expenses (known as the medical gap )

13 HCF has arrangements (under our Medicover or other medical agreements) with more than 35,000 doctors across Australia that help eliminate or reduce gaps for doctors services for our members. Please note: these agreements are updated from time to time and subject to change. EXTRAS Under HCF extras, we will pay a set amount of benefits for services, subject to annual limits. The amount of benefits will vary depending on your cover. You must pay the difference between what the extras provider charges and the benefits we pay. WHAT S NOT COVERED There are a number of situations where our health insurance doesn t cover you: Elective Cosmetic Surgery; If a Service is listed as an exclusion in the Product Information. For some Hospital Covers, an exclusion may not apply when a Member receives Treatment as the result of an Accident (see hcf.com.au/accident-safeguard). For other Hospital Covers, the Service is excluded regardless of whether or not Treatment is required as a result of an Accident; Claims made 2 years or more after date of Service; When a Member has the right to recover the costs from a third party other than HCF, including an authority, another insurer or under an employee benefit scheme; Treatment for Pre-Existing Conditions (other than for psychiatric, rehabilitation or palliative care) within the 12 month Waiting Period (the Pre-Existing Condition Waiting Period applies to new Members and Members upgrading their Policy to any higher level Benefits under their New Policy); Services received during any period where payment is in arrears, the Policy is not financial, the Policy is suspended or within a Waiting Period; Treatment that HCF deems to be 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; Emergency room fees; Services that are not delivered face to face, such as online or telephone consultations, unless a Member is participating in a Chronic Disease Management Program or Health Management Program; Services supplied by a provider not recognised by HCF; Services provided outside Australia which do not meet the requirements under the Private Health Insurance Act Ambulance transfers between hospitals (emergency or non-emergency); or Claims that do not meet HCF s criteria as set out in the Fund Rules. In addition, our hospital cover doesn t include: Hospital Benefits (including Medical Benefits) for Services in respect of which the claim is not approved for payment by Medicare; Experimental treatment; Experimental, high cost non-pbs Drugs and Therapeutic Goods Administration (TGA) approved Drugs used for a purpose other than that for which they were approved; Procedures normally performed in the doctor s surgery or as an outpatient; Private room accommodation for same-day procedures; Respite care; Benefits for Nursing Home Type Patients except as determined under the Minimum Benefits requirements of the Private Health Insurance Act; Special nursing; Luxury room surcharge; Donated blood and blood products; Donated blood collection and storage; PBS pharmaceutical benefits in private Non-Participating Hospitals; Pharmaceuticals (including PBS pharmaceuticals benefits) and other sundry supplies not directly associated with the reason for admission; Take home items including crutches, toothbrushes and drugs; Personal convenience items including the cost of phone calls, newspapers, magazines and beauty salon services; Massage and aromatherapy services; Select Services provided while in Hospital by non-hospital providers; Benefits where a Service is an Excluded Service for the payment of Benefits in a Hospital, and any other Services including medical, diagnostic, Prosthesis and pharmacy received at the same time except when Accident Safeguard applies; The gap on government approved gappermitted Prostheses items; and Benefits greater than Minimum Benefits if a Service is listed as a Minimum Benefit Service in the Product Information. For some Hospital Covers, Minimum Benefits may not apply when a Member receives Treatment as the result of an Accident (see hcf.com.au/accidentsafeguard). For other Hospital Covers, Minimum Benefits apply regardless of whether or not Treatment is required as a result of an Accident. In addition, our extras cover doesn t include: Psychological and developmental assessments; Co-payments and gaps for Government funded health services including the co-payment for PBS items; Psychology treatment (where included under a Policy) unless a mental health plan has been prescribed under Medicare entitlements and these entitlements have been used up for the Calendar Year; Services while a Hospital patient except for eligible oral surgery; Pharmacy items that are not on HCF s approved pharmacy list including items listed on the PBS, items prescribed without an illness, items that are available without a prescription, items supplied by a Hospital as take-home drugs, or items that are not registered with the Australian Register of Therapeutic Goods; Services that had not been provided at time of claim; Fees for completing claim forms and/or reports; 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; Where a provider is not in an independent Private Practice; Add-ons for optical such as high index material, coatings and tinting. Please note: our list of approved pharmacy items, artificial aids and appliances, participating hospitals and no gap providers are subject to change and updated regularly. If your cover includes any of these items and you wish to make a claim, please call us on to confirm your benefits. EMERGENCY AMBULANCE (EXTRAS ONLY) For NSW or ACT residents with standalone extras cover, there is unlimited emergency ambulance cover for transport within NSW or the ACT. For emergency transport received outside of NSW or the ACT, there is an annual limit of 1 service per person and 2 per policy. Residents of Queensland are covered Australiawide under their state ambulance service scheme and no Benefits for ambulance services are payable by HCF. Residents of Tasmania are covered across Australia under their state ambulance service scheme, excluding in Queensland and South Australia. You may claim under your HCF cover for emergency ambulance services in these states, with an annual limit of 1 service per person and 2 per policy