Your member guide. Get the most out of your membership

Transcription

1 Your member guide Get the most out of your membership

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3 More than 1 million Australians like you have chosen HBF for their health cover. Here s why: 75 years We have over 75 years experience, so we ll be there for you when you need us most We have the highest customer satisfaction of all major health funds, which means you can trust us to be on your side when the unexpected happens * We offer excellent value for money. But don t just take our word for it: HBF is ranked number 1 for benefits paid to members in Australia^ Our extensive network of Member Plus providers means you may significantly reduce or avoid any out-of-pocket expenses HBF members get access to a great range of Momentum benefits including discounts on gym membership, movie tickets, eye care and more Our members enjoy healthy discounts on home, car and travel insurance $ 1.56 billion In 2017, HBF returned 91.4% of premium contributions that s $1.56 billion as benefits to members As a not-for-profit fund, we have no shareholders to pay, so more goes back to our members *Roy Morgan Single Source (Australia) 12 months to June ^Australian Medical Health Association Health Insurance Report Card

4 Taking control of your HBF cover With HBF, your health is in safe hands. Whether you re new or been with us for a while, here s a step-by-step guide to understanding and managing your membership. 1 Register for myhbf With our self-service portal, myhbf, taking charge of your cover is easy. myhbf is where you ll find everything you need to manage your membership, including viewing the details of your cover, updating your payment and contact details, ordering a replacement card and submitting claims. Just go to hbf.com.au/myhbf. If you re registering for the first time, you ll just need your HBF member number. 2 Understand your cover in advance Knowing what you re covered for and if a waiting period applies not only gives you peace of mind, it can also help minimise any out-of-pockets expenses. You ll find more information about waiting periods on page 4. 3 Get a quote before your treatment We know your cover inside out, so contact us before you book a hospital stay or significant medical treatment. We ll check all details including any waiting periods, restrictions, and if any excess, co-payments or out-of-pocket payments apply. To ensure we give you accurate advice, please call us with your written cost estimate from your provider. 4 Choose a Member Plus provider At HBF, we ve negotiated great deals for our members at a range of hospitals and with health professionals across Australia. Choosing to undergo treatment with a Member Plus provider could significantly reduce or avoid any out-of-pocket expenses compared to those of a non-participating provider. Find a provider at hbf.com.au/health-insurance/find-a-provider. 5 Use your Momentum member benefits All HBF Members get access to a great range of Momentum member benefits including discounts on gym membership, fruit and veg, eye care and more. Uncover the full range at hbf.com.au/momentum. We recommend you carefully read and keep your policy documents, so you know exactly what you re covered for. You can find an electronic copy of your policy documents at anytime in myhbf. 2

5 Need to make a claim? Here s how to do it As an HBF member, the power of choice is yours. When you need to make a claim on your health insurance, you ve got several options: On the spot at your provider Many health providers (such as dentists, physios and chiros) can claim your benefit electronically. Just swipe your HBF member card and your benefit will be deducted from the provider s fee. All you have to do is pay any difference. Use our app With our HBF Health app, available via the App Store or Google Play Store, you can make a claim whenever it s convenient for you. Just log in with your HBF member number and password, take a photo of your account or receipts and submit your claim. Claim online If your provider doesn t have electronic claiming, you can log into myhbf and submit a claim at any time. Simply upload your account or receipts and we ll do the rest. Visit a local branch Present your HBF member card and original account or receipts and our friendly team will help process your claim. Remember, we only pay for claims made within two years of the date you had the service, so don t delay. If you need assistance understanding medical and hospital bills, turn to page 6. 3

6 Watch out for waiting periods A waiting period is a set amount of time during which you can t claim a benefit from HBF. Waiting periods apply when you have: Never had private health insurance Upgraded your level of cover Rejoined HBF after a break in cover Example of common services: Urgent ambulance (by road) + Non urgent ambulance (by road) Antenatal classes Clinical psychology General dental Psychiatric, rehabilitation or palliative care All other services Repatriation Foot orthoses Pre-existing conditions Maternity services Major dental (root canals, crowns and bridges) (implants and orthodontics) Waiting periods 7 days^ 30 days^ 2 months^ 2 months^ 2 months 2 months 2 months 6 months 12 months 12 months 12 months 12 months Hearing aids and appliances 12 to 36 months +No waiting period for HBF Overseas Visitors cover. ^GMF products have a different waiting period, so please refer to your product sheet. Things to keep in mind: Joining HBF from another fund? We ll honour any waiting periods you ve already served as long as your HBF cover includes the same benefits and services. Make sure to check if your HBF cover is similar or different to your previous level of cover, as you may have to serve additional waiting periods for new services, or for services with increased benefits and annual limits. Planning to have a baby? You ll need to take out hospital cover that includes maternity at least 12 months before your due date. What is a pre-existing condition? A pre-existing condition, illness or ailment is one where the signs or symptoms were known to exist during the six-month period prior to the date of joining HBF or transferring to a higher level of cover. It is not necessary for the condition, illness or ailment to have been diagnosed in the six-month period only that signs or symptoms were, or would have been evident. Please be aware that if you choose to go ahead with the treatment and it is found to be a pre-existing condition, you will be liable for all costs not covered by Medicare. If you re not sure which waiting period applies to your planned treatment, give us a call us on or check your product sheet in myhbf. We re here to help. 4

7 Smarter ways to save Staying in control of your health doesn t have to put a hole in your budget. Here s four initiatives to save with your private health insurance. 1. Take out HBF GapSaver To assist with eligible out-ofpocket expenses, HBF offers a service called GapSaver that lets you put aside a little extra money to cover these gaps. GapSaver benefits accrue quarterly, and you can use the benefits if you need to go to hospital, or on Extras treatments. 2. Review your excess To help you pay a lower premium, we offer a range of hospital excess options. The excess is only paid once per member, per calendar year, no matter how many times you may be admitted to hospital. An excess may also be applicable for dependants or day procedures. 3. Pre-pay your cover in advance We offer a discount if you pay your premium annually. Plus, you can pre-pay your health policy up to 18 months in advance, which could mean avoiding any increase in your health insurance premiums until the date you ve paid up to. Contact us to pre-pay your premium. 4. Understand Government rebates, surcharges and incentives a. The Australian Government Rebate on private health insurance To make private health insurance more affordable, the Government offers you a reduction on your private health insurance premium. If you would like an automatic reduction in your premium, make sure you nominate your rebate tier in myhbf. b. The Medicare Levy Surcharge If you re a high-income earner and you don t have hospital insurance, this is a tax you might pay when you lodge your tax return. In many cases it s cheaper to have hospital cover than to pay the surcharge. It s important to note the surcharge is not covered on our HBF Overseas products. c. Lifetime Health Cover loading This Government initiative is designed to encourage people to buy hospital insurance earlier in life and maintain that cover. It s an extra cost applied to a hospital premium and only applies to people aged 31 or older who buy hospital insurance after the loading deadline. 5

8 HBF Hospital cover: all the ins and outs We know that planning a hospital stay can be stressful. If you have HBF Hospital insurance, the following information will help you understand how your cover works, the out-of-pocket costs you may face and some options on how to avoid them. That way, you can approach your treatment with peace of mind. Talk to us before your treatment Before going to hospital, we recommend that you call us to obtain a quote so that we can explain how to keep your costs down and if any out-of-pocket expenses will apply. You ll just need the written estimate from your provider. 6

9 Understand your cover in advance Avoid unexpected costs by understanding what you re covered for before you head to hospital. Please refer to your product sheet in myhbf for full details about your coverage. To ensure no surprises, there are a few circumstances where HBF won t pay a benefit: If your membership is unfinancial at the time of treatment or service Treatments, services or goods provided outside of Australia Treatments before your waiting periods are served If a claim is not lodged within two years of the date of service Hospital treatments that aren t eligible for a Medicare benefit. If you aren t eligible for Medicare, you may wish to consider HBF Overseas Visitor cover Cosmetic surgery Outpatient hospital treatment and services. Note: This is covered on some HBF Overseas Visitor cover Excluded treatments. For details, refer to your product sheet Care and accommodation in nursing homes Claims covered by workers compensation, third-party or other legal right. A special note for our Overseas Visitors and reciprocal Medicare card holders If you are not entitled to Medicare, and have not purchased an HBF Overseas Visitor cover, you will experience large hospital and medical out-of-pocket expenses. The Australian Government also has Reciprocal Health Care Agreements (RHCA) with certain countries. Under these agreements, visitors can receive publicly funded medically necessary care. If you are from a RHCA country and do not have an appropriate level of HBF Overseas Visitors cover, you may also experience significant hospital and medical out-of-pocket expenses. Please refer to your product sheet in myhbf for full details about your coverage or talk to us if you would like to take out HBF Overseas Visitor cover. If your circumstances change or you become eligible for Medicare benefits, please notify us immediately and we ll review your cover. Understand out-of-pocket costs Depending on your level of cover, it s possible you might have to pay part of the bill from your own pocket. This occurs when the total cost of your treatment is more than the combined amount Medicare and HBF pays. This is known as the out-of-pocket gap and can happen in two ways: 1. Medical costs Medicare and private health funds will both pay a benefit for inpatient medical treatment and services provided by a doctor in a private hospital. Medicare will pay 75% of the Medicare Benefits Schedule (MBS) fee for treatment, with health funds paying the remaining 25% and in some cases, an amount above the MBS fee, depending on the agreement the doctor has with the health fund. To help manage your out-of-pocket costs, it s important to understand that your medical specialist s fee will fall into one of the three categories: Fully covered: These specialists are fully covered by Medicare and HBF, which means you won t have anything to pay Known gap: These specialists charge within a specified fee limit, which means we ll cover a fixed amount above the MBS fee and you ll pay the remaining balance Opt out or no agreement: These specialists have opted not to participate in any agreement, which means you will pay all costs charged above the MBS fee. Total medical cost Fully covered Known gap No agreement Paid by HBF 25% paid by HBF 75% paid by Medicare You pay the balance Fixed portion paid by HBF 25% paid by HBF 75% paid by Medicare You pay the balance 25% paid by HBF 75% paid by Medicare MBS Fee Medical Gap 7

10 2. Hospital costs A gap will occur if the total cost of your hospital stay (e.g. accommodation and theatre fees) exceeds the amount that HBF will cover. To help members avoid these gaps, we have arrangements with a large network of Member Plus hospitals across Australia, which means you can minimise or eliminate any out-ofpocket costs. However, you ll still need to pay any excess or co-payment on your policy. To find a fully covered medical specialist and hospital go to hbf.com.au/health-insurance/find-a-provider Be aware of common out-of-pocket expenses To ensure there are no surprises, you may have to pay for the following: If you ve opted to reduce your premiums by adding an excess, you will need to pay this for an inpatient hospital stay If your policy doesn t cover a private room, but your selected hospital only has private rooms available, you may need to pay the difference between a shared room rate and a private room rate A $100 co-payment and a $1400 limit towards non-pharmaceutical Benefits Scheme (PBS) drugs included in your hospital stay A $40 co-payment for pathology and radiology tests Recovery aids such as slings, crutches, compression stockings Any sundries that you use in hospital, such as pay TV, internet, phone calls and newspapers Specialist, anaesthetist, podiatric surgeon and surgical assistant gaps Surgical implanted prostheses (joint, cataract or heart prostheses) that aren t on government prostheses list Some plastics and reconstructive procedures Robotic consumables Any service that is listed as an exclusion on your HBF policy If a service is listed as restricted on your HBF policy, you ll be covered for it but will only receive the minimum default benefit set by the government. Understanding the claiming process Your medical bills Some specialists submit bills directly to Medicare and HBF on your behalf, while specialists who do not have an agreement with us may bill you directly. If you receive an inpatient specialist s bill from a doctor or surgeon, you ll need to claim from Medicare first. Then, bring us your Statement of Benefit form when you submit your claim. Your hospital bills If you re treated at a Member Plus hospital, your bills will be sent directly to us by the hospital. While you can get treatment at any hospital in Australia, if you go to a non-member Plus hospital you may be asked to pay the bill upfront and cover any out-of-pocket costs. If this happens, you can submit a claim to HBF afterwards to be reimbursed for some of these fees. Other useful information Co-payment If your policy has a co-payment, this is a fixed amount you may pay towards the cost of your hospital stay. Excess An excess is paid once per calendar year, per member, per health fund, no matter how many times you may be admitted to hospital. If you re moving from a level of cover with an excess to one without an excess, you ll still need to pay the excess if you re admitted to hospital during the waiting period. Depending on your level of cover, there may also be an excess for dependants or day procedures. Exclusions If you receive treatment for any service listed as an exclusion in your cover, you won t receive any benefits towards your hospital or medical costs for that episode of care. Informed financial consent You re legally entitled to know what your costs are likely to be before being admitted into hospital, except in a life-threatening situation. If your hospital stay involves any out-of-pocket charges, the hospital (whether public or private) and your specialist must disclose the cost and obtain your agreement in writing before your admission. 8

11 Hospital boarders If you need someone to stay with you while you re in hospital, and provided it is an agreed service with the hospital, we ll cover the cost for a hospital boarder whose presence is necessary for the management of your condition. Inclusions Inclusions are the types of procedures and services you ll be covered for. You can check your cover in our self-service portal, myhbf. Inpatients and outpatients An inpatient is someone who s been formally admitted to hospital for a day or overnight treatment. Not all treatment in a hospital may be classified as an inpatient hospital treatment (for example, some day procedures). This is classed as outpatient hospital treatment, which your private health insurance cannot pay a benefit for. Long stay patients After 35 days of continuous hospitalisation (and if you no longer need acute care), the hospital must classify you as a nursing home patient. If this happens, due to private health insurance legislation, we can only pay a small portion of the fee incurred per day and you ll be required to contribute towards the cost of your care. If you re in a private hospital these costs may be quite substantial. Mental health waiver HBF may waive the 2 month waiting period for higher benefits for in-patient psychiatric treatments when you upgrade your cover. This waiver must be requested and is available once per person per lifetime and is subject to strict eligibility criteria. Podiatric surgery HBF will contribute a benefit towards podiatric surgery when it occurs in a hospital as an agreed service by a HBF approved podiatric surgeon, and when the member has the relevant level of hospital cover. The maximum benefit for anaesthetic services provided in these instances is outlined in the schedule. If podiatric services are provided in a clinic they are classified as outpatient services and may be payable under Extras cover. Restrictions For restricted procedures, HBF will only pay a benefit equivalent to a public hospital shared room accommodation benefit. If you have treatment in a private hospital you ll have to pay the difference, which could be a significant out-of-pocket cost. To avoid this cost, we recommend going to a public hospital. Check your product sheet in myhbf to see what restrictions may apply. Ambulance cover Depending on your level of cover, we cover emergency road transport anywhere in Australia when provided by the recognised state based ambulance organisation. Each state runs a little differently so here s what you need to know when processing any bills: If you live in VIC, SA, WA or NT and receive a bill for emergency ambulance transport, simply send it to us for processing If you live in NSW or ACT and have Hospital cover, you need to return your bill to your respective state/ territory ambulance levy scheme with your HBF member information. Alternatively, if you don t have Hospital cover, please send your bill to us for processing If you live in QLD or TAS, you are covered under your state based schemes and shouldn t receive any bill. HBF won t pay a benefit under the following circumstances: For transport to booked medical appointments For air ambulance services Where the benefit or cost is subsidised by a state scheme 9

12 HBF Extras cover: things you need to know Extras insurance helps you stay healthy by covering you for everyday services like dental, physio and optical. These services are generally not covered by Medicare, and without private health insurance you could incur large out-of-pocket expenses. 10

13 Understand your cover in advance The amount you can claim back (known as a benefit) depends on the level of cover you select. Nearly all Extras policies only cover services to a limited extent, which means you ll usually pay for some of the service yourself. Benefits are usually a set amount, or calculated as a percentage of the service cost. To find out exactly how much you ll get back for an upcoming treatment, you can check your cover in myhbf. Keep track of your annual limits An annual limit is the maximum amount of money you can claim for a particular service within a year. Each person on your policy will have their own annual limits. For most Extras services, annual limits reset on 1 January. If you ve switched health funds and you ve already used some of your benefits, we ll adjust the balance of your annual limits to reflect this. The same applies if you ve changed your level of HBF cover. To find out your annual limits usage, login to myhbf. Approved providers HBF benefits are only paid for services and programs provided by HBF approved providers, who must be registered with their government registration board (where applicable) and who must practise solely and exclusively in private practice, except where HBF decides otherwise. Exclusions on benefits HBF is unable to pay benefits for the following: If your membership is unfinancial at the time of treatment or service If you re claiming for treatment,services or goods provided outside of Australia Before a treatment or service has been received If a claim is not lodged within two years of the date of service On internet purchases, except for pharmaceuticals, some appliances, glasses or contact lenses from an HBF approved provider that operates in Australia For Extras services where Medicare would pay a benefit Any service that is listed as an exclusion on your policy Rewarding member loyalty Some annual limits are based on the length of your cover, which means you may see an increase after your first year. For more information, refer to your product sheet. Other useful information Saver Flexi Extras and Flexi Extras: swapping services If you ve got a Saver Flexi Extras or Flexi Extras policy and you choose to swap the services you re covered for, new benefit levels, waiting periods and annual limits will apply to the services you select. For example, if you swap from chiropractic to physiotherapy, you may need to serve the waiting period for physiotherapy, and you will have a new benefit level and annual limit. Orthodontic benefits for banding A benefit is not paid for orthodontic treatment commenced during the waiting period. The benefit for banding is for the full course of treatment and includes all associated treatment (such as removable appliances and/or adjustments) following the fitting of the appliances. The benefit for banding varies depending on your treatment and the associated item numbers. It s best to contact us in advance to discuss your treatment and how this will impact you. Dental benefit restrictions The benefit we pay on some dental items may be restricted if it s performed in conjunction with other specific dental services, or if a service is received more than once in a specified period of time. Also, benefits are only paid for medically necessary bleaching and procedures undertaken in the surgery; we don t pay a benefit for home bleaching. Optical benefits Please note that when purchasing glasses or contacts, your HBF benefit applies to the calendar year when you order them, not when you collect them. For example, if you order your glasses in December but don t receive them until January, your benefit will be calculated from your current annual maximum. 11

14 Managing your policy If you ve got a question about changing or managing your HBF health cover, this is where to start. Adding or removing people from your policy Cancelling your policy How dependants cover works Ordering a member card Making changes to your cover Contact us for any of the following, and we ll tell you if you need to supply any extra information and if additional waiting periods will apply to your cover: Add a new partner You ll need to upgrade from a Singles/Parent Plus to a Couples/Family policy. Remove a partner in the case of divorce or separation. Add dependants such as foster children, adopted children, children under your guardianship or children under 25 who are returning to full-time study. Add a new baby If you do this within two months of your baby s birth, your child will be covered immediately from their date of birth and won t have to serve any new waiting periods, this is provided the parent has completed their waiting periods. We want you to be sure that you ve chosen the policy that best suits your needs, so you have a 30-day cooling-off period from the start date of your new policy. If you cancel your policy within the cooling-off period, and provided you haven t made a claim on your new policy, you ll receive a refund for the premiums you ve paid. On most Family or Parent Plus policies your children will be covered at no extra charge until the end of the year they turn 18, * unless they re married or in a de facto relationship. At HBF we also choose to cover your children up to the age of 25, provided they re studying full-time and aren t married, in a de facto relationship or earning more than $24,500 in a calendar year. HBF cards will be given to all adults on your policy. You can also request additional cards for any dependants listed on your policy. Likewise, if you lose your HBF card, you can order a free replacement via myhbf. Log in to myhbf to make changes to your personal details. Alternatively, please contact us if you need to make a change to your level of cover. We ll be happy to discuss options and find a solution that best suits your needs. As part of our core purpose to provide our members with affordable and effective health insurance, HBF reserves the right to make changes to our products, benefits and terms and conditions from time to time. If this occurs, HBF will notify all policyholders a reasonable time in advance of any changes that might be detrimental to your interests. *For GMF product holders, a person is considered a dependant until they turn 21 12

15 What to do if you re moving interstate HBF provides comprehensive cover across Australia. Premiums and some benefits (like ambulance cover) vary from state to state, so we recommend you contact us to change your address and to see if your level of cover best suits your needs. Payment methods As an HBF member, there s a range of flexible payment methods available to you: Direct Debit: Our most popular and most convenient option. Your premiums are deducted fortnightly, monthly, quarterly, half yearly or yearly from your bank, building society, credit union or credit card account (MasterCard or Visa). It is your responsibility to ensure your direct debit details are up to date, as failure to do so may deem your policy unfinancial Prepay online: You can quickly and securely pay your premiums online via myhbf Telephone: Call us on Fallen behind in payment? If your premiums are more than two months in arrears, you won t be able to claim any benefits. If you decide to rejoin at a later date, waiting periods may apply. Suspending your If you re planning on going overseas for an extended period of time, cover while overseas you can suspend your cover. This way, when you return, you can pick up where you left off so you don t have to re-serve waiting periods, lose GapSaver benefits or be affected by the Lifetime Health Cover penalty. Different suspension time periods apply for HBF products so contact us for full conditions. Once you return to Australia, you ll need to: Contact us within two months to resume your cover. Provide proof of the dates you left and returned to Australia. We accept boarding passes or an international movement card. To be effectively covered, your premium will commence on the day you arrive back in Australia, not the day you resumed your cover. Using GapSaver cover You can check your GapSaver balance at any time in myhbf, and change your GapSaver claiming preferences too. This means you can choose to receive your GapSaver benefits automatically when you can claim, or manually on a claim-by-claim basis. Things to be aware of: GapSaver can t be used for any services not covered on your policy, any out-of-pocket expenses incurred after your annual limits have been reached, or where you haven t completed the standard waiting periods GapSaver is not available to members on GMF or Overseas Visitor Cover only. Overseas Visitor Cover members who hold an Extras product are able to purchase GapSaver but it can only be used towards Extras out-of-pocket expenses. Your GapSaver balance is non-refundable if you cancel your policy. 13

16 Our Privacy Policy We are HBF Health Limited ABN which provides private health insurance. References to HBF us, we or our include HBF, HBF Health, and other business names, and where the context requires, other related bodies corporate (collectively HBF). At HBF we comply with the Privacy Act 1988 (Cth) (Privacy Act).We respect the privacy of your personal information. We process personal details on a daily basis and are committed to ensuring that the privacy and security of personal information remains protected. Personal information is information or an opinion about an individual, or an individual who is reasonably identifiable, whether the information or opinion is true or not, or is recorded in a material form or not. It includes your name, age, gender and contact details as well as your sensitive information (which includes health information). Collection, use and disclosure of your personal information HBF collects and uses your personal (including sensitive) information (Information) to provide you with private health insurance and health and wellness related services, including to: manage our ongoing relationship with you; administer, process and audit private health insurance premiums and claims and pay benefits; assess your suitability for, enrol you in and administer health and wellness related services such as chronic disease management programs and health management programs; provide you with access to smartphone applications and website portals in relation to managing your health, your private health insurance membership and your relationship with us; conduct market research that informs the strategic direction of HBF, by seeking to understand ways to improve the health of members, the effectiveness of marketing activities, the member experience and the products and services HBF offer; manage, review and develop our private health insurance products and related services whether provided by us or other parties on our behalf; manage, review, develop and improve our business and operational processes, including training and systems, provided by us or other parties on our behalf; resolve any legal and/or commercial complaints or issues including compensation recovery; prevent, detect and follow up fraudulent or invalid claims or misrepresentations; meet legislative requirements relating to private health insurers; and perform any of our other functions and activities relating to our private health insurance and health and wellness businesses. HBF may collect your Information from you, the person responsible for the management of your private health insurance membership (Principal Policyholder) or a person authorised to provide us this information on your behalf in order to, amongst other things, provide you with private health insurance cover and pay you benefits. HBF may also collect your Information from one of its related bodies corporate (in order to, amongst other things, investigate potential fraudulent claims and misrepresentations) or a third party such as a health service provider, broker or employer (in order to, amongst other things, provide you with private health insurance cover and pay you benefits). HBF also engages third parties to carry out functions on behalf of HBF (such as claims administration, membership management services, facilitators to organise and manage hospital, doctors and health service providers, providers of claims advice and chronic disease management program providers) and they may collect your Information from you and pass this Information to HBF. 14

17 In order to carry out the purposes described in this statement, HBF may disclose your Information to persons or organisations such as: other related bodies corporate; our brokers and agents who refer your business to us; our service providers (who may provide some services directly to you on our behalf) including mail houses, market researchers, manufacturers of membership cards, claim administrators, claim auditors, claim advisers, our membership management service providers, the facilitators of our arrangements with health providers and IT support (including by way of cloud computing); our professional advisors; health and wellness service providers (such as hospital, our pharmacies, general practitioners, allied health providers, and chronic disease and health management program providers); payment system operators and financial institutions; persons authorised by you, including other persons covered by your private health insurance membership, and your agents and professional advisors such as legal practitioners; if you have a compensation claim, the insurer or statutory body responsible for paying your compensation claim or compensation recovery organisations; if you have an overseas visitors product, your educational institution, migration agent or broker; if you have a corporate private health insurance product, your employer; regulatory bodies and government agencies (such as the Department of Health & Ageing, the Private Health Insurance Ombudsman and Medicare Australia); parties involved in a prospective or actual transfer of any part of our assets or business; and other parties to whom we are authorised or required by law to disclose information. These third parties may also collect your Information directly from you. HBF may transfer your Information overseas in the following circumstances. At your request, HBF may provide a transfer certificate or claims history containing your Information to an overseas insurer nominated by you. By making such a request, you give consent for your Information to be transmitted overseas in these circumstances. HBF also sometimes use service providers who either host or store personal information overseas. This means HBF may transfer Information about you between countries to those service providers for the purposes described in this statement. In the event HBF transfers your Information outside Australia, we will comply with the requirements of the Privacy Act that relate to transborder data flows. If you are not the Principal Policyholder of your private health insurance membership, HBF may also disclose your personal information to the Principal Policyholder as part of administering the membership and paying benefits. This may include the disclosure of sensitive information about benefits claimed by you under your policy. If the Principal Policyholder has authorised his/her spouse/partner to administer the private health insurance membership, HBF may disclose the Principal Policyholder s Information to his/her spouse/partner. If you do not provide Information requested of you to HBF, we may be unable to provide you with private health insurance cover, pay you benefits, assess or waive lifetime health cover loading or apply an entitlement to the Australian Government rebate on private health insurance as a premium reduction. 15

18 Marketing HBF may use your Information to contact you (including by telephone call, text message or ) in relation to other products or services we think may be of interest to you. This may include our own products and services, the products or services of any related bodies corporate or the products or services of third parties. By way of example, HBF may contact you in relation to a general insurance offering that we think may be of interest to you. Personal information is shared between related bodies corporate. Related bodies corporate may use your personal information to contact you (including by telephone call, text message or ) in relation to their products or services or the products or services of third parties. HBF and its related bodies corporate may contact you about products and services we think may be of interest to you during the period you are a private health insurance member and after you cease your private health insurance membership. For example, if you cease your private health insurance cover with us, HBF may contact you about its private health insurance offering under other brands. You may opt-out of receiving marketing information from HBF and its related bodies corporate at any time by: calling us on ; ing us on hello@hbf.com.au ticking the box on the relevant form when you apply for a product or service. Service Related Communications Where you provide us with an address or use our member web portal myhbf, we send most service related communications to you by . Service-related communications are the essential things you need to know about your cover, like annual tax statements and changes to premiums and policy details. You can manage how we communicate with you by contacting us as detailed in the previous section. If you are the Principal Policyholder As the Principal Policyholder, you must ensure that your spouse/partner and dependent children (if any) are aware of, and consent to, how their Information is handled under this Privacy Statement and the HBF Privacy Policy (current as at 1 July 2015) which can be accessed at (Privacy Policy). You and your spouse/ partner and dependent children (if any) should not provide us with any Information unless you and they consent to it being handled in accordance with this Privacy Statement and the Privacy Policy. By: taking out or maintaining your private health insurance policy; or providing your Information to HBF, or you or your spouse/partner and/or dependent children (if any) providing their Information to HBF, for whatever purpose, you consent to, and warrant that your spouse/partner and/or dependent children have consented to, HBF collecting, using and disclosing your and their Information, however collected by us, in accordance with this Privacy Statement and the Privacy Policy. Access to your information and contacting us HBF will allow you to access and correct personal information we hold about you as required by law. If you have any queries about how HBF handles your personal information, or would like to request access to that information, please contact us: By mail - HBF Privacy Officer, GPO Box C101, Perth WA 6839; or By telephone If you have any concerns or complaints about the manner in which your personal information has been collected or handled by HBF, please contact the Privacy Officer using the details above. 16

19 The Privacy Policy contains further information about how HBF generally handles your personal information including: how you can access and correct personal information we hold about you; and how you can submit a privacy complaint to HBF and how HBF will deal with your complaint. How your rights are protected Our obligation to you under the Private Health Insurance Code of Conduct We will endeavour to: work towards improving the standards of the practice and service within HBF, provide information to our members in plain language promote better informed decisions about our private health insurance products and services: by ensuring that our policy documentation is full and complete; by providing an effective and clear verbal or written explanation of the contents of the policy documentation; by ensuring that our employees providing information on health insurance are appropriately trained provide information to members on their rights and obligations under their relationship with HBF, including information on the Code; and provide members with easy access to our internal dispute resolution procedures, which will be undertaken in a fair and reasonable manner and advise them of their rights to take an issue to an external body such as the Private Health Insurance Ombudsman. How the Code helps our members Apart from promoting improved standards in clarity and usefulness of information given to members, the Code is designed to help solve problems between members and us. We have a complaints handling process for members who may have a dispute with HBF. Examples of disputes include contents of advertising by HBF, representations made to the member when they purchase a product, features of their product, and benefits paid under their product. How HBF handles complaints Here s what you should do if you have a complaint about HBF: 1. The best thing to do is talk to us first, so we can see what we can do to rectify the issue 2. If you re not satisfied with the outcome you can ask to have it reviewed by the Internal Dispute Resolution process. Address your complaints to: HBF Dispute Resolution Manager, GPO Box C101, Perth, WA, 6839 or by ing memberexperience@hbf.com.au 3. If a resolution is still not reached to your satisfaction you can contact: Private Health Insurance Ombudsman, GPO Box 442, CANBERRA ACT 2601 Phone: phio.info@ombudsman.gov.au Visit: ombudsman.gov.au forward the problem to a health care complaints commission or fair trading body in your state of residence, or Report HBF s behaviour to the Australian Competition and Consumer Commission. HBF Fund Rules To obtain the HBF Fund rules visit hbf.com.au/fundrules or contact us. How can I get a copy of the Code? A full copy of the Code is available at privatehealth.com.au/codeofconduct or by calling us. 17

20 We re here to help you understand and make the most of your cover. Visit a branch For branch opening hours, please visit hbf.com.au/contact-us Go to hbf.com.au Call us on For call centre opening hours, please visit hbf.com.au/contact-us Postal address GPO Box C101 Perth 6839 Stay in touch Find us at HBF Health HBF Health Limited ABN The information in this brochure is correct at time of print. Minor changes may have occurred since that date. If major changes occur, the brochure will be replaced. Details of any minor changes can be obtained from HBF on request. General insurance issued by Insurance Australia Limited ABN AFSL (IAL) trading as CGU Insurance. HBF Health Limited ABN AR No is an authorised representative of IAL. This is general advice only and does not take into account your personal circumstances. Please consider the Product Disclosure Statement available from HBF on or from hbf.com.au when deciding whether to buy or hold these products. HI /07/18