guide to · 2020-07-03 · the peace of mind of our members. We pride ourselves on our coverage for wellness initiatives including dental, optical, physio, chiro, antenatal education

guide to cover _

peace of mind when

JULY 2020

you need it most

CONTACT US DIRECTLY

Call: 1800 804 950

Email: [email protected]

Visit our website: hciltd.com.au

Fax: 1800 643 969

Mail: PO Box 931, Burnie TAS 7320

Or, come into our office: 25 Cattley Street, Burnie TAS 7320

Why should I have private health cover? 3Health cover for you 4Hospital Care 6Hospital Waits 10I need to go into hospital 12Levels of excess 14Lifetime Health Cover Loading 15Our Extras Products 16Extras Levels of Cover 17Healthy Extras 18Premier Extras 20Active Life Extras 24Extras Waiting Periods 25Packaged Cover 26How to Claim 28Best Doctors 30Smile.com.au 32Important Info 34Useful links and glossary items 37

contents

1

happy _ healthy & worry free HCI gives you the confidence and

flexible coverage to be your best self. Happy, healthy and worry free.

At HCI we are committed to providing you with access to the health care services that best suit you and your family, it’s that simple.

We are here to ensure that private health insurance is easy to understand and delivers both comprehensive and affordable health care.

As a member owned and not-for-profit insurer, we consider your needs first - we are here for the peace of mind of our members.

We pride ourselves on our coverage for wellness initiatives including dental, optical, physio, chiro, antenatal education and much more.

We have been supporting our local communities since 1939. HCI has experienced first hand the trials and tribulations our members have faced. As one of Australia’s oldest health funds we are proud to say we have been there for generations of families.

We are here to help you face to face, over the phone, via our online claiming app and via email. Let us work with you to guide you through the process of selecting the cover you need.

In this booklet you will find all the information you need to make an informed decision about your cover including the Federal Government insurance rebates and incentives. The information detailed herein is subject to change from time to time and we will notify you of any changes to your policy as and when they occur.

In January 2019, HCI

turned 80!

Choice With private health you can choose your doctor, the hospital you want to be treated in and a

private room if available.

Save moneyIf you take out private hospital insurance you

may be able to save money on:

1. The Medicare Levy Surcharge (MLS): High income earners can avoid the MLS altogether by taking out the appropriate level of hospital cover. See page 35 for more information on the MLS.

2. The Lifetime Health Cover loading (LHC): By taking out hospital cover before you turn 31 you can avoid paying the LHC. See page 15 for more information on LHC.

Reduce waiting periods

For non-emergency treatment, average

waiting times are lower as a private patient.

Benefits on more servicesDepending on your level of extras cover you can claim

benefits on most extras services like massage, optical,

dental and more.

Why should I have private health cover?

2 3

Choose the right health cover mix for you with HCI. We try to keep it really simple with our ME, WE and US cover options, it’s health care designed with you in mind.

MEhealth care

for team me

WEhealth care for me and my partner

UShealth care for

me and my kids (up to age 25 if full

time student)

ME+UShealth care for me, my partner and all our kids

(up to age 25 if full time student)

All of ushealth care for me, my partner and all our kids

(aged 23-25)

US+health care for

me and my kids (aged 23-25)

Gold Hospital with Premier Extras equals complete peace of mind with your HCI.

health cover for you _

hospital cover GOLD HOSPITALHCI offers comprehensive hospital cover with a range of excess options. It’s that simple.

SILVER PLUS HOSPITALQuality cover without pregnancy, giving you access to a range of treatments and care, while saving you more.

BRONZE HOSPITALAn exclusionary cover that won't break the budget. Ideal for those just starting out.

For the full breakdown go to pages 6-7.

extras cover PREMIER EXTRASAvailable in HCI’s Gold Hospital with Premier Extras package.

HEALTHY EXTRASProvides wide-ranging cover on a broad range of extras services.

ACTIVE LIFE EXTRASExtras cover that doesn’t break the budget.

For the full breakdown of services covered and annual limits see pages 16-25.

packaged cover GOLD HOSPITAL OR SILVER PLUS HOSPITAL WITH PREMIER EXTRAS

For more details go to pages 26-27.

Note: Premier Extras is only available In HCI's Gold Hospital with Premiers Extras package or when combined with Silver Plus Hospital and Premier Extras.

Or, You Choose!Choose to combine Gold Hospital, Silver Plus Hospital or Bronze Hospital with Healthy Extras or Active Life Extras.

Choose who will be covered:

4 5

BRONZE HOSPITAL

HCI’s Bronze Hospital cover is an exclusionary product that won’t break the budget.This product is ideal for those who want lower costs and only need cover for a select group of services. You may still be able to access the public system for any services that are not covered. If you’re just starting out, this might be the cover for you!

It should be noted whilst Gold Hospital cover is comprehensive, the Bronze Hospital cover does have exclusions and limitations.

If you are going into hospital, please check with HCI first to ensure your are covered.

GOLD HOSPITAL, SILVER PLUS HOSPITAL AND BRONZE INCLUDED (AND EXCLUDED) PROCEDURES:

GOLD HOSPITAL

SILVER PLUS

HOSPITALBRONZE

HOSPITALRehabilitation ✔ ✔ (R) ✔ (R)

Hospital psychiatric services ✔ ✔ (R) ✔ (R)

Palliative care ✔ ✔ (R) ✔

Brain and nervous system ✔ ✔ ✔

Eye (not cataracts) ✔ ✔ ✔

Ear, nose and throat ✔ ✔ ✔

Tonsils, adenoids and grommets ✔ ✔ ✔

Bone, joint and muscle ✔ ✔ ✔

Joint reconstructions ✔ ✔ ✔

Kidney and bladder ✔ ✔ ✔

Male reproductive system ✔ ✔ ✔

Digestive system ✔ ✔ ✔

Hernia and appendix ✔ ✔ ✔

Gastrointestinal endoscopy ✔ ✔ ✔

Gynaecology ✔ ✔ ✔

Miscarriage and termination of pregnancy ✔ ✔ ✔

Chemotherapy, radiotherapy and immunotherapy for cancer ✔ ✔ ✔

Pain management ✔ ✔ ✔

Skin ✔ ✔ ✔

Breast surgery (medically necessary) ✔ ✔ ✔

Diabetes management (excluding insulin pumps) ✔ ✔ ✔

Heart and vascular system ✔ ✔ ✘

Lung and chest ✔ ✔ ✘

Blood ✔ ✔ ✘

Back, neck and spine ✔ ✔ ✘

Plastic and reconstructive surgery (medically necessary) ✔ ✔ ✘

Dental surgery ✔ ✔ ✘

Podiatry surgery (provided by a registered podiatric surgeon) ✔ ✔ ✘

Implantation of hearing devices ✔ ✔ ✘

Cataracts ✔ ✔ ✘

Joint replacements ✔ ✔ ✘

Dialysis for chronic kidney failure ✔ ✔ ✘

Pregnancy and birth ✔ ✘ ✘

Assisted reproductive services ✔ ✘ ✘

Weight loss surgery ✔ ✘ ✘

Insulin pumps ✔ ✘ ✘

Pain management with device ✔ ✘ ✘

Sleep studies ✔ ✘ ✘

(R) This is a Restricted Service.

GOLD HOSPITAL

SILVER PLUS HOSPITAL

+ COMBINE WITH YOUR CHOICE OF EXTRAS COVER TO CREATE YOUR UNIQUE PACKAGE

HCI’s Gold Hospital cover ensures you can have total confidence in your hospital cover.Gold Hospital does not have any exclusions or limitations when it comes to the necessary treatment. As long as you have served the relevant waiting periods and the service is eligible for a Medicare benefit HCI has you covered.

Be confident that you are fully covered with HCI's Gold Hospital.

HCI’s Silver Plus Hospital cover has all the benefits of Gold Hospital with pregnancy and some other infrequent procedures removed.If your family is complete or you are childfree and not planning a family in the near future this product is for you. You’ll still be covered in the event of an unexpected accident or illnesses with access to the best possible treatment and care.

Please note Silver Plus Hospital does have some exclusions and restrictions (see page 7 for details).

If you are going into hospital, please check with HCI first to ensure you are covered.

EXCESS OPTIONS EXCESS OPTIONS EXCESS OPTIONS$250 $250NIL $750$500 $500

hospital care _

Private hospital insurance with HCI enables you to take more control over how, where and by whom you are treated. HCI is part of the Australian Health Service Alliance (AHSA). Through the AHSA our members have access to a wide range of doctors and hospitals Australia wide.

HCI knows that choice is important to our members; knowing when you will be treated, by which doctor, and especially, where you will be treated.

HCI provides access to more than 500 private hospitals and 30,000 doctors across Australia.

Visit hciltd.com.au/search-doctor to find a doctor near you.

$750 $750

6 7

HCI has you covered with up to

100%hospital accommodation costs

WHAT’S COVERED*:

Up to 100% of hospital accommodation costs and theatre fees in all contracted hospitals and day surgery facilities in Australia.

Up to 100% of the cost of surgically implanted prostheses (as listed by the Federal Government).

Private room accommodation (if available).

Up to 100% of the cost of most hospital prescriptions relating to the admission. (Subject to hospital agreement details).

Dental theatre costs for surgical tooth extraction by an oral surgeon.

100% of the cost of the difference between the Medicare refund and the Commonwealth Medical Benefit Scheme (CMBS) fee for medical services provided during a hospital admission.

Up to 100% of the cost of medical services provided during a hospital admission where the doctor charges above the Commonwealth Medical Benefit Scheme (CMBS) fee and chooses to use Access Gap Cover.

WHAT’S NOT COVERED:

Cosmetic Surgery.

Extra services beyond the hospital treatment plan.

Personal expenses like phone calls, newspapers and TV rental.

Hospital benefits where the professional service performed is not eligible for Medicare benefits.

Pharmaceutical items supplied or prescribed on discharge.

Medical Gap.

Surgically Implanted Prosthesis Gap.

Medical treatment provided in doctors’ rooms out of hospital.

* Coverage applies to eligible services only. See table on page 7 for inclusions and exclusions.

Thinking aboutstarting a family?Or want to build your confidence and knowledge as a new parent?

Health Care Insurance is excited to partner with Nourish Baby.

THE NOURISH BABY PROGRAM IS SUITABLE FOR HEALTH CARE INSURANCE MEMBERS WITH GOLD HOSPITAL COVER WHO ARE:- Planning to have a baby in the near future;- Are already pregnant;- Have a newborn baby;- Or have a toddler.

WHAT’S INCLUDED IN THE PROGRAM:

Access To Nourish Baby OnlineNourish Baby Online is an online antenatal and early parenting education platform, providing informative courses to support you every step of the way. The online courses are fun and easy to follow, featuring engaging videos, interactive, learning activities and knowledge checks.

The online courses cover the following topics:- Pregnancy health and fitness- Antenatal and postnatal pelvic health- Feeding from birth up to age 3- Emotional health and wellbeing- Parenting and relationships- Baby and toddler growth and development- Sleep and settling from birth up to age of 3

Telephone supportDelivered by infant and toddler sleep experts Safe Sleep Space. Following the birth of your baby, members receive two x 20 minute phone consultations at approximately 3 weeks and 3 months of age.

Learn more: https://hciltd.com.au/nourish

across Australia

HCI provides access to more than

30,000

8 9

HCI will always inform you of any waiting periods that apply to your policy.

HCI does not apply waiting periods to accidents. Psychiatric and rehabilitation services only require a two month waiting period.

New and existing members of HCI may be able to upgrade from a policy that has restricted benefits on psychiatric hospital services to a policy with full cover for psychiatric hospital services.

This upgrade can be done without serving the standard two month wait. This upgrade can only be used once in a person’s lifetime, regardless of whether you have transferred between insurers.

WHO HAS WAITING PERIODS? New members: If you are taking out private health insurance for the first time you will be required to serve full waiting periods before services can be claimed. This includes people joining as dependants on an existing member’s policy who have not been financial members of a health fund within the previous two months.

Existing members: If you are upgrading to a higher level of cover you will need to serve waiting periods on the higher level of benefits.*

Transferring from another fund: If you switch to HCI from another health fund and within 2 months of ceasing your membership with your previous fund, join a similar level of cover with HCI you will receive the same level of benefits and incur no new waiting periods.

If you transfer to a level of HCI cover that provides benefits for services not previously covered by your previous health fund you will need to serve waiting periods for the additional services not previously covered or the higher level of benefits.#NO new wait times

when you

switchto HCI from

another health fund** On an equal or lower level of cover

* Members who are serving waiting periods on higher levels of benefit will receive the same annual limits as their previous health fund until waits have been served. For example, if you received a $500 annual limit on a service with your previous fund and HCI offer a higher limit for that service, HCI will still honour your previous fund’s limit until you have served waits on the higher benefit.

# If you have used all of a benefit limit with your previous health fund that benefit usage will transfer over to HCI. Where the benefit limit has been used HCI benefits may be reduced. HCI benefits are on a calendar year cycle.

PRE-EXISTING CONDITION WAITING PERIODSA pre-existing condition is any ailment, illness or condition you have had at anytime in the last 6 months. This can be either identified and diagnosed or unidentified and undiagnosed.

The pre-existing condition waiting periods apply to new members and existing policy holders upgrading their policy.

An independent medical practitioner appointed by HCI will form an opinion as to whether any signs or symptoms existed at any time during the six months prior to taking out hospital cover, or, upgrading to a higher level of cover.

If you are planning to go into hospital and have had less than twelve months hospital cover with HCI please contact us beforehand so we can determine whether the pre-existing waiting period applies.

If a condition is deemed pre-existing by an independent medical practitioner benefits are not payable in the first 12 months of a membership. This means that, in the opinion of an independent medical practitioner (not your doctor), any signs or symptoms of a condition did exist in the six months prior to taking out hospital cover or upgrading to a higher level of cover.

OBSTETRICSObstetrics and birth related services are covered under HCI's Gold Hospital. A 12 month waiting period applies to all pregnancy and birth related services including IVF and assisted reproductive services.

Check with HCI before proceeding with IVF or similar treatments to confirm what services you will be required to pay for and that you have completed any required waiting periods. Only an admission to hospital can be covered under private hospital insurance.

Always check with the hospital, HCI and your doctor before proceeding with a hospital booking to ensure you will be covered and to discuss what costs you may incur.

MAKING YOUR POLICY BABY READYIf you already have a single parent or family policy there will be no waiting periods for the baby provided your policy contributions are up to date and the new child is added to your plan within 2 months of their birth.

If your policy covers just you or just you and a partner, you will need to contact us to upgrade to a single parent or family policy from the birth date.

hospital waits _

SERVICESWAITING PERIOD

HOSPITAL TREATMENT OR HOSPITAL SUBSTITUTE

Pre-existing conditions 12 months

Obstetrics (pregnancy related services) 12 months

IVF and assisted reproduction technology 12 months

Sterilisation including reversal 12 months

Psychiatric care, rehabilitation or palliative care 2 months

All other hospital treatment services 2 months

waiting periods

10 11

Under the Commonwealth Medical Benefits Schedule (CMBS) fees are determined and accordingly split between HCI and Medicare. Between HCI and Medicare we cover 100% of the CMBS. Prior to treatment it is imperative to discuss with your doctor if there will be any out of pocket expenses. If your doctor charges over the CMBS fee HCI cannot cover these expenses.

HCI has agreements with more than 500 private hospitals and day stay surgery hospital facilities around Australia. For a comprehensive list of our contracted hospitals in your local area visit: hciltd.com.au/search-hospital

It’s important to remember that as an Australian resident, Medicare covers public hospital treatment and emergency patients will normally go to a public hospital with Intensive Care Units.

ACCESS GAPIn the event you need specialist care in hospital your doctor can use HCI’s Access Gap Cover. Access Gap is a simple billing system that aims to eliminate out-of-pocket expenses all together, or, reduce them considerably. Through Access Gap your doctor can let you know exactly what you have to pay prior to treatment.

Doctors can choose to opt in or out of Access Gap on a patient by patient basis. They may choose to use Access Gap for one patient but not for another.

Doctor’s may not be publicly listed on the AHSA as being Access Gap doctors but can still be participating in the scheme. It is worth asking your doctor if they will treat you through Access Gap.

To find an Access Gap doctor near you visit: www.ahsa.com.au/web/doctors/information/ doctor_search

GAP COVER AND SURGICALLY IMPLANTED PROSTHESESSurgically implanted prostheses are sometimes required during a medical procedure, such as a replacement lens for a cataract surgery, an artificial hip joint, a pacemaker, or a heart valve.

For medical procedures covered by Medicare, HCI fully cover the cost of at least one prosthesis – this is referred to as a ‘no gap’ prostheses. There are however some items listed on the Prostheses Schedule that are not, or only partially covered. Please review the list with your doctor prior to surgery.

Ask your health fund: Does my policy cover me for this procedure

or service?

Under my policy, do I have to pay an excess?

Will I have to pay extra for my hospital accommodation, my doctors fees and those of any one else involved with my treatment, or is it covered under my policy?

If I have to pay extra, when and to whom do I pay it?

Ask your hospital: Does this hospital have an agreement with my

private health fund?

Will I have a gap to pay for my hospital accommodation?

What else do I have to pay for out of my own pocket during my time in hospital?

your Hospital Gap Checklist _Ask your treating doctor or specialist:

How much is your fee?

Will your fee be covered under my private health insurance or will I have to pay a gap out of my own pocket?

If I have to pay a gap, how much will that be?

What if I can't afford to pay this gap?

Which other doctors and medical staff will be involved in my treatment?

How can I get information about their fees and if they will be covered by my private health insurance?

How will I know how much I have to pay out of my own pocket all up?

Will I receive just one bill?

Am I having a surgically implanted device or prosthesis? Will the cost of this be covered by my health fund or will I have to pay a gap?

What is the Medicare Benefits Schedule item number for the procedure I am to have?

I need to go into hospital _

Remember to ask your doctor:Will I have any out-of-pocket expenses? Please provide a formal quote of these costs.

Will you treat me under the Access Gap Cover?

Will any assisting doctors also use the Access Gap Cover and if so, how can I obtain a quote for their services?

Search for doctors at: hciltd.com.au/search-doctor

12 13

OVERNIGHT ADMISSIONS

PER ADULT EXCESS APPLICATION OF HOSPITAL TREATMENT EXCESS

GOLD HOSPITAL

NIL EXCESS

GOLD HOSPITAL

$250

GOLD HOSPITAL

$500

GOLD HOSPITAL

$750

SILVER PLUS

HOSPITAL $250 / $500

/ $750

BRONZE HOSPITAL

$750

Note the maximum annual excess per policy for all categories except ME (single person policies) is double the per adult excess.

ME N/A YES YES YES YES YES The excess is payable when admitted to hospital overnight.

WE N/A YES YES YES YES YES The excess is payable for each person admitted to hospital overnight.

ME+US N/A YES YES YES YES YESThe excess is payable for each of the first two adults admitted to hospital overnight.

ALL OF US N/A YES YES YES YES YESThe excess is payable for each of the first two adults admitted to hospital overnight.

US N/A N/A YES YES YES YESThe excess is payable for each of the first two adults admitted to hospital overnight.

US+ N/A N/A YES YES YES YESThe excess is payable for each of the first two adults admitted to hospital overnight.

SAME DAY ADMISSIONS

WAIVER OF EXCESS FOR SAME DAY ADMISSIONS

N/A YES YES NO NO NO

For Gold Hospital $250 and $500 products HCI will waive the excess for same day procedures. For Silver Plus Hospital $250, $500, $750 and Bronze Hospital $750 products, the full excess is payable for both same day and overnight admissions.

HOSPITAL COVER EXCESS OPTIONS You can choose to not pay an excess under a policy for Gold Hospital cover. Having a hospital excess however will reduce your premium, the greater the excess the lower the premium. There is no excess for dependent children under the age of 18 years. The excess per adult is the maximum payable per person in any calendar year.

If a person covered is under the age of 18 but not a dependant on a single or couple policy they will be required to pay the excess.

Lifetime Health Cover Loading (LHC) is a government initiative that started on July 1st 2000. It is a financial loading that can be payable in addition to your private health insurance hospital cover premiums. One of the benefits to joining HCI earlier in life is minimising or eliminating the LHC all together, compared to someone who takes out hospital cover later in life.

If you take out hospital cover by July 1st following your 31st birthday you will not have to pay LHC. If you take out hospital cover after this date you may be required to pay a 2% loading for every year you are over 30. For example, if you wait until you are 40 to take out hospital cover you could be paying an extra 20% on your base premium hospital rate.

If you are a new migrant to Australia, and are aged 31 or over, you will not have to pay an LHC loading if you purchase hospital cover within 12 months of being registered for full Medicare benefits. If you delay purchasing hospital cover for more than 12 months after your registration, you will have to pay the 2% more for each year you are aged over 30 when you purchase your hospital cover.

Any LHC loading that you pay will be removed from your hospital cover premium after you have held hospital cover for 10 continuous years. However, if you cancel your hospital cover after the LHC loading has been removed, you may become liable to pay an LHC loading again in the future.

Visit www.ato.gov.au/Individuals/Medicare-levy/Private-health-insurance-rebate/Lifetime-health-cover/ to find our more information about LHC and www.privatehealth.gov.au/dynamic/lifetimehealthcover.aspx to calculate your level of LHC.

lifetime health cover loading _

PERMITTED DAYS WITHOUT HOSPITAL COVER:

You are able to stop your hospital cover for a total of 1094 days in your lifetime without it effecting your certified entry age. However, after the 1094 days of absence you may be subject to the LHC.

14 15

SERVICESHEALTHY EXTRAS

PREMIER EXTRAS

ACTIVE LIFE

Acupuncture ✔ ✔ ✔

Ambulance ✔ ✔ ✘

Audiology (Hearing Tests) ✔ ✔ ✘

Chiropractic ✔ ✔ ✔

Dental – General ✔ ✔ ✔

Dental – Major (excl. Orthodontics) ✔ ✔ ✔

Dental – Orthodontics ✔ ✔ ✘

Diabetes Education ✔ ✔ ✘

Diabetes Australia Membership ✘ ✔ ✘

Dietetics ✔ ✔ ✘

Eye Therapy (Orthoptics) ✔ ✔ ✘

Funeral* (eligible members only) ✘ ✔ ✘

Health Screening Checks ✔ ✔ ✘

Hearing Aids ✔ ✔ ✘

Home Nursing ✔ ✔ ✘

Hydrotherapy ✔ ✔ ✘

Laser Eye Surgery ✘ ✔ ✘

Medical Appliances ✔ ✔ ✘

Natural Therapy (incl. Remedial Massage) See separate table below

✔ ✔ ✔

Non-surgical Prostheses ✔ ✔ ✘

Occupational Therapy ✔ ✔ ✘

Optical ✔ ✔ ✔

Orthotics ✔ ✔ ✘

Osteopathy ✔ ✔ ✔

Pharmacy ✔ ✔ ✘

Physiotherapy ✔ ✔ ✔

Podiatry / Chiropody ✔ ✔ ✘

Psychology ✔ ✔ ✘

Quit Smoking Programs ✔ ✔ ✘

Speech Therapy ✔ ✔ ✘

Surgical Footwear ✔ ✔ ✘

Travel and Accommodation ✘ ✔ ✘

Weight Loss Programs ✔ ✔ ✘

* Funeral cover special conditions are on page 23

Extras levels of cover

NATURAL THERAPY INCLUDES:Chinese medicine (Consultation only)

Chiropractor

Remedial Massage

Myotherapy

Osteopathy

our extras products _

Claiming made easy so you can enjoy the more important things in life.

Note: Premier Extras is only available in HCI’s Gold Hospital with Premier Extras package.

HEALTHY EXTRAS

ACTIVE LIFE

Healthy Extras is your gateway to living your best life. pages 18-19

Active Life Extras is designed to give you cover for what you need right now. page 24

PREMIER EXTRASPremier Extras is only available when packaged with Gold Hospital or Silver Plus Hospital cover as a Premier Extras Package. pages 20-23

16 17

SERVICES EXTRAS LEVEL OF COVER

PHYSIOTHERAPY GROUP ANNUAL LIMIT $700

Physiotherapy - Annual Limit - Initial Services - Subsequent Services - Group Session

$700 $60 $25 $15

Hydrotherapy - Annual Limit - Consultation / Treatment

$100

$15

OTHER THERAPIES ANNUAL LIMIT $1,000

Podiatry / Chiropody - Annual Limit - Initial Consultation - Subsequent Consultations - Nail surgery (excludes inpatient

services)*

* Letter required from referring specialist

$300

$30 $25

$100

Orthotics (custom made) Annual Limit

$200

Eye Therapy (Orthoptics) - Annual Limit - Initial Consultation - Subsequent Consultations - Group Session

$200

$30 $25 $15

Speech Therapy - Annual Limit - Initial Consultation - Subsequent Consultations - Group Session

$400

$33 $25 $15

Dietetics - Annual Limit - Initial Consultation - Subsequent Consultations

$200

$33 $30

Occupational Therapy - Annual Limit - Initial Consultation - Subsequent Consultations - Group Session

$375 $33 $30 $15

Healthy Extras is your gateway to living your best life. This extensive extras cover leaves little room for concern. It will help you live the life you want, meeting your day to day needs, and will have you back up and running through life’s unforeseen situations. You can combine Healthy Extras with Silver Plus Hospital or Bronze Hospital for a more comprehensive cover, complete with a range of excess options, you will have satisfaction of knowing you’re putting your best foot forward.


AMBULANCE

For emergency transport provided by a registered ambulance provider within Australia

Cost

ALTERNATIVE THERAPIES GROUP ANNUAL LIMIT $500

Chiropractic / Osteopathic- Annual Limit - Initial service - Subsequent services

$500

$33 $25

Acupuncture- Annual Limit - Consultations

$500

$25

Remedial Message, Chinese Medicine and Myotherapy - Annual Limit - Consultations

$500

$27

DENTAL TREATMENT

Benefits are paid according to the Australian Dental Association item number used. Benefits are payable at 90% of cost to a set maximum per item. For an itemised quote please contact us.

GENERAL DENTAL ANNUAL LIMIT$1,000

(INCLUDING ENDODONTICS)

The maximum number of services in which a benefit will be paid on items 011-015 in total is 2 per year and 016-017 in total 2 per yearItem 011 - comprehensive oral examinationItem 121 - topical application of remineralisation agentItem 311 - removal of a toothItem 511 - metallic filling 1 surfaceEndodonticsWith Healthy Extras cover, you can also receive NO GAP on annual check up and cleans in the smile.com.au dental network!

$25$14$70$68

$500

MAJOR DENTAL $1,500

Crowns and BridgeworkPeriodonticsImplantsDentures (benefits are payable every 2 years)Orthodontics - Lifetime Limit - Annual Limit per person

$700$500$700$800

$1,800

$600

PSYCHOLOGY $250

Initial ConsultationSubsequent ConsultationsGroup Session

$60$50$20

HEARING TESTS AND APPLIANCES

Hearing AidsAppliance limit every 3 years with a benefit payable of 90% of cost for:- Single hearing aid- Bilateral hearing aid- Repairs (per year)

up to $800

up to $1,600 up to $120


Audiology (hearing tests)- Annual Limit- Initial Consultation- Subsequent Consultations

$200

$33$30

PHARMACY $700

Per Script100% less the applicable co-payment amount. The applicable co-payment is equivalent to the maximum cost for a pharmaceutical benefit item for a general patient under the pharmaceutical benefits scheme as determined by the Federal Government each year.Benefits are excluded for items that can be obtained without a prescription, contraceptives, anabolic steroids and drugs not approved in Australia.Medical Botox* (For treatment of a medical condition only) – 100% of cost up to annual limit.

$75

$75

OPTICAL

Annual Limit for supply of glasses and contact lenses - Single Vision - Bifocal - Multifocal - Contact lenses

$200 $200 $200 $200

90% of the cost up to $200

LIFE CHOICES ANNUAL LIMIT $300

Quit Smoking Programs Programs must be approved by the Fund.

Weight Loss Programs Programs must be approved by the Fund.

Diabetes Education - Annual Limit - Consultation

Health Screening Checks For health checks that are not eligible for Medicare benefits. Screening services must be approved by the Fund. - Annual Limit - Per Service

90% of cost up to $100


$200

$20

$100 90% of cost

up to $100

HOME NURSING $500

For a visit by a home nursing provider approved by the Fund. Visit/treatment must be prescribed by a doctor. - Annual Limit - Per Visit

$500 $20

MEDICAL APPLIANCES / SURGICAL FOOTWEAR* $1,000

3 year limit for appliances (TENS machines, blood glucose monitors, nebulisers, blood pressure monitors)* except sleep apnoea appliances

3 year limit for sleep apnoea appliances*

Surgical Footwear

Medical Braces

Non Surgical Prostheses






healthy extras _

Annual limits and services per person, per calendar year.

PLEASE NOTE:There is an annual limit imposed on the dollar amount that can be claimed per service per year. Expenses beyond the set annual limit are exempt from cover.

* When making medical botox or medical appliance claims members are required to supply a letter from their treating medical practitioner indicating the medical condition requiring treatment. For all pharmacy claims please ensure an official pharmacy receipt is provided to HCI. The official pharmacy receipt will have the name of the patient, script number, prescribing doctor information, cost, name of medication and dispensed date on it. Your pharmacist who should be able to provide this to you upon request.

18 19

Premier Extras is only available when packaged with Gold Hospital or Silver Plus Hospital cover as a Premier Extras Package. It provides comprehensive extras’ cover with an extensive range of services.Gold Hospital or Silver Plus Hospital is ideal for those who want the comfort of knowing their hospital cover has them covered for all life’s unexpected twists and turns with an extras cover to match.

If you’re just starting out, starting a family or retired, Gold Hospital or Silver Plus Hospital with the Premiers Extra Package is able to grow with you and your needs.


AMBULANCE

For emergency transport provided by a registered ambulance provider within Australia

Cost


Chiropractic- Annual Limit - Consultations - X-Rays

$500

$33 $65

Osteopathy- Annual Limit - Consultations

$500

$33


$500

$33

Remedial massage, Chinese medicine and Myotherapy- Annual Limit - Consultations

$500

$33

DENTAL TREATMENT

Benefits are paid according to the Australian Dental Association item num-ber used. Benefits are payable at 90% of cost to a set maximum per item. For an itemised quote please contact us.

GENERAL DENTAL ANNUAL LIMIT $1,500

The maximum number of services in which a benefit will be paid on items 011-015 in total is 2 per year and 016-017 in total 2 per yearItem 011 - comprehensive oral examinationItem 121 - topical application of remineralisation agentItem 311 - removal of a toothItem 511 - metallic filling 1 surface

$40$22

$105$104

MAJOR DENTAL $1,500

Crowns and BridgeworkPeriodonticsImplantsDentures (benefits are payable every 2 years)Orthodontics - Lifetime Limit - Annual Limit per person

up to $1,000up to $700

up to $1,000up to $1,200

$2,700

up to $900

HEARING TESTS AND APPLIANCES

Hearing AidsAppliance limit every 3 years with a benefit payable of 90% of cost for:- Single hearing aid- Bilateral hearing aid- Repairs (per year)

up to $1,200 up to $2,000

up to $120

Audiology (hearing tests)- Annual Limit- Initial Consultation- Subsequent Consultations

$200$50$40


premier extras _


OPTICAL

Annual Limit for supply of glasses - Contact lenses

Annual Limit for repairs to glasses

$250 90% of the cost up to

$250$50

LASER EYE SURGERY (LASIK AND ASLA EYE SURGERY)For laser eye surgery performed in a registered day surgery facility. Annual maximum benefit entitlements per person increase with each completed year of membership, as follows:

1 year2 years3 years4 + years

Nil90% of cost up to $500

90% of cost up to $1,00090% of cost up to $1,500

LIFE CHOICES ANNUAL LIMIT $350

Quit Smoking Programs Programs must be approved by the Fund.

Weight Loss Programs Programs must be approved by the Fund.

Diabetes Education - Annual Limit - Consultation

Diabetes Australia Membership

Health Screening Checks For health checks that are not eligible for Medicare benefits. Screening services must be approved by the Fund. - Annual Limit - Per Service



$200

$20

$36


$100

MEDICAL APPLIANCES* (LIMIT FOR SAME APPLIANCE EVERY 3 YEARS)

Medical Appliances* Prescribed by a specialist or doctor, including tens machine, nebuliser, glucose monitor, blood pressure monitor.

Non-surgical Prostheses* Items prescribed by a specialist or doctor, including breast prosthesis and surgical stockings.

CPAP machine* Your doctor will first diagnose your requirement and determine your eligibility to insure the therapy is right for you.





Podiatry / Chiropody - Annual Limit - Initial Consultation - Subsequent Consultations - Nail surgery (excludes inpatient services)*

*Letter required from referring specialist

$300

$30 $27

$100

Orthotics (custom made) Annual Limit

Orthotic Casting Annual Limit

$200

$100

Eye Therapy (Orthoptics) - Annual Limit - Initial Consultation - Subsequent Consultations - Group Session

$375 $30 $25 $10


20 21

** Members who make a change to their policy, (e.g changing excess level or level of cover) will lose their funeral benefit as Federal Government Legislation as of 1st April 2007 prohibits health funds from offering this entitlement.

# For HCI to pay a benefit on travel and accommodation, members must have a Gold Hospital and Premier Extras.


premier extras cont _ SERVICES EXTRAS LEVEL

OF COVER


Speech Therapy - Annual Limit - Initial Consultation - Subsequent Consultations - Group Session

$375 $50 $30 $10

Dietetics - Annual Limit - Initial Consultation - Subsequent Consultations

$200

$35 $30

Occupational Therapy - Annual Limit - Initial Consultation - Subsequent Consultations - Group Session

$375 $40 $30 $10

HOME NURSING

For a visit by a home nursing provider approved by the Fund. Visit/treatment must be prescribed by a doctor.- Annual Limit- Per Visit

$500$25

PHARMACY $1,000

Per Script100% less the applicable co-payment amount. The applicable co-payment is equivalent to the maximum cost for a pharmaceutical benefit item for a general patient under the pharmaceutical benefits scheme as determined by the Federal Government each year.Benefits are excluded for items that can be obtained without a prescription, contraceptives, anabolic steroids and drugs not approved in Australia.

Medical Botox* (For treatment of a medical condition only) – 100% of cost up to annual limit.

$100An Annual Limit of $600 applies

for prescriptions for the following

conditions: weight loss,

baldness and male erectile dysfunction

$600


Physiotherapy - Annual Limit - Consultation - Group Session

$700

$33 $15

Hydrotherapy - Annual Limit - Consultation / Treatment

$300

$15

PSYCHOLOGY $250

Initial ConsultationSubsequent ConsultationsGroup Session

$60$50$20


SURGICAL FOOTWEAR & CUSTOM MADE SUPPORT APPLIANCES

For surgical footwear and custom made support appliances prescribed by a specialist or doctor and individually made by a provider approved by the Fund.

90% of cost up to $1,000

FUNERAL (ELIGIBLE MEMBERS ONLY)**

This benefit is only payable to members who had entitlement under the Rules in force prior to 1st April 2007. A benefit is payable to eligible members following the death of a member or dependent (refer to waiting period).

$1,150

TRAVEL AND ACCOMMODATION#

Benefits payable when attending a medical specialist or hospital more than 50kms from normal place of residence within home state.

Accommodation - per night $50

Travel - per km 15 cents

Travel and Accommodation - Maximum Per Trip per person - Annual Limit per person - Annual Limit per family

$125 $300 $800



22 23



Chiropractic - Annual Limit - Consultations - X-Rays

$400

$22 $30

Osteopathy- Annual Limit - Consultations

$400

$22


$400

$22

Remedial Message, Chinese Medicine and Myotherapy- Annual Limit - Consultations

$400

$22

DENTAL TREATMENT $500

Benefits are paid according to the Australian Dental Association item number used. Benefits are payable at 90% of cost to a set maximum per item. For an itemised quote please contact us.

(GENERAL & MAJOR DENTAL

COMBINED)

GENERAL DENTAL ANNUAL LIMIT

The maximum number of services in which a benefit will be paid on items 011-015 in total is 2 per year and 016-017 in total 2 per yearItem 011 - comprehensive oral examinationItem 121 - topical application of remineralisation agentItem 311 - removal of a toothItem 511 - metallic filling 1 surface

$27$13$70$57

MAJOR DENTAL

Crowns and Bridgework

Periodontics

Implants

up to $500up to $500up to $500

OPTICAL $220

Annual Limit for supply of glasses and contact lenses - Single Vision - Bifocal - Multifocal - Contact lenses Annual Limit for repairs to glasses

$220 $170 $190 $220

90% of the cost up to

$180 $50


Physiotherapy - Annual Limit - Consultation - Group Session

$400

$22 $10

Annual limits and services per

person, per calendar year.

active life extras _

Active Life Extras is designed to give you cover for what you need right now. Active Life Extras is a budget friendly extras cover that allows you to be covered for the essentials without breaking the bank. Active Life Extras will be the support you need to kick start, or maintain, your best possible self.

You can combine Active Life Extras with Gold, Silver Plus or Bronze Hospital for a more comprehensive cover, complete with a range of excess options, you will have the security of hospital cover with the benefits of Active Life Extras.



SERVICES WAITING PERIOD

Acupuncture 2 months

Ambulance 2 months

Audiology (Hearing Tests) 2 months

Chiropractic 2 months

Dental – General 6 months

Dental – Major (excl. Orthodontics) 12 months

Dental – Orthodontics 12 months

Diabetes Education 2 months

Diabetes Australia Membership 2 months

Dietetics 2 months

Eye Therapy (Orthoptics) 2 months

Funeral* (eligible members only) 120 months

Health Screening Checks 2 months

Hearing Aids 24 months

Home Nursing 2 months

Hydrotherapy 2 months

Laser Eye Surgery 12 months

Medical Appliances 12 months

Remedial Massage, Chinese Medicine & Myotherapy

2 months

Non-surgical Prostheses 12 months

Occupational Therapy 2 months

Optical 6 months

Orthotics 2 months

Osteopathy 2 months

Pharmacy 2 months

Physiotherapy 2 months

Podiatry / Chiropody 2 months

Psychology 2 months

Quit Smoking Programs 2 months

Speech Therapy 2 months

Surgical Footwear 2 months

Travel and Accommodation 6 months

Weight Loss Programs 2 months

* Funeral cover special conditions are on page 23.

Extras waiting periods

24 25

packaged cover _

Package your cover so you have everything to suit your needs. GOLD HOSPITAL WITH

PREMIER EXTRASOur highest level of cover. Be confident that you are fully covered. +

MEhealth care

for team me

WEhealth care for me and my partner

ME+UShealth care for me, my partner and all our kids

(up to age 25 if full time student)

All of ushealth care for me, my partner and all our kids

(aged 23-25)

UShealth care for

me and my kids (up to age 25 if full

time student)

US+health care for

me and my kids (aged 23-25)

Choose to combine Gold Hospital, Silver Plus Hospital or Bronze Hospital with Healthy Extras or Active Life Extras.

Note: Premier Extras is only available In HCI's Gold Hospital with Premiers Extras package or when combined with Silver Plus Hospital and Premier Extras.

Or, You Choose!

26 27

We offer a range of claiming options that are fast, easy-to-use and even paperless. In most cases, Extras claims are processed the same day they’re received.

HICAPS electronic claiming (HICAPS) has streamlined extras claiming so you can be refunded on the spot. Based on your level of extras cover, benefits will be paid to the provider instantly and you will just need to pay the difference.

HOSPITAL AND MEDICAL CLAIMSHospital claims:

Generally, when you are discharged from hospital, the hospital staff will forward the account for your hospital treatment directly to HCI. Check this before you leave.

Medical claims for treatment received whilst in hospital:

If you receive bills from your doctor for medical treatment you received whilst in hospital, you must lodge your medical claims at a Medicare office first, before submitting with us. Visit: www.humanservices.gov.au/individuals/forms/ms014 to find out more information.

You cannot claim your out-of-pocket expenses and HCI does not pay benefits for medical treatment provided to you out of hospital.

If you have paid the account, your benefit can be paid electronically into your bank account. You will receive a separate notification as to the payment details. Or, if you have not paid the account, a cheque will be made payable to the practitioner who provided the treatment.

Claiming made easyHCI Smartphone Claiming App Download the HCI Claiming App to send us your claim straight from your mobile or tablet.

HICAPS Go Download the HICAPS Go App to find a practitioner in your area, get a quote, calculate their rebate, and pay.

Email – with a completed claim form* Email your claim form to us at: [email protected]

Fax Fax your claim to 1800 643 969

Mail Post your claim to PO Box 931, Burnie TAS 7320

*To download claim form, visit: hciltd.com.au/downloads

how to claim _

PAYING FOR YOUR PREMIUMSPaying your premiums is easy, you choose the payment method that works for you:

Direct Debit

Payroll Deduction

BPAY

Over the Phone

Online via our website

Cheque

Credit Card

In person

Note: To pay your premiums through payroll deduction there must be a minimum of four people in your work place paying through payroll.

It’s important to remember:All accounts and receipts must include the appropriate item number and a full description of the services/products being claimed and must be accompanied with a completed claim form.

All services/products must be provided by practitioners who are operating in private practice and who are approved by HCI.

Claims must be lodged within two years of the date of service.

Benefit payments are calculated on the date services/products are provided.

Claims posted, faxed or emailed must have a completed claim form attached, with a handwritten signature.

28 29

best doctors _

Health Care Insurance (HCI) has partnered with Best Doctors to give all HCI members peace of mind and a clear way forward in their times of need.

HCI’s Best Doctors provides access to a second opinion from the world’s leading medical specialists. If a HCI member has received a diagnosis or treatment for an illness, injury, or mental health condition, HCI’s Best Doctors can arrange for a top expert to conduct an in-depth review of your case.

It’s a confidential service that complements the care your own doctor is providing. With HCI’s Best Doctors, you can be sure you have the right diagnosis and treatment plan. And you can be confident you’re making the right decisions about your health.

HCI’s Best Doctors offers an array of services including Expert Medical Opinion, Doctor Online™, Find an Expert™ and Mental Health Navigator.

Find out more about HCI’s Best Doctors services on their member portal. On the portal you'll find online services that enable you to ask a GP a question, check a symptom and learn more about medical conditions. For more information, go to: www.askbestdoctors.com

30 31

Health Care Insurance (HCI) has partnered with smile.com.au to make quality dental care more affordable for our members across Australia.

There are 2000+ quality approved dentists across Australia! Find your nearest by following:

www.smile.com.au/health-funds/hci

healthy. smiles. everyday _

here’s how it works

1. Book an appointment with a smile.com.au approved dentist

2. Show your card to receive the savings

3. Claim as you would usuallyIf you have extras cover, you are now automatically entitled to save 15 – 40% off all dental treatments when you visit a smile.com.au approved dentist.

Of course your usual HCI benefit is still payable. The lower up front costs means your out of pocket costs are also lower!

And for those with Healthy Extras cover, in addition to the savings, you can receive No Gap on annual check up and cleans!

Now that’s something to smile about!

32 33

3434

SUSPENDING MEMBERSHIPMembers may apply for suspension of their membership if they have held private health insurance cover for at least 12 months and paid all contributions due as of the application date.

Suspension of membership can be approved on two grounds: • The member’s absence from Australia

for 28 days and up to two years. • The member’s financial hardship

for 1 to 6 months.

Periods of suspension of hospital cover do not count towards the cumulative absence allowed by Lifetime Health Cover legislation.

If a member reinstates membership within 30 days of the period suspension ending and pays contributions from the end of the suspension period, there will be no new waiting periods to be served.

For details of what information you will need to provide in your application for suspension of membership, call us on 1800 804 950.

CEASING MEMBERSHIPIf you choose to cease your hospital cover, your future hospital health cover premiums will be subject to the Lifetime Health Cover provisions dealing with periods of absence.

Please note that high income earners will be subject to the Medicare Levy Surcharge (MLS) during a period of suspended hospital cover.

PRIVATE HEALTH INFORMATION STATEMENTS Private Health Information Statements provide a brief summary of your level of cover to help you review your existing policy and compare other health funds. HCI is required by law to issue you with a Private Health Information Statement when you first join and thereafter at your request.

For more information about Private Health Information Statements you can phone on 1800 804 950 or visit hciltd.com.au

You can view each health fund’s Private Health Information Statements by visiting privatehealth.gov.au

RECOGNISED/APPROVED TREATMENT PROVIDERS HCI can only pay benefits to members that use providers who are recognised and approved by HCI. Recognition of providers by HCI is subject to change without notice.

If you are not sure about a provider’s approved status with HCI, call us on 1800 804 950 to check before arranging treatment.

SERVICES PROVIDED BY FAMILY MEMBERSUnless a member has received prior approval from the General Manager, HCI will not pay benefits for services or goods provided to a person covered by a membership where those services or goods are supplied by a family member.

OVERSEAS TREATMENTHCI will not pay a benefit for services, treatment or appliances provided or purchased overseas. HCI will only pay a benefit towards services, treatment and appliances by approved providers and/or suppliers registered within Australia only.

COMPENSATION AND DAMAGESHCI does not pay benefits for services or treatment where you are entitled to receive compensation or damages from another source. Where an accident or illness is caused by the actions of another party, HCI expects that you will pursue a claim for compensation or damages from the party concerned. HCI may, however, make provisional payments where compensation or damages are claimable by you, provided you agree to repay such payments from your final settlement.

If you become involved in circumstances where compensation or damages may be claimable by you, please call us on 1800 804 950 to seek clarification of your benefit entitlements.

30 DAY MONEY BACK GUARANTEEOur 30 day money back guarantee lets you cancel your membership within 30 days with a full refund of any contributions you have paid. Your 30 day cooling-off period starts as soon as you join. However, your cooling off period is no longer available if a claim under your policy has been made during the cooling-off period.

PAYMENT DEFAULT Should your contributions fall more than two months in arrears, your membership may be ceased. Acceptance of arrears payments after two months is not automatic, so please talk to us if you need time to pay. It should be noted that benefits are not payable for treatment if your contributions are in arrears.

BENEFIT LIMITATION PERIODSSome private health insurers will apply Benefit Limitation Periods (BLP) for certain types of treatments and hospital policies.

BLP are periods applied after your waiting period has already been served and a lower benefit is paid than the normal benefit. HCI does not apply BLP for members.

FEEDBACKAt HCI we value your opinion and if a product or service does not meet your expectations, we want to know about it. Talk to us - our team is here to listen. We want your feedback and aim to solve any questions or concerns on the spot. You can call us on 1800 804 950 or alternatively you can write to us at [email protected] or PO Box 931, Burnie TAS 7320.

In managing your complaints HCI will seek to: • Resolve your matter at first point of call. • Keep you informed of the process. • Investigate your complaint and respond

to you within 5 business days. • Provide you with a final response within

45 days.

OBTAIN AN EXTERNAL REVIEWIf despite everyone’s best efforts we are unable to resolve your concerns with our senior manager, you may wish to have the matter investigated by an independent person. The Private Health Insurance Ombudsman (PHIO) handles complaints for Private Health Insurance consumers and can be contacted by:

Complaints Hotline: 1300 362 072 www.ombudsman.gov.au www.privatehealth.gov.au

PRIVATE HEALTH INSURANCE INDUSTRY CODE OF CONDUCT HCI is a signatory to the Private Health Insurance Industry Code of Conduct.

The code was developed by the industry and is designed to set benchmarks of standards of service to members to be achieved by all Private Health Insurers. A copy of the code is available at privatehealthcareaustralia.org.au/codeofconduct

PRIVACY STATEMENTHCI respects your privacy and is committed to keeping your personal information safe through compliance with the Privacy Act 1988 and the Notifiable Data Breaches (NDB) scheme under Part IIIC of the Privacy Act.

HCI collects information that is necessary to assist the fund to meet your health insurance needs.

If you wish to obtain more information about HCI’s Privacy Policy, please contact our Privacy Officer on 1800 804 950 or refer to our website at hciltd.com.au

important info _

FEDERAL GOVERNMENT INCENTIVES TO GET PRIVATE HEALTH CARE:

PRIVATE HEALTH INSURANCE REBATEThe federal government private health insurance rebate helps make private health insurance more affordable. The rebate applies to hospital and general treatment policies. Since 2012 this rebate is income tested.

The income thresholds are indexed every financial year. For more information on the income threshold please refer to our health cover premiums, our website hciltd.com.au or alternatively you can visit the Australia Taxation Office website ato.com.au

The level of rebate you may be entitled to also depends on the age of the oldest person covered by your policy. The rebate increases when you turn 65 and again at age 70.

You can claim your rebate in one of two ways: as a reduction in your contributions; or as an income tax offset on your income tax return.

For convenience and certainty that you receive your full rebate entitlement, we recommend you register to have your rebate taken off the contributions you pay to HCI.

MEDICARE LEVY SURCHARGE (MLS)The MLS of up to 1.5% is paid in addition to the 2% Medicare Levy that is deducted from your taxable income in Australia. With private hospital cover you are exempt from the MLS 1.5% surcharge.

The MLS applies if you do not have an appropriate level of hospital cover and your annual adjustable taxable income exceeds the limit set by the Federal Government for single, single parent, couple and family memberships. For more information visit our website hciltd.com.au

34

HCI will do everything possible to ensure that your privacy is not breached. However, if you believe we have breached your privacy, you may write to:

HCI Privacy Officer PO Box 931, Burnie TAS 7320

We will endeavour to resolve the matter amicably with you. However, if you consider we have not resolved the matter to your satisfaction, you may contact the Privacy Commissioner’s Office at:

The Director of Compliance Office of the Privacy Commissioner GPO Box 5218, Sydney NSW 2001

3535

useful links _

glossary items _Unlock the key

to peace of mind with HCI.

HCI is your ticket to being well, being covered and being well covered.

Access gap cover A scheme offered by HCI in partnership with AHSA to allow members more choice and minimise medical gaps. The Access Gap Cover scheme gives members more clarity with private hospital cover to help reduce out-of-pocket expenses (medical gap) for in-hospital admissions. Doctors can opt-in or opt-out of the Access Gap Cover scheme at any time.Accident An unforeseen event or incident which results in an injury and requires immediate treatment or medical attention.Admission Treatment or medical attention as a Private Patient in a registered public, private or day Hospital where a member has been admitted by a medical practitioner and declared an inpatient. Treatment in the emergency room of a Private Hospital is not an Admission.Agreement hospital A hospital with which we have negotiated a contract to minimise out-of-pocket expenses for most Hospital related expenses.Australian Health Services Alliance (AHSA) A third party contracted by HCI to negotiate fees and benefits with hospitals and medical providers.Benefit(s) An amount that is paid to the member or the provider for approved services or treatment as outlined in the brochure.Calendar year is 1 January to 31 December. Claim A request for the entitlement and payment of benefits in accordance with fund rules and the product the member holds.Certified entry age is the age at which you took up hospital cover.Compensation Means legally entitled to, likely to receive, or had received payment by way of compensation, damages or other benefits for expenses. For example workers compensation, motor vehicle accident claims where an entitlement has been received from another party.Commonwealth Medical Benefit Scheme (CMBS) is a list of Medicare services that are subsidised by the Australian Government.Contribution(s) An amount of money a member is required to pay to us to receive private health insurance cover.Dependants - Dependant children • A person who is not the member

or member's partner • Your children under 23 years of

age including step children, legally adopted children, foster children and grandchildren (supporting legal guardianship document required)

• Full-time students who are enrolled in an Australian a school, college or tertiary institution up until their 25th birthday.

• Are not married or living in a de facto relationship

Exclusions Services and treatments that you are not covered by your health insurance cover.Excess If you are going into hospital for the first time that calendar year, you may have to pay an excess. An excess is the amount you have agreed to pay towards a claim on your hospital insurance.

HCI Health Care Insurance Ltd. Lifetime Health Cover A private health insurance initiative introduced by the Australian Government in July 2000 for the purpose of encouraging Australians to takeout private health insurance earlier in life and continue to hold their cover.Medical gap Also known as ‘out-of-pocket’ is any amount above the listed Medicare Benefit Schedule Fee or Access Gap Schedule. We encourage you to contact your health provider to find out if you will have to pay medical gap.Medicare Benefit Schedule (MBS) Medicare contributes a set amount for each treatment or procedure, as laid out in the Australian Government’s MBS. This schedule of Medicare services is subsidised by the Australian Government. Your doctor may choose to charge more than the MBS fee so you may have to pay additional out-of-pocket expenses. Member A person who is a member of HCI in accordance with its constitution.Medicare Levy Surcharge (MLS) Set by the Australian Government, the surcharge is an additional charge on top of your contribution. The charge will depend on your or family's taxable income.Partner A person who lives with the policy holder in a marital or de facto relationship. Policy The contract between you and Health Care Insurance Ltd which provides you with private health insurance cover in exchange for a contribution.Pre-existing conditions Illness or ailment A pre-existing ailment, illness or condition is one where the signs or symptoms existed during the six months before joining HCI (or upgrading to a higher level of cover).Private Health Insurance rebate A rebate amount from the Australian Government to help cover the cost of private health insurance for consumers. Private Health Insurance Statement A separate document that provides you with a summary of your health insurance cover.Restricted Services Hospital claims that are limited to a default/minimum benefit. The default benefit is the minimum dollar amount that is set by the Australian Government for accommodation as a private patient in a shared room in a public hospital. HCI cannot pay towards the cost of intensive care or theatre fees in a private hospital or private day center, therefore you may incur large out of pocket costs.Same Day admission An admission in a registered private hospital or day hospital where the member is not required to stay overnight. Waiting period(s) A period of time set by HCI in accordance with the Private Health Insurance Act 2007 by which you and anyone else who is insured under the policy must continuously be covered by before anyone insured can receive a paid benefit.You The person or persons covered by the policy.

For HCI: hciltd.com.au

Download claim forms, rates, brochures and much more: hciltd.com.au/downloads

To obtain a quote: hciltd.com.au/get-a-quote

Search for providers: hciltd.com.au/provider-search

To view our products: hciltd.com.au/types-of-cover

Private Health Care Australia: www.privatehealthcareaustralia.org.au

Australian Health Service Alliance: www.ahsa.com.au/web

Department of Health: www.health.gov.au

LHC calculator: www.privatehealth.gov.au/dynamic/lifetimehealthcover.aspx

LHC information: www.ato.gov.au/Individuals/Medicare-levy/Private-health-insurance-rebate/Lifetime-health-cover/

Medicare: www.humanservices.gov.au/individuals/medicare

Claiming through Medicare: www.humanservices.gov.au/individuals/forms/ms014

Australian Government website for all things related to Private Health Insurance: www.privatehealth.gov.au

Private Health Insurance Ombudsman: www.ombudsman.gov.au

Australian Prudential Regulation Authority (APRA): www.apra.gov.au

36 37

Our Website and Online Member Services put you in control of your membership with everything at your fingertips 24/7.

Call: 1800 804 950

Email: [email protected]

Visit our website: hciltd.com.au

Fax: 1800 643 969

Mail: PO Box 931, Burnie TAS 7320

Or, come into our office: 25 Cattley Street, Burnie TAS 7320

A Registered Private Health Insurer ABN 43 009 579 088

How you can talk to us _

SOME OF THE THINGS YOU CAN DO ONLINE: Get a quote and choose the best

level of cover for you, visit: hciltd.com.au/get-a-quote

Become a member

Find a healthcare provider (Hospital, Access Gap doctor or HICAPS provider)

Member log-in to check/update your membership details and make changes to your policy

Make credit card payments

Order a new membership card

Download all HCI’s forms and brochures

Print your tax statement

SOME OF THE INFORMATION YOU CAN FIND ONLINE:

How to claim

Extras providers

Hospital contract arrangements and product information

What you need to know about going to hospital

Documents

guide to · 2020-07-03 · the peace of mind of our members. We pride ourselves on our coverage for wellness initiatives including dental, optical, physio, chiro, antenatal education