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HCF - Top Plus

At HCF, we like to do things differently.

We're a not-for-profit organisation so our goal isn't to pay dividends to shareholders. It's to provide

benefits to our members. That's why we don't charge our members a hospital excess for accidents,

same-day surgery or dependants and why we include medical gap cover in all our Hospital covers.

We also provide generous benefit limits for Extras like dental, optical, chiro and physio services. We

offer outstanding private hospital access, and fast online claiming so our members can feel better,

sooner.

It's called the HCF difference, and it's our way of making sure our members get the most out of

their cover.

V3.3

Excess Excess applies Effective April 1 2011

$450 per person to a maximum of $450 per calendar year for a single or single parent membership

to a maximum of $900 per calendar year for a couple or family membership

NO Excess is payable for;

same day surgery

hospitalisation as a result of an accident.

children or student dependants

dependants covered on extended family policies

Hospital Service Private Patient in

HCF Participating

Private Hospital

Private Patient

Public Hospital

Hospital Waiting Periods

Accommodation yes yes 1 day

Emergency Ambulance

2 months

Psychiatric

Rehabilitation

Palliative care.

All other treatments except

where there's a longer waiting

period.

12 months

Treatments for pre-existing

ailments excluding Psychiatric,

Rehabilitation, Palliative care.

Pregnancy and birth- related

services

A pre- existing ailment is an

ailment or illness where the signs

and symptoms existed any time

during the six month before a

member joined or upgraded to a

higher level of cover, even though

a diagnosis may not have been

made. If there is any doubt as to

whether an ailment is pre-

existing, HCF will appoint an

independent medical practitioner

to examine information provided

by your doctor, together with other

relevant claim details.

Operating theatre yes yes

Intensive Care yes yes

Neo-natal Intensive Care yes yes

Coronary Care yes yes

Pregnancy and birth related services yes yes

Assisted reproductive services (IVF,

GIFT)

yes yes

Hip and knee joint replacements yes yes

Cataract eye surgery yes yes

Dialysis for chronic renal failure yes yes

Psychiatric services

(including eating disorders and post-

natal depression)

yes yes

Pharmaceuticals in hospital directly

associated with the reason for

admission. Excluding experimental

and very high cost non-PBS drugs.

yes yes

Rehabilitation programs yes yes

Surgical weight loss procedures e.g.

gastric banding

yes yes

Sterility reversals yes yes

Cosmetic surgery minimal benefits minimal benefits

Surgery by an accredited Podiatrist minimal benefits minimal benefits

If you choose a product which has minimal benefits for some procedures, then you'll be covered in a public hospital

shared room, but your private hospital costs won't be fully covered.This means you may face significant personal

expenses if you have any of these procedures in a private hospital. For procedures (such as those listed in this table)

attracting minimal benefits in a private hospital, HCF would:• Pay a small amount towards your accommodation;• Pay for prostheses, if required (100% cover for no-gap prosthesis list items. There are a small number of prosthesesthat will attract a gap); and• Not pay operating theatre expenses, or labour ward charges.In addition, there are some services where doctor's charges are not payable (for example, elective cosmetic surgery

and surgery by an accredited podiatrist). For these, HCF will only pay a very small amount towards the total cost of

the procedure (and no doctor's charges). This only applies to services which do not attract a benefit from Medicare.

Ambulance

Full cover for emergency ambulance with State Government road or air services where you require hospital or on-the-

spot treatment in Australia.

Up to $5000 per person per calendar year for State Government non-emergency ambulance services where your

doctor requests ambulance transport because your condition requires monitoring and support in transit.

Super Multicover

V3.3

General Treatment Service Rebate

effective

1/7/2011

Annual Limit per

person per calendar

year

Waiting

Period

General Dental

Diagnostic Dental 2 months

Examination (011) $38 2 claims

X-rays (022) - initial

Subsequent visit

$29

$25

No limit

Preventative Dental

Removal of plaque (114 & 115) $63 2 claims

Application of fluoride (121) $25 1 claim

Restorative Dental

Adhesive fillings - one surface (531) $95 $550

Adhesive fillings - two surfaces (532) $108

Adhesive fillings - three surfaces (533) $125

Orthodontic

By an Orthodontist - two full arch banding(831) x 2

- accrues at $440 per year.

or

By a General Dentist - two full arch banding (831) x 2

- accrues at $440 per year.

$1,720

$1,000

$2,640 lifetime limit

sub limit of $1,000

lifetime limit

12 months

Major Dental

Crowns and Bridges $800 per person

Increases by $100 each year to

$1,200

12 months

Full crown non metallic indirect (615) $635

Dentures $800 per person

every three years from date of

service

Complete upper and lower denture $800

Maintenance & repair $37-$200 $200 sub-limit applies for

maintenance & repairs

Other Dental $500

Endodontic: Preparation of root canal

(415)

$170

Oral Surgery - (eg. extractions) $100-$260

Root canal obturation (417) $150


effective 1/7/2011

Annual Limit per person

per calendar year

Waiting

Period

Optical

Spectacle frames $135 $250 2 months

Spectacle lenses - pair $130 - $250

Contact lenses - pair $140 - $250

Disposal contact lenses $160

Chiropractor

Visit 1-2

Visit 3-11

Visit 12+

Chiropractic X-ray

$42

$33

$18

$63

$600 - (Increases by $120

each year to $1,200)

Max $600 each for Chiro &

Osteo.

Max $300 for exercise

physiology

2 months

Osteopathy

Visit 1-2

Visit 3-11

Visit 12+

$45

$35

$18

Exercise Physiology

Initial consultation

Subsequent consultation

$40

$33

Physiotherapy / Eye Therapy

Visit 1-2 $53 $600 - (Increases by $120

each year to $1,200)

2 months

Visit 3-11 $38

Visit 12+ $18

Hydrotherapy/Group Physiotherapy $18 per visit

Eye Therapy $38

Acupuncture / Naturopathy / Remedial Massage /Myotherapy /Homeopathy/ Alexander Technique/

Chinese Herbal Medicine

Acupuncture - sub-limit $250 per person,

Chinese Herbal Medicine- sub-limit $100 per person

Combined Limit

$600

2 months

Initial consultation $40

Subsequent consultation $25

Naturopathy/Nutrition, Remedial Massage/Myotherapy, Homeopathy,

Alexander Technique - sub-Limit $250 per person

Initial consultation $40



effective 1/7/2011

Annual Limit per

person per calendar

year

Waiting

Period

Speech Pathology / Audiology

Speech Pathology

Initial consultation $83 $500

2 months


Audiology

Initial consultation $58 $350

2 months


Occupational Therapy

Initial consultation $72 $600 2 months


Dietetics



Podiatry



Psychology (after Medicare entitlement is exhausted)

Per consultation $80 $600 2 months

Artificial Appliances

HCF approved artificial appliances (eg: Nebuliser, TENS machine, Orthotics) $600 12 months

Pharmacy (HCF approved, non-PBS)

(non-PBS) An excess applies to all non-

PBS drugs which is equivalent to the

current PBS fee.

$50 per drug per script. $700 2 months


effective 1/7/2011

Annual Limit per person per

calendar year

Waiting

Period

Home Nursing, Travel and Accommodation

Home Nursing $50 per claim

Up to $100 per return trip per membership for travel per trip/

membership.

Journeys of more than 200km for specialist/hospital treatment.

up to $30 per night for accommodation

$1,000

$400 sub-limit for Travel and

Accommodation

(up to $400 for travel & $200

for accommodation)

2 months

Hearing Aids

Benefits payable every 5 years depending on length of membership Less than 5 years - $800

6-9 years - $1,100

10-14 years - $1,400

15 years and more - $1,800

2 years

Health Management Programs

HCF approved programs eg. First Aid Courses, Learn to Swim, Stress

Management, Quit Smoking , Childbirth/Ante-natal Education, Lactation

consultation, Weight Management & Exercise regimes

(recommended by a GP or specialist).

$200 per person

$400 per family

6 months

Other services

School accident cover

(approved general treatment related

service only)

100% of cost (where

benefits are not payable

from any other source)

$800 24 hours

Did you know?

Version 3.2 - Effective April 1 2011

Waiting Periods

Waiting periods must be served before benefits are paid.

They apply to:

New members.

Existing HCF members who upgrade to a higher level of cover or reduce excess payable. In this case, you need to serve

the necessary waiting period for the higher benefit entitlement.

Members who switch from another fund who have not already completed the required waiting period for equivalent

benefits.

New dependants, unless they switch from another fund where they have completed the required waiting period for

equivalent benefits.

Treatment of pre-existing ailment.

Waiting periods vary according to the type of treatment or services and are as follows.

Hospital Waiting Periods

1 day - Emergency Ambulance

2 months - Psychiatric, rehabilitation and palliative care. All other treatments except where there's

a longer waiting period.

12 months - Treatments for pre-existing ailments (excluding Psychiatric, Rehabilitation and

Palliative care), Pregnancy and birth- related services.

Please note:

If your previous cover did not include a particular service and your new cover does, you will need to

serve waiting periods for this service (2 months and 12 months for pre- existing conditions). If the

excess you are paying with HCF is lower than the excess paid with your previous fund, and any one

on the membership is hospitalised within the first 12 months with HCF, the higher excess will

apply.

Extras waiting periods

2 months - All services except those below

6 months - Health Management Programs

12 months - Crowns, bridges, dentures, endodontics, occlusal therapy, oral surgery, periodontal,

prosthodontics, dental bleaching and orthodontics, veneers, artificial appliances and pre existing

ailments.

2 years - hearing aids/repairs

Participating Hospitals

To check the participating hospitals in your state go to:

http://hcf/Services/participating_hospitals.asp?member_id=Guest

Non-participating hospitals

If you are using a non-HCF participating hospital you may incur out of pocket expenses. There are

many factors involved in determining your benefit at a non-HCF participating hospital. For more

details call HCF prior to going into hospital.

Minimal Benefits

If you choose a product which has minimal benefits for some procedures (such as pregnancy and

birth-related services), then you'll be covered in a public hospital shared room, but your private

hospital costs won't be fully covered.

This means you may face significant personal expenses if you have any of these procedures in a

private hospital.

For procedures (such as those listed in this table) attracting minimal benefits in a private hospital,

HCF would:• Pay a small amount towards your accommodation;• Pay for prostheses, if required (100% cover for no-gap prosthesis list items. There are a small

number of prostheses that will attract a gap); and• Not pay operating theatre expenses, or labour ward charges.

In addition, there are some services where doctor's charges are not payable (for example, elective

cosmetic surgery and surgery by an accredited podiatrist). For these, HCF will only pay a very

small amount towards the total cost of the procedure (and no doctor's charges). This only applies

to services which do not attract a benefit from Medicare.

Pre-existing ailments or conditions

A pre- existing ailment is an ailment or illness where the signs and symptoms existed any time

during the six month before a member joined or upgraded to a higher level of cover, even though a

diagnosis may not have been made. If there is any doubt as to whether an ailment is pre- existing,

HCF will appoint an independent medical practitioner to examine information provided by your

doctor, together with other relevant claim details.

Note 1: Procedures such as sterilization, reversal of previous elective sterilization, assisted

reproductive services (e.g. IVF, GIFT) may be deemed to be pre- existing ailments.

Note 2: If you join under a waiver, waiting periods are only waived for services with waiting

periods equal to or less than the waiver. All other waiting periods in excess of the waiver still apply.

All pre- existing ailments or illnesses and obstetric services attract a 12 month waiting period for

both Hospital and Extras services irrespective of any waiver.

Pregnancy and Birth related Services

If you have a single membership, you will need to change to a Family membership 3 to 4 months

before the birth so your new born has health insurance. The official waiting period for the unborn

child is 2 months but changing cover earlier covers the possibility of early arrival.

The 12 month waiting period for obstetric services starts from the date you first join the fund,

whether you're planning a child or not.

Eliminating out-of-pocket medical expenses for hospital members

HCF has entered into arrangements with many doctors and a number of private hospitals. The

arrangements eliminate both the medical gap for services provided by participating doctors and the

need for HCF patients to handle multiple accounts or to claim from Medicare and/or HCF.

HCF pays any gap fees for participating doctors, so that the patient has no out- of- pocket

expenses.

No gap hospital agreements. With HCF no gap hospital agreements, members can choose to be

treated at participating hospitals by a participating doctor. This eliminates gap charges altogether

and your medical bill is automatically paid by HCF.

HCF Medicover. HCF Medicover is a direct billing system for doctors. If your doctor is willing to use

this new system, all in-hospital medical services that you receive from your doctor will be covered

by HCF, eliminating any gap charges. Also, with HCF Medicover, HCF pays your medical bills directly

for you. There are also no gap pathology and radiology arrangements. With HCF's pathology

arrangement with Australia's leading providers, members who find themselves in hospital will now

be covered for the full cost of pathology services supplied by these providers. See the Did you

Know section for more information about the Medicare Gap and the Medical Gap. HCF is not

responsible for the care or treatment received from any hospital or other service provider nor for

any aspect of the administration of a hospital or other service provider.

Who is covered?

Family cover

The Policyholder, their partner and dependants listed on the policy. Only the Policyholder can

determine who is covered under a membership.

Cover for your dependants

Your children are automatically covered at no extra cost under your family cover until the day

before they turn 22.

If your children are full-time students, simply register them as Student Dependants at the start of

each academic year, and they will be covered for no extra cost until the day before they turn 25. If

they cease study during that year their cover will lapse.

If your children are not full-time students, you can also continue to cover them until they turn 25

with Extended Family Cover, available on certain levels of HCF cover. Otherwise, your grown

children will need to take out their own cover.

All new dependants must serve waiting periods, unless they are transferring from another

membership or another private health insurer where they have already completed the relevant

waiting periods. In this case they will need to request an Interfund Transfer Certificate from their

previous fund, which is provided to HCF when joining.

In addition, the Policyholder's children and student dependant must be:

Unmarried and not in a de facto relationship; and

Primarily reliant on the Policyholder and or (Partner listed on policy) for maintenance and support; and

Related to the Policyholder (or Partner listed on policy) as a child, step-child, foster child or other children that the

Policyholder (or Partner listed on policy) have legal guardianship over.

The student dependant must also be:

Aged between 22 – 24 (inclusive); and

A full time student at school, college or university.

Couples cover

The Policyholder and their Partner listed on the policy.

Singles cover

The Policyholder only.

HCF Extended Family Cover

HCF automatically covers your children until their 22nd birthday. With HCF Extended Family Cover

you can continue to provide health insurance for your 22, 23 and 24 year old children, even if they are no

longer studying full- time or living at home, as long as they are unmarried and not in a de facto

relationship. For a small additional premium you can extend your cover to provide your children with

the health insurance they need.

On turning 25: With HCF Extended Family Cover your children remain covered until they turn 25 or

until such time as they marry. HCF will contact you before your child's 25th birthday to notify you

that your membership will revert back to your standard membership and invite your child to choose a

cover that suits their individual lifestyle.

Student dependants: Eligible students are covered free of charge until they turn 25. Extended Family

Cover is available with HCF Top Plus Cover and HCF Hospital Savings Option. Extended Family Cover

also applies to your extras cover when taken with these hospital products.

Single Parent Family Cover

As per Family Cover, excluding the contributor's nominated partner.

Single parent families receive a reduction (approximately 20%) on the family rate of certain

Hospital

and Extras products. The reduction in applicable to your Extras cover on Levels 1 and 2 and your

entire cover on levels 3, 4, 5 and 6. This reduction does not apply to Hospital Advanced Savings,

Ambulance Only Cover and HCF Life Products.

Family memberships and Single Parent Family memberships are not available for the Fit and Free

policy and young singles and couples policies.

Overseas Cover

If you travel overseas you aren't covered. HCF cannot cover you for overseas medical expenses

under your membership. However, you can obtain a 10% discount on travel insurance through HCF

which will cover overseas medical

Fit & Free policy holders are covered for emergency overseas medical expenses through their

special overseas travel insurance. See www.hcf.com.au/fitandfree for details

HCF supports the Private Health Insurance Code of Conduct ensuring:

You will receive correct information on private health insurance

You are aware of the internal and external dispute resolution procedures

You can make an informed decision about your purchase through informative policy

documentation

You are protected in accordance with privacy principles

A full copy of the code is available at www.privatehealth.com.au/codeofconduct

Resolution of problems

If you have any queries or feedback about any aspect of a health insurance product or iSelect's

service, you could either call the consultant you dealt with or contact the Compliance Manager by

telephone on 1300 735 255, and by email on [email protected].

If you have queries or feedback about the HCF products please contact HCF on 13 13 34.

If you are not satisfied with iSelect's response you may contact the Private Health Insurance

Ombudsman on 1800 640 695.

Privacy

For further information about iSelect's privacy policy please visit iSelect's web site:

http://www.iselect.com.au/

HCF APPLICATION FORM

Signature x Date:

PRE EXISTING AILMENT/CONDITION (PLEASE COMPLETE THIS SECTION)

DECLARATION (PLEASE SIGN THIS SECTION WHERE INDICATED)I declare all details stated to be true and correct and agree to be bound by the registered rules and by-laws of HCF as amended from time to time. I have read and understood the information for my chosen fund regarding pre-existing ailments/conditions, waiting periods, benefit limitations and lifetime exclusions (where applicable). I declare that all persons to be covered are permanent residents of Australia and entitled to full Australian Medicare Benefits. I will advise HCF of any changes to the information supplied on this application. I declare that dependant students aged between 22 and 25 mentioned on this form are attending a full time course of approved study. I declare that I have not been declined health insurance from any other fund on the basis of fraud. I understand that proof of identity and age may be required.

IMPORTANT: PLEASE READ AND NOTEBenefits are not payable in the first 12 months of membership for the treatment of a pre-existing ailment/condition, the signs or symptoms of which were in existence at any time during the 6 months prior to joining or upgrading to a higher cover, whether or not diagnosed by a doctor. This is an industry wide standard rule applied by Health Funds for the protection of existing members.

Cover commences on ________/________/________Conditional on receipt of payment within 14 days.

If YES, please state the aliment/condition/sDo you, your spouse/partner or any of your dependants have any pre-existing ailment/condition/s?

Phone: Home ( )

OTHER PERSONS TO BE COVERED

Email address:

Mr/Mrs/Ms/Miss/Other: _____________

Given name/s:

Date of birth: (DD/MM/CCYY)

Address:

Postcode

Yes

No

StateTown/Suburb:

Surname:

Occupation:

Work ( ) Mobile

(nominate date)

MEMBERSHIP NUMBER ISSUED BY FUNDOFFICE USE ONLY

iSelect Client No.

SELECTED PRODUCT/S

Type of Cover

Excess amount

Base Premium Quoted $

New Membership Transfer Membership from another Fund Change cover with HCF

Please fax or mail pages 1 & 2 only. Fax: 1300 735 322 or call 1300 735 255 Mail: Reply Paid 2021 Moorabbin VIC 31891

iSelect Health Pty Ltd ABN 87 088 749 955

Please fax pages 1 & 2 to 1300 735 322 or mail to Reply Paid 2021 Moorabbin, VIC 3189

HCF’s Terms & Conditions are available at www.iselect.com.au/tc8

Given Name Family Name Date of birth Sex Relationship StudentYES/NO

Member’s Name Details of Ailment/Condition/s

R20810 ISN R/C 20 Customer Note No:

Lifetime Loading (if applicable)

Total Premium $Premiums quoted valid to March 31st 2012

NSW

$450 x 1

Single Male

0.00

154.7

WB 6 3 8

154.70 p/month inc 30.0% rebate

41 0 8

Top Plus Cover $450 AND Super Multicover

[email protected]

10-Jun-1986

HCF APPLICATION FORM

DIRECT CREDIT OF CLAIMS If you would like your claim benefits paid directly into your account please complete the following details.

I request HCF to credit my/our nominated account with any amount which may be payable by the fund in respect of a claim or benefit on my membership.

If YES please complete the remainder of this section.

FEDERAL GOVERNMENT REBATEPlease complete this section in full to receive the Federal Government 30% Rebate on private health insurance as a reduced premium. If you do not complete this section, full membership fees apply.Are all people nominated on Page 1 on this membership eligible for full Medicare benefits?

If NO you cannot apply for the rebate until you obtain a card from Medicare.

Are you covered on this membership? If NO, employers and trustees of organisations cannot claim the Federal Government 30% Rebate on policies paid on behalf of employees.

Date premium reduction to commence / /

Your Medicare Card No.Valid To

Your name exactly as it appears on your Medicare card

Some of the information provided on this form will be used for the purposes of registering you for the Federal Government 30% Rebate on private health insurance. Its collection is authorised by law, and information collected will be disclosed to the Department of Health and Aged Care, the Health Insurance Commission and the Australian Taxation Office.

Name of Bank, Credit Union or Building Society

Name on a/c BSB No. - Account No.

Signature x Date:

(Start date of this policy)

Signature x Date:

YesNo

Yes No

Signature x

Account name

BSB No. Account No.-

I/We authorise The Hospitals Contribution Fund Limited User ID Number 480 to arrange for funds to be debited from my/our account at the financial institution identified below and as prescribed below.

Monthly YearlyPlease tick Fortnightly on the 1-27 day* of the month

*Please nominate your first debit day. Please note: debit dates of 28, 29, 30 and 31 are not available.

This authorisation is to remain in force in accordance with the terms described in the HCF Direct Debit Customer Service Agreement.

Details of the Account to be debited (All details must be supplied.)

Name of Financial Institution

Branch

1. EZIPAY DIRECT DEBIT REQUEST

*Please nominate day. (If you do not nominate a day your account will be debited on the 7th day.) I acknowledge that the credit card I am using to pay for this insurance has been issued and used prior to paying for this insurance.

2. CREDIT CARD AUTHORITY

Card Holder's Name

Expiry Date

Type of card (please tick)

Visa MasterCard

Card No.

Debit frequency (please tick) Monthly Yearly

Please debit my account on the ________________________ day of the due month.

Signature x

Date:

Date:

PAYMENT OPTIONS – ( PLEASE COMPLETE 1 OF THE 2 PAYMENT OPTIONS)

MEDICARE ELIGIBILITY

My Medicare card is

My Medicare card number is

Green – Full unrestricted access

Blue – Interim card full unrestricted access until expiry date

Yellow – Reciprocal card – restricted access until expiry dateValid To

CCVV No

CCVV No – this is the 3 digit number on the back of your credit card

Please fax or mail pages 1 & 2 only. Fax: 1300 735 322 or call 1300 735 255 Mail: Reply Paid 2021 Moorabbin VIC 31892

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