1 HEALTH INSURANCE HCF FAQs What benefit is available through Member Advantage? Members receive a 5% discount off all current HCF hospital and extras products. What is the relationship between Member Advantage and HCF? HCF is the fund provider and Member Advantage acts as an agent on behalf of HCF. We do not have access to the HCF database, so we cannot advise on any queries relating to your claims history, account details etc. Can I apply for my discount directly through HCF? No, you cannot apply directly through HCF as they will simply refer you back to us. All applications will need to be submitted to Member Advantage, as we have to verify your membership status and authorise the discount. APPLICATION FOR NEW MEMBERS JOINING HCF How do I apply to join HCF and receive my discount? You can download and complete the application form on the website and forward it to Member Advantage via fax or by post to Member Advantage Health, Reply Paid 1922, Melbourne VIC 8060 (no stamp required). How do I transfer to HCF from my previous fund? Complete the Interfund Transfer section on the application form and HCF will do the rest. If you have a direct debit arrangement with your existing fund, it is suggested that you personally advise the fund to cancel your deductions. How long does it take to process my application? Online application: Welcome is issued straight after the application is submitted Welcome letter with debit date / amount is generated overnight and posted next day HCF card is sent a day after application is submitted Manual application: Processed within a week Do I need to reapply for the discount every year? No, the discount is ongoing and you will not need to reapply for your discount every year. If you decide to upgrade or downgrade your policy at any stage, the discount will remain in place. When will my cover commence? Your cover will commence on the date you have nominated on the application form. This is located just to the right of the date of birth field on the first page of the application. TRANSFERS FOR EXISTING HCF MEMBERS I am already with HCF - am I eligible for the 5% member discount? You can obtain the member discount if you are on current products and excess options, and on a current payment method (i.e. direct debit from a bank account or credit card). The discount is applied by HCF on their database. How do I apply to transfer my existing policy? You can apply for the discount online by completing the member transfer form. Alternatively, download the application form from the Member Advantage website and send it via
2 fax or by post to Member Advantage Health, Reply Paid 1922, Melbourne VIC 8060 (no stamp required). Can the discount be applied retrospectively? The discount cannot be backdated, and will apply from the date you complete the application. Can I still apply for the discount if I have already paid my annual premium? Yes. The discount will be applied to your policy on a pro-rata basis and your period of cover will be extended accordingly. How will the transfer affect my current policy? The transfer will not affect your current policy as long as you choose the products you are currently on, and do not upgrade or downgrade your level of cover. If you are unsure of the level of your cover, call HCF on When will I receive confirmation of my transfer? The discount will be applied within a week of the application being received, and the next debit letter is sent advising the premium. I used to be with Manchester Unity and this fund was taken over by HCF. How do I get the Member Advantage discount? Members on Manchester Unity products are not entitled to the member discount. You will need to change to current HCF products and excess options in order to obtain the member discount. GOVERNMENT SURCHARGES & INCENTIVES What is Lifetime Health Cover Loading? Lifetime Health Cover (LHC) is a Government initiative to encourage people to take out private hospital cover. If you do not have hospital cover on July 1 following your 31 st birthday, you will pay an additional 2% on top of your premium for every year you are aged over 30. The maximum loading is 70%. For example, if you are single and take out hospital cover when you are 40, you will pay 20% more. If you are a couple and one person is aged 35 (10%) and the other is 39 (18%), the loading will be calculated at 28% divided by 2, so total loading applied will be 14%. Once you have paid a LHC loading on your private hospital cover for 10 continuous years, the loading is removed as long as you retain your hospital cover. What is the Medicare Levy Surcharge? You may be charged up to an additional 1.5% surcharge of your taxable income on your Medicare levy when your tax return is assessed. If you are single and earn more than $88,000 or a family or couple earning more than $176,000 a year, you can avoid the surcharge by taking out private hospital cover. (See Table 1 for further details) What is the Australian Government Rebate? The Australian Government provides an income tested rebate to help make private health cover more affordable. (See Table 1 for further details)
3 The rebate is available to people with hospital, extras or ambulance cover, and registered with Medicare. You can elect to take the rebate either as: a reduced premium; a cash rebate for a Medicare office; or a tax offset credit in your annual tax return Table 1 - Government Rebate and Medicare Levy Surcharge levels INCOME NO CHANGE TIER 1 TIER 2 TIER 3 SINGLES $88,000 or less $88,001 - $102,000 $102,000 - $136,000 $136,001+ FAMILIES $176,000 or less $176,000 - $204,000 $204,001 - $272,000 $272,001+ PRIVATE HEALTH INSURANCE REBATE AGE NO CHANGE TIER 1 TIER 2 TIER 3 UNDER 65 30% 20% 10% 0% % 25% 15% 0% % 30% 20% 0% MEDICARE LEVY SURCHARGE NO CHANGE TIER 1 NO CHANGE TIER 2 TIER 3 ALL AGES 0.0% 1.0% 1.25% 1.5% I am a new migrant to Australia. How does Lifetime Health Cover affect me? If you are a new migrant to Australia, and are aged 31 or over, you will not have to pay a LHC loading if you take out private hospital cover within 12 months of being registered for Medicare. After this, you will have to pay 2% more for each year you are aged over 30. If applying for health insurance, a Medicare Eligibility Letter will be required to prove your date of eligibility so no loading is applied. Medicare can be contacted on I have been living overseas for three years and have recently returned to Australia. I was previously insured will I have to pay Lifetime Health Cover loading if I re-apply for private health cover? You will need to produce a statement of movements form from the Department of Immigration to prove you flew out and back into the country. Otherwise the loading will be applied. The contact number for the Department of Immigration is Where can I get further information about the Government incentives and surcharges?
4 GENERAL HCF HEALTH INSURANCE FAQs What happens to benefits from my previous fund? If you transfer, you will receive continuity of your existing benefits/services and you will not have to serve additional waiting periods as long as: You transfer from another Australian Registered Health Fund You transfer to a level of cover that is equal or less than your existing cover Your chosen HCF cover includes the services which are covered by your current fund You have served the required waiting periods with your current fund You transfer within one month or ceasing membership with your previous fund Please note that continuity of cover does not extend to any incremental benefits such as loyalty limits for therapies and orthodontics. What limits can I get for my extras? The details of extras benefits are included in the HCF brochure. When a range amount is indicated, this means it will depend on the item number (or ID number) of the particular service which determines the amount you can claim. What are the waiting periods? Waiting periods will need to be served before benefits are paid and apply to: New members Existing HCF members who upgrade to a higher level of cover Members who transferred from another fund who have not already completed the required waiting period for equivalent benefits Treatment of pre-existing conditions 2 months All hospital and extras benefits, except those which attract a longer waiting period (waived if you take hospital with extras) 6 months For access to HCF s Health Management programs (waived if you take hospital with extras) 12 months For obstetrics services, pre-existing conditions, artificial appliances, dental crowns, bridges, dentures, endodontics, oral surgery, periodontics, orthodontics, occlusal therapy, dental bleaching, prosthodontics, veneers 2 years Hearing aids What is excess and how does it work? An excess is the amount you nominate to pay if you are admitted to hospital. Choosing an excess means you can lower your hospital premiums. No excess is payable for day surgery with no overnight stay (with the exception of Budget Hospital) and for accidents if treatment is within 12 months of the accident. There is also no excess payable for dependent children. What is a pre-existing condition? A pre-existing ailment or condition is an ailment or illness or a condition where the signs or symptoms existed any time during the six months before a member joined or upgraded to a higher level of cover, even though a diagnosis may not have been made. If there is any doubt as to whether an ailment or condition is pre-existing, a medical practitioner appointed by HCF will examine information provided by your doctor, together with other relevant claim details.
5 Do I receive cover for ambulance? HCF Hospital cover includes full cover for emergency ambulance services with State Government road or air services where you require hospital or on-the-spot treatment in Australia. You ll also be covered for State Government non-emergency ambulance services where your doctor requests ambulance transport because your condition requires monitoring and support in transit (up to $5000 per person per calendar year). The non-emergency ambulance services are not included under the Budget Hospital product. Please note: This cover is not available to residents of WA, Tas and Qld. What does Minimal Benefits mean? Minimal benefits are sufficient to cover your stay in a public hospital, but you may incur substantial out-of-pocket expenses if a procedure is undertaken in a private hospital. There is generally no benefit paid for theatre or labour ward charges under Minimal Benefits. Does my health insurance cover my children? As long as they are listed on your policy, your children are automatically covered under your family cover until the day before they turn 22. If they are full-time students, simply register them as Student Dependants, and they ll be covered for no extra cost until the day before they turn 25 or cease full time study (whichever comes first). What is Extended Family Cover? If your children aren t full time students, you can also continue to cover them until they turn 25 with Extended Family cover on selected levels of HCF cover. As long as they re not married or in a defacto relatationship, you can take out this cover for a surcharge of about 25% of your existing premium even if your children are living away from home. What sort of cover do I need for pregnancy? All HCF hospital cover include pregnancy but only minimal benefits are paid on the lower levels of cover. You need to ensure you are on an appropriate level of cover at least 12 months prior to giving birth. Please be aware that a 12 month waiting period applies for pregnancy and birth related services. We are having a baby when do I need to add my baby to my membership so he or she is covered? It s important to take out a family membership before your child is born so that the child doesn t have to serve any waiting periods. To cover your baby from birth, just transfer your single membership to a family two months or more before they re born. How do I make a claim for extras? You can make a claim on the spot for some services such as visiting your optometrist, dentist, physiotherapist, chiropractor, osteopath or podiatrist. Done via the electronic claims and payment system, you just need to pay the difference between the cost and benefit once the claim is approved electronically. What are Days of Absence? You are able to be without hospital cover for periods totalling 1094 days (i.e. three years less one day) during your lifetime, without affecting your loading. This is known as Days of Absence. If you exceed this period you will pay a 2% loading if you rejoin. The loading will increase by 2% for every year after that without cover. If you apply to your health fund to suspend your hospital cover for a short period, this will not affect your LHC loading as you are considered to be maintaining your cover. If you cancel your hospital cover because you are going overseas, the days you spend outside of Australia aren t counted towards your Days of Absence as long as you stay overseas for at least one continuous year. Where can I get further information regarding HCF?
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