Ultimate. The absolute best in health cover.

Transcription

1 Ultimate The absolute best in health cover.

2 Contents 4 Why HBF? 5 Momentum 6 Your Hospital cover 8 Maternity 8 Long-stay patients 8 Support for a healthier life 9 How soon can you claim? 9 How to claim 11 Your Extras cover 12 Dental 14 Friendlies health checks 14 Optical 14 Pharmacy 14 Podiatry surgery 14 Podiatry foot orthoses 14 Psychology 19 Wellness therapies 19 How to claim 20 Annual maximums 20 Medically necessary services 20 Approved providers 20 Your questions answered 22 Your rights and obligations 24 Your privacy Healthcare doesn t come any better. Ultimate gives you the highest level of Hospital, Extras and Wellness cover of any health insurer in Australia. There is simply no better way to look after your health. Ultimate cover for your ultimate priority Ultimate reassurance 100% cover for any surgeon in any hospital you choose in Australia. Ultimate value 90% to 100% back (up to annual maximums) on Extras and Wellness services including dental, physio, chiro, optical and complementary therapies. Ultimate service Your own dedicated relationship manager to answer any questions about your cover. Every body deserves the Ultimate in healthcare. 3

3 Why HBF? Better value CANSTAR has awarded us with most Outstanding Value in WA for both our extras cover and packages cover. We cover more of the dental bill on average, compared to any other major fund in WA. We cover more of the total hospital bill on average than any other major fund in WA. HBF health members can enjoy home, car and travel insurance discounts. HBF Momentum is a special selection of member benefits to help get your health journey started. There s $1000 in added value for HBF health members. Enjoy free fitness sessions throughout the year with HBF Fitness Discounted swimming and gym memberships at HBF Arena and HBF Stadium, plus discounted gym memberships at Snap Fitness < Fitness events discounts and Sportswear discounts We look after you We have more satisfied members! More people stay with HBF and fewer people complain to the Private Health Insurance Ombudsman about us than any other health fund, relative to market share. We visit around 85% of our members staying overnight in Member Plus private hospitals in WA. We provide access to a range of practical health programs to support a healthier life. If you become unemployed, we won t abandon you. HBF members can get complimentary cover for up to nine months.^ It s easy to speak to us with 19 branches and a local call centre in WA. More choice Our members can choose from more Member Plus hospitals, dentists and optical stores in WA than any other major health fund. Most trusted We ve been looking after the health of West Australians for over 70 years. Today we re the largest health fund in WA, with over 900,000 members. As a not for profit business, we don t have shareholders to pay so we can focus on giving as much back as possible to our members. 15% off purchases at Friendlies pharmacies *, free flu vaccinations +, personalised advice and free medication checks. Discounted movie tickets Discounts at Perth Zoo, Adventure World, the Rottnest ferry, The Maze and Botanic Golf Friendlies Plus free health checks for eligible members + To find out more and see what you could access in HBF Momentum, visit hbf.com.au. ^Conditions apply. State of the Health Funds Report PHIO 4 < Conditions apply. *Excludes restricted Pharmaceuticals, already discounted products, health services and products. +HBF members on Ultimate can receive 100% back on a flu vaccination and health check at Friendlies pharmacies. 5

4 Your Hospital cover HBF Ultimate gives you comprehensive hospital cover for over 5000 medical procedures, including removal of tonsils and wisdom teeth, knee and shoulder reconstructions, chemotherapy treatment, maternity and birth-related services, cataract and eye lens procedures, heart treatment, joint replacement surgery and psychiatric care. We don t cover hospital treatment that s not eligible for a Medicare benefit, such as cosmetic surgery (see the full list of exclusions towards the back of this booklet). As an HBF Ultimate member, you can choose any surgeon in any hospital in Australia knowing you ll be 100% covered. And, of course, you can avoid public hospital waiting lists by choosing to be treated in a private hospital. This ensures you ll get the best available treatment as soon as possible. Ultimate benefits 100% cover Medical 1, 2 Includes fees charged by surgeons, anaesthetists and pathologists in hospital 100% cover Accommodation 2, 3 Includes fees charged for a private or shared room in any Australian private or public hospital 100% cover Theatre 1, 2 Includes fees charged for the theatre in which your procedure is performed 100% cover Intensive care Includes all fees associated with a stay in ICU 100% cover Maternity and labour ward Incudes labour ward and accommodation fees and the doctor and hospital of your choice. Includes the cost for your partner to stay in your room with you. Some hospitals even have double or king-size beds for you 100% cover Hospital boarder Includes all meals and accommodation (in some HBF Member Plus private hospitals) for a relative or carer who is needed for the management of your condition 100% cover Pharmacy 2 Includes the cost of any medication you receive in hospital 100% cover Prostheses 2 Includes the costs of any prostheses (surgically implanted devices you may need for procedures such as joint replacement or cataract surgery), up to the amount specified by the Federal Government Prostheses List 100% cover Psychiatric Covers fees for all in-hospital HBF approved psychiatric treatment 1 Excludes some plastic and reconstructive procedures. 2 Excludes procedures where Medicare doesn t pay a benefit, such as cosmetic surgery. 3 Nursing home type patients must pay an uninsurable patient contribution set by the Commonwealth towards their care. 6 7

5 Maternity We re here for you - and your little one If your newborn isn t well and is admitted to hospital, they will be fully covered for paediatric care. We also cover medically necessary interhospital ambulance transport. For example, if your baby is born at a private maternity hospital but needs to go to King Edward or Princess Margaret Hospital, we ll pay for the ambulance transfer. Cover for your baby If you already have couple or family cover, you won t need to pay anything to add your newborn to your policy. However, if you re currently on a single policy and want your newborn to be covered from birth, you ll need to add your baby to your policy within two months of your baby s birth date. Family or parent plus premiums will apply from your baby s date of birth. Newborns If your baby is admitted to a special care nursery, their care will be fully covered on your family Ultimate cover. Lactation support If you need support through the early stages of breastfeeding, you may be able to access a lactation service through your hospital. We will pay a benefit towards this as part of your hospital stay. Long-stay patients After 35 days of continuous hospitalisation (and if you no longer need acute care) by law the hospital must classify you as a nursing home type patient. If this happens, we can only pay a small portion of the benefit per day and you ll need to contribute towards the cost of your care, which can be substantial if you re in a private hospital. Support for a healthier life If you have a long-term health condition such as diabetes, osteoarthritis or a heart condition, we can help find and deliver the support you may need to access practical health programs, take control of your condition and stay well outside of hospital. These services are fully covered for members on Ultimate with long term health conditions. Find out more at hbf.com.au/healthconnect. How soon can you claim? As with all health insurance, waiting periods apply before you can receive benefits. Waiting periods protect our members by preventing new members from making a large claim shortly after joining or upgrading their cover, and then dropping their membership, which would result in increased premiums for all members. The table below provides an overview of the standard waiting periods that may apply to your hospital treatment. If you haven t completed the necessary waiting period, we may not be able to pay a benefit or will pay a benefit applicable to your previous level of cover. Pre-existing ailments or conditions Defined as an illness or condition, which, in the opinion of a medical practitioner appointed by HBF, was known to exist, or where signs or symptoms were evident during the 6-month period before you became an HBF member, including on the day you joined Maternity and birth-related services Other hospital treatments including surgery Urgent ambulance Cover for urgent ambulance transport Non-urgent ambulance Cover for non-urgent ambulance transport How to claim 12-month waiting period (does not apply for psychiatric, rehabilitation, or palliative care) 12-month waiting period 2-month waiting period 7-day waiting period 30-day waiting period Most hospitals and medical practitioners bill HBF directly. But if you need to make a hospital claim, contact us and we ll be able to help. 8 9

6 Your Extras cover As an Ultimate member, you will receive 90% to 100% back on services essential to your everyday wellbeing. The tables on the following pages show what Ultimate covers, how much you can claim for each treatment type each calendar year and the waiting periods that apply

7 Dental Ultimate members receive: 90% back on all dental treatment at any dentist 100% cover on a scale and clean every calendar year at any HBF Member Plus dentist No annual maximums on general dental You can claim benefits for medically necessary dental services provided by an HBF approved dentist or dental prosthetist. What s the difference between general dental and major dental? General dental includes routine dental care such as regular checkups, consultations, extractions, simple fillings, x-rays and mouthguards. Major dental includes more extensive treatments such as dentures, root canal treatments, crowns and bridges. The benefit we pay on some dental items may be restricted if performed in conjunction with other specific dental services, or if a service is received more than once in a specified period of time. Benefits are only paid for medically necessary bleaching and procedures undertaken in the surgery; we don t pay a benefit for home bleaching. Service General dental All services (including consults, scale and clean, mouthguard, fillings and extractions) Major dental Veneer indirect (2 bondings 1 ) Veneer direct (2 bondings 1 ) Tooth coloured filling indirect (3 services 1 ) Crowns (excludes crowns for implants, 3 units of crowns/bridges per yr 1, 2 ) Bridges (3 units of crowns/bridges per year 1, 2 ) Full dentures Dental implants and orthodontics Orthodontics Implants (2 complete implants per 2 yrs) 1 Waiting periods Benefit Maximums pp per calendar year 2 months 90% No limit 12 months 90% 12 months 90% $1000 under 3 yrs $ yrs $ yrs $ yrs and over $1000 under 3 yrs $ yrs $ yrs $ yrs and over No gaps for kids You ll get 100% back on general dental for children on your policy at HBF Member Plus dentists Sub-limits included in overall maximums. 2 Crowns associated with implants limited to 2 per 2 years. Note: A single tooth can have more than one service. 13

8 Friendlies health checks All members on Ultimate are fully covered for a Friendlies health check each year at selected pharmacies. To find your nearest pharmacy, visit friendliespharmacies.com.au. Optical For more value when choosing new glasses, visit an HBF Member Plus optical store where you ll be able to choose from hundreds of fully covered frames (a minimum of 30% of the store s range). If you choose glasses outside the fully covered range, you ll receive at least 20% discount in addition to your HBF benefit. This includes frames, all lens types (such as single vision, bi-focal, multi-focal and progressive lenses) and extras like tinting. To find your nearest Member Plus optical store, go to hbf.com.au/memberplus or download the HBF Health app from the App Store or Google Play. Please note that when purchasing glasses or contacts, your HBF benefit applies to the calendar year in which you order them, not when you collect them. For example, if you order your glasses in December 2015 but don t receive them until January 2016, your benefit will be calculated from your 2015 annual maximum so you ll be able to claim for glasses again in Pharmacy The Government subsidises the cost of some pharmaceuticals under the Pharmaceutical Benefits Scheme (PBS). You can claim benefits for prescriptions and repeats for non-pbs medications listed on the HBF Pharmacy Schedule, but you may need to pay a co-payment (usually no more than that specified by the National Health Act). You ll usually receive a benefit for the balance of the cost, however some items may have an out-of-pocket expense. Podiatry surgery You will receive 90% benefit for podiatry surgery, assistant fees and associated anaesthetist services. You re 100% covered for hospital accommodation, theatre fees and pharmacy. Podiatry foot orthoses We will pay a benefit for the supply of foot orthoses custom-made by a podiatrist, orthotist, pedorthist, surgical bootmaker or other medical practitioner approved by HBF. Please note: for some items, we only pay benefits when provided by a podiatrist. Psychology We will pay benefits for treatment by psychologists registered with Psychology Board Australia. Service Optical glasses Frames only Frames and single vision lens Frames and bi-focal lens Frames and multi-focal lens Optical contact lenses Spherical rigid or soft contact lenses pair Waiting periods Benefit Maximums pp per calendar year 2 months 100% $400 maximum of 1 pair of glasses $230 1 Toric rigid or soft lenses pair 2 months 100% $300 1 Bi-focal progressive lenses $350 1 Frequent replacement disposable contact lenses Optical laser eye procedures LASIK - bilateral eye surgery PRK - bilateral eye surgery Keratoconus cross linking Refractive lens exchange Implantable contact lenses Pharmacy For pharmaceuticals listed on the HBF Pharmacy Schedule Podiatry Consultation Surgery Podiatry foot orthoses $ months 100% $6500 lifetime maximum 2 months Cost of medicine less member co-payment 2 months 90% $800 under 6 yrs $ yrs and over $800 under 6 yrs $1000 6yrs and over No limit Foot orthoses (including casting) $ months 100% Diagnostic testing $200 Psychology Psychology consultations 2 months 90% Psychology and clinical psychology maximums combined $ Maximum 1 pair of contacts or $300 frequent replacement/ disposable lenses per yr

9 Service Waiting periods Benefit Maximums pp per calendar year Service Waiting periods Benefit Maximums pp per calendar year Aids to recovery Dietetics and nutritionist Includes crutches, walking frame, wheelchair, blood pressure monitor, circulation booster and vaporiser Ambulance 2 months 100% Urgent ambulance 1 7 days 100% No limit Non-urgent ambulance 2 30 days 100% $3000 Antenatal classes Antenatal classes 2 months 100% $100 Appliances Blood glucose monitor (1 pp per 3 yrs) Nebuliser (1 pp per 3 yrs) Other appliances Chiropractic Chiropractic x-ray (1 pp per calendar yr) Initial individual consultation (1 pp per calendar yr) 2-12 months depending on appliance 2 months % Subsequent individual consultations 90% Clinical psychology Consultations Complementary therapies Naturopathy Homeopathy Acupuncture Traditional Chinese medicine $300 combined for aids to recovery, health monitoring equipment and preventative equipment $300 $250 Depends on appliance 90% Chiropractic and osteopathy maximums combined $800 under 3 yrs 90% $ yrs $ yrs and over 2 months 90% Psychology and clinical psychology maximums combined $ months 90% Combined maximum 3 $500 under 3 yrs $ yrs $ yrs and over Consultations 2 months 90% Exercise physiology Consultations 2 months 90% Eye therapy Consultations 2 months 90% Healthy living programs 4 Friendlies health check Subsequent Friendlies health check, health education programs (including Living Longer Living Stronger), quit smoking programs, weight management programs, travel vaccination, pilates and yoga programs Flu vaccinations, health program and dose administration aids Hearing aid 2 months One fully covered health check when provided at selected Friendlies pharmacies 100% 100% when provided at selected Friendlies pharmacies Combined maximum for dietetics and nutritionist $700 under 3 yrs $ yrs and $ yrs and over $700 under 3 yrs $ yrs and over Occupational therapy, eye therapy and speech therapy maximums combined $1200 under 3 yrs $ yrs and over One health check Hearing aid 12 months 100% $2500 every 2 calendar yrs Occupational therapy Consultations 2 months 90% $500 Occupational therapy, eye therapy and speech therapy maximums combined $1200 under 3 yrs $ yrs and over 1 For all trips St John Ambulance classifies as requiring urgent attention. 2 For transport by road in WA in an ambulance of the St John Ambulance WA service where the ambulance service type is classified by St John Ambulance as non-urgent or transfer. 3 Complementary therapies forms part of combined maximum with Bowen therapy, Alexander technique, kinesiology, hypnotherapy, Feldenkrais, shiatsu, aromatherapy, reflexology, herbalist consult and complementary therapies (naturopathy, acupuncture, traditional Chinese medicine and homeopathy) For HBF approved programs only. A program is a minimum of eight sessions within a 3 month period. 17

10 Service Osteopathy Initial individual consultation (1 pp per calendar yr) Subsequent individual consultations Other lifestyle services Remedial massage Waiting periods Benefit Maximums pp per calendar year 2 months 90% 90% $600 Chiropractic and osteopathy maximums combined $800 under 3 yrs $ yrs $ yrs and over Wellness therapies Because prevention is better than cure, all Ultimate members receive 90% back on a wide range of lifestyle services and complementary therapies. These include remedial massage, yoga and pilates programs, nutritionist and herbal consultations, reflexology and more. We re waiving waiting periods for Wellness therapies, so you can claim straight away. Service Benefit Annual maximum Wellness therapies Bowen therapy 90% Pilates program 1 2 months $ % Yoga program 1 $300 Physiotherapy Initial individual consultation (1 pp per calendar yr) Subsequent individual consultations Individual consultations by a specialised physiotherapist for continence and women s health 2 (3 pp per calendar yr 3 ) Individual consultations by a specialised Physiotherapist for lymphoedema management 2 (3 pp per calendar yr 3 ) Speech therapy 2 months 90% Consultations 2 months 90% Travel and accommodation Travel and accommodation 2 months 100% $300 $1100 under 3 yrs $ yrs and over Occupational therapy, eye therapy and speech therapy maximums combined $1200 under 3 yrs $ yrs and over Alexander technique 90% Kinesiology 90% Hypnotherapy 90% Feldenkrais 90% Shiatsu 90% Aromatherapy 90% Reflexology 90% Herbalist consultation 90% Health monitoring equipment 100% Preventative equipment 100% How to claim Bowen therapy, Alexander technique, kinesiology, hypnotherapy, Feldenkrais, shiatsu, aromatherapy, reflexology, herbalist consult and complementary therapies (naturopathy, acupuncture, traditional Chinese medicine and homeopathy) have combined maximum of $500 under 3 yrs $ yrs $ yrs and over $300 combined with aids to recovery, health monitoring equipment and preventative equipment Claiming for most Extras services (dental and optical for example) is easy just swipe your member card when paying for your treatment. Other ways to claim Claim online via hbf.com.au/myhbf Claim in person at your local HBF branch Complete a claim form (available from our website or by calling us) and claim by mail For more details on how to claim, please go to hbf.com.au/howtoclaim. 1 A program is a minimum of eight sessions within a 3 month period. 2 Benefits only payable for services provided by providers that are approved by HBF as a Specialised Physiotherapist. 3 Forms part of the overall physiotherapy maximum

11 Annual maximums Your questions answered To reward our long-standing members, some Extras entitlements are based on the length of your membership. Maximum benefits for treatment and services are calculated and based on calendar years. Please note maximums cannot be advanced from future years and unused entitlements can t be carried forward to the following year. If you re switching to HBF from another insurer and you ve already used some of your annual Extras benefits with your former fund, we ll need to adjust the balance of your Extras policy to reflect this. Medically necessary services Benefits are only payable where treatment is medically necessary. Approved providers HBF benefits are only paid for services provided by HBF approved providers who must be registered with their government registration board (where applicable) and who must practise solely and exclusively in private practice, except where HBF decides otherwise. Since not all providers are HBF approved, be sure to ask first. If you need further information, please call your HBF relationship manager on or visit hbf.com.au. To what age are my children covered? Children are covered on their parents policy until they re 25 years old if they are studying full time or earn less than $21,250 taxable income in a calendar year and not married or in a de facto relationship. Children are covered until the end of the year they turn 18 as long as they re not married or in a de facto relationship, regardless of their income or whether they re studying. Do I have to use my HBF cover in a public hospital? No. As a patient in a public hospital, you can choose to be treated as a private or public patient even if you have private health insurance. A public patient s accommodation and treatment are provided without charge. The allocation of single rooms in public hospitals is decided according to clinical need, however if you choose to be a public patient you will be treated by a medical practitioner assigned by the hospital (not your preferred doctor). What if I m not eligible for Medicare? If you aren t eligible for Medicare, you could have large out-of-pocket expenses on Ultimate it isn t the right HBF cover for you. Contact us so we can discuss more suitable types of cover that provide benefits for services normally covered by Medicare. Am I covered outside Australia? We re not legally permitted to pay benefits for treatment or services provided outside Australia, including general treatment such as dental, optical or any hospital or medical treatment. You may want to take out travel insurance that covers benefits for emergency treatment received overseas. As an HBF health member, you ll get a 10% discount and an additional 10% if you join online. If you are away for longer than two months you can suspend your health membership without losing any benefits or having to re-serve waiting periods when you return. It won t cost you anything to suspend your cover, and you won t need to pay for your health insurance while you re out of Australia. Please contact us if you d like to suspend your cover. What if I change my mind? So you can be sure you ve chosen the policy that best suits your needs, you have a 30-day cooling-off period from the start date of your Ultimate policy. During this time, you may cancel your policy or return to your previous level of cover and receive a full refund for any premium you ve paid as long as you haven t made a claim. Are there any exclusions on benefits? There are a few circumstances where we don t pay a benefit: If your membership is unfinancial at the time of treatment or service (that is, you have not paid your premium by the due date) On claims covered by worker s compensation, third party or other legal right For treatment or services required by your employer or potential employer to be provided to you as a condition of your employment or by your insurer as a condition of your policy For treatment or services provided outside of Australia For care and accommodation in nursing homes Before a treatment or service has been received. This simply means we don t pay in advance for future treatments If the claim isn t made within two years of the date of service For hospital treatment that isn t eligible for a Medicare benefit, such as cosmetic surgery On internet purchases, except for pharmaceuticals, some appliances, glasses or contact lenses from an HBF approved provider that operates in Australia For outpatient services 20 21

12 Your rights and obligations When we provide you with products and services we believe you should have access to information about your rights and obligations. The following pages explain some of your key obligations and rights, as well as HBF s obligations to you. You ll also find information about how we operate and how we collect information. Specifically, this information will help you to understand the Private Health Insurance Code of Conduct, how we protect your privacy, where you can access more information and how to raise a concern or make a complaint. HBF Fund Rules All registered health funds are required to have fund rules under the Private Health Insurance Act These Fund Rules set out the general principles and rules of membership under which each fund conducts its business. When you take out private health insurance with HBF, you become a member of our fund and you agree to our Fund Rules. As a member of HBF, you have rights and obligations concerning your health insurance policy and membership. It is important that you are aware of the contents of the Fund Rules as they form the terms and conditions of your policy, so please ensure you read them. We recommend that these Fund Rules be read together with your Policy Certificate and the brochures relevant to your cover. To obtain the HBF Fund Rules, visit hbf.com.au/fundrules or contact us on Private Health Insurance Code Of Conduct HBF is a signatory to the Private Health Insurance Code of Conduct (the Code). The Code is designed to help you by providing clear information and transparency in your relationships with health funds. The Code covers four main areas of conduct in private health insurance. They are: People selling private health insurance are properly trained. Members are aware of the internal and external dispute resolution procedures available in the event that they have a dispute with their health fund. Policy documentation contains all the information that members require in a way that enables them to make a fully informed decision about their purchase. Members purchasing health insurance from persons other than the health funds employees understand the nature of the arrangement between the fund and the person selling the insurance on the fund s behalf. HBF s obligation to you under the Code We will try to: work towards improving the standards of practice and service within HBF, provide information to our members in plain language, promote better informed decisions about our private health insurance products and services: -- by ensuring that our policy documentation is full and complete, -- by providing an effective and clear verbal or written explanation of the contents of the policy documentation, -- by ensuring that our employees providing information on health insurance are appropriately trained, provide information to members on their rights and obligations under their relationship with HBF, including information on the Code, and provide members with easy access to our internal dispute resolution procedures, which will be undertaken in a fair and reasonable manner and advise them of their rights to take an issue to an external body such as the Private Health Insurance Ombudsman. How the Code helps HBF members Apart from promoting improved standards in clarity and usefulness of information given to members, the Code is designed to help solve problems between members and HBF. HBF has a complaints handling process for members who may have a dispute with HBF. Examples of disputes include: content of advertising by HBF, representations made to the member when they purchased a product, features of their product, benefits paid under their product. You can access HBF s complaint handling process by visiting your nearest HBF branch, by contacting an HBF member service advisor on or by writing to us at GPO Box C101, Perth If you are not satisfied with the outcome of your concern you can ask to have it reviewed by the internal dispute resolution process. Complaints should be addressed to: HBF Dispute Manager GPO Box C101 Perth 6839 Phone: Fax: [email protected] If a resolution is not reached to your satisfaction you can: contact the Private Health Insurance Ombudsman by ringing toll free on , or by writing to Suite 2, Level 22, 580 George Street, Sydney NSW 2000, forward the problem to a health care complaints commission or fair trading body in your state of residence, or report HBF s behaviour to the Australian Competition and Consumer Commission. Your documentation All documentation regarding your policy is important, please read it carefully and contact us if you require any further information. Please keep your policy certificate in a safe place for future reference. How can I get a copy of the Code? A full copy of the Code is available at: privatehealth.com.au/codeofconduct or by calling HBF on

13 Your privacy We are HBF Health Limited ABN which provides private health insurance (under the brands HBF Health and GMF Health). References to HBF us, we or our include HBF, HBF Health, GMF Health, and other business names, and where the context requires, other related bodies corporate (collectively HBF). At HBF, we comply with the Privacy Act 1988 (Cth) (Privacy Act). We respect the privacy of your personal information. We process personal details on a daily basis and are committed to ensuring that the privacy and security of personal information remains protected. Personal information is information or an opinion about an individual, or an individual who is reasonably identifiable, whether the information or opinion is true or not, or is recorded in a material form or not. It includes your name, age, gender and contact details as well as your sensitive information (which includes health information). Collection, use and disclosure of your personal information HBF collects and uses your personal (including sensitive) information (Information) to provide you with private health insurance and health and wellness related services, including to: manage our ongoing relationship with you; administer, process and audit private health insurance premiums and claims and pay benefits; assess your suitability for, enrol you in and administer health and wellness related services such as chronic disease management programs and health management programs; provide you with access to smartphone applications and website portals in relation to managing your health, your private health insurance membership and your relationship with us; conduct market research that informs the strategic direction of HBF, by seeking to understand ways to improve the health of members, the effectiveness of marketing activities, the member experience and the products and services HBF offer; manage, review and develop our private health insurance products and related services whether provided by us or other parties on our behalf; manage, review, develop and improve our business and operational processes, including training and systems, provided by us or other parties on our behalf; resolve any legal and/or commercial complaints or issues including compensation recovery; prevent, detect and follow up fraudulent or invalid claims or misrepresentations; meet legislative requirements relating to private health insurers; and perform any of our other functions and activities relating to our private health insurance and health and wellness businesses. HBF may collect your Information from you, the person responsible for the management of your private health insurance membership (Principal Policyholder) or a person authorised to provide us this information on your behalf in order to, amongst other things, provide you with private health insurance cover and pay you benefits. HBF may also collect your Information from one of its related bodies corporate (in order to, amongst other things, investigate potential fraudulent claims and misrepresentations) or a third party such as a health service provider, broker or employer (in order to, amongst other things, provide you with private health insurance cover and pay you benefits). HBF also engages third parties to carry out functions on behalf of HBF (such as claims administration, membership management services, facilitators to organise and manage hospitals, doctors and health service providers, providers of claims advice and chronic disease management program providers) and they may collect your Information from you and pass this Information to HBF. In order to carry out the purposes described in this statement, HBF may disclose your Information to persons or organisations such as: other related bodies corporate; our brokers and agents who refer your business to us; our service providers (who may provide some services directly to you on our behalf) including mailhouses, market researchers, manufacturers of membership cards, claim administrators, claim auditors, claim advisers, our membership management service providers, the facilitators of our arrangements with health providers and IT support (including by way of cloud computing); our professional advisors; health and wellness service providers (such as hospitals, our pharmacies, general practitioners, allied health providers, and chronic disease and health management program providers); payment system operators and financial institutions; persons authorised by you, including other persons covered by your private health insurance membership, and your agents and professional advisors such as legal practitioners; if you have a compensation claim, the insurer or statutory body responsible for paying your compensation claim or compensation recovery organisations; if you have an overseas visitors product, your educational institution, migration agent or broker; if you have a corporate private health insurance product, your employer; regulatory bodies and government agencies (such as the Department of Health & Ageing, the Private Health Insurance Ombudsman and Medicare Australia); parties involved in a prospective or actual transfer of any part of our assets or business; and other parties to whom we are authorised or required by law to disclose information. These third parties may also collect your Information directly from you. HBF may transfer your Information overseas in the following circumstances. At your request, HBF may provide a transfer certificate or claims history containing your Information to an overseas insurer nominated by you. By making such a request, you give consent for your Information to be transmitted overseas in these circumstances. HBF also sometimes use service providers who either host or store personal information overseas. This means HBF may transfer Information about you between countries to those service providers for the purposes described in this statement. In the event HBF transfers your Information outside Australia, we will comply with the requirements of the Privacy Act that relate to transborder data flows. If you are not the Principal Policyholder of your private health insurance membership, HBF may also disclose your personal information to the Principal Policyholder as part of administering the membership and paying benefits. This may include the disclosure of sensitive information about benefits claimed by you under your policy. If the Principal Policyholder has authorised his/her spouse/partner to administer the private health insurance membership, HBF may disclose the Principal Policyholder s Information to his/her spouse/partner. If you do not provide Information requested of you to HBF, we may be unable to provide you with private health insurance cover, pay you benefits, assess or waive lifetime health cover loading or apply an entitlement to the Australian Government rebate on private health insurance as a premium reduction

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

15 Ni hao! Go to hbf.com.au Visit a branch Mon to Fri: 9am to 5pm Sat: 9am to 12.30pm* Call us Mon to Fri: 7am to 6pm Sat: 8am to 2pm Postal address GPO Box C101 Perth 6839 Stay in touch Find us at HBF Health Metropolitan branches Perth 96 William St Belmont Belmont Forum Booragoon * Garden City Cannington * Carousel Fremantle Corner Market St and High St Mall Hillarys Whitford City Innaloo Innaloo Joondalup * Lakeside Joondalup Shopping City Karrinyup * Karrinyup Mandurah 32 Pinjarra Rd Midland * Midland Gate Morley * Galleria Rockingham * Rockingham Subiaco 142 Rokeby Rd Success Cockburn Gateway We speak your language If English is not your first language, our multilingual team is fluent in many languages including Mandarin, Cantonese and Hindi. Call us on Regional branches Albany 21 Albany Hwy Bunbury 12 Arthur St Busselton 2/90-92 Queen St Geraldton Northgate Even the healthiest bodies need looking after. HBF is the Official Health Partner of WA s favourite teams, the Fremantle Dockers and the West Coast Eagles. HBF Health Limited ABN The information in this brochure is correct at time of print. Minor changes may have occurred since that date. If major changes occur, the brochure will be replaced. Details of any minor changes can be obtained from HBF on request. General Insurance issued by CGU Insurance Limited (CGU) ABN AFSL HBF Health Limited ABN AR No (HBF Health), is an authorised representative of and also acts under a binder from CGU. This is general advice only and does not take into account your personal circumstances. Before buying consider the PDS available from HBF. Discounts subject to minimum premiums and vary depending on policies held. HI /07/15