Health insurance that gives you more. March 2014

Transcription

1 Health insurance that gives you more March

2 We're committed to giving you more As Australia s largest not-for-profit health fund, we return the highest benefits back to our members, not shareholders Contents You ll get more with HCF 4 Health and well-being programs 6 Singles & couples under 30 packages 8 Planning a family packages 10 Family with kids packages 12 Singles & couples 30 to 65 packages 14 Complete peace of mind packages 16 Stand-alone covers 18 Cash Assist covers 22 Loyalty benefits 24 Hospital benefits summary 26 Extras benefits summary 29 Rebates, surcharges and incentives 32 Things you need to know 34 How your rights are protected 38 Cash Assist Combined Product Disclosure Statement and Financial Services Guide 40 More insurance options 44 Our privacy statement 47 Changes to products and pricing 47 Branch, Dental and Eyecare Centre locations 48 How to join 50 3

3 You ll get more with HCF We provide health insurance cover to help you stay healthy More peace of mind Want to avoid public hospital waiting lists? Want a doctor you know and trust? With HCF, it s your choice. More benefits As Australia s largest not-for-profit health fund, we seek to return the highest benefits back to our members, not shareholders. And we have the figures to prove it. We returned 91.6 cents in the dollar in benefits compared to an average of 86.4 cents for other health funds in the 2013 financial year. This means you get more value with HCF. But don t just take our word for it. Canstar, one of Australia s leading independent rating agencies, has awarded us their top national award for outstanding value health insurance five years in a row. More savings Depending on your level of hospital cover, you can reduce your premium by opting for a higher excess, or pay a bit more to get a lower excess. An excess is the amount you nominate to pay if you re admitted to hospital. You can also save more if you need to claim because: You won t pay a hospital excess for accident-related treatment You won t pay a hospital excess for dependent children You won t pay a hospital excess for same day treatment on Top Plus Hospital You pay only one hospital excess amount per person per calendar year if an excess is applicable. You ll save even more by choosing a doctor who participates in our no-gap Medicover arrangements. Many doctors charge above the Medicare Benefits Schedule fee which can lead to significant out-of-pocket expenses for in-hospital medical services. More cover You'll get the best full coverage for medical services of any health fund in Australia You get a range of fully covered services for teeth, eyes, muscles, backs and feet under our More for You programs. More than health insurance You ll find it easier to look after your health and well-being with our My Health Guardian program You can access our My Home Doctor after-hours home doctor service in selected locations You get a 10% discount on travel insurance, pet insurance and new Fitness First gym memberships You can get a range of affordable life insurance cover from HCF Life to provide financial relief from illness or accidents You ll get high quality service. In 2012 we became the first Australian health fund to achieve accreditation to the International Customer Service Standard. In 2013 HCF won six awards from the Customer Service Institute of Australia (CSIA). This included the coveted national Best of the Best award for the most outstanding customer service and the ESi award for being the easiest health fund to do business with, in Australia. More for You programs Want more fully covered services? Want to get back on your feet faster? Our More for You programs include a range of fully covered services. These programs aim to encourage you to seek early intervention for an injury or illness and to look after your health. More for Teeth This program gives you a range of fully covered diagnostic and preventative dental services. These services are available through our seven HCF Dental Centres in Sydney, and participating dental providers in regional/rural NSW, ACT, Queensland, Victoria, South Australia and Western Australia. It's available with all extras covers and subject to available limits. More for Eyes This program gives you a range of fully covered glasses and access to free digital retinal photography through our participating optical providers across Australia and seven HCF Eyecare Centres in Sydney. It s available with selected extras covers and subject to available limits. HCF Eyecare is independently owned and operated by Eyecare Holdings Pty Limited ACN More for Muscles This program gives you one fully covered initial consultation a year for a new health condition, or flare up of an existing condition, through our participating physiotherapists across Australia. It s available with all extras covers and subject to available limits. More for Backs This program gives you one fully covered initial consultation a year for eligible musculoskeletal conditions; whether for a new health condition or flare up of an existing condition, through our participating chiropractors and osteopaths across Australia. It s available with all extras covers and subject to available limits. More for Feet This program gives you one fully covered initial consultation a year for a new health condition, or flare up of an existing condition, through our participating podiatry providers across Australia. It s available with selected extras covers and subject to available limits. Health management programs Looking to improve your health? On eligible extras products, you can claim on a range of HCF approved health programs to help you lead a fit and healthy life. They include: Weight management programs Healthy Weight for Life Exercise and gym membership for a specific health problem (Doctor's referral required) Childbirth education Lactation consultant Learn to swim Stress management and quit smoking programs Faecal occult blood test A six month waiting period and conditions apply. 10% off for members You get a 10% discount on HCF travel insurance, pet insurance and new Fitness First gym memberships. For more information on travel insurance and pet insurance, see page 44. For more information on Fitness First visit hcf.com.au/memberoffer. Terms, conditions and a start up fee apply

4 Health and well-being programs We give you access to easy-to-use health and well-being management tools, exclusive home care and support for a number of specific health conditions. Two of these services, My Home Doctor and My Global Specialist are a first for Australia s health insurers. Health and well-being My Health Guardian is our unique online health and well-being management program, that lets you create an easy and effective well-being plan. It s like having your own health coach 24/7. Want more energy? To lose weight? Or to simply feel healthier? My Health Guardian can help you achieve your health goals with a wide range of innovative online planning and monitoring tools. It s a fully covered service for members aged 18 years and over with hospital or extras cover. Make a plan and monitor your progress Helpful tools include: Well-being assessment a simple, guided process to assess your lifestyle and overall health Well-being action plan put together your plan, including focus areas to keep you on track Online resource library a wealth of information with hundreds of articles, exercises and recipes for you to access Your personal health coach ask any questions you have on diet, exercise and lifestyle Exercise and diet plans create personalised plans using the Get Fit and Eat Fit tools. Our new mobile app To help keep you motivated and on target to achieve your health goals, you can track your health and well-being wherever you are with the My Health Guardian mobile app, Well-being Plus. Available for iphone and Android. Daily Challenge Improve your health and well-being one step at a time with the Daily Challenge. It encourages healthy behaviours that boost emotional and physical health. Getting started? We recommend you see how you or a family member can benefit. To find out what My Health Guardian can do for you, take the virtual tour at hcf.com.au/mhg After-hours home doctor service My Home Doctor is a convenient non-emergency after-hours home doctor service for eligible members in selected areas. The service is provided at no cost to you if you have hospital cover. Think of the peace of mind, having access to such a service. Whether it s having your distressed young child seen by a doctor in the middle of the night, or simply helping you get treatment sooner when you feel sick. Coverage spans most of Sydney, Melbourne, Geelong, Adelaide and South East Queensland, and is constantly expanding. To see if your area is covered, contact us or visit hcf.com.au/mhd Access world leading medical experts If you or someone on your family membership had a serious illness, wouldn t it be reassuring to know that you could access a world-leading medical expert to review your case? My Global Specialist is a specialist medical information service. It is available to members on our highest level of hospital cover, Top Plus with nil excess, with either Multicover or Super Multicover Extras. You will have access to a global network of 50,000 medical experts to review your medical records and provide you with a report on your diagnosis and treatment plan. We have engaged Best Doctors, the world s leading resource for specialist medical advice founded by doctors from the Harvard Medical School in 1989, to provide this innovative new service. Please visit hcf.com.au/mgs or contact us for more information

5 Singles & couples under 30 packages Cover for the essentials without blowing your budget Much, Much More Hospital Advanced Savings Accident related treatment Removal of tonsils Removal of appendix Back surgery Rehabilitation services Shoulder reconstruction Emergency ambulance and more Excess options: $250 or $450 Want an even higher level of cover? Check out our Complete peace of mind packages on page 16. with Multicover Extras Exercise physiology Remedial massage and acupuncture Travel vaccinations and more Young Singles and Couples Hospital with Young Singles and Couples Extras Much More Accident related treatment Removal of tonsils Removal of appendix Back surgery Shoulder reconstruction Emergency ambulance and more Excess: $450 Exercise physiology Travel vaccinations and more Budget Hospital with General Extras Plus Choose this Cash Assist option: Get added protection, with $2,500 cash back if you suffer an accident or serious illness. Add Cash Back Cover for just $1 per week for singles. See page 22. More Accident related treatment Removal of tonsils Removal of appendix Shoulder reconstruction Emergency ambulance and more Excess: $450 This cover is designed for young, fit and healthy singles and couples. See notes below. Exercise physiology Remedial massage and acupuncture Travel vaccinations and more See Hospital benefits summary table on page 26 and Things you need to know on page 34 for product details including benefits, limits, waiting periods, restrictions and exclusions. These are suggestions only. To compare our products and learn more about what is covered, refer to pages Joining is easy too! Go to hcf.com.au Call between 8am and 8pm, Monday to Friday or 9am to 5pm on weekends (AEST) Visit a branch Find your nearest HCF branch on page 48 or visit hcf.com.au 8 Fill in the form Complete the attached application and send it to us 8 9

6 Planning a family packages Cover for when you re having kids Much, Much More Top Plus Hospital Pregnancy and birth related services Assisted reproductive services (e.g. IVF, GIFT) Accident related treatment Hip and knee joint replacement surgery Rehabilitation services Emergency ambulance Bonus Permanent Disability from Accident Cover (see page 41) and more Excess options: Nil, $250 or $450 with Super Multicover Extras Orthodontics with flexible two year limit Antenatal classes Remedial massage, acupuncture and other therapies HCF approved health management programs Travel vaccinations and more Top Plus Hospital with Multicover Extras Choose this Cash Assist option: Cash Back Cover gives even more peace of mind. See page 22. Much More Same comprehensive hospital cover as above Top Plus Hospital Orthodontics Antenatal classes Remedial massage and acupuncture HCF approved health management programs Travel vaccinations and more with General Extras Plus More Same comprehensive hospital cover as above but excludes Bonus Permanent Disability from Accident Cover (see page 41) Exercise physiology Remedial massage and acupuncture Travel vaccinations and more See Hospital benefits summary table on page 26 and Things you need to know on page 34 for product details including benefits, limits, waiting periods, restrictions and exclusions. These are suggestions only. To compare our products and learn more about what is covered, refer to pages If you are thinking of becoming pregnant, please check that your cover includes pregnancy and birth related services and ensure that you have served any relevant waiting periods. If you are currently on a single or couples membership, you will need to transfer to a family membership at least two months prior to your baby s birth. This will ensure that your baby is covered under your membership from their date of birth. 10 Joining is easy too! Go to hcf.com.au Call between 8am and 8pm, Monday to Friday or 9am to 5pm on weekends (AEST) Visit a branch Find your nearest HCF branch on page 48 or visit hcf.com.au Fill in the form Complete the attached application and send it to us 1111

7 Family with kids packages Cover for everyone in the family Much, Much More Top Plus Hospital Pregnancy and birth related services Assisted reproductive services (e.g. IVF, GIFT) Accident related treatment Hip and knee joint replacement surgery Rehabilitation services Emergency ambulance Bonus Permanent Disability from Accident Cover (see page 41) and more Excess options: Nil, $250 or $450 with Multicover Extras Orthodontics Selected natural therapies Learn to swim Exercise physiology Speech pathology and more Hospital Advanced Savings with General Extras Plus Much More Back surgery Shoulder reconstruction Removal of tonsils Removal of appendix Rehabilitation services Emergency ambulance and more Excess options: $250 or $450 Orthodontics Exercise physiology Travel vaccinations and more Budget Hospital with General Extras Plus Choose this Cash Assist option: Kids Accident Cover for your little daredevils. See page 22. More Accident related treatment Removal of tonsils Removal of appendix Shoulder reconstruction Emergency ambulance and more Excess: $450 This cover is designed for young, fit and healthy families. See notes below. Orthodontics Exercise physiology Travel vaccinations and more See Hospital benefits summary table on page 26 and Things you need to know on page 34 for product details including benefits, limits, waiting periods, restrictions and exclusions. These are suggestions only. To compare our products and learn more about what is covered, refer to pages If you are thinking of becoming pregnant, please check that your cover includes pregnancy and birth related services and ensure that you have served any relevant waiting periods. If you are currently on a single or couples membership, you will need to transfer to a family membership at least two months prior to your baby s birth. This will ensure that your baby is covered under your membership from their date of birth. 12 Joining is easy too! Go to hcf.com.au Call between 8am and 8pm, Monday to Friday or 9am to 5pm on weekends (AEST) Visit a branch Find your nearest HCF branch on page 48 or visit hcf.com.au Fill in the form Complete the attached application and send it to us 13

8 Singles & couples 30 to 65 packages Cover for wherever life takes you Much, Much More Top Plus Hospital Accident related treatment Back surgery Digestive disorders Kidney and gall stone removal Hip and knee joint replacement surgery Cataract and other lens surgery Rehabilitation services Emergency ambulance Bonus Permanent Disability from Accident Cover (see page 41) and more Excess options: Nil, $250 or $450 Fit & Free Hospital with Multicover Extras Dentures Selected natural therapies Hearing aids and health appliances HCF approved health management programs Travel vaccinations and more with Fit & Free Extras Much More Accident related treatment Back surgery Digestive disorders Kidney and gall stone removal Hip and knee joint replacement surgery Cataract and other lens surgery Rehabilitation services Emergency ambulance Bonus Overseas Travel Insurance for under 75 s (see page 45) and more Podiatry HCF approved health management programs Travel vaccinations and more Excess options: Nil or $250 Choose this Cash Assist option: Permanent Disability Benefit Plus. See page 22. More Hospital Advanced Savings Accident related treatment Back surgery Digestive disorders Kidney and gall stone removal Emergency ambulance and more Excess options: $250 or $450 with General Extras Plus Exercise physiology Remedial massage and acupuncture Travel vaccinations and more See Hospital benefits summary table on page 26 and Things you need to know on page 34 for product details including benefits, limits, waiting periods, restrictions and exclusions. These are suggestions only. To compare our products and learn more about what is covered, refer to pages Joining is easy too! Go to hcf.com.au Call between 8am and 8pm, Monday to Friday or 9am to 5pm on weekends (AEST) Visit a branch Find your nearest HCF branch on page 48 or visit hcf.com.au Fill in the form Complete the attached application and send it to us 15

9 Complete peace of mind packages Cover for anyone wanting complete peace of mind Much, Much More Much More Top Plus Hospital Cataract and other lens related surgery Hip and knee joint replacement surgery Heart surgery Rehabilitation services Emergency ambulance Bonus Permanent Disability from Accident Cover (see page 41) and more Excess options: Nil, $250 or $450 Top Plus Hospital Same comprehensive hospital cover as above with Super Multicover Extras Dentures Hearings aids with flexible two year limit Chiropractic, osteopathy and exercise physiology Podiatry Selected natural therapies HCF approved health management programs Travel vaccinations and more with Multicover Extras Dentures Hearing aids Podiatry Selected natural therapies HCF approved health management programs Travel vaccinations and more Top Plus Hospital with General Extras Plus More Same comprehensive hospital cover as above but excludes Bonus Permanent Disability from Accident Cover (see page 41) Exercise physiology Remedial massage, acupuncture and more See Hospital benefits summary table on page 26 and Things you need to know on page 34 for product details including benefits, limits, waiting periods, restrictions and exclusions. These are suggestions only. To compare our products and learn more about what is covered, refer to pages Joining is easy too! Go to hcf.com.au Call between 8am and 8pm, Monday to Friday or 9am to 5pm on weekends (AEST) Visit a branch Find your nearest HCF branch on page 48 or visit hcf.com.au Fill in the form Complete the attached application and send it to us 17

10 Stand-alone covers Hospital Top Plus Hospital Accident related treatment Pregnancy and birth related services Assisted reproductive services (e.g. IVF, GIFT) Hip and knee joint replacement surgery Heart surgery Back surgery Digestive disorders Kidney and gall stone removal Cataract and other lens surgery Rehabilitation services Emergency ambulance Excess options: Nil or $450 Budget Hospital Accident related treatment Removal of tonsils Removal of appendix Shoulder reconstruction Emergency ambulance and more Excess: $450 This cover is designed for young, fit and healthy families, singles and couples. See notes below. Quality cover when you need it See Hospital benefits summary table on page 26 and Things you need to know on page 34 for product details including benefits, limits, waiting periods, restrictions and exclusions. To compare our products and learn more about what is covered, refer to pages If you are thinking of becoming pregnant, please check that your cover includes pregnancy and birth related services and ensure that you have served any relevant waiting periods. If you are currently on a single or couples membership, you will need to transfer to a family membership at least two months prior to your baby s birth. This will ensure that your baby is covered under your membership from their date of birth. Are you visiting from overseas? Talk to us about cover options on or visit a branch. 18 Joining is easy too! Go to hcf.com.au Call between 8am and 8pm, Monday to Friday or 9am to 5pm on weekends (AEST) Visit a branch Find your nearest HCF branch on page 48 or visit hcf.com.au Fill in the form Complete the attached application and send it to us 19

11 Stand-alone covers Extras and Ambulance Multicover Extras Only Orthodontics Selected natural therapies Exercise physiology Learn to swim Speech pathology and more For this stand-alone cover: annual limit is $600 Chiropractic, osteopathy and exercise physiology combined annual limit is $500. Sublimits of $375 each for chiropractic, osteopathy & exercise physiology apply Loyalty benefits don't apply Ambulance Cover Cover for State Government emergency ambulance services where you require hospital or on-the-spot treatment in Australia Up to $5,000 per person per calendar year for State Government medically necessary non-emergency ambulance services where your doctor requests ambulance transport because your condition requires monitoring and support in transit Notes: Ambulance Cover is available without hospital or extras cover to residents of NSW, ACT, VIC, NT and SA This cover is not available to QLD, TAS and WA residents See Extras benefits summary table on page 29 and Things you need to know on page 34 for product details including benefits, limits, waiting periods, restrictions and exclusions. To compare our products and learn more about what is covered, refer to pages Are you visiting from overseas? Talk to us about cover options on or visit a branch. 20 Joining is easy too! Go to hcf.com.au Call between 8am and 8pm, Monday to Friday or 9am to 5pm on weekends (AEST) Visit a branch Find your nearest HCF branch on page 48 or visit hcf.com.au Fill in the form Complete the attached application and send it to us 21

12 Cash Assist covers Financial cover for accidents and illnesses Kid s Accident Cover Only 90 cents per child per week Cover for children under 17 Pays up to $100,000 for accidental injury or permanent disability Paid in addition to any other benefits you may receive Covers broken bones, burns and stitches Cash Back Cover Only $1 per week for singles or $2 per week for families For more details please refer to page 40. Cover for Australian residents aged Pays $2,500 if you suffer an accident resulting in surgery Pays $2,500 if you suffer a serious specified medical condition Can claim multiple times up to $10,000 for singles and $20,000 for family cover For more details please refer to page 41. Permanent Disability Benefit Plus Only $1 per week for singles or $2 per week for families Pays cash if you have an accident resulting in a specified disablement Pays up to $100,000 for you or your spouse Pays up to $10,000 for your children For more details please refer to page 41. These products are issued by HCF Life Insurance Company Pty Ltd. Please read the Product Disclosure Statement on page 40 before you apply and consider whether this cover is appropriate for your objectives, financial situation or needs, as the information we have provided does not take these into account. Joining is easy too! Go to hcf.com.au Call between 8am and 8pm, Monday to Friday or 9am to 5pm on weekends (AEST) Visit a branch Find your nearest HCF branch on page 48 or visit hcf.com.au Fill in the form Complete the attached application and send it to us 22 23

13 Loyalty benefits More rewards for members Multicover Extras (when packaged with hospital cover) Service Orthodontics Loyalty limits Limit accrues at $440 per year. Up to $2,640 for treatment by an orthodontist ($1,000 sublimit for a general dentist). Lifetime limit applies. Physiotherapy Limit starts at $600 and accrues at $120 per year up to $1,200 per person per year. The longer you stay with us, the higher your extras limits can become. Depending on your cover, the amount you can claim on many of our extras increases each year. These increased limits are shown below. Super Multicover Extras Service Loyalty limits Please note that when you upgrade your cover you will need to serve waiting periods before you can take advantage of the increased benefit and limits. Chiropractic, osteopathy & exercise physiology Combined limit starts at $600 and increases by $100 per year up to $1,000. Sublimits apply. Hearing aids Length of membership Loyalty limits Under 2 years 2-5 years 6-9 years years years 20+ years Nil $600 $800 $1,000 $1,200 $1,600 Orthodontics Crowns, bridges & implants Optical (when taken with Top Plus) Physiotherapy Chiropractic, osteopathy & exercise physiology Limit accrues at $440 per year. Up to $2,640 for treatment by an orthodontist ($1,000 sublimit for a general dentist). Lifetime limit applies. Limit starts at $800 and accrues at $100 per year up to a maximum of $1,200 per person per year. Once you have been a member on this cover for 12 months, your optical limit converts to a 2 year limit of $500. Your $500 limit always spans the current and previous year and entitles you to claim the full $500 in one year or progressively over the two year period. If the full limit of $500 is exhausted in one year, there is no benefit the following year. Sub-limit of $250 per year for contact lenses applies. Limit starts at $600 and accrues at $120 per year up to $1,200 per person per year. Combined limit starts at $600 and increases by $120 per year up to $1,200. Sublimits apply. Multicover Only Extras Service Orthodontics Loyalty limits Limit accrues at $440 per year. Up to $2,640 for treatment by an orthodontist ($1,000 sublimit for a general dentist). Lifetime limit applies. Hearing aids Length of membership Loyalty limits General Extras Plus Under 2 years 2-5 years 6-9 years years years 20+ years Nil $600 $800 $1,000 $1,200 $1,600 Hearing aids Length of membership Loyalty limits Service Loyalty limits Under 2 years 2-5 years 6-9 years years 15+ years Nil $800 $1,100 $1,400 $1,800 Orthodontics Limit accrues at $250 per year. Up to $1,500 for treatment by an orthodontist ($1,000 sublimit for a general dentist). Lifetime limit applies

14 Hospital benefits summary Benefits are changing on some levels of cover from 1 July 2014 Key features Top Plus Fit & Free Hospital Advanced Savings Young Singles & Couples Excess (per person per calendar year) Nil, $250 or $450 Nil or $250 $250 or $450 $450 $450 No excess for accident related treatment No excess for kids NA NA No excess for same day treatment Prior to 1 July 2014 From 1 July 2014 Available as hospital cover only (without extras) Yes (Nil or $450) No No No Yes Example hospital procedures at HCF participating private and public hospitals Accommodation, operating theatre, intensive care Accident related treatment Physiotherapy & pharmaceuticals # related to admission Removal of tonsils Removal of adenoids Removal of appendix Hernia treatment Removal of kidney stones & gall stones Digestive disorder procedures (e.g. bowel surgery) Cancer related services (e.g. chemotherapy) Government approved prostheses for covered services Heart surgery including diagnostics and therapeutic cardiac procedures Spinal fusion, spinal scoliosis & disc replacement surgery Cochlear implant surgery & bone anchored hearing devices* Insulin pump treatments Dialysis for chronic renal failure MB MB Rehabilitation services MB MB Psychiatric services Gastric banding & obesity surgery MB from 1 July, see below Excluded from 1 July, see below Budget Hospital MB MB MB Excluded from 1 July, see below MB Excluded from 1 July, see below Assisted reproductive services (e.g. IVF, GIFT) MB MB MB Pregnancy & birth related services MB MB MB Hip & knee joint replacement surgery MB MB Cataract & other lens related surgery MB MB Elective cosmetic surgery MB MB MB MB Podiatric surgery by an accredited podiatrist MB MB MB MB Emergency ambulance Non-emergency ambulance (up to $5,000) Important note: Gastric banding & obesity surgery will be excluded (not covered) on Young Singles & Couples, Fit & Free & Free from 1 July or Hospital Advanced Savings from 1 July In addition, Psychiatric services will be covered at Minimal Benefits on Fit 27 Hospital waiting periods Palliative care Psychiatric services Rehabilitation services Pre-existing ailments or conditions Pregnancy & birth related services All other hospital services Extras waiting periods Health management programs Artificial appliances (e.g. orthopaedic footwear, blood glucose monitors) Dental bleaching Dental bridges Dental crowns Dentures Endodontics Foot orthotics Occlusal therapy Oral surgery Orthodontics Periodontics Pre-existing ailments & conditions Prosthodontics Veneers Hearing aids All other extras services Ambulance waiting periods Emergency ambulance (where not for pre-existing ailments) Medically necessary non-emergency ambulance (where not for pre-existing ailments) Pre-existing ailments 2 months 12 months 2 months 6 months 12 months 24 months 2 months 1 day 2 months 12 months Covered MB Minimal Benefits. See page 34 for definition Exclusions. See page 35 for definition # Excluding experimental and high cost non-pbs drugs * Includes associated speech and sound processors including upgrades Certified type C procedures and certified overnight type C procedures for the treatment of diabetes. Reduced or no benefits may apply. See hcf.com.au/insulinpumps or page 15 of the Member Guide for details For more information on waiting periods, see page 20 of the Member Guide. 28

15 DENTAL OPTICAL THERAPIES OTHER Extras benefits summary Diagnostic Preventative Services Details Waiting Period Super Multicover Multicover Fit & Free General Extras Plus Young Singles & Couples Benefits Limits Benefits Limits Benefits Limits Benefits Limits Benefits Limits Examinations general dentist/prosthetist 2 services 2 services 2 services 2 services 2 services $32 - $80 $30 - $55 $30 - $55 $30 - $55 $30 - $55 Examinations specialist dentist 1 service 1 service 1 service 1 service 1 service Single film x-rays initial/subsequent $30/$25 No limit $25/$18 No limit $25/$18 No limit $25/$18 No limit $25/$18 No limit 2 months Remove plaque & calculus $40 - $63 2 services $36 - $57 2 services $33 - $57 2 services $36 - $57 2 services $33 - $57 2 services Application of fluoride $27 1 service $27 1 service $27 1 service $27 1 service $27 1 service Fillings Metallic & tooth coloured (direct) $105 - $210 $550 $75 - $140 $550 $75 - $140 $550 $65 - $115 $400 $65 - $115 $400 Accrues at $440 per year. Accrues at $440 per year. Accrues at $250 per year. Orthodontics E.g. braces to straighten teeth. Up to $2,6 40* for orthodontist Up to $2,640* for orthodontist Up to $1,500* for orthodontist Lifetime limit applies 12 months (Sublimit of $1, 000 for general dentist). (Sublimit of $1,000 for general dentist). (Sublimit of $1,000 for general dentist). Lifetim e limit applies Lifetime limit applies Lifetime limit applies Surgical extractions $210 - $330 $165 - $240 $165 - $240 $150 - $215 $150 - $215 Oral surgery $300 Extractions 2 months $120 - $175 $90 - $130 $90 - $130 $80 - $110 $80 - $110 $300 Occlusal therapy Treatment to improve bite $35 - $300 $500 $35 - $250 $500 $35 - $250 $500 Endodontic services Treatment of root canals $60 - $190 $50 - $187 $50 - $187 $38 - $130 Periodontic services Treatment of tissue around teeth $25 - $305 $15 - $281 $15 - $ months Complete dentures & components $35 - $800 $800 over 3 years $30- $800 $800 over 3 years Dentures Maintenance & repair $37 - $200 $200 $29 - $120 $120 Crowns, bridges & implants Preparation & placing $20 - $750 $800 - $1,200 $20 - $635 $800 $20 - $635 $800 Spectacles & contacts First/subsequent visits (unless otherwise specified) First/subsequent visits Spectacle frames $135 $250 $85 $85 $75 $75 Spectacle lenses pair 2 months $130 - $330 Sublimit of $250 $92 - $180 $220 $92 - $180 $250 $80 - $140 $180 $80 - $140 Contact lenses pair $160 - $250 for contact lenses per year $140 - $220 $140 - $220 $140 - $180 $140 - $180 Psychology (after Medicare exhausted) $80 per visit $600 $75 per visit $300 $75 per visit $300 Dietetics $55/$40 $350 $45/$35 $300 $45/$30 Podiatry consultation $38/$34 $400 $33/$25 $200 $300 $38/$34^ Sublimit of $200 Audiology $58/$40 $350 $52/$35 $500 $52/$35 for foot orthotics Speech pathology (SP) $83/$51 $500 $60/$40 Sublimit of $200 audiology $60/$40 $40/$30 Occupational therapy (OT) $72/$50 $600 $62/$40 $500 $62/$40 2 months $42 visits 1-2, $32 visits 1-2, $40 first visit, Chiropractic $33 visits 3-11, $28 visits 3-11, $35 visits 2-6, $18 visits 12+ $600 - $1,200 $14 visits 12+ $600 - $1,000 $20 visits 7+ $45 visits 1-2, Sublimit of $600 each $35 visits 1-2, Sublimit of $375 $40 first visit, Osteopathy $35 visits 3-11, for chiro & osteo $29 visits 3-11, each for chiro, $35 visits 2-6, $18 visits 12+ $400 for EP $14 visits 12+ osteo & EP $20 visits 7+ $600 $40/$30 $30 first visit, $20 visits 2-6, $10 visits 7+ $28 visits 1-2, $20 visits 3-11, $10 visits 12+ $30 visits 1-2, $20 visits 3-11, $10 visits 12+ $500 Sublimit of $250 each for chiro, osteo and EP, $200 combined for OT and SP. $100 combined remedial massage, myotherapy, acupuncture and CHM Exercise physiology (EP) $40/$33 $30/$28 $30/$28 $25/$20 $25/$20 Physiotherapy $53 visits 1-2, $38 visits 3-11, $18 visits 12+ $600 - $1,200 $45 visits 1-2, $32 visits 3-11, $17 visits 12+ $600 - $1,200 $45 first visit, $40 visits 2-6, $22 visits 7+ $33 visits 1-2, $20 visits 3-11, $10 visits 12+ $30 first visit, $25 visits 2-6, $10 visits 7+ Acupuncture/Chinese herbal $200 medicine consultation (CHM) Sublimit of $100 for CHM $22/$10 $25/$20 $600 $30/$17 Remedial massage/myotherapy 2 months $40/$25 Sublimit of $250 $27/$20 $300 Naturopathy/nutrition consultation per therapy (max. $100 for CHM) $200 Alexander technique $27/$20 Homoeopathy $27/$17 Up to $100 per trip, Up to $100 per trip, Travel & accommodation per membership $400 per membership $400 for hospital treatment 200km + return trip 2 months ($30 per night ($200 accomm. sublimit) ($30 per night ($200 accomm. sublimit) accomm.) accomm.) HCF approved pharmacy After PBS equivalent co-payment subtracted Up to $50 per script $700 Up to $50 per script $600 Up to $50 per script $500 Up to $50 per script $500 Up to $50 per script $200 Artificial aids Approved appliances (e.g.cpap) 12 months $20 - $500 $600 $20 - $500 $500 Hearing aids Every 5 years (depending on length of membership) 24 months Up to $1,800 $800 - $1,800 every 5 years Up to $1,600 $600 - $1,600 every 5 years Health management programs HCF approved single/couple or family 6 months Up to $200 $200 single/$400 couple or family Up to $150 $150 single/$300 couple or family Up to $200 $200 single/$400 couple or family School accident cover Approved ancillary services only 2-12 months Up to $800 $800 Up to $800 $800 Up to $400 $400 For more information on waiting periods, see page 20 of the Member Guide. *At a specialist orthodontist, members receive $1,720 for full upper and lower braces on Super Multicover and Multicover and $1,200 on General Extras. Loyalty benefits. See pages ^Up to $200 for orthotics 12 months waiting period. Current as at 1 March Benefits shown are valid until 30 June Annual limits are per person per calendar year, unless otherwise specified. $30 first visit, $20 visits 2-6, $10 visits 7+ $180 $350 Sublimit of $150 for remedial massage, myotherapy, acupuncture and CHM

16 Changes to private health legislation can affect your choice of health cover, so it s important to understand how to maximise your entitlements, and avoid unnecessary expenses. Australian Government Rebate on Private Health Insurance To help make private health cover more affordable, the Australian Government provides a rebate on your health insurance premium. The rebate is available to people with hospital, extras or ambulance cover, and who are registered with Medicare. The rebate is income tested, so your entitlement may change depending on your income and also your age. You can elect to take the rebate either as: A reduced premium A tax offset credit in your annual tax return. 32 Rebates, surcharges and incentives Income thresholds for the 2013/14 income tax year Income You can use the table below as a guide to nominating your rebate tier. When calculating your income you need to include taxable income, fringe benefits, reportable superannuation contributions, net financial investment losses and more. We can provide you with general information about the rebate tiers. However for personal advice specific to your circumstances, please consult your accountant, financial advisor or the ATO at ato.gov.au or on Government rebate change From 1 April 2014 the Australian Government will be changing how your rebate is calculated. The Government s contribution to an individual s private health insurance rebate will be adjusted on 1 April each year. This change will apply to all Australian private health funds. Please note: this only affects you if you currently receive a Government rebate. See below table for the list of new rebate percentages. Type of member No Tier Tier 1 Tier 2 Tier 3 Singles < $88,000 $88, ,000 $102, ,000 > $136,001 Families* < $176,000 $176, ,000 $204, ,000 > $272,001 Rebate < Age % % 9.680% 0% Age % % % 0% Age % % % 0% Medicare Levy Surcharge All ages 0.0% 1.0% 1.25% 1.5% *Note: Single parents and couples (including de facto couples) are subject to the family tiers. For families with children, the thresholds are increased by $1,500 for each child after the first. Rebate amounts listed are effective from 1 April For rebate amounts prior to 1 April 2014 visit hcf.com.au/rebate, or visit a branch, or call us on Medicare Surcharge The Medicare Levy Surcharge is an Australian Government initiative designed to encourage high-income earners to take responsibility for their health care. It applies to people earning a taxable income of $88,001 or more per year for singles and $176,001 and over for couples and families where they don t have eligible private hospital cover. You can avoid having to pay this simply by having eligible HCF hospital cover. If you don t have eligible private hospital cover and you fall into these income thresholds then you will be charged up to an additional 1.5% surcharge on your Medicare levy when your tax return is assessed. Please refer to the 'Medicare Levy Surcharge' section of the table opposite to see what your surcharge may be. We can provide you with general information on these thresholds. However for personal advice specific to your circumstances, please consult your accountant, financial advisor or the ATO at ato.gov.au or Lifetime Health Cover Lifetime Health Cover (LHC) is a Government initiative designed to encourage people to take out hospital insurance earlier in life and maintain their cover. In some cases you may be exempt or fit into a special circumstances category. If you do not have a product that includes hospital cover with an Australian registered health fund on 1 July following your 31st birthday and then decide to take out hospital cover later in life, you will pay a 2% loading on top of your premium for every year you are aged over 30. For example, if you take out hospital cover at age 40 you will pay 20% more than someone who first took out hospital cover at age 30. The maximum loading is 70%. Once you have paid a LHC loading for 10 continuous years, the loading is removed as long as you retain your hospital cover. You can use the Lifetime Health Cover calculators to find out if you need to pay the LHC loading by visiting privatehealth.gov.au and looking for Lifetime Health Cover. For more information visit hcf.com.au or contact us Changes to LHC and the Australian Government Rebate From 1 July 2013 the Australian Government Rebate no longer applies to the LHC component of private health insurance. This means if you are eligible to receive the rebate and also have a LHC loading, the rebate will not apply to the LHC portion of your health insurance. 33

17 Things you need to know Pre-existing ailments or conditions A pre-existing ailment, illness or condition is one where the signs or symptoms existed during the six months before joining HCF or upgrading to a higher level of cover, even though a diagnosis may not have been made. If there s any doubt that 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. Hospital cover in-patient services Hospital benefits are payable when you re admitted to hospital for treatment. These are called in-patient services, and only in-patient services are covered by your hospital cover. 34 Minimal Benefits If you choose a product with Minimal Benefits for some procedures (like pregnancy and birthrelated services), you ll be covered in a public hospital shared room, but your private hospital costs won t be fully covered. This means you could face significant personal expense if you have any of these procedures in a private hospital. For procedures attracting Minimal Benefits in a private hospital, we would: Pay a small amount towards your accommodation Pay for Government approved prosthesis for covered services Not pay operating theatre expenses, or labour ward charges. There are also some services where doctor s charges aren t payable (for example, elective cosmetic surgery and surgery by an accredited podiatric surgeon). For these, we will only pay a small amount towards the total cost of the procedure (and no doctor s charges). This only applies to services which don t attract a benefit from Medicare. Exclusions If you need treatment for any procedures listed as an Exclusion in your hospital cover, you won t receive any benefits from us and you may have significant out-of-pocket expenses. Make sure you have reviewed the Exclusions list on page 26 before purchasing your cover. What's not covered There are a number of situations where our health insurance doesn t cover you: Where there are Exclusions on your policy Claims made two years or more after the date of service When you or your dependants have the right to recover the costs from a third party other than us, including an authority, another insurer (like motor vehicle or workers compensation), or under an employee benefit scheme Treatment for pre-existing ailments or conditions within waiting periods Goods and services received during any period where your payment is in arrears, your membership is suspended or you re within waiting periods Treatment that we deem inappropriate or not reasonable, after receiving independent medical or clinical advice Any service where the treatment does not meet the standards in the Private Health Insurance Accreditation Rules 2011 or as amended Services that aren t delivered face to face, like online or telephone consultations, unless you re participating in one of our chronic disease management or health improvement programs like My Health Guardian Goods or services supplied by a provider not recognised by us Goods or services provided outside Australia, which don t meet the requirements under the Private Health Insurance Act (2007) Claims that don t meet our criteria. This brochure should be read in conjunction with the HCF Member Guide, a copy of which is available on the HCF website, at HCF branches or by calling

18 In addition, our hospital cover doesn t include: Medical and associated hospital benefits for which there is no Commonwealth Medical Benefits Schedule item number or when the medical services are not approved for payment by Medicare Private room accommodation for same-day procedures Experimental treatments Experimental and high cost non-pbs drugs Procedures normally performed in the doctor s surgery or as an outpatient Private hospital emergency room fees Respite care Nursing home-type patients are limited to benefits set by the Commonwealth Department of Health Special nursing like your own private nurse Luxury room surcharge Donated blood and blood products and donated blood collection and storage PBS pharmaceutical benefits in non-participating private hospitals Pharmaceuticals (including PBS pharmaceuticals benefits) and other sundry supplies not directly associated with the reason for admission Take home items e.g. crutches, toothbrushes and drugs Personal convenience items e.g. phone calls, newspapers, magazines and beauty salon services Massage and aromatherapy services Some services provided while in hospital by non-hospital providers Where a service is not covered for the payment of benefits in a hospital, any associated items (e.g. medical gap, prosthesis, pharmacy) are also not covered The gap on government approved prostheses in non-participating private hospitals The gap on government approved gap-permitted prostheses items. In addition, our extras cover doesn t include: Psychological and developmental assessments. Where psychology is included in your cover, psychology treatment is only payable when your GP has prescribed a mental health plan under Medicare and your psychology entitlements from Medicare for that year are exhausted Goods and services while a hospital patient except for eligible oral surgery Pharmacy items that aren t on our approved pharmacy list e.g. items listed on the PBS, items prescribed without an illness, items that are available without a prescription, or items that are not TGA approved Goods or services that had not been provided at time of claim e.g. pre-payment Fees for completing claim forms and/or reports Goods and/or services received overseas or purchased from overseas including items sourced over the internet Where no specific health condition is being treated or in the absence of symptoms, illness or injury Routine health checks, screening and mass immunisations More than one therapy service performed by the same provider in any one day Co-payments and gaps for government funded health services e.g. the co-payment for PBS items, or services where you receive a rebate from Medicare such as the Child Dental Benefit Schedule, or Chronic Disease Management - Individual Allied Health Services Where a provider is not in an independent private practice More than one of the following therapies received on the same day (physiotherapy, chiropractic and osteopathy). Please Note This is not a comprehensive list of items not covered under hospital or extras cover. Who can be covered? Prior to taking out health insurance, we encourage you to understand who can be covered under your policy. Our staff will be only too happy to explain who can be covered and answer any questions you have. Alternatively, you can read more about who can be covered in the HCF Member Guide or by visiting hcf.com.au. Once on our website follow the link to the Frequently Asked Questions (FAQ s) section and look under Who s covered by my 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, provided they aren t married or in a de-facto relationship. If your children are full-time students aged between 22-24, aren t married or in a de-facto relationship and are primarily reliant on you for maintenance and support, you can register them as student dependants, and they will be covered for no extra cost until the day before they turn 25. If your children aren t full-time students, you can also continue to cover them until they turn 25 with extended family cover, provided they aren t married or in a de-facto relationship. You can take out this cover for a surcharge of about 25% of your existing premium. Extended family cover is available with Budget Hospital, Hospital Advanced Savings or Top Plus. Please call to check what you re covered for prior to going to hospital or for treatment

19 How your rights are protected Private Health Insurance Code of Conduct We support the Private Health Insurance Code of Conduct by ensuring: You receive correct information about private health insurance You re aware of the internal and external dispute resolution procedures You can make an informed decision about your purchase through informative policy documentation You re protected in accordance with the privacy principles. For a full copy of the code, visit privatehealth.com.au/codeofconduct Private Patients Hospital Charter We also support the Private Patients Hospital Charter, which outlines what members can expect from doctors, hospitals and their health fund. For a copy call or visit the Private Health insurance section for consumers at health.gov.au Private Health Insurance Ombudsman Should any problem arise concerning your membership, contact HCF directly so that it can be resolved as quickly as possible. An internal dispute resolution officer will be appointed to independently review your complaint. If your complaint isn t dealt with satisfactorily, you can also contact the Private Health Insurance Ombudsman, an independent body formed to help resolve complaints and provide advice and Information. To contact the Ombudsman: Call: Visit: phio.org.au Write: Private Health Insurance Ombudsman Suite 2, Level 22, 580 George St Sydney NSW