Say hello to HCF Corporate September 2014
Contents BENEFITS OF PRIVATE HEALTH INSURANCE 4 HEALTH INSURANCE OPTIONS 5 Choosing your level of cover 6 Top Hospital 7 Healthmate Ultimate 8 Healthmate Advanced 9 Healthmate Essentials 10 Healthcover Plus Extras 11 HOSPITAL COVER 12 Your hospital cover 13 Private hospital services 14 What hospital charges are covered? 16 Having a baby 18 EXTRAS COVER 19 Extras benefits & limits 20 Extras services 24 ADDITIONAL MEMBER BENEFITS 28 My Health Guardian 29 My Home Doctor 30 My Global Specialist 30 Health Dollars Loyalty Rewards 30 Involuntary Unemployment 31 OTHER PRODUCTS AND OFFERS 32 Our other products and offers for members 33 Manage your health cover online 34 Cash Assist Covers 36 Cash Assist Covers Combined Product Disclosure Statement 38 Financial Services Guide 42 IMPORTANT INFORMATION 43 Things you need to know 44 Rebates, surcharges and incentives 49 Our privacy statement 51 HOW TO JOIN 52 2 How HCF gives you more MORE BENEFITS We re Australia s largest not-for-profit health fund 91.6 cents in the dollar were returned as member benefits in the 2013 financial year, compared to only 86.4 cents for the average health fund 5 time winner (2009-2013) of Canstar s top outstanding value award, so you re assured of getting more value Australia s best customer service HCF won the 2013 Best of the Best award from the Customer Service Institute of Australia (CSIA) With our member first attitude, branches across Australia, plus a call centre open 7 days a week, we re there for you HCF also won CSIA s 2013 Easiest health fund to do business with award. MORE SAVINGS No hospital excess for dependent children or for treatment as a result of an accident You ll only pay one hospital excess amount per person per calendar year, (if an excess is applicable) Enjoy the best no-gap medical coverage of any health fund in Australia (PHIO report 2013) Get a 10% discount on pet and travel insurance. HCF S LOYALTY BENEFITS. MORE REWARDS THE LONGER YOU STAY WITH US. The HCF Corporate Health Dollars Loyalty Rewards program lets you reduce your hospital excess or claim more back on extras services such as dental and optical. See pages 30-31 for more information. MORE COVER Heart cover is included in all HCF Corporate hospital products Access a range of fully covered services for your teeth, eyes, muscles, back and feet through over 9,500 providers with our More for You programs 7 Sydney HCF Dental Centres, exclusively for members, offering a range of fully covered services 7 Sydney HCF Eyecare Centres, with reduced member pricing for contacts, frames, lenses and sunglasses. MORE THAN HEALTH INSURANCE Look after your health and wellbeing easily with our My Health Guardian program Eligible members in selected areas can access our afterhours My Home Doctor service Victor Chang heart health checks are available with HCF extras cover at no cost and at scheduled times, in selected branches Regular health news updates, magazines, exclusive member offers, competitions and more Low cost covers from HCF Life that provide financial relief from illness or accidents. 3
Benefits of private health insurance Health Insurance Options MORE CHOICE, MORE CONTROL Private health insurance is all about peace of mind and choice your choice of doctor at a conveniently located hospital or day hospital facility. If you need hospital treatment, your private hospital cover will help safeguard you and your family against high costs and the lengthy waiting lists having you back on the road to recovery faster. LIFETIME HEALTH COVER Lifetime Health Cover is an Australian Government initiative designed to encourage life-long membership of private health insurance. People who take out hospital cover early in life will be charged lower contribution rates throughout their life, relative to people who take out hospital cover later. MEDICARE LEVY 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 those singles earning a taxable income $90,001 and over per year for singles and $180,001 and over for couples/families. For information on how the Medicare levy applies to you please refer to page 50. All information contained in this brochure assumes that you are a permanent resident of Australia with full Medicare eligibility. If you are not, please let us know so we can provide you with complete information about the appropriate cover. For more information on how the Lifetime Health Cover applies to you please refer to page 50. AUSTRALIAN GOVERNMENT REBATE ON PRIVATE HEALTH INSURANCE The Australian Government provides an income tested rebate to help make private health cover more affordable. While most people will receive the full rebate, income testing will reduce the rebate for singles earning $90,001 and over per year and couples/families earning $180,001 and over combined per year. For information on how the rebate applies to you please refer to page 49. 4 5
Choosing your level of cover The products featured in this brochure are part of the HCF Corporate products range The following table is designed to assist you when choosing your health insurance by looking at the type of cover you need and your life stage. When choosing your level of cover, we recommend you consider a range of other factors not incorporated in this table, including your family s medical history, any pre-existing conditions and the hospital and extras cover needs of each person covered on the membership. Recommended level of cover Top Hospital Healthmate Ultimate Life stage You have a maturing family or are looking for the maximum protection and flexibility in your hospital cover, with the choice of adding an extras cover for total peace of mind (see page 7). You re a single, couple or family looking for a value for money hospital and extras cover, offering the ideal pregnancy package to see you through the birth of your children (see page 8). Coverage High level hospital cover Medium high level hospital and extras cover Top Hospital For those who want the very best in private hospital cover Top Hospital is our top level of private hospital cover in the HCF Corporate range, giving you maximum protection and choice, with complete peace of mind. You are covered for your own private room with ensuite (where available) at any of our contracted hospitals, along with all the additional charges such as theatre fees and government approved surgical prostheses. ADD EXTRAS COVER FOR TOTAL PEACE OF MIND For a total health care package we recommend that you add Healthcover Plus Extras cover, which pays benefits for a range of costly extras services, such as dental and optical (see pages 20-27). A RANGE OF ADDITIONAL BENEFITS Adding an extras cover will also give you access to a range of additional member benefits that help you to maintain good health. These easyto-use health and wellbeing management tools include exclusive home care and support for a number of specific health conditions. For more information, including details on the My Health Guardian, My Home Doctor and My Global Specalist services, see pages 29-31. Importantly, Top Hospital and Healthcover Plus Extras give you access to Health Dollars our loyalty program which can be used to reduce your personal expense when claiming extras benefits or reduce your hospital excess (see page 30). Healthmate Advanced Healthmate Essentials You re looking for comprehensive hospital and extras cover with generous benefits, and not planning a family or any more children (see page 9). You re a young, active single, or couple not planning a family and looking for basic, affordable hospital and extras cover for the things you need (see page 10). Medium level hospital and extras cover Low level hospital and extras cover Hospital Extras Participating private and public hospitals included. Top Hospital can be taken with or without extras cover. See page 11 for our Healthcover Plus Extras level of cover. Healthcover Plus Extras (extras only) You want quality extras cover for services like dental, optical, physio and chiro or you are looking to add an extras cover to your Top Hospital cover. Healthcover Plus Extras also includes benefits to help you stay fit and healthy (see page 11). Medium high level extras cover Ambulance Excess Included. Singles: $250 per person to a maximum of $250 per calendar year. Couples/Families: $250 per person to a maximum of $500 per policy per calendar year. Note: Whilst this table indicates a recommended level of cover for each life stage, it is provided as a general guide only. State Government emergency ambulance cover is included in all of our hospital covers except for QLD and TAS residents who are covered by their State Government ambulance service. You won t pay any excess for accidents or dependent children. You also won t pay an excess for same day treatment after serving the relevant waiting periods. A 12 month waiting period applies for pre-existing conditions, and a 2 month waiting period for all other procedures. 6 7
Healthmate Ultimate Healthmate Advanced The ultimate cover for planning your family A healthy step forward that won t break your budget Whether you re single, a couple planning a family or a young family after cover for the things that really matter, Healthmate Ultimate is the right cover for you. Healthmate Ultimate provides you with quality private hospital cover, as well as cover for many of the expensive extras, like dental (including crowns, bridges and orthodontics), optical and physiotherapy to name just a few. See pages 20-27 for details. Our loyalty rewards program can also help you reduce your personal expenses when claiming extras or to reduce your hospital excess. PLANNING A BABY Of course, if you re planning for a baby (see page 18), affordable private health cover is a must, and Healthmate Ultimate is the complete package. Hospital Extras Participating private and public hospitals included. Included. Healthmate Ultimate also provides cover for ante-natal classes and hospital services to treat post-natal depression if required. YOUR PREMIUMS REMAIN AFFORDABLE To keep your premiums affordable, Healthmate Ultimate includes an excess. Some services on Healthmate Ultimate attract Minimal Benefits and exclusions and these are listed on pages 14-15. Having Minimal Benefits and exclusions on services you are unlikely to need means you ll save money on your premiums. All in all, Healthmate Ultimate is the perfect health cover for anyone planning to start a family. If you re looking for a comprehensive cover and you aren t planning a family or any more children, Healthmate Advanced is the right choice for you. Healthmate Advanced gives you quality hospital and extras cover and a range of added benefits that will keep you healthy. With Healthmate Advanced you can rest easy, knowing you have the security of private hospital cover. You ll also be covered for a great range of extras services like dental, optical, physiotherapy and chiropractic. See pages 20-27 for more information. A MORE AFFORDABLE CHOICE OF COVER While Healthmate Advanced covers you for most hospital treatments that you are likely to need at your stage of life, some hospital services receive Minimal Benefits, like pregnancy and birth related services. However you can still enjoy the benefits of being a private patient in a shared room, in a public hospital which means you choose who treats you. Gastric banding and obesity surgery is excluded, see pages 14-15 for more details. To make your cover even more affordable, an excess has been included with Healthmate Advanced. WE HAVE YOU COVERED WITH A GREAT RANGE OF EXTRA BENEFITS Healthmate Advanced includes a great range of additional member benefits, so you are always getting value for your money. You ll have access to our loyalty reward program that you can use to reduce your personal expense when claiming extras or to reduce your hospital excess. To help you stay fit and healthy, you ll have access to HCF approved health management programs. See page 26 for more details. Ambulance Included. Excess Singles: $250 per person to a maximum of $250 per calendar year. Couples/Families: $250 per person to a maximum of $500 per policy per calendar year. You won t pay any excess for accidents or dependent children. Hospital Participating private and public hospitals included. Extras Ambulance Included. Included. Excess Singles: $250 per person to a maximum of $250 per calendar year. Couples/Families: $250 per person to a maximum of $500 per policy per calendar year. You won t pay any excess for accidents or dependent children. 8 9
Healthmate Essentials Healthcover Plus Extras Your first step into private health cover Quality cover for the things you really need If you re a young, active single or couple and looking for your first step into private health cover then consider Healthmate Essentials. Healthmate Essentials is a great value package ideal for young people looking for basic hospital and extras cover. COVER TO SUIT YOUR BUDGET With so many other things on your shopping list, you don t need expensive health cover. To make Healthmate Essentials more affordable, some services you are less likely to need attract Minimal Benefits and exclusions. See pages 14-15 for more details. Even though some services are restricted, you re still covered for services you may need like knee reconstructions or getting your appendix out. STAYING HEALTHY IS EASY With Healthmate Essentials you have access to a range of extras services to help you stay fit and healthy. Extras services can be costly and most of them are not covered by Medicare. Healthmate Essentials provides cover for things like contact lenses, dental check-ups or visits to the physio. See pages 20-27 for a detailed list. If you re planning a trip overseas, Healthmate Essentials pays benefits on some travel vaccinations, so you can look after your health wherever you are in the world. IF YOUR JOB FALLS THROUGH, YOUR HEALTH COVER DOESN T HAVE TO To give you that little bit of extra support, we ll take care of your Healthmate Essentials contributions for up to 12 months if you are retrenched from work, through no fault of your own. See page 31 for more details. Healthcover Plus Extras will give you quality cover on extras services that aren t covered by Medicare. Plus, you re covered for State government emergency ambulance road and air services. A WIDE RANGE OF BENEFITS Healthcover Plus Extras gives you quality cover for an extensive range of services such as: Dental (including crowns, bridges and dentures) Orthodontics Optical Physiotherapy Chiropractic Osteopathy Speech pathology Recognised natural therapies HCF approved health management programs (see page 26 for more details). Hospital Not included. As an added bonus, benefits for crowns, bridges, indirect restorations and orthodontics increase the longer you are a member. For a detailed list of extras benefits and limits see pages 20-27. GREAT BENEFITS TO KEEP YOU HEALTHY To help you and your family stay on top of your health, included with Healthcover Plus Extras is a great range of additional member benefits. This includes benefits for approved health and weight loss programs. For more details see pages 26. TAILOR YOUR HEALTH COVER TO MEET YOUR NEEDS This cover can be taken on its own or paired with Top Hospital to help put your mind at ease. See Top Hospital on page 7 for more details. Hospital Participating private and public hospitals included. Extras Included. Extras Included. Ambulance Included. Ambulance Included. Excess N/A. Excess Singles: $250 per person to a maximum of $250 per calendar year. Couples: $250 per person to a maximum of $500 per policy per calendar year. You won t pay any excess for accident related treatment. Note: This cover is not available for family policies. 10 11
Your hospital cover WHY DO I NEED HOSPITAL COVER? Hospital cover is important for two main reasons. It gives you the freedom to access private hospital care when and where you need it within Australia. And it gives you the peace of mind of knowing that you and your family are protected from unforeseen medical costs that could cause financial hardship. Hospital cover provides benefits for two types of services provided to admitted patients in hospital. Some services are billed by the hospital and are referred to as hospital benefits. Other services are billed by doctors who treat you in hospital and are referred to as medical benefits. All HCF hospital covers provide you with access to different types of hospital treatment but you are not covered for medical services provided outside a hospital. AM I COVERED FOR AMBULANCE SERVICES? With every HCF hospital or extras cover you have benefits for State Government ambulance services: Cover for State Government emergency ambulance services to transport you to the nearest hospital that can provide the care you need, or to treat you on the spot Up to $5,000 per person per calendar year for non-emergency, but medically necessary State Government ambulance services where the treating doctor requests the ambulance because your condition requires that level of monitoring and support in transit. Ambulance costs are not claimable if they are covered elsewhere. e.g. by your State Government (TAS and QLD), by a third party (such as another insurance policy) through other funding arrangements (such as a levy) or for transfers between hospitals where the hospitals are liable. HOW IS THE EXCESS APPLIED? For more information about the excesses available on each level of cover, see pages 7-10. BONUS ON TOP HOSPITAL COVER You won t pay an excess for same day hospital treatment after serving the relevant waiting periods. See page 7 for more details. WHAT ABOUT WAITING PERIODS? Generally, all health funds require new members, and existing members upgrading their level of cover or reducing their excess, to wait before benefit payments are made at the level that applies to their new cover. A 12 month waiting period is applied to some treatments and conditions, including pre-existing ailments, illnesses or conditions, and pregnancy and birth-related services. Other waiting periods are listed on page 44. 12 Hospital Cover 13
Private hospital services Prior to any hospital admission please call HCF on 13 13 34 to confirm that your procedure is covered. For other circumstances where you may not be covered see page 44-47. Participating private hospitals and public hospitals Excess per calendar year Accommodation Operating theatre Intensive care Coronary care Physiotherapy Pharmaceuticals* Gastric banding and obesity surgery Pregnancy and birth related services Psychiatric services Government approved prostheses Assisted reproductive services (e.g. IVF, GIFT, etc) Hip and knee joint replacement surgery Cataract and other lens related surgery Dialysis for chronic renal failure Elective cosmetic surgery Surgery by accredited podiatric surgeon Emergency ambulance Top Hospital $250 per person to a maximum of $500 per family policy. Minimal Benefits Minimal Benefits Healthmate Ultimate Healthmate Advanced Healthmate Essentials $250 per person to a maximum of $500 per family policy. $250 per person to a maximum of $500 per family policy. $250 per person to a maximum of $500 per couple. Excluded Excluded Excluded Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Minimal Benefits Apart from the services listed above as Minimal Benefits and exclusions, you are covered for all other conditions or surgical procedures provided you have served the required waiting periods. Having Minimal Benefits reduces the cost of hospital cover, but you should carefully consider your current and future health needs when selecting your level of cover. For example, you are required to serve waiting periods if you upgrade to a level of cover where the service is not a Minimal Benefit. What do we mean by Minimal Benefits? If you choose a product which has Minimal Benefits for some procedures (such as pregnancy and birth-related services), then you ll be covered in a public hospital shared room, but your private hospital costs won t be fully covered. This means you may face significant personal expenses if you have any of these procedures in a private hospital. For procedures attracting Minimal Benefits in a private hospital, HCF would: Pay a small amount towards your accommodation; Pay for prostheses, if required (cover for government approved prosthesis list items); and Not pay operating theatre expenses, or labour ward charges. In addition, there are some services where doctor s charges are not payable (for example, elective cosmetic surgery and surgery by an accredited podiatric surgeon). For these, HCF will only pay a very small amount towards the total cost of the procedure (and no doctor s charges). This applies to services which do not 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 excluded services on your selected hospital cover listed in the table above. * Excluding experimental and high cost non-pbs drugs. 14 15
What hospital charges are covered? We ll cover hospital charges related to your admission provided the service or treatment is not excluded on the cover you have chosen. The table below provides a guide as to how we pay, depending on the type of hospital you choose. Hospital Charge Accommodation (single room if available) Theatre fees for covered services Labour ward* Intensive care for covered services Most required pharmaceuticals for your treatment Therapies provided by the hospital Emergency ambulance cover Same day admission. Participating Private Hospitals 100% of most services are covered, excluding services with Minimal Benefits or where an excess is payable. HCF has agreements with more than 400 private hospitals and day surgeries throughout Australia. See our website hcf.com.au for a list of contracted private hospitals or call 13 13 34. * Not covered on Healthmate Advanced or Healthmate Essentials. Non-Participating Private Hospitals HCF has agreements with most private hospitals and day surgeries, but at the few private hospitals or day surgeries where we do not have an agreement, Minimal Benefits apply and you are likely to have high personal expenses in relation to all hospital charges. Public Hospitals If you choose to be treated as a private patient in a public hospital, you are fully covered for all hospital charges for services without Minimal Benefits in a shared ward, excluding any excess payable. MEDICAL CHARGE Private hospital cover pays the difference between the Medicare benefit and the Medicare Schedule Fee for medical services received as a private patient in hospital. A benefit is payable by Medicare for most services received as a hospital in-patient. No health fund benefit is payable for out-patient medical services or where Medicare has not paid a benefit. CLOSING THE GAP If your doctor charges above the Schedule Fee, the difference between the cost and your benefit (known as the Gap ) is payable by you. This may be reduced or eliminated altogether if your doctor has agreed to take part in our medical gap scheme. WHAT ARE YOU NOT COVERED FOR? If your hospital cover has services with Minimal Benefits you will be covered for shared ward accommodation costs as a private patient in a public hospital, but only Minimal Benefits apply for treatment in a private hospital or private day hospital. Please note that in most cases this will leave you with a personal expense. PARTICIPATING PRIVATE HOSPITALS These are private hospitals and day surgeries where we have an agreement with the hospital to secure the maximum level of cover for our members. INFORMED FINANCIAL CONSENT Before you agree to treatment, doctors should provide you with information so that you can give your Informed Financial Consent. Before you are admitted into hospital, ask your doctor if they, and other doctors who will be treating you, participate in our medical gap scheme. Also, elect to have your treatment in an HCF participating hospital. A list of these can be found at hcf.com.au PROSTHESIS Our benefits meet the cost of the government approved surgically implanted prostheses. If your surgeon chooses a prosthesis that is not fully covered, you are likely to incur personal expense. Your surgeon should advise you of this before your operation. 16 17
Having a baby Extras Cover If you re considering having a baby, there are a few important things to take into account ARE YOU ON THE RIGHT LEVEL OF COVER? All of the hospital covers in this brochure provide shared ward coverage in a public hospital but if you are considering having a baby in a private hospital then Healthmate Ultimate or Top Hospital needs to be your choice of cover. Healthmate Ultimate and Top Hospital cover pregnancy and birth related services, such as assisted reproductive services, infertility investigations and infertility treatments performed in hospital. You will also have access to a range of benefits and programs ensuring that you have everything you need to get you through your pregnancy. DO WAITING PERIODS APPLY IF YOU ARE TRANSFERRING FROM ANOTHER FUND? If you are new to a product that covers pregnancy and birth related services, you have to serve the waiting periods outlined on page 44 to be covered for this service. However, if you have already served the waiting periods for preganancy and birth related services on an equivalent level of cover at another health fund, we will recognise those waiting periods you have already served as long as you transfer to HCF within 30 days from the end date with the previous fund. The services related to pregnancy and childbirth have a waiting period of 12 months. WILL YOUR BABY BE COVERED? To ensure that your baby is covered at birth, it s important to upgrade to family cover at least two months prior to the birth to ensure the baby is covered. We strongly advise that you transfer to a family membership when you are considering starting a family. 18 19
Extras benefits & limits The following table shows you the annual limits of our extras covers and benefits payable on some commonly used extras services. All services are subject to individual item benefit limits. Note: Where initial consultations are shown, lower benefits apply for subsequent consultations. Annual limit per person (Individual benefits listed as examples) Type of Service Healthcover Plus Extras Healthmate Ultimate Optical $210 $200 Single sighted glasses (frames and lenses) $177 $175 Preventative & diagnostic dental Service limits apply Service limits apply Periodic oral exam 012 (2 per person, per year) $26 $24 Scale and clean 111 (2 per person, per year) $27 $25 Single film x-rays (initial / subsequent) $22/$18 $20/$15 Fluoride treatment 121 (1 per person per year) $22 $22 General dental $400 $400 Metallic filling, one surface, direct 511 $75 $75 Tooth coloured filling, one surface, direct 551 $250 $225 Crowns, bridges, indirect restorations (1) $750/$1,000 after 5 years $700 Full crown: Non-Metallic $625 $600 Bridge Pontic: Indirect $570 $570 Periodontics, endodontics, occlusal therapy & oral surgery $500 $400 Orthodontic (2) After 12 months we pay up to (orthodontist or dentist) $400 or $300 $400 or $300 After 5 years we pay up to (orthodontist or dentist) $2,200 or $1,800 per lifetime $1,800 or $1,500 per lifetime Orthopaedic Shoes (3) $185 Foot Orthotics (3) $120 $120 Exercise Physiology (5) $350 $350 First visit $30 $30 Subsequent visits $25 $25 Chiropractic (5) (6) $350 $350 First 4 visits $35 $35 Subsequent visits $24 $22 Annual limit per person (Individual benefits listed as examples) Healthmate Advanced Healthmate Essentials* Waiting Periods $180 $180 2 months $155 $155 Service limits apply Service limits apply 2 months $22 $22 $25 $25 $20/$15 $20/$15 $22 $20 $400 $400 2 months $65 $63 $210 $600 12 months $600 $570 $400 $300 (8) 12 months 12 months $400 or $300 $1,200 or $900 per lifetime 12 months $100 (4) 12 months $350 $350 (9) 2 months $30 $25 $25 $20 $350 $350 (9) 2 months $35 $30 $22 $20 20 21
Extras benefits & limits (cont.) Annual limit per person (Individual benefits listed as examples) Type of Service Healthcover Plus Extras Healthmate Ultimate Osteopathy (5) (6) $350 $350 First 2 visits $42 $40 Subsequent visits $34 $32 Physiotherapy (6) (7) $750 $700 First 2 visits $40 $35 Subsequent visits $29 $28 After 14 visits $22 $22 Occupational therapy (7) $750 $700 First 2 visits $49 $44 Dietetics (7) $750 $700 First 2 visits $45 $40 Podiatry $250 $200 Consultation $30 - $36 $28 - $33 Speech pathology (7) $750 $700 First 4 visits $49 $45 Orthoptic therapy (7) $750 $700 First 2 visits $40 $35 Natural therapies (1) : acupuncture, remedial massage, naturopathy and more $300 $300 Initial consultation $35 $35 Subsequent consultation $20 $20 Pharmaceutical prescriptions (10) $700 $600 Psychology (11) $300 $300 Consultation $45 $45 HCF approved health management programs - refer to page 26 for more details $150 per person, $300 per policy $150 per person, $300 per policy Annual limit per person (Individual benefits listed as examples) Healthmate Advanced Healthmate Essentials* Waiting Periods $350 $350 (9) 2 months $37 $30 $30 $20 $600 $350 (9) 2 months $35 $32 $27 $25 $22 $10 $600 2 months $41 $600 2 months $35 $150 2 months $25 - $30 $600 2 months $42 $600 2 months $35 $250 $150 (12) 2 months $35 $30 $20 $20 $600 $300 2 months $300 2 months $45 $100 per person, $200 per policy 6 months * Limits are applicable per person for singles and couples. Cover is not available on family memberships. (1) Limit shown is the overall limit for all services in this group. (2) Orthodontic limits are lifetime limits which include benefits paid in previous years from any extras cover. (3) Combined limit for orthopaedic shoes and foot orthotics. (4) Combined limit for foot and sports orthotics on Healthmate Advanced. (5) The limit shown is a combined limit for chiropractic, exercise physiology and osteopathy services. Excludes Healthmate Essentials which has a different combined limit, see (9). (6) You cannot claim for more than one therapy received on the same day for physiotherapy, chiropractic and osteopathy. (7) Limit shown is a combined limit for physiotherapy, occupational therapy, dietetics, speech pathology and orthoptic therapy services. Excludes Healthmate Essentials which has a different combined limit, see (9). (8) $300 limit is for oral surgery only. Other services not covered under this product. (9) Limit shown is a combined limit for physiotherapy, chiropractic, exercise physiology and osteopathy. (10) Up to $50 per script for HCF approved items. A co-payment equivalent to the standard PBS prescription charge for general patients is deducted per script before benefits are calculated. (11) Claimable only when you have been prescribed a Mental Health Plan by your GP and your Medicare entitlement is exhausted for the calendar year. (12) Limited range of therapies are covered on Healthmate Essentials. See pages 25 for full list. Please note: Only one therapy service performed by the same provider in any one day can be claimed. 22 23
Extras services OPTICAL Benefits are payable per person per calendar year, up to the maximum indicated. Individual limits apply to both lenses and frames. If you are making an optical claim, your prescription details must be provided when claiming benefits. More for Eyes program 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 cover and subject to available limits. For more details on the program, including a list of participating providers, please visit hcf.com.au/more-for-eyes or call 13 13 14. HCF Eyecare Centres are independently owned and operated by Eyecare Holdings Pty Limited ACN 054 365 196. DENTAL Benefits are payable up to the amounts shown in the table on pages 20-21, note that individual items benefit limits also apply. We refer to the item numbers supplied by your dentist when paying benefits. Diagnostic Dental includes items and services such as examinations, consultations and x-rays. Preventative Dental includes items and services such as the removal of plaque, fluoride application and the provision of a mouthguard. General Dental includes items and services such as simple extractions and simple fillings. Periodontics, Endodontics & Oral Surgery: benefits are payable upon completion of services. Not all services are covered on all products. Crowns, Bridges & Indirect restorations:* benefits depend upon the type of treatment. Note: After 5 years of membership on Healthcover Plus Extras your benefit limit increases to $1,000. Not all services are covered on all products. Orthodontics: benefit limits accrue for each year of membership, up to the maximum payable. Up to half of the accrued limit is claimable when the treatment commences and the remaining accrued limit when the treatment is completed. So we will need a treatment plan and quotation from your Orthodontist when the treatment begins and confirmation of completion at the time it is finalised. Orthodontic limits are lifetime limits which include benefits paid in previous years from any extras cover. Not all services are covered on all products. More for Teeth program Available in Sydney through HCF Dental Centres and across Australia (except NT and TAS) through participating dental providers. It is available with all extras covers and subject to available limits. To learn more about the program, or to find participating dentists in your area, please visit hcf.com.au/more-for-teeth or call 13 13 14. THERAPIES More for Muscles program 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. For more information on the program, including a list of participating physiotherapists, please visit hcf.com.au/more-for-muscles or call 13 13 14. More for Backs program 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. For more information on the program, including a list of participating providers, please visit hcf.com.au/more-for-backs or call 13 13 14. More for Feet program 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. For more information on the program, including a list of participating podiatrists, please visit hcf.com.au/more-for-feet or call 13 13 14. NATURAL THERAPIES We pay benefits for a range of natural therapies. Please contact us on 13 13 34 to find out if your therapist is recognised for benefit purposes. See below for benefits are payable for. Acupuncture Remedial massage/ myotherapy Nutrition consultations Naturopathy consultations Western herbal medicine consultations* Aromatherapy* Traditional Chinese medicine consultations Kinesiology* Homeopathy* Reflexology* Shiatsu* Sports Therapy* Note: Only one natural therapy service can be claimed per day from the same provider. * These services are not available on Healthmate Essentials. * Restorations made outside the mouth. 24 25
ORTHOPAEDIC SHOES & FOOT ORTHOTICS Benefits are payable for custom made orthopaedic shoes and foot orthotics when prescribed by a podiatrist, orthopaedic surgeon, rheumatologist or rehabilitation specialist, and supplied by a recognised provider. Limits apply per person per calendar year. Not all services are covered on all products. PHARMACY Benefits are payable for prescription medicines when they are dispensed by a pharmacist in an independent private practice. A co-payment equivalent to the standard Pharmaceutical Benefits Scheme (PBS) prescription charge for general patients is deducted per script before benefits are calculated. HCF does not pay towards: Items listed under the government PBS in any form, brand or strength Items available without a prescription Items prescribed outside of illness or disease, or for reproductive medicine e.g. contraception Items that are not on the HCF approved pharmacy list. To find out if your prescription is eligible for a benefit, please call us on 13 13 34. For more detailed information about pharmaceutical benefits please refer to the HCF Member Guide. PSYCHOLOGY If you are covered for psychology you are only eligible for psychology benefits from HCF once you have been referred for a mental health plan by your GP through Medicare and your entitlements from Medicare have been exhausted. HCF APPROVED HEALTH MANAGEMENT PROGRAMS Our approved health management programs offer a benefit for a range of services to help prevent or manage specific health and medical conditions. The programs are available to members with extras cover, excluding Healthmate Essentials, who have served the 6 month waiting period. Programs include: Weight management programs Exercise and gym membership for a specific health problem (Doctor s referral required) Childbirth education* Lactation consultation* Quit smoking Stress management Faecal occult blood test (FOBT). More information can be found by visiting the FAQ s section of our website hcf.com.au. Before you start any program, please contact us on 13 13 34 to ensure your particular program is eligible for a benefit (annual limits apply). AIDS & APPLIANCES When you combine Top Hospital with Healthcover Plus Extras, we will assist with the purchase or hire of a range of aids and appliances certified by your doctor as being helpful to the management of your medical condition. See below for more examples. Category A After 2 years of membership Wheelchair CPAP machine (purchase) Callipers SIDS monitor (purchase) Oxygen concentrator Hearing Aids Annual limits: Healthcover Plus Extras Single Couple/Family The maximum you can claim on aids and appliances is the annual limit on your chosen level of cover. Individual benefit amounts apply to each item under both categories. MORE FOR HEARING PROGRAM Category B After 1 year of membership Glucose monitor TENS machine Blood pressure monitor Lymphoedema garments Mammary prosthesis Wig (for approved medical condition) Nebuliser Annual limit $1,000 total ($250 sub-limit for category B items) $2,000 total ($500 sub-limit for category B items) This program provides free online tools to help you better understand your hearing ability. Depending on your level of cover we ll significantly reduce out-of-pocket costs for high-quality hearing aids from Blamey Saunders Hears, our participating hearing aid provider. More for information on the program visit hcf.com.au/more-for-hearing or call 13 13 34. * These services are only available on Top Hospital with Healthcover Plus Extras or Healthmate Ultimate. 26 27
Your additional member benefits Depending on your level of cover, you are eligible for a range of member benefits to care for your health. The table below is a summary of benefits available. Added Member Benefits Top Hospital with Healthcover Plus Extras Healthmate Ultimate Healthmate Advanced Healthmate Essentials Top Hospital Only Healthcover Plus Extras only Waiting Periods My Health Guardian 1 day My Home Doctor* 1 day My Global Specialist* 1 day Health Dollars Loyalty Rewards 12 months Involuntary Unemployment Benefit 2 months Aids & appliances 1 to 2 years * Refer to sections overleaf. Additional My Health Guardian is our unique online health and wellbeing management program, that lets you create an easy and effective wellbeing plan. It s like having your own health coach 24/7. My Health Guardian can help you achieve your health goals with a wide range of innovative online planning and monitoring tools. There is also a disease management program available to eligible members with a chronic condition. It s a fully covered service for members aged 18 years and over with hospital or extras cover. WELL-BEING PLUS MOBILE APP To help keep you motivated and on target to achieve your health goals, you can track your health and wellbeing wherever you are with the My Health Guardian mobile app, Well-being Plus. 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 28 Member Benefits 29
OUR NEW SERVICE The following table shows the Health Dollars that apply to each level of cover per year for Single or Family membership. My Home Doctor is a convenient, 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 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. More at Home is a community care service available in Northern and Western Sydney, providing home support to those who need a helping hand on either a regular basis or once off. More at Home gives you access to a compassionate professional who will assist you with domestic and/or personal care. They ll help with housework, shopping and meal preparation or even just getting ready in the morning and providing transport if needed. You ll also receive ongoing nursing care with a registered nurse if you need it. This paid service is managed by Manchester Unity, a HCF subsidiary with 65 years of experience providing high quality aged care services for Australians. To find out more visit moreathome.com.au or call 1300 550 124. HEALTH DOLLARS LOYALTY REWARDS One of the unique benefits of the HCF Corporate range is our Health Dollars Loyalty Rewards. This loyalty rewards program allows you to reduce your excess if you are going to hospital or reduce your personal expense when you make a claim for extras services such as dental and optical. You choose how and when your Health Dollars are best used, suiting your individual health care needs. The amount of Health Dollars you receive each year depends on your time with us; the longer you are a member, the more Health Dollars you receive. Each year your Health Dollars are renewed on your renewal date, which put simply, is the anniversary of the date you joined our health fund on an eligible level of cover. Loyalty Rewards Years of Membership To claim your Health Dollars simply fill out the Health Dollars section of an HCF claim form. Please note that when you make an extras claim, you will be required to pay the first $50 each year in order to claim Health Dollars. No payment amount is required for hospital excess claims. Rewards not used within the year do not get accrued into the next year. Health Dollars can only be claimed on services covered under your HCF policy or product. INVOLUNTARY UNEMPLOYMENT If you have been in permanent full time employment for the last six months, and you are retrenched through no fault of your own, we will take care of your HCF health fund contributions for up to 12 months, or until you find another job. Top Hospital with Healthcover Plus Extras First year of cover N/A N/A N/A N/A As at 1st anniversary of cover or 2nd year Single Membership $100 $75 $50 N/A Couple/Family Membership $200 $150 $100 N/A As at 2nd anniversary of cover or 3rd year Single Membership $150 $100 $100 N/A Couple/Family Membership $300 $200 $200 N/A Following 3rd anniversary of cover and ongoing Single Membership $200 $150 $125 N/A Couple/Family Membership $400 $300 $250 N/A Healthmate Ultimate Healthmate Advanced Healthmate Essentials Waiting Periods 12 months While we hope you will never need to take advantage of these initiatives, we re sure they will add to your overall peace of mind. Conditions apply: A no claim period of 29 days applies to each claim and claims must be made within three months There is a waiting period of 2 months for new or upgrading members Terminations due to unsuitability to work, unsatisfactory work performance, misconduct or voluntary redundancy are not eligible. 30 31
Other products and offers for members At HCF, we have a range of other products on offer to give you the total peace of mind you need 10% DISCOUNT ON PET INSURANCE 10% DISCOUNT ON TRAVEL INSURANCE HCF PET INSURANCE If your dog or cat is suddenly or unexpectedly injured or becomes ill, pet insurance can help pay for veterinary expenses. Choice of two comprehensive covers Up to 80% of covered veterinary expenses (less an annual excess that you choose). Visit hcf.com.au/petinsurance for more information. HCF Pet Insurance is issued by The Hollard Insurance Company Pty Ltd ABN 78 090 584 473, AFSL 241 436. We recommend that you consider the Product Disclosure Statement and Financial Services Guide, which is available by calling 1800 630 681 or by visiting hcf.com.au/petinsurance before deciding to buy or continue to hold this product. WHEN YOU TRAVEL OVERSEAS, AUSTRALIAN HEALTH COVER DOESN T PROTECT YOU. As our member, you get 10% off our international travel insurance. It provides: Worldwide emergency assistance A range of benefits for overseas medical and hospital expenses Legal assistance Compensation for journey delays or lost luggage Plus more. Visit hcf.com.au/travel for more information. We recommend that you read the Travel Insurance Product Disclosure Statement and Financial Services Guide which is available by calling 13 13 34 or visiting hcf.com.au/travel before deciding to buy or continue to hold this product. The HCF Travel Insurance Policy is issued by QBE Insurance (Australia) Limited Other ABN 78 003 191 035, AFSL 239 545. Products and Offers 32 33
Manage your health cover online We encourage all of our members to visit our website hcf.com.au Here you will find a range of member services to help you manage your health cover needs quickly and easily, including an email service if you need an answer for something that we haven t covered in this brochure. We are always looking at new ways to provide you with better products and services. This is made easier if you let us know your email address, by registering online. We provide a variety of online services to help you get the most from your membership: Online claims for extras services Make a payment securely online View and change your membership and cover details View your extras claims history Sign up to receive your HCF ATO statement policy summary and rate notifications electronically Sign up for other member notifications including reminder and arrears notices and reminders via SMS Prostheses items list including price, benefits and gap information. Registering is easy - simply go to hcf.com.au/members and click on the First time users link. We d love to be able to communicate with all our members online it s easier for you and better for the environment. So we are continually updating and improving our website. Keep coming back to check out the changes we are making. 34 35
Cash Assist Covers Financial cover for accidents and illnesses NOW THAT YOU VE SELECTED THE RIGHT HOSPITAL AND EXTRAS OPTIONS, YOU SHOULD THINK ABOUT TOPPING UP YOUR COVER WITH ONE OR MORE OF THESE CASH ASSIST COVERS. COMBINED PRODUCT DISCLOSURE STATEMENT AND FINANCIAL SERVICES GUIDE These products are issued by HCF Life Insurance Company Pty Ltd ABN 37 001 831 250, AFSL 236 806. Please read the Product Disclosure Statement 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. The Product Disclosure Statement and Financial Services Guide for Cash Back Cover, Kids Accident Cover and Permanent Disability Benefit Plus, is available on pages 38-42. For more information on Smart Term Insurance, Income Assist Insurance, Medical Trauma and Personal Accident Insurance please visit hcf.com.au, call 13 13 34, or visit your local branch. COOLING OFF PERIOD When you receive your policy document from us, you have 30 days to check whether the policy meets your needs. Within this time, you may cancel your policy in writing and receieve a full refund of any money paid provided you have not made a claim. Affordable cover which pays up to $100,000 if your child (under 17) is accidently injured. Specified sum paid for injuries Cover against accidents Cover 24 hours a day anywhere in Australia Paid regardless of any other benefits $ Kids Accident Up to $100,000 cover Only 90 cents per week per child Cash Back Cover $2,500 Benefit $1 per week for singles $2 per week for families Pays $2,500 if you suffer an accident requiring surgery within 6 months or suffer a listed serious medical condition. Cover for illnesses such as heart attack, cancer and stroke Single and family cover options Make multiple claims up to a total of $10,000 for singles and $20,000 for families Cover against accidents and illness Permanent Disability Benefit Plus Up to $100,000 cover $1 per week for singles $2 per week for families Low cost cover which provides up to $100,000 protection in the event you are permanently disabled due to an accident. Single and family cover options Up to $10,000 is paid for each of your children Pays your HCF Health Insurance premium if on claim (up to $1000 for singles, $2000 for families) Cover against accidents Specified sum paid for injuries Smart Term Insurance Up to $300,000 cover From $3.45 per week Pays the sum insured in the event of death or terminal illness. Five benefit levels to choose from, ranging from $100,000 to $300,000 Lump sum cash benefit Benefit doubled if death is caused by an accident Easy to apply- no blood tests or medicals Income Assist Insurance Up to $6,000 per month From $1.65 per week Pays 75% of your monthly income (up to a max $6,000) for 12 months if you are unable to work for more than 30 days. Cover against accident and illness Additional benefits paid for child care expenses and bed confinement Premiums may be tax deductible Protection for your biggest asset - your income Medical Trauma Up to $50,000 cover From $2.50 per week Pays a specified sum if you suffer one of over 40 listed serious medical conditions. Choice of $25,000 or $50,000 cover Lump sum cash benefit Cover for serious illnesses such as heart attack, cancer and stroke Single and family cover options 90 day waiting period applies for heart attack, cancer and stroke Personal Accident Insurance Up to $50,000 cover From $3.15 per week Designed for those aged 55 and over this cover pays a specific cash benefit if you suffer one of the listed injuries such as burns, fractures and dislocations. Choice of $25,000 or $50,000 cover Lump sum cash benefit No Pre-Existing conditions exclusions Pays a benefit in the event of accidental death For more information on Cash Assist Covers visit hcf.com.au/cashassist 36 37
Cash Assist Combined Product Disclosure Statement and Financial Services Guide Now that you ve selected the right hospital and extras options, you should think about topping up your cover with one or more of these Cash Assist covers. They offer you cash assistance to help you and your family recover from accidents and illnesses. You can choose an option that protects your kids, too. Product Disclosure Statement The low cost financial benefits offered in this Product Disclosure Statement are available to permanent Australian residents aged 16-60, with the exception of Kids Accident Cover which is available for children under the age of 17. These products are sold by HCF and issued by HCF Life Insurance Company Pty Limited. KIDS ACCIDENT COVER (KAC) Only $3.90 per child per month. Kids Accident Cover pays up to $100,000 if your child (under 17) is accidentally injured, 24 hours a day, anywhere in Australia provided the accident results in impairment immediately or permanent disability within six months. The sum is paid regardless of any liability or damages claim and covers impairments detailed in the table opposite and on page 39. 38 KIDS ACCIDENT COVER BENEFITS Benefits $100,000 Impairments Maximum Broken or fractured bones Skull compound or depressed fracture $2,000 hairline fracture $1,000 Spine fractured vertebrae $2,000 chipped vertebrae $400 Neck $2,000 Hip, pelvis or jaw $1,500 Leg, ankle or knee compound (open) simple (closed) $1,000 $500 Shoulder or cheekbone $600 Arm, elbow or wrist compound (open) simple (closed) $500 $250 Ribs $500 Nose or collarbone $400 Foot other than toe $200 Hand (other than finger $200 or thumb) Burns second degree third degree $400 $650 Wounds requiring more than three stitches per stitch $10 Internal injuries Rupture of internal chest $500 or abdominal organ KIDS ACCIDENT COVER BENEFITS Benefits $100,000 Impairments Maximum Permanent disabilities Total and permanent paralysis of all limbs $100,000 Total and permanent paralysis of both legs and the lower part of the body $50,000 Permanent loss of all sight in both eyes $50,000 Permanent loss of all sight in one eye $3,000 Permanent and total loss of use of both hands or both feet Permanent and total loss of use of one hand or one foot $30,000 $3,000 Permanent loss of all hearing in both ears $50,000 Permanent loss of all hearing in one ear $3,000 Permanent and total loss of use of one thumb of either hand PERMANENT DISABILITY BENEFIT PLUS BENEFITS Disablement Total and permanent paralysis of all limbs Total and permanent paralysis of both legs and the lower part of the body Permanent loss of all sight of both eyes Permanent loss of all sight of one eye Permanent and total loss of use of both hands or both feet Permanent and total loss of use of one hand or one foot Permanent loss of all hearing in both ears Permanent loss of all hearing in one ear Permanent and total loss of use of one thumb of either hand Contributor or spouse $500 Benefit Other Persons $100,000 $10,000 $100,000 $10,000 $100,000 $10,000 $50,000 $5,000 $100,000 $10,000 $50,000 $5,000 $100,000 $10,000 $50,000 $5,000 $40,000 $4,000 CASH BACK COVER (CBC) Only $4.30 for singles OR $8.65 for families per month. Cash Back Cover pays you a cash benefit of $2,500 if you or any person covered by your membership suffers an accident that requires surgery in an operating theatre within six months of the date of the accident. You also receive $2,500 for malignant cancer, chronic kidney failure, heart disease requiring bypass surgery, heart attack, stroke, or any disease requiring a major organ transplant. A maximum of $10,000 is payable for single cover and $20,000 for family cover if you have a number of accidents or illnesses during the life of the policy. PERMANENT DISABILITY BENEFIT PLUS (PDBP) Only $4.30 for singles OR $8.65 for families per month. Permanent Disability Benefit Plus pays you a cash benefit up to $100,000 for you and your spouse, and up to $10,000 for each of your children, in the event you or any person covered by your membership has an accident which results in one of the disablements listed in the table below. A maximum of $100,000 for singles and $200,000 for families is payable during the life of the policy. The disablement must occur within six months of the date of the accident, and this product provides valuable benefits when covers such as motor vehicle or workers compensation don t apply. Plus your HCF contributions will be paid up to $1,000 for singles and $2,000 for families if you are unable to work due to accident, sickness or involuntary unemployment. 39