Our Product Disclosure Statement (PDS)

Our Product Disclosure Statement (PDS) Your HIF hospital and ancillary health cover in detail. The smart choice for health cover. Visit hif.com.au or call 1300 13 40 60 to get a quote and join (or switch) today. Australia s first certified Carbon Neutral health fund

What s inside? A bit about us, this PDS and health insurance A bit about us, this PDS and health insurance... 2-3 HIF Hospital Cover Options...4 GoldStarter Hospital...8 GoldSaver Hospital...10 Gold Hospital...12 GoldStar Hospital...14 About our ancillary cover...16 Ways to claim...17 Feedback, disputes and privacy...38 Frequently asked questions...40 Glossary...42 At HIF, we aim to make choosing smart health insurance simple and painless. With that in mind, we ll keep this Product Disclosure Statement (PDS) as short and sweet as possible. No unnecessary information. Just the must-know stuff. We want you to be able to make the right health insurance choice but we don t want you to fall asleep. So here we go

About us and you HIF is a not-for-profit private health insurer. That means we don t have shareholders, so any income we earn after paying for our members benefits and covering our operating expenses is available to pay bigger and better benefits. And that s a good thing. About this PDS You ll find lots of useful info about our health insurance in this brochure: what s and what isn t; details of different cover options; explanations about our services and the terminology we use. All the stuff you need to know when comparing, choosing and reviewing your health cover. Important Tip When you join HIF or change your level of cover, we will send you a Member Statement confirming your new level of cover. To avoid confusion, it s a good idea to keep your statement with this brochure. Keep Updated HIF is always reviewing and improving its services and benefits so to ensure you are claiming all possible benefits remember to regularly visit hif.com.au for an updated version of this PDS. The legislation or rules that affect your premiums, cover and membership obligations include: The Private Health Insurance Act 2007 (the PHI Act) Fairer Private Health Insurance Incentives Act 2012 Fairer Private Health Insurance Incentives (Medicare Levy Surcharge) Act 2012 Fairer Private Health Insurance Incentives (Medicare Levy Surcharge Fringe Benefits) Act 2012 Under the PHI Act, we are required to document our operating guidelines, known as Fund Rules or Business Rules. All private health funds have to do this. These rules detail our obligations as a private health insurer, as well as the obligations of our members. As such, when you become a HIF member, you agree to be bound by these rules. If you would like a copy of the rules, simply email info@hif.com.au or call us on 1300 13 40 60. Want more information? Visit hif.com.au to find out more about our not-for-profit health fund. Alternatively, if you would like to know more about us or the rules and regulations around health insurance, please email info@hif.com.au or call us on 1300 13 40 60. About Australian private health insurance All Australian private health insurers, and residents and non-residents who pay tax in Australia, have potential responsibilities, obligations and entitlements under Australian health insurance laws. These laws include directions about services that can or must be, entitlement to the private health insurance rebate and obligations to pay the Medicare Levy Surcharge (MLS) and the Lifetime Health Cover (LHC) loading. 3

HIF Hospital Cover Options Cover for in-hospital procedures GoldStarter GoldSaver Gold GoldStar Choice of Excess Private Room Private room (maternity) (3 days) (5 days) (uned) Shared room Intensive Care Theatre Care Same-day Accommodation Same-day Theatre Appliances Prostheses Pharmacy Drugs AccessGap Palliative Care (disease) Cardio Thoracic (heart/chest) Psychiatric Care & Treatment Joint Replacement Assisted Reproductive Technology (e.g. IVF) Eye Surgery (non-cosmetic) Some restrictions and exclusions may apply. 4

Restrictions and exclusions Product Restricted Excluded GoldStar Surgery by podiatrists Cosmetic services* Services not by Medicare Gold Surgery by podiatrists Cosmetic services* Services not by Medicare* GoldSaver Assisted reproductive technology Gastric banding and obesity surgery GoldStarter Cardiac and thoracic (heart and/ or chest) conditions, procedures or monitoring** Eye surgery Joint replacement Psychiatric Palliative care Psychiatric Rehabilitation Cosmetic services* Services not by Medicare* Surgery by podiatrists Gastric banding and obesity surgery Cardiac and thoracic (heart and/or chest) conditions, procedures or monitoring** Eye surgery Joint replacement Assisted reproductive technology Obstetrics (maternity) Cosmetic services* Services not by Medicare Surgery by podiatrists For restricted services HIF will pay a basic benefit known as the public hospital rate, toward accommodation charges. All other charges raised by the hospital during the stay will be paid by the member. An excluded service means all charges raised during the stay will be paid by the member. * Where a service is deemed by Medicare to be cosmetic and/or does not attract a Medicare rebate, all charges raised in association with the hospital stay will not be eligible for payment. ** Some examples of cardiac and thoracic surgery treatment or monitoring are: heart bypass, angiograms, coronary care, lung surgery, chest conditions such as pneumonia, bronchitis, asthma and emphysema. Contact us prior to admission to confirm benefits payable. 5

Things you need to know about our hospital cover When selecting hospital cover, it s important to ensure that you understand how each level of cover will apply to you, as well as being aware of details such as ations, restrictions or exclusions that might also apply to your chosen cover. AccessGap Cover AccessGap Cover applies to medical accounts for members undergoing in-patient hospital procedures. It s designed to reduce or eliminate out-of-pocket expenses by allowing doctors to use the scheme on a patient-by-patient basis. If a doctor uses the scheme, he/she agrees to charge you a set fee for each item and will then receive a payment from HIF and Medicare combined, which is more than the Medicare Schedule Fee. To be eligible for AccessGap Cover, doctors must be willing to participate for your particular surgery and the account must be lodged directly with HIF (not Medicare). To find out more about specific payment amounts for upcoming procedures, or for your doctor to register for the scheme, please call us on 1300 13 40 60. Healthcare providers HIF covers ancillary, medical and hospital providers throughout Australia. To confirm if a provider is approved by HIF, go to hif.com.au, email us at info@hif.com.au or call us on 1300 13 40 60. Benefits will not be paid for any hospital services provided outside Australia, or for services purchased or provided within Australia from a non-australian recognised provider. Ambulance services HIF is required under New South Wales and Australian Capital Territory legislation to financially contribute toward the cost of operating state or territory-provided emergency ambulance services on behalf of any person who is a permanent state or territory resident and holds any level of HIF hospital cover. Under this arrangement, our members who are residents of NSW or ACT and hold HIF hospital cover may submit their resident state or territory emergency ambulance invoice to HIF to claim a benefit toward the fees charged. Please note that ambulance benefits may not be claimable under a NSW or ACT HIF hospital cover if the service was not provided by your local statecontrolled ambulance service, or if the service was not deemed by the ambulance attendant to be an emergency (medically necessary). For more information about this, see page 18 or visit hif.com.au and visit the Ambulance Cover page within the Health section. Medical Gap Different medical providers may charge different prices for the same procedure. If you are planning a procedure, we recommend that you ask your medical provider and any associated health provider (e.g. anaesthetist or assistant) if they will participate in our AccessGap scheme to help you avoid or minimise your out-of-pocket expenses. If your health provider does not confirm your out-of-pocket expenses, we recommend you contact us with your provider s details, item numbers and charges and we will provide you with a benefit estimate. 6

The Pre-existing Ailment Rule This standard rule is applied across the health insurance industry. It is designed to ensure that long-term members are not financially disadvantaged by new members who join and claim benefits immediately for pre-existing conditions. A pre-existing ailment is defined as an ailment or condition for which the signs or symptoms were evident or known at any time during the 6 months prior to when the member joins HIF, or upgrades to a higher level of cover or the same cover with a reduced or nil excess. HIF is not required to pay benefits for a pre-existing ailment during the first 12 months of a new member s hospital cover. Where an existing member upgrades to a higher level of cover or the same cover with a reduced or nil excess, any services related to the pre-existing ailment will be paid out at the previous level of cover for the first 12 months. Restricted services Where services are noted as restricted in your hospital cover, this means that if you receive them in a private hospital, you will only be at the basic public hospital benefit rate, which includes: The cost of a shared room in a public hospital A benefit towards the cost of surgically implanted prosthesis AccessGap for in-patient medical services Workers Compensation and Dual Insurance Benefits cannot be claimed and are not payable by HIF where you have or can claim benefits or compensation (in full or in part) for treatment, goods or services from a third party including Workers Compensation or Public Liability sources, your employer or any other Insurance policy. Transferring and upgrading your cover New members who transfer hospital cover from another Australian health fund to an equivalent level of HIF hospital cover will not have any waiting periods applied, providing these were served with the previous fund. New members who transfer hospital cover from another Australian health fund to a higher level of hospital cover, or equivalent level of cover with a reduced or nil excess, will have qualifying periods applied for the higher level of cover and/ or benefits. During these periods benefits will be payable at the equivalent level of cover to that of your previous fund. Current HIF members who transfer hospital cover to a higher level of hospital cover, or equivalent level of cover with a reduced or nil excess, will have qualifying periods applied for the higher level of cover and/or benefits. During these periods benefits will be payable at the lower level of cover. No other benefits are payable for restricted services, unless specifically listed in the individual product description within this brochure. Excluded services Where services are noted as excluded in your hospital cover, this means that you are not and you must pay all costs. 7

GoldStarter Hospital This is our entry-level private hospital insurance cover a smart choice if you re younger and less likely to require things like maternity and cardio-thoracic procedures. It covers all the essentials and is great value for money too. GoldStarter Hospital No maternity cover Restrictions and exclusions apply Full cover for the cost of a shared room, theatre fees and charges in a HIF contracted hospital anywhere in Australia for approved services Full AccessGap Cover for inpatient medical procedures for approved services Includes an excess to reduce the premium Hospital waiting periods General hospitalisation two months All treatment related to a pre-existing ailment or condition, but not including pre-existing conditions for psychiatric care, rehabilitation or palliative care 12 months Restricted services Benefits for the following services will include basic public hospital rate (only) for accommodation. However, full AccessGap coverage for inpatient medical procedures and benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List. Items on the list (excluding human tissue) may be subject to a co-payment by the patient: Psychiatric care or attention Palliative care Rehabilitation Surgery by podiatrists No benefits will be payable for other charges related to these services (e.g. theatre or some pharmaceutical costs), so significant out-of-pocket expenses may apply for these procedures if you are admitted as a private patient. Exclusions Benefits are not payable for any charges raised for the following services: Assisted reproductive technology (e.g. IVF) Cardio and thoracic (e.g. conditions of the heart and chest requiring surgery, monitoring or other procedures such as heart or lung surgery, treatment for asthma, emphysema, etc) Eye surgery (any procedure on the surface or within the structures of the eye) Gastric banding and obesity surgery Joint replacement Obstetrics Services deemed cosmetic by Medicare and services that do not attract a Medicare rebate Services GoldStarter Hospital will cover the following services in a public hospital or contracted private hospital facility, subject to any waiting periods which may apply and the Pre-existing Ailment Rule. Benefits for non-contracted private hospitals are available from HIF. Check with us prior to admission to ensure that the hospital is a HIF contracted facility. HIF has negotiated contractual arrangements with most hospitals and day hospital facilities throughout Australia. The listed benefits are offered to members who are admitted to those hospitals. 8

Accommodation charges including day patient, intensive care and neonatal care Theatre fee and labour ward charges Pharmaceutical drugs (does not include discharge drugs) Prostheses and consumables Outpatient theatre fees (not emergency department fees) Medical Gap For more details, please refer to the AccessGap Cover section in this brochure, or email info@hif.com.au or call us on 1300 13 40 60 Public hospital Private hospital Public hospital Private hospital Public hospital Private hospital Public hospital Private hospital Public hospital Private hospital All hospitals and approved day care facilities Full cover in a shared or private room. The full cost of a shared room. If you occupy a private room you will be up to the hospital charge for a shared room and you will be required to meet the balance of the accommodation charge. Charges are not raised for this service. Full cover for theatre charges. Charges are not raised for this service. Charges vary between hospitals depending on the contract that s in place. Please check with the hospital or HIF. Benefits may not apply to, or be restricted for, non-tga* approved, experimental or high cost drugs. Benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List. Items on the list (excluding human tissue) may be subject to a co-payment by the patient. Prostheses items used in relation to relevant exclusion services are not. Benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List. Items on the list (excluding human tissue) may be subject to a co-payment by the patient. Benefits may not apply or be restricted for non hospital contract medical treatments or consumables. Prostheses items used in relation to relevant exclusion services are not. No charge raised. Full cover for outpatient theatre fees. Admitted patients are entitled to the difference between the Medicare rebate and the Commonwealth Medical Benefits Schedule fee for all medical services performed whilst the patient is admitted as an inpatient in hospital and may be entitled to a further refund of the AccessGap cover amount. Funds are not permitted to pay gap cover if the patient is treated as an outpatient or when the patient is not formally admitted to hospital. Applicable excess A mandatory excess is applied to GoldStarter hospital cover to reduce premium costs: GoldStarter $200 per person to a max of $400** * Therapeutic Goods Administration ** Excesses are paid once per person per admission under the policy in a calendar year up to the maximum. Excesses apply to all hospital treatments. 9

GoldSaver Hospital This is our intermediate hospital cover and is a step up from GoldStarter. It s great for young couples and families who are likely to need things like maternity cover but not services such as cardio-thoracic and joint replacement surgery. GoldSaver Hospital Intermediate hospital cover Includes maternity services Full cover for the cost of a shared room, theatre fees and labour ward charges in a HIF contracted hospital anywhere in Australia for approved services Private room for up to 3 days for management of labour and delivery of child Full AccessGap cover for inpatient medical procedures Includes an excess to reduce the premium Some restricted services Hospital waiting periods General hospitalisation 2 months All obstetric related services 12 months All treatment related to a pre-existing ailment or condition, but not including pre-existing conditions for psychiatric care, rehabilitation or palliative care 12 months Restricted Services Benefits for the following services will include basic public hospital rate (only) for accommodation. However, full AccessGap coverage for in-patient medical procedures and benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List. Items on the list (excluding human tissue) may be subject to a co-payment by the patient: Joint replacement Cardio and thoracic (e.g. conditions of the heart and chest requiring surgery, monitoring or other procedures such as heart or lung surgery, treatment for asthma, emphysema, etc) Eye surgery (any procedure on the surface or within the structures of the eye) Psychiatric care or attention Assisted reproductive technology (e.g IVF) Surgery by a podiatrist No benefits will be payable for other charges related to these services (e.g. theatre or some pharmaceutical costs), so significant out-of-pocket expenses may apply for these procedures if you are admitted as a private patient. Exclusions Benefits are not payable for any charges raised for the following services: Gastric banding and obesity surgery Services deemed cosmetic by Medicare and services that do not attract a Medicare rebate Services GoldSaver Hospital will cover the following services in a public hospital or contracted private hospital facility, subject to any waiting periods which may apply and the Pre-existing Ailment Rule. Benefits for non-contracted private hospitals are available from HIF. Check prior to admission to ensure that the hospital is a HIF contracted facility. HIF has negotiated contractual arrangements with most hospitals and day hospital facilities throughout Australia. The listed benefits are offered to members who are admitted to those hospitals. 10

Accommodation charges including day patient, intensive care and neonatal care Theatre fee and labour ward charges Pharmaceutical drugs (does not include discharge drugs) Prostheses and consumables Outpatient theatre fees (not emergency department fees) Medical Gap For more details, please refer to the AccessGap Cover section in this brochure, or email info@hif.com.au or call us on 1300 13 40 60 Public hospital Private hospital Public hospital Private hospital Public hospital Private hospital Public hospital Private hospital Public hospital Private hospital All hospitals and approved day care facilities Full cover in a shared or private room. Full cover in a shared room. A private room will be fully for up to 3 days for maternity stays relating to the management of labour and delivery. If you occupy a private room for maternity stays greater than 3 days, for the fourth and additional days you will be up to the hospital charge for a shared room and you will be required to meet the balance of the accommodation charge. Charges are not raised for this service. Full cover for theatre and labour ward charges. Charges are not raised for this service. Charges vary between hospitals depending on the contract that s in place. Please check with the hospital or HIF. Benefits may not apply to, or be restricted for, non-tga* approved, experimental or high cost drugs. Benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List. Items on the list (excluding human tissue) may be subject to a co-payment by the patient. Prostheses items used in relation to relevant exclusion services are not. Benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List. Items on the list (excluding human tissue) may be subject to a co-payment by the patient. Benefits may not apply or be restricted for non hospital contract medical treatments or consumables. Full cost of the charge raised. Full cover for outpatient theatre fees. Admitted patients are entitled to the difference between the Medicare rebate and the Commonwealth Medical Benefits Schedule fee for all medical services performed whilst the patient is admitted as an inpatient in hospital and may be entitled to a further refund of the AccessGap cover amount. Funds are not permitted to pay gap cover if the patient is treated as an outpatient or when the patient is not formally admitted to hospital. Applicable excess A mandatory excess is applied to reduce premium costs: GoldSaver $200 per person to a max of $400** * Therapeutic Goods Administration ** Excesses are paid once per person per admission under the policy in a calendar year, up to the maximum. Excesses apply to all hospital treatments. 11

Gold Hospital This is our award-winning top shared room hospital insurance cover. You re fully for theatre fees, ward fees and all other services. It s especially great if you re planning on having a baby, because our maternity cover includes up to five days in a private room at no extra cost. Gold Hospital Top hospital cover Comprehensive cover for all Medicare approved items Includes maternity services Private room for up to 5 days for management of labour and delivery Full cover for the cost of a shared room, theatre fees and labour ward charges in a HIF contracted hospital anywhere in Australia Full AccessGap Cover for inpatient medical procedures Choice of excesses to reduce cost Hospital waiting periods General hospitalisation 2 months All obstetric related services 12 months All treatment related to a pre-existing ailment or condition, but not including pre-existing conditions for psychiatric care, rehabilitation or palliative care 12 months Restrictions Surgery performed in a hospital by registered podiatrists is not eligible for Medicare rebates. However, under this level of cover HIF will pay ed benefits toward the podiatrist s charges. Hospital accommodation and theatre charges will also be ed. Exclusions No benefit is payable for services deemed as cosmetic by Medicare and/or services that do not attract a Medicare benefit. Services Gold Hospital will cover the following services in a public hospital or contracted private hospital facility, subject to any waiting periods which may apply and the Pre-existing Ailment Rule. Benefits for non-contracted private hospitals are available from HIF. Check prior to admission to ensure that the hospital is a HIF contracted facility. HIF has negotiated contractual arrangements with most hospitals and day hospital facilities throughout Australia. The listed benefits are offered to members who are admitted to those hospitals. 12

Accommodation charges including day patient, intensive care and neonatal care Theatre fee and labour ward charges Pharmaceutical drugs (does not include discharge drugs) Prostheses and consumables Outpatient theatre fees (not emergency department fees) Medical Gap For more details, please refer to the AccessGap Cover section in this brochure, or email info@hif.com.au or call us on 1300 13 40 60 Public hospital Private hospital Public hospital Private hospital Public hospital Private hospital Public hospital Private hospital Public hospital Private hospital All hospitals and approved day care facilities Full cover in a shared or private room. The full cost of a shared room. A private room will be fully for up to 5 days for maternity stays relating to the management of labour and delivery. If you occupy a private room for maternity stays greater than 5 days, for the sixth and additional days you will be up to the hospital charge for a shared room and you will be required to meet the balance of the accommodation charge. Charges are not raised for this service. Full cover for theatre and labour ward charges. Charges are not raised for this service. Charges vary between hospitals depending on the contract that s in place. Please check with the hospital or HIF. Benefits may not apply to, or be restricted for, non-tga* approved, experimental or high cost drugs. Benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List. Items on the list (excluding human tissue) may be subject to a co-payment by the patient. Benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List. Items on the list (excluding human tissue) may be subject to a co-payment by the patient. Benefits may not apply or be restricted for non hospital contract medical treatments or consumables. No charge raised. Full cover for outpatient theatre fees. Admitted patients are entitled to the difference between the Medicare rebate and the Commonwealth Medical Benefits Schedule fee for all medical services performed whilst the patient is admitted as an inpatient in hospital and may be entitled to a further refund of the AccessGap cover amount. Funds are not permitted to pay gap cover if the patient is treated as an outpatient or when the patient is not formally admitted to hospital. Excess options Optional excesses to reduce premium costs: Gold Excess 100/200 $100 per person to a max of $200** Gold Excess 200/400 $200 per person to a max of $400** Gold Excess 400/800 $400 per person to a max of $800** * Therapeutic Goods Administration * * Excesses are paid once per person per admission under the policy in a calendar year, up to the maximum. The excess is not applied to same-day surgery or to child dependants under the age of 18. 13

GoldStar Hospital This is our premium hospital insurance cover, with all the bells and whistles. You re fully for everything, including a private room for all services, theatre fees and all ward fees. No worries. Just total peace of mind for you and your family. GoldStar Hospital Cover Top hospital cover Comprehensive cover for all Medicare approved items Includes maternity services Full cover for the cost of a private room, theatre fees and labour ward charges in a HIF contracted hospital anywhere in Australia Full AccessGap Cover for inpatient medical procedures Choice of excesses to reduce cost Exclusions No benefit is payable for services deemed as cosmetic by Medicare and/or services that do not attract a Medicare benefit. Services GoldStar Hospital will cover the following services provided in a public hospital or contracted private hospital facility, subject to any waiting periods which may apply and the Pre-existing Ailment Rule. Benefits for non-contracted private hospitals are available from HIF. Check prior to admission to ensure that the hospital is a HIF contracted facility. HIF has negotiated contractual arrangements with most hospitals and day hospital facilities throughout Australia. The listed benefits are offered to members who are admitted to those hospitals. Hospital waiting periods General hospitalisation 2 months All obstetric related services 12 months All treatment related to a pre-existing ailment or condition, but not including pre-existing conditions for psychiatric care, rehabilitation or palliative care 12 months Restrictions Surgery performed in a hospital by registered podiatrists is not eligible for Medicare rebates. However, under this level of cover HIF will pay ed benefits toward the podiatrist s charges. Hospital accommodation and theatre charges will also be ed. 14

Accommodation charges including day patient, intensive care and neonatal care Theatre fee and labour ward charges Pharmaceutical drugs (does not include discharge drugs) Prostheses and consumables Outpatient theatre fees (not emergency department fees) Medical Gap For more details, please refer to the AccessGap Cover section in this brochure, or email info@hif.com.au or call us on 1300 13 40 60 Public hospital Private hospital Public hospital Private hospital Public hospital Private hospital Public hospital Private hospital Public hospital Private hospital All hospitals and approved day care facilities Full cover in a shared or private room. Full cover in a shared or private room. Charges are not raised for this service. Full cover for theatre and labour ward charges. Charges vary between hospitals depending on the contract that s in place. Please check with the hospital or HIF. Benefits may not apply to, or be restricted for, non-tga* approved, experimental or high cost drugs. Benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List. Items on the list (excluding human tissue) may be subject to a co-payment by the patient. Benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List. Items on the list (excluding human tissue) may be subject to a co-payment by the patient. Benefits may not apply or be restricted for non hospital contract medical treatments or consumables. Benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List. Items on the list (excluding human tissue) may be subject to a co-payment by the patient. Benefits may not apply or be restricted for non hospital contract medical treatments or consumables. No charge raised. Full cover for outpatient theatre fees. Admitted patients are entitled to the difference between the Medicare rebate and the Commonwealth Medical Benefits Schedule fee for all medical services performed whilst the patient is admitted as an inpatient in hospital and may be entitled to a further refund of the AccessGap Cover amount. Funds are not permitted to pay gap cover if the patient is treated as an outpatient or when the patient is not formally admitted to hospital. Excess options Optional excesses are available to reduce premium costs: GoldStar Excess 200/400 $200 per person to a max of $400** GoldStar Excess 400/800 $400 per person to a max of $800** GoldStar Excess 500/1000 $500 per person to a max of $1000** * Therapeutic Goods Administration ** Excesses are paid once per person per admission under the policy in a calendar year, up to the maximum. The excess is not applied to same-day surgery or to child dependants under the age of 18. 15

Things you should know about our ancillary cover Here at HIF, we pride ourselves on enabling member choice. So, unlike some health fund insurers who pay lower benefits if you don t go to their preferred providers, with HIF you re free to visit any ancillary provider in Australia. Our only requirement is that members must visit healthcare providers who are legally qualified to practise in Australia (and approved by HIF). So as long as your preferred doctor, dental provider, optical provider, physiotherapist, chiroprator or other type of healthcare provider is approved by HIF, you re free to use whichever one you want. Our Member Loyalty Program HIF recognises and rewards members who retain their ancillary cover each year by providing increasing benefits or annual s. Our dental s increase every year from commencement until the maximum is available in your sixth year of membership. Benefits or s for services like optical, physiotherapy, occupational and speech therapy increase after 5 years and benefits or s increase for complementary therapies, chiropractic, osteopathic and pharmacy after 3 years. Where a policy is upgraded to a higher level of ancillary cover, annual s and benefits will automatically move to the next highest loyalty benefit on the new level of cover and progress each year until all maximum benefits and s are reached. Annual s HIF ancillary covers have an annual for most services, which means there is a on how much HIF will pay toward your claims. Most s are for the calendar year (January to December) but each January your benefit s will be refreshed, allowing you to claim benefits again for ancillary services provided in the new year. Claiming timeframe ation Claims must be made within two years of the service being provided. Approved consultations Unless stated, to be eligible for HIF benefits all services must be provided by a HIF approved health provider at that provider s registered practice address in a face-to-face setting, or as otherwise approved by HIF. Video, telephone or online facilitated services, with the exception of HIF approved Hospital Substitute treatment or Chronic Health Disease Management programs, are not approved consultations. Workers Compensation and Dual Insurance Benefits cannot be claimed and are not payable by HIF where you have or can claim benefits or compensation (in full or in part) for treatment, goods or services from a third party including Workers Compensation or Public Liability sources, your employer or any other Insurance policy. 16

Ways to claim Electronic Claiming Providers with electronic claiming technology (HICAPS or IBA) can settle your account with you on the spot. Simply swipe your HIF membership card and pay any difference. SmartClaim for mobile Members who own an Apple or Android mobile device can now submit paid ancillary accounts of $700 or less by using their mobile s in-built camera to photograph receipts and invoices. To find out more, visit hif.com.au or download HIF SmartClaim now from the Apple App Store or the Android Market. By post Complete a claim form and post it to: HIF GPO Box X2221 Perth WA 6847 Claim forms can be downloaded from hif.com.au or mailed to you on request. For more information on the different ways to make a claim, check out the How to Claim page on hif.com.au Fast-Track e-claiming (email/fax) For paid ancillary accounts of $700 or less, try our quick and easy Fast-Track option. Simply scan your completed HIF claim form and associated receipts and invoices, and email a copy to claims@hif.com.au or fax a copy to (08) 9328 1685. To find out more, visit hif.com.au Hospital and AccessGap Accounts Your doctor may send the accounts to HIF direct. If not, you can send the unpaid account to us for processing the HIF and Medicare benefits payable. We will then send the payment direct to your doctor or hospital on your behalf. Please call us before you go into hospital so we can assist you with your claims. 17

Ambulance benefits Benefit is paid on charges raised for approved ambulance services. HIF fully covers the cost of emergency ambulance transport for cases classified by approved ambulance service providers as requiring urgent attention and where the patient is admitted to the emergency department of a hospital. A patient co-payment of $50 per service applies to non-emergency call-outs and transportation. Benefits are not payable for transportation from a hospital to your home, nursing home or other hospital, or for transportation for ongoing medical treatment. Benefits are not payable for off road or air ambulance. Where a member is eligible for a state or Federal government subsidy, HIF will pay a benefit, less this entitlement. e: Ambulance services, charges and levies vary significantly across Australian states and territories: QLD & TAS Residents are for uned emergency services provided by their respective state governments. Interstate ambulance service charges for these residents may not apply if reciprocal agreements are in place with the other states where the ambulance service was required. NSW and ACT Residents who hold HIF hospital cover are for uned emergency ambulance services provided in their home state by their state government or territory ambulance service. Interstate emergency services may also be if under a reciprocal state agreement. Premium Options Super Type of service Additional information Benefit Person Membership Benefit Pers Ambulance As above Emergency: 100% Nonemergency call-outs and transportation: 100% with a $50 co-payment Interhospital transfers: No benefit N/A N/A Emergency: 100% Nonemergency call-outs and transportation: 100% with a $50 co-payment Interhospital transfers: No benefit N/A 18

All other emergency services In all other locations and circumstances, emergency ambulance services may be claimable from HIF Options covers, subject to the services being provided by the recognised St John or state government controlled ambulance organisation and the service being deemed as medically necessary by the attending ambulance officer. Options Special Options Saver Options on Membership Benefit Person Membership Benefit Person Membership N/A Emergency: 100% N/A N/A Emergency: 100% N/A N/A Nonemergency call-outs and transportation: 100% with a $50 co-payment Nonemergency call-outs and transportation: 100% with a $50 co-payment Interhospital transfers: No benefit Interhospital transfers: No benefit 19

Ancillary benefits Premium Options Super Options Type of service Additional information Benefit Person Membership Benefit Person Membership Asthmatic spacers N/A $18 2 per person per year No $18 2 per person per year No Auxiliary Home Nursing Benfits must be ordered by a medical practitioner. Contact us for conditions. $120 $1,800 per year No $75 $1,800 per year No Blood glucose or blood pressure monitor A letter of recommendation from the patient s treating practitioner is required. 75% of cost 1 of either monitor every 3 years Max: $200 No 75% of cost 1 of either monitor every 3 years Max: $200 No Chiropractic Benefits are paid for spinal manipulation or spinal adjustments carried out by a registered chiropractor approved by HIF. Spinal adjustment manipulation First visit: $30 Visits 2-10: $29 Visits 10+: $18 X-ray: $110 annual (chiropractic and osteopathic) Up to 3 years: $650 Over 3 years: $750 1 x-ray per year annual (chiropractic and osteopathic) Up to 3 years: $1300 Over 3 years: $1500 Spinal adjustment manipulation First visit: $28 Visits 2-10: $23 Visits 10+: $14 X-ray: $85 annual (chiropractic and osteopathic) Up to 3 years: $550 Over 3 years: $650 1 x-ray per year annual (chiropractic and osteopathic) Up to 3 years: $1100 Over 3 years: $1300 20

Special Options Saver Options Type of service Additional information Benefit Person Membership Benefit Person Membership Asthmatic spacers N/A N/A N/A No N/A N/A No Auxiliary Home Nursing Benfits must be ordered by a medical practitioner. Contact us for conditions. N/A N/A No N/A N/A No Blood glucose or blood pressure monitor A letter of recommendation from the patient s treating practitioner is required. N/A N/A No N/A N/A No Chiropractic Benefits are paid for spinal manipulation or spinal adjustments carried out by a registered chiropractor approved by HIF. Spinal adjustment manipulation First visit: $26 Visits 2-10: $21 Visits 10+: $10 X-ray: $70 annual (chiropractic, osteopathic, physiotherapy, podiatry and complementary therapies) $450 1 x-ray per year annual (chiropractic, osteopathic, physiotherapy, podiatry and complementary therapies) $900 Spinal adjustment - manipulation: First visit: $26 Visits 2-10: $21 Visits 10+: $10 X-ray: $65 annual (chiropractic, dietetics healthy lifestyle, complementary therapies, pharmacy, osteopathic, physiotherapy and podiatry) $350 annual (chiropractic, dietetics healthy lifestyle, complementary therapies, pharmacy, osteopathic, physiotherapy and podiatry) $700 1 x-ray per year 21

Ancillary benefits Premium Options Super Options Type of service Additional information Benefit Person Membership Benefit Person Membership Complementary therapies - Naturopathy - Homeopathy - Acupuncture - Traditional Chinese Medicine - Remedial massage therapy - Myotherapy Benefits are not payable on medicines provided by the practitioner. The treatment must be provided by a practitioner who is registered with HIF in the speciality for which the charge is raised. Visits 1-6: $25 Visits 7+: $17 Up to 3 years: $500 Over 3 years: $600 No Visits 1-6: $20 Visits 7+: $13 Up to 3 years: $250 Over 3 years: $350 $700 Dental See page 36 for more details Diabetics education For consultations or information sessions held by Diabetes Association in relation to diabetes. First visit: $36 Subsequent: $18 6 visits per year No First visit: $36 Subsequent: $18 6 visits per year No Dietetics Benefits are paid on consultations carried out by a registered dietician approved by HIF. First visit: $40 Subsequent: $20 Group: $12 $324 per year No First visit: $36 Subsequent: $18 Group: $10 $324 per year 22

Special Options Saver Options Type of service Additional information Benefit Person Membership Benefit Person Membership Complementary therapies - Naturopathy - Homeopathy - Acupuncture - Traditional Chinese Medicine - Remedial massage therapy - Myotherapy Benefits are not payable on medicines provided by the practitioner. The treatment must be provided by a practitioner who is registered with HIF in the speciality for which the charge is raised. Visits 1-6: $16 Visits 7+: $11 Up to 3 years: $100* Over 3 years: $200* $400* Visit 1-6: $15 Visits 7+: $10 Up to 3 years: $50 # Over 3 years: $100 # $200 # Dental See page 36 for more details Diabetics education For consultations or information sessions held by Diabetes Association in relation to diabetes. N/A N/A No N/A N/A No Dietetics Benefits are paid on consultations carried out by a registered dietician approved by HIF. First visit: $36 Subsequent: $18 Group: $10 $252 per year No First visit: $36 Subsequent: $18 Group: $10 annual (chiropractic, dietetics healthy lifestyle, complementary therapies, osteopathy, pharmacy, physiotherapy and podiatry) $350 annual (chiropractic, dietetics healthy lifestyle, complementary therapies, osteopathy, pharmacy, physiotherapy and podiatry) $700 * Subject to combined overall person of $450 and membership of $900 for complementary therapies, chiropractic incl. 1 X-ray per year per person, osteopathic, physiotherapy and podiatry. # Subject to combined overall person of $350 and membership of $700 for complementary therapies, chiropractic incl. 1 X-ray per year per person, dietetics, healthy lifestyle, pharmacy, osteopathic, physiotherapy, and podiatry. 23

Ancillary benefits Type of service Additional information External prostheses Benefits are paid on HIF approved prosthetics items such as artificial limbs, wigs and external mammary prostheses. Contact us for details prior to purchasing item. First aid courses For first aid courses held by St John Ambulance or Royal Life Saving Association. Healthy Lifestyle - Health management program - Weight loss program - Quit smoking plan - Health assessments - Skin cancer screening Benefits are payable for HIF approved programs delivered by registered providers only. Please contact us prior to commencing the program or paying subscriptions to ascertain if the program is eligible for a rebate. Premium Options Super Options Benefit Person Membership Benefit Person Membership 75% of fee $1,500 per year. No 75% of fee $1,500 per year. No e: sub s apply depending upon item. e: sub s apply depending upon item. $70 1 every 3 years No N/A N/A No Single: $50 Single: $50 1 per year Single: $50 Single: $50 1 per year Family: $100 Family: $100 Family: $100 Family: $100 24

Type of service Additional information External prostheses Benefits are paid on HIF approved prosthetics items such as artificial limbs, wigs and external mammary prostheses. Contact us for details prior to purchasing item. First aid courses For first aid courses held by St John Ambulance or Royal Life Saving Association. Healthy Lifestyle - Health management program - Weight loss program - Quit smoking plan - Health assessments - Skin cancer screening Benefits are payable for HIF approved programs delivered by registered providers only. Please contact us prior to commencing the program or paying subscriptions to ascertain if the program is eligible for a rebate. Special Options Saver Options Benefit Person Membership Benefit Person Membership N/A N/A No N/A N/A No N/A N/A No N/A N/A No Single: $50 Family: $100 Single: $50 Family: $100 1 per year Single: $50 Family: $100 annual (chiropractic, dietetics healthy lifestyle, complementary therapies, osteopathic, pharmacy, physiotherapy and podiatry) $350 annual (chiropractic, dietetics healthy lifestyle, complementary therapies, osteopathic, pharmacy, physiotherapy and podiatry) $700 25

Ancillary benefits Premium Options Super Options Type of service Additional information Benefit Person Membership Benefit Person Membership Hearing aids Benefits are paid on replacement hearing aids after 5 years from date of supply. Up to 5 years: $550 5 to 10 years: $600 per ear Up to 5 years:1 Over 5 years: 1 per ear No Up to 5 years: $550 5+ years: $550 per ear Up to 5 years: 1 Over 5 years: 1 per ear No 10+ years: $700 per ear Humidifier or nebuliser A letter of recommendation from the patient s treating practitioner is required. 75% of cost 1 of either monitor every 3 years. Maximum $180. No 75% of cost 1 of either monitor every 3 years. Maximum $140. No Occupational therapy Benefits are paid on consultations carried out by a registered occupational therapist, approved by HIF. First Visit $60 Subsequent $27 Group $10 (orthoptics, physiotherapy and speech therapy) Up to 5 years: $1200 Over 5 years: $1500 No First visit: $45 Subsequent: $25 Group: $10 (orthoptics, physiotherapy and speech therapy) Up to 5 years: $900 Over 5 years: $1100 No Optical See page 34 for more details Orthotics Benefits are paid on items carried out by a registered podiatrist or orthotic supplier, approved by HIF #. 75% of cost $240 1 every 2 years from date of supply^ No 75% of cost $200 1 every 2 years from date of supply ^ No # e: benefits are not available for orthotics which are not specifically modified and fitted for the individual member s condition. ^ Orthotic includes associated services such as muscle testing, ROM testing and gait analysis. 26

Special Options Saver Options Type of service Additional information Benefit Person Membership Benefit Person Membership Hearing aids Benefits are paid on replacement hearing aids after 5 years from date of supply. N/A N/A No N/A N/A No Humidifier or nebuliser A letter of recommendation from the patient s treating practitioner is required. N/A N/A No N/A N/A No Occupational therapy Benefits are paid on consultations carried out by a registered occupational therapist, approved by HIF. N/A N/A No N/A N/A No Optical See page 34 for more details Orthotics Benefits are paid on items carried out by a registered podiatrist or orthotic supplier, approved by HIF #. N/A N/A No N/A N/A No # e: benefits are not available for orthotics which are not specifically modified and fitted for the individual member s condition. 27

Ancillary benefits Premium Options Super Options Type of service Additional information Benefit Person Membership Benefit Person Membership Orthoptics (eye therapy) Benefits are paid on items carried out by a registered podiatrist or orthotic supplier, approved by HIF #. Initial: $50 Subsequent: $25 with occupational physiotherapy and speech therapy No Initial $50 Subsequent $25 with occupational physiotherapy and speech therapy No Up to 5 years: $1200 Up to 5 years: $900 Over 5 years: $1500 Over 5 years: $1100 Osteopathic Benefits are paid on items carried out by a registered osteopath, approved by HIF. First visit: $30 Visits 2-10: $29 Visits 10+: $18 annual (chiropractic and osteopathic) annual (chiropractic and osteopathic) First visit: $28 Visits 2-10: $23 Visits 10+: $17 annual (chiropractic and osteopathic) annual (chiropractic and osteopathic) Up to 3 years: $650 Up to 3 years: $1300 Up to 3 years: $550 Up to 3 years: $1100 Over 3 years: $750 Over 3 years: $1500 Over 3 years: $650 Over 3 years: $1300 Peak Flow Meter N/A $30 1 per year No $30 1 per year No # e: benefits are not available for orthotics which are not specifically modified and fitted for the individual member s condition. 28

Special Options Saver Options Type of service Additional information Benefit Person Membership Benefit Person Membership Orthoptics (eye therapy) Benefits are paid on items carried out by a registered orthoptics supplier, approved by HIF #. N/A N/A No N/A N/A No Osteopathic Benefits are paid on items carried out by a registered osteopath, approved by HIF. First visit: $26 Visits 2-10: $21 Visits 10+: $16 annual (chiropractic, physiotherapy, osteopathic and podiatry) $450 annual (chiropractic, physiotherapy, osteopathic and podiatry) $900 First visit: $26 Visits 2-10: $21 Visits 10+: $16 annual (chiropractic, dietetics, healthy lifestyle, complementary therapies, osteopathic, pharmacy, physiotherapy & podiatry) $350 annual (chiropractic, dietetics, healthy lifestyle, complementary therapies, osteopathic, pharmacy, physiotherapy and podiatry) $700 Peak Flow Meter N/A N/A N/A No N/A N/A No # e: benefits are not available for orthotics which are not specifically modified and fitted for the individual member s condition. 29

Ancillary benefits Type of service Additional information Pharmacy payable on contraceptives or NHS (PBS) prescriptions or over the counter items purchased with or without a prescription. Physiotherapy Benefits are paid on items carried out by a registered physiotherapist, approved by HIF. Premium Options Super Options Benefit Person Membership Benefit Person Membership Member pays PBS contribution. Benefit is 100% of balance up to $80 per script item. Up to 3 years: $200 Over 3 years: $400 No Member pays PBS contribution. Benefit is 100% of balance up to $80 per script item. Up to 3 years: $200 Over 3 years: $400 No First visit: $45 Visits 2-10: $40 Visits 10+: $30 Hydrotherapy: $15 Antenatal: $15 Group: $15 (physiotherapy, occupational, orthoptics and speech therapy) Up to 5 years: $1200 Over 5 years: $1500 No First visit: $35 Visits 2-10: $29 Visits 10+: $20 Hydrotherapy: $13 Antenatal: $13 Group: $13 (physiotherapy, occupational, orthoptics and speech therapy) Up to 5 years: $900 Over 5 years: $1100 No $600 sub for hydrotherapy, antenatal and group. $500 sub for hydrotherapy, antenatal and group. 30

Type of service Additional information Pharmacy payable on contraceptives or NHS (PBS) prescriptions or over the counter items purchased with or without a prescription. Physiotherapy Benefits are paid on items carried out by a registered physiotherapist, approved by HIF. Special Options Saver Options Benefit Person Membership Benefit Person Membership Member pays PBS contribution. Benefit is 100% of balance up to $80 per script item. $200 No Member pays PBS contribution. Benefit is 100% of balance up to $80 per script item. annual (chiropractic, dietetics, healthy lifestyle, complementary therapies, osteopathic, pharmacy, physiotherapy & podiatry) $350 annual (chiropractic, dietetics, healthy lifestyle, complementary therapies, osteopathic, pharmacy, physiotherapy and podiatry) $700 First visit: $32 Visits 2-10: $24 Visits 10+: $19 Hydrotherapy: $13 Antenatal: $13 Group: $8 annual (complementary therapies, chiropractic, physiotherapy, osteopathic and podiatry) $450 $400 sub for hydrotherapy, antenatal and group. annual (complementary therapies, chiropractic, physiotherapy, osteopathic and podiatry) $900 First visit: $32 Visits 2-10: $24 Visits 10+: $19 Hydrotherapy: $13 Antenatal: $13 Group: $8 annual (chiropractic, dietetics, healthy lifestyle, complementary therapies, osteopathic, pharmacy, physiotherapy and podiatry) $350 $300 sub for hydrotherapy, antenatal and group. annual (chiropractic, dietetics, healthy lifestyle, complementary therapies, osteopathic, pharmacy, physiotherapy and podiatry) $700 31

Ancillary benefits Premium Options Super Options Type of service Additional information Benefit Person Membership Benefit Person Membership Podiatry* Benefits are paid on consultations carried out by a registered podiatrist, approved by HIF. First visit: $32 Subsequent: $25 Consultations that are not performed in the podiatrist s registered practice: $12 $382 includes podiatry surgery performed in the podiatrist s registered rooms only. No First visit: $32 Subsequent: $23 Consultations that are not performed in the podiatrist s registered practice: $12 $354 includes podiatry surgery performed in the podiatrist s registered rooms only. No Psychology Maximum of 2 sessions will be paid on the same date if there is a minimum of 2 hours between sessions. Benefits are paid on consultations carried out by a registered psychologist, approved by HIF. First visit: $100 Subsequent: $55 Group: $30 per person to a max of $75 per session $1,000 per year No First visit: $75 Subsequent: $55 Group: $25 per person to a max of $75 per session $740 per year No Speech therapy Benefits are paid on items carried out by a registered speech therapist, approved by HIF. First visit: $75 Subsequent: $45 (occupational, orthoptics and physiotherapy) Up to 5 years: $1200 Over 5 years: $1500 No First visit: $75 Subsequent: $45 (occupational, orthoptics and physiotherapy) Up to 5 years: $900 Over 5 years: $1100 No * Benefits not payable when provided as part of treatment provided in, or arranged by, a hospital (including surgery). 32

Special Options Saver Options Type of service Additional information Benefit Person Membership Benefit Person Membership Podiatry* Benefits are paid on consultations carried out by a registered podiatrist, approved by HIF. First visit: $32 Subsequent: $23 Consultations that are not performed in the podiatrist s registered practice: $12 annual (chiropractic, physiotherapy, osteopathic and podiatry) $450 annual (chiropractic, physiotherapy, osteopathic and podiatry) $900 First visit: $32 Subsequent: $23 Consultations that are not performed in the podiatrist s registered practice: $12 annual (chiropractic, dietetics, healthy lifestyle, complementary therapies, osteopathic, pharmacy, physiotherapy & podiatry) $350 annual : (chiropractic, dietetics, healthy lifestyle, complementary therapies, osteopathic, pharmacy, physiotherapy and podiatry) $700 Psychology Maximum of 2 sessions will be paid on the same date if there is a minimum of 2 hours between sessions. Benefits are paid on consultations carried out by a registered psychologist, approved by HIF. N/A N/A No N/A N/A No Speech therapy Benefits are paid on items carried out by a registered speech therapist, approved by HIF. N/A N/A No N/A N/A No * Benefits not payable when provided as part of treatment provided in, or arranged by, a hospital (including surgery). 33

Ancillary benefits: Optical Type of service Additional information Premium Options Super O Optical Benefits are paid on items carried out by a registered optometrist or optical provider, approved by HIF. Benefits are not paid on non-prescription safety glasses, protective glasses, tinting, sunglasses, cosmetic glasses or cosmetic contact lenses, or frames not purchased via a registered Australian optical provider. Most common services listed below. Contact us for other services and benefits. Memberships up to 5 years Memberships over 5 years Frames (item no 110): $90 $112.50 $70 Pair Single Vision Lenses (item no 212): Pair Bifocal Lenses (item no 312): Pair Trifocal Lenses (item no 412): $75 $93.75 $70 $100 $125 $95 $150 $187.50 $145 Pair Progressive Lenses $150 $187.50 $145 (item no 512): Pair Frequently Replaced $170 $212.50 $150 Contact Lenses (item no 852): Limit per person $280 $350 $260 Annual, all services (including frames and contacts) Frames sub- $110 $140 $85 Pair frequently replaced contact lenses sub- $170 $215 $150 Memberships up to 5 years 34

ptions Special Options Saver Options Memberships over 5 years Memberships up to 5 years Memberships over 5 years Memberships up to 5 years Memberships over 5 years $87.50 $55 $60.50 $50 $55 $87.50 $45 $49.50 $40 $44 $118.75 $60 $66 $55 $60.50 $181.25 $60 $66 $55 $60.50 $181.25 $60 $66 $55 $60.50 $187.50 $110 $121 $100 $110 $325 $140 $155 $110 $121 $110 $65 $71.50 $55 $60.50 $190 $110 $121 $100 $110 35

Ancillary benefits: Dental annual s Premium Options General - Uned General - Limited Item Number 022 311-314 511-535 011-017 025-171 322-399 572-597 911-949 961-986 Year 1 Year 2 Year 3 Year 4 Year 5 After 5 Years No Limit No Limit No Limit No Limit No Limit No Limit $1,500 $1,800 $2,100 $2,400 $2,700 $3,000 Inlay/Onlay 541-555 $1,000 $1,100 $1,200 $1,300 $1,400 $1,500 Denture, Crown, Bridge+ Periodontic & Endodontic Orthodontic (Lifetime Limit*) Total annual s per person 611-691 711-779 213-282 411-458 $1,200 $1,300 $1,400 $1,500 $1,600 $1,700 $700 $800 $900 $1,000 $1,100 $1,200 811-878 $1,500 $1,800 $2,100 $2,400 $2,700 $3,000 $1,500 $1,800 $2,100 $2,400 $2,700 $3,000 Super Options Item Number Year 1 Year 2 Year 3 Year 4 Year 5 After 5 Years 36 General - Uned General - Limited 022 311-314 511-535 011-017 025-171 322-399 572-597 911-949 961-986 No Limit No Limit No Limit No Limit No Limit No Limit $1,150 $1,350 $1,550 $1,750 $2,050 $2,350 Inlay/Onlay 541-555 $700 $800 $900 $1,000 $1,100 $1,200 Denture, Crown, Bridge+ Periodontic & Endodontic Orthodontic (Lifetime Limit*) Total annual s per person 611-691 711-779 213-282 411-458 $900 $1,000 $1,100 $1,200 $1,300 $1,400 $500 $600 $700 $800 $900 $1,000 811-878 $1,300 $1,500 $1,700 $1,900 $2,200 $2,500 $1,300 $1,500 $1,700 $1,900 $2,200 $2,500

Special Options General - Uned General - Limited Item Number 022 311-314 511-535 011-017 025-171 322-399 572-597 911-949 961-986 Year 1 Year 2 Year 3 Year 4 Year 5 After 5 Years No Limit No Limit No Limit No Limit No Limit No Limit $800 $950 $1,150 $1,350 $1,550 $1,750 Inlay/Onlay 541-555 $500 $600 $700 $800 $900 $1,000 Denture, Crown, Bridge+ Periodontic & Endodontic Orthodontic (Lifetime Limit*) Total annual s per person 611-691 711-779 213-282 411-458 $600 $700 $800 $900 $1,000 $1,100 $300 $400 $500 $600 $700 $800 811-878 $1,000 $1,200 $1,400 $1,600 $1,800 $2,000 $1,000 $1,200 $1,400 $1,600 $1,800 $2,000 Saver Options Item Number Year 1 Year 2 Year 3 Year 4 Year 5 After 5 Years General - Uned General - Limited 022 311-314 511-535 011-017 025-171 322-399 572-597 911-949 961-986 Inlay/Onlay 541-555 Denture, Crown, Bridge+ Periodontic & Endodontic Orthodontic (Lifetime Limit*) Total annual s per person 611-691 711-779 213-282 411-458 811-878 No Limit No Limit No Limit No Limit No Limit No Limit $750 $850 $950 $1,050 $1,150 $1,250 $750 $850 $950 $1,050 $1,150 $1,250 * For more information on Lifetime Limits please refer to Important information about your dental cover on page 38. 37

Important information about your dental cover Benefits are only paid on accounts rendered by a registered dentist or dental prosthetist. The dentist or dental prosthetist must be in private practice. Dental prosthetists are allowed to perform a ed range of services for benefit purposes. There are some items within item code ranges for which HIF does not pay a benefit, or if they are performed with another item in the same course of treatment. Limits apply to the number of times some items, such as bleaching, attract a benefit. If you are unsure of your entitlements, please contact us before commencing a course of treatment with full details of the necessary dental items as provided by your dental provider and we will provide you with a benefit estimate. Annual s are refreshed on 1 January each year, so if you re planning a course of treatment it may be financially advantageous to stagger services over two calendar years. Benefits for replacement dentures and partial dentures are not paid within three years of previous supply. The applicable benefit is payable on the date the service is rendered e.g. the date braces are fitted. Feedback, disputes and privacy Our Code of Conduct The Private Health Insurance Code of Conduct is a self-regulatory code with the primary goal of enhancing regulatory compliance. We support and apply these industry standards in four fundamental ways: 1. Our employees are trained in private health insurance; 2. The information we provide to you is communicated in a way that is easy to understand and allows you to make an informed decision; 4. We ensure that any information you provide to us is maintained in accordance with our privacy policy. To download a full copy of the Code of Conduct, please visit hif.com.au Cooling Off Period When you have applied for a HIF membership, you have 30 days to read your policy. If you decide during this time that you do not wish to take up the cover, you may cancel the policy and HIF will give you a full refund, provided you have not made a claim. 3. We openly communicate our procedures for resolving any concerns you may have about your HIF membership and private health cover; and 38

Compliments and complaints Your feedback is valuable to us, so don t be afraid to get in touch. You may wish to comment on your personal experiences with HIF, or you may wish to lodge a compliment (or complaint) about the service you ve received from our team. Whatever your feedback relates to, we address each and every compliment/complaint and will always respond accordingly. Your input is a vital part of ensuring our organisation meets or ideally exceeds your expectations at all times. To submit feedback, simply visit hif.com.au and complete the online feedback form. Alternatively, you can email info@hif.com.au or call us on 1300 13 40 60. Our dispute resolution process We are committed to providing our members with access to the highest level of service and we value the feedback that our members provide. If you have a concern regarding your HIF membership, our products, benefits or our service, we would be happy to hear from you, please call us on 1300 13 40 60 or email info@hif.com.au You can contact the Ombudsman on 1800 640 695 or write to: Private Health Insurance Ombudsman Suite 2 Level 22 580 George St Sydney, NSW 2000 Your privacy The personal information you provide to us will be primarily used by HIF to deliver health insurance products and services as requested by you. The information supplied by you will remain confidential. This information may be disclosed to third parties and authorised government agencies in order to facilitate the delivery of services associated with your health insurance. Failure to provide personal information may result in the failure to process or deliver the service requested. For a complete HIF Privacy Policy brochure, please contact us on 1300 13 40 60 or download a copy at hif.com.au Our friendly customer service consultants will gladly discuss the matter with you or escalate the matter to a senior manager if required. Should you be unhappy with the outcome, please rest assured that we have an internal dispute resolution process in place. To escalate your complaint to this level, please put the issue in writing and send it to: Member Action Review Committee HIF GPO Box X2221 PERTH WA 6847 If you are not satisfied with the outcome from our internal dispute resolution process, you may wish to contact the Private Health Insurance Ombudsman. The Ombudsman is an independent body and services are provided free of charge. 39

Frequently asked questions How long can children remain on family policies? With HIF, dependants are up until the age of 21, or up to 24 years of age for those registered as full-time students at a recognised educational institution. If I have health insurance can I still be admitted to hospital as a public patient? Yes. Every public hospital is required to ask if you wish to be treated as a public or private patient. It s your choice if you use your insurance or not. Which bills should I claim from HIF and which ones should I claim from Medicare? If you don t have health insurance, Medicare pays benefits for all medical accounts. For example, accounts for doctors, specialists, eye examinations, X-rays and pathology. However, if you have HIF hospital cover, we ll process your hospital accounts. We also pay up to one quarter of the Medicare schedule fee for any medical accounts resulting from your time as a private inpatient in a hospital. If you have HIF ancillary cover, we also process all your bills for ancillary services, such dental, physiotherapy or optical treatments. What is the Medicare Levy Surcharge (MLS)? The Medicare Levy Surcharge (MLS) is levied on Australian taxpayers who earn above a certain income and don t have private hospital cover. The MLS is a Federal Government initiative designed to encourage individuals to take out private hospital cover and, where possible, to use the private hospital system to reduce demand on the public system. Is the Federal Government Rebate on Private Health Insurance means tested? Yes, since 1 July 2012, the Federal Government Rebate on Private Health Insurance is means tested, as is the Medicare Levy Surcharge (MLS). There are effectively four annual income tiers for single people and couples/families. The rebate you receive for holding private health insurance and the size of the MLS you pay are dictated by your age and annual income. For instance, if you re a single person under the age of 65 and you re earning less than $84,000 a year, you will receive a 30% rebate on the cost of your health insurance. Furthermore, while you have to pay the Medicare Levy (everyone does), you don t have to pay the MLS. On the other hand, if you re classified as a high income Tier 3 earner, you will be taxed 3% of your income if you don t have private hospital cover (1.5% MLS plus the standard 1.5% Medicare Levy that everyone pays). See table on page 41. What is the Lifetime Health Cover loading (LHC)? The Federal Government introduced the Lifetime Health Cover loading to encourage Australians to take out private hospital cover at a younger age. Basically, it recognises the length of time you ve had private health insurance and rewards that loyalty by offering lower premiums so the earlier you take out health cover, the cheaper your premiums. Does everyone have to pay LHC loading? No, you won t incur the loading if you: Had hospital cover on 1 July 2000 and have maintained it since then; or Were born on or before 1 July 1934. How is the loading applied? For every year over the age of 30 that you don t have private hospital cover, a 2% loading is applied to the cost of your insurance (and increases each year until it reaches 70%). For example, a single 40

37 year old would pay 14% LHC loading so it really pays to take out private hospital cover sooner rather than later. For couples and families, however, the loading is initially calculated based on your respective dates of birth and then halved. For example, a couple aged 33 and 36 years would generate a combined loading of 18% initially (6% + 12%), so the final loading that is applied to their joint policy is 9%. If you find that you will incur a loading, you will be required to pay this on top of the base premium that you re initially quoted for your hospital cover. If you decide to join HIF, your loading will automatically be applied to the quoted amount once you provide your date of birth. What if I m already over 31? If you re over 31, it still makes sense to take out hospital cover. Remember, the sooner you join, the smaller the loading you will pay. And once you ve held continuous private hospital cover for 10 years, your loading will be removed (as per the Private Health Insurance Act 2007). to your GP and consultations with specialists, as well as X-rays and blood tests (unless they re taken once you re admitted to hospital). What are waiting periods? Waiting periods are the time you need to be a member of a health fund before you can claim a benefit. They re there to protect the fund and its existing members from people who simply join a fund to make a big claim, only to cancel their membership afterwards. But there s good news. If you join us from another Australian health fund and take out an equivalent level of cover with us, you don t have to re-serve any waiting periods that you ve already served. Even better, it s really easy to switch we ll take care of all the paperwork for you. The waiting periods for hospital and ancillary cover can be found in our health insurance brochure or at hif.com.au To read all these FAQs (and more) online, visit hif.com.au/faqs What isn t by private health insurance? Private health insurance doesn t cover you for outpatient services. These services include visits Federal Government Rebate (Refers to FAQ on page 40) Annual Income Threshholds Policy Type Unchanged Tier 1 Tier 2 Tier 3 Single $84,000 $84,001-97,000 $97,001-130,000 $130,001 or more Couple $168,000 $168,001-194,000 $194,001-260,000 $260,001 or more Age Applicable Private Health Insurance Rebate Under 65 30% 20% 10% 0% 65-69 years 35% 25% 15% 0% 70 and over 40% 30% 20% 0% Medicare Levy Surcharge (applicable if hospital cover is not held) All ages 0% 1.0% 1.25% 1.5% Medicare Levy 1.5% for everyone 41

Glossary 42 AccessGap Cover AccessGap Cover is our medical gap cover arrangement, designed to minimise or eliminate out-of-pocket expenses for medical services when you re an inpatient in a registered overnight hospital or day facility. Admission The period of time during which a person is admitted as an inpatient for a condition or illness into an approved hospital/day facility for the purpose of receiving hospital treatment until the time they are discharged from the hospital/day facility. Annual The maximum of benefits payable to a member in a calendar year, commencing 1 st January and ending 31 st December. Approved service provider A provider or service that s approved by HIF. If you re unsure about the status of a hospital, medical or ancillary provider, contact us on 1300 13 40 60. Unless stated, ancillary services are not approved unless the health provider and HIF member (patient) are both physically present in the health provider s registered practice at the time of a consultation. Basic benefit When the benefit payable is equivalent to the benefits available if the service was provided in a shared room in a public hospital. Benefit The payment due to the primary member for services received by an approved provider. Dependant A person dependent upon the primary member. This includes: Domestic partners, your own children, stepchildren, legally adopted children to whom the primary member is the legal guardian (they must be under the age of 21, unmarried and not in a de facto relationship, nor the child of a dependant child). Student dependants children, stepchildren, legally adopted children and children to whom the primary member is the legal guardian, where the dependant is under the age of 25 years, unmarried, not in a de facto relationship and enrolled in a full-time course of study at a recognised educational institution. Excess The amount selected on a hospital cover which the primary member agrees to pay before a benefit will be payable. Excluded service Services that are not by a benefit, so all costs will be paid by you. Federal Government Rebate The proportion of private health cover premiums that the Government contributes for permanent Australian residents. HICAPS/ISOFT Providers with HICAPS or ISOFT technology can electronically claim your benefit directly from HIF. Inpatient A person who has been admitted into an approved hospital or day facility, allocated a bed and then discharged following treatment. Lifetime Health Cover Age The age that each member of a health fund is assigned when they first purchase hospital cover from a registered health fund. The certified age at entry is based on a person s actual age at the time of joining a hospital fund table. Medicare Benefit Schedule (MBS) The schedule of benefits produced by the Department of Health and Aged Care, listing eligible services, fees and benefits for Medical Services, including inpatient services. The MBS is used to calculate the 75% Medicare benefit payable in respect to inpatient services.

Non-contracted hospital A private hospital not contracted by the Australian Health Services Alliance or HIF to provide services to HIF members. Out-of-pocket costs cannot be guaranteed in these hospitals (basic default benefit applies). Out-of-pocket The amount remaining to be paid by the member after the HIF and/or Medicare benefits have been paid. Outpatient An outpatient is someone who has received medical treatment in a doctor s surgery or casualty department and has not been admitted into hospital. Benefits for outpatient services are only payable by Medicare Australia. Policy holder A holder of an insurance policy who is referable to HIF. A holder of a HIF insurance policy is referred to as the primary member. Practitioners in private practice A practitioner who does not: a) Use any publicly funded hospital, clinic, health centre or other such facility, including a facility provided by a municipal authority for, or in connection with, the provision of an ancillary service for which a benefit is claimed under the ancillary table b) Receive publicly funded assistance or support, whether by way of remuneration, subsidy or otherwise, in connection with the provision of the ancillary service, except where the ancillary service is provided at the clinics of strategic alliance partners, joint ventures or HIF s clinics Pre-existing ailment In accordance with HIF s Fund Rules and The National Health Act, a pre-existing ailment is an ailment, illness or condition of which the signs or symptoms, in the opinion of a medical practitioner appointed by HIF, existed at any time during the 6 months preceding the day on which the member commenced cover with HIF for: 1. Benefits in accordance with the applicable benefits arrangement; or 2. If applicable, benefits in accordance with a previous benefits arrangement. In forming an opinion referred to above, the medical practitioner appointed by the organisation must have regard to any information relating to the ailment, illness or condition that was given to him or her by the medical practitioner who treated the ailment, illness or condition. This rule applies whether the ailment, illness or condition was known to the member or not. Primary member The first named member, irrespective of who pays contributions to HIF for the provision of health cover. The primary member also holds the legal responsibility to ensure the membership is kept financial at all times, and holds the right to add or remove dependants from the membership. In the instance that the primary member wishes to provide authority for another person to act on their behalf, a spousal/agents authority is required. Qualifying periods Any period occurring immediately after joining the fund or joining a higher benefiting table, during which either some or all fund benefit is not payable. Recognised educational institution An Australian educational institution such as a school, college or university, recognised by the Commonwealth, State or Territory Governments. Restricted service Hospital services which are only for payments at the basic benefit level. Transfer certificate The document transferred between registered health funds, detailing the member s fund history (including Certified Age at Entry), confirmation of the financial status of the member and claims history. Waiting periods The standard period which applies before a member becomes eligible for benefit. For more glossary terms, visit hif.com.au 43

Health Insurance Fund of Australia Ltd (HIF) ACN 128 302 161 An Australian public company ed by guarantee. A registered private health insurer. Need some help? Visit hif.com.au Call 1300 13 40 60 Email info@hif.com.au Follow us on Australia s first certified Carbon Neutral health fund The information in this brochure is correct as at 1 September 2012. Minor changes may occur after that date. If major changes occur, a separate insertion will be included in the brochure or the brochure will be reprinted. HIF members are encouraged to regularly download the latest copy of this brochure from hif.com.au, or contact us and we will send one to you.