Note: this is a summary of the most frequently asked information. It is not the complete fund rules, and it is intended as a guide only. Members are welcome to clarify issues with the fund. We especially recommend that members seek advice before incurring costs.

Eligibility
Transferring from another fund
Pre-existing ailments
Obstetric cover
Ceasing / suspending membership
How to claim
Benefit payments
Conditions of claiming
Annual limits
Travel insurance
Special cases
Recognised providers
Compensation
Money back guarantee

Who can join HCI?
• Anyone who is working, or has worked in the forestry, timber and downstream production industries including paper and paper products.
• Regular contractors and employees of regular contractors serving forestry, timber and paper industry businesses.
• Dependants of the above.

Continuing eligibility
Once accepted as a member you will retain your HCI membership eligibility for life.

HCI - caring for young adults
HCI extends the family cover for young adults up to the age of 25 under certain circumstances.

Who can be included in my cover?
You may include the following in your membership:
• Spouse or de-facto spouse
• Unmarried (includes those not in a defacto relationship) children under 23 years of age
• Student dependants of a member being:
- Single persons between 23 and under 25 years of age
- Financially dependent on the member
- Full-time students undertaking a course that satisfies the Student Youth Allowance criteria at a school, college or university
• Other persons wholly financially dependent on the member, and who HCI is satisfied should be recognised as dependants for health insurance purposes.

First-time health cover
If at the time of joining you do not have health cover, full waiting periods will apply before benefits can be paid.

Transferring from another health fund
You can transfer from another fund to HCI at any time.
If you join within 7 days of the expiration of your current cover, you will not have any new waiting periods for the same or lower level of cover with HCI.
Normal fund waiting periods, including pre-existing, apply to benefits not covered by your previous fund cover.
Your Certified Entry Age for the Federal Government’s Lifetime Health Cover purposes will be recognised by HCI on transfer.

Upgrading Your HCI Membership
Members may upgrade to a higher level of cover, or move to a lower cover option, or no excess cover, at any time. Normal waiting periods apply to the higher level of benefit entitlements. Benefits will be paid at your previous level of cover until waiting periods are served.

Pre-existing ailments
Benefits are not payable during the first 12 months of cover for an ailment, illness or condition, the signs or symptoms of which, in the opinion of an independent medical practitioner appointed by the fund, existed at any time during the 6 months preceding the date of joining or upgrading to a higher level of cover.

Obstetric Cover
Under a single membership, a mother is eligible for benefits provided she has been a member of a hospital table for 12 months or more. However, costs incurred by the baby itself at birth are not covered.
Normal fund waiting periods apply to the baby if it joins after the birth.
We strongly recommend single members upgrade to family membership as soon as their pregnancy is confirmed to ensure cover for a premature baby.
For your baby to receive immediate cover without waits, family membership must be taken out at least 4 months prior to the birth.
Note, immediate cover from birth is not available for the new-born baby when it is known or suspected the baby has a congenital condition. Congenital conditions are subject to the 12 month pre-existing rule.
The member must have belonged to family or couples hospital cover a full 12 months prior to the birth, for a baby with a congenital condition to receive immediate cover.

Ceasing or suspending membership
• Payment default
Should your premiums fall more than two months in arrears, your membership may be ceased. Acceptance of arrears payments after two months is not automatic, so talk to HCI if you need time to pay your premium.

• Period of suspension
With the agreement of HCI, you can suspend your cover for the following reasons:
• Financial hardship.
• Temporary absence from Australia
- Overseas travel.
- Overseas employment.
To be eligible the member must have contributed to a hospital cover with the fund for at least 12 continuous months prior to any application for suspension.
Periods of suspension do not count towards the 24 month cumulative absence allowed by Lifetime Health Cover.

• Financial Hardship
During a period of hardship a member may apply to suspend cover for a period not exceeding 6 months, subject to approval by the fund. Upon reinstating the membership, no new waiting periods will apply.

• Overseas Travel
If you travel overseas for employment, you can apply to suspend your membership for a period not less than 3 months and not greater than the period of your employment or 2 years (whichever is the shorter), subject to approval of the fund.

• Overseas employment
If you travel overseas for employment, you can apply to suspend your membership for a period not less than 3 months and not greater than the period of your employment, subject to approval of the fund.
For membership suspension due to overseas travel or employment, you must recommence your contributions within 30 days of returning to Australia to avoid application of new waiting periods. Proof of your return date is required.

• Medicare Levy Surcharge Note
The Medicare Levy Surcharge is payable by high income earners during any period of suspended hospital cover.

Service provided by family members
Services provided to members by their own family are ineligible for fund benefits.

How to claim Ancillary Claims
If your claims are not processed at the point of treatment through the HICAPS card system, you can forward your claims to us by:
• Mail - PO Box 931 Burnie, TAS 7320
• Fax - (03) 6432 1160
• In person at our Burnie office.
• Email - enquiries@hciltd.com.au

Hospital Claims
In most cases, when you are discharged from hospital the hospital staff will forward the invoice direct to HCI. Ask the hospital before you leave.

Medical Claims
HCI participates in the Medicare 2 Way Scheme. You can lodge your medical claims at either a Medicare office or at the fund office.

Benefit payments
You can receive your benefits by:
• Direct Credit. If you have paid the account, your benefit can be paid electronically into your nominated bank account. You will receive separate notification as to the payment details.
• Cheque. If you have paid the account, a cheque made payable to you or if you have not paid the account, to the provider. We will mail the cheque.

Conditions of claiming
• All accounts and receipts must include the appropriate item number and/or a full description of the service or product.
• All services must be provided by practitioners in private practice and must be acceptable to the Fund.
• Claims must be lodged within 2 years of the service date.
• Benefit payments are calculated on the date of service or supply.

Annual limits
Annual limits are individual limits and based on a calendar year - 1 January to 31 December unless otherwise stated.

Travel Insurance
Your usual benefit entitlements apply throughout Australia. Members who travel away from their home (within Australia or overseas) and fall ill may incur expenses that fall outside the range of health fund benefits, including loss of air fares, additional accommodation costs etc.
HCI strongly recommends members travelling consider taking out travel insurance.
HCI has negotiated highly competitive travel insurance packages for members through CGU.
Call us to receive a brochure.

Special cases
Members may apply in writing to the HCI Board requesting consideration be given for treatment which is not covered by any other benefit. The Board may approve benefits for members in special circumstances that are not covered by the fund rules, but within the general intent of the rules.
Each application is assessed on a confidential basis.
It should be noted that application does not automatically indicate approval.

Recognised providers
To protect your interests, all services must be rendered by providers who are recognised by HCI. Recognition of providers by HCI is subject to change without notice. Some providers may not be recognised by HCI.

Compensation
The fund advises members who are, or may be, involved in compensation or damages claims to seek individual clarification from the fund as soon as possible. Benefits are not payable when the member has the right to recover expenses from another source. This includes injuries, accidents and conditions where an entitlement to damages exists, or may exist. Any benefits initially paid by the fund must be repaid. Fund benefits are not payable for future medical and hospital treatment relating to an injury or condition that has been the subject of a compensation or damages settlement.

Money Back Guarantee
We make a commitment to you that if within 30 days of signing your membership form, you are not completely satisfied with the cover you choose, we will refund your money in full, less any claims paid.