Frequently Asked Questions

Need answers? Check out our Frequently Asked Questions

Who can be included in my cover?

You may include the following in your policy:

  • Spouse or defacto 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
  • Unmarried (includes those not in a defacto relationship) children between  23 years and 25 years of age (Family Dependent Plus and Single Parent Plus policies only)

How do I transfer to HCI from another fund?

You can transfer from another fund to HCI at any time. If you join within 2 months 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.

What do I need to consider if I wanted to update my existing HCI policy?

You can vary your level of cover to meet your changing needs at any time. If you increase your level of cover by adding a new benefit type, or by increasing your benefit level, or moving from an excess product to a lower or excess free product, waiting periods will apply to the higher benefits of your new cover. You will, however, be entitled to the benefit levels of your previous cover.

What does the pre-existing condition rule mean?

A pre-existing condition is defined as any ailment, illness, or condition where, in the opinion of a medical adviser appointed by the health insurer, the signs or symptoms of that illness, ailment or condition existed at any time in the period of 6 months ending on the day on which the person became insured under the policy. The pre-existing condition waiting period applies to new members and members upgrading their policy to any higher level benefits under the new policy.

How do I lodge a claim?

If your claims are not processed at the point of treatment through an electronic swipe card system such as HICAPS, you can forward your claims to us by:

  • Mail to PO Box 931 Burnie, TAS 7320
  • Fax to 1800 643 969
  • In person at 25 Cattley Street, Burnie
  • Email to enquiries@hciltd.com.au
  • Smart phone App - Please see our website for more details

In most cases extra claims are processed on the day they are received, assuming they include all the necessary information.

How does HCI pay benefits to members?

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 will be made payable to you, or if you have not paid the account, a cheque will be made payable to the practitioner who provided the treatment.

How do I make a medical claim?

If you receive bills from your doctor for medical treatment you received whilst in hospital, you must lodge your medical claims at a Medicare office first, before submitting with us. Please note you cannot claim your out-of-pocket expenses.

Does HCI pay a benefit for overseas treatment?

HCI will not pay a benefit for services, treatment or applicances provided or purchased overseas. HCI will only pay a benefit towards services, treatment and applicances by approved providers and/or suppliers registered within Australia only.

Can HCI assist with 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 QBE.

What is HCI’s obstetric cover?

Obstetrics (Pregnancy and birth related services - including IVF and assisted reproductive services)

A 12 month wait applies to any obstetric related services.

  • Services outside of a hospital admission, including consultations and tests, may be claimable on Medicare or paid out of your own pocket.
  • A person with single membership is eligible for obstetric benefits provided she has been a member of a hospital table for 12 months or more.
  • Always check with the hospital, HCI and your doctor before proceeding with a hospital booking to ensure you will be covered and to discuss what costs you may incur.

How do I suspend my policy?

Members may apply for suspension of their membership, if at the time of application, they have held private health insurance cover for at least 12 months and paid all contributions due by them at the date of application.

Application for suspension of membership can only be made on one of the following grounds:

  • the member’s absence from Australia for travel reasons for a period not less than 28 days and not more than 2 years ; or
  • the member’s financial hardship for a period not less than 1month and not more than 6 months.

Periods of suspension of hospital cover do not count towards the 1,094 days cumulative absence allowed by Lifetime Health Cover legislation.

If a member reinstates membership within 30 days of the period of suspension ending and pays contributions from the end of the suspension period, there will be no new waiting periods to be served. For details of what information you will need to provide in your application for suspension of membership, please call us on Freecall 1800 804 950.

How do I cancel my Policy?

If you choose to cease your hospital cover, your future hospital health cover premiums will be subject to the Lifetime Health Cover provisions dealing with periods of absence Please note that high income earners will be subject to the Medicare Levy Surcharge (MLS) during a period of suspended hospital cover

Can I make a claim if the service was provided by a family member?

Unless a member has received prior approval from the General Manager, HCI will not pay benefits for services or goods provided to a person covered by a membership where those services or goods are supplied by a family member.

Does HCI have recognised/approved providers of treatment?

To help ensure the propriety of services offered to members by health care providers, benefits will only be paid for services rendered to members by providers who are recognised and approved by HCI.

Recognition of providers by HCI is subject to change without notice. If you are not sure about a providers approved status with HCI, please call us on Freecall 1800 804 950 to check before arranging treatment.

What is Lifetime Health Cover?

Lifetime Health Cover (LHC) is a Government initiative that started on 1 July 2000. It was designed to encourage people to take out hospital insurance earlier in life, and to maintain their cover. In Australia, private health insurance is not ‘risk-rated’ like most forms of insurance. Private health insurers cannot refuse to insure any person, and must charge everyone the same premium for the same level of cover, despite their risk profile and likelihood of using health services.

LHC is a financial loading that can be payable in addition to the base rate premium for your private health insurance hospital cover. If you purchase hospital cover earlier in life, and keep it, you will pay lower premiums compared to someone who joins when they are older.

How many days can I go without hospital cover?

You are able to stop your hospital cover for a cumulative period of 1094 days in your lifetime without affecting your certified age at entry. However, after the 1094 days aggregated absence, your certified age at entry will be increased by one year.

What is certified entry age?

Each adult is assigned a “certified age at entry” for contribution rate setting purposes.

People who do not have hospital cover on the 1 July following their 31st birthday must pay a 2% loading on top of the “base rate” contribution for the hospital cover they wish to purchase. The “base rate” is the lowest contribution rate for the hospital cover chosen.

For example, John turns 31 on 1 April 2016. If he purchases hospital cover by 1 July 2016, he will pay the base contribution rate. If he purchases hospital cover on 2 July 2016, he will pay a 2% loading. If he further delays purchasing hospital cover, he will pay an extra 2% for each year he delays.

What is the Medicare Levy?

Medicare is the scheme that gives Australian residents access to health care. To help fund the scheme, most taxpayers pay a Medicare Levy of 1.5% of their taxable income.

For more information refer to the Australian Taxation Office www.ato.gov.au or your tax agent. 

What is the Medicare Levy Surcharge?

You may also be liable for the Medicare Levy Surcharge (MLS) in addition to the Medicare Levy. Individuals and families on incomes above the MLS thresholds, who do not have an appropriate level of private patient hosptial cover, pay MLS for any period during the year that they did not have this cover. If you become liable for MLS, your MLS rate can either be 1%, 1.25% or 1.5%.

If your income for MLS purposes is above the base income threshold the Australian Taxation Office (ATO) will apply the rate of MLS that corresponds with your income for MLS purposes. If you have a spouse (married or defacto) your combined income for MLS purposes will be used.

Income for MLS Purposes

The rate of MLS that you may have to pay depends on your income for surcharge purposes. This is referred to as your income for MLS purposes, which is the sum of your:

  • Taxable income
  • Reportable fringe benefits
  • Total net investment loss
  • Reportable super contributions
  • Any amount on which your family trust distribution tax has been paid

If you have to pay the surcharge, it will be included with the Medicare Levy and shown as one amount on your notice of assessment you receive from the ATO.

Appropriate Level of Private Patient Hospital Cover

Private patient hospital cover is cover provided by an insurance policy issued by a registered health insurer for some or all hospital treatment provided in an Australian hospital or day hospital facility. However, an insurance policy for hospital cover taken out after 24 May 2000 that has an 'annual front-end deductible' amount or excess of more than $500 in the case of a policy covering only one person, or more that $1 000 for all other policies, does not provide private patient hospital cover for MLS purposes.

Income Thresholds

The income thresholds are varied each year by the Australian Taxation Office (ATO) for the current income thresholds please refer to the ATO website www.ato.gov.au or your tax agent.

Private Health Insurance Rebate Tiers 2016 – 2017

For more information on the MLS please visit the Australian Taxation Office website www.ato.gov.au 

(Source:http://www.ato.gov.au/Individuals/Medicare-levy/Medicare-levy-surcharge/)

How do I pay my membership?

You can select what suits your finances by either paying fortnightly, monthly quarterly, half yearly or yearly.

Direct Debit

You can have your premium automatically debited from your bank, building society, credit union or credit card account. Simply complete the relevant section on the membership application form.

Payroll Deduction

Where your employer offers a payroll deduction facility, you may also be able to pay by salary deduction. Check with your pay

office or contact Health Care Insurance for more information. An authority to deduct from salary form is included in the membership application form.

BPAY®

You can pay by BPAY® using your financial institution’s telephone or internet banking. Renewal notices sent to members paying monthly, quarterly, half yearly or yearly, will display a BPAY® Biller Code and reference number. This information will be required when paying your renewal through BPAY®.

For more information on BPAY® contact your bank, building society or credit union or visit www.bpay.com.au.

Cheque

Please make cheques payable to Health Care Insurance Ltd.

Credit card

You can pay in person or over the telephone using Mastercard, American Express and Visa.

In Person

You can pay direct by visiting one of our friendly customer service staff at 25 Cattley Street, Burnie, by cheque, Mastercard, Visa, American Express or cash.

Telephone

You can pay over the phone by credit card by calling 1800 804 950 during normal business hours.

Online

If you register for online member services you can pay by credit card through our website. 

Can I update my information online?

Yes if you are a HCI member you are also able to access HCI’s secure Online Member Services (OMS) to manage your membership at your convenience. OMS gives you the option to:

  • Look at your membership details
  • Change your address, level of cover or contact details
  • Make credit card payments
  • Order a new membership card
  • Organise travel insurance
  • Print your tax statement

To register for OMS, click here and follow the link. All information passed through the secure site along with access to your membership details is protected by the use of your own chosen password.

What to do if I have out-of-pocket expenses?

You cannot claim out of pocket expenses. HCI pays benefits for treatment provided to you by a doctor whilst you are a patient in hospital. As a private patient in a public or private hospital, Medicare pays 75% of the Commonwealth Medical Benefits Schedule (CMBS) fee and HCI pays 25% of the CMBS fee.

If your doctor chooses to charge above the CMBS fee you may have to pay the gap.

However, if your doctor chooses to use HCI's Access Gap Cover, you will have either no out-of-pocket expenses or, before receiving treatment, the doctor will give yuo an estimate of the costs you will have to meet.

It is your doctors' choice whether they treat and charge you under Access Gap Cover.

To search for doctors who have agreed to particpate in the Access Gap Scheme, click here.

What is access gap cover?

All HCI hospital cover includes our Access Gap Cover at no extra charge, helping to reduce or eliminate out-of-pocket (gap costs) between the Medicare Benefits Schedule Fee and the doctor’s charge for in-hospital medical treatment. If your doctor agrees to treat you under Access Gap Cover, you will either have no out-of-pocket expenses or you will know the amount of any out of pocket expenses before your hospital treatment.

What is the Pharmaceutical Benefit Scheme (PBS)?

The PBS subsidies the cost of various medications resulting in the consumer paying a reduced price for certain medications. These medications are reduced on average by 80%. A benefit is not payable for PBS items because they are already subsidised by the Federal Government.

What Pharmacy Items can I claim?

Non- PBS items are medications that are not listed on the PBS. For a benefit to be paid, the Non PBS item must be equivalent to an S4 item or above and not listed on the PBS and can only be obtained with a prescription.

Having ancillary cover with HCI can help offset the cost of Non-PBS medications. HCI have a co-payment* per prescription and pays 100% over and above this amount up to $100.00 depending on the cover you have.

*The Federal Government sets and applies the co-payment amount annually. As of 1 January 2016 the co-payment amount is $38.30. 

What is the Private Health rebate?

The Australian Government Rebate on Private Health Insurance was introduced as a financial incentive to help Australians afford private health cover. 

The rebate depends on your age, is income-tested and applies to all Health Care Insurance products. The rebate isn't available for the Lifetime Health Cover loading portion of membership payments.

Your rebate amount is based on your age and assessable income*. Below are the thresholds set by the Australian Government for the 2016/17 financial year. 

Private Health Insurance Rebate Tiers 2016 – 2017

From 1 April 2014, the rebate is indexed each year by the difference between Consumer Price Index (CPI) and the industry average increase in premiums using a Government - calculated formula.

It's up to you to nominate a rebate tier (based on your age and assessable income*). If you don't tell us, or if you choose the wrong tier, don't worry because the Australian Taxation Office (ATO) will work out any differences when you put in your annual tax return.

If you aren't sure which rebate tier you should choose, please contact your tax agent, financial advisor or the ATO at www.ato.gov.au/privatehealthinsurance

Most people choose to take their rebate up front as a lower premium, but if you'd prefer to claim the rebate as a lump sum through your tax at the end of the financial year, you can just pay the full premium.

* For the calculation of assessable income which is known as income for Medicare Levy Surcharge puproses, please seek the advice of your tax agent, financial advisor or contact the ATO help line on 132 862 or visit their webiste at https://www.ato.gov.au/Calculators-and-tools/Host/?anchor=MedicareLevy&anchor=MedicareLevy#MedicareLevy/questions

 How can I claim the rebate?

You can claim your rebate in one of three ways:

  1. as a reduction in your contributions; or
  2. as an income tax offset on your income tax return.

For your convenience and certainty that you receive your full rebate entitlement, we recommend you register to have your rebate taken off the contributions you pay to HCI.

Who is eligible for the Rebate?

Most Australians with private health insurance receive a rebate from the Australian Government to help cover the cost of their premiums. However, from July 1 2012 the private insurance rebate is income tested. The rebate applies to hospital, general treatment and ambulance policies.

What are my waiting periods?

First-time health cover

If you are taking out private health insurance for the first time, you will be required to serve full waiting periods before benefits can be paid.

Transferring from another health fund (portability)

If you already have health cover with another health fund, you can transfer to HCI at any time. If you join within 2 months of the expiration of your cover with your previous fund, you will not have to serve any new waiting periods for the same or lower level of cover with HCI.

HCI’s normal waiting periods will be applied, including the pre-existing ailments rule, to benefits not covered by your previous fund cover. Under the Federal Government’s Lifetime Health Cover initiative, your “certified age at entry” with your previous fund will be recognised by HCI if you join immediately after the expiration of your cover with your previous fund.

More information

Waiting periods for Health Care Insurance benefits

Changing your HCI cover

You can vary your level of cover to meet your changing needs at any time. If you increase your level of cover by adding a new benefit type, or by increasing your benefit level, or moving from an excess product to a lower or excess free product, waiting periods will apply to the higher benefits of your new cover. You will, however, be entitled to the benefit levels of your previous cover.

Hospital treatment or Hospital substitute Waiting Period (months)

Hospital treatment  or  Hospital substitute

Waiting Period (months)

Pre- existing conditions

12

Obstetrics (pregnancy related services)

12

IVF and assisted reproduction technology

12

Sterilisation including reversal

12

Psychiatric Care, rehabilitation or palliative care

2

All other hospital treatment services

2

What are benefit limitations?

Some private health funds apply a Benefit Limitation Period (BLP) which is similar to a waiting period, however if you haven’t served your BLP your health fund will still pay a benefit. This benefit is a limited amount and is usually restricted to what they would pay at a public hospital.

Some waiting periods applied are regulated and set by the Australian Government, however a BLP is applied and set by the individual health fund.

HCI does not apply a BLP.

How do I provide feedback?

We welcome and value your comments on our products and service. If you require further explanation or have problems on matters affecting any aspect of your health insurance cover, please call us to discuss your concerns. We will endeavour to resolve all issues of concern to your satisfaction as quickly as possible. However, if you believe we have not addressed your issues satisfactorily, you can contact us on 1800 804 950, email us enquires@hciltd.com.au, or click here 

How do I join?

Join online or call one of our friendly customer service staff on 1800 804 950.

Who can join?

HCI is now open for everyone to join!