Frequently asked questions

We have answered the questions that you ask the most! HCi has been operating and providing health cover for over 80 years to our valued members – we have experienced it all! We are here to provide personalised help when needed.

If you don’t find your answer below, please contact our friendly team on 1800 804 950 or via HCi Chat.

Joining, switching & updating questions

Who can join?

HCi is open for all Australian residents to join! Chat to our friendly team today about your health insurance needs  – call us on 1800 804 950, email us or chat online!

How do I join?

It’s really simple! Join online, use our form or call one of our friendly member services team on Freecall 1800 804 950.

Who can be included in my cover?

At HCi, we provide flexible health insurance to cover your particular situation – cover for you, cover for you and a partner, or cover for your family.

Dependent children can be on your plan up to 31 years of age, depending on their circumstances.

How do I transfer to HCi from another fund?

You can transfer from another fund to HCi at any time. It’s quick and easy as we’ll help you at every step.

What’s more, 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 apply to benefits not covered by your previous fund cover, including pre-existing waits.

Your Certified Entry Age for the Federal Government’s Lifetime Health Cover purposes will be recognised by HCi on transfer.

It’s easy to switch to HCi,

  1. When joining online or via our form make sure the Clearance Request section is completed,
  2. HCi will take care of the rest!

make the switch

*When switching from a comparable level of cover.

What should I consider if I want to vary my existing HCi policy?

You can vary your level of cover to meet your changing needs at any time.

If you change your cover by adding a new option, increasing your cover level, or moving to a lower excess, waiting periods will apply to the higher benefits of your new cover. You will, however, have continued access the existing level of cover.

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. If you’re considering cancelling or suspending your health insurance, please contact us on 1800 804 950.

How do I suspend my policy?

Members may apply for suspension of their membership, if when applying, they have held  cover for at least 12 months and all premiums are current.

Suspension (or postponement) of membership can only be made on one of the following grounds:

  • the member’s absence from Australia for travel reasons for 28 days to 2 years; or
  • the member’s financial hardship for  to 6 months.

Hospital cover suspensions do not count towards the 1,094 days cumulative absence allowed by Lifetime Health Cover legislation. If membership is reinstated within 30 days of the suspension ending and premiums are paid from the end of the suspension period, no new waiting periods apply. For details of what you need to provide in your application for membership suspension, please call us on 1800 804 950 or catch us on HCi Chat.

What is the LHC certified entry age and loading rate?

Under the Lifetime Health Cover scheme, you may have additional premiums for your health cover.

Each Australian 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, or were 31 or older at 1 July 2000 and did not have cover at that time, must pay a loading. The loading is calculated as 2% per year past 31. It is charged on top of the “base rate” premium for their hospital cover.

The “base rate” is the lowest premium rate for the hospital cover chosen.

For example, John turns 31 on 1 April 2023. If he purchases hospital cover by 1 July 2023, he will pay the base fee rate. However, if he purchases hospital cover on 2 July 2023, he will pay a 2% loading for that year. And, if he further delays purchasing hospital cover, he will pay an extra 2% for each year he delays.

Can I update my information online?

Yes! As an HCi member you can 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
  • 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 through a password you chose.

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 option, or by increasing your cover level, or moving to a lower excess, waiting periods will apply to the higher levels of your new cover. You will, however, coninute to have access to the levels of your previous cover.

Most changes can be made via our policy updates form or within OMS.

Claiming questions

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:

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

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.

What are my waiting periods?

First-time health cover

If you are taking out private health insurance for the first time, you have to serve full waiting periods before any claims can be paid.

Transferring (switching) 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 your previous cover ending, 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 ending your previous cover.

More information

Waiting periods for HCi benefits

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

Unless our CEO gave prior approval, HCi will not pay claims for services or goods provided by a family member.

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 you 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 participate in the Access Gap Scheme, click here.

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 extras cover with HCi can help offset the cost of Non-PBS medications. HCi has 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 2022, the co-payment amount is $42.50.

Policies & Benefits questions

HCi offers four levels of hospital cover and three levels of extras cover. Members can select one or both types of cover.
HCi also offers additional health programs for members, such as cancer and DIabtets support.

What is HCi’s obstetric cover?

Pregnancy, Obstetrics and birth related services.

A 12 month wait applies to any obstetric related services.

We also cover ‘IVF and assisted reproductive services’, although these are not part of obstetrics, instead they are treatments which precede any need for obstetric care. A 12 month waiting period applies to all IVF and assisted reproductive services where utilisation of these services generally relates to treatment of a pre-existing condition. If there is not a pre-existing condition, a 2 month waiting period applies to IVF and assisted reproductive services.

Only an admission to hospital can be covered under private hospital insurance.

Services outside of a hospital admission, including consultations and tests, may be claimable on Medicare or paid out of your own pocket.
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.

What is Lifetime Health Cover (LHC)?

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.

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 take out private health cover before the age of 31 and hold it continually from that time, you will not have to pay the LHC loading. If you don’t take out private health cover by that time, or stop holding private health cover for a defined period of 1094 days, the loading will apply.

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.

Click here for more information 

How many days can I go without hospital cover?

You are able to stop your hospital cover for a cumulative period of 1,094 days in your lifetime without affecting your certified age at entry. However, after the 1,094 days aggregated absence, your certified age at entry will be increased by one year.

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 Commonwealth 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.

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

Cover questions

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.

Does HCi pay a benefit for overseas treatment?

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

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 provider’s approved status with HCi, please call us on Freecall 1800 804 950 to check before arranging treatment.

General FAQs

How do I pay for my membership

You can select fortnightly, monthly, quarterly, half yearly or yearly payments.

Direct Debit

You can have your premium automatically debited from your bank, building society, credit union or credit card account. Please refer to the terms of our direct debits arrangements.

Simply complete the relevant section on the membership application form  or update it later via our payments form or within OMS.

Payroll Deduction

Where your employer offers a payroll deduction facility, you may  be able to pay by salary deduction. Check with your pay office or contact HCi for more information. An authority to deduct from salary is included in the membership application form and our payments form

BPAY®

You can pay by BPAY® using your financial institution’s telephone or internet banking. Renewal notices sent to members paying monthly, quarterly or half 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 phone 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. You can pay 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 (Tasmanian time).

Online

Once you register for OMS (online member services), you can pay by credit card through our website.

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 HCi, 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.

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.

We do not offer travel insurance but strongly recommend members traveling seek advice from their travel agent or specialist travel insurer.

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 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 hospital 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 will be 1%, 1.25% or 1.5%.

Income for MLS Purposes

The rate of MLS that you may have to pay depends on your income for surcharge or 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 a spouse (married or de facto), your combined income for MLS purposes will be used. The income thresholds are varied each year by the Australian Taxation Office (ATO) for the current income thresholds please refer to the ATO website  or your tax agent.

Appropriate Level of Private Patient Hospital Cover

An appropriate level of private patient hospital cover is generally a hospital policy with an excess of up to $750 in the case of a policy covering only one person, or up to $1,500 for all other policies, that provides private patient hospital cover for MLS purposes.

Rebate Tiers 2022
Income Threshold Medicare Levy Surcharge
All Ages
Base Tier Single $90,000 or less 0.0%
Family* $180,000 or less
Tier 1 Single $90,001 – $105,000 1.0%
Family* $180,001 – $210,000
Tier 2 Single $105,001 – $140,000 1.25%
Family* $210,001 – $280,000
Tier 3 Single $140,001 or more 1.5%
Family* $280,001 or more

*For the calculation of assessable income for Medicare Levy Surcharge purposes, please seek the advice of your tax agent, financial advisor or contact the Australian Taxation Office (ATO) Help Line on 132 862 or visit their website at www.ato.gov.au/calculators-and-tools/medicare-levy

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

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 HCi 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 2021/2022 financial year.

Rebate Tiers 2022
Income Threshold Age and Rebate amount
(age of the oldest person on your cover)
Under

65 Years
65-69

Years
70+ Years
Base Tier Single $90,000 or less 24.608% 28.710% 32.812%
Family* $180,000 or less
Tier 1 Single $90,001 – $105,000 16.405% 20.507% 24.608%
Family* $180,001 – $210,000
Tier 2 Single $105,001 – $140,000 8.202% 12.303% 16.405%
Family* $210,001 – $280,000
Tier 3 Single $140,001 or more 0% 0% 0%
Family* $280,001 or more

*For the calculation of assessable income which is known as income for Medicare Levy Surcharge purposes, please seek the advice of your tax agent, financial advisor or contact the Australian Taxation Office (ATO) Help Line on 132 862 or visit their website.

Since 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.

How can I claim the rebate?

You can claim your rebate in one of two 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, since July 1 2012 the private insurance rebate is income tested. The rebate applies to hospital, general treatment and ambulance policies.

What is the Pharmaceutical Benefits Scheme (PBS)?

The PBS subsidises 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.

How do I provide feedback?

We welcome and value your comments on our products and service. We have a range of ways to contact us, including…

An orange tick of approval   call 1800 804 950

An orange tick of approval   email enquiries@hciltd.com.au

An orange tick of approval   visit 25 Cattley St, Burnie, TAS

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 your concerns 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 or email us enquiries@hciltd.com.au.

Giving you access to more than

30,000+ Doctors

Giving you access to more than

30,000+ Doctors

Giving you access to more than

30,000+ Doctors

// Mobile App

HCi App

The new HCi phone app allows you to easily claim through the use of your smart phone.

Download the app and, when you have to claim, simply take a photo of your service provider’s receipts. Your claim will then be submitted electronically.