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HCF - Top Plus
At HCF, we like to do things differently.
We're a not-for-profit organisation so our goal isn't to pay dividends to shareholders. It's to provide
benefits to our members. That's why we don't charge our members a hospital excess for accidents,
same-day surgery or dependants and why we include medical gap cover in all our Hospital covers.
We also provide generous benefit limits for Extras like dental, optical, chiro and physio services. We
offer outstanding private hospital access, and fast online claiming so our members can feel better,
sooner.
It's called the HCF difference, and it's our way of making sure our members get the most out of
their cover.
V3.3
Excess Excess applies Effective April 1 2011
$450 per person to a maximum of $450 per calendar year for a single or single parent membership
to a maximum of $900 per calendar year for a couple or family membership
NO Excess is payable for;
same day surgery
hospitalisation as a result of an accident.
children or student dependants
dependants covered on extended family policies
Hospital Service Private Patient in
HCF Participating
Private Hospital
Private Patient
Public Hospital
Hospital Waiting Periods
Accommodation yes yes 1 day
Emergency Ambulance
2 months
Psychiatric
Rehabilitation
Palliative care.
All other treatments except
where there's a longer waiting
period.
12 months
Treatments for pre-existing
ailments excluding Psychiatric,
Rehabilitation, Palliative care.
Pregnancy and birth- related
services
A pre- existing ailment is an
ailment or illness where the signs
and symptoms existed any time
during the six month before a
member joined or upgraded to a
higher level of cover, even though
a diagnosis may not have been
made. If there is any doubt as to
whether an ailment is pre-
existing, HCF will appoint an
independent medical practitioner
to examine information provided
by your doctor, together with other
relevant claim details.
Operating theatre yes yes
Intensive Care yes yes
Neo-natal Intensive Care yes yes
Coronary Care yes yes
Pregnancy and birth related services yes yes
Assisted reproductive services (IVF,
GIFT)
yes yes
Hip and knee joint replacements yes yes
Cataract eye surgery yes yes
Dialysis for chronic renal failure yes yes
Psychiatric services
(including eating disorders and post-
natal depression)
yes yes
Pharmaceuticals in hospital directly
associated with the reason for
admission. Excluding experimental
and very high cost non-PBS drugs.
yes yes
Rehabilitation programs yes yes
Surgical weight loss procedures e.g.
gastric banding
yes yes
Sterility reversals yes yes
Cosmetic surgery minimal benefits minimal benefits
Surgery by an accredited Podiatrist minimal benefits minimal benefits
If you choose a product which has minimal benefits for some procedures, then you'll be covered in a public hospital
shared room, but your private hospital costs won't be fully covered.This means you may face significant personal
expenses if you have any of these procedures in a private hospital. For procedures (such as those listed in this table)
attracting minimal benefits in a private hospital, HCF would:• Pay a small amount towards your accommodation;• Pay for prostheses, if required (100% cover for no-gap prosthesis list items. There are a small number of prosthesesthat will attract a gap); and• Not pay operating theatre expenses, or labour ward charges.In addition, there are some services where doctor's charges are not payable (for example, elective cosmetic surgery
and surgery by an accredited podiatrist). For these, HCF will only pay a very small amount towards the total cost of
the procedure (and no doctor's charges). This only applies to services which do not attract a benefit from Medicare.
Ambulance
Full cover for emergency ambulance with State Government road or air services where you require hospital or on-the-
spot treatment in Australia.
Up to $5000 per person per calendar year for State Government non-emergency ambulance services where your
doctor requests ambulance transport because your condition requires monitoring and support in transit.
Super Multicover
V3.3
General Treatment Service Rebate
effective
1/7/2011
Annual Limit per
person per calendar
year
Waiting
Period
General Dental
Diagnostic Dental 2 months
Examination (011) $38 2 claims
X-rays (022) - initial
Subsequent visit
$29
$25
No limit
Preventative Dental
Removal of plaque (114 & 115) $63 2 claims
Application of fluoride (121) $25 1 claim
Restorative Dental
Adhesive fillings - one surface (531) $95 $550
Adhesive fillings - two surfaces (532) $108
Adhesive fillings - three surfaces (533) $125
Orthodontic
By an Orthodontist - two full arch banding(831) x 2
- accrues at $440 per year.
or
By a General Dentist - two full arch banding (831) x 2
- accrues at $440 per year.
$1,720
$1,000
$2,640 lifetime limit
sub limit of $1,000
lifetime limit
12 months
Major Dental
Crowns and Bridges $800 per person
Increases by $100 each year to
$1,200
12 months
Full crown non metallic indirect (615) $635
Dentures $800 per person
every three years from date of
service
Complete upper and lower denture $800
Maintenance & repair $37-$200 $200 sub-limit applies for
maintenance & repairs
Other Dental $500
Endodontic: Preparation of root canal
(415)
$170
Oral Surgery - (eg. extractions) $100-$260
Root canal obturation (417) $150
General Treatment Service Rebate
effective 1/7/2011
Annual Limit per person
per calendar year
Waiting
Period
Optical
Spectacle frames $135 $250 2 months
Spectacle lenses - pair $130 - $250
Contact lenses - pair $140 - $250
Disposal contact lenses $160
Chiropractor
Visit 1-2
Visit 3-11
Visit 12+
Chiropractic X-ray
$42
$33
$18
$63
$600 - (Increases by $120
each year to $1,200)
Max $600 each for Chiro &
Osteo.
Max $300 for exercise
physiology
2 months
Osteopathy
Visit 1-2
Visit 3-11
Visit 12+
$45
$35
$18
Exercise Physiology
Initial consultation
Subsequent consultation
$40
$33
Physiotherapy / Eye Therapy
Visit 1-2 $53 $600 - (Increases by $120
each year to $1,200)
2 months
Visit 3-11 $38
Visit 12+ $18
Hydrotherapy/Group Physiotherapy $18 per visit
Eye Therapy $38
Acupuncture / Naturopathy / Remedial Massage /Myotherapy /Homeopathy/ Alexander Technique/
Chinese Herbal Medicine
Acupuncture - sub-limit $250 per person,
Chinese Herbal Medicine- sub-limit $100 per person
Combined Limit
$600
2 months
Initial consultation $40
Subsequent consultation $25
Naturopathy/Nutrition, Remedial Massage/Myotherapy, Homeopathy,
Alexander Technique - sub-Limit $250 per person
Initial consultation $40
Subsequent consultation $25
General Treatment Service Rebate
effective 1/7/2011
Annual Limit per
person per calendar
year
Waiting
Period
Speech Pathology / Audiology
Speech Pathology
Initial consultation $83 $500
2 months
Subsequent consultation $51
Audiology
Initial consultation $58 $350
2 months
Subsequent consultation $40
Occupational Therapy
Initial consultation $72 $600 2 months
Subsequent consultation $50
Dietetics
Initial consultation $55 $350 2 months
Subsequent consultation $40
Podiatry
Initial consultation $38 $400 2 months
Subsequent consultation $34
Psychology (after Medicare entitlement is exhausted)
Per consultation $80 $600 2 months
Artificial Appliances
HCF approved artificial appliances (eg: Nebuliser, TENS machine, Orthotics) $600 12 months
Pharmacy (HCF approved, non-PBS)
(non-PBS) An excess applies to all non-
PBS drugs which is equivalent to the
current PBS fee.
$50 per drug per script. $700 2 months
General Treatment Service Rebate
effective 1/7/2011
Annual Limit per person per
calendar year
Waiting
Period
Home Nursing, Travel and Accommodation
Home Nursing $50 per claim
Up to $100 per return trip per membership for travel per trip/
membership.
Journeys of more than 200km for specialist/hospital treatment.
up to $30 per night for accommodation
$1,000
$400 sub-limit for Travel and
Accommodation
(up to $400 for travel & $200
for accommodation)
2 months
Hearing Aids
Benefits payable every 5 years depending on length of membership Less than 5 years - $800
6-9 years - $1,100
10-14 years - $1,400
15 years and more - $1,800
2 years
Health Management Programs
HCF approved programs eg. First Aid Courses, Learn to Swim, Stress
Management, Quit Smoking , Childbirth/Ante-natal Education, Lactation
consultation, Weight Management & Exercise regimes
(recommended by a GP or specialist).
$200 per person
$400 per family
6 months
Other services
School accident cover
(approved general treatment related
service only)
100% of cost (where
benefits are not payable
from any other source)
$800 24 hours
Did you know?
Version 3.2 - Effective April 1 2011
Waiting Periods
Waiting periods must be served before benefits are paid.
They apply to:
New members.
Existing HCF members who upgrade to a higher level of cover or reduce excess payable. In this case, you need to serve
the necessary waiting period for the higher benefit entitlement.
Members who switch from another fund who have not already completed the required waiting period for equivalent
benefits.
New dependants, unless they switch from another fund where they have completed the required waiting period for
equivalent benefits.
Treatment of pre-existing ailment.
Waiting periods vary according to the type of treatment or services and are as follows.
Hospital Waiting Periods
1 day - Emergency Ambulance
2 months - Psychiatric, rehabilitation and palliative care. All other treatments except where there's
a longer waiting period.
12 months - Treatments for pre-existing ailments (excluding Psychiatric, Rehabilitation and
Palliative care), Pregnancy and birth- related services.
Please note:
If your previous cover did not include a particular service and your new cover does, you will need to
serve waiting periods for this service (2 months and 12 months for pre- existing conditions). If the
excess you are paying with HCF is lower than the excess paid with your previous fund, and any one
on the membership is hospitalised within the first 12 months with HCF, the higher excess will
apply.
Extras waiting periods
2 months - All services except those below
6 months - Health Management Programs
12 months - Crowns, bridges, dentures, endodontics, occlusal therapy, oral surgery, periodontal,
prosthodontics, dental bleaching and orthodontics, veneers, artificial appliances and pre existing
ailments.
2 years - hearing aids/repairs
Participating Hospitals
To check the participating hospitals in your state go to:
http://hcf/Services/participating_hospitals.asp?member_id=Guest
Non-participating hospitals
If you are using a non-HCF participating hospital you may incur out of pocket expenses. There are
many factors involved in determining your benefit at a non-HCF participating hospital. For more
details call HCF prior to going into hospital.
Minimal Benefits
If you choose a product which has minimal benefits for some procedures (such as pregnancy and
birth-related services), then you'll be covered in a public hospital shared room, but your private
hospital costs won't be fully covered.
This means you may face significant personal expenses if you have any of these procedures in a
private hospital.
For procedures (such as those listed in this table) attracting minimal benefits in a private hospital,
HCF would:• Pay a small amount towards your accommodation;• Pay for prostheses, if required (100% cover for no-gap prosthesis list items. There are a small
number of prostheses that will attract a gap); and• Not pay operating theatre expenses, or labour ward charges.
In addition, there are some services where doctor's charges are not payable (for example, elective
cosmetic surgery and surgery by an accredited podiatrist). For these, HCF will only pay a very
small amount towards the total cost of the procedure (and no doctor's charges). This only applies
to services which do not attract a benefit from Medicare.
Pre-existing ailments or conditions
A pre- existing ailment is an ailment or illness where the signs and symptoms existed any time
during the six month before a member joined or upgraded to a higher level of cover, even though a
diagnosis may not have been made. If there is any doubt as to whether an ailment is pre- existing,
HCF will appoint an independent medical practitioner to examine information provided by your
doctor, together with other relevant claim details.
Note 1: Procedures such as sterilization, reversal of previous elective sterilization, assisted
reproductive services (e.g. IVF, GIFT) may be deemed to be pre- existing ailments.
Note 2: If you join under a waiver, waiting periods are only waived for services with waiting
periods equal to or less than the waiver. All other waiting periods in excess of the waiver still apply.
All pre- existing ailments or illnesses and obstetric services attract a 12 month waiting period for
both Hospital and Extras services irrespective of any waiver.
Pregnancy and Birth related Services
If you have a single membership, you will need to change to a Family membership 3 to 4 months
before the birth so your new born has health insurance. The official waiting period for the unborn
child is 2 months but changing cover earlier covers the possibility of early arrival.
The 12 month waiting period for obstetric services starts from the date you first join the fund,
whether you're planning a child or not.
Eliminating out-of-pocket medical expenses for hospital members
HCF has entered into arrangements with many doctors and a number of private hospitals. The
arrangements eliminate both the medical gap for services provided by participating doctors and the
need for HCF patients to handle multiple accounts or to claim from Medicare and/or HCF.
HCF pays any gap fees for participating doctors, so that the patient has no out- of- pocket
expenses.
No gap hospital agreements. With HCF no gap hospital agreements, members can choose to be
treated at participating hospitals by a participating doctor. This eliminates gap charges altogether
and your medical bill is automatically paid by HCF.
HCF Medicover. HCF Medicover is a direct billing system for doctors. If your doctor is willing to use
this new system, all in-hospital medical services that you receive from your doctor will be covered
by HCF, eliminating any gap charges. Also, with HCF Medicover, HCF pays your medical bills directly
for you. There are also no gap pathology and radiology arrangements. With HCF's pathology
arrangement with Australia's leading providers, members who find themselves in hospital will now
be covered for the full cost of pathology services supplied by these providers. See the Did you
Know section for more information about the Medicare Gap and the Medical Gap. HCF is not
responsible for the care or treatment received from any hospital or other service provider nor for
any aspect of the administration of a hospital or other service provider.
Who is covered?
Family cover
The Policyholder, their partner and dependants listed on the policy. Only the Policyholder can
determine who is covered under a membership.
Cover for your dependants
Your children are automatically covered at no extra cost under your family cover until the day
before they turn 22.
If your children are full-time students, simply register them as Student Dependants at the start of
each academic year, and they will be covered for no extra cost until the day before they turn 25. If
they cease study during that year their cover will lapse.
If your children are not full-time students, you can also continue to cover them until they turn 25
with Extended Family Cover, available on certain levels of HCF cover. Otherwise, your grown
children will need to take out their own cover.
All new dependants must serve waiting periods, unless they are transferring from another
membership or another private health insurer where they have already completed the relevant
waiting periods. In this case they will need to request an Interfund Transfer Certificate from their
previous fund, which is provided to HCF when joining.
In addition, the Policyholder's children and student dependant must be:
Unmarried and not in a de facto relationship; and
Primarily reliant on the Policyholder and or (Partner listed on policy) for maintenance and support; and
Related to the Policyholder (or Partner listed on policy) as a child, step-child, foster child or other children that the
Policyholder (or Partner listed on policy) have legal guardianship over.
The student dependant must also be:
Aged between 22 – 24 (inclusive); and
A full time student at school, college or university.
Couples cover
The Policyholder and their Partner listed on the policy.
Singles cover
The Policyholder only.
HCF Extended Family Cover
HCF automatically covers your children until their 22nd birthday. With HCF Extended Family Cover
you can continue to provide health insurance for your 22, 23 and 24 year old children, even if they are no
longer studying full- time or living at home, as long as they are unmarried and not in a de facto
relationship. For a small additional premium you can extend your cover to provide your children with
the health insurance they need.
On turning 25: With HCF Extended Family Cover your children remain covered until they turn 25 or
until such time as they marry. HCF will contact you before your child's 25th birthday to notify you
that your membership will revert back to your standard membership and invite your child to choose a
cover that suits their individual lifestyle.
Student dependants: Eligible students are covered free of charge until they turn 25. Extended Family
Cover is available with HCF Top Plus Cover and HCF Hospital Savings Option. Extended Family Cover
also applies to your extras cover when taken with these hospital products.
Single Parent Family Cover
As per Family Cover, excluding the contributor's nominated partner.
Single parent families receive a reduction (approximately 20%) on the family rate of certain
Hospital
and Extras products. The reduction in applicable to your Extras cover on Levels 1 and 2 and your
entire cover on levels 3, 4, 5 and 6. This reduction does not apply to Hospital Advanced Savings,
Ambulance Only Cover and HCF Life Products.
Family memberships and Single Parent Family memberships are not available for the Fit and Free
policy and young singles and couples policies.
Overseas Cover
If you travel overseas you aren't covered. HCF cannot cover you for overseas medical expenses
under your membership. However, you can obtain a 10% discount on travel insurance through HCF
which will cover overseas medical
Fit & Free policy holders are covered for emergency overseas medical expenses through their
special overseas travel insurance. See www.hcf.com.au/fitandfree for details
HCF supports the Private Health Insurance Code of Conduct ensuring:
You will receive correct information on private health insurance
You are aware of the internal and external dispute resolution procedures
You can make an informed decision about your purchase through informative policy
documentation
You are protected in accordance with privacy principles
A full copy of the code is available at www.privatehealth.com.au/codeofconduct
Resolution of problems
If you have any queries or feedback about any aspect of a health insurance product or iSelect's
service, you could either call the consultant you dealt with or contact the Compliance Manager by
telephone on 1300 735 255, and by email on [email protected].
If you have queries or feedback about the HCF products please contact HCF on 13 13 34.
If you are not satisfied with iSelect's response you may contact the Private Health Insurance
Ombudsman on 1800 640 695.
Privacy
For further information about iSelect's privacy policy please visit iSelect's web site:
http://www.iselect.com.au/
HCF APPLICATION FORM
Signature x Date:
PRE EXISTING AILMENT/CONDITION (PLEASE COMPLETE THIS SECTION)
DECLARATION (PLEASE SIGN THIS SECTION WHERE INDICATED)I declare all details stated to be true and correct and agree to be bound by the registered rules and by-laws of HCF as amended from time to time. I have read and understood the information for my chosen fund regarding pre-existing ailments/conditions, waiting periods, benefit limitations and lifetime exclusions (where applicable). I declare that all persons to be covered are permanent residents of Australia and entitled to full Australian Medicare Benefits. I will advise HCF of any changes to the information supplied on this application. I declare that dependant students aged between 22 and 25 mentioned on this form are attending a full time course of approved study. I declare that I have not been declined health insurance from any other fund on the basis of fraud. I understand that proof of identity and age may be required.
IMPORTANT: PLEASE READ AND NOTEBenefits are not payable in the first 12 months of membership for the treatment of a pre-existing ailment/condition, the signs or symptoms of which were in existence at any time during the 6 months prior to joining or upgrading to a higher cover, whether or not diagnosed by a doctor. This is an industry wide standard rule applied by Health Funds for the protection of existing members.
Cover commences on ________/________/________Conditional on receipt of payment within 14 days.
If YES, please state the aliment/condition/sDo you, your spouse/partner or any of your dependants have any pre-existing ailment/condition/s?
Phone: Home ( )
OTHER PERSONS TO BE COVERED
Email address:
Mr/Mrs/Ms/Miss/Other: _____________
Given name/s:
Date of birth: (DD/MM/CCYY)
Address:
Postcode
Yes
No
StateTown/Suburb:
Surname:
Occupation:
Work ( ) Mobile
(nominate date)
MEMBERSHIP NUMBER ISSUED BY FUNDOFFICE USE ONLY
iSelect Client No.
SELECTED PRODUCT/S
Type of Cover
Excess amount
Base Premium Quoted $
New Membership Transfer Membership from another Fund Change cover with HCF
Please fax or mail pages 1 & 2 only. Fax: 1300 735 322 or call 1300 735 255 Mail: Reply Paid 2021 Moorabbin VIC 31891
iSelect Health Pty Ltd ABN 87 088 749 955
Please fax pages 1 & 2 to 1300 735 322 or mail to Reply Paid 2021 Moorabbin, VIC 3189
HCF’s Terms & Conditions are available at www.iselect.com.au/tc8
Given Name Family Name Date of birth Sex Relationship StudentYES/NO
Member’s Name Details of Ailment/Condition/s
R20810 ISN R/C 20 Customer Note No:
Lifetime Loading (if applicable)
Total Premium $Premiums quoted valid to March 31st 2012
NSW
$450 x 1
Single Male
0.00
154.7
WB 6 3 8
154.70 p/month inc 30.0% rebate
41 0 8
Top Plus Cover $450 AND Super Multicover
10-Jun-1986
HCF APPLICATION FORM
DIRECT CREDIT OF CLAIMS If you would like your claim benefits paid directly into your account please complete the following details.
I request HCF to credit my/our nominated account with any amount which may be payable by the fund in respect of a claim or benefit on my membership.
If YES please complete the remainder of this section.
FEDERAL GOVERNMENT REBATEPlease complete this section in full to receive the Federal Government 30% Rebate on private health insurance as a reduced premium. If you do not complete this section, full membership fees apply.Are all people nominated on Page 1 on this membership eligible for full Medicare benefits?
If NO you cannot apply for the rebate until you obtain a card from Medicare.
Are you covered on this membership? If NO, employers and trustees of organisations cannot claim the Federal Government 30% Rebate on policies paid on behalf of employees.
Date premium reduction to commence / /
Your Medicare Card No.Valid To
Your name exactly as it appears on your Medicare card
Some of the information provided on this form will be used for the purposes of registering you for the Federal Government 30% Rebate on private health insurance. Its collection is authorised by law, and information collected will be disclosed to the Department of Health and Aged Care, the Health Insurance Commission and the Australian Taxation Office.
Name of Bank, Credit Union or Building Society
Name on a/c BSB No. - Account No.
Signature x Date:
(Start date of this policy)
Signature x Date:
YesNo
Yes No
Signature x
Account name
BSB No. Account No.-
I/We authorise The Hospitals Contribution Fund Limited User ID Number 480 to arrange for funds to be debited from my/our account at the financial institution identified below and as prescribed below.
Monthly YearlyPlease tick Fortnightly on the 1-27 day* of the month
*Please nominate your first debit day. Please note: debit dates of 28, 29, 30 and 31 are not available.
This authorisation is to remain in force in accordance with the terms described in the HCF Direct Debit Customer Service Agreement.
Details of the Account to be debited (All details must be supplied.)
Name of Financial Institution
Branch
1. EZIPAY DIRECT DEBIT REQUEST
*Please nominate day. (If you do not nominate a day your account will be debited on the 7th day.) I acknowledge that the credit card I am using to pay for this insurance has been issued and used prior to paying for this insurance.
2. CREDIT CARD AUTHORITY
Card Holder's Name
Expiry Date
Type of card (please tick)
Visa MasterCard
Card No.
Debit frequency (please tick) Monthly Yearly
Please debit my account on the ________________________ day of the due month.
Signature x
Date:
Date:
PAYMENT OPTIONS – ( PLEASE COMPLETE 1 OF THE 2 PAYMENT OPTIONS)
MEDICARE ELIGIBILITY
My Medicare card is
My Medicare card number is
Green – Full unrestricted access
Blue – Interim card full unrestricted access until expiry date
Yellow – Reciprocal card – restricted access until expiry dateValid To
CCVV No
CCVV No – this is the 3 digit number on the back of your credit card
Please fax or mail pages 1 & 2 only. Fax: 1300 735 322 or call 1300 735 255 Mail: Reply Paid 2021 Moorabbin VIC 31892