Things worth knowing

Why do I need Private Health Insurance?

Private Health Insurance provides peace of mind. It means you can choose the doctor, the hospital and the type of room you want.

As a public patient, you are not given a choice of doctor. Medicare will cover you for treatment in a public hospital, however if your condition is not life threatening or you require elective surgery, you may have to wait for a long time before treatment becomes available. This can adversely affect your work, family and social life because you have no choice on when you will be treated.

Alternatively, you may elect to be a private patient and be treated by a specialist of your choice. But are you aware that as a private patient without private health cover, you will be required to pay 25% of the doctors' medical fees or more if they charge more than the Medicare Benefits Schedule, plus accommodation and ancillary hospital costs.

Having Private Health Insurance also means that you can be covered for things that Medicare doesn't cover like dental, physiotherapy, optical, chiropractic, ambulance and podiatry.

What is the Federal Government 30% Rebate on private health insurance?

The Federal Government Rebate is a government initiative designed to make private health insurance more affordable and accessible for all Australians.

Who is eligible for the Federal Government 30% Rebate on private health insurance? All Australians who are eligible for Medicare and are members of a registered health fund are eligible for the rebate-regardless of level of cover, income or type of membership.

What Rebate am I entitled to? Effective 1 April 2005, the Federal Government 30% Rebate on private health insurance provides the following entitlements:

• If you are aged under 65 years of age, you are eligible to receive a 30% Rebate.
• If either you or a person covered by your membership are aged 65 to 69 years, then you are eligible to a 35% Rebate.
• If either you or a person covered by your policy are aged 70 years and over, then you are eligible to a 40% Rebate.

The level of rebate on a membership is determined by the age of the oldest member on the membership and applies to the total contributions.

How does the Rebate work? The rebate provides a savings on your private health insurance dependent on your age. For example if you are under 65 years of age, you are entitled to the 30% Rebate. So, put simply, for every $1 you pay, the government gives you 30 cents back. So if your annual private health insurance actually costs $1000, you will receive $300 back from the Federal Government.

How can I receive the Rebate? There are three simple ways to claim the Rebate:

• Reduction in your premiums 
• A direct payment from a Medicare office
• Tax rebate in your annual tax return

 Download the Federal Government 30% Rebate application form.

What is the Medicare Levy Surcharge?

In the 2010/2011 financial year, if you earn more than $77,000 as a single or $154,000* as a family and you don't have private hospital cover, you will incur an additional 1% Medicare Levy Surcharge. This is in addition to the normal 1.5% Medicare Levy.

So for example if you earn $80,000 as a single and you don't have private hospital cover, you will incur a $800 Medicare Levy Surcharge bill at tax time.

By simply taking out HBF Hospital Cover, you could avoid the 1% surcharge and save yourself or your family money.
Get a quote for hospital cover for less than the Federal Government's surcharge here.

Get a quote for hospital cover for less than the Federal Government's surcharge. 

*The threshold increases by $1,500 for each child from the second onwards.

Can someone else manage my policy for me?

If you would like a partner, friend or relative to manage your membership, or if a person has been granted Power of Attorney to act on your behalf, simply fill out the Power of Attorney/Appointment of Agent form and post it to us at HBF, GPO Box C101, Perth WA 6809.

The nominated person will then be able to access and update your personal information. You can cancel this access at any time by calling us on 133 423.

How long will my children be covered on our family membership?

Your children can remain on your family policy up until the end of the year they turn 18, unless they're married or in a de facto relationship.

Cover may then be continued up to the age of 25, provided they are not married or in a de facto relationship and either:

• are a full-time student; or
• do not earn a taxable income of more than $19,500 pa.

What is a Membership Summary?

Under the Lifetime Health Cover legislation, all health funds are required to supply their hospital insurance members with a summary of their membership details.

What does the Membership Summary show? The summary sheet shows information such as the level of cover held and any exclusions that apply to your hospital cover, like in the case of Twin Pack products. It also shows any Lifetime Health Cover loading that applies to the policy and days without hospital cover.

What should I do with the Membership Summary? It should be kept for your personal records. It is not needed to complete anything on your Tax Return, it is completely separate from the Tax Statement you receive.

What happens if I become unemployed or seriously ill?

If you lose your job or can't work due to illness, we offer complimentary cover or suspension of membership for members in those times of need.

Who is eligible? Health Cover Protection is available to HBF Health members who have been issued a Centrelink Health Care Card for Newstart or Sickness Allowance. As long as you are a financial HBF Health Member and have had 12 months continuous cover on a health policy at the time you apply for Health Cover Protection, we may assist you with your Health options commencing from the date of your last payment.

If you are under 25 years of age, become unemployed and your parents have an HBF Health family membership, you may be able to be covered as a dependant on their policy during your period of unemployment. Conditions apply, just call 133 423 for advice.

Please note that:

• Urgent Ambulance or Overseas Visitors members are not eligible for Health Cover Protection.
• Your entitlements are determined by the length of your HBF Health membership.

For more detailed information, please contact a Member Service Advisor by calling 133 423.

What if I live outside WA?

If I move interstate, should I keep my HBF health cover? If you move interstate we are happy to continue to cover you and your family. Being a Western Australian based organisation, our benefits are designed for treatment and services received in Western Australia.

Whilst benefits for standard treatment (eg hospitalisation and dental treatment) are suitable in other states, special arrangements (like medical gap and no cost spectacles) are made with Western Australian providers only. Therefore you may wish to compare benefits and contribution rates of interstate based health funds in order to decide which health fund cover is best for you. Interstate members can call us on 133 423.

If I don't live in Western Australia, can my doctor be covered? HBF members will receive the same level of cover regardless of whether they reside in WA or Interstate. Please be aware that the number of fully covered doctors based Interstate are fewer than in WA.

We recommend that you check if your referred doctor/specialist is fully covered before arranging a hospital stay. We will need to know the item number and the fee charged.

What is Lifetime Health Cover?

The Federal Government introduced the Lifetime Health Cover Loading to make sure the premiums you pay reflect the length of time you have private hospital cover.

When does the loading apply?

If you don’t have hospital cover on 1 July following your 31st birthday, you’ll pay more for your premium when you take out cover, because the Lifetime Health Cover loading will apply. You will pay a premium loading for each year that you don’t have hospital cover.

For example:

Serena celebrated her 31st birthday on 12 November 2008. If she took out cover before 1 July 2009, she would still only pay the base rate. However, if she took out cover on 1 July 2009, she would pay a 2% loading. If Serena doesn’t take out cover for every year ending the 30 June, she will continue to pay a 2% loading each year.

Will the loading always apply?

Once you have had hospital cover continuously for 10 years, the loading will no longer apply.

Are there any exclusions?

If you were born anytime before 1 July 1934 or earlier, you can take out hospital cover at any time and avoid the Lifetime Health Cover loading.

What if I already have Essentials or Ambulance cover?

If you’re an Ambulance or Essentials only member and you take out private hospital cover after 1 July following your 31st birthday, you will pay a premium loading. This is because Essentials and Ambulance covers don’t include any private hospital cover. To avoid the premium, make sure you have hospital cover before 1 July following your 31st birthday.

Why has Lifetime Health Cover been introduced?

The scheme was introduced to ensure people don't take out private hospital cover only when they need to make a claim, at the expense of others who have had cover for a long time.

How will Lifetime Health Cover affect people if they wish to switch between funds?

Under Lifetime Health Cover, you can switch between health funds, as all registered health funds must recognise certified age of entry of any individual wanting to transfer from another fund.

Does Lifetime Health Cover affect Ambulance, Essentials or Overseas Visitors Cover premiums?

No. Lifetime Health Cover premium loadings do not apply to premiums for Essentials, Ambulance or Overseas Visitors Cover.

What is an HBF Participating Hospital?

HBF Participating Hospitals are hospitals with which we have negotiated special agreements that provide greater value for our members.

These agreements ensure that when you need hospital treatment you will be covered for accommodation and theatre fees, less any co-payment or agreed excess. (Please remember all benefits are subject to any restrictions or exclusions on your level of cover.)

   
What if I don't go to an HBF Participating Hospital? If you visit a non HBF Participating Hospital you may incur a significant out-of-pocket expense and these expenses may vary between hospitals.

Can I save money by using Direct Debit?

 Did you know you can save up to 4% off your health insurance premiums when you pay by Direct Debit?

How does Direct Debit work?

Your membership fees are deducted fortnightly, monthly, quarterly, half yearly or yearly from your bank, building society, credit union or credit card account (MasterCard or Visa). You can arrange your payments to coincide with your pay or pension day. Only the amount required to pay for your membership premiums will be transferred to HBF.

How do I arrange for Direct Debit?

First you need to have a cheque, savings or credit card account with your bank, building society or credit union. Call us on 133 423 with your BSB or Financial Institution number and account number. We’ll do the rest for you. Your payments will be automatically debited according to your chosen frequency.*

Is there a cost to me?

Contact your bank, building society, credit union or credit card authority regarding any possible charges as some financial institutions may apply transaction fees.

A few guidelines to remember

You will need to ensure there are sufficient funds in your account to cover the specified deductions and your premiums are being correctly debited from the account. If three consecutive deductions (for the same payment period) are not met, we will cancel the Direct Debit Authority with your financial institution. If premiums alter or a change is made to the membership, we will adjust the deductions accordingly and will advise you in writing.
If you would like more information about Direct Debit, please call us on 133 423.

*Please note that your initial deduction may include an adjustment to ensure your membership is financial or to coincide with your nominated date. Any fees or charges incurred as a result of insufficient funds will be the responsibility of the policyholder.

For full terms and conditions, please refer to our Direct Debit FAQs

What are Standard Information Statements?

The private health insurance Standard Information Statement (SIS) is a Federal Government requirement and provides an overview of cover and waiting periods.As it is only an overview, the premium and benefit amounts do not take into consideration individual circumstances, including your length of membership or waiting periods.

If you wish to find out exactly what your policy covers, please refer to your policy details brochure.

Why are the details on the Statement different to my membership summary?

The Federal Government requires private health insurers to provide a SIS so members can review their cover and compare private health insurance products.

SIS only give a summary of the key product features and benefits, and premiums shown are indicative only.  The format is set by the Government and is the same across all health insurers. SIS help you see if your broad needs are covered and where products differ in both price and features.

The premiums and benefits on SIS are provided for comparison only. The actual premium may vary depending on your circumstances such as Lifetime Health Cover loading and the Federal Government 30% Rebate on private health insurance (if applicable). Benefits and maximums may differ from the stated amounts due to variables such as length of membership.

More information

For more information on Standard Information Statements, visit www.privatehealth.gov.au/sis.htm.

What is the Medical Gap?

What is the Medical Gap? The Medical Gap is the difference between the Medicare Benefit Schedule (MBS) set by the Federal Government, and the amount Medical Practitioners charge for services provided to private patients admitted to a hospital or day hospital facility.

Medicare covers you for 75% of the MBS fee for private in-hospital medical services and, if you have HBF Hospital cover, we pay the remaining 25%. This means that there is no Medical Gap to pay when your medical practitioner charges no more than the MBS fee.

However, many medical practitioners do charge more than the MBS fee. It is this amount above the MBS fee that is known as the Medical Gap. Having HBF Hospital cover means you can substantially reduce the gap or avoid having to pay the gap at all.

When will HBF cover the Medical Gap? All HBF Hospital policies include our Medical Gap cover. This cover could either eliminate or substantially reduce your medical out of pocket expenses for in-hospital treatment provided by a wide range of Medical Practitioners in Western Australia.

Our Medical Gap cover applies for treatment provided when you are admitted to a hospital or day hospital. However, limitations and exclusions do apply for some plastic and reconstructive surgery items, and for treatment that is specifically excluded from your level of cover.

It is important to note that we are unable to pay benefits for medical fees charged for services provided out of hospital, such as consultations in a medical practitioner's rooms. In certain cases such as maternity, you may have substantial out of pocket expenses for visits to your medical practitioner, both before and after hospitalisation. These out of pocket expenses arise when the medical practitioner charges fees that are higher than the benefit that Medicare will pay for out of hospital services (The amount Medicare will pay for out of hospital services is 85% of the fee listed in the MBS).

How do I find out if I'm covered by HBF's Medical Gap? We can tell you if your medical practitioner is 'Fully Covered' or 'Known Gap Covered' by HBF. Simply call us on 133 423, visit one of our service centres BEFORE your hospital stay, or use our online map to search for a Fully Covered Medical Practitioner.

How do we decide if a medical practitioner is covered by our Medical Gap arrangements? We advise Medical Practitioners' of the amount we can afford to pay under our Medical Gap Scheme. It is then up to each individual medical practitioner to decide whether they wish to participate, and if so, if they would like to be a 'Fully Covered' or 'Known Gap' covered provider.

Why can't HBF fully cover every medical practitioner? The fees that Medical Practitioners' charge can vary significantly. As a not for profit fund, we cannot afford to cover the range of fees charged by every medical practitioner without having to significantly increase health insurance premiums.

Need more information? To find out more about our Medical Gap cover, how to save on out of pocket hospital expenses, or for information to help you prepare for your hospital stay please refer to the following:

Explaining the Medical Gap

Preparing for your hospital stay

Tax Statements

What is a Private Health Insurance Statement? This statement identifies your entitlement as an HBF member to the Federal Government 30% Rebate on private health insurance, provided you are eligible for full Medicare entitlements. Regardless of your income, HBF members are eligible to receive this as it is not means tested. Higher Rebate entitlements do apply for people aged over 65.

Your statement will detail how much you have paid in premiums in the financial year and the value of your Rebate. The statement is issued to all HBF members in accordance with Government legislation even if the rebate is received through a reduced premium.

What should I do with it? When you receive your Tax Pack, you will see a reference to a Private Health Insurance Statement for the rebate. If you receive the rebate through a reduced premium, you will need to retain this statement to correctly complete your tax return.

What if I don't lodge a tax return? If you do not receive the rebate through reduced premiums you will need a receipt to claim your rebate from Medicare. If you do receive your rebate through reduced premiums and you are not lodging a tax return you only need to keep your Private Health Insurance Statement for your personal records. However, we recommend that you review the Membership Summary to ensure that your health cover meets your current needs.

Will it help me avoid the Medicare Levy? If you earn more than $73,000 a year as a single or $146,000 a year as a couple or family (for families this threshold increases by $1,500 per child from the second child onwards), your statement may help you avoid the additional Medicare Levy that applies to taxpayers without private hospital insurance.

How can Lifetime Health Cover Loading effect me? There are financial penalties for every year you do not have private hospital cover by 1 July following your 31st birthday.

What if I'm an Urgent Ambulance only member? If you have not registered to receive the rebate as a reduced premium, you can use your Private Health Insurance Statement to claim it on your tax return. If you do not lodge a tax return and are not registered to receive the rebate, we will enclose a Medicare receipt so you can claim cash from Medicare.

Please note that a receipt is only included if you have made a premium payment for your Urgent Ambulance cover in the financial year and therefore have something to claim. You only require a Medicare receipt if you are not registered to receive the rebate as a reduced premium, and have made a payment in the current financial year. Please call us on 133 423 and we can issue a receipt for you.

When do Tax Statements get issued? We will mail Private Health Insurance Statements to HBF Health members by mid July in the new financial year. 

What Premiums are included on Private Health Insurance Statements? The total premium stated on your tax statement is the total amount of premiums we received from you within the financial year. It does not reflect what the cover is worth for that period. For example: A member has Top Hospital and Essentials Standard Family cover. On 5 July 2009, this member made an annual payment of $2150.40 for cover for 1 July 2009 to 30 June 2010. The same member then made their next annual payment of $2281.40 on 27 June 2010 for cover from 1 July 2007 to 30 June 2011. The total premiums received by us in the 2009/2010 financial year are therefore $4,431.80. It is this figure that will appear in the member's 2009/2010 Private Health Insurance Statement. Our refunds are taken into account when calculating premiums.

What is the State of the Health Funds Report?

Every year the Private Health Insurance Ombudsman publishes a State of the Health Fund report to assist consumers in assessing the comparative performance and service delivery of Australia’s private health insurance providers.

A copy of the report can be downloaded from www.phio.org.au.

Why does HBF have waiting periods?

Once you are a member of HBF, there are waiting periods which apply before you can receive benefits.

These waiting periods also apply when transferring to a higher product. Removing waiting periods for members upgrading to a higher product leaves the Fund open to abuse by people who would simply join for an expensive operation and then leave the Fund once treated.

If we allowed this, the cost of claims would dramatically increase and these costs would have to be passed on to all members through premium increases. Waiting periods therefore simply provide a way for HBF to protect long term existing members.

Does HBF offer a 'no claim' bonus?

We recognise the importance of long standing members and would like to offer members a "no claim bonus" similar to that of home and car insurance. Unfortunately we, like all health insurers, are not legally permitted to provide such a bonus.

The Private Health Insurance Act 2007 requires all health funds to charge the same premiums for people, regardless of their medical condition. The principle is followed to ensure that groups with a higher level of claims, such as the elderly or persons with chronic illness, are not disadvantaged.

Similarly, crediting benefits not used from one year to the next has the same effect as a "no claims bonus" and is therefore not possible either under current legislation.

Have you recently moved to Australia?

If you have recently migrated to Australia you could be eligible to receive a grace period when you buy hospital cover, so you won't incur a Lifetime Health Cover loading.

Does this apply to me? If you became eligible for Medicare on or after 23 April 2004, you won't have to pay a Lifetime Health Cover loading if you purchase hospital cover by:

• 1 July, following your 31st birthday, or
• the first anniversary of the day you became eligible for Medicare. 

What do I need? You will need to supply us with a copy of your 'Medicare Eligibility Letter'. If you have any further queries on how the grace period is applied when you purchase your policy, please call us on 133 423.

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Going overseas for more than two months?

If you're going overseas for more than two months you can suspend your health cover until you return to Australia. This means you won't need to pay your premium while you're away, but still retain all your length of membership benefits for when you return.

However, if you suspend your cover and earn over certain income threshold, you may need to pay the Government's Medicare Levy Surcharge for the period of time in which your hospital cover isn't active. If you have any questions about this, don't hesitate to contact us on 133 423.

There are other things you should know if you plan to suspend your cover - we encourage you to read the frequently asked questions in this brochure.