Things worth knowing

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 can’t choose your doctor, your room or when you get treated. 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 receiving your treatment.  Unfortunately, this may mean waiting when you’re in pain or uncomfortable.

Alternatively, you may elect to be a private patient and be treated by a specialist of your choice. But, 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 like physiotherapy or occupational therapy.

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

Last updated: November 15, 2010

The Private Health Insurance Rebate (sometimes called the Australian Government Rebate on Private Health Insurance) is a government initiative to help ensure private health insurance is  affordable for all Australians. . The Rebate means a certain percentage of a health fund member’s premium is paid by the Australian Government on behalf of the member.

The Rebate is means-tested and the % of your premium which the Australian Government will pay on your behalf will depend on your income, the age of the oldest person covered and (for families) how many children you have.

The table below will help you calculate the rebate you may  be eligible to receive: 

*For families with children, the thresholds are increased by $1,500 for each child after the first child.

How can I receive the Rebate?

There are three simple ways to claim the Rebate:

• You can elect to receive a reduction in your premiums   
• A direct payment from a Medicare office  
• Or as a tax Rebate in your annual tax return

You can download the application for the Australian Government Rebate on private health insurance, or call us for more information on how this affects your policy.

Last updated: January 15, 2013

Australians whose taxable income is above a certain threshold and who do not have private hospital cover are charged an additional Medicare Levy Surcharge (MLS) on their taxable income by the Australian Government. This surcharge is in addition to the standard 1% Medicare Levy.

The Medicare Levy Surcharge, ranges from 1% to 1.5% depending on your income. The table below shows the Medicare Levy Surcharge you may be liable for if your income is higher than the Government threshold and you do not have private hospital cover.

*For families with children, the thresholds are increased by $1,500 for each child after the first child.

We have hospital cover for less than the Federal Government's surcharge. Find out more about cover options here.

Last updated: January 15, 2013 Watch video

When you need to go to hospital, your first priority should be to get better. So we’ve put together this guide to help ease any concerns and to provide some important and useful information about your hospital stay.

We’ve broken everything down into what you might need to know before, during and after you go to hospital, covering things like;

• questions you should ask before going into hospital 
• waiting periods and pre-existing conditions
• accommodation types and what you’ll be covered for
• participating hospitals
• our Hospital Liaison Officers, who may visit you to answer any questions you have during your stay
• information about the medical gap and how to minimise out-of-pockets
• an explanation of your hospital bills and how to claim 
• things you might need to know after you’re discharged

There’s a lot to consider, and we understand that some of it can be confusing. So if you’d like to talk through any concerns or if you have questions about your personal circumstances, please call us on 133 423 or visit your nearest branch.

Last updated: October 6, 2011

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 or drop it into your nearest Branch.

The nominated person will then have the ability to access and update your personal information. You can cancel this access at any time simply by contacting us.

Last updated: November 4, 2011

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 $20,500 pa.

Last updated: January 9, 2012

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.

Last updated: November 24, 2010

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 - we call this Health Cover Protection.
 
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 cover 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, please call us 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 call a Member Service Advisor.

Last updated: November 24, 2010

If I move interstate, should I keep my HBF health cover?
As an HBF member, you can access the best in health care no matter which state you’re living in.

If you need treatment in any Australian hospital, you’ll be covered for accommodation and theatre fees, less any co-payments and agreed excess.

You’ll be able to claim the same set benefits for dental, optical, physio and other Essentials services from any provider, and will have exactly the same annual claims maximums.

Find out more about HBF cover around Australia.
 
If I don't live in Western Australia, can my doctor be covered?
Hospitals, doctors and specialists all around Australia are covered, and our members receive the same level of cover regardless of which state they live in.

Before arranging a hospital stay, it’s always a good idea to get a quote from your doctor or specialist and contact us to see how much will be covered by your HBF health insurance.

Last updated: June 30, 2011

The Federal Government introduced the Lifetime Health Cover loading to encourage people to take out and maintain health insurance from a younger age. The scheme ensures 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 does Lifetime Health Cover work?

If you don’t have hospital cover on 1 July following your 31st birthday and you choose to take hospital cover at a later date you’ll pay an additional 2% (the loading) for each year you delayed taking out hospital cover. The maximum loading a member will pay is 70%. For example:

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

Will the loading always apply?

After you have paid for hospital cover for 10 years, the loading no longer applies.

Are there any exclusions?

If you were born anytime before 1 July 1934, you can take out hospital cover at any time and avoid the Lifetime Health Cover loading. Other exclusions may apply so please call us for more information.

What if I already have Essentials or Ambulance cover?

The loading relates only to hospital cover and having Essentials and Ambulance cover doesn’t exempt you from Lifetime Health Cover loading. If you’re a health fund member with only Ambulance or Essentials and you take out private hospital cover after 1 July following your 31st birthday, you will still pay a loading. . To avoid the loading, make sure you have hospital cover by 1 July following your 31st birthday.

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

Lifetime Health Cover does not affect your ability to transfer between funds as all registered health funds are obliged to recognise the loading of any member 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.

Last updated: January 15, 2013 Watch video

HBF Participating Hospitals are hospitals with which HBF has negotiated special agreements that provide greater value for our members. The good news for HBF members is that we have agreements with more hospitals in WA than any other health fund.  
 
These agreements ensure that when you need hospital treatment, for all agreed services you will be covered for accommodation and theatre fees, less any co-payment or agreed excess.  

Non-agreed services in HBF participating Hospitals

While most services are agreed in HBF Participating Hospitals, there may be some services that are not. It's important to check that your required service is covered at your chosen hospital before your treatment to avoid any significant out-of-pocket expenses.

   
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.

Last updated: June 28, 2012

How does Direct Debit work?
Your premiums 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 premiums will be transferred to HBF.

How do I arrange for Direct Debit?
Firstly, you need to have either a cheque, savings or credit card account with a bank, building society or credit union. Call us with your BSB/Financial Institution number and account number. We’ll do the rest. 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
Please ensure there are sufficient funds in your account to cover the specified deductions and your premiums are being correctly debited from the account. In the event that 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.

*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.

Last updated: May 23, 2012 Watch video

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 the 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, for example, 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. 

Last updated: November 24, 2010

The medical gap isn’t easy to explain but it’s important for you to understand should you ever find yourself in hospital.

To start with, medical practitioners registered with HBF (ie. doctors) fall into three categories:

1. Fully covered – no out-of-pocket expense.
   
2. Known gap option – there may be an out-of-pocket expense.
   
3. No agreement with HBF – there will be an out-of-pocket expense.
   For example, if an HBF member undergoes a knee reconstruction with a Medicare Schedule fee of $5000 and the practitioner’s fee is $8000, the member’s out-of-pocket will be $3000, which is the difference between the Medicare Schedule fee and the practitioner’s fee. See the diagram below.

A medical gap occurs when the fee comes in above the amount covered by Medicare and HBF. Fortunately, HBF has fully covered arrangements with more doctors in WA than any other private insurer. This means that more often than not you won’t have an out-of-pocket expense.
 
How do I find out if my doctor is 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, visit an HBF branch 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 

Last updated: June 29, 2011

What is a Private Health Insurance Statement?

This statement identifies you as an HBF Health member who may be entitled to the Australian Government Rebate on private health insurance depending on your income.

As of 1 July 2012, the rebate will be means-tested based on your annual income. You can see if you are eligible by finding your annual household income in the chart below. Higher Rebate entitlements apply for people aged over 65. Your statement details how much you have paid in premiums in the financial year and the value of your Rebate. It is issued to all HBF members in accordance with Government legislation even if they receive the rebate 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 sent with your statement  to ensure that your health cover meets your current needs.

Will it help me avoid the Medicare Levy Surcharge? As of 1 July 2012, the income thresholds will increase as will the Medicare Levy Surcharge, which will range from 1% to 1.5% depending on your income. The table below shows the Medicare Levy Surcharge you may be liable for if your income is higher than the Government threshold and you do not have private hospital cover.

* For families with children, the thresholds are increased by $1,500 for each child after the first child.

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 as a reduced premium , 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 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 2006, this member made an annual payment of $2150.40 for cover for 1 July 2006 to 30 June 2007. The same member then made their next annual payment of $2281.40 on 27 June 2007 for cover for July 1 2007 to June 30, 2008. The total premiums received by us in the 2006/2007 financial year are therefore $4,431.80. It is this figure that will appear in the member's 2006/2007 Private Health Insurance Statement.

Last updated: July 2, 2012

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.

Last updated: November 24, 2010

Imagine you’ve been paying your health insurance premiums for years, then a new member comes along, pays just enough premiums to cover their treatment period, claims and then leaves. You and other long-term members will have, in effect, paid for their treatment, while they have contributed almost nothing to any treatment you may need in the future. It simply wouldn’t be fair.

That’s why, once you’re an HBF member, there are waiting periods that apply before you can receive benefits. This is a standard arrangement in the private health insurance industry.

For hospital cover, there is also a 12 month pre-existing condition waiting period which applies for illnesses or conditions that you may already have prior to taking out health insurance.

In this situation, we will appoint a doctor who can independently confirm if your condition was pre-existing.

If you’re already an HBF member, keep in mind that waiting periods (including the pre-existing waiting period) still apply when transferring to a product that has higher benefits or covers treatments not covered by your previous product.

You can find out all about waiting periods by calling us, visiting hbf.com.au or one of our branches.

Last updated: October 17, 2011

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 prohibits all health funds from charging a different premium 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 under current legislation.

Last updated: November 16, 2010

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.

Last updated: November 24, 2010

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.
 
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. 

Last updated: November 24, 2010

Under health insurance legislation, your kids are covered on your policy at no extra cost. So if you have a family policy, no matter how many dependant children you have, your policy will cost the same. If you are on a single policy you will have to transfer to a family policy in order to add your child.

In addition, on most HBF levels of hospital and twin pack cover, you won’t need to pay an excess for your children if they stay in hospital overnight. 

Last updated: December 3, 2010

If you’re admtted into a public hospital, you can choose to be treated as either a public or private patient. You can still choose to be treated as a public patient even if you have private health insurance.

What happens if I choose to be a public patient in a public hospital?
If you choose to be treated as a public patient you will be fully covered by Medicare for your hospital stay, including free accommodation, doctors’ services, diagnostic tests and medications (but excluding personal expenses such as TV hire or telephone calls).

However, as a public patient you may be put on a waiting list for non-emergency surgery, and you will not have a choice of doctor or room type. Doctors will be appointed by the hospital to treat you and single rooms will only be allocated according to clinical need.

What happens if I choose to be a private patient in a public hospital?
If you choose to be treated as a private patient in a public hospital you are entitled to choose your doctor, if they are available. Depending on your illness or condition, this may be the same doctor who would have been allocated to you by the hospital as a public patient.

In public hospitals, single rooms are generally allocated to people who medically need them most. So while you can request a single room as a private patient, you may not always be allocated one depending on availability. The hospital may also transfer you from a single room to a shared room throughout your stay if another patient needs the single room.

As a private patient in a public hospital, you are responsible for the cost of your stay and will be charged for your hospital accommodation, doctor’s services (including diagnostic tests), surgically implanted prostheses (e.g. artificial hips) and personal expenses such as TV hire and telephone calls.

The hospital and the treating doctor should let you know what you’ll be billed for – if they don’t, make sure to ask for the details. Some of these costs may be covered by your private health insurance so if you have HBF Hospital cover, call us to confirm what benefits we’ll pay for a public hospital stay.

Last updated: November 24, 2010

This is an illness or condition which, in the opinion of an independent Medical Practitioner (appointed by HBF) was known to exist, or where signs or symptoms were evident during the six month period before you became an HBF member or transferred to a product that has higher benefits.  If you proceed with a hospital admission without confirming what benefits you’re eligible for and your condition is determined to be pre-existing, you will be required to pay all outstanding hospital and medical charges not covered by Medicare. (See the question number 23 if you have transferred from another level of cover.)

The 12 month pre-existing ailment waiting period does not apply for psychiatric, rehabilitation or palliative treatment.

Last updated: March 9, 2011

If you are going to hospital and are concerned about a pre-existing condition, please call us straight away to check your entitlements. In order to determine a pre-existing ailment, you will need to complete two copies of the Pre-existing Query – Medical Practitioner Certificate form and ask your treating general practitioner and specialist to complete their part. It will take HBF up to five working days for the assessment process.

If you have transferred to a product that has higher benefits and been assessed by HBF's medical practitioner as having a pre-existing condition or ailment, benefit will be paid at your previous level of cover until the 12 month pre-existing waiting period has been served.

Last updated: March 9, 2011