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You're from Overseas
133 423
  • Exclusive member benefits.
  • Largest health fund in WA.
  • 30 day cooling-off period.

Health insurance

Understanding Health Insurance in Australia

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 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 such as physiotherapy or occupational therapy.

Having private health insurance also means that you can be covered for things that Medicare doesn't generally cover such as dental, physiotherapy, optical, chiropractic, ambulance and podiatry.

We’ve created a guide to help you understand how your health cover works. We strongly recommend that you read this guide in conjunction with your HBF product sheet. Please note this guide is not relevant to Overseas visitors products. If you require further information about your cover, please call us on 133 423 or drop in to your nearest branch. Download the Important Information Guide

How do I prepare for going to hospital?

When you need to go to hospital, your first priority should be to get better. Our 'Hospital stay guide' has been designed to help ease your 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
  • Member Plus hospitals
  • Information about the medical gap and how to minimise out-of-pocket expenses
  • An explanation of your hospital bills and how to claim 
  • Things you might need to know after you’re discharged

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.

Can someone else manage my policy for me?

If a person has been granted Power of Attorney to act on your behalf, simply fill out the Power of Attorney form and post it to us at: HBF, GPO Box C101, Perth WA 6809 or drop it into your nearest Branch. 

If you would like a partner, friend or relative to manage your membership, then we suggest you visit your local branch or alternatively call us on 133 423 and we can appoint them as your agent.The nominated person will then have the ability to access and update your personal information. 

If your circumstances change and you wish to make a change about who is managing your policy then simply contact us on 133 423.

Are my kids covered?

On most Family and Parentplus policies, your kids will be covered at no extra charge until the end of the year they turn 18, unless they are married or in a de facto relationship. At HBF, we also choose to continue to cover your kids up to the age of 25, provided they're studying fulltime and aren't married or in a de facto relationship or earning more than $24,500 per calendar year.

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.

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 between three and nine months – called 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 on 133 423 for advice.

Please note

  • 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 an HBF Member Service Advisor on 133 423.
Am I covered outside WA

Although HBF is a Western Australian based organisation, you'll be covered wherever you are in Australia. As different states have varying medical costs, premiums are a reflection of the state you reside in. If you have any questions about your cover outside WA, please call us or visit hbf.com.au/australia..

The only difference will be if the provider isn't yet registered for on-the-spot electronic claiming. In that case it is simple to claim online at myhbf.com.au or by mail after downloading a claim form.

What is an HBF Member Plus hospital?

HBF Member Plus hospitals provide great value for our members. In Member Plus hospitals you'll be covered for accomodation and theatre fees, less any co-payment or agreed excess for all agreed services.

HBF non-Member Plus hospitals

It's important to stay at an HBF Member Plus hospital, otherwise you may have significant out-of-pocket expenses. We recommend that before arranging a hospital stay, you call us on 133 423 to find out if you are being admitted to an HBF Member Plus hospital and to confirm what you are covered for. Please also remember, all the benefits are subject to any restrictions or exclusions on your chosen level of cover.

Non-agreed services in HBF Member Plus hospitals

While most services are covered in all Member Plus hospitals, there may be some services that are not - we refer to them as 'non-agreed' services. It's important to check that your required service is covered by HBF before going to hospital to avoid any significant out-of-pocket expenses.

Did you know you can save up to 4% on your health insurance payments when you pay by direct debit (except Urgent Ambulance and GapSaver portion of your premiums)?

How does direct debit work?

Paying by direct debit is fuss-free and saves you 4% on your premiums. 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?

You need to have either a cheque, savings or credit card account with a bank, building society or credit union. Call us on 133 423 with your BSB/financial institution number and account number or credit card details and 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.

Points to note

Please ensure there are sufficient funds in your account to cover the specified deductions and that 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 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.

What are Standard Information Statements (SIS)?
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 SIS different to my policy certificate?
The Federal Government requires private health insurers to provide a SIS so members can review their cover and compare private health insurance products.

A SIS only gives 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. Your SIS will help you see if your broad needs are being covered and where policies differ in both price and features.

The premiums and benefits on the 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 privatehealth.gov.au/sis.htm.
What is the medical gap cover?

If your medical practitioner (such as your doctor, specialist or anaesthetist) charges more than the Medicare Benefits Schedule (MBS) fee, you may have to pay the difference (gap) to the doctor. Fortunately, HBF has fully covered arrangements with more doctors in WA than any other major Western Australian private insurer. This means that more often than not, you won't have an out-of-pocket expense.

You should always call us or speak to your doctor to check what arrangement they have with HBF and what, if any, gap you'll have to pay. HBF may cover all, some, or none of this gap, depending on the agreement we have with the doctor. The doctor will fall into one of three categories.

Fully covered - These practitioners are fully covered by Medicare and your HBF insurance, so you won't have anything to pay.

Known-gap - These practitioners have agreed to charge a fixed amount above the MBS fee. HBF will cover some of this gap, but there may also be an out-of-pocket expense. However, for some procedures, ‘known-gap’ doctors might choose to charge above the agreed amount, in which case you will only be covered up to the MBS fee. So ‘known gap’ practitioners should provide you with details of out-of-pocket expenses in writing prior to the procedure. You’ll need to agree to these charges before your surgery, which is known as giving your ‘informed financial consent’.

No agreement – These doctors choose not to participate in any form of gap cover. If you use a ‘no agreement’ provider, you’ll have to pay all costs that are charged above the MBS fee.

Many surgeons work with a preferred anaesthetist and may also use an assistant. Be sure to speak with your doctor before your procedure to find out if anyone else will be involved in your surgery. You should then check with us about whether these supporting medical practitioners will be covered. It’s also a good idea to check whether your doctor and associates will invoice you directly or submit an account to HBF, so that you know what to expect after your hospital stay.

Please note, plastic and reconstructive items are generally only covered up to the MBS regardless of the doctor’s agreement.

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 on 133 423, 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 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 How does gap saver work?.

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 help consumers compare the performance and service delivery of Australia’s private health insurance providers.

A copy of the report can be downloaded from phio.org.au.
How soon can I claim after joining?
Every fund has waiting periods that need to be served before you can receive benefits and HBF is no different. This is to stop people joining just to get treatment for a specific health problem and then leaving the fund.
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, like all health insurers, we’re 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, as crediting benefits not used from one year to the next would have the same effect as a ‘no claims bonus’ it is therefore not possible under current legislation.

Have you recently immigrated 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’ll 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.
Will I be covered outside of Australia?

No Australian Health Fund is legally permitted to pay benefits for any medical treatment or services provided outside Australia. You may want to check out HBF travel insurance (generous discounts apply for every HBF health member) if you’re travelling overseas.

If you’re going to be away for longer than two months you can suspend your health cover membership without losing any benefits or having to re-serve waiting periods when you return. It won’t cost you anything to suspend your cover and you won’t need to pay for your health insurance while you’re out of Australia. To find out how, simply call us 133 423 or read this brochure.

Does it cost more to have kids on my policy?

On most Family and Parentplus policies, your kids will be covered at no extra charge until the end of the year they turn 18, unless they are married or in a de facto relationship. At HBF, we also choose to continue to cover your kids up to the age of 25, provided they're studying fulltime and aren't married or in a de facto relationship or earning more than $24,500 per calendar year.

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.

Do I have to use private hospital cover in a public hospital?

Do I have to use private hospital cover in a public hospital?
No. Even if you have private health insurance, you can still choose to be treated as a public patient in a public hospital.

What happens if I choose to be a private patient in a public hospital? 

If you choose to be a private patient in a public hospital, you’re entitled to choose your doctor, if they’re available. However, depending on your illness or condition and the size of the hospital, this may be the same doctor who would have been allocated to you by the hospital as a public patient.

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

As a private patient in a public hospital, you're responsible for the cost of your stay and will be charged for your hospital accommodation, doctor’s services (including diagnostic tests), surgically implanted prostheses (for example artificial hips) and personal expenses such as television 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, please call us on 133 423 to confirm what benefits we’ll pay for a public hospital stay.

What happens if I choose to be a public patient in a public hospital?

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

However, as a public patient you won’t be able to choose your doctor or room type, and you may be put on a long waiting list for non-emergency surgery. Doctors will be appointed by the hospital to treat you and private rooms will only be allocated according to clinical need.

Pre-existing ailments or conditions

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, including on the day you joined. This also applies if you transferred to a level of cover with 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.

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

What if my condition is assessed as pre-existing

For Hospital cover there is also a 12-month waiting period for pre-existing conditions. 

If you’re going to hospital and are concerned about a pre-existing condition, please call us straight away to check your entitlements. To determine a pre-existing condition, you’ll 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’ve transferred (from another fund to HBF) to a product that has higher benefits, and have been assessed by HBF's medical practitioner as having a pre-existing condition or ailment, a benefit will be paid at your previous level of cover until the 12-month pre-existing waiting period has been served.

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 more about waiting periods by calling us or visiting one of our branches.

What if my claim is regarding compensation for injury or loss?
If you have recently lodged a compensation claim for injury or loss due to:
  • A workplace accident
  • A motor vehicle accident
  • Medical negligence
  • Public liability

Please complete the member Compensation Claim form and mail it to GPO Box H548, Perth WA 6841 or contact us on 133 423.

The Making a Compensation Claim PDS gives a simple explanation of what you can expect from HBF regarding the payment of your medical bills while your compensation claim is in progress.

What is the Health Insurance Complaints process

We have a complaints handling process for members who may have a dispute with HBF

Examples of disputes include:

  • contents of advertising by HBF
  • representations made to the member when they purchase a product
  • features of their product, and
  • benefits paid under their product

You can access our complaints handling process by visiting your nearest HBF branch, by contacting an HBF member service advisor on 133 423 or by writing to us at GPO Box C101, Perth 6839.

If you are not satisfied with the outcome of your concern you can ask to have it reviewed by the internal dispute resolution process.

Complaints should be addressed to

HBF Dispute Manager
GPO Box C101
Phone: 133 423
Fax: (08) 9265 6356
Email: memberexperience@hbf.com.au

If a resolution is still not reached to your satisfaction you can contact

Private Health Insurance Ombudsman
GPO Box 442
Phone: 1300 362 072
Fax: (02) 6276 0123
Email: phio.info@ombudsman.gov.au
Visit:  ombudsman.gov.au 

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