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Extras cover

Hospital cover

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Getting started

Congratulations on joining over 1 million HBF members who trust us with their health insurance. Before you get into things, it’s important that you read your Welcome Pack – this was either emailed or posted to you. It includes your policy certificate, product sheet(s), Member Guide and Private Health Information Statement. Once that’s done, get set up and ready to claim with these five easy steps.

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Even if you switched to a similar level of cover with HBF, the services you’re covered for, annual limits and benefits will likely be different. If you’re ever unsure of what you’re covered for, these are all listed in your product sheet(s). Your product sheet(s) also list out your waiting periods and any other important details you need to be aware of. 

Waiting periods

A waiting period is a set amount of time during which you must continuously hold your level of health cover before you can claim a benefit. You can only claim benefits for services or treatments received after the waiting period has been served. 

If you have switched to HBF within two months of leaving another Australian health fund, you won’t have to re-serve any waiting periods that you have already served with your previous insurer. For waiting periods that have been partly served, you’ll only have to serve the remainder of the waiting period before being eligible to claim benefits.

Just keep in mind that waiting periods will apply for any new services you were not covered for previously, for any higher benefits and/or higher annual limits, and if you decrease your hospital cover excess level.

Waiting periods explained 

Exclusions and restrictions (applies to hospital cover)

If a treatment is listed as an exclusion on your hospital cover, we won’t pay any benefits towards that treatment. For example, if your hospital cover excludes Joint Replacements, we will not pay any benefits for any hospital accommodation, theatre fees or medical costs if you choose to be treated for that excluded treatment as a private patient.

If a treatment is listed as restricted on your hospital cover, you’ll only be covered for it to a limited extent. This means you’ll only receive the minimum default benefit as set by the government, and you’ll likely incur significant out-of-pocket costs if you are treated for that restricted service as a private patient. Before any major treatment, it’s a good idea to call us for a quote. We’ll be able to tell you what you’re covered for and any costs you may need to pay out of your own pocket.

Pre-existing conditions

A pre-existing condition is an illness or condition which, in the opinion of an independent doctor (appointed by HBF), was known to exist, or where signs or symptoms were evident in the six months leading up to you getting insured, including on the day you joined us. A pre-existing condition doesn't mean there has to be a diagnosis – only that you had signs or symptoms of the condition that should have been reasonably apparent to you or to a doctor during those six months.

If you served a 12-month waiting period for a pre-existing condition with your previous health fund, you will not need to reserve your waiting period with HBF. However, if you haven’t completed your 12-month waiting period then you will need to serve the remainder of your waiting period before you are able to claim benefits. 

Annual and lifetime limits (applies to extras cover)

If you have extras cover, limits will apply to each service covered by your policy. You can view your extras limits and usage in myHBF and the HBF App. 

Annual limits are the maximum amount of money you can claim for a service within a calendar year. Each person on your policy has their own annual limits.

Lifetime limits are the total amount you can claim for a service over the course of your lifetime. A lifetime limit applies to orthodontic cover with HBF. This means, once you’ve claimed your limit for orthodontics, you won’t be able to claim again. Each person on your policy has their own lifetime limit.

For more information on how your cover works, read the HBF Member Guide. 

myHBF is our online portal where you can manage your cover and submit claims. Once you’re registered, you will be able to access your cover information, update your personal details, and – if you have extras cover - get fast online benefit quotes and track your service limits and usage. 

When you first log in, we recommend checking that the details we have for all policy members are correct – this includes things like your date of birth, rebate tier, postal address, residential address and payment details. 

How to check if you're covered

Our award-winning HBF App is one of the easiest ways to manage you cover and submit claims. Plus, you can access your digital member card so you can simply tap and claim at participating HICAPS providers for your covered extras services*.

You can start claiming as soon as you’ve finished serving your service waiting period. To make things easy, follow these steps ahead of your treatment or service:

  1. Research Member Plus and Access Gap Cover providers. They can help you reduce your out-of-pocket costs. 
  2. Use HBF Provider Search to find providers near you. You can search by agreement, name and speciality.
  3. Get a benefit quote. This will tell you exactly how much HBF will cover, and any out-of-pocket costs you’ll have to pay. Call us on 133 423, or get an instant extras benefit quote in myHBF. 

How to check if you're covered

As an HBF member, you get exclusive access to HBF Member Perks. You’ll find discounts on gym memberships, shopping, entertainment and more. And the best part is that these offers are ready to claim straight away!

 

When you buy extras insurance for the first time, there will generally be a waiting period you need to serve before you can claim if you haven't had continuous cover, or if you've just upgraded to a higher level of cover.

The amount you can claim back on extras services depends on your benefits (the amount you get back when you claim) and your annual limits (the maximum amount you can claim in a year).

Nearly all extras insurance policies only cover services to a limited extent, which means you'll usually pay for some of the service out of your own pocket.

What makes extras insurance worthwhile is that Medicare generally doesn't cover extras services, so without extras insurance you'd have to cover the full cost of treatment every time you receive a service.

A sub-limit is the maximum amount of money you can claim for a specific service, which is deducted from a larger annual limit.

For example, a policy might have a combined annual limit of $500 for dentures, crowns and bridges, with a sub-limit of $300 for each service. That means you'd only be able to claim a maximum of $300 for any one of those services in the year. If you claimed $300 on bridges, you would not be able to claim more for that service during the year, while the remaining $200 could be claimed against one or both of the other services.

A combined annual limit is the maximum amount of money you can claim, distributed across a group of services.

When you buy hospital insurance for the first time or after not having it for a long time, or you upgrade to include a new service, there will generally be a waiting period you need to serve before you can claim.

At HBF, waiting periods for hospital insurance are as follows

  • 12 months for pre-existing conditions* and Pregnancy and birth
  • Two months for other in-hospital treatments
  • Seven days for Urgent ambulance (by road)
  • From the day after you join for Accident Cover*

Where your treatment is an included service on your hospital cover, your hospital costs will either be fully or partially covered depending on the type of agreement your health fund has with your specialists and hospital.

With HBF, when you’re admitted to hospital for treatment you will get 100% back for the cost of your hospital accommodation and specialists so long as you choose providers that have ‘no-gap’ (otherwise known as ‘fully covered’) agreements with HBF. Just be aware of out-of-pocket costs, which can include excess or co-payments. Please note, outpatient services are not covered under hospital insurance.

Before you book hospital treatments, contact us and we’ll help you understand what you can claim, how much you can claim, and if any excess, co-payments or waiting periods apply. To ensure we give you accurate advice, please have a written cost estimate from your provider on-hand.

When you take out HBF Hospital cover, you will be asked to choose an excess level ($0, $250, $500 or $750). Excess options available vary by cover and not all excess levels are offered across all covers.

If you choose to have a higher excess (e.g. $750), you will have a greater reduction on your premium, however you will need to pay that excess amount upfront for your hospital treatment prior to claiming a benefit from your health fund. In comparison, you might choose $0 excess, in which case your premium will be higher, but you won't be required to pay anything upfront prior to treatment.

Here's some things to consider when deciding which excess to choose:

  • Your medical history
  • How likely you are to be admitted to hospital
  • How many times you've been admitted to hospital in the past
  • The amount of money you'd be able to pay upfront if you're admitted to hospital and make a claim
We understand that life changes, and so do your health insurance needs. Call us on 133 423 to learn more about what to do when your coverage needs an update.

You will need to add your newborn to your policy within three months of your baby’s birth. This way, your baby will be covered from their birth and won’t have to serve any new waiting periods, provided you have completed yours.

If you’re currently on a Single or Couples policy and want your newborn to be covered, you will need to increase your cover to a Parent Plus or Family policy. If you’re already on a Family policy, you won’t need to pay anything extra to add your newborn to the policy.

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