Hc 5s3w50

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 . That's why we don't charge our 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 can feel better, sooner. It's called the HCF difference, and it's our way of making sure our 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 hip to a maximum of $900 per calendar year for a couple or family hip

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

Private Patient

HCF Participating

Public Hospital

Hospital Waiting Periods

Private Hospital Accommodation

yes

yes

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

1 day Emergency Ambulance 2 months Psychiatric Rehabilitation Palliative care. All other treatments except where there's a longer waiting period. 12 months

Assisted reproductive services (IVF,

yes

yes

GIFT)

Treatments for pre-existing ailments excluding Psychiatric, Rehabilitation, Palliative care.

Hip and knee t replacements

yes

yes

Cataract eye surgery

yes

yes

Dialysis for chronic renal failure

yes

yes

Psychiatric services

yes

yes

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

(including eating disorders and post-

member ed or upgraded to a

natal depression)

higher level of cover, even though

Pharmaceuticals in hospital directly

yes

yes

associated with the reason for

a diagnosis may not have been made. If there is any doubt as to whether an ailment is pre-

ission. Excluding experimental

existing, HCF will appoint an

and very high cost non-PBS drugs.

independent medical practitioner

Rehabilitation programs

yes

yes

Surgical weight loss procedures e.g.

yes

yes

Sterility reversals

yes

yes

Cosmetic surgery

minimal benefits

minimal benefits

Surgery by an accredited Podiatrist

minimal benefits

minimal benefits

to examine information provided by your doctor, together with other relevant claim details.

gastric banding

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 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.

Ambulance Full cover for emergency ambulance with State Government road or air services where you require hospital or on-thespot 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 in transit.

Super Multicover

V3.3 General Treatment Service

Rebate

Annual Limit per

Waiting

effective

person per calendar

Period

1/7/2011

year

General Dental 2 months

Diagnostic Dental Examination (011)

$38

2 claims

X-rays (022) - initial

$29

No limit

Subsequent visit

$25

Preventative Dental Removal of plaque (114 & 115)

$63

2 claims

Application of fluoride (121)

$25

1 claim

Adhesive fillings - one surface (531)

$95

$550

Adhesive fillings - two surfaces (532)

$108

Adhesive fillings - three surfaces (533)

$125

Restorative Dental

Orthodontic By an Orthodontist - two full arch banding(831) x 2

$1,720

$2,640 lifetime limit

$1,000

sub limit of $1,000

- accrues at $440 per year. or By a General Dentist - two full arch banding (831) x 2 - accrues at $440 per year.

lifetime limit

12 months

Major Dental $800 per person

Crowns and Bridges

Increases by $100 each year to Full crown non metallic indirect (615)

$635

$1,200 $800 per person

Dentures

every three years from date of Complete upper and lower denture

$800

Maintenance & repair

$37-$200

service

$200 sub-limit applies for maintenance & repairs $500

Other Dental Endodontic: Preparation of root canal

$170

(415) Oral Surgery - (eg. extractions)

$100-$260

Root canal obturation (417)

$150

12 months

General Treatment Service

Rebate

Annual Limit per person

Waiting

effective 1/7/2011

per calendar year

Period

Spectacle frames

$135

$250

2 months

Spectacle lenses - pair

$130 - $250

lenses - pair

$140 - $250

Disposal lenses

$160

2 months

Optical

Chiropractor Visit 1-2

$42

$600 - (Increases by $120

Visit 3-11

$33

each year to $1,200)

Visit 12+

$18

Max $600 each for Chiro &

Chiropractic X-ray

$63

Osteo. Max $300 for exercise

Osteopathy

physiology

Visit 1-2

$45

Visit 3-11

$35

Visit 12+

$18

Exercise Physiology Initial consultation

$40

Subsequent consultation

$33

Physiotherapy / Eye Therapy Visit 1-2

$53

Visit 3-11

$38

Visit 12+

$18

Hydrotherapy/Group Physiotherapy

$18 per visit

Eye Therapy

$38

$600 - (Increases by $120

2 months

each year to $1,200)

Acupuncture / Naturopathy / Remedial Massage /Myotherapy /Homeopathy/ Alexander Technique/ Chinese Herbal Medicine Acupuncture - sub-limit $250 per person,

Combined Limit

Chinese Herbal Medicine- sub-limit $100 per person

$600

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

2 months

General Treatment Service

Rebate effective 1/7/2011

Annual Limit per

Waiting

person per calendar

Period

year Speech Pathology / Audiology Speech Pathology Initial consultation

$83

Subsequent consultation

$51

$500

2 months

$350

2 months

$600

2 months

$350

2 months

$400

2 months

$600

2 months

$600

12 months

$700

2 months

Audiology Initial consultation

$58

Subsequent consultation

$40

Occupational Therapy Initial consultation

$72

Subsequent consultation

$50

Dietetics Initial consultation

$55

Subsequent consultation

$40

Podiatry Initial consultation

$38

Subsequent consultation

$34

Psychology (after Medicare entitlement is exhausted) Per consultation

$80

Artificial Appliances HCF approved artificial appliances (eg: Nebuliser, TENS machine, Orthotics) Pharmacy (HCF approved, non-PBS) (non-PBS) An excess applies to all nonPBS drugs which is equivalent to the current PBS fee.

$50 per drug per script.

General Treatment Service

Annual Limit per person per

Waiting

calendar year

Period

Home Nursing $50 per claim

$1,000

2 months

Up to $100 per return trip per hip for travel per trip/

$400 sub-limit for Travel and

hip.

Accommodation

Journeys of more than 200km for specialist/hospital treatment.

(up to $400 for travel & $200

up to $30 per night for accommodation

for accommodation)

Rebate effective 1/7/2011

Home Nursing, Travel and Accommodation

Hearing Aids Benefits payable every 5 years depending on length of hip

Less than 5 years - $800

2 years

6-9 years - $1,100 10-14 years - $1,400 15 years and more - $1,800

Health Management Programs HCF approved programs eg. First Aid Courses, Learn to Swim, Stress

$200 per person

Management, Quit Smoking , Childbirth/Ante-natal Education, Lactation

$400 per family

6 months

consultation, Weight Management & Exercise regimes (recommended by a GP or specialist). Other services School accident cover

100% of cost (where

(approved general treatment related

benefits are not payable

service only)

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 . Existing HCF who 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. 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 hip 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 ed 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 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 hip, you will need to change to a Family hip 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 the fund, whether you're planning a child or not.

Eliminating out-of-pocket medical expenses for hospital 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 s 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, 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, 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 istration 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 hip. 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 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 hip 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 ing. 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 ; 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 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 you before your child's 25th birthday to notify you that your hip will revert back to your standard hip 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 hips and Single Parent Family hips 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 hip. 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 s 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 about any aspect of a health insurance product or iSelect's service, you could either call the consultant you dealt with or the Compliance Manager by telephone on 1300 735 255, and by email on [email protected]. If you have queries or about the HCF products please HCF on 13 13 34. If you are not satisfied with iSelect's response you may the Private Health Insurance Ombudsman on 1800 640 695.

Privacy For further information about iSelect's please visit iSelect's web site: http://www.iselect.com.au/

HCF APPLICATION FORM Please fax pages 1 & 2 to 1300 735 322 or mail to Reply Paid 2021 Moorabbin, VIC 3189 iSelect Health Pty Ltd ABN 87 088 749 955

OFFICE USE ONLY

1 0 8 6 3 8 4

WB

iSelect Client No. Change cover with Transfer hip from another Fund HCF

HIP NUMBER ISSUED BY FUND

New hip R20810

ISN

Mr/Mrs/Ms/Miss/Other: _____________

R/C 20

Customer Note No:

Surname:

Given name/s: Date of birth:

10-Jun-1986

Occupation:

(DD/MM/CCYY)

Address: State

Town/Suburb: Phone: Home ( Email address:

)

Work (

)

NSW

Postcode

Mobile

[email protected]

OTHER PERSONS TO BE COVERED Given Name

Family Name

Date of birth

Sex

Relationship

Student YES/NO

PRE EXISTING AILMENT/CONDITION (PLEASE COMPLETE THIS SECTION) Do you, your spouse/partner or any of your dependants have any pre-existing ailment/condition/s? Member’s Name

Yes If YES, please state the aliment/condition/s No

Details of Ailment/Condition/s

IMPORTANT: PLEASE READ AND NOTE Benefits are not payable in the first 12 months of hip 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 ing 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 .

SELECTED PRODUCT/S Top Plus Cover $450 AND Super Multicover Type of Cover

Single Male

Excess amount $450 x 1 Cover commences on ________/________/________

(nominate date)

Conditional on receipt of payment within 14 days.

154.7 Base Quoted $ Lifetime Loading (if applicable) 0.00 Total $ 154.70 p/month inc 30.0% rebate s quoted valid to March 31st 2012

DECLARATION (PLEASE SIGN THIS SECTION WHERE INDICATED) I declare all details stated to be true and correct and agree to be bound by the ed 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.

Signature x

Date:

HCF’s & Conditions are available at www.iselect.com.au/tc8 Please fax or mail pages 1 & 2 only.

Fax: 1300 735 322 or call 1300 735 255 1

Mail: Reply Paid 2021 Moorabbin VIC 3189

HCF APPLICATION FORM MEDICARE ELIGIBILITY Green – Full unrestricted access

My Medicare card is

Blue – Interim card full unrestricted access until expiry date

My Medicare card number is

Valid To

Yellow – Reciprocal card – restricted access until expiry date

FEDERAL GOVERNMENT REBATE Please complete this section in full to receive the Federal Government 30% Rebate on private health insurance as a reduced . If you do not complete this section, full hip fees apply. Are all people nominated on Page 1 on this hip eligible for full Medicare benefits? If YES please complete the remainder of this section. If NO you cannot apply for the rebate until you obtain a card from Medicare.

Yes No

Are you covered on this hip?

Yes

Date reduction to commence

/

No

If NO, employers and trustees of organisations cannot claim the Federal Government 30% Rebate on policies paid on behalf of employees.

(Start date of this policy)

/

Your Medicare Card No. Your name exactly as it appears on your Medicare card

Valid To

Some of the information provided on this form will be used for the purposes of ing 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.

Date :

Signature x

PAYMENT OPTIONS – ( PLEASE COMPLETE 1 OF THE 2 PAYMENT OPTIONS) 1. EZIPAY DIRECT DEBIT REQUEST I/We authorise The Hospitals Contribution Fund Limited ID Number 480 to arrange for funds to be debited from my/our at the financial institution identified below and as prescribed below.

Please tick

Fortnightly

Monthly

Yearly

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 described in the HCF Direct Debit Customer Service Agreement.

Details of the to be debited

(All details must be supplied.)

Name of Financial Institution

Branch

name BSB No.

-

No.

Signature x

Date:

2. CREDIT CARD AUTHORITY Type of card (please tick) Visa

MasterCard

Debit frequency (please tick)

Monthly

Yearly

Please debit my on the ________________________ day of the due month. *Please nominate day. (If you do not nominate a day your 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.

Card Holder's Name

CCVV No – this is the 3 digit number on the back of your credit card

Card No.

Expiry Date

Signature x

DIRECT CREDIT OF CLAIMS

CCVV No

Date: If you would like your claim benefits paid directly into your please complete the following details.

Name of Bank, Credit Union or Building Society I request HCF to credit my/our nominated with any amount which may be payable by the fund in respect of a claim or benefit on my hip.

Name on a/c

BSB No.

-

Signature x Please fax or mail pages 1 & 2 only.

No. Date:

Fax: 1300 735 322 or call 1300 735 255 2

Mail: Reply Paid 2021 Moorabbin VIC 3189