Our Product Disclosure Statement (PDS)

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Australia’s first certified Carbon Neutral health fund.

Our Product Disclosure Statement (PDS)

Your HIF Hospital and Extras health cover in detail.

hif.com.au

Visit online to get a quote and join (or switch).

Call 1300 13 40 60

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What’s inside?

A bit about us, this PDS and health insurance

At HIF, we aim to make choosing smart health insurance simple and painless. With that in mind, we’ll keep this Product Disclosure Statement (PDS) as short and sweet as possible. No unnecessary information. Just the must-know stuff. We want you to be able to make the right health insurance choice but we don’t want you to fall asleep. So here we go…

About us and you

HIF is a not-for-profit private health insurer.

That means we don’t have shareholders, so any income we earn after paying for our members’ benefits and covering our operating expenses is available to pay bigger and better benefits.

And that’s a good thing.

About this PDS

You’ll find lots of useful info about our health insurance in this brochure: what’s covered and what isn’t; details of different cover options; explanations about our services and the terminology we use.

All the stuff you need to know when comparing, choosing and reviewing your health cover.

Important Tip

When you join HIF or change your level of cover, we will send you a Member Statement confirming your new level of cover. To avoid confusion, it’s a good idea to keep your statement with this brochure.

Keep Updated

HIF is always reviewing and improving its services and benefits so to ensure you are claiming all possible benefits remember to regularly visit hif.com.au/domesticpds for an updated version of this PDS.

About Australian private health insurance

All Australian private health insurers, and residents and non-residents who pay tax in Australia, have potential responsibilities, obligations and entitlements under Australian health insurance laws.

These laws include directions about services that can or must be covered, entitlement to the private health insurance rebate and obligations to pay the Medicare Levy Surcharge (MLS) and the Lifetime Health Cover (LHC) loading.

The legislation or rules that affect your premiums, cover and membership obligations include:

• The Private Health Insurance Act 2007 (the PHI Act)

• Fairer Private Health Insurance Incentives Act 2012

• Fairer Private Health Insurance Incentives (Medicare Levy Surcharge) Act 2012

• Fairer Private Health Insurance Incentives (Medicare Levy Surcharge – Fringe Benefits) Act 2012

Under the PHI Act, we are required to document our operating guidelines, known as Fund Rules or Business Rules. All private health funds have to do this.

These rules detail our obligations as a private health insurer, as well as the obligations of our members. As such, when you become a HIF member, you agree to be bound by these rules. If you would like a copy of the rules, simply email [email protected] or call us on 1300 13 40 60.

Want more information?

Visit hif.com.au to find out more about our not-for-profit health fund. Alternatively, if you would like to know more about us or the rules and regulations around health insurance, please email [email protected] or call us on 1300 13 40 60.

What’s inside?

A bit about us, this PDS

and health insurance 2-3 HIF Hospital Cover Options 4

GoldVital Hospital 8

GoldStarter Hospital 12

GoldSaver Hospital 14

Gold Hospital 16

GoldStar Hospital 18

About our Extras cover 20

Ways to claim 22

Feedback, disputes and privacy 46 Frequently asked questions 48

Glossary 51

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Cover for in-hospital procedures

GoldStarter GoldSaver Gold GoldStar

Choice of Excess Private Room Private room

(maternity) (3 days) (5 days) (unlimited)

Shared room Intensive Care Theatre Care Same-day Accommodation Same-day Theatre Appliances Prostheses Pharmacy Drugs AccessGap

Palliative Care Restricted Restricted

Cardio (heart)** Restricted

Psychiatric Care

& Treatment

Restricted Restricted

Joint Replacement Restricted

Assisted Reproductive Technology (e.g. IVF)

Restricted

Eye Surgery (non-cosmetic)

Restricted

Gastric banding &

Obesity surgery

Some restrictions and exclusions may apply.

Product Restricted Excluded

GoldStar • Surgery by podiatrists • Cosmetic services*

• Services not covered by Medicare*

Gold • Surgery by podiatrists • Cosmetic services*

GoldSaver • Assisted reproductive technology

• Cardiac (heart) conditions, procedures or monitoring**

• Eye surgery

• Joint replacement

• Psychiatric

• Palliative care

• Rehabilitation

• Gastric banding and obesity surgery

• Cosmetic services*

• Surgery by podiatrists

GoldStarter • Palliative care

• Psychiatric

• Rehabilitation

• Cardiac (heart) conditions, procedures or monitoring**

• Eye surgery

• Assisted reproductive technology

• Obstetrics (maternity)

• Cosmetic services*

For restricted services HIF will pay a basic benefit known as the public hospital rate, toward accommodation charges.

All other charges raised by the hospital during the stay will be paid by the member. An excluded service means all charges raised during the stay will be paid by the member.

* Where a service is deemed by Medicare to be cosmetic and/or does not attract a Medicare rebate, all charges raised in association with the hospital stay will not be eligible for payment.

** Some examples of cardiac (heart) procedures including medical treatment or surgical procedures for cardiac conditions, are arrhythmias, artery bypass grafts, coronary angioplasty, congenital defects, heart disease, heart transplants, pacemakers and defibrilators, stent insertion.

HIF Hospital Cover Options Restrictions and exclusions

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When selecting Hospital cover, it’s important to ensure that you understand how each level of cover will apply to you, as well as being aware of details such as limitations, restrictions or exclusions that might also apply to your chosen cover.

AccessGap Cover

AccessGap Cover applies to medical accounts for members undergoing in-patient hospital procedures. It’s designed to reduce or eliminate out-of-pocket expenses by allowing doctors to use the scheme on a patient-by- patient basis. If a doctor uses the scheme, he/

she agrees to charge you a set fee for each item and will then receive a payment from HIF and Medicare combined, which is more than the Medicare Schedule Fee.

To be eligible for AccessGap Cover, doctors must be willing to participate for your particular surgery and the account must be lodged directly with HIF (not Medicare).

To find out more about specific payment amounts for upcoming procedures, or for your doctor to register for the scheme, please call us on 1300 13 40 60.

Healthcare providers

HIF covers extras, medical and hospital providers throughout Australia. To confirm if a provider is approved by HIF, go to hif.com.au, email us at [email protected] or call us on 1300 13 40 60.

Benefits will not be paid for any hospital services provided outside Australia, or for services purchased or provided within Australia from a non-Australian recognised provider.

Ambulance services

HIF is required under New South Wales and Australian Capital Territory legislation to financially contribute toward the cost of operating state or territory-provided emergency ambulance services on behalf of any person who is a permanent state or territory resident and holds any level of HIF Hospital cover. Under this arrangement, our members who are residents of NSW or ACT and hold HIF Hospital cover may submit their resident state or territory emergency ambulance invoice to HIF to claim a benefit toward the fees charged.

Please note that ambulance benefits may not be claimable under a NSW or ACT HIF Hospital cover if the service was not provided by your local state-controlled ambulance service, or if the service was not deemed by the ambulance attendant to be an emergency (medically necessary).

For more information about this, see page 24 or visit hif.com.au and visit the “Ambulance Cover” page within the “Health” section.

Medical Gap

Different medical providers may charge different prices for the same procedure. If you are planning a procedure, we recommend that you ask your medical provider and any associated health provider (e.g. anaesthetist or assistant) if they will participate in our AccessGap scheme to help you avoid or minimise your out-of-pocket expenses.

If your health provider does not confirm your out-of-pocket expenses, we recommend you contact us with your provider’s details, item numbers and charges and we will provide you with a benefit estimate.

The Pre-existing Condition Rule This standard rule is applied across the health insurance industry. It is designed to ensure that long-term members are not financially disadvantaged by new members who join and claim benefits immediately for pre-existing conditions.

• A pre-existing condition is defined as an ailment or condition for which the signs or symptoms were evident or known at any time during the 6 months prior to when the member joins HIF, or upgrades to a higher level of cover or the same cover with a reduced or nil excess.

• HIF is not required to pay benefits for a pre-existing condition during the first 12 months of a new member’s Hospital cover.

• Where an existing member upgrades to a higher level of cover or the same cover with a reduced or nil excess, any services related to the pre-existing condition will be paid out at the previous level of cover for the first 12 months.

Restricted services

Where services are noted as ‘restricted’ in your Hospital cover, this means that if you receive them in a private hospital, you will only be covered at the basic public hospital benefit rate, which includes:

• The cost of a shared room in a public hospital

• A benefit towards the cost of surgically implanted prosthesis

• AccessGap for in-patient medical services No other benefits are payable for

restricted services, unless specifically listed in the individual product description within this brochure.

Excluded services

Where services are noted as ‘excluded’ in your Hospital cover, this means that you are not covered and you must pay all costs.

Workers Compensation and Dual Insurance

Benefits cannot be claimed and are not payable by HIF where you have or can claim benefits or compensation (in full or in part) for treatment, goods or services from a third party including Workers Compensation or Public Liability sources, your employer or any other Insurance policy.

Transferring and upgrading your cover

New members who transfer Hospital cover from another Australian health fund to an equivalent level of HIF Hospital cover will not have any waiting periods applied for the services for which you were previously covered, providing these were served with the previous fund.

• New members who transfer Hospital cover from another Australian health fund to a higher level of Hospital cover, or equivalent level of cover with a reduced or nil excess, will have qualifying periods applied for the higher level of cover and/

or benefits. During these periods benefits will be payable at the equivalent level of cover to that of your previous fund.

• Current HIF members who transfer Hospital cover to a higher level of Hospital cover, or equivalent level of cover with a reduced or nil excess, will have qualifying periods applied for the higher level of cover and/or benefits.

During these periods benefits will be payable at the lower level of cover.

• Any benefits paid by your previous private health insurer will be considered when determining rebates for your future claims.

Things you need to know about our Hospital cover

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GoldVital Hospital

This is our entry-level option for young singles and couples who want cover for vital medical services. It covers treatment after an accident, intensive care and theatre fees, plus other essential services, including surgery to remove tonsils, adenoids, appendix and wisdom teeth.

GoldVital Hospital

• Cover for emergency treatment in hospital resulting from an accidental injury*

• Surgical removal of wisdom teeth, tonsils, appendix and adenoids^†

• Minor gynaecological procedures^

• Joint reconstruction and investigation

• Same-day accommodation and theatre fees for approved services

• No maternity cover

• Full cover for the cost of a shared or private room, theatre fees and charges in an HIF contracted hospital anywhere in Australia for approved services

• Full AccessGap Cover for inpatient medical procedures for approved services

• Includes an excess to reduce the premium

• Restrictions and exclusions apply

• Available for singles and couples only

Hospital waiting periods

• Treatment received as the result of an accident – one day

• General hospitalisation – two months

• All treatment related to a pre-existing ailment or condition, but not including pre-existing conditions for psychiatric care, rehabilitation or palliative care – 12 months Services covered

GoldVital Hospital will cover the services outlined in the table on the following page in a public hospital or contracted private hospital facility, subject to any waiting periods which may apply and the Pre- existing Ailment Rule. Benefits for non- contracted private hospitals are available from HIF. Check with us prior to admission to ensure that the hospital is an HIF contracted facility.

HIF has negotiated contractual

arrangements with most hospitals and day hospital facilities throughout Australia. The benefits listed in the table opposite are offered to members who are admitted to those hospitals.

Exclusions

As an entry-level option, GoldVital provides basic cover for a limited range of vital medical services and essential emergency treatment. As such, it only covers the services listed in the table on page 10 – all other non-emergency and hospital care services are excluded.

• Assisted reproductive technology (eg IVF)

• Cardiac (Heart) procedures including medical treatment or surgical procedures for cardiac conditions such as, arrhythmias, artery bypass grafts, coronary angioplasty, congenital defects, heart disease, heart transplants, pacemakers and defibrillators, stent insertion.

• Eye Surgery (any procedure on the surface or within the structures of the eye)

• Dialysis

• Gastric banding and Obesity surgery including reversal and adjustment procedures

• Obstetrics related services

• Spinal fusion

• Sterility reversals

• Services deemed cosmetic by Medicare and service that do not attract a Medicare rebate

• Services not listed as include are excluded.

Restricted services

Benefits for the following services will include basic public hospital rate (only) for accommodation. However, full AccessGap coverage for inpatient medical procedures and benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List. Items on the list (excluding human tissue) may be subject to a co- payment by the patient:

• Psychiatric care or attention

• Palliative care

• Rehabilitation

No benefits will be payable for other charges related to these services (e.g. theatre or some pharmaceutical costs), so significant out-of-pocket expenses may apply for these procedures if you are admitted as a private patient.

Applicable excess

A mandatory excess of $500 per person, per admission, per year (up to a maximum of $500 per year single policy or $1,000 per year couple policy) is applied to GoldVital Hospital cover to reduce premium costs.

The excess applies to overnight and same day admissions

* An accident is an unforeseen event, occurring by chance and caused by an external force or object which results in an injury to the body requiring immediate medical treatment in hospital within 24 hours of the accident. If further hospital treatment (as an admitted patient) is required, the patient must be re-admitted to a hospital within 90 days of the initial hospital treatment.

^ Benefits will be paid for Same Day Procedures only for minor gynaecological procedures.

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Description of charges and benefits

Accommodation Charges Public hospital Full cover in a shared or private room Private hospital Full cover in a shared or private room Theatre Fees charges Public hospital Charges are not raised for this service

Private hospital Full cover for theatre charges Pharmaceutical drugs (does

not include discharge drugs)

Public hospital Charges are not raised for this service Private hospital Charges vary between hospitals depending on

the contract that’s in place. Please check with the hospital or HIF. Benefits may not apply to, or be restricted for, non-TGA* approved, experimental or high cost drugs,

Prostheses and consumables Public hospital Benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List. Items on the list (excluding human tissue) may be subject to a co-payment by the patient.

Prostheses items used in relation to relevant exclusion services are not covered.

Private hospital Benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List. Items on the list (excluding human tissue) may be subject to a co-payment by the patient.

Benefits may not apply or be restricted for non hospital contract medical treatments or consumables. Prostheses items used in relation to relevant exclusion services are not covered.

Outpatient theatre fees (not emergency department fees)

Public hospital No charge raised

Private hospital Full cover for outpatient theatre fees

Medical Gap

For more details please refer to the ‘AccessGap Cover’

section in this brochure, or email [email protected] or call us on 1300 13 40 60

All hospitals and approved day care facilities

Admitted patients are entitled to the difference between the Medicare rebate and the

Commonwealth Medical Benefits Schedule fee for all medical services performed whilst the patient is admitted as an inpatient in hospital and may be entitled to a further refund of the AccessGap cover amount. Funds are not permitted to pay gap cover if the patient is treated as an outpatient or when the patient is not formally admitted to hospital.

Applicable Excess Mandatory excess is applied to GoldVital hospital.

GoldVital - $500 per person in a calendar year to a max of $1000 per membership. Excess applies to overnight or same day admissions.

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This is our basic-level private Hospital insurance cover. Like GoldVital, it’s great value and a smart choice if you’re younger and less likely to require things like maternity and cardio procedures, but it also includes a broader range of non-

emergency care.

GoldStarter Hospital

• No maternity cover

• Restrictions and exclusions apply

• Full cover for the cost of a shared room, theatre fees and charges in a HIF contracted hospital anywhere in Australia for approved services

• Full AccessGap Cover for inpatient medical procedures for approved services

• Includes an excess to reduce the premium Hospital waiting periods

• General hospitalisation – two months

• All treatment related to a pre-existing ailment or condition, but not including pre-existing conditions for psychiatric care, rehabilitation or palliative care – 12 months Restricted services

Benefits for the following services will include basic public hospital rate (only) for accommodation. However, full

AccessGap coverage for inpatient medical procedures and benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List. Items on the list (excluding human tissue) may be subject to a co-payment by the patient:

• Palliative care

• Rehabilitation

No benefits will be payable for other charges related to these services (e.g.

theatre or some pharmaceutical costs), so significant out-of-pocket expenses may apply for these procedures if you are admitted as a private patient.

Exclusions

Benefits are not payable for any charges raised for the following services:

• Assisted reproductive technology (e.g. IVF)

• Cardio (e.g. conditions of the heart requiring surgery, monitoring or other procedures)†

• Eye surgery (any procedure on the surface or within the structures of the eye)

• Obstetrics

• Services deemed cosmetic by Medicare and services that do not attract a Medicare rebate

Services covered

GoldStarter Hospital will cover the following services in a public hospital or contracted private hospital facility, subject to any waiting periods which may apply and the Pre-existing Ailment Rule. Benefits for non-contracted private hospitals are available from HIF. Check with us prior to admission to ensure that the hospital is a HIF contracted facility.

arrangements with most hospitals and day hospital facilities throughout Australia. The listed benefits are offered to members who are admitted to those hospitals.

GoldStarter Hospital

Accommodation charges

including day patient, intensive care and neonatal care

Public hospital Full cover in a shared or private room.

Private hospital The full cost of a shared room. If you occupy a private room you will be covered up to the hospital charge for a shared room and you will be required to meet the balance of the accommodation charge.

Theatre fee Public hospital Charges are not raised for this service.

Private hospital Full cover for theatre charges.

Pharmaceutical drugs (does not include discharge drugs)

Public hospital Charges are not raised for this service.

Private hospital Charges vary between hospitals depending on the contract that’s in place. Please check with the hospital or HIF. Benefits may not apply to, or be restricted for, non-TGA* approved, experimental or high cost drugs.

Benefits may not apply or be restricted for non hospital contract medical treatments or consumables. Prostheses items used in relation to relevant exclusion services are not covered.

Public hospital No charge raised.

Private hospital Full cover for outpatient theatre fees.

Medical Gap

For more details, please refer to the ‘AccessGap Cover’

Admitted patients are entitled to the difference between the Medicare rebate and the Commonwealth Medical Benefits Schedule fee for all medical services performed whilst the patient is admitted as an inpatient in hospital and may be entitled to a further refund of the AccessGap cover amount. Funds are not permitted to pay gap cover if the patient is treated as an outpatient or when the patient is not formally admitted to hospital.

A mandatory excess is applied to GoldStarter Hospital cover to reduce premium costs:

• GoldStarter – $200 per person to a max of $400**

* Therapeutic Goods Administration

** Excesses are paid once per person per admission covered under the policy in a calendar year up to the maximum.

Excesses apply to all hospital treatments.

† Some examples of cardiac (heart) procedures including medical treatment or surgical procedures for cardiac conditions, are arrhythmias, artery bypass grafts, coronary angioplasty, congenital defects, heart disease, heart transplants, pacemakers and defibrilators, stent insertion.

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This is our intermediate Hospital cover and is a step up from GoldStarter. It’s great for young couples and families who are likely to need things like maternity cover but not services such as cardio and joint replacement surgery.

GoldSaver Hospital

• Intermediate Hospital cover

• Includes maternity services

• Full cover for the cost of a shared room, theatre fees and labour ward charges in a HIF contracted hospital anywhere in Australia for approved services

• Private room for up to 3 days for

management of labour and delivery of child

• Full AccessGap cover for inpatient medical procedures

• Includes an excess to reduce the premium

• Some restricted services Hospital waiting periods

• General hospitalisation – 2 months

• All obstetric related services – 12 months

• All treatment related to a pre-existing ailment or condition, but not including pre-existing conditions for psychiatric care, rehabilitation or palliative care – 12 months Restricted Services

Benefits for the following services will include basic public hospital rate (only) for accommodation. However, full AccessGap coverage for in-patient medical procedures and benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List. Items on the list (excluding

human tissue) may be subject to a co-payment by the patient:

• Cardio (e.g. conditions of the heart requiring surgery, monitoring or other procedures)†

• Eye surgery (any procedure on the surface or within the structures of the eye)

• Assisted reproductive technology (e.g IVF)

• Surgery by a podiatrist

No benefits will be payable for other charges related to these services (e.g.

theatre or some pharmaceutical costs), so significant out-of-pocket expenses may apply for these procedures if you are admitted as a private patient.

Exclusions

Benefits are not payable for any charges raised for the following services:

• Services deemed cosmetic by Medicare and services that do not attract a Medicare rebate

GoldSaver Hospital will cover the following services in a public hospital or contracted private hospital facility, subject to any waiting periods which may apply and the Pre-existing Ailment Rule. Benefits for non- contracted private hospitals are available from HIF. Check prior to admission to ensure that the hospital is a HIF contracted facility.

GoldSaver Hospital

† Some examples of cardiac (heart) procedures including medical treatment or surgical procedures for cardiac conditions, are arrhythmias, artery bypass grafts, coronary angioplasty, congenital defects, heart disease, heart transplants, pacemakers and defibrilators, stent insertion.

Accommodation charges including day patient, intensive care and neonatal care

Private hospital Full cover in a shared room. A private room will be fully covered for up to 3 days for maternity stays relating to the management of labour and delivery. If you occupy a private room for maternity stays greater than 3 days, for the fourth and additional days you will be covered up to the hospital charge for a shared room and you will be required to meet the balance of the accommodation charge.

Theatre fee and labour ward charges

Private hospital Full cover for theatre and labour ward charges.

Benefits may not apply or be restricted for non hospital contract medical treatments or consumables. Prostheses from excluded services not covered.

Public hospital Full cost of the charge raised.

Medical Gap

For more details, please refer to the ‘AccessGap Cover’

Admitted patients are entitled to the difference between the Medicare rebate and the Commonwealth Medical Benefits Schedule fee for all medical services performed whilst the patient is admitted as an inpatient in hospital and may be entitled to a further refund of the AccessGap cover amount. Funds are not permitted to pay gap cover if the patient is treated as an outpatient or when the patient is not formally admitted to hospital.

A mandatory excess is applied to reduce premium costs:

• GoldSaver – $200 per person to a max of $400**

** Excesses are paid once per person per admission covered under the policy in a calendar year, up to the maximum.

Excesses apply to all hospital treatments.

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This is our award-winning top shared room hospital insurance cover. You’re fully covered for theatre fees, ward fees and all other services. It’s especially great if you’re planning on having a baby, because our maternity cover includes up to five days in a private room at no extra cost.

Gold Hospital

• Top Hospital cover

• Comprehensive cover for all Medicare approved items

• Private room for up to 5 days for management of labour and delivery of child

• Full cover for the cost of a shared room, theatre fees and labour ward charges in a HIF contracted hospital anywhere in Australia

• Full AccessGap Cover for inpatient medical procedures

• Choice of excesses to reduce cost

• All treatment related to a pre-existing ailment or condition, but not including pre-existing conditions for psychiatric care, rehabilitation or palliative care – 12 months

Restrictions

Surgery performed in a hospital by registered podiatrists is not eligible for Medicare rebates. However, under this level of cover HIF will pay limited benefits toward the podiatrist’s charges. Hospital accommodation and theatre charges will also be limited.

Exclusions

No benefit is payable for services deemed as cosmetic by Medicare and/or services that do not attract a Medicare benefit.

Gold Hospital will cover the following services in a public hospital or contracted private hospital facility, subject to any waiting periods which may apply and the Pre-existing Ailment Rule. Benefits for non- contracted private hospitals are available from HIF. Check prior to admission to ensure that the hospital is a HIF contracted facility.

Gold Hospital

Excess options

Optional excesses to reduce premium costs:

• Gold Excess 100/200 – $100 per person to a max of $200**

* * Excesses are paid once per person per admission covered under the policy in a calendar year, up to the maximum.

The excess is not applied to same-day surgery or to child dependants under the age of 18.

Accommodation charges including day patient, intensive care and neonatal care

Private hospital The full cost of a shared room. A private room will be fully covered for up to 5 days for maternity stays relating to the management of labour and delivery.

If you occupy a private room for maternity stays greater than 5 days, for the sixth and additional days you will be covered up to the hospital charge for a shared room and you will be required to meet the balance of the accommodation charge.

Prostheses and consumables

Public hospital Benefits will be paid towards prostheses in

accordance with the Commonwealth Prostheses List.

Items on the list (excluding human tissue) may be subject to a co-payment by the patient.

Private hospital Benefits will be paid towards prostheses in

Items on the list (excluding human tissue) may be subject to a co-payment by the patient. Benefits may not apply or be restricted for non hospital contract medical treatments or consumables.

Medical Gap

For more details, please refer to the ‘AccessGap Cover’ section in this brochure, or email [email protected] or call us on 1300 13 40 60

Commonwealth Medical Benefits Schedule fee for all medical services performed whilst the patient is admitted as an inpatient in hospital and may be entitled to a further refund of the AccessGap cover amount. Funds are not permitted to pay gap cover if the patient is treated as an outpatient or when the patient is not formally admitted to hospital.

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This is our premium hospital insurance cover, with all the bells and whistles. You’re fully covered for everything, including a private room for all services, theatre fees and all ward fees. No worries. Just total peace of mind for you and your family.

GoldStar Hospital Cover

• Top Hospital cover

• Comprehensive cover for all Medicare approved items

• Full cover for the cost of a private room, theatre fees and labour ward charges in a HIF contracted hospital anywhere in Australia

• Full AccessGap Cover for inpatient medical procedures

• Choice of excesses to reduce cost

• All treatment related to a pre-existing ailment or condition, but not including pre-existing conditions for psychiatric care, rehabilitation or palliative care – 12 months

Restrictions

Surgery performed in a hospital by registered podiatrists is not eligible for Medicare rebates. However, under this level of cover HIF will pay limited benefits toward the podiatrist’s charges. Hospital accommodation and theatre charges will also be limited.

Exclusions

No benefit is payable for services deemed as cosmetic by Medicare and/or services that do not attract a Medicare benefit.

GoldStar Hospital will cover the following services provided in a public hospital or contracted private hospital facility, subject to any waiting periods which may apply and the Pre-existing Ailment Rule. Benefits for non-contracted private hospitals are available from HIF. Check prior to admission to ensure that the hospital is a HIF contracted facility.

GoldStar Hospital

Accommodation charges

including day patient, intensive care and neonatal care

Private hospital Full cover in a shared or private room.

Prostheses and consumables

Public hospital Benefits will be paid towards prostheses in

Items on the list (excluding human tissue) may be subject to a co-payment by the patient.

Private hospital Benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List.

Items on the list (excluding human tissue) may be subject to a co-payment by the patient. Benefits may not apply or be restricted for non hospital contract medical treatments or consumables.

Medical Gap

For more details, please refer to the ‘AccessGap Cover’ section in this brochure, or email [email protected] or call us on 1300 13 40 60

Commonwealth Medical Benefits Schedule fee for all medical services performed whilst the patient is admitted as an inpatient in hospital and may be entitled to a further refund of the AccessGap Cover amount. Funds are not permitted to pay gap cover if the patient is treated as an outpatient or when the patient is not formally admitted to hospital.

Excess options

Optional excesses are available to reduce premium costs:

• GoldStar Excess 200/400 – $200 per person to a max of $400**

** Excesses are paid once per person per admission covered under the policy in a calendar year, up to the maximum.

The excess is not applied to same-day surgery or to child dependants under the age of 18.

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Here at HIF, we pride ourselves on enabling member choice.

So, unlike some health fund insurers who pay lower benefits if you don’t go to their

“preferred providers”, with HIF you’re free to visit any Extras provider in Australia.

Our only requirement is that members must visit healthcare providers who are legally qualified to practise in Australia and are therefore approved by HIF.

So as long as your preferred doctor, dental provider, optical provider, physiotherapist, chiropractor or other type of healthcare provider is approved by HIF, you’re free to use whichever one you want.

Our Member Loyalty Program HIF recognises and rewards members who retain their Extras cover (excluding Vital Options) each year by providing increasing benefits or annual limits.

Our dental limits increase every year from commencement until the maximum limit is available in your sixth year of membership.

Benefits or limits for services like optical, physiotherapy, occupational and speech therapy increase after 5 years and benefits or limits increase for complementary therapies, chiropractic, osteopathic and pharmacy after 3 years.

Where a policy is upgraded to a higher level of Extras cover (excluding Vital Options), annual limits and benefits will automatically move to the next highest loyalty benefit on the new level of cover and progress each year until all maximum benefits and limits are reached.

Annual limits

HIF Extras covers have an annual limit for most services, which means there is a limit on how much HIF will pay toward your claims. Most limits are for the calendar year (January to December) but each January your benefit limits will be refreshed, allowing you to claim benefits again for Extras services provided in the new year.

Claiming timeframe limitation Claims must be made within two years of the service being provided.

Approved consultations

Unless stated, to be eligible for HIF benefits all services must be provided by a HIF approved health provider at that provider’s registered practice address in a face-to- face setting, or as otherwise approved by HIF. Video, telephone or online facilitated services, with the exception of HIF approved Hospital Substitute treatment or Chronic Health Disease Management programs, are not approved consultations.

Workers Compensation and Dual Insurance

Benefits cannot be claimed and are not payable by HIF where you have or can claim benefits or compensation (in full or in part) for treatment, goods or services from a third party including Workers Compensation or Public Liability sources, your employer or any other Insurance policy.

Things you should know about our Extras cover

Vital Options

Transferring and upgrading your cover

New members who transfer Extras cover from another Australian health fund to an equivalent level of HIF Extras cover will not have any waiting periods applied, providing these were served with the previous fund.

• New members who transfer Extras cover from another Australian health fund to a higher level of Extras cover, or equivalent level of cover with additional or higher benefits will have qualifying periods applied for the higher level of cover and/

or benefits. During these periods benefits will be payable at the equivalent level of cover to that of your previous fund.

• Current HIF members who transfer Extras cover to a higher level of Extras cover, or equivalent level of cover with a reduced or nil excess, will have qualifying periods applied for the higher level of cover and/or benefits. During these periods benefits will be payable at the lower level of cover.

• Any benefits paid by your previous private health insurer will be considered when determining rebates for your future claims.

Vital Options offers great value, entry-level Extras cover for singles and couples only (not available for families).

What services are included?

• Chiropractic

• Dental (General)

• Emergency Ambulance

• Endodontic

• Periodontal

• Osteopathy

• Physiotherapy

Please note: Benefits are only payable on the following dental items. There are some items within item code ranges for which HIF does not pay a benefit, or if they are performed with another item in the same course of treatment. If you are planning dental treatment in the future, please call HIF prior to treatment on 1300 13 40 60 to confirm that you will be covered.

• General dental: 011 – 017, 022 – 118, 121, 123 – 171, 311 – 399, 511 – 535, 572 – 597, 911 – 915, 926, 949 – 986

• Endodontic: 411 – 458

• Periodontal: 213 – 282

How much can be claimed?

With a combined annual limit of $800 per person per year, Vital Options gives complete choice as to how the limit is used. This could be used for a quick check-up at the dentist or visits to a chiropractor, for example. Each member can choose the services they’d like to use and Vital Options will pay back 50% on each service claimed until the maximum annual limit of $800 is reached.

For example, one member could claim up to $800 on dental services each year, while another member chooses to split the limit across more of the services covered by Vital Options. For instance, they could choose to use $250 on dental, $400 on osteopathy and $150 on chiropractic treatment.

Emergency ambulance services are included.

If urgent ambulance transport is needed, Vital Options cover will pay 50% of the bill up to the maximum annual limit of $800 per person.

This can be a valuable benefit as Medicare doesn’t cover urgent ambulance transport, which can cost over $900.

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Extras waiting benefits

Type of service Vital Saver Special Super Premium Waiting Period

Ambulance* 2 months

Auxiliary Home Nursing 2 months

Asthmatic Spacers 2 months

Chiropractic 2 months

Complementary Therapies 2 months

Dental - General Unlimited Limited 2 months

Diabetes Education 2 months

Dietetics 2 months

Healthy Lifestyle 2 months

Occupational Therapy 2 months

Optical 2 months

Orthoptics (Eye Therapy) 2 months

Osteopathy 2 months

Peak-flow Meter 2 months

Pharmacy Drugs 2 months

Physiotherapy 2 months

Podiatry Consultations 2 months

Speech Therapy 2 months

Dental - General Limited** Up to 12

months Blood Glucose/Pressure

Monitor

12 months

Dental - Major 12 months

External Prosthesis/

Medical Appliances

12 months

Nebuliser / Humidifier 12 months

Orthotic Appliances 12 months

Psychological Consultations

12 months

Assisted Reproduction Drugs

36 months

Hearing Aids 36 months

From time to time we promote special offers for new members. Visit hif.com.au for more information and to view our current offers.

* Does not include inter-hospital transfers or transport to home.

** Limited item numbers are covered, please contact HIF for more details

Electronic Claiming

Providers with electronic claiming

technology (HICAPS or IBA) can settle your account with you on the spot. Simply swipe your HIF membership card and pay any difference.

SmartClaim for mobile

Members who own an Apple or Android mobile device can now submit paid extras accounts of $700 or less by using their mobile’s in-built camera to photograph receipts and invoices. To find out more, visit hif.com.au or download HIF SmartClaim now from the Apple App Store or the Android Market.

Fast-Track e-Claiming (email/fax) For paid Extras accounts of $700 or less, try our quick and easy Fast-Track option.

Simply scan your completed HIF claim form and associated receipts and invoices, and email a copy to [email protected] or fax a copy to (08) 9328 1685. To find out more, visit hif.com.au

Hospital and AccessGap Accounts Your doctor may send the accounts to HIF direct. If not, you can send the unpaid account to us for processing the HIF and Medicare benefits payable. We will then send the payment direct to your doctor or hospital on your behalf. Please call us before you go into hospital so we can assist you with your claims.

By post

Complete a claim form and post it to:

HIF

GPO Box X2221 Perth WA 6847

Claim forms can be downloaded from hif.com.au or mailed to you on request.

For more information on the different ways to make a claim, check out the “How to Claim” page on hif.com.au

Ways to claim

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Premium Options Super Options Special Options Saver Options Type of service Additional

information Benefit Person limit Membership

limit Benefit Person

limit Membership

limit Benefit Person limit Membership

limit Benefit Person limit Membership limit

Ambulance As above Emergency:

100%

Non- emergency call-outs and transportation:

100% with a $50 co-payment Interhospital transfers:

No benefit

N/A N/A Emergency:

100%

No benefit

N/A N/A Emergency:

100%

No benefit

N/A N/A Emergency:

100%

No benefit

N/A N/A

Ambulance benefits

Benefit is paid on charges raised for approved ambulance services. On all our Extras cover except Vital Options, HIF fully covers the cost of emergency ambulance transport for cases classified by approved ambulance service providers as requiring urgent attention and where the patient is admitted to the emergency department of a hospital.

A patient co-payment of $50 per service applies to non-emergency call-outs and transportation.

Benefits are not payable for transportation from a hospital to your home, nursing home or other hospital, or for transportation for ongoing medical treatment.

Benefits are not payable for off road or air ambulance.

Vital Options cover will pay 50% of an emergency ambulance bill up to a maximum annual limit of $800 per person per

calendar year.

Where a member is eligible for a state or Federal government subsidy, HIF will pay a benefit, less this entitlement.

Note: Ambulance services, charges and levies vary significantly across Australian states and territories:

QLD & TAS

Residents are covered for unlimited emergency services provided by their respective state governments. Interstate ambulance service charges for these residents may not apply if reciprocal agreements are in place with the other states where the ambulance service was required.

NSW and ACT

Residents who hold HIF Hospital cover are covered for unlimited emergency ambulance services provided in their home state by their state government or territory ambulance service. Interstate emergency services may also be covered if under a reciprocal state agreement.*

All other emergency services In all other locations and circumstances, emergency ambulance services may be claimable from HIF Options covers, subject to the services being provided by the recognised St John or state government controlled ambulance organisation and the service being deemed as medically necessary by the attending ambulance officer.

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Extr as benefits

Premium Options Super Options

Type of service Additional information Benefit Person limit Membership

limit Benefit Person limit Membership limit Asthmatic

spacers N/A $18 2 per person

per year

No limit $18 2 per person

per year

No limit

Auxiliary Home

Nursing Benefits must be ordered by a medical practitioner. Contact us for conditions.

$120 $1,800 per

year

No limit $75 $1,800 per

year

No limit

Blood glucose or blood pressure monitor

A letter of

recommendation from the patient’s treating practitioner is required.

75% of cost 1 of either monitor every 3 years Max: $200

No limit 75% of cost 1 of either monitor every 3 years Max: $200

No limit

Chiropractic Benefits are paid for spinal manipulation or spinal adjustments carried out by a registered chiropractor approved by HIF.

Spinal adjustment – manipulation First visit:

$30 Visits 2-10:

$29 Visits 10+: $18 X-ray: $110

Combined annual limit (chiropractic and osteopathic) Up to 3 years:

$650 Over 3 years:

$750 1 x-ray per year

$1300 Over 3 years:

$1500

$28 Visits 2-10:

$23 Visits 10+: $14 X-ray: $85

$550 Over 3 years:

$1100 Over 3 years:

$1300

Special Options Saver Options

Type of service Additional information Benefit Person limit Membership

limit Benefit Person limit Membership

limit Asthmatic

spacers N/A N/A N/A No limit N/A N/A No limit

Auxiliary Home

Nursing Benefits must be ordered by a medical practitioner. Contact us for conditions.

N/A N/A No limit N/A N/A No limit

Blood glucose or blood pressure monitor

A letter of

recommendation from the patient’s treating practitioner is required.

N/A N/A No limit N/A N/A No limit

Chiropractic Benefits are paid for spinal manipulation or spinal adjustments carried out by a registered chiropractor approved by HIF.

$26 Visits 2-10: $21 Visits 10+: $10 X-ray: $70

Combined annual limit (chiropractic, osteopathic, physiotherapy, podiatry and complementary therapies)

$900

Spinal adjustment - manipulation:

First visit:

$26 Visits 2-10: $21 Visits 10+: $10 X-ray: $65

Combined annual limit (chiropractic, dietetics, healthy lifestyle, complementary therapies, pharmacy, osteopathic, physiotherapy and podiatry)

$700

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