Health cover

made simple
Your guide to HIF
and health insurance

Health Cover Guide for Australian Citizens and

Permanent Residents
The information in this Guide is correct as at
29 May 2023. Minor changes may occur after that
date. HIF members are encouraged to regularly
download the latest copy of this Guide from
hif.com.au/guide and read in conjunction with
HIF’s product factsheets.
Health Insurance Fund of Australia Ltd (HIF)
ACN 128 302 161. An Australian public company limited
by guarantee. A registered private health insurer.
 Contents
Why choose HIF? ....................................................... 3 Making claims..............................................................16
About HIF Hospital cover ........................................ 4 How to make an Extras claim ............................16
Inclusions, restrictions and exclusions ............ 4 HIF mobile app for members ............................16
Medical and hospital benefits, expenses Hospital claims and AccessGap accounts ....17
and gap cover .......................................................... 6
Frequently asked questions ..................................18
Hospital accommodation costs, upgrades
HIF and you ............................................................... 20
and co-payments .................................................... 8
Government legislation ..........................................22
Dental and podiatry surgery ............................... 9
Glossary .......................................................................24
Pregnancy and Birth Cover ................................. 9
Useful links ..................................................................27
About HIF Extras cover.............................................11
Need some no-obligation advice? .....................27
What is Extras cover? ............................................11
Inclusions and exclusions .....................................11
Benefits and limits .................................................12
Extras waiting periods .........................................13
Ambulance cover ...................................................13
Dental cover .............................................................14
Orthodontic benefits ............................................15

2 HIF – Health cover made simple

Why choose HIF?
HIF is the Health Insurance Fund of Australia, and we’ve been providing great value
health cover since 1954. As a not-for profit, here-for-you health fund, our members
and their well-being are the sole reason we exist.

Why choose us? It’s simple. More specific information

We’re all about doing the right thing. We created this Guide to answer any general
By our members. By our community. questions you might have about our Hospital
By the environment. and Extras cover. It’s been designed to be read
in conjunction with our product factsheets,
Less confusion. More choice. which outline our policies and include details
about specific benefits, inclusions, waiting
Health insurance can be confusing. We get it.
periods and more.
But that’s why we’re here, to make it easy
to understand, so you get the most from
your cover.

HIF – Health cover made simple 3

 About HIF Hospital cover
Let’s start at the beginning: What is Which medical health providers are
Hospital cover? recognised by HIF?
Our Hospital cover is private health insurance Generally, we pay benefits for government-
that covers you for overnight or same-day recognised health provider who provides
treatment as a private patient in an hospital or hospital substitute (in your home)
HIF-contracted or public hospital. services that are included in the Medicare
Benefit Schedule (MBS).
Hospital cover includes benefits for services
provided by:
What are hospital substitute services?
• Any HIF-contracted medical or hospital
Hospital substitute services are hospital
provider
services that are delivered in the comfort
• Non-agreement medical or hospital of your own home, including chemotherapy,
providers rehabilitation, complex wound management
• Public hospitals. (home nursing) and chronic health
disease management.
You’re also covered for a range of treatments
and services provided in your home (hospital If you’re not sure about the status of a provider
substitute services) by a recognised health or hospital substitute service, please call us on
service provider. 1300 134 060.

What are ‘agreement’ or ‘contracted’ Inclusions, restrictions and

private hospitals? exclusions
We have agreements in place with most private
hospitals across Australia. This means there is What hospital or hospital substitute
an agreed schedule of fees, including inpatient services are included?
accommodation, theatre and special care/ For all the inpatient services included in your
intensive care fees. These fees are charged policy (inclusions), you’re covered for hospital
by the hospital and paid by us on your behalf, accommodation and the delivery of medical
so on most occasions, you’ll never see a bill. treatments and services that are itemised in
So, wherever we have an agreement in the Medicare Benefit Schedule (MBS).
place, you’re less likely to have out of pocket Visit hif.com.au/hospital to check out our
expenses. However, if you’re admitted to Hospital cover factsheets for a comprehensive
a private hospital where we don’t have an rundown of inclusions, restrictions, exclusions,
agreement in place, you may have significant excesses and waiting periods – they differ from
out-of-pockets expenses and you may be cover to cover.
asked to pay up-front for your procedure.
Please note: If you choose to have an excess on What is the difference between an
your hospital policy this amount is also payable inpatient and outpatient?
upon admission to hospital, once per person
per calendar year (to a maximum of twice per An inpatient refers to a person who has been
couple or family policy). For some covers, the admitted to an approved hospital or day
excess does not apply for same-day admissions facility, allocated a bed and then discharged
and/or dependant children under the age of 18. following treatment.
For more information, please read your product An approved hospital means a facility which
factsheet or visit www.hif.com.au/hospital. has obtained a Hospital declaration from
the Government. It must obtain this in order
Where is your nearest ‘agreement’ to receive payments of health benefits
private hospital? from health insurers, following treatment of
We have hundreds of contracted hospitals insured patients.
in Australia. Visit hif.com.au/hospitalsearch An outpatient refers to a person who has
or call us on 1300 134 060 to find your received medical treatment in a doctor’s
nearest hospital. surgery or hospital emergency department
but hasn’t been admitted to hospital as
an inpatient.

4 HIF – Health cover made simple

What are restricted services? What’s not included in any of our
Take a look at our product factsheets and Hospital covers?
you’ll see some services or treatments referred The following services are not covered under
to as ‘restricted’.. This means the benefits for any of our Hospital policies:
that service or treatment are limited at the
basic public hospital default rate (only) for • Any treatment, service, pharmaceutical item
accommodation – it’s just a way to keep the or device, or circumstances of provision
cost of that particular cover down. which is:
– Not approved for payment by Medicare
Restricted benefits include:
or the Therapeutic Goods Administration
• The cost of a shared room in a (TGA)
public hospital – Does not meet the requirements or
• A benefit towards the cost of surgically standards legislated under the Private
implanted prosthesis Health Insurance Act (2007), including
• AccessGap cover for inpatient in-hospital services such as high cost
medical services drugs, experimental drugs, procedures,
prostheses and technologies
No other benefits are payable for restricted • Any treatment or service provided as an
services, so there could be significant outpatient (i.e. when you’re not admitted
out-of-pocket expenses for you. as an inpatient) or where you’re not
being treated by an approved hospital
What are excluded services or substitute service
exclusions? • Any ambulance or transport service (unless
Where services, treatments and items are you live in New South Wales or the ACT –
noted as excluded, it means no benefit is see the next section for more details)
payable for services that are not included on • Charges raised by your dentist for dental
your cover, therefore you are responsible for all surgery in hospital. If you wish to claim a
costs beyond the Medicare benefit. benefit towards the dentist’s fees you’ll need
Some HIF policies exclude benefits for certain to hold Extras Cover
services, treatments and items which means • Any treatment or service provided
the policy can be offered at a lower price. outside Australia
For more information on what’s excluded on • Any treatment or service for a patient
your cover, check out our product factsheets. who’s not eligible for Medicare benefits –
for example, cosmetic surgery
What should you do if the treatment • Any treatment or service where a patient
you need is restricted or excluded on has the right to claim costs from a
third party (e.g. another private health
your policy? insurer, Workers’ Compensation or motor
Always check with us, your doctor or hospital vehicle insurance)
prior to admission to ensure your planned • Any treatment or services by a provider who
treatment is covered (an ‘inclusion’) on your is not recognised by HIF
policy and that all applicable waiting periods • Respite care.
have been served.
If the treatment or service you are planning
is not covered and you do not want to be
liable for the personal expense that will apply,
you can ask your doctor to treat you as a
public patient in a public hospital (if they
practice in this capacity).

HIF – Health cover made simple 5

 Are ambulance services included on Medical and hospital benefits,
Hospital cover? expenses and gap cover
Ambulance cover is not included on any
of our Hospital policies, instead on eligible What is the ‘medical gap’?
Extras cover; however, under New South Wales
The medical gap refers to the out-of-pocket
and Australian Capital Territory legislation,
expenses that apply if your medical provider’s
we’re obliged to contribute toward the cost
fee is higher than the Medicare Benefit
of operating state or territory-provided
Schedule (MBS) fee for the services provided.
emergency ambulance services on behalf
of anyone with HIF Hospital cover who is If your provider’s fee is the same or less than
a permanent state or territory resident. the MBS fee, you’ll be covered by Medicare
and HIF. However, different providers can
Residents of New South Wales or the ACT
charge different prices for the same procedure,
with HIF Hospital cover simply submit
and if your provider’s fee is higher than the
their emergency ambulance invoice (from
MBS fee, you’re likely to have an out-of-pocket
their resident state or territory emergency
(gap) expense.
ambulance service) to us and we’ll finalise the
invoice with the relevant service provider. If you’re planning a procedure, ask your
medical provider and any associated health
Please note, ambulance benefits may not
provider (e.g. anaesthetist or assistant surgeon)
be claimable if the service was not provided
if they will participate in our AccessGap
by your local state-controlled ambulance
scheme (see below) to help minimise or
service, or if the service was not deemed by
eliminate your out-of-pocket expenses.
the ambulance attendant to be an emergency
(i.e. medically necessary). If they don’t confirm your out-of-pocket
expenses, contact us with your provider’s
For more info, please visit
details, item numbers and charges and we’ll
hif.com.au/ambulance
provide you with a benefit estimate.
What about Workers’ compensation What is HIF AccessGap Cover?
and dual insurance?
AccessGap Cover (our medical gap cover)
You’re not entitled to benefits under is designed to minimise or eliminate any
your policy if you can claim benefits or out-of-pocket expenses for inpatient medical
compensation (in full or in part) from a third services. Medical providers can opt in or out
party, including Workers’ Compensation or of the AccessGap scheme, so it’s important to
public liability sources, your employer or any check whether your provider will participate.
other insurance policy.
When will benefits for included
Can I get a medical benefit estimate services not be paid?
before having treatment?
Benefits won’t be paid for:
Absolutely! In fact, it’s something we strongly
recommend that you do. • Any claims submitted when membership
is not paid up to date (i.e. in arrears or
To request a benefit estimate in advance, suspended) when the benefit is claimed
please ask your doctor or specialist for a • Any claim for a service provided more than
detailed medical estimate (this will include two years ago
a list of the Medicare Benefit Schedule (MBS)
items you’ll be billed for and your doctor’s • Any treatment, service or item listed as an
provider number), then complete our exclusion on your policy
online estimate request form at • The benefit amount doesn’t exceed the
hif.com.au/medical-estimate excess payable on your policy
Alternatively, you’re welcome to call us on • Any treatment, service or item which is
1300 134 060 and we can provide a benefit provided within a waiting period
estimate over the phone. • Any treatment, service or item which is
subject to the Pre-existing Condition Rule
• Any treatment or service not yet received
• Any treatment or service not covered
by Medicare

6 HIF – Health cover made simple

When could benefits be less than the Find an AccessGap doctor or specialist
provider’s fee? Want to find a medical provider who’s part
You’re likely to have an out-of-pocket (gap) of our AccessGap scheme? Go to hif.com.au/
expense when: accessgap or call us on 1300 134 060.

• The treatment, service or item is listed as a What is an excess?

restriction on your policy
An excess is the amount selected on a hospital
• You’re admitted to a non-contracted
insurance policy which the member agrees to
private hospital
pay for a hospital admission before a benefit
• Your health provider doesn’t participate in will be payable from HIF. For more information
AccessGap and their charge is higher than on the excess that applies to your policy please
the Medicare Benefit Schedule (MBS) fee refer to the relevant product factsheet.
• Your health provider participates in
AccessGap but charges above the fully Do I have to pay an excess?
covered gap schedule fee
It depends on the cover you choose. If you
• Your policy requires you to pay an initial opt for cover with an excess, which reduces
excess amount your premiums, you’ll have to pay an excess
• You’re required or elect to pay a co-payment per-person per calendar year (to a maximum of
for a private room (if you’re not covered for twice per couple or family policy) if admitted
private room accommodation) to hospital.
• You were charged for services in a hospital Members can choose from a range of optional
that are not part of the treatment and care excesses to reduce their premiums.
for your admitted condition (e.g. access to a Visit hif.com.au/hospital to compare covers,
TV, internet access, vehicle parking) view our excess options or to read our
• You require a prostheses item that’s not product factsheets.
covered under the Government’s Approved
For some covers, the excess doesn’t apply
Prosthesis List
for same-day admissions and/or dependant
• You have take-home equipment, children under the age of 18.
appliances or items from your hospital stay
(e.g. pressure stockings, pharmaceuticals
and pharmacy items).

HIF – Health cover made simple 7

 Hospital accommodation costs, How do waiting periods work?
upgrades and co-payments Waiting periods apply when you first join HIF
or if you’re already a member and upgrade
Depending on the cover you choose, you’re your cover.
either fully covered for a shared room or a
private room in an HIF-contracted hospital. If you join us or upgrade to a higher level of
Hospital cover or take out an equivalent level
If your policy provides full cover for a shared of cover with a reduced or nil excess, waiting
room, you can still choose to upgrade to periods will apply to the higher level of cover
a private room – you’ll just be charged a and benefits. Your previous excess will also
co-payment by the hospital (i.e. the additional apply until you have served your waiting period
cost won’t be covered by your insurance). for pre-existing conditions.

The Pre-existing Condition Rule

Important
A 12-month waiting period for hospital
If you’re admitted to hospital and a treatment relating to a pre-existing condition
shared room isn’t available, you may be – it’s a rule that applies whether the ailment,
given a private room instead. In those illness or condition was known to the
instances (if you don’t have private member or not.
room cover), the hospital has the right
to charge you a daily co-payment for The pre-existing condition waiting period does
the duration of your stay. not apply to psychiatric care, rehabilitation and
palliative care (a two-month waiting period
applies to these services).

Hospital waiting periods and the A pre-existing condition is defined as,

Pre-existing Condition Rule ‘Any ailment, illness, or condition where, in the
opinion of a medical adviser appointed by the
A waiting period is the time you have to wait
health insurer, the signs or symptoms of that
before you can claim for a service, treatment
illness, ailment or condition existed at any time
or item. It’s the only way we can protect our
in the period of six months ending on the day
members from those who would otherwise join
on which the person became insured under
us only to make a big claim, then leave.
the policy.’
That’s why, if you switch to us from another
The pre-existing condition waiting period
health fund on an equivalent level of cover,
applies to new members and existing members
we’ll take your previous membership into
upgrading their cover. The test applied under
account, so you don’t have to re-serve any
the law relies on the presence of signs or
waiting periods already served.
symptoms of the illness, ailment or condition,
not on a diagnosis (i.e. it’s not necessary for
the member or their doctor to know what their
condition is or for it to be diagnosed).
In forming an opinion about whether or
not an illness is a pre-existing condition,
an HIF-appointed medical practitioner will
take into account information provided by the
member’s treating doctor.

8 HIF – Health cover made simple

Dental and podiatry surgery Pregnancy and Birth Cover
Is inpatient dental surgery covered? Do we provide pregnancy and
It depends on your level of Hospital cover; birth cover?
but assuming your policy includes dental Yes, we do – pregnancy and birth cover services
surgery and you undergo surgery by a are included on our Gold level of Hospital cover.
recognised dentist in a hospital, you can claim You’ll find more information about inclusions
benefits for theatre, accommodation and and benefits in our product factsheets available
anaesthetist costs. from hif.com.au/ hospital
Benefits towards your dentist’s costs
will only be paid under a suitable Extras What do you get with pregnancy and
policy (check out our Extras factsheets at birth cover?
hif.com.au/extras for details). This means,
Whether it’s your first or your fifth child, a new
if you only have Hospital cover, you won’t
addition to the family is always a magical time.
be able to claim a benefit towards your
But it can also be stressful, which is why it
dentist’s fees.
makes sense to take out pregnancy and birth
Is inpatient podiatry surgery covered? cover if you’re planning to have a baby –
it’ll give you more peace of mind as you plan
Again, it depends on the cover you choose – this exciting journey.
check out our Hospital cover factsheets or visit
hif.com.au/hospital to compare options. With HIF pregnancy and birth cover you can:

If your cover includes podiatry surgery, you can • Choose your hospital, obstetrician and other
claim benefits for hospital: specialists
• Enjoy private-room accommodation during
• Accommodation; and your stay in hospital. (Please refer to the
• The cost of a prosthesis as listed in the product factsheet for accommodation
prostheses list set out in the Private Health benefits on pregnancy and birth)
Insurance (Prostheses) Rules, as in force at • Claim for labour ward fees
that time.
• Your partner may be able to stay with you in
Please note: No benefits are paid for anaesthetist hospital as a boarder at no extra cost.
costs. Please call us on 1300 134 060 prior to
surgery to confirm your benefits payable. Please note: Private room and boarder
accommodation is subject to Hospital availability.

What is the waiting period for

Pregnancy and birth cover?
The waiting period for all pregnancy and birth
services is 12 months. That means you’ll need
to have held pregnancy and birth cover for
12 months prior to your delivery date.

HIF – Health cover made simple 9

 Will your baby be covered on your Ways to pay
Hospital policy? We’re all about choice and making life easy.
Yes, your baby will be covered on your family Choose the cover that suits you. Choose
policy. In fact, there’s no limit to the number your hospital, your doctor, your specialist,
of children that can be included on your your dental provider. And choose the most
family policy, and all child dependants may be convenient way to pay your premiums and
covered up to at least 21 years of age or up to make a claim.
31 years of age for those who are (a) registered • Direct debit. Flexible. Automatic.
as full-time students at a recognised Convenient. No wonder it’s our most
educational institution; and (b) not living in popular payment option.
a defacto relationship.
• Manually. We send you an account when
If you hold a single or couple membership, your premium is due and you can pay
you have two months from your baby’s date however you like.
of birth to add them to your policy. If you add • By phone. Call 1300 134 060 for
them after two months, they’ll have to serve over-the-phone credit card payments.
waiting periods.
• Via BPAY. Simply use your bank’s phone or
If you hold a family membership, you have four internet banking system.
years from your baby’s date of birth to add • Via our website. Simply visit hif.com.au/
them to your policy. If you add them after four members and log in to the secure
years, they’ll have to serve waiting periods. members’ area.
Read the ‘Frequently Asked Questions’ and • Post Billpay. Just hop on the phone or
‘Glossary’ sections in this Guide for more the internet.
information about dependants. • In person. At any Australia Post branch.
• By mail. Post your cheque or money order
and the lower half of your invoice to:
HIF, Whadjuk Country,
GPO Box X2221, Perth WA 6847.

Pay upfront and save

When you pay for six months’ cover in advance
you get a 2% discount. Pay a whole year in
advance and you’ll save 4% on your premiums.

10 HIF – Health cover made simple

About HIF Extras cover
What is Extras cover? What isn’t covered on included
services and when will benefits not
Extras health insurance covers you for
everyday general healthcare services, which are be paid?
not related to hospital treatment. The services You’ll find a detailed description of inclusions
must be provided by a recognised provider and exclusions for each of our Extras covers in
(or allied health service professional) – our product factsheets, but in general terms
dentists, optometrists, physios and many more our Extras insurance doesn’t cover:
– but you’re free to choose any provider you
like with HIF. • Any general treatment or service that does
not meet the requirements or standards
Which Extras providers are recognised legislated under the Private Health Insurance
Act (2007)
by HIF?
• Any treatment, service or item provided
We recognise and accept most providers. outside Australia
In fact, any allied health service professionals • Any treatment, service or item where a
who are registered with the Australian Health patient has the right to claim costs from
Practitioner Regulation Agency (AHPRA) – a third party (e.g. another private health
which regulates health practitioners and health insurer, Workers’ Compensation or motor
service delivery standards – are automatically vehicle insurance)
recognised. • Any treatment or service by a provider
For disciplines that aren’t regulated by AHPRA, who is not recognised by HIF, or services
we’ll assess and approve them on a case-by- which are not in the HIF-approved range of
case basis, based on formal qualifications. treatments (e.g. trainee providers)
• Any treatment or service deemed by HIF to
If you’re not sure if your chosen provider is
be inappropriate or not medically necessary
recognised, call us on 1300 134 060 to check.
for the patient’s condition (based on expert
clinical advice)
We know how important it is that • Any services that have already been claimed
you’re comfortable with your provider. from another insurer or where another
That’s why at HIF, we let you choose insurer or third party has a liability to cover
your own. that service
• Any treatment, service or item which is
claimable from Medicare
• Any treatment, service or item that is
Inclusions and exclusions provided within a waiting period or prior to
joining HIF
What services are included with
• Any policy which is not financial
Extras cover?
(i.e. in arrears or suspended) when the
We’re all about choice, which is why we offer benefit is claimed
a range of Extras options, giving you the • Any claim is for a service provided more
flexibility to choose the ideal cover for your than two years ago
budget and lifestyle.
• Any treatment, service or item not listed as
Check out our product factsheets to find out an inclusion on your policy
what services are included (inclusions) and • Any claim where you’ve exceeded the
excluded (exclusions) with each level of cover, maximum claimable limit or sublimit for a
or compare online at hif.com.au/extras. service (i.e. the maximum you’re allowed to
claim in a calendar year for a given service,
treatment or item).

HIF – Health cover made simple 11

 Benefits and limits
What is an annual limit?
Does Extras insurance cover the entire
The annual limit for a service is simply
cost of a service or treatment? the maximum amount we can pay
We pride ourselves on affordable premiums toward your claims in a calendar year
and great member benefits; however, (most limits are renewed at the start of
depending on your level of cover and the type every year).
of service, there may be a gap between the
cost of the service and the benefit you receive.
This is what’s called an out-of-pocket expense,
and it happens when: You have plenty of time to claim – all
claims must be made within two years
Benefits won’t be paid on included services if:
of the date the service was provided.
• The treatment, service or item fee is greater
than the maximum benefit payable by HIF
• You’ve switched to HIF from another health What about Workers’ Compensation
fund, and your old fund has already paid and dual insurance claims?
your annual limit on the service,treatment,
item in the current calendar year We’re unable to pay benefits if you can
• You’ve switched to HIF from another health claim benefits or compensation (in full or in
fund, claiming a benefit from both us and part) from a third party, including Workers’
them for the same service, treatment,item Compensation or public liability sources, your
and the combined benefit exceeds the employer or any other insurance policy.
annual limit or sublimit for the service,
treatment or item
• Your Provider performs more than one
Extras item limits and
consultation or treatment less than two replacement periods
hours after an identical service on the Benefits for some items – such as
same day. dentures, orthotics and hearing aids
are either limited in number or subject
Please read our product factsheets (available
to item replacement periods. For more
at hif.com.au/extras) for detailed info about
details on this visit hif.com.au/extras
benefits and annual limits.

12 HIF – Health cover made simple

Extras waiting periods Ambulance cover
Why do we have waiting periods? Do you get ambulance cover
Waiting periods exist so we can protect our with Extras?
members from people who would otherwise Yes! All of our Extras policies pay benefits
become members to claim for expensive for emergency ambulance callouts and
treatment, only to leave once their treatment transportation. Visit hif.com.au/extras for
is complete. If waiting periods didn’t exist, more information.
customers could take out private health
insurance or upgrade to a higher level of What ambulance services are covered?
cover only when they knew or suspected that
they might need cover and then immediately We recognise all emergency road ambulance
make a claim. This would lead to much higher transport services provided by the state/
premiums for all existing contributors to territory ambulance service. Benefits are
health insurance. only paid on charges raised for approved
emergency ambulance services that transport
Waiting periods apply to new policies, or you to the emergency ward of a hospital.
when you upgrade your policy to include more
services or higher benefits or annual limits. At HIF, on selected levels of Extras Cover,
Read our product factsheets for more info if your ambulance service is classified as
about specific waiting periods. ‘non-urgent’ by the attending ambulance
service personnel, all you have to contribute is
What happens if you switch to HIF or a $50 co-payment.
upgrade your cover? What ambulance services are not
If you join or switch from another health fund covered?
and you take out an equivalent level of cover
with us, we’ll take your previous membership Benefits are not payable for transportation:
into account, so you don’t have to re-serve any • From a hospital to your home, nursing home
waiting periods you’ve already served. or other hospital
For example, if you’ve already served the • For ongoing medical treatment
optical waiting period with your previous • Benefits are not payable for inter-hospital
insurer, and you switch to an equivalent or transport except in cases of emergency or
lower level of cover with us, you won’t have to new illness where approved on a case by
re-serve any waiting periods. case basis by HIF at its absolute discretion
But please note: • Private ambulance, off-road, sea and air
emergency ambulance service providers are
• If you switch from another Australian
not recognised and any services provided
health fund to a higher level of Extras
are not eligible for benefits from HIF.
cover with HIF (that provides additional
or higher benefits), waiting periods will be
applied before you are entitled to claim Do state governments subsidise
for the higher level of cover or benefits. emergency ambulance services?
During these periods, benefits will be Some do, and some pensioners and
payable at the equivalent benefit level of low-income earners may be entitled to free
your previous cover. ambulance assistance. If you’re eligible for a
• If you upgrade your existing HIF Extras government subsidy, we will still pay a benefit
cover to a higher level, waiting periods will (less your entitlement).
be applied for the higher level of cover or
benefits. During these periods, benefits will
be payable at the lower level of cover.
• If you switch from another fund, any
benefits paid by your previous insurer will
be considered when determining benefits
for your future claims in the same calendar
year (or regarding the Lifetime Limit
for orthodontics).

HIF – Health cover made simple 13

 How do ambulance services and Dental cover
ambulance cover differ from state
Before you start a course of treatment please
to state? contact us with full details of your proposed
Here’s a quick guide to the states and dental service before starting any course of
territories: dental treatment. That way, we can estimate
your benefit in advance, giving you total peace
Queensland and Tasmania of mind.
Residents are covered for unlimited emergency To request a dental estimate, call 1300 134 060,
services provided by their respective state email hello@hif.com.au or visit hif.com.au/
governments. Interstate ambulance service dentalestimate
charges for these residents may not apply if
reciprocal agreements are in place with the How are your dental benefits
other states where the ambulance service
was required. calculated?
We’ll pay a set maximum benefit or percentage
NSW and the ACT back for each service, treatment or item
Residents who hold HIF Hospital cover are depending on your level of cover.^
covered for unlimited emergency ambulance
services provided in their home state by their For more information, visit hif.com.au/dental,
state government or territory ambulance or read our product factsheets for details.
service. Interstate emergency services may ^Benefits may be limited where potential
also be covered if there’s a reciprocal state benefits exceed dental service sublimits
agreement. If you have Extras cover HIF will or annual limits.
pay for the ambulance bill; however depending
on your level of cover a co-payment of Dental Surgery
$50 may apply. Visit hif.com.au/extras for Dental surgery is classified as Hospital
more info. treatment for surgery to the teeth and gums.
WA, SA, Victoria and the NT Please note: If you undergo surgery by a
In all other locations and circumstances, recognised dentist in a hospital, you may
you can claim on your Extras insurance for be able to claim benefits for theatre,
emergency ambulance services, subject to accommodation and anaesthetist costs.
the service being provided by the recognised Benefits towards your dentist’s fees will only be
St John or state government-controlled paid if you also hold a suitable Extras product
ambulance organisation (the service being and have served all relevant waiting periods in
deemed as medically necessary by the addition to your Hospital cover.
attending ambulance officer).

Emergency ambulance transport

is when…an approved transport
ambulance service provider classifies
your case as requiring urgent attention,
or where you’re admitted to the
emergency department of a hospital.

14 HIF – Health cover made simple

 If your orthodontic treatment continues across
Orthodontic benefits multiple calendar years and you maintain
orthodontic cover under your Extras policy,
Having braces fitted?
we may pay benefits up to your annual limits
Braces are fitted and managed according to each calendar year, until you reach your
a personal treatment plan prepared by your lifetime limit.
orthodontist. This incorporates the initial
Contact us to prior to your treatment to
fitting of the braces, scheduled ongoing visits
understand how benefits will be paid and
for adjustments, and eventual removal of the
which limits are applicable to your level
braces as your teeth are gradually repositioned
of cover.
to the preferred alignment. Your orthodontist
will charge a ‘bundled’ fee for this treatment
Already on an orthodontic treatment
plan to cover all services that are likely to be
provided over the course of the treatment. plan and planning to switch to HIF?
If you’re already on a treatment plan and
How do you claim for your intend to take out HIF Extras cover, it’s
orthodontics treatment? important to note we only cover (bundled)
fees for the fitting and management of braces
While the total cost of your braces treatment
if you have an eligible level of Extras cover
plan is one bundled price, orthodontists may
on the date your braces are fitted and served
allow you to pay off your treatment plan in
the 12-month waiting period. If you don’t have
instalments. For some HIF covers, we pay
eligible Extras cover on the date your braces
the full applicable orthodontic benefit as an
are fitted, we’ll be unable to provide a benefit
immediate benefit (claimable when your braces
for any instalment payment plan or invoice.
are fitted), subject to your annual or lifetime
orthodontic limits.
Already have Extras cover and
For other HIF covers, we will pay a benefit per considering orthodontic treatment?
orthodontic item. In these instances, we’ll pay
benefits up to your annual limit on your Then please contact us on 1300 134 060 or
initial claim. email hello@hif.com.au with the details of your
proposed dental or orthodontic treatment
(your dentist or orthodontist can provide the
item numbers) and we’ll let you know how
much you can claim.

HIF – Health cover made simple 15

 Making claims
How to make an Extras claim Make Extras claims on the go
HIF members can choose from the following While swiping your membership card is still
options to lodge an Extras claim: the quickest way to make Extras claims, there
may be times when electronic claiming isn’t
On the spot. Healthcare providers with an option.
electronic claiming technology (HICAPS or
iSOFT) can settle your account with you When that happens, the HIF member app
on the spot. All you need to do is swipe is there to take the pain out of the manual
your HIF membership card and pay the process, ensuring you’re reimbursed asap.
difference (if any). All you have to do is:
Online. Our Online Member Centre gives you • Tap. Review and confirm your personal info
access to a range of services to help manage and claim details.
your policy including lodging an Extras claim • Snap. Use your phone or tablet to
online. Even better, you’ll instantly see the photograph your invoices, then the HIF
estimated benefit payable! Before you get member app will cleverly bundle them up
started, you’ll just need to ensure that your with your claim details.
provider’s fees are paid in full before uploading
• Submit. Hit the submit button to send your
receipts. Go to hif.com.au/members to
claim to us.
claim online.
On your mobile. Submit Extras claims anytime, Things to note
anywhere, with our easy-to-use mobile app.
It’s fast, free and reduces paper waste. Our handy app puts the power to claim in
the palm of your hand. When lodging a claim
By email. For paid Extras accounts, simply please bear in mind that:
email a scan of your completed HIF claim form*
and associated receipts to claims@hif.com.au. • The HIF member app can only be used for
Extras claims, not hospital or medical claims
By post. Complete a claim form* and post it to:
• Incomplete or illegible photographs of
HIF, Whadjuk Country,
invoices and other accounts will be rejected
GPO Box X2221, Perth WA 6847.
until an acceptable replacement is provided
*Claim forms can be downloaded from • Provider invoices must be paid in full prior
hif.com.au/claimform or mailed to you to lodging a mobile claim
on request.
• The date of service (on your invoice) must
be no more than two (2) years prior to the
HIF mobile app for members date you lodge a claim
Our handy mobile app enables members to • You must retain all original invoices/receipts
manage their policy at a time that suits them. for two years from the date you lodge
Available to download free of charge from the claim
the Apple and Android stores, the app lets
• HIF reserves the right to randomly select
you update your contact details, view your
claims for auditing purposes
policy information, lodge an Extras claim,
view your claims history and Extras limits, • Benefits for services, items or treatments
order replacement membership cards, contact rendered outside Australia are not payable
HIF plus more. by HIF.

Full terms and conditions at hif.com.au/legal-

stuff/hif-app-terms-and-conditions

16 HIF – Health cover made simple

Hospital claims and Don’t forget
AccessGap accounts To ensure your claim is processed as quickly as
possible, please remember to:
When you’re admitted to hospital as a
private patient, you’ll be asked to pay the • Complete both an HIF claim form and a
excess (if applicable). With your excess Medicare claim form, including:
paid, all hospital accounts will be forwarded • The member’s name
directly to us on your behalf. The same goes • The patient’s name
for your doctor’s accounts (this includes
• The healthcare provider’s name
surgeons, specialists, anaesthetists and
assistant surgeons). • An itemised account (original copy)
• The receipt (if paid)
Once we receive your HIF and Medicare claim
forms and your hospital and medical accounts, • Sign each new claim form before sending a
we can arrange payment of your HIF and copy to us
Medicare benefits, settling your accounts • Send your claim forms and any accounts
directly with your doctor or hospital. If any out you receive to us, not Medicare (claims sent
of pocket expenses apply, you’ll receive a bill to Medicare first are not eligible for any
from your provider. AccessGap payments).

Received a hospital or doctor’s What about inpatient pathology and

account in post? radiology accounts?
No problem. We’ll take care of it – simply Inpatient pathology and radiology accounts
request a reply paid to envelope and send to: can either be submitted to us or Medicare first.
HIF, Whadjuk Country, Claim forms for both HIF and Medicare are
GPO Box X2221, Perth WA 6847. required when submitting these accounts.

How to claim About to be admitted to hospital?

If you’re claiming for hospital or medical Please call us prior to admission so we can
treatment, you’ll need to complete two forms: help you with your claims and provide a
• Our claim form medical estimate.
• Hospital inpatient claim form. Please note:
• We’ll retain all documents relating to a claim.
Both forms can be downloaded from
hif.com.au/claim – you can type directly into • All claims must be lodged within two years
our claim form, then save or print a copy. of the date of service.

Please send your claims to: Please note: If you attend an emergency
HIF, Whadjuk Country, department of a private hospital and you are
GPO Box X2221, Perth, WA 6847. not admitted into the hospital, you may need
to pay a fee that will be determined by the
hospital. You will be informed of this by the
hospital staff at the time of admission.

HIF – Health cover made simple 17

 Frequently asked questions
How long can children remain on Which bills should I claim from HIF,
family policies? and which ones should I claim from
With HIF, your dependants may be covered up Medicare?
until the age of 21, or up to 31 years of age for If you don’t have Hospital cover, then you claim
those who are: directly from Medicare for medical services,
(a) registered as full-time students at a including doctors, specialists, eye examinations,
recognised educational institution; and X-rays and pathology.
(b) not living in a defacto relationship. However, if you have HIF Hospital cover, you
send all your inpatient hospital and medical
If I have private hospital insurance can claims and accounts to us, so we can arrange
payment of your HIF and Medicare benefits.
I still be admitted to public hospital as
a public patient? Similarly, if you have HIF Extras cover, we’ll
process all your bills for Extras services, such
Yes. Every public hospital is required to as dental, physiotherapy or optical treatments.
ask if you wish to be treated as a public or
private patient. It’s your choice if you use your Check out our Hospital and Extras product
insurance or not. factsheets for more information about what
we cover and learn more about how to make
When you’re admitted to a public hospital, a claim in the ‘Hospital claims and AccessGap
it’s usually at a time when you’re scared, in pain accounts’ and ‘Extras claims’ sections in
or stressed – particularly if it’s an emergency. this Guide.
And, it can be really confusing too.
When you’re asked for your private health What is the Medicare Levy Surcharge
insurance details it’s natural to just do (MLS)?
what you’re asked and hand them over.
The Medicare Levy Surcharge (MLS) is levied
Unfortunately, though, this is leading to
on Australian taxpayers who earn above
premium increases for everyone.
a certain income and don’t have private
So next time you’re admitted to a public hospital cover.
hospital, think about whether you really need
The MLS is an Australian Government initiative
or want to use your private health insurance
designed to encourage individuals to take out
and together we can all work to reduce
private hospital cover and, where possible,
premium increases.
to use the private hospital system to reduce
demand on the public system.
Visit hif.com.au/mls to calculate your
MLS eligibility.

What’s the difference between the

Medicare Levy and Medicare Levy
Surcharge?
Medicare Levy: this is a compulsory tax that’s
automatically deducted from your annual
taxable income if you earn over the income
amount set by the Government.
Medicare Levy Surcharge (MLS): this is an
additional tax which you’ll pay if you earn over
$93,000 a year as a single or $186,000 as a
couple/family (plus $1,500 for each dependant
child after the first one) and don’t have private
hospital insurance, or visit hif.com.au/mls to
try our MLS calculator.

18 HIF – Health cover made simple

What is Lifetime Health Cover (LHC) Is the Australian Government
loading? Rebate on Private Health Insurance
The Australian Government introduced means tested?
Lifetime Health Cover loading to encourage Yes, the Australian Government Rebate on
Australians to take out private hospital cover private health insurance is means tested, as is
at a younger age and encourage them to the Medicare Levy Surcharge (MLS).
maintain it.
There are four taxable annual household
To find out more about LHC loading income tiers for singles, couples and families.
visit hif.com.au/lhc The rebate you receive for holding private
health insurance and the size of the MLS
Does HIF cover same-sex couples? you pay are determined by your age and
Absolutely. We support choice and our annual income.
policies cover all types of couples and families. The Australian Government Rebate applies
We were also the first private health fund to to Hospital and/or Extras cover. For more
add our brand’s support to the Australian information on the Australian Government
Marriage Equality campaign back in 2014. Rebate, please visit hif.com.au/rebate
If you’d like to chat to one of our consultants
about joining HIF, or you’d like to add your
partner to your existing policy, please email
hello@hif.com.au or call 1300 134 060.

What isn’t covered by private

hospital insurance?
Private hospital insurance doesn’t cover you
for outpatient services. These services include
visits to your GP and consultations with
specialists, as well as X-rays and blood tests
(unless they’re taken once you’re admitted
to hospital).

HIF – Health cover made simple 19

 HIF and you
Our promise to you Compliments and complaints
We’re a not-for-profit private health insurer. We’re always looking for ways to continually
This means we don’t have shareholders, so any improve our service, products and benefits,
income we earn (after paying our members’ so your feedback is valuable to us, whether
benefits and covering our operating expenses) you’d like to lodge a compliment or
is used to pay bigger and better benefits a complaint.
in future.
Whatever your feedback relates to, we address
We aim to continually improve the value of our each and every compliment/complaint and will
products and services and make it easier for always respond accordingly. Your input is a
you to deal with us. We’ll keep you informed, vital part of ensuring our organisation meets or
treat you with respect and protect your privacy ideally exceeds your expectations at all times.
by fully complying with Australian legislation
If you have a compliment, complaint or
and industry best practice.
concern, you can:
Our Code of Conduct • Complete the online feedback form at
hif.com.au/contact-us
The Private Health Insurance Code of Conduct
is a self-regulatory code with the primary • Discuss it with one of our Member service
goal of is to maintain and enhance regulatory representatives on 1300 134 060
compliance and service standards across the • Email your feedback to hello@hif.com.au.
private health insurance industry. We support • Whether your feedback is positive or
and apply these industry standards in four negative, we promise to:
fundamental ways:
– Treat you with respect and deal with your
1. Our employees are trained in private concerns promptly
health insurance. – Resolve complaints in an equitable
2. The information we provide to you is manner, with the best interests of all
communicated in a way that is easy to members in mind
understand and allows you to make an – Escalate complaints (if necessary)
informed decision. and resolve them swiftly, within two
3. We openly communicate our procedures business days
for resolving any concerns you may have – Use feedback to improve our products
about your HIF membership and private and services by passing it on to our
health cover. Product team
4. We ensure that any information you provide – Invite you to further escalate complaints
to us is maintained in accordance with our (that could not be resolved to your
privacy policy. satisfaction) to our formal Member
Action Review Committee who will
To download a full copy of the
formally review all of your concerns
Code of Conduct, please visit
and our actions within one month of
privatehealthcareaustralia.org.au
lodging your complaint and will direct
a representative to advise you of the
outcome of the hearing within three days
of the Committee hearing
– If you’re not satisfied with the outcome
of our internal dispute resolution process,
For further information call HIF on 1300 134 060. you can seek an independent review by
the Private Health Insurance Ombudsman,
Our Commitment Health Care Compliant Commission or
Fair Trading Body in your State and/or
We will respect you and your circumstances,
the Australian Competition Consumer
with the intention of optimising the benefits
Commission. You can also contact the
you receive from your policy and ensuring
Ombudsman on 1300 362 072 or write
equity and value for all members.
to them at: GPO Box 442, Canberra,
ACT 2601 or Privacy Commissioner.

20 HIF – Health cover made simple

Your cooling-off period Your obligations to HIF
We offer a 30-day cooling-off period for new As an adult insured under an HIF policy,
HIF health insurance policies. If you decide you agree it is your responsibility to:
during this time that the policy isn’t right for
• Read and seek clarification if you’re unsure
you, you can cancel your policy and receive
of the policy terms and conditions relating
a full refund of any premiums you have paid
to you or your dependants, benefit eligibility
within 30 days of your policy starting, as long
conditions (including waiting periods),
as you haven’t yet made a claim.
the services you are covered for and the
circumstances under which they may not be
Your privacy
covered or only partially covered
The personal information you provide will be • Claim benefits for services to which you
primarily used to deliver the health insurance are lawfully and contractually entitled and
products and services you have requested. provide information relevant to your claim
The information you supply will remain or policy which is accurate and truthful
confidential. This information may be disclosed
• Pay your policy contributions within the
to third parties and authorised government
timeframe and manner agreed, including
agencies to facilitate the delivery of services
honouring your Direct Debit Service
associated with your health insurance.
Agreement, where applicable
Failure to provide personal information may
result in the failure to process or deliver the • Seek informed financial consent from your
service requested. health practitioner prior to being admitted
to hospital for treatment, and where you’re
Please note: Member’s privacy will be handled unsure of coverage, benefits or gaps,
in accordance with the Privacy Act, Australian contacting HIF in advance of any procedure.
Privacy Principles and HIF’s Privacy Policy.
For a complete HIF Privacy Policy Statement,
please contact us on 1300 134 060 or
download a copy at hif.com.au/privacy.

HIF – Health cover made simple 21

 Government legislation
The Australian Government Rebate on Lifetime Health Cover loading
Private Health Insurance The Government introduced Lifetime Health
The Australian Government Rebate on Private Cover (LHC) loading to encourage Australians to
Health Insurance is means tested, with four take out private hospital cover at a younger age.
annual income tiers for singles, couples and Not everyone is subject to LHC loading.
families. The rebate you receive for holding You won’t incur the loading if you:
private health insurance is dictated by your
age and annual income. • Are aged under 31 years old
• Had continuous private hospital cover since
For more information on the rebate,
1 July 2000
visit hif.com.au/rebate
• Were born on or before 1 July 1934
The Medicare Levy Surcharge • Are an Australian citizen or resident who
The Medicare Levy Surcharge (MLS) is a is overseas at the time of the deadline and
Government initiative, designed to encourage take out Hospital Cover within 12 months
individuals to take out private hospital of your return. (In order to review your
cover and, where possible, use the private LHC correctly, we will require a copy of
hospital system to reduce the demand on the your International Movements Record
public system. which you can obtain from Department of
Home Affairs)
The MLS is levied on Australian taxpayers
• Are a new migrant aged 31 or over but take
who do not have private hospital cover and
out hospital cover within 12 months of being
who earn above a certain income. The income
eligible for Medicare
thresholds increase incrementally, as does
the MLS itself, depending on your annual • Are a member of the Australian
household Adjusted Taxable Income (ATI). Defence Forces
• Are a Department of Veteran Affairs Gold
For a full rundown of how the MLS works,
Card Holder.
along with the current ATI thresholds,
visit hif.com.au/mls

Did you know…

If you’re likely to incur the MLS, it could
be more cost effective to take out HIF
Hospital cover – a number of our covers
could actually be cheaper than the
additional tax you’ll have to pay.

22 HIF – Health cover made simple

How is LHC loading applied? What if you’re already over 31?
For every year over the age of 30 that you If you’re over 31, it still makes sense to take out
don’t have private hospital cover, a 2% loading Hospital cover. Remember, the sooner you join,
is applied to the cost of your insurance the smaller your loading. And once you’ve held
(the loading increases each year until it continuous private Hospital cover for 10 years,
reaches 70%). your loading will be removed (as per the
Private Health Insurance Act 2007).
For example, a single 37-year-old person would
For more info, visit hif.com.au/lhc
pay 14% LHC loading – so it really pays to
take out private Hospital cover sooner rather
than later.
It’s slightly different for couples. The loading
is initially calculated based on your respective
dates of birth and then halved. For example, a
couple aged 33 and 36 years would generate
a combined loading of 18% initially (6% + 12%),
so the final loading that is applied to their joint
policy would be 9%.
If you find that you’ll incur a loading, you’ll
be required to pay this on top of the base
premium initially quoted for your HIF
Hospital cover.
If you decide to join HIF, your loading will
automatically be applied to the quoted amount
once you provide your date(s) of birth.

HIF – Health cover made simple 23

 Glossary
AccessGap Cover Dental Item Code
AccessGap Cover is our medical gap cover A dental item code is a three digit number for
arrangement, designed to minimise or dental items or clinical procedures considered
eliminate your out-of-pocket expenses for to be part of current dental practice by the
medical services when you’re an inpatient in a Australian Dental Association.
registered hospital or day facility.
Dependant
Accident
A person dependant upon the primary
An accident is an unforeseen event, occurring member. This includes:
by chance and caused by an external force or
• Partners
object which results in an injury to the body.
• Children, stepchildren, legally adopted
Admission children to whom the primary member is
The period of time during which a person the legal guardian (they must be under
is admitted for a condition or illness as an the age of 21, unmarried and not in a
inpatient into an approved hospital/day facility de facto relationship)
for the purpose of receiving hospital treatment • Student dependants – children, stepchildren,
until the time they are discharged from the legally adopted children and children
hospital/day facility. to whom the member is the legal
guardian, where the dependant is under
Annual limit
the age of 31 years, unmarried, not in a
The maximum limit of Extras benefits payable de facto relationship and enrolled in a
to a member in a calendar year, commencing full-time course of study at a recognised
1 January and ending 31 December. educational institution.
Approved service provider Excess
A provider or service that’s approved by HIF. The amount selected on a Hospital cover which
If you’re unsure about the status of a Hospital, the member agrees to pay before a benefit will
Medical or Extras provider, contact us on be payable.
1300 134 060. Unless stated, Extras services Excluded service
are not approved unless the health provider
and HIF member (patient) are both physically An excluded service means no benefit is
present in the health provider’s registered payable for services that are not included on
practice at the time of a consultation. your cover, therefore you are responsible for all
costs beyond the Medicare benefit.
Australian Government Rebate on Private
Health Insurance Extras services

The private health insurance rebate is an At HIF, we call ancillary cover ‘Extras’
amount the government contributes towards – it’s our name for all those day-to-day
the cost of your private health insurance healthcare services, such as dental, optical
premiums. The rebate is income tested which and physiotherapy, plus a whole host more,
means if you have a higher income, your rebate including emergency ambulance cover which
entitlement may be reduced, or you may not are generally not covered by Medicare. Extras
be entitled to any rebate at all. cover is also known as Ancillary or General
Treatment cover.
Basic Benefit (public default rate)
HICAPS/iSOFT
When the benefit payable is equivalent to the
benefits available if the service was provided in Providers with HICAPS or iSOFT technology
a shared room in a public hospital. can electronically claim your Extras benefit
directly from HIF.
Benefit
Inpatient
The payment due to the member for services
received by an approved provider. A person who has been admitted into an
approved hospital or day facility, allocated a
Couples bed and then discharged following treatment.
A couples membership includes one adult
member and partner only. It does not include
children/student dependants.

24 HIF – Health cover made simple

Medicare Benefit Schedule (MBS) Pre-existing condition
The schedule of benefits produced by the Under the Private Health Insurance Act 2007,
Department of Health, listing eligible services, a health insurer may impose a 12-month
fees and benefits for medical services, waiting period on benefits for hospital
including inpatient services. As an admitted treatment for pre-existing conditions.
patient (or inpatient), Medicare will pay
The pre-existing condition waiting period does
a benefit of 75% of the Medicare Benefit
not apply to psychiatric care, rehabilitation and
Schedule (MBS) fee.
palliative care (a two-month waiting period
Non-contracted hospital applies to these services).
A private hospital not contracted by the A pre-existing condition is defined as,
Australian Health Services Alliance or
“Any ailment, illness, or condition where, in the
HIF to provide services to HIF members.
opinion of a medical adviser appointed by the
Out-of-pocket costs cannot be guaranteed in
health insurer, the signs or symptoms of that
these hospitals.
illness, ailment or condition existed at any time
Out-of-pocket (Gap expense) in the period of six months ending on the day
on which the person became insured under
The amount remaining to be paid by the
the policy.”
member after the HIF and/or Medicare benefits
have been paid. Policyholder or Primary member
Outpatient The first named member on a policy,
irrespective of who pays contributions to HIF
An outpatient is someone who has received
for the provision of health cover. The primary
medical treatment in a GP’s surgery or
member also holds the legal responsibility to
emergency department and has not been
ensure the membership is kept financial at all
admitted to hospital. Benefits for outpatient
times and holds the right to add or remove
services are only payable by Medicare.
dependants from the membership. In the
Partner instance that the primary member wishes to
provide authority for another person to act on
A person who lives with a fund member in a
their behalf, a spousal/agent authority form
marital or de facto relationship and who is
is required. The person who is responsible
covered under the same fund membership.
for the insurance policy. Also known as the
Not withstanding the primary fund member ‘primary member’.
and partner may live apart temporarily.
Waiting periods
Practitioners in private practice
Any period occurring immediately after joining
A practitioner who does not: the fund or joining a higher level of cover,
• Use any publicly funded hospital, clinic, during which either some or all fund benefit is
health centre or other such facility, including not payable.
a facility provided by a municipal authority Recognised educational institution
for, or in connection with, the provision of an
An Australian, government-recognised
Extras service for which a benefit is claimed
educational institution such as a school, college
on Extras cover.
or university.
• Receive publicly funded assistance or
support, whether by way of remuneration, Restricted service
subsidy or otherwise, in connection with the Hospital services which are only covered for
provision of the Extras service, except where payments at the public default rate.
the Extras service is provided at the clinics
of strategic alliance partners, joint ventures Transfer certificate
or HIF’s clinics. The document transferred between registered
health funds, detailing the member’s fund
history (including ‘certified age at entry’),
confirmation of the financial status of the
member and claims history.

HIF – Health cover made simple 25

 Did you know... HIF can cover your
pets and travel plans too?
We understand the importance of
protecting your health (and your fur-kid’s
health) at home and away. That’s why
we also offer great-value pet and travel
insurance for HIF members. Visit hif.com.au
to find out more and get a quote.

26 HIF – Health cover made simple

Useful links Need some
• Hospital cover factsheets
hif.com.au/hospital
no-obligation
• Extras cover factsheets advice?
hif.com.au/extras
At HIF, we’re all about choice, which means
• Medicare Levy Surcharge calculator giving you more health cover and healthcare
hif.com.au/mls choices, as well as helping you make the
• Lifetime Health Cover loading calculator right ones.
hif.com.au/lhc If you’d like to discuss your options or you
• Get a health insurance quote need some clarification on anything you’ve
hif.com.au read in this Guide, please get in touch.
• Get a pet insurance quote hif.com.au
hif.com.au/pet 1300 134 060
• Get a travel insurance quote hello@hif.com.au
hif.com.au/travel
Whadjuk Country,
• HIF knowledge base GPO Box X2221
hif.com.au/help Perth WA 6847
• Online Member Centre The information in this Guide is correct
hif.com.au/members as at 2 December 2022. Minor changes
• Contact HIF may occur after that date. HIF members
hif.com.au/contact-us are encouraged to regularly download the
latest copy of this Guide from hif.com.au/
guide and read in conjunction with HIF’s
product factsheets.
Health Insurance Fund of Australia Ltd
(HIF) ACN 128 302 161. An Australian public
company limited by guarantee. A registered
private health insurer.

HIF – Health cover made simple 27

Freedom
to choose.
Call, email or visit us online.
hif.com.au
1300 134 060
hello@hif.com.au
Whadjuk Country GPO Box X2221 Perth WA 6847

Find us on:

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