Claims and payments
What do I need to know before I claim?
- Your premiums need to have been paid up to the date you received the service
- You must have served any relevant waiting periods
- You can't lodge a claim before the service has been provided
- Claims must be lodged within 2 years of the date of service
- The policyholder's (or nominated partner's) signature must appear on the claim form
- An HCF recognised health practitioner must provide the service
- Claims for artificial appliances may need a letter of authorisation from the practitioner, stating the condition being treated. If you'd like to claim for an artificial appliance please call us on 13 13 34 to find out if you need a letter from your practitioner
- Submit original receipts detailing the date of service, the item number, the description of service and the cost
- Claims relating to school accident cover must be made within 12 months of the date of the accident.
If you're treated in a participating private hospital, they'll send the bill directly to us. All you need to do is read the claim form carefully, answer the questions and sign it before being discharged.
Non-participating private hospitals and public hospitals will also send the bills straight to us.
If you're required to pay an excess or have restricted cover, you'll need to pay the excess and any gap payment directly to the hospital. This usually happens when you're discharged, but check with your hospital to make sure.
Doctor and specialist claims during hospital admission
If your doctor or specialist treated you under our Medicover agreement, they'll send the bills directly to us.
If your doctor or specialist sends a bill to you, please take it to Medicare and complete a Medicare Two-Way form then visit an HCF branch and complete a Medicare claim form and HCF claim form.
Here's how you can claim:
1. On the spot
This is the most convenient way to claim for services like your optometrist, dentist (claims for orthodontic treatment must be submitted by mail or at a branch), physiotherapist or chiropractor.
Using our electronic claims and payment system, you just need to pay the difference between the cost and benefit once the claim is approved electronically.
2. HCF app
Download the HCF app to submit a claim with a photo of your receipt.
- Complete and sign the claim form and, attach the original receipts (the receipts must have the name and address of the provider printed or stamped on them, not handwritten)
- Post the form to us at: GPO BOX 4242, Sydney, NSW, 2001
- We'll credit your nominated bank account, or send a cheque, if the receipt you’ve attached shows that you’ve paid the provider. If there's no receipt attached to the claim form, and only an account, a cheque will be drawn to the person or organisation that provided the service.
- We'll also send you a statement for your records.
You can claim at any HCF branch – bring your membership card and original receipts. The name and address of your provider must be printed or stamped on the receipt, not handwritten. We'll credit your nominated bank account, and give you a statement for your records.
To claim, log in to online member services, go to 'make an online claim'. Then post your original receipts.
You can claim online for:
- Diagnostic dental
- Preventative dental
- Periodontic dental
- Speech pathology
- Occupational therapy
- Remedial massage
- Pharmaceutical (non-PBS, limited items available)
- Artificial appliances
- Peak flow meter
Medicare doesn’t cover the cost of ambulances and these services can be expensive.
HCF hospital and extras include cover for State Government emergency ambulance services. Plus, on selected levels of cover, you may also be able to claim up to $5,000 per person, per year for non-emergency, medically necessary State Government ambulance transport (i.e. where your doctor requests ambulance transport because your condition requires medical monitoring and support in transit).
Ambulance transport is to the nearest appropriate hospital able to provide the level of care you need. There's a waiting period of 1 day for emergency ambulance cover, 2 months for non-emergency ambulance cover and 12 months for pre-existing ailments or conditions.
NSW & ACT members
If you live in New South Wales or Australian Capital Territory, a levy is included in the hospital component of your private health cover. This entitles you to free ambulance transport under the State Government ambulance transport schemes.
If you're sent an invoice for ambulance transport, send it to us and we'll settle it. If you have pension or social security entitlements in NSW or the ACT complete that section on the back of the invoice and return it to the ambulance service.
If you fall outside the state-based arrangement for ambulance services and aren’t otherwise covered, you can claim under your HCF cover for State Government-provided emergency ambulance services.
Qld & Tas members
If you live in Queensland or Tasmania, you’re covered under your state ambulance service scheme.
If you fall outside your state-based arrangement and aren’t otherwise covered for emergency ambulance services, you can claim under your HCF cover for State Government-provided emergency ambulance services.
Vic, SA, NT & WA members
If you live in Victoria, South Australia, the Northern Territory or Western Australia and don’t have an ambulance subscription with your state ambulance service and aren’t otherwise covered (including under another state-based arrangement) you can claim under your HCF cover for State Government-provided emergency ambulance services.
How can I make a payment?
You can choose your direct debit date (apart from the 28th, 29th, 30th or 31st of the month). You can pay your premiums yearly, half yearly, quarterly or monthly.
We'll advise you if your payment isn't made, and what you need to do to keep your membership up to date. Please note: If your account becomes overdrawn, some financial institutions may charge you a fee.
We guarantee to abide by the Direct Debit Customer Service Agreement so we can maintain a trusting relationship with you.
You can pay your premiums through direct debit from a bank, building society or credit union account. Complete and submit a payment authority form.
To set up automatic payments by direct debit from your credit card, complete and submit a payment authority form.
To change your details for direct credits, please call us on 13 13 34.
Payroll deduction is an automatic payment from your wages or salary. If your employer participates under an HCF Payroll Scheme, you can arrange to have your contributions paid directly from your salary or wages.
If you're unsure whether your company has a scheme, ask your Human Resource or Payroll team, or call us on 13 13 34.
You can make a secure payment with your credit card online. Just log in to online member services and go to 'make a payment'.
We accept American Express, MasterCard and VISA. Just call 13 13 34.
You can mail a cheque to us at: HCF, GPO BOX 4242, Sydney, NSW, 2001.
Please write your membership number on the back of your cheque. We can't accept cash through the mail.
With BPAY, you can make your payments any time online or over the phone on 13 13 34.
What are minimum benefits?
For procedures identified on your cover as 'minimum benefits', we'll pay the rate set out by the Commonwealth as the minimum shared room benefit, and benefits for government approved Prostheses List items, if applicable.
In a private hospital: These benefits wouldn't cover all hospital costs and are likely to result in large out-of-pocket expenses.
In a public hospital: If the minimum benefits are less than what your chosen public hospital charges, you may have out-of-pocket expenses to pay.
What are pre-existing ailments or conditions?
A pre-existing ailment or condition is an ailment, illness or condition where the signs or symptoms existed during the 6 months before you joined HCF or upgraded to a higher level of cover, even though you may not have been diagnosed.
If there's any doubt as to whether an ailment or condition is pre-existing, we'll appoint a medical practitioner to examine information provided by your doctor, together with other relevant claim details.
What's an exclusion?
If you need treatment for any procedures listed as an exclusion on your hospital cover, you won't receive any benefits from us and may have significant out-of-pocket expenses.
Ensure you've reviewed the exclusions list before buying your cover.
What are waiting periods?
Waiting periods must be served before you can claim for a service. They apply to:
- New members
- Existing HCF members who upgrade to a higher level of cover or reduce excess payable (In this case, you need to serve the necessary waiting period for the higher entitlement)
- Members who switch from another fund who haven't already completed the required waiting period for equivalent benefits
- New dependants, unless they switch from another fund where they've completed the required waiting period for equivalent benefits
- Hearing aid benefits for members switching from another health fund, irrespective of the previous cover held
- Treatment of a pre-existing ailment
- Members who cancel their policy for a period of time and then rejoin HCF without having cover with another insurer during the gap period.
Waiting periods vary according to the type of treatment or service and are as follows:
|Palliative care||2 months|
|Psychiatric treatment#||2 months|
|Rehabilitation services||2 months|
|Pre-existing ailments or conditions||12 months|
|Pregnancy & birth related services||12 months|
|All other hospital services||2 months|
|Health Management Programs||2 months|
|Artificial appliances (e.g. CPAP machine, blood glucose monitors)||12 months|
|Dental bleaching, bridges and crowns||12 months|
|Hearing aids||12 months|
|Occlusal therapy||12 months|
|Oral surgery||12 months|
|Pre-existing ailments & conditions||12 months|
|School Accident benefit||2 - 12 months|
|All other extras services||2 months|
|Emergency ambulance (where not for pre-existing ailments)||1 day|
|Medically necessary non-emergency ambulance (where not for pre-existing ailments)||2 months|
|Pre-existing ailments||12 months|
If you joined during an HCF waiver offer, waiting periods are only waived for extras with waiting periods equal to or less than the waiver. All other waiting periods in excess of the waiver apply.
Waivers are only available to new members taking both hospital and extras cover. All hospital services (including the same day excess) and ambulance services are excluded from the waiver offer.
* From 1 April 2018, members who've held hospital cover for at least 2 months and upgrade to Premium Hospital to receive psychiatric treatment as covered services may not have to serve the waiting period for psychiatric treatment. This exemption can only be accessed once in a member's lifetime.
What's an excess?
An excess is the amount you choose to pay if you're admitted to hospital for planned treatment. Depending on your level of hospital cover, you can reduce your premium by opting for a higher excess or pay a bit more to get a lower excess.
You won’t pay a hospital excess for dependant children.
You pay only one hospital excess amount per person per calendar year if an excess is applicable.