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HCF - Top Plus

At HCF, we like to do things differently. We're a not-for-profit organisation so our goal isn't to pay dividends to shareholders. It's to provide benefits to our members. That's why we don't charge our members a hospital excess for accidents, same-day surgery or dependants and why we include medical gap cover in all our Hospital covers. We also provide generous benefit limits for Extras like dental, optical, chiro and physio services. We offer outstanding private hospital access, and fast online claiming so our members can feel better, sooner. It's called the HCF difference, and it's our way of making sure our members get the most out of their cover.

V3.3 Excess $450 per person Excess applies Effective April 1 2011

to a maximum of $450 per calendar year for a single or single parent membership to a maximum of $900 per calendar year for a couple or family membership

NO Excess is payable for; same day surgery hospitalisation as a result of an accident. children or student dependants dependants covered on extended family policies

Hospital Service

Private Patient in HCF Participating Private Hospital

Private Patient Public Hospital

Hospital Waiting Periods

Accommodation Operating theatre Intensive Care Neo-natal Intensive Care Coronary Care Pregnancy and birth related services Assisted reproductive services (IVF, GIFT) Hip and knee joint replacements Cataract eye surgery Dialysis for chronic renal failure Psychiatric services (including eating disorders and postnatal depression) Pharmaceuticals in hospital directly associated with the reason for admission. Excluding experimental and very high cost non-PBS drugs. Rehabilitation programs Surgical weight loss procedures e.g. gastric banding Sterility reversals Cosmetic surgery Surgery by an accredited Podiatrist

yes yes yes yes yes yes yes

yes yes yes yes yes yes yes

1 day Emergency Ambulance 2 months Psychiatric Rehabilitation Palliative care. All other treatments except where there's a longer waiting period. 12 months Treatments for pre-existing ailments excluding Psychiatric, Rehabilitation, Palliative care.

yes yes yes yes

yes yes yes yes

Pregnancy and birth- related services A pre- existing ailment is an ailment or illness where the signs and symptoms existed any time during the six month before a member joined or upgraded to a higher level of cover, even though

yes

yes

a diagnosis may not have been made. If there is any doubt as to whether an ailment is preexisting, HCF will appoint an independent medical practitioner

yes yes

yes yes

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

yes minimal benefits minimal benefits

yes minimal benefits minimal benefits

If you choose a product which has minimal benefits for some procedures, then you'll be covered in a public hospital shared room, but your private hospital costs won't be fully covered.This means you may face significant personal expenses if you have any of these procedures in a private hospital. For procedures (such as those listed in this table) attracting minimal benefits in a private hospital, HCF would: Pay a small amount towards your accommodation; Pay for prostheses, if required (100% cover for no-gap prosthesis list items. There are a small number of prostheses

that will attract a gap); and Not pay operating theatre expenses, or labour ward charges.

In addition, there are some services where doctor's charges are not payable (for example, elective cosmetic surgery and surgery by an accredited podiatrist). For these, HCF will only pay a very small amount towards the total cost of the procedure (and no doctor's charges). This only applies to services which do not attract a benefit from Medicare.

Ambulance Full cover for emergency ambulance with State Government road or air services where you require hospital or on-thespot treatment in Australia. Up to $5000 per person per calendar year for State Government non-emergency ambulance services where your doctor requests ambulance transport because your condition requires monitoring and support in transit.

Super Multicover

V3.3 General Treatment Service Rebate effective 1/7/2011 General Dental Diagnostic Dental Examination (011) X-rays (022) - initial Subsequent visit $38 $29 $25 2 claims No limit 2 months Annual Limit per person per calendar year Waiting Period

Preventative Dental Removal of plaque (114 & 115) Application of fluoride (121) Restorative Dental Adhesive fillings - one surface (531) Adhesive fillings - two surfaces (532) Adhesive fillings - three surfaces (533) Orthodontic By an Orthodontist - two full arch banding(831) x 2 - accrues at $440 per year. or By a General Dentist - two full arch banding (831) x 2 - accrues at $440 per year. $1,000 sub limit of $1,000 lifetime limit $1,720 $2,640 lifetime limit 12 months $95 $108 $125 $550 $63 $25 2 claims 1 claim

Major Dental Crowns and Bridges Full crown non metallic indirect (615) $635 $800 per person Increases by $100 each year to $1,200 $800 per person every three years from date of Complete upper and lower denture $800 service 12 months

Dentures

Maintenance & repair

$37-$200

$200 sub-limit applies for maintenance & repairs

Other Dental Endodontic: Preparation of root canal (415) Oral Surgery - (eg. extractions) Root canal obturation (417) $100-$260 $150 $170

$500

General Treatment Service

Rebate effective 1/7/2011

Annual Limit per person per calendar year

Waiting Period

Optical Spectacle frames Spectacle lenses - pair Contact lenses - pair Disposal contact lenses Chiropractor Visit 1-2 Visit 3-11 Visit 12+ Chiropractic X-ray Osteopathy Visit 1-2 Visit 3-11 Visit 12+ Exercise Physiology Initial consultation Subsequent consultation Physiotherapy / Eye Therapy Visit 1-2 Visit 3-11 Visit 12+ Hydrotherapy/Group Physiotherapy Eye Therapy $53 $38 $18 $18 per visit $38 $600 - (Increases by $120 each year to $1,200) 2 months $40 $33 $45 $35 $18 $42 $33 $18 $63 $600 - (Increases by $120 each year to $1,200) Max $600 each for Chiro & Osteo. Max $300 for exercise physiology 2 months $135 $130 - $250 $140 - $250 $160 $250 2 months

Acupuncture / Naturopathy / Remedial Massage /Myotherapy /Homeopathy/ Alexander Technique/ Chinese Herbal Medicine Acupuncture - sub-limit $250 per person, Chinese Herbal Medicine- sub-limit $100 per person Initial consultation Subsequent consultation $40 $25 Combined Limit $600 2 months

Naturopathy/Nutrition, Remedial Massage/Myotherapy, Homeopathy, Alexander Technique - sub-Limit $250 per person Initial consultation Subsequent consultation $40 $25

General Treatment Service

Rebate effective 1/7/2011

Annual Limit per person per calendar year

Waiting Period

Speech Pathology / Audiology Speech Pathology Initial consultation Subsequent consultation $83 $51 $500 2 months

Audiology Initial consultation Subsequent consultation $58 $40 $350 2 months

Occupational Therapy Initial consultation Subsequent consultation Dietetics Initial consultation Subsequent consultation Podiatry Initial consultation Subsequent consultation $38 $34 $400 2 months $55 $40 $350 2 months $72 $50 $600 2 months

Psychology (after Medicare entitlement is exhausted) Per consultation Artificial Appliances HCF approved artificial appliances (eg: Nebuliser, TENS machine, Orthotics) Pharmacy (HCF approved, non-PBS) (non-PBS) An excess applies to all nonPBS drugs which is equivalent to the current PBS fee. $50 per drug per script. $700 2 months $600 12 months $80 $600 2 months

General Treatment Service

Rebate effective 1/7/2011

Annual Limit per person per calendar year

Waiting Period

Home Nursing, Travel and Accommodation Home Nursing $50 per claim Up to $100 per return trip per membership for travel per trip/ membership. Journeys of more than 200km for specialist/hospital treatment. up to $30 per night for accommodation Hearing Aids Benefits payable every 5 years depending on length of membership Less than 5 years - $800 6-9 years - $1,100 10-14 years - $1,400 15 years and more - $1,800 2 years $1,000 $400 sub-limit for Travel and Accommodation (up to $400 for travel & $200 for accommodation) 2 months

Health Management Programs HCF approved programs eg. First Aid Courses, Learn to Swim, Stress Management, Quit Smoking , Childbirth/Ante-natal Education, Lactation consultation, Weight Management & Exercise regimes (recommended by a GP or specialist). Other services School accident cover (approved general treatment related service only) 100% of cost (where benefits are not payable from any other source) $800 24 hours $200 per person $400 per family 6 months

Did you know?


Version 3.2 - Effective April 1 2011

Waiting Periods
Waiting periods must be served before benefits are paid. They apply to: New 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 benefit entitlement. Members who switch from another fund who have not already completed the required waiting period for equivalent benefits. New dependants, unless they switch from another fund where they have completed the required waiting period for equivalent benefits. Treatment of pre-existing ailment. Waiting periods vary according to the type of treatment or services and are as follows.

Hospital Waiting Periods


1 day - Emergency Ambulance 2 months - Psychiatric, rehabilitation and palliative care. All other treatments except where there's a longer waiting period. 12 months - Treatments for pre-existing ailments (excluding Psychiatric, Rehabilitation and Palliative care), Pregnancy and birth- related services. Please note: If your previous cover did not include a particular service and your new cover does, you will need to serve waiting periods for this service (2 months and 12 months for pre- existing conditions). If the excess you are paying with HCF is lower than the excess paid with your previous fund, and any one on the membership is hospitalised within the first 12 months with HCF, the higher excess will apply.

Extras waiting periods


2 months - All services except those below 6 months - Health Management Programs 12 months - Crowns, bridges, dentures, endodontics, occlusal therapy, oral surgery, periodontal, prosthodontics, dental bleaching and orthodontics, veneers, artificial appliances and pre existing ailments. 2 years - hearing aids/repairs

Participating Hospitals
To check the participating hospitals in your state go to: http://hcf/Services/participating_hospitals.asp?member_id=Guest

Non-participating hospitals
If you are using a non-HCF participating hospital you may incur out of pocket expenses. There are many factors involved in determining your benefit at a non-HCF participating hospital. For more details call HCF prior to going into hospital.

Minimal Benefits
If you choose a product which has minimal benefits for some procedures (such as pregnancy and birth-related services), then you'll be covered in a public hospital shared room, but your private hospital costs won't be fully covered.

This means you may face significant personal expenses if you have any of these procedures in a private hospital. For procedures (such as those listed in this table) attracting minimal benefits in a private hospital, HCF would: Pay a small amount towards your accommodation; Pay for prostheses, if required (100% cover for no-gap prosthesis list items. There are a small

number of prostheses that will attract a gap); and Not pay operating theatre expenses, or labour ward charges.

In addition, there are some services where doctor's charges are not payable (for example, elective cosmetic surgery and surgery by an accredited podiatrist). For these, HCF will only pay a very small amount towards the total cost of the procedure (and no doctor's charges). This only applies to services which do not attract a benefit from Medicare.

Pre-existing ailments or conditions


A pre- existing ailment is an ailment or illness where the signs and symptoms existed any time during the six month before a member joined or upgraded to a higher level of cover, even though a diagnosis may not have been made. If there is any doubt as to whether an ailment is pre- existing, HCF will appoint an independent medical practitioner to examine information provided by your doctor, together with other relevant claim details. Note 1: Procedures such as sterilization, reversal of previous elective sterilization, assisted reproductive services (e.g. IVF, GIFT) may be deemed to be pre- existing ailments. Note 2: If you join under a waiver, waiting periods are only waived for services with waiting periods equal to or less than the waiver. All other waiting periods in excess of the waiver still apply. All pre- existing ailments or illnesses and obstetric services attract a 12 month waiting period for both Hospital and Extras services irrespective of any waiver.

Pregnancy and Birth related Services


If you have a single membership, you will need to change to a Family membership 3 to 4 months before the birth so your new born has health insurance. The official waiting period for the unborn child is 2 months but changing cover earlier covers the possibility of early arrival. The 12 month waiting period for obstetric services starts from the date you first join the fund, whether you're planning a child or not.

Eliminating out-of-pocket medical expenses for hospital members


HCF has entered into arrangements with many doctors and a number of private hospitals. The arrangements eliminate both the medical gap for services provided by participating doctors and the need for HCF patients to handle multiple accounts or to claim from Medicare and/or HCF. HCF pays any gap fees for participating doctors, so that the patient has no out- of- pocket expenses. No gap hospital agreements. With HCF no gap hospital agreements, members can choose to be treated at participating hospitals by a participating doctor. This eliminates gap charges altogether and your medical bill is automatically paid by HCF. HCF Medicover. HCF Medicover is a direct billing system for doctors. If your doctor is willing to use this new system, all in-hospital medical services that you receive from your doctor will be covered by HCF, eliminating any gap charges. Also, with HCF Medicover, HCF pays your medical bills directly for you. There are also no gap pathology and radiology arrangements. With HCF's pathology arrangement with Australia's leading providers, members who find themselves in hospital will now be covered for the full cost of pathology services supplied by these providers. See the Did you Know section for more information about the Medicare Gap and the Medical Gap. HCF is not responsible for the care or treatment received from any hospital or other service provider nor for any aspect of the administration of a hospital or other service provider.

Who is covered?
Family cover The Policyholder, their partner and dependants listed on the policy. Only the Policyholder can determine who is covered under a membership. Cover for your dependants Your children are automatically covered at no extra cost under your family cover until the day before they turn 22. If your children are full-time students, simply register them as Student Dependants at the start of each academic year, and they will be covered for no extra cost until the day before they turn 25. If they cease study during that year their cover will lapse. If your children are not full-time students, you can also continue to cover them until they turn 25 with Extended Family Cover, available on certain levels of HCF cover. Otherwise, your grown children will need to take out their own cover. All new dependants must serve waiting periods, unless they are transferring from another membership or another private health insurer where they have already completed the relevant waiting periods. In this case they will need to request an Interfund Transfer Certificate from their previous fund, which is provided to HCF when joining. In addition, the Policyholder's children and student dependant must be: Unmarried and not in a de facto relationship; and Primarily reliant on the Policyholder and or (Partner listed on policy) for maintenance and support; and Related to the Policyholder (or Partner listed on policy) as a child, step-child, foster child or other children that the Policyholder (or Partner listed on policy) have legal guardianship over. The student dependant must also be:

A full time student at school, college or university. Couples cover The Policyholder and their Partner listed on the policy. Singles cover The Policyholder only. HCF Extended Family Cover HCF automatically covers your children until their 22nd birthday. With HCF Extended Family Cover you can continue to provide health insurance for your 22, 23 and 24 year old children, even if they are no longer studying full- time or living at home, as long as they are unmarried and not in a de facto relationship. For a small additional premium you can extend your cover to provide your children with the health insurance they need. On turning 25: With HCF Extended Family Cover your children remain covered until they turn 25 or until such time as they marry. HCF will contact you before your child's 25th birthday to notify you that your membership will revert back to your standard membership and invite your child to choose a cover that suits their individual lifestyle. Student dependants: Eligible students are covered free of charge until they turn 25. Extended Family Cover is available with HCF Top Plus Cover and HCF Hospital Savings Option. Extended Family Cover also applies to your extras cover when taken with these hospital products. Single Parent Family Cover As per Family Cover, excluding the contributor's nominated partner. Single parent families receive a reduction (approximately 20%) on the family rate of certain Hospital and Extras products. The reduction in applicable to your Extras cover on Levels 1 and 2 and your

Aged between 22

24 (inclusive); and

entire cover on levels 3, 4, 5 and 6. This reduction does not apply to Hospital Advanced Savings, Ambulance Only Cover and HCF Life Products. Family memberships and Single Parent Family memberships are not available for the Fit and Free policy and young singles and couples policies.

Overseas Cover
If you travel overseas you aren't covered. HCF cannot cover you for overseas medical expenses under your membership. However, you can obtain a 10% discount on travel insurance through HCF which will cover overseas medical Fit & Free policy holders are covered for emergency overseas medical expenses through their special overseas travel insurance. See www.hcf.com.au/fitandfree for details HCF supports the Private Health Insurance Code of Conduct ensuring: You will receive correct information on private health insurance You are aware of the internal and external dispute resolution procedures You can make an informed decision about your purchase through informative policy documentation You are protected in accordance with privacy principles A full copy of the code is available at www.privatehealth.com.au/codeofconduct

Resolution of problems
If you have any queries or feedback about any aspect of a health insurance product or iSelect's service, you could either call the consultant you dealt with or contact the Compliance Manager by telephone on 1300 735 255, and by email on compliance@iselect.com.au. If you have queries or feedback about the HCF products please contact HCF on 13 13 34. If you are not satisfied with iSelect's response you may contact the Private Health Insurance Ombudsman on 1800 640 695.

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

HCF APPLICATION FORM


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

OFFICE USE ONLY

MEMBERSHIP NUMBER ISSUED BY FUND

New Membership
R20810
Mr/Mrs/Ms/Miss/Other: _____________ Given name/s: Date of birth: Address: Town/Suburb: Phone: Home ( Email address: )

iSelect Client No. Change cover with Transfer Membership from another Fund HCF
ISN R/C 20 Customer Note No:

WB

1 0 8 6 3 8 4

Surname:

10-Jun-1986

(DD/MM/CCYY)

Occupation:

State Work ( )

NSW
Mobile

Postcode

thomas@veritechcorp.com.au

OTHER PERSONS TO BE COVERED


Given Name Family Name Date of birth Sex Relationship
Student YES/NO

PRE EXISTING AILMENT/CONDITION (PLEASE COMPLETE THIS SECTION)


Do you, your spouse/partner or any of your dependants have any pre-existing ailment/condition/s?
Members Name Details of Ailment/Condition/s

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

IMPORTANT: PLEASE READ AND NOTE Benefits are not payable in the first 12 months of membership for the treatment of a pre-existing ailment/condition, the signs or symptoms of which were in existence at any time during the 6 months prior to joining or upgrading to a higher cover, whether or not diagnosed by a doctor. This is an industry wide standard rule applied by Health Funds for the protection of existing members.

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


Type of Cover
Single Male

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


Conditional on receipt of payment within 14 days. (nominate date)

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

DECLARATION (PLEASE SIGN THIS SECTION WHERE INDICATED)


I declare all details stated to be true and correct and agree to be bound by the registered rules and by-laws of HCF as amended from time to time. I have read and understood the information for my chosen fund regarding pre-existing ailments/conditions, waiting periods, benefit limitations and lifetime exclusions (where applicable). I declare that all persons to be covered are permanent residents of Australia and entitled to full Australian Medicare Benefits. I will advise HCF of any changes to the information supplied on this application. I declare that dependant students aged between 22 and 25 mentioned on this form are attending a full time course of approved study. I declare that I have not been declined health insurance from any other fund on the basis of fraud. I understand that proof of identity and age may be required.

Signature x
HCFs Terms & Conditions are available at www.iselect.com.au/tc8
Please fax or mail pages 1 & 2 only. Fax: 1300 735 322 or call 1300 735 255 1

Date:

Mail: Reply Paid 2021 Moorabbin VIC 3189

HCF APPLICATION FORM


MEDICARE ELIGIBILITY
My Medicare card is My Medicare card number is Green Full unrestricted access Blue Interim card full unrestricted access until expiry date Valid To Yellow Reciprocal card restricted access until expiry date

FEDERAL GOVERNMENT REBATE


Please complete this section in full to receive the Federal Government 30% Rebate on private health insurance as a reduced premium. If you do not complete this section, full membership fees apply. Are all people nominated on Page 1 on this membership eligible for full Medicare benefits?

Yes No

If YES please complete the remainder of this section. If NO you cannot apply for the rebate until you obtain a card from Medicare.

Are you covered on this membership? Date premium reduction to commence

Yes

No

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

(Start date of this policy) Valid To

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

Some of the information provided on this form will be used for the purposes of registering you for the Federal Government 30% Rebate on private health insurance. Its collection is authorised by law, and information collected will be disclosed to the Department of Health and Aged Care, the Health Insurance Commission and the Australian Taxation Office.

Signature x

Date :

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

Please tick

Fortnightly

Monthly

Yearly

on the

1-27 day* of the month

*Please nominate your first debit day. Please note: debit dates of 28, 29, 30 and 31 are not available. This authorisation is to remain in force in accordance with the terms described in the HCF Direct Debit Customer Service Agreement.

Details of the Account to be debited


Name of Financial Institution Account name BSB No.

(All details must be supplied.)

Branch

Account No.

Signature x

Date:

2. CREDIT CARD AUTHORITY


Type of card (please tick) Visa MasterCard Debit frequency (please tick) Monthly Yearly

Please debit my account on the ________________________ day of the due month.


*Please nominate day. (If you do not nominate a day your account will be debited on the 7th day.) I acknowledge that the credit card I am using to pay for this insurance has been issued and used prior to paying for this insurance.

Card Holder's Name

Card No.

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

Signature x

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

DIRECT CREDIT OF CLAIMS

Name of Bank, Credit Union or Building Society


I request HCF to credit my/our nominated account with any amount which may be payable by the fund in respect of a claim or benefit on my membership.

Name on a/c

BSB No.

Account No. Date:

Signature x
Please fax or mail pages 1 & 2 only. Fax: 1300 735 322 or call 1300 735 255 2

Mail: Reply Paid 2021 Moorabbin VIC 3189