Frequently Asked Questions

When changing your level of cover, the lower level of benefits apply for 12 months for pre-existing ailments and pregnancy (childbirth). Restricted Benefits may apply for specific services. If changing to another cover you may no longer receive Excess Bonuses or your Excess Bonuses may be cancelled, please contact us for details.

If you are changing from another Australian health fund to HBA you may receive Restricted Benefits for some services if specified on your cover with HBA. You will continue to be covered for all benefit entitlements on your new cover that you had on your old cover, as long as you transfer to HBA within 30 days of leaving the previous fund. This is referred to as 'continuity of cover'. Where your level of cover differs from your cover with your old fund, the lower level of benefits applies for pre-existing ailments in the first 12 months.

I have a singles cover but have just married. How do we apply for a couples package?

Use the Change Cover form on the website. Make the relevant changes for the cover you would like to change to and submit your changes. You will be advised the difference in the premium you will be required to pay.

I have a singles cover but have just moved in with my partner. How do we apply for a couples package?

How do I change my cover?

Changing details

How do I change who is covered on my membership?

Use the Change Persons Covered form on the website. Make the relevant changes for the people you want covered by your membership and submit your changes.

I just recently married - how do I change my surname on my membership?

Simply change your name details with Medicare and then contact us to advise us of your name change. We will verify your name change with Medicare and then update our records.

How do I change my address telephone number or email address?

Use the Change Details form on the website. Update the relevant information and then submit your changes.

Claiming

What is the timeframe that claims have to be submitted after a service has been delivered or performed?

You can submit a claim for a service up to two years after it has been provided to you. This will be the date that appears on the receipt for the service used.

How do I make a claim?

Online
At HBA we have developed an online claims system which takes the pain out of paying your medical bills. It's so simple!

On-the-spot
Nationwide, there are now more than 17,000 health service providers that offer on-the-spot electronic claiming to HBA members for services covered by extras cover.

It's simple. You just swipe your HBA membership card after your treatment at a Members First extras provider, and pay only the outstanding balance, if any.

When and how can I use my Excess Bonus?

HBA has introduced a scheme that rewards members with Excess Bonuses on a number of cover options.

Some hospital covers offer an Excess Bonus feature, which entitles you to 1 excess-free overnight or same day hospital admission per calendar year on a single or single parent membership, and 2 excess-free overnight or same day hospital admission per calendar year on a family membership.

If you have hospital cover that offers the Excess Bonus feature and have also accumulated Excess Bonus dollars prior to 1 April 2007, you will be able to use your Excess Bonus dollars towards the payment of any excess on a dollar for dollar basis once you have used your excess-free hospital admission/s.

How do I know what I can claim?

To find out what your private health insurance covers you for, log on to My HBA Online and check out the full policy page.

Complaints

Who do I talk to if I have a complaint?

If you have a complaint or query regarding your cover or the terms and conditions that apply to your cover (these are called "Our Fund Rules"), please contact us. Our consultants will endeavour to resolve any issues you may have but if you are not satisfied with our response, then you can contact the Private Health Insurance Ombudsman. It has been established by the Commonwealth Government to deal with enquiries and complaints about any aspect of private health insurance on 1800 640 695.

Cover type

How do I choose a cover that suits my needs?

At HBA we have developed an online system that allows you to walk through your stage of life and to match our insurance offerings with what you want from your health insurance. It only takes a few minutes and will help you to choose a cover that suits your needs!

What is packaged cover?

HBA offers some packaged covers, which combine hospital cover and extras cover. These include: Ultimate Health Cover*, Young Couples Choice, Young Singles Saver and Young Singles Choice.

* Please note that Ultimate Health Cover is not available through ANZ Health at this time.

What is extras cover?

Extras cover is private health insurance for health services that are not covered by Medicare, such as dental, physiotherapy, optical, chiropractic, osteopathy, massage, Chinese herbalism, acupuncture, naturopathy and homoeopathy that are all considered "extras". Medicare provides no rebates for these health services so you have to pay the entire bill. That's where extras cover comes in...meaning depending on your choice of extras cover you don't have to pay full price for services included under your extras cover.

What is hospital cover?

Hospital cover is private health insurance that covers you for the cost of hospital treatment and some medical expenses incurred during admission to hospital.

With HBA hospital cover, depending on your level of cover you are covered within our network of Members First or Participating Private hospitals, or public hospitals in Australia for the following:

Accommodation fees for overnight or same-day stays
Operating theatre, intensive care and labour ward fees
Pharmaceuticals supplied to you while in hospital as part of your hospital treatment (covered by the Pharmaceutical Benefit Scheme)
Allied services such as physiotherapy, occupational therapy and dietetics
Surgically implanted Government-recognised No Gap prostheses

You are covered for the cost of any medical treatment up to the Government Schedule fee - this is the amount set by the Federal Government for each medical service covered by Medicare. Medicare pays 75% of the Schedule fee and HBA pays the remaining 25%. If your specialist charges more than the Schedule fee, there will be a `gap? for you to pay. However, our Ezyclaim system can help to eliminate or reduce the gap for you.

HBA hospital cover also allows you to choose your own hospital and doctor or specialist. And on top of your hospital cover you receive cover for ambulance services.*

* Please refer to the full policy details to determine what is covered. Level of cover for ambulance services is dependent on the provisions of your state of residence, membership type and level of hospital cover.

What is a Cover?

A cover is the type and level of health insurance you take out. There are three types of covers: hospital cover, extras cover and packaged cover. The level of cover varies depending on the services you want to be covered for and how much you wish to pay.

Can I change my level of cover and if so what do I have to do?

Naturally, you can switch between HBA cover options as your needs change.

Why are the rates for couples the same as those for families?

Rates for couples are the same as those for families because children are insured for 'free' under their parents cover.

What sort of cover do I need if I am a single parent?

At HBA we've made health cover for single parents cheaper than for a family membership (2 adults plus) and we have a range of affordable, quality hospital and extras covers to suit your budget and needs. View our range of single parent cover options.

I am in a couple - is it more cost effective to purchase a family or couples membership or 2 singles memberships?

No, family membership is the same price as two singles covers. Young Couples Choice is designed specifically for young couples.

Who can be covered by a family membership?

HBA's Family membership covers you, your partner and your single children under 17 years.

Family Plus membership covers you, your partner and your single children under 25 years.

Who can be covered by a couples membership?

HBA's Couple membership covers you and your partner living with you in a bona fide domestic relationship (such as legally married or defacto), including same sex couples.

Who is covered by a singles membership?

This covers the individual member only.

If I change the level of my cover are there additional Waiting Periods that I have to serve?

When you change your level of cover with us if we pay a benefit for a service on your new cover that was not covered under your old level of cover, we may require you to serve a Waiting Period or a period of Restricted Benefits for that new type of service.

Emergency ambulance cover

How does ambulance cover differ from an Ambulance subscription?

In all states except WA, the ambulance cover that is on top of your hospital cover only covers for recognised emergency-only ambulance transport services or on-the-spot ambulance treatment*. This is capped at one service for a single membership and two services for couple, single parent and family memberships each calendar year - unless you have Ambo Cover, in which case you are covered for unlimited emergency services.

We define an emergency as an event that is unplanned, non-routine, and in which you require immediate medical attention. You are not covered for transportation from a hospital to: your home, a nursing home, or another hospital (where the member has been admitted to the transferring [first] hospital). You are also not covered for transportation from your home, a nursing home or hospital for ongoing medical treatment, e.g. Chemotherapy or dialysis.

An ambulance subscription to your state ambulance service covers you for transportation and treatment by the ambulance service that is not restricted to emergency-only ambulance transport services and on-the-spot treatment.

Please note that benefits for ambulance subscriptions are not payable by HBA but the state ambulance service.

* The level of emergency ambulance cover may vary depending on your state of residence, membership type and level of cover. Please refer to the full policy details for further information.

Does my cover include ambulance cover?

On top of most HBA hospital covers you will receive cover for recognised emergency-only ambulance transport services or on-the-spot ambulance treatment. The level of ambulance cover you receive is dependent on the provisions of your state of residence.

If you live in VIC, SA or NT you will receive cover for capped recognised emergency-only ambulance transport services or on-the-spot treatment.

If you live in NSW or ACT, you pay an ambulance levy as part of your hospital cover premium. This entitles you to recognised emergency-only ambulance services under the State Government ambulance transport schemes in every state except QLD and SA. When you receive an account for ambulance services in any state except QLD and SA, simply send it to us and we will endorse it for you to send back to the appropriate ambulance transport scheme. In QLD and SA you will receive cover for capped recognised emergency-only ambulance transport or on-the-spot treatment.

If you live in QLD or TAS you will receive full ambulance cover under your state ambulance service. If you fall outside of your state based arrangement, you will receive cover for recognised emergency-only ambulance transport or on-the-spot treatment.

If you live in WA you will receive full ambulance cover nationwide, including uncapped non-emergency transportation and on-the-spot treatment.

Cover for recognised emergency-only ambulance transport services or on-the-spot ambulance treatment on top of your hospital cover is is capped at one service for a single membership and two services for couple, single parent and family memberships each calendar year - unless you have Ambo Cover, in which case you are covered for unlimited emergency services.

We define an emergency as an event that is unplanned, non-routine, and in which you require immediate medical attention. You are not covered for transportation from a hospital to: your home, a nursing home, or another hospital (where the member has been admitted to the transferring [first] hospital). You are also not covered for transportation from the member?s home, a nursing home or hospital for ongoing medical treatment, e.g. Chemotherapy or dialysis.

If you do not have an ambulance subscription with your state ambulance service and need to make a claim for emergency ambulance services covered on top of your hospital cover, please complete and return to us the Particulars of Ambulance Transportation form [in addition to your claim form?].

Government related

What is Lifetime Health Cover?

Lifetime Health Cover (LHC) is a system introduced on 1 July 2000. It affects how much you pay for your private health insurance with hospital cover by recognising your years of membership.

Basically, you won't have to pay a Lifetime Health Cover loading if:

You first took out private health insurance when you were 30 or under and you have had private health insurance without any break (or any break less than 2 years) since you took it out),

Have had private hospital cover at 1 July 2000 and have maintained it since; or

You were born before 1 July 1934.

You need to join before you turn 31 to aviod incurring a loading over and above your normal insurance premium (2% for every year you are over 31, up to a maximum of 70%). For example, if you join at 30 you pay a lower annual premium when compared to joining at 50, as you will then have to pay a 40% loading.

So what does all this mean? The sooner you take out private health insurance, the less loading you will have to pay.

What is the Government Schedule fee?

An amount set by the Federal Government for each medical service covered by Medicare. This amount is used to determine the rebate payable by Medicare. It is reviewed at least once a year to take inflation into account.

What is Medicare Levy Surcharge?

All Australian taxpayers pay the government's 1.5% Medicare Levy. If you fall into either high income earner category below - and don't have private health cover - you'll also pay the Medicare Levy Surcharge (MLS), which is another 1% on top of that again.

If you're a single and on more than $50K a year, or a couple with a combined annual income over $100K (and you don't have private hospital cover), the Government classifies you as a high income earner. This means you'll be hit with the Government's 1% Medicare Levy Surcharge. If you take out a low cost HBA hospital cover option, that is less than the surcharge you will not have to pay the surcharge, and have access to benefits.

What is the Government Pharmaceutical Benefits Scheme (PBS)?

PBS is a scheme funded by the Commonwealth Government to subsidise certain drugs. It is administered by Medicare. If you take out a hospital cover, we will pay for PBS drugs provided as part of your hospital treatment when admitted to hospital.

How can I claim the Federal Government Rebate?

You can claim the Government Rebate as a reduction on your premium paid to HBA (this requires a completed Government Rebate Application form), as a refund from a Medicare office (on presentation of a HBA contribution receipt), or as a rebate through your annual tax return.

Who is eligible for the Federal Government Rebate?

The Federal Government's Rebate is available to everyone who is eligible for Medicare and has private health insurance.

What is the Federal Government Rebate?

The Federal Government's Rebate is available to everyone who is eligible for Medicare and has private health insurance. The Rebate applies to both hospital and extras premiums and is not means tested.

The amount of Rebate you are entitled to is calculated based on age or whether a Savings Provision Entitlement is applied to your membership. There are three levels of rebate:

Under 65 years - 30% Government Rebate

65 to 69 years, or persons on a policy that also covers someone aged 65 to 69 - 35% Government Rebate

70 years or over, or persons on a policy that also covers someone aged 70 or over - 40% Government Rebate

What are the benefits of Private Health Insurance?

30% off your premium - The Federal Government contributes 30%, 35% or 40% (depending on the age of the people covered on your policy) of your private health insurance premium, which effectively cuts the cost of your cover by, at the least, almost a third.

You may save on tax - Private health insurance may reduce the tax you have to pay. If you're single and earning more than $50K a year, or a couple with a combined annual income of over $100K - and don't have private hospital cover - you'll be hit with the Government's 1% Medicare Levy Surcharge. That's on top of the normal 1.5% Medicare Levy imposed on all tax payers.

If you take out private health insurance you will not have to pay the Medicare Levy Surcharge. Take out and maintain private hospital cover by age 31, and you will not have to pay the Government's Lifetime Health Cover loading on your premiums. Under the initiative, your age is determined by how old you are on 1 July before you join. If you're over 31, the sooner you take out private hospital cover, the less loading you pay.

What does Medicare cover?

While Medicare is acknowledged as one of the world's best public health systems, it only covers things like:

Treatment at general and specialist practitioners

Treatment at public hospitals

A portion of the cost of medical treatment in private hospitals by surgeons, anaesthetists and other specialists

What is Medicare?

Medicare is Australia's public health system. It covers all Australian citizens and permanent residents. A compulsory Federal Government public health insurance scheme covering all Australian residents, it is partly funded by a levy on taxable income. It covers public hospital treatment and doctor services.

What is Private Health Insurance?

Private health insurance is about having choice and access, and being in control of your situation. It's the only affordable way to choose your own hospital, your own doctor and your own timeframe. Just as extras cover is the only option if you want to pay less for dental, physiotherapy, optical, chiropractic and all the other every day health services not covered by Medicare. Currently almost 8 million Australians (40%) have private health cover.

What is Savings Provision Entitlement?

There are circumstances where you may be entitled to an increased Government Rebate. The Savings Provision Entitlement ensures that people remaining on a policy that has been eligible for the 35% or 40% Government Rebate do not have their rebate amount reduced to 30% when the person aged 65 years or over leaves or cancels the policy.

The Savings Provision Entitlement only applies when the person 65 years or over leaves or cancels the policy after 1 April 2005. Anyone who is aged under 18 or a full-time student under the age of 25 at the time the person leaves the membership cannot inherit the 35% or 40% Rebate.

Hospital cover

How do I find a recognised provider or participating hospital?

Search for your closest Participating Hospital by entering your state and suburb. If you select a specialty, only hospitals offering that specialty will be listed OR Search for a particular hospital by entering the hospital's name or part of the hospital's name.

What is the difference between public and private hospitals?

Public hospitals

If you go into a public hospital as a public patient, you are fully covered under Medicare. That's the good news. The not so good news is that you'll have little or no say over who treats you, or when.

If you go into a public hospital as a private patient, your HBA hospital cover will pay for some of the costs associated with your treatment. You get to choose your doctor but you'll still have little or no control over where or when you get treated.

Private hospitals
If you go into a private hospital, Medicare will cover a portion of your medical treatment costs, but not a cent of your accommodation and theatre expenses. The only way to cover yourself for those bills - and they usually have plenty of zeros - is with hospital cover offered by private health insurance. HBA, preferably.

Our hospital cover contributes to the portion of treatment costs not covered by Medicare:

The Government sets a dollar amount for types of in-hospital medical treatment, known as the "Schedule Fee"

Medicare pays 75% of the Schedule Fee

HBA private hospital cover pays the remaining 25%

Sounds simple? It's not.
Some doctors and specialists charge more than the Schedule Fee. The difference between the two is the "gap", which is normally up to you to pay, but if your doctor or specialist uses our Ezyclaim system, they agree with HBA to either charge you no gap or a maximum gap that is agreed with us. They also agree to bill us directly. So in most cases, there's no gap and no bill!

What is not covered by my hospital cover in a private hospital?

There are a small number of private hospital services that are never covered by a health fund's hospital cover:

Outpatient treatment, which is where you receive treatment at a private hospital but are not actually admitted to hospital
Medical costs for surgical procedures performed in hospital by a dentist or podiatrist cannot be covered as they are not eligible for Medicare rebate
Pharmaceuticals supplied on discharge from hospital, unless covered by your extras cover

Services that can be claimed elsewhere such as via a compensation claim eg. Worker's Compensation or TAC

All hospital covers have Restricted Benefits for cosmetic surgery and sterilisation reversal that will result in significant out-of-pocket costs

Your level of cover sets out the types of services covered. If it is not stated that a service is covered, then it is not covered by that level of cover:

Some levels of cover exclude specific services to make it absolutely clear that you will need to upgrade to cover that service. This means you will not be covered for that particular service whilst on that level of cover. The types of services that may be excluded are: all pregnancy related services, including childbirth; heart and artery related services; psychiatric services; assisted reproductive services, including IVF; hip or knee replacements; rehabilitation services; and cataract surgery
Some services have a Waiting Period. You will not receive benefits for these services during the Waiting Period. A Waiting Period starts from the date you join. Once the Waiting Period is over, you will receive the full benefits listed under your level of cover for that treatment type. All hospital covers have 12 month Waiting Periods for pre-existing ailments and pregnancy (childbirth), where applicable.

If you transfer to HBA from another health fund on an equivalent level of cover we will honour all

What is a non-participating private hospital?

Private hospitals HBA does not have an agreement with. If you go to a non-participating private hospital, we pay lower benefits which are unlikely to cover the cost of your stay. Therefore you will be "out-of-pocket" by the amount that the hospital charges over your benefits.

What is a recognised provider or participating hospital?

Recognised providers and Participating hospitals are providers and hospitals with which HBA has established agreements that help to minimise out-of-pocket expenses for its members.

At Participating hospitals, which includes most private hospitals and all public hospitals in Australia, you're covered for the following in-hospital services:

Overnight and same day accommodation
Operating theatre and intensive care fees
Supplied pharmaceuticals that are approved by the Pharmaceutical Benefits Scheme and provided as part of your treatment
Allied services such as physiotherapy, occupational therapy and dietetics
No Gap prostheses that are surgically implanted and Government recognised

Joining

Can I suspend my membership if I lose my job and temporarily cannot afford it?

At HBA we understand that sometimes there's the odd bump in the road. If you are retrenched or your position is made redundant, on some levels of hospital cover we will pay your health insurance premium (at the same level of cover) for up to 12 months, as long as you remain unemployed. The main conditions are:

If you have a family membership, only the main income earner is eligible
The main income earner must have been continuously employed for at least six months prior to being retrenched or made redundant
You must have been enrolled in a level of hospital cover that includes 'unemployment cover'* for the preceding 12 months

* Please note that 'unemployment cover' is not currently available through ANZ Health.

What is not covered by my private health insurance?

To keep premiums to a minimum, some HBA hospital and extras covers have 'Waiting Periods', 'Exclusions' and 'Restricted Benefits' that apply. Though these terms sound confusing, they are pretty much self-explanatory. For example:

If your hospital cover has a one year Waiting Period on pre-existing ailments, it means that you cannot claim for any hospital stay relating to that ailment in your first year of HBA membership.

If your cover has an Exclusion on some services, you cannot claim for those services.

If your cover has a Restricted Benefit on a medical treatment or condition, you will only ever receive minimum default benefits set by the Minister for Health for that treatment or condition.

When does my cover start?

Your cover will start as soon as you have competed our application process and paid us all premiums due at the time you apply. Waiting Periods and some Restricted Benefits may apply so please make sure you check out how these impact your membership before you join.

How do I join?

Online
You can fill out and lodge an application form online. Your cover will commence either from a future date that you nominate or as soon as we receive the forms, providing you return the forms we send you with your first payment within 14 days.

Contact us
Contact us and an enrolment form will be sent to you the same day. Your cover will commence either from the date you nominate or as soon as we receive the forms, providing you return the form to us with your first payment within 14 days.

Lifetime Health Cover Loading

How can I avoid Lifetime Health Cover?

Take out private hospital insurance before you are 31 and maintain your hospital cover and you can avoid the loading.

Why did the Government introduce Lifetime Health Cover - has the Government Rebate failed?

The Lifetime Health Cover scheme was part of the Government's comprehensive strategy to arrest the decline in private health insurance membership and ease the burden on the public health system. The first step was the introduction of the 30% Rebate, which addressed the issue of affordability of private health insurance. Lifetime Health Cover was designed to build on the Government Rebate by increasing membership stability among the young and healthy.

I think it is unfair that older people will face penalties?

The new system was only introduced after a moratorium period of 12 months to allow people to consider taking out health insurance if they wanted to avoid paying the penalty. Lifetime Health Cover encourages young, low-risk members to take out health insurance earlier.

Who is affected by Lifetime Health Cover?

You will have to pay the Lifetime Health Cover loading, if you are:

Aged over 30 and were aged under 65 on July 1st 1999 and are not currently covered by private hospital insurance

I have been with your fund for 25 years and hardly claimed - why not introduce loyalty and no claim bonuses instead of Lifetime Health Cover?

To reward members for their loyalty, HBA has a loyalty scheme on a number of cover options. This scheme rewards members with Excess Bonuses. Excess Bonuses are either excess-free hospital admissions or Excess Bonus dollars that are allocated to the member's account each year and can be used towards the payment of any hospital excesses. For more information, please refer to the 'What is an Excess Bonus' FAQ.

Will the sick be penalised?

No. After the introduction of Lifetime Health Cover, registered health funds are still prevented by law from charging different premiums depending on the health status or claims history of their members. Waiting Periods for members with pre-existing ailments will continue to apply.

Why do people over 65 get a special provision under this scheme?

People who were aged 65 or over on 1 July 1999 are not affected by the new scheme. The Government recognised that by the age of 65 the majority of Australians have retired and are living on fixed incomes. This special provision ensured that people in this age group did not feel that they were under any pressure to take out private health insurance when they may not be able to afford it.

How does Lifetime Health Cover affect people if they wish to switch between funds?

Under Lifetime Health Cover, people are still able to transfer between funds as they always have. All health funds are obliged to recognise the certified age at entry of any contributor wanting to transfer from another fund.

What happens if someone is unemployed goes overseas or simply chooses to drop out for a while?

The Government recognised that there are going to be times when people need to drop their hospital cover. For example, if people are travelling overseas for extended periods of time or in the case of unemployment. To cater for this, people can drop their hospital cover for up to 24 months, cumulative, without having to pay an additional loading when they are ready to take out hospital cover again. Health funds currently have discretion to allow periods of absence to members if they wish. The Government expects that health funds will still use their discretion to consider increasing the allowable period of absence beyond 24 months in circumstances of genuine hardship such as long term unemployment or extended overseas postings. If a member drops their membership for longer than 24 months, without their health fund agreeing to an extension, they will be required to pay a loading for each additional period of 12 months absence if they return to private health insurance. They will still pay a lower premium than someone of the same age who joins for the first time.

How is the Government Rebate affected by Lifetime Health Cover?

The Rebate applies to the whole premium as it always has, including any applicable loadings on top of the base rate premium.

Does Lifetime Health Cover affect premiums for extras cover and ambulance cover?

Lifetime Health Cover does not apply to extras cover or ambulance cover. It only applies to hospital cover.

Will people still be able to vary the level of their private health insurance cover under Lifetime Health Cover?

Yes. People will still be able to upgrade or downgrade their hospital cover under Lifetime Health Cover without affecting their certified age at entry. The usual Waiting Periods and applicable pre-existing ailment rules will still apply.

However, because Lifetime Health Cover only applies to hospital cover, if you decide to drop your hospital cover and simply maintain your extras cover, your certified age may be affected.

What is the maximum loading someone would ever have to pay?

The Government has capped the loading for late entry at 70%. If in future a person delays joining until they are 65 or over, and they were not born before 1 July 1934, they will pay the base rate plus a loading of 70% for late entry.

Will people under 30 who take out hospital cover pay less than the base rate premium?

No. People who are aged under 30 when they take out hospital cover will pay the same premium as 30 year olds.

When did Lifetime Health Cover take effect?

Lifetime Health Cover came into effect on 1 July 2000.

What does a person need to do to lock in base rate premiums under Lifetime Health Cover?

Under Lifetime Health Cover, if a person takes out hospital cover before they turn 31, as long as they maintain their cover, this will lock in that person's certified age of entry at 30.

People who already had hospital cover with a registered health fund on 1 July 2000 did not have to do anything. Their fund automatically gave them a certified age at entry of 30. People who were born on or before 1 July 1934 do not have to do anything either, even if they do not already have private health insurance. People in this age group are able to join a registered health fund at any time during the rest of their lives and pay the base rate.

Members site and password

How do I logon to My Member area?

To logon you'll need your membership number and your password. If you haven't logged on before, you'll need your name, postcode etc. and you can set your password online for immediate access to My HBA Online.

How do I change my password?

Use the Change Password form on the website. You will be required to enter your old password, a new password and a reminder message in case you forget it in the future!

I have forgotten my password - how do I log into my account?

Click on ?Lost your password? from the left hand menu, which will display the Member Site Login. Enter your membership number and then click on the ?View your Password Reminder? link at the bottom of the page. A pop up will provide you with your Password Reminder.

Membership card

I have misplaced my membership card. How can I get a new one?

Use the Order a card form on the web site. You will be asked to logon using your membership number and your password to access the form. Enter the relevant information and then submit. You will receive your new card within 10 working days.

Will I get a membership card?

Yes. Upon joining, all HBA members receive a membership card that lists the type of cover, membership number and the names of those covered. You can use your membership card to make on the spot claims with our Electronic Claimings system. You will receive your card within 10 working days of joining HBA.

No Gap Dental

Is orthodontic treatment included?

No, orthodontics are excluded.

Does 'No gap dental' for kids include wisdom teeth extraction in hospital?

No, only procedures done at a Members First dentist are fully covered. As circumstances can vary with our Members First dentists please contact us for further information.

We are with another health fund and would like to switch will we be eligible for 'No gap dental' for our kids as soon as we join?

If you switch to HBA from a health fund where you and your children were on an equivalent level of extras cover to one of the eligible HBA covers and have served all the applicable Waiting Periods, you will be able to access 'No gap dental' for your kids from 1 October 2006.

However, if you switch to HBA from a health fund where you and your children are not on an equivalent level of extras cover you will only be able to take advantage of 'No gap dental' for your kids once you join HBA on an eligible level of cover and have served any applicable Waiting Periods.

If you have any queries or would like to switch to HBA, please contact us.

What are the applicable Waiting Periods?

If you are not already on an eligible level of cover with HBA and upgrade, or are not on an equivalent level of cover to the eligible HBA covers with another health fund before you switch to HBA, then the Waiting Periods for 'No gap dental' for kids are:

2 months for General Dental
12 months for Major Dental, root fillings, complex fillings, dental sleep apnoea devices and pre-existing ailments

Can we take our kids to any dentist and get 'No gap dental' for them?

No, your kids will need to receive treatment at a Members First dentist to enjoy the benefits of 'No gap dental'. Find a Members First dentist.

Which covers are eligible for 'No gap dental' for kids?

To enjoy the benefits of 'No gap dental' for your kids, you and your children need to be covered by a Family or Family Plus hospital cover plus one of the following extras covers: Platinum Extras, Gold Extras, Silver Extras, General Extras, Premier Extras, Ultimate Health Cover Extras, Executive Extras, Corporate Extras, Corporate 80 Extras or Corporate 60 Extras.

We are already members are we automatically eligible for 'No gap dental' for our kids?

Providing you have one of the eligible combinations of HBA hospital and extras cover and have served all applicable Waiting Periods, you will be able to take advantage of 'No gap dental' for your children from 1 October 2006.

If you do not have one of the eligible combinations of HBA hospital and extras cover you can upgrade and will be able to take advantage of 'No gap dental' for your children once you have served any applicable Waiting Periods. Until all applicable Waiting Periods have been served on your new level of cover your dental benefits will be payable under your previous level of cover.

If you have any queries or would like to upgrade please contact us.

Up to what age can our kids receive 'No gap dental' on one of the eligible levels of cover?

On HBA Family memberships, any single children under 17 and single full-time students under 25 are covered.

On HBA Family Plus memberships, all single children are covered up to the age of 25, even if they are no longer students and living away from home.

Payment

How can I pay my premiums?

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Pregnancy

How much notice do we have to give to change our hospital cover to make sure the birth of our baby and the baby are covered?

A Waiting Period applies to all HBA hospital covers for pregnancy related services, including childbirth. If you decide to have a baby, you need to take into consideration that Waiting Period if you wish to have the baby in a private hospital or as a private patient in a public hospital. To cover the baby once it is born, you will need to take out a family membership before your baby is born. You can change your cover at any time by using the Change Cover form on the website or by contacting us.

If I have a baby is my child covered under my health insurance policy?

Your baby can be covered under your health insurance policy if you have a family membership. If you have a single membership, you need to transfer to a family membership before your baby is born. Your baby is not required to serve any Waiting Periods or Restricted Benefits.

What sort of cover do I need if I want to have children and I want to cover the birth?

All HBA's hospital covers include pregnancy, except Young Singles Choice and Young Couples Choice.

A Waiting Period of 12 months applies, with no benefits payable during this time for any pregnancy related services, including childbirth. Restricted Benefits apply to some of our hospital covers. If you transfer to a higher level of cover, benefits are automatically payable at the previous level of hospital cover.

What are pregnancy related services?

Medical services that are directly related to pregnancy and childbirth such as ante-natal services, complications of pregnancy, delivery itself and post natal care of the mother.

We are having a baby - when do I need to add my baby to my membership so it is covered?

To cover the baby once it is born, you will need to take out a family membership before your baby is born. If you do not take out a family membership before the baby is born, your child will need to serve the standard Waiting Periods. You can change your cover at any time by using the Change Cover form on the Member website or by contacting us.

I want to have a baby but my current cover does not cover me for pregnancy. What are my options and what do I need to do to cover myself?

You will need to contact HBA to change your level of cover. We have many options that will cover you for pregnancy related services after your Waiting Period has been served. A Waiting Period applies to all HBA hospital covers for pregnancy related services. If you decide to have a baby, you need to take into consideration that Waiting Period. If you wish to have the baby in a private hospital or as a private patient in a public hospital you will not be covered for 12 months from the date you change. You can change your cover at any time by using the Change Cover form on the website or by contacting us.

Student/Dependents

I am still living at home but just finished studying at university full time - what do I need to know?

If you have just finished studying at university full time you will no longer be covered by your parent's family membership, unless they have a Family Plus membership and you are under 25 years old. If the former applies, you have 2 months from the date of completion of your final studies to purchase your own cover to ensure that you do not lose the Waiting Periods already served on the family membership.

I am still studying at university - do I need health insurance?

If you are single, aged 17 to 24 years and studying full time, you can continue to be covered under your parent's Family or Family Plus membership.

I have just finished school and am joining the work force - what do I need to know for my health insurance?

If you are listed on your parents family membership and leave school during the year, you have 2 months to take out your own membership on the same level of cover as your parent's family membership to ensure that you maintain the Waiting Periods and Restricted Benefits previously served.

If you complete the school year, you can remain on your parents family membership until 1st March the following year. Following which, as long as you take out your own membership at a similar level of cover to your parent's family membership, you will maintain the Waiting Periods and Restricted Benefits previously served.

If your parent's membership is a Family Plus membership it will cover you and any other non-studying children up to the age of 25, even if they live away from home.

To what age are my children covered under my health insurance cover?

If your child is aged 17 to 24 and is studying full time, they can be covered under your Family or Family Plus membership.

Alternatively, if your child is single, aged 17 to 24 years and working or in part-time study, you can cover them under a Family Plus membership. They can be covered under your membership even if they live away from home. Family Plus covers you, a partner and any single children up to their 25th birthday, and single full-time students under 25 years.

Summary of Cover

When will I get my Summary of Cover for this financial year?

If you opt-in before 8:00pm EST on 30 June your Summary of Cover will be available for you online from early July. Otherwise, we'll post it to you by mid-July.

What do I have to do to get a Summary of Cover?

If you are an existing member, or have held private health insurance with HBA during this financial year but suspended it, we will automatically provide you with a Summary of Cover. It will be either posted to you by mid-July, or if you opt-in before 8:00pm EST on 30 June, we'll make it available for you online in early July.

Can I get a Summary of Cover earlier?

Yes, you can request a Summary of Cover at any time. Simply contact us and ask one of our customer service consultants to send you one, or you can request a Summary of Cover online.

Why do I need a Summary of Cover?

The Summary of Cover provides a summary of your current Lifetime Health Cover status as well as an overview of your current level of cover.

Will I receive anything else along with my Summary of Cover?

If you are an existing member, or have held private health insurance with HBA during this financial year you will also receive a Tax Statement.

Do I need my Summary of Cover to complete my Tax Return?

No. The Summary of Cover is for your personal records only.

I am heading overseas to work for a couple of years. Can I suspend my membership and if so what do I need to do?

If you have been a member for 12 months, you can suspend your health insurance twice for a period of between 2 months and 2 years. While your membership is suspended, we do not pay benefits and that period will not count towards any Waiting Periods or Restricted Benefits. Please do not hesitate to contact us if you have any queries.

Switching Funds

How do I switch from another Health Insurance provider?

It's simple! Just check out our online application form and we can transfer your health insurance to HBA in no time! Or contact us at any time.

Can I transfer between health funds?

If your cover starts within 30 days of the end of your cover with another health fund, we will take into account any Waiting Periods already served by you before joining HBA.

If we pay a benefit under the HBA cover you choose for a service not covered under the cover you had with the other health fund, we may require you to serve a Waiting Period for that service.

If you are a member of another health fund, but wish to transfer to HBA, please refer to our information on Switching Funds.

Tax Statements

When will I get my Tax Statement for this financial year?

If you opt-in before 8:00pm EST on 30 June your Tax Statement will be available online from early July. Otherwise, we'll post it to you by mid-July.

What do I have to do to get a Tax Statement?

If you are an existing member, or have held private health insurance with HBA during this financial year, we will automatically provide you with a Tax Statement - either we'll post it to you by mid-July, or if you opt-in before 8:00pm EST on 30 June, we'll make it available for you online in early July.

Can I get my Tax Statement earlier?

Tax Statements include details of all payments processed by HBA up to and including 30 June. This means we cannot begin processing them until after that date. Though it takes some time to process all of our members' Tax Statements, we get them out to as quickly as we can. If you opt-in to receive your Tax Statement online before 8:00pm EST on 30 June it will be available for you online from early July. Otherwise, we will post it to you by mid-July.

Why do I need the Private Health Insurance Tax Statement?

You may need it to complete your Tax Return. Your Tax Statement will have details of the number of days you have been covered by an appropriate level of patient hospital cover during the last financial year. If you did not have an appropriate level of private patient hospital cover for the full financial year and fall within certain income brackets, you may be liable for the Medicare Levy Surcharge. For more information, please refer to question M2 in TaxPack 2008, question 26 in Retirees Tax Pack 2008 or question 43 in the Short tax return instructions 2008.

Your Tax Statement will also outline premium reductions you have received due to the Federal Government's Rebate on Private Health Insurance as well as details of any additional rebate you may be able to claim as part of your Tax Return. For more information, please refer to question T5 in Tax Pack 2008, question 22 in Retirees Tax Pack 2008 or item 37 in the Short tax return instructions 2008.

If you have any questions about the rebate, please call the Australian Taxation Office helpline on 132 861.

Will I receive anything else along with my Tax Statement?

If you are an existing member, you will also receive a Summary of Cover, which provides a summary of your current Lifetime Health Cover status as well as an overview of your current level of cover.

Do I need my Summary of Cover to complete my Tax Return?

No. The Summary of Cover is for your personal records only.

What is an exclusion?

An exclusion for a service means that no benefits are payable for that service.

Are there any conditions of membership?

When you take out private health insurance cover with us, you become a member of our fund. The terms and conditions of your membership are governed by Our Fund Rules. Some of the key terms that apply to your cover are include in these Frequently Asked Questions. You should note that not every term that applies to your cover is included here. These are contained in Our Fund Rules. A full copy of these can be obtained from our head office or on request by contacting us .

Before you take out cover, you should take the time to read these Frequently Asked Questions. If you have any further questions, we encourage you to contact us.

When you take out cover with us and become a member of our fund, you consent to the collection, use and disclosure by us of your personal and health information to provide private health insurance to you if you take out a Family, Family Plus or couples membership.

You acknowledge that we may collect, use and disclose personal and health information about the other people on your membership and the person nominated as owner of the membership will be notified of details of services claimed under the membership which may include personal and health information about you and those other people. You are responsible for ensuring that those other people are aware, before you include them, that by being included on and claiming under the membership their personal and health information will be disclosed to the owner of the membership.

We may end your membership at any time if you have not paid your premiums for 2 months or if you breach Our Fund Rules.

What is Ezyclaim?

If your doctor or specialist charges more than the Government schedule fee for your hospital treatment, it's up to you to pay the 'gap'. With our EzyClaim system, your doctor agrees with HBA on the fee charged for services and also agrees to bill us directly. So in most cases, there's no gap and no bill, and if there is a gap, you will know the maximum amount you will have to pay prior to your treatment. How 'Ezy' is that!

What is C-POS?

An electronic claiming facility for extras.

What is cosmetic surgery?

Any type of surgery where Medicare does not pay a benefit.
Some examples of cosmetic surgery are:

Augmentation mammaplasty

Liposuction

Reduction of eyelids

Meloplasty

Laser sculpting of eyes

What are conditions of membership?

All benefits are subject to the Fund's regulations. Complete copies of these are available for reference at head office.

In regard to the assessment and/or payment of claims, the Fund may require access to the clinical and other relevant medical or ancillary or paramedical records of the enrolled member or any persons covered under the enrolled member's membership. By accepting membership of the Fund, the enrolled member has agreed to authorise the Fund to access any such clinical and other relevant records as seen fit.

The Fund has the right to terminate a person's membership at any time. The Fund may terminate a person's membership immediately if, in the Fund's opinion, the person has deliberately obtained, or attempted to obtain, a benefit to which they were not entitled under it's rules.

Claims can only be paid within two years of the date on which the service was rendered.

What are considered compensation and damages from other sources?

Fund benefits are not payable where compensation and/or damages may be claimed from another source.

For example:

Workers' Compensation
Compulsory Third Party Insurance
Common Law
Sports Insurance
Travel Insurance
Litigation

The Fund reserves the right to recover any benefits paid in this regard.

What is a claim?

One or a number of invoices a member (or provider on behalf of a member) presents to a health fund for the payment of benefits. The invoices may relate to hospital, extras or medical services. If the invoices are unpaid, the hospital, doctor or ancillary provider may in some instances claim the benefits directly from the fund on the member's behalf. The member would then only be required to reimburse the provider with the balance owing.

A member must complete the appropriate claim form. If for extras cover, a member needs to swipe their membership card through the electronic claiming facility at the Recognised Provider's place of business, attach all documents we require and ensure the application for benefit is signed by the member.

What is Chinese Herbalism?

The treatment of a wide range of conditions with the use of raw herbs as well as a vast array of prepared or patented medicines available in manufactured pill granule and powder form.

What is involved when changing covers?

If you would like to change your level of cover, simply login to My HBA Online and go to 'My Membership > Change my details > Change my cover'. Otherwise, you can call us on 131 243.

Please note:

Please contact us on 131 243 if you have any queries or require further information.

What is Cardiovascular Surgery?

An area of surgery devoted to the treatment of the heart and great vessels.

What is Bowen Technique?

A dynamic system of muscle and connective tissue movements that effectively realigns the body and balances and stimulates energy flow, empowering the body's own resources to heal itself. Bowen involves light, simple and pain free vibrational therapy.

What is defined as an accident?

An accident means an unforeseen event, occurring by chance and caused by an unintentional and external force or object, resulting in involuntary hurt or damage to the body, which requires immediate medical advice or treatment from a registered practitioner other than the member or the member's immediate family.

What is a benefit?

The amount we pay for services provided to you whilst you are in hospital under one of HBA's hospital covers or for extras services under one of HBA's extras cover.

What is Excess?

You can reduce your health insurance premium by agreeing to pay a fixed amount towards the cost of any hospital admission, including same day treatment. The agreed amount you pay for each admission is called the Excess. The amount of the Excess varies depending on your choice of cover.

What is the gap?

Where a doctor or specialist charges more than the Government Schedule Fee, it's normally up to you to pay the 'gap'. The Federal Government sets a dollar amount - known as the 'schedule fee'. When you're treated in hospital, Medicare pays 75% of the schedule fee and your HBA private hospital cover the remaining 25%.

Some doctors and specialists charge more than the schedule fee. However, with our Ezyclaim system your doctor or specialist agrees with HBA on the fee charged and also agrees to bill us directly, so in most cases, you won't even see a bill. And if there is a gap, you will have to pay prior to your treatment. How Ezy is that!

What is a loyalty maximum?

The amount you can claim each year on your extras cover under your membership. With most extras services, you receive an annual maximum, which is the available benefit limit for all persons covered under the membership.

For some extras services, after you have had extras cover for 12 months, your annual maximum will automatically increase each year until it's double the amount when you joined.

What is Electronic claiming?

You can claim when you get your extras services treatment by simply swiping your membership card through a dedicated C-POS apparatus.

What is an Excess Bonus?

Some hospital covers offer the Excess Bonus feature, which entitles you to 1 excess-free overnight or same day hospital admission per calendar year on a single or single parent membership, and 2 excess-free overnight or same day hospital admission per calendar year on a family membership.

If you have hospital cover tha