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.

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.

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.

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.

Family Plus membership covers you, your partner and your single children under 25 years, even if they are not students and are living away from home.

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.

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?].

There are some situations where you won't have to pay a Lifetime Health Cover loading, for example:

• You first took out private health insurance when you were under 31 and you have had private health insurance without any break (or any break less than 3 years) since you took it out);
• You had private hospital cover on 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 avoid incurring a loading over and above your base 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. Once you've had hospital cover for 10 consecutive years, you won't have to pay the loading any longer.

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

* Increases by $1,500 per child after the first child

The amount of Rebate you are entitled to depends on your age. 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

• At least 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
• No Medicare Levy Surcharge - private health insurance may reduce the tax you have to pay. If you're single and earn more than $50,000 a year, or a couple with a combined annual income of over $100,000* and don't have private hospital cover you may have to pay the Government's 1% Medicare Levy Surcharge. That's on top of the normal 1.5% Medicare Levy imposed on all eligible tax payers
• Take out and maintain private hospital cover by age 31, without any break (or any break less than 3 years), and you may 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

* Increases by $1,500 per child after the first child

• 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

• 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 your accommodation and theatre expenses. A way to cover yourself for those bills is with hospital cover offered by private health insurance.

Our hospital cover contributes to the portion of medical costs if you are admitted to any hospital within our network of Members First or Participating Private hospitals, or public hospitals in Australia:

• We cover you for the cost of medical treatment up to the Government Schedule Fee
• Medicare pays 75% of the Schedule Fee
• HBA pays the remaining 25%

Some doctors and specialists charge more than the Government 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!

• 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. 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:

• Pregnancy related services, including childbirth
• Heart and artery related services
• Psychiatric services
• Assisted reproductive services, including IVF
• Hip or knee replacements
• Rehabilitation services
• Cataract surgery

Some services have a waiting period. A waiting period starts from the date you join. During a waiting period you are not covered and will not receive any benefits for the types of treatment affected by the waiting period. Once the waiting period is over, you will receive the full benefits listed under your level of cover for that treatment type.

If you transfer to HBA from another health fund on an equivalent level of cover, we will honour all the waiting periods you have already served when we receive confirmation of your previous membership and level of cover, but you will need to join HBA within 30 days of leaving the other fund.

When you upgrade to a higher level of cover, the benefits from your previous level of cover apply during waiting periods.

Waiting periods apply to all levels of cover. Please refer to the full policy details to determine the waiting periods that apply to your level of cover.

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

At HBA we understand that sometimes there's the odd bump in the road. If you are involuntarily 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:

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

• If your hospital cover has a waiting period, it means that you will not be covered and will not receive benefits for that treatment during the waiting period
• If your cover has an Exclusion on some services, you cannot claim for those services for as long as you are on that level of cover
• If your cover has a Restricted Benefit on a medical treatment or condition, you will only ever receive minimum default benefits set by the Government for that treatment or condition

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

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.

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

If you wish to have the baby in a private hospital or as a private patient in a public hospital and your current policy does not cover pregnancy, you will need to change your level of hospital cover to a policy that covers pregnancy and serve the 12 month waiting period.

Please note that 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 my cover form on the website or by contacting us.

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.

• Augmentation mammaplasty


• Liposuction


• Reduction of eyelids


• Meloplasty


• Laser sculpting of eyes

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

Please note:

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.

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

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 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.