Frequently Asked Questions Is HICA a health fund?
What is a Government Registered Health Fund?
Can I take hospital cover with one fund and dental/ancillary with another fund?
How do I transfer from one fund to another?
Can I transfer from one health fund to another without having to undergo further waiting times?
Why do I have to have a clearance certificate, and how do I get one?
What is an excess?
What is an exclusion?
What is a co-payment?
How do I make claims with the majority of health funds?
Why do some funds specify preferred hospitals?
Do I have to pay my health insurance premiums while I am overseas?
Why do premiums vary between Australian States and Territories?
What are the Federal Government incentives for health insurance?
Important note: The information on this page has been sourced from Health Funds, the Department of Health and Ageing and the Australian Taxation Office (ATO) and is subject to change. While we take great care to provide accurate and detailed advice to clients, the following information should be used as a general guide only. For definitive information regarding taxation relevant to private health insurance, we recommend you contact your Health Fund, a taxation specialist or the Australian Taxation Office (ATO).
No, HICA is not a health fund - although we do know an awful lot about health insurance!
We listen to what you need and then identify the right cover for you at the best possible price. In fact, we'll provide you with a free, no obligation recommendation and quote... selected from the huge range of health insurance policy options available through HICA. Over the last 20 years, we've helped tens of thousands of Australians to optimise their health cover in this way - without obligation and free of charge.
Private health insurance is provided through organisations registered under Federal Government legislation. These are called Registered Health Funds or sometimes Registered Health Benefits Organisations. Read more
The financial performance of Registered Health Funds is independently monitored to ensure solvency and capital adequacy requirements are met. There are more than 35 Registered Health Funds in Australia. Read more
Yes. You can take hospital cover with one fund and ancillary cover with another (sometimes the hospital and ancillary covers are offered as a combination in which case they cannot be separated).
It's easy to transfer from another registered health fund. You simply complete the application form for the new policy and advise your previous fund that you wish to cancel your cover with them. You also need to ask your previous fund for a "Clearance Certificate" and "Claims History" to send to your new fund.
When you use HICA's service, your HICA consultant will help you with the hassle free switch to your new health fund. Read more
Yes. Federal Government legislation allows for portability between Government Registered Health Funds. Anyone can transfer from one fund to another at the same level of cover and will not have new waiting times imposed - even for pre-existing conditions. If you transfer from a lower level, the new fund will usually pay benefits for treatment of a pre existing conditions at the same rate as your previous fund would have paid for a specified time (usually the first 12 months). Your Lifetime Health Cover rating is also be portable from one fund to another. Read more
A clearance certificate and claims history is proof of your previous health insurance membership, indicating the level of cover held and providing a record of your claims. Your new fund requires this information from your previous fund to establish what, if any, waiting periods may apply. The number of years you held your previous membership and any dental/ancillary benefits paid by your previous fund may also be taken into account by your new fund. You must formally request a claims history and clearance certificate when you are transferring from one fund to another, and forward it to your new fund. Some funds include a "Clearance Request" form with their application documents. Read more
When you use HICA's free assessment service, your HICA consultant will help you with the hassle free switch to your new health insurance.
An excess is an amount you agree to pay should you be hospitalised. If you have a $100 excess you need to pay this amount towards your hospital costs before the fund pays their benefits. Some excesses apply once per year while others may apply for the first 2 or 3 times you are hospitalised or each time you are hospitalised. Some excesses are divided between the first two people being admitted. Excesses are only ever payable if you are hospitalised. Some policies do not apply an excess to day stays/surgery. Contact HICA on 1300 732 757 for free advice regarding the various excess options and which may best suit you.
An exclusion is a condition for which you are not covered by a policy, e.g. some policies may not cover you for cardiac surgery or maternity, etc.
A co-payment is an amount you are required to pay each day you are in hospital or possibly for a limited number of days. For example, you may have a policy that requires you to pay $50 or $150 for every day you are hospitalised.
When you are hospitalised, the hospital will usually claim directly from your health fund on your behalf (you may be directly responsible for the payment of an excess and/or a co-payment).
Ancillary claims can now be lodged at any Medicare Office under the Medicare Two-way facility, or forwarded with the paid or unpaid account directly to the Health Fund with your claim form and membership details. Many ancillary services are now claimed electronically by your health care provider when you receive treatment.
If you anticipate health care treatment you should contact your fund before treatment commences to confirm your benefit entitlements. Read more
These are hospitals with which that fund has negotiated contracts to reduce or eliminate your out-of-pocket costs for hospital services. Generally if you do not use the specified hospitals you may have additional out of pocket expenses.
Some funds will allow you to suspend your cover for the period you are away if it is longer than one month. Contact your health fund for details of their rules regarding membership suspension. Read more
We strongly suggest you take out appropriate Travel Insurance when travelling overseas.
Health care costs and members claiming profiles vary from State to State. Premiums are calculated to reflect the variation in benefit costs between states.
The Federal Government has introduced a number of initiatives to encourage Australians to join and retain Private Health Insurance. These include:
Medicare Levy Surcharge
For those without an eligible Private Health Insurance policy for hospital costs, and who have an income in excess of $50,000 per annum single, ($100,000 p.a. for a family unit) the Federal Government has introduced a further 1 percent Medicare levy. This represents an additional $500 plus for a single ($1000 plus for a family) to be paid with their income tax for no additional benefits. Taking an eligible hospital cover will enable you to avoid this levy. Read more
Federal Government Rebate on Private Health Insurance
On 1 January 1999 the Federal Government introduced a 30 percent rebate on all health insurance premiums for both hospital cover and dental/ancillary cover. This rebate is not means tested and has since been increased to 35% for people aged more than 64 - 69 years and 40% for those aged 70+ years. Eligible Australians who take out private health insurance can:
- Have their premiums reduced (up front) by the value of the rebate (30%, 35% or 40%).
- Receive the rebate as a tax rebate at the end of the financial year.
- Receive the rebate in cash over the counter at any Medicare office.
Read more
Lifetime Health Cover
On 1 July 2000 an incentive called "Lifetime Health Cover" was introduced, and was designed to encourage people to join a n eligible hospital policy with a health insurance fund early in life and maintain their membership with a fund through their life. Under Lifetime Health Cover, people taking out hospital cover after July 2000 are assigned a "Lifetime Health Cover age" (also known as a Certified Age At Entry). The Lifetime Health Cover Age is the persons age on 1 July before they joined hospital cover. Under Lifetime Health Cover, they will incur a 2% loading for every year their Lifetime Health Cover Age is more than 30 at the time of joining. That is, a person of 40 years of age could pay an extra 20 percent over the base premium rate. Read more
Portability of Cover
Federal legislation allows for portability between funds. This means that anybody can transfer from one fund to another at the same level and will not have new waiting periods imposed, even for pre-existing conditions. Waiting periods may apply if you increase your cover at the time of transfer. If you transfer from a lower level, the new fund will pay any benefits at the same rate as your previous fund would have paid until the waiting periods for the higher benefits have been served. Your Lifetime Health Cover rating is also portable from one fund to another. Read more
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