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Frequently Asked Questions

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).

Is HICA a health fund?

No , HICA is a Health Insurance Brokerage that has been providing advice and assistance for more than 25 years.

We educate our clients and prospective clients on every facet of Health Insurance and provide personalised service and advice. By using our free consultancy service you can make an informed decision to ensure that you obtain appropriate health insurance cover at a competative premium. We assist with the selection and placement of cover; claims matters; policy alterations; and ongoing advice at rate review time or on the anniversary of your policy to ensure that your existing cover continues to represent good value in both cover and cost. We may recommend that you change your health fund as your circumstances and as the prevailing market dictates. 

What is a Government Registered Health Fund?

Private health insurance is provided through organisations registered under Federal Government legislation. These are called Registered Health Funds or sometimes Registered Health Benefits Organisations.  Learn  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.  Learn more 

Can I take hospital cover with one fund and dental/ancillary with another fund?

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). 

How do I transfer from one fund to another?

It's easy to transfer from registered health fund to another. You simply complete the application form for the new policy and complete the cancellation request. Your previous fund will then send a "Clearance Certificate" and "Claims History" to send to your new fund. If you receive this please forward it to HICA.

When you use HICA's service, your HICA consultant will help you with the hassle free switch to your new health fund.  Learn more 

Can I transfer from one health fund to another without having to undergo further waiting times?

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.   Learn more

Why do I have to have a clearance certificate, and how do I get one?

A clearance certificate and claims history is proof of your previous health insurance membership, indicating the level of cover held and providing a six month 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. Learn 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. 

What is an excess?

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.

What is an exclusion?

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. 

What is a co-payment?

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.

How do I make claims with the majority of health funds?

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. Learn more

Why do some funds specify preferred hospitals?

These are hospitals with which that fund has negotiated contracts called Hospital Purchaser Provider Agreement (HPPA) with the insurer 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.    

What is a default benefit?

Default benefit is a legislated minimum benefit payable to private and public hospitals for insured patients, which applies where there is no contract between a private hospital and a fund, but where the hospital has in place arrangements for informed financial consent and simplified billing, and evidence of an appropriate level of quality of treatment (including accreditation).

This default benefit is set at 85% of the average benefits paid under contracts made by a particular fund. 


Do I have to pay my health insurance premiums while I am overseas?

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. Learn more

We strongly suggest you take out appropriate travel insurance when travelling overseas.

 
Why do premiums vary between Australian States and Territories?

Health care costs and members claiming profiles vary from State to State. Premiums are calculated to reflect the variation in benefit costs between states.

 
What are the Federal Government incentives for health insurance?

The Federal Government has introduced a number of initiatives to encourage Australians to join and retain Private Health Insurance. These include:

Medicare Levy Surcharge

As of July 2012, those without an eligible Private Health Insurance policy and with an income above specified three tier thresholds pay either 1.00%, 1.25% or 1.50% additional income tax.  This means that those without eligible hospital cover with an income in excess of $84,000 per annum single, ($168,000 p.a. for a family unit) will pay $840 plus for a single ($1680 plus for a family) Medicare Levy Surcharge with their income tax for no additional benefits.  Learn more

Eligible hopsital covers will enable you to avoid this levy and may be available for less than the  Medicare Levy Surcharge cost.  See HICA's Tax Saver Calculator

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 has since been increased to 35% for people aged more than 65 - 69 years and 40% for those aged 70+ years. As of 1 July 2012, the rebate is means tested and reduces as income rises above specified tiers. Learn more 

Lifetime Health Cover

On 1 July 2000 an incentive called "Lifetime Health Cover" was introduced, and was designed to encourage people to join an 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.  Learn 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.  Learn more 

 

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