Professional Documents
Culture Documents
hif.com.au
Whats inside?
Whats
inside?
A bit about us, this PDS
and health insurance
2-3
GoldVital Hospital
GoldStarter Hospital
12
GoldSaver Hospital
14
Gold Hospital
16
GoldStar Hospital
18
20
Ways to claim
22
46
48
Glossary
51
Important Tip
When you join HIF or change your level
of cover, we will send you a Member
Statement confirming your new level of
cover. To avoid confusion, its a good idea
to keep your statement with this brochure.
Keep Updated
GoldSaver
Gold
GoldStar
Choice of Excess
Product
Restricted
Excluded
GoldStar
Surgery by podiatrists
Cosmetic services*
Gold
Surgery by podiatrists
Private Room
Private room
(maternity)
(3 days)
Shared room
(5 days)
(unlimited)
Theatre Care
Cosmetic services*
Same-day
Accommodation
Eye surgery
Intensive Care
Palliative care
Prostheses
Rehabilitation
Pharmacy Drugs
GoldStarter
AccessGap
Palliative care
Restricted
Restricted
Psychiatric
Restricted
Rehabilitation
Restricted
Restricted
Cardio (heart)**
Psychiatric Care
& Treatment
Surgery by podiatrists
Psychiatric
Appliances
Palliative Care
Joint replacement
Same-day Theatre
Restricted
Assisted Reproductive
Technology (e.g. IVF)
Restricted
Eye Surgery
(non-cosmetic)
Restricted
Eye surgery
Joint replacement
Joint Replacement
Cosmetic services*
Healthcare providers
HIF covers extras, medical and hospital
providers throughout Australia. To confirm if
a provider is approved by HIF, go to
hif.com.au, email us at info@hif.com.au or
call us on 1300 13 40 60.
Benefits will not be paid for any hospital
services provided outside Australia, or for
services purchased or provided within Australia
from a non-Australian recognised provider.
Ambulance services
HIF is required under New South Wales
and Australian Capital Territory legislation
to financially contribute toward the cost
of operating state or territory-provided
emergency ambulance services on behalf
of any person who is a permanent state or
territory resident and holds any level of HIF
Hospital cover. Under this arrangement, our
members who are residents of NSW or ACT
and hold HIF Hospital cover may submit
their resident state or territory emergency
ambulance invoice to HIF to claim a benefit
toward the fees charged.
Please note that ambulance benefits may
not be claimable under a NSW or ACT
HIF Hospital cover if the service was not
provided by your local state-controlled
ambulance service, or if the service was not
deemed by the ambulance attendant to be
an emergency (medically necessary).
For more information about this, see page 24
or visit hif.com.au and visit the Ambulance
Cover page within the Health section.
Medical Gap
Different medical providers may charge
different prices for the same procedure. If you
are planning a procedure, we recommend
that you ask your medical provider and any
associated health provider (e.g. anaesthetist
or assistant) if they will participate in our
AccessGap scheme to help you avoid or
minimise your out-of-pocket expenses.
If your health provider does not confirm
your out-of-pocket expenses, we
recommend you contact us with your
providers details, item numbers and
charges and we will provide you
with a benefit estimate.
Restricted services
Where services are noted as restricted in
your Hospital cover, this means that if you
receive them in a private hospital, you will
only be covered at the basic public hospital
benefit rate, which includes:
The
cost of a shared room in a public
hospital
A
benefit towards the cost of surgically
implanted prosthesis
Excluded services
Where services are noted as excluded in
your Hospital cover, this means that you are
not covered and you must pay all costs.
GoldVital Hospital
This is our entry-level option
for young singles and couples
who want cover for vital
medical services. It covers
treatment after an accident,
intensive care and theatre fees,
plus other essential services,
including surgery to remove
tonsils, adenoids, appendix
and wisdom teeth.
GoldVital Hospital
Cover for emergency treatment in
hospital resulting from an accidental
injury*
Surgical removal of wisdom teeth, tonsils,
appendix and adenoids
Minor gynaecological procedures^
Joint reconstruction and investigation
Same-day accommodation and theatre fees
for approved services
No maternity cover
Full cover for the cost of a shared or
private room, theatre fees and charges in
an HIF contracted hospital anywhere in
Australia for approved services
Services covered
GoldVital Hospital will cover the services
outlined in the table on the following page
in a public hospital or contracted private
hospital facility, subject to any waiting
periods which may apply and the Preexisting Ailment Rule. Benefits for noncontracted private hospitals are available
from HIF. Check with us prior to admission
to ensure that the hospital is an HIF
contracted facility.
HIF has negotiated contractual
arrangements with most hospitals and day
hospital facilities throughout Australia. The
benefits listed in the table opposite are
offered to members who are admitted to
those hospitals.
Exclusions
Restricted services
Applicable excess
A mandatory excess of $500 per person,
per admission, per year (up to a maximum
of $500 per year single policy or $1,000 per
year couple policy) is applied to GoldVital
Hospital cover to reduce premium costs.
The excess applies to overnight and same
day admissions
* An accident is an unforeseen event, occurring by chance and caused by an external force or object which
results in an injury to the body requiring immediate medical treatment in hospital within 24 hours of the
accident. If further hospital treatment (as an admitted patient) is required, the patient must be re-admitted
to a hospital within 90 days of the initial hospital treatment.
^ B enefits will be paid for Same Day Procedures only for minor gynaecological procedures.
Public hospital
Private hospital
Public hospital
Private hospital
Public hospital
Private hospital
Public hospital
Private hospital
10
Public hospital
No charge raised
Private hospital
Medical Gap
For more details please refer
to the AccessGap Cover
section in this brochure, or
email info@hif.com.au or call
us on 1300 13 40 60
Applicable Excess
Mandatory excess
is applied to
GoldVital hospital.
11
GoldStarter Hospital
This is our basic-level private
Hospital insurance cover. Like
GoldVital, its great value and a
smart choice if youre younger
and less likely to require things
like maternity and cardio
procedures, but it also includes
a broader range of nonemergency care.
Surgery by podiatrists
No benefits will be payable for other
charges related to these services (e.g.
theatre or some pharmaceutical costs),
so significant out-of-pocket expenses
may apply for these procedures if you are
admitted as a private patient.
No maternity cover
Restricted services
Benefits for the following services will
include basic public hospital rate (only)
for accommodation. However, full
AccessGap coverage for inpatient medical
procedures and benefits will be paid
towards prostheses in accordance with the
Commonwealth Prostheses List. Items on
the list (excluding human tissue) may be
subject to a co-payment by the patient:
Psychiatric care or attention
Palliative care
Public hospital
Private hospital
Theatre fee
Public hospital
Private hospital
Pharmaceutical drugs
(does not include discharge
drugs)
Public hospital
Private hospital
Public hospital
Private hospital
Public hospital
No charge raised.
Private hospital
Medical Gap
For more details, please refer
to the AccessGap Cover
section in this brochure, or
email info@hif.com.au or call
us on 1300 13 40 60
Exclusions
GoldStarter Hospital
12
Rehabilitation
Accommodation charges
including day patient,
intensive care and
neonatal care
Services covered
GoldStarter Hospital will cover the following
services in a public hospital or contracted
private hospital facility, subject to any
waiting periods which may apply and
the Pre-existing Ailment Rule. Benefits
for non-contracted private hospitals are
available from HIF. Check with us prior to
admission to ensure that the hospital is a
HIF contracted facility.
HIF has negotiated contractual
arrangements with most hospitals and day
hospital facilities throughout Australia. The
listed benefits are offered to members who
are admitted to those hospitals.
Applicable excess
A mandatory excess is applied to GoldStarter Hospital cover to reduce premium costs:
GoldStarter $200 per person to a max of $400**
* Therapeutic Goods Administration
** Excesses are paid once per person per admission covered under the policy in a calendar year up to the maximum.
Excesses apply to all hospital treatments.
Some examples of cardiac (heart) procedures including medical treatment or surgical procedures for cardiac
conditions, are arrhythmias, artery bypass grafts, coronary angioplasty, congenital defects, heart disease, heart
transplants, pacemakers and defibrilators, stent insertion.
13
GoldSaver Hospital
This is our intermediate Hospital
cover and is a step up from
GoldStarter. Its great for
young couples and families
who are likely to need things
like maternity cover but not
services such as cardio and joint
replacement surgery.
Surgery by a podiatrist
Restricted Services
Benefits for the following services will
include basic public hospital rate (only) for
accommodation. However, full AccessGap
coverage for in-patient medical procedures
and benefits will be paid towards prostheses
in accordance with the Commonwealth
Prostheses List. Items on the list (excluding
Private hospital
Public hospital
Private hospital
Pharmaceutical drugs
(does not include discharge
drugs)
Public hospital
Private hospital
Public hospital
Private hospital
Public hospital
Private hospital
Medical Gap
For more details, please refer
to the AccessGap Cover
section in this brochure, or
email info@hif.com.au or call
us on 1300 13 40 60
Public hospital
Joint replacement
GoldSaver Hospital
14
Accommodation charges
including day patient,
intensive care and
neonatal care
Exclusions
Benefits are not payable for any charges
raised for the following services:
Gastric banding and obesity surgery
Services deemed cosmetic by Medicare
and services that do not attract a
Medicare rebate
Services covered
GoldSaver Hospital will cover the following
services in a public hospital or contracted
private hospital facility, subject to any
waiting periods which may apply and the
Pre-existing Ailment Rule. Benefits for noncontracted private hospitals are available
from HIF. Check prior to admission to ensure
that the hospital is a HIF contracted facility.
HIF has negotiated contractual
arrangements with most hospitals and day
hospital facilities throughout Australia. The
listed benefits are offered to members who
are admitted to those hospitals.
S
ome examples of cardiac (heart) procedures including medical treatment or surgical procedures for cardiac
conditions, are arrhythmias, artery bypass grafts, coronary angioplasty, congenital defects, heart disease, heart
transplants, pacemakers and defibrilators, stent insertion.
Applicable excess
A mandatory excess is applied to reduce premium costs:
GoldSaver $200 per person to a max of $400**
* Therapeutic Goods Administration
** Excesses are paid once per person per admission covered under the policy in a calendar year, up to the maximum.
Excesses apply to all hospital treatments.
15
Gold Hospital
This is our award-winning top
shared room hospital insurance
cover. Youre fully covered for
theatre fees, ward fees and all
other services. Its especially
great if youre planning on
having a baby, because our
maternity cover includes up to
five days in a private room at
no extra cost.
Gold Hospital
Top Hospital cover
Comprehensive cover for all Medicare
approved items
Includes maternity services
Private room for up to 5 days for
management of labour and delivery
of child
Full cover for the cost of a shared room,
theatre fees and labour ward charges in
a HIF contracted hospital anywhere in
Australia
Full AccessGap Cover for inpatient
medical procedures
Choice of excesses to reduce cost
Accommodation charges
including day patient,
intensive care and
neonatal care
Public hospital
Private hospital
Public hospital
Private hospital
Pharmaceutical drugs
(does not include discharge
drugs)
Public hospital
Private hospital
Prostheses and
consumables
Public hospital
Private hospital
Public hospital
No charge raised.
Private hospital
Medical Gap
For more details, please
refer to the AccessGap
Cover section in this
brochure, or email
info@hif.com.au or call us
on 1300 13 40 60
Restrictions
Surgery performed in a hospital by
registered podiatrists is not eligible for
Medicare rebates. However, under this
level of cover HIF will pay limited benefits
toward the podiatrists charges. Hospital
accommodation and theatre charges
will also be limited.
Exclusions
No benefit is payable for services deemed
as cosmetic by Medicare and/or services
that do not attract a Medicare benefit.
Services covered
Gold Hospital will cover the following
services in a public hospital or contracted
private hospital facility, subject to any
waiting periods which may apply and the
Pre-existing Ailment Rule. Benefits for noncontracted private hospitals are available
from HIF. Check prior to admission to ensure
that the hospital is a HIF contracted facility.
HIF has negotiated contractual
arrangements with most hospitals and day
hospital facilities throughout Australia. The
listed benefits are offered to members who
are admitted to those hospitals.
Excess options
Optional excesses to reduce premium costs:
Gold Excess 100/200 $100 per person to a max of $200**
Gold Excess 200/400 $200 per person to a max of $400**
Gold Excess 400/800 $400 per person to a max of $800**
16
17
GoldStar Hospital
This is our premium hospital
insurance cover, with all the
bells and whistles. Youre
fully covered for everything,
including a private room for
all services, theatre fees and
all ward fees. No worries. Just
total peace of mind for you
and your family.
GoldStar Hospital Cover
Top Hospital cover
Comprehensive cover for all Medicare
approved items
Includes maternity services
Full cover for the cost of a private room,
theatre fees and labour ward charges in
a HIF contracted hospital anywhere in
Australia
Full AccessGap Cover for inpatient
medical procedures
Choice of excesses to reduce cost
Restrictions
Surgery performed in a hospital by
registered podiatrists is not eligible for
Medicare rebates. However, under this
level of cover HIF will pay limited benefits
toward the podiatrists charges. Hospital
accommodation and theatre charges will
also be limited.
Accommodation charges
including day patient,
intensive care and
neonatal care
Public hospital
Private hospital
Public hospital
Private hospital
Pharmaceutical drugs
(does not include discharge
drugs)
Public hospital
Private hospital
Prostheses and
consumables
Public hospital
Private hospital
Public hospital
No charge raised.
Private hospital
Medical Gap
For more details, please
refer to the AccessGap
Cover section in this
brochure, or email
info@hif.com.au or call
us on 1300 13 40 60
Exclusions
No benefit is payable for services deemed
as cosmetic by Medicare and/or services
that do not attract a Medicare benefit.
Services covered
GoldStar Hospital will cover the following
services provided in a public hospital or
contracted private hospital facility, subject
to any waiting periods which may apply
and the Pre-existing Ailment Rule. Benefits
for non-contracted private hospitals
are available from HIF. Check prior to
admission to ensure that the hospital is
a HIF contracted facility.
HIF has negotiated contractual
arrangements with most hospitals and day
hospital facilities throughout Australia. The
listed benefits are offered to members who
are admitted to those hospitals.
Excess options
Optional excesses are available to reduce premium costs:
GoldStar Excess 200/400 $200 per person to a max of $400**
GoldStar Excess 400/800 $400 per person to a max of $800**
GoldStar Excess 500/1000 $500 per person to a max of $1000**
* Therapeutic Goods Administration
**E
xcesses are paid once per person per admission covered under the policy in a calendar year, up to the maximum.
The excess is not applied to same-day surgery or to child dependants under the age of 18.
18
19
Annual limits
HIF Extras covers have an annual limit for
most services, which means there is a limit
on how much HIF will pay toward your
claims. Most limits are for the calendar year
(January to December) but each January
your benefit limits will be refreshed, allowing
you to claim benefits again for Extras
services provided in the new year.
Approved consultations
Unless stated, to be eligible for HIF benefits
all services must be provided by a HIF
approved health provider at that providers
registered practice address in a face-toface setting, or as otherwise approved by
HIF. Video, telephone or online facilitated
services, with the exception of HIF approved
Hospital Substitute treatment or Chronic
Health Disease Management programs, are
not approved consultations.
Any
benefits paid by your previous
private health insurer will be considered
when determining rebates for your
future claims.
Vital Options
Vital Options offers great value, entry-level
Extras cover for singles and couples only
(not available for families).
Periodontal
Physiotherapy
Osteopathy
General dental: 011 017, 022 118, 121,
123 171, 311 399, 511 535, 572 597,
911 915, 926, 949 986
Endodontic: 411 458
Periodontal: 213 282
20
Current
HIF members who transfer
Extras cover to a higher level of Extras
cover, or equivalent level of cover with a
reduced or nil excess, will have qualifying
periods applied for the higher level of
cover and/or benefits. During these
periods benefits will be payable at the
lower level of cover.
21
Ways to claim
Electronic Claiming
22
Vital
Saver
Special
Super
Premium
Waiting
Period
Ambulance*
2 months
2 months
Asthmatic Spacers
2 months
Chiropractic
2 months
2 months
Complementary Therapies
Dental - General Unlimited
Limited
2 months
By post
Diabetes Education
2 months
Dietetics
2 months
Healthy Lifestyle
2 months
Occupational Therapy
2 months
Optical
2 months
2 months
Osteopathy
2 months
Peak-flow Meter
2 months
Pharmacy Drugs
2 months
Physiotherapy
2 months
Podiatry Consultations
2 months
Speech Therapy
2 months
Up to 12
months
Blood Glucose/Pressure
Monitor
12 months
Dental - Major
12 months
External Prosthesis/
Medical Appliances
12 months
Nebuliser / Humidifier
12 months
Orthotic Appliances
12 months
Psychological
Consultations
12 months
Assisted Reproduction
Drugs
36 months
Hearing Aids
36 months
HIF
GPO Box X2221
Perth WA 6847
From time to time we promote special offers for new members. Visit hif.com.au for more information and
to view our current offers.
* Does not include inter-hospital transfers or transport to home.
** Limited item numbers are covered, please contact HIF for more details
23
Ambulance benefits
Benefit is paid on charges raised for
approved ambulance services. On all our
Extras cover except Vital Options, HIF fully
covers the cost of emergency ambulance
transport for cases classified by approved
ambulance service providers as requiring
urgent attention and where the patient is
admitted to the emergency department
of a hospital.
Premium Options
24
Ambulance
As above
Additional
information
Type of service
Super Options
Benefit
Person limit
Membership
limit
Emergency:
100%
N/A
N/A
Benefit
Emergency:
100%
Special Options
Person
limit
Membership
limit
N/A
N/A
Saver Options
Benefit
Person limit
Membership
limit
Emergency:
100%
N/A
N/A
Benefit
Person limit
Membership
limit
Emergency:
100%
N/A
N/A
Nonemergency
call-outs and
transportation:
100% with
a $50
co-payment
Nonemergency
call-outs and
transportation:
100% with
a $50
co-payment
Nonemergency
call-outs and
transportation:
100% with
a $50
co-payment
Nonemergency
call-outs and
transportation:
100% with
a $50
co-payment
Interhospital
transfers:
No benefit
Interhospital
transfers:
No benefit
Interhospital
transfers:
No benefit
Interhospital
transfers:
No benefit
25
26
Super Options
Membership
limit
Benefit
Person limit
2 per person
per year
No limit
$18
2 per person
per year
No limit
$120
$1,800 per
year
No limit
$75
$1,800 per
year
No limit
A letter of
recommendation from
the patients treating
practitioner is required.
75% of cost
1 of either
monitor every
3 years
No limit
75% of cost
1 of either
monitor every
3 years
No limit
Spinal
adjustment
manipulation
Type of service
Additional information
Benefit
Person limit
Asthmatic
spacers
N/A
$18
Auxiliary Home
Nursing
Benefits must be
ordered by a medical
practitioner. Contact us
for conditions.
Blood glucose
or
blood pressure
monitor
Chiropractic
Max: $200
Max: $200
First visit:
$30
Visits 2-10:
$29
Visits 10+: $18
X-ray: $110
Membership
limit
Extras benefits
Premium Options
Combined
annual limit
(chiropractic
and
osteopathic)
Combined
annual limit
(chiropractic
and
osteopathic)
Up to 3 years:
$650
Up to 3 years:
$1300
Over 3 years:
$750
Over 3 years:
$1500
Spinal
adjustment
manipulation
First visit:
$28
Visits 2-10:
$23
Visits 10+: $14
X-ray: $85
1 x-ray per
year
Combined
annual limit
(chiropractic
and
osteopathic)
Combined
annual limit
(chiropractic
and
osteopathic)
Up to 3 years:
$550
Up to 3 years:
$1100
Over 3 years:
$650
Over 3 years:
$1300
1 x-ray per
year
Special Options
Saver Options
Type of service
Additional information
Benefit
Person limit
Membership
limit
Benefit
Person limit
Membership
limit
Asthmatic
spacers
N/A
N/A
N/A
No limit
N/A
N/A
No limit
Auxiliary Home
Nursing
Benefits must be
ordered by a medical
practitioner. Contact us
for conditions.
N/A
N/A
No limit
N/A
N/A
No limit
Blood glucose
or
blood pressure
monitor
A letter of
recommendation from
the patients treating
practitioner is required.
N/A
N/A
No limit
N/A
N/A
No limit
Chiropractic
Spinal
adjustment
manipulation
Combined
annual limit
(chiropractic,
osteopathic,
physiotherapy,
podiatry and
complementary
therapies)
$900
Spinal
adjustment manipulation:
Combined
annual limit
(chiropractic,
osteopathic,
physiotherapy,
podiatry and
complementary
therapies)
$450
X-ray: $70
Combined
annual limit
(chiropractic,
dietetics,
healthy
lifestyle,
complementary
therapies,
pharmacy,
osteopathic,
physiotherapy
and podiatry)
$350
Combined
annual limit
(chiropractic,
dietetics,
healthy
lifestyle,
complementary
therapies,
pharmacy,
osteopathic,
physiotherapy
and podiatry)
$700
First visit:
$26
Visits 2-10: $21
First visit:
$26
Visits 2-10: $21
Visits 10+: $10
X-ray: $65
27
28
Super Options
Type of service
Additional information
Benefit
Person limit
Complementary
therapies
- Naturopathy
- Homeopathy
- Acupuncture
- Traditional
Chinese
Medicine
- Remedial
massage
therapy
- Myotherapy
Up to 3 years:
$500
Visits 7+:
$17
Membership
limit
Benefit
Person limit
No limit*
Up to 3 years:
$250
Visits 7+:
$13
Over 3 years:
$600
Dental
Membership
limit
$700
Over 3 years:
$350
Extras benefits
Premium Options
Diabetics
education
For consultations or
information sessions
held by Diabetes
Association in relation to
diabetes.
Dietetics
First visit:
$40
Subsequent:
$18
6 visits per
year
No limit
No limit
Subsequent:
$20
6 visits
per year
No limit
$324
per year
Group: $10
Group: $12
Special Options
Saver Options
Type of service
Additional information
Benefit
Person limit
Complementary
therapies
- Naturopathy
- Homeopathy
- Acupuncture
- Traditional
Chinese
Medicine
- Remedial
massage
therapy
- Myotherapy
Visits 1-6:
$16
Up to 3 years:
$100*
Visits 7+:
$11
Over 3 years:
$200*
Dental
Membership
limit
$400*
Benefit
Person limit
Membership
limit
Visit 1-6:
$15
Up to 3 years: $50#
$200 #
Visits 7+:
$10
Diabetics
education
For consultations or
information sessions
held by Diabetes
Association in relation to
diabetes.
N/A
N/A
No limit
N/A
N/A
No limit
Dietetics
No limit
Combined annual
limit (chiropractic,
dietetics, healthy
lifestyle,
complementary
therapies,
osteopathy,
pharmacy,
physiotherapy and
podiatry) $350
Combined annual
limit (chiropractic,
dietetics, healthy
lifestyle,
complementary
therapies,
osteopathy,
pharmacy,
physiotherapy and
podiatry) $700
Subsequent:
$18
Subsequent:
$18
Group: $10
Group: $10
29
*S
ubject to combined overall person limit of $450 and membership limit of $900 for complementary therapies, chiropractic incl. 1 X-ray
per year per person, osteopathic, physiotherapy and podiatry.
# Subject to combined overall person limit of $350 and membership limit of $700 for complementary therapies, chiropractic incl. 1 X-ray
per year per person, dietetics, healthy lifestyle, pharmacy, osteopathic, physiotherapy, and podiatry.
30
Type of service
Additional information
Benefit
Person limit
External
Prosthesis/
Medical
Appliances
75% of fee
$1,500 per
year.
Super Options
Membership
limit
Benefit
Person limit
No limit
75% of fee
$1,500 per
year.
Note: sub
limits apply
depending
upon item.
Membership
limit
No limit
Note: sub
limits apply
depending
upon item.
Conditions apply so
please contact us
for details prior to
purchasing item.
Healthy Lifestyle
- Health
management
program
- Weight loss
program
- Quit smoking
plan
- Health
assessments
- Skin cancer
screening
Single: $125
$125
Single: $100
Family: $250
$100
Family: $200
Special Options
Saver Options
Type of service
Additional information
Benefit
Person limit
Membership
limit
Benefit
Person limit
Membership
limit
External
Prosthesis/
Medical
Appliances
N/A
N/A
No limit
N/A
N/A
No limit
Single: $75
$75
Single: $50
$50
Combined
annual limit
(chiropractic,
dietetics, healthy
lifestyle,
complementary
therapies,
osteopathic,
pharmacy,
physiotherapy
and podiatry)
$700
Conditions apply so
please contact us
for details prior to
purchasing item.
Healthy Lifestyle
- Health
management
program
- Weight loss
program
- Quit smoking
plan
- Health
assessments
- Skin cancer
screening
Family: $150
Family: $100
Extras benefits
Premium Options
31
32
Type of service
Additional information
Benefit
Person limit
Hearing aids
Up to 5 years:
$550
Up to 5
years: 1
5 to 10 years:
$600 per ear
Over 5 years:
1 per ear
Membership
limit
No limit
Super Options
Benefit
Person limit
Up to 5 years:
$550
Up to
5 years: 1
5+ years:
$550 per ear
Over 5 years:
1 per ear
Membership
limit
No limit
10+ years:
$700 per ear
Humidifier or
nebuliser
A letter of
recommendation from
the patients treating
practitioner is required.
75% of cost
1 of either
monitor every
3 years.
Maximum
$180.
No limit
75% of cost
1 of either
monitor every
3 years.
Maximum
$140.
No limit
Occupational
therapy
Combined
limit
(orthoptics,
physiotherapy
and speech
therapy)
No limit
Combined
limit
(orthoptics,
physiotherapy
and speech
therapy)
No limit
Subsequent
$27
Group $10
Optical
Orthotics
Subsequent:
$25
Group: $10
Up to 5 years:
$1200
Up to 5 years:
$900
Over 5 years:
$1500
Over 5 years:
$1100
75% of cost
$240 1
every
2 years from
date of
supply ^
No limit
75% of cost
$200 1 every
2 years from
date of
supply ^
No limit
# Note: benefits are not available for orthotics which are not specifically modified and fitted for the individual members condition.
^ Orthotic limit includes associated services such as muscle testing, ROM testing and gait analysis.
Special Options
Saver Options
Type of service
Additional information
Benefit
Person limit
Membership
limit
Benefit
Person limit
Membership
limit
Hearing aids
N/A
N/A
No limit
N/A
N/A
No limit
Humidifier or
nebuliser
A letter of
recommendation from
the patients treating
practitioner is required.
N/A
N/A
No limit
N/A
N/A
No limit
Occupational
therapy
N/A
N/A
No limit
N/A
N/A
No limit
N/A
N/A
N/A
N/A
No limit
Optical
Orthotics
# Note: benefits are not available for orthotics which are not specifically modified and fitted for the individual members condition.
Extras benefits
Premium Options
33
34
Type of service
Additional information
Benefit
Person limit
Orthoptics
(eye therapy)
Initial: $50
Combined
limit with
occupational
physiotherapy
and speech
therapy
Osteopathic
Peak Flow
Meter
N/A
Subsequent:
$25
$30
Super Options
Membership
limit
Benefit
Person limit
No limit
Initial $50
Combined
limit with
occupational
physiotherapy
and speech
therapy
Subsequent
$25
Up to 5 years:
$1200
Up to 5 years:
$900
Over 5 years:
$1500
Over 5 years:
$1100
Combined
annual limit
(chiropractic
and
osteopathic)
Combined
annual limit
(chiropractic
and
osteopathic)
Up to 3 years:
$650
Membership
limit
No limit
Combined
annual limit
(chiropractic
and
osteopathic)
Combined
annual limit
(chiropractic
and
osteopathic)
Up to 3 years:
$1300
Up to 3 years:
$550
Up to 3 years:
$1100
Over 3 years:
$750
Over 3 years:
$1500
Over 3 years:
$650
Over 3 years:
$1300
1 per year
No limit
1 per year
No limit
$30
Special Options
Saver Options
Type of service
Additional information
Benefit
Person limit
Membership
limit
Benefit
Person limit
Membership
limit
Orthoptics
(eye therapy)
N/A
N/A
No limit
N/A
N/A
No limit
Osteopathic
Combined
annual limit
(chiropractic,
physiotherapy,
osteopathic
and podiatry)
$450
Combined
annual limit
(chiropractic,
physiotherapy,
osteopathic
and podiatry)
$900
Combined
annual limit
(chiropractic,
dietetics,
healthy lifestyle,
complementary
therapies,
osteopathic,
pharmacy,
physiotherapy &
podiatry) $350
Combined annual
limit (chiropractic,
dietetics,
healthy lifestyle,
complementary
therapies,
osteopathic,
pharmacy,
physiotherapy
and podiatry)
$700
N/A
N/A
N/A
No limit
N/A
N/A
No limit
Peak Flow
Meter
Visits 2-10:
$21
Visits 10+: $16
Visits 2-10:
$21
Visits 10+: $16
Extras benefits
Premium Options
35
36
Type of service
Additional information
Benefit
Person limit
Pharmacy
Not payable on
contraceptives or NHS
(PBS) prescriptions or
over the counter items
purchased with or
without a prescription.
Member
pays PBS
contribution.
Benefit is 100%
of balance up
to $80 per
script item.
Up to 3 years:
$200
Combined limit
(occupational,
orthoptics
and speech
therapy)
Physiotherapy
Super Options
Membership
limit
No limit
Over 3 years:
$400
No limit
Benefit
Person limit
Member
pays PBS
contribution.
Benefit is 100%
of balance up
to $80 per
script item.
Up to 3 years:
$200
Combined limit
(occupational,
orthoptics
and speech
therapy)
Up to 5 years:
$1200
Antenatal: $13
Over 5 years:
$1500
Group: $13
$600 sublimit
for
hydrotherapy,
antenatal and
group.
Additional information
Benefit
Person limit
Membership
limit
Pharmacy
Not payable on
contraceptives or NHS
(PBS) prescriptions or
over the counter items
purchased with or
without a prescription.
Member
pays PBS
contribution.
Benefit is
100% of
balance up to
$80 per script
item.
$200
Physiotherapy
Antenatal: $13
Combined
annual limit
(complementary therapies,
chiropractic,
physiotherapy,
osteopathic and
podiatry)
Group: $8
$450
Hydrotherapy:
$13
$400 sublimit
for
hydrotherapy,
antenatal and
group.
Over 3 years:
$400
No limit
Up to 5 years:
$900
Over 5 years:
$1100
Saver Options
Type of service
No limit
$500 sublimit
for
hydrotherapy,
antenatal and
group.
Special Options
Membership
limit
Benefit
Person limit
Membership
limit
No limit
Member
pays PBS
contribution.
Benefit is
100% of
balance up to
$80 per script
item.
Combined
annual limit
(chiropractic,
dietetics,
healthy lifestyle,
complementary therapies,
osteopathic,
pharmacy,
physiotherapy
& podiatry)
$350
Combined
annual limit
(chiropractic,
dietetics,
healthy
lifestyle,
complementary therapies,
osteopathic,
pharmacy,
physiotherapy
and podiatry)
$700
Combined
annual limit
(complementary therapies,
chiropractic,
physiotherapy,
osteopathic
and podiatry)
$900
Combined
annual limit
(chiropractic,
dietetics,
healthy lifestyle,
complementary therapies,
osteopathic,
pharmacy,
physiotherapy
and podiatry)
$350
Combined
annual limit
(chiropractic,
dietetics,
healthy
lifestyle,
complementary therapies,
osteopathic,
pharmacy,
physiotherapy
and podiatry)
$700
$300
sublimit for
hydrotherapy,
antenatal and
group.
Extras benefits
Premium Options
37
38
Membership
limit
Benefit
Person limit
$382
includes
podiatry
surgery
performed
in the
podiatrists
registered
rooms only.
No limit
$354
includes
podiatry
surgery
performed in
the podiatrists
registered
rooms only
No limit
$1,000 per
year
No limit
No limit
Combined limit
(occupational,
orthoptics and
physiotherapy)
No limit
Type of service
Additional information
Benefit
Person limit
Podiatry*
Maximum of 2 sessions
will be paid on the
same date if there is a
minimum of 2 hours
between sessions.
Benefits are paid on
consultations carried
out by a registered
psychologist, approved
by HIF.
Psychology
Speech therapy
Subsequent:
$25
Consultations
that are not
performed in
the podiatrists
registered
practice: $12
Subsequent:
$55
Super Options
Subsequent:
$23
Consultations
that are not
performed in
the podiatrists
registered
practice: $12
Subsequent:
$55
Group: $30
per person to
a max of $75
per session
Subsequent:
$45
Membership
limit
Group: $25
per person to
a max of $75
per session
Combined
limit
(occupational,
orthoptics and
physiotherapy)
No limit
Up to 5 years:
$900
Up to 5 years:
$1200
Over 5 years:
$1100
Over 5 years:
$1500
* Benefits not payable when provided as part of treatment provided in, or arranged by a hospital (including surgery).
Special Options
Saver Options
Type of service
Additional information
Benefit
Person limit
Membership
limit
Podiatry*
Combined
annual limit
(chiropractic,
physiotherapy,
osteopathic
and podiatry)
$450
Psychology
Maximum of 2 sessions
will be paid on the
same date if there is a
minimum of 2 hours
between sessions.
Benefits are paid on
consultations carried
out by a registered
psychologist, approved
by HIF.
N/A
Speech therapy
N/A
Subsequent:
$23
Consultations
that are not
performed in
the podiatrists
registered
practice: $12
Benefit
Person limit
Membership
limit
Combined
annual limit
(chiropractic,
physiotherapy,
osteopathic
and podiatry)
$900
Combined
annual limit
(chiropractic,
dietetics,
healthy lifestyle,
complementary therapies,
osteopathic,
pharmacy,
physiotherapy
& podiatry)
$350
Combined
annual limit:
(chiropractic,
dietetics,
healthy
lifestyle,
complementary therapies,
osteopathic,
pharmacy,
physiotherapy
and podiatry)
$700
N/A
No limit
N/A
N/A
No limit
N/A
No limit
N/A
N/A
No limit
Subsequent:
$23
Consultations
that are not
performed in
the podiatrists
registered
practice: $12
* Benefits not payable when provided as part of treatment provided in or arranged by, a hospital (including surgery).
Extras benefits
Premium Options
39
Additional information
Optical
Memberships up
to 5 years
Memberships over
5 years
Memberships up to
5 years
Memberships over
5 years
Memberships up to
5 years
Memberships over
5 years
Memberships up to
5 years
Memberships over
5 years
Benefits are
paid on items
carried out by
a registered
optometrist or
optical provider,
approved by HIF.
$90
$112.50
$70
$87.50
$55
$60.50
$50
$55
$75
$93.75
$70
$87.50
$45
$49.50
$40
$44
$100
$125
$95
$118.75
$60
$66
$55
$60.50
$150
$187.50
$145
$181.25
$60
$66
$55
$60.50
$150
$187.50
$145
$181.25
$60
$66
$55
$60.50
$170
$212.50
$150
$187.50
$110
$121
$100
$110
$280
$350
$260
$325
$140
$155
$110
$121
Frames sub-limit
$110
$140
$85
$110
$65
$71.50
$55
$60.50
$170
$215
$150
$190
$110
$121
$100
$110
Premium Options
Super Options
Special Options
Saver Options
(item no 412):
Pair Progressive Lenses
(item no 512):
Pair Frequently Replaced
Contact Lenses
(item no 852):
Limit per person
Annual limit, all services
(including frames and
contacts)
40
41
Description
Subsequent Visits
First Visit
011 or 012
Oral examination
100%
80%
100%
80%
121
100%
80%
151 or 153
Provision of a mouthguard
100%
80%
Please note: These benefits are payable on all our Extras products. The actual benefit amount cannot exceed our
set maximum beneft for each dental item, service sub limits or annual dental limit. See the example on page 8 for
more information.
Item
Number
Description
Premium
Options
Super
Options
Special
Options
Saver
Options
013
80%
70%
65%
65%
014
Consultation
80%
70%
65%
65%
022
80%
70%
65%
65%
118
80%
70%
65%
65%
161
80%
70%
65%
65%
311
80%
70%
65%
65%
512
80%
70%
65%
65%
513
80%
70%
65%
65%
521
80%
70%
65%
65%
522
80%
70%
65%
65%
523
80%
70%
65%
65%
531
80%
70%
65%
65%
532
80%
70%
65%
65%
533
80%
70%
65%
65%
575
80%
70%
65%
65%
577
80%
70%
65%
65%
Please note: The actual benefit amount cannot exceed our set maximum benefit for each dental item, service sub
limits or overall annual limit.
42
43
Item
Number
General Unlimited
022
311 - 314
511 - 535
Year 2
Year 3
Year 4
Year 5
After 5
Years
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
Item
Number
Year 1
Year 2
Year 3
Year 4
Year 5
After 5
Years
General Unlimited
022
311 - 314
511 - 535
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
General Limited
011 - 017
025 - 171
322 - 399
572 - 597
911 - 949
961 - 986
$800
$950
$1,150
$1,350
$1,550
$1,750
Inlay/Onlay
541 - 555
$500
$600
$700
$800
$900
$1,000
Denture, Crown,
Bridge *
611 - 691
711 - 779
$600
$700
$800
$900
$1,000
$1,100
Periodontic &
Endodontic
213 - 282
411 - 458
$300
$400
$500
$600
$700
$800
Orthodontic
(Lifetime
Limit *)
811 - 878
$1,000
$1,200
$1,400
$1,600
$1,800
$2,000
$1,000
$1,200
$1,400
$1,600
$1,800
$2,000
Year 1
Year 2
Year 3
Year 4
Year 5
After 5
Years
011 - 017
025 - 171
322 - 399
572 - 597
911 - 949
961 - 986
$1,500
Inlay/Onlay
541 - 555
$1,000
$1,100
$1,200
$1,300
$1,400
$1,500
Denture, Crown,
Bridge *
611 - 691
711 - 779
$1,200
$1,300
$1,400
$1,500
$1,600
$1,700
Periodontic &
Endodontic
213 - 282
411 - 458
$700
$800
$900
$1,000
$1,100
$1,200
Orthodontic
(Lifetime
Limit* )
811 - 878
$1,500
$1,800
$2,100
$2,400
$2,700
$3,000
Total annual
limits per
person
$1,500
$1,800
$2,100
$2,400
$2,700
$3,000
Saver
Options
Item
Number
General Unlimited
022
311 - 314
511 - 535
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
General Limited
011 - 017
025 - 171
322 - 399
572 - 597
911 - 949
961 - 986
$750
$850
$950
$1,050
$1,150
$1,250
Inlay/Onlay
541 - 555
Not
covered
Not
covered
Not
covered
Not
covered
Not
covered
Not
covered
Denture, Crown,
Bridge *
611 - 691
711 - 779
Not
covered
Not
covered
Not
covered
Not
covered
Not
covered
Not
covered
Periodontic &
Endodontic
213 - 282
411 - 458
Not
covered
Not
covered
Not
covered
Not
covered
Not
covered
Not
covered
Orthodontic
(Lifetime Limit*)
811 - 878
Not
covered
Not
covered
Not
covered
Not
covered
Not
covered
Not
covered
$750
$850
$950
$1,050
$1,150
$1,250
General Limited
Total annual
limits per
person
Super
Options
Item
Number
General Unlimited
022
311 - 314
511 - 535
$1,800
$2,100
$2,400
$2,700
$3,000
Year 1
Year 2
Year 3
Year 4
Year 5
After 5
Years
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
011 - 017
025 - 171
322 - 399
572 - 597
911 - 949
961 - 986
$1,150
Inlay/Onlay
541 - 555
$700
$800
$900
$1,000
$1,100
$1,200
Denture, Crown,
Bridge *
611 - 691
711 - 779
$900
$1,000
$1,100
$1,200
$1,300
$1,400
Periodontic &
Endodontic
213 - 282
411 - 458
General Limited
Orthodontic
(Lifetime
Limit *)
Total annual
limits per
person
44
Year 1
Special
Options
811 - 878
$500
$1,350
$600
$1,550
$700
$1,750
$800
$2,050
$900
$2,350
$1,000
$1,300
$1,500
$1,700
$1,900
$2,200
$2,500
$1,300
$1,500
$1,700
$1,900
$2,200
$2,500
Total annual
limits per
person
* For more information about replacement periods and lifetime limits refer to "Important information about your dental
cover" on page 46
45
46
Compliments and
complaints
Your feedback is valuable to us, so dont
be afraid to get in touch. You may wish to
comment on your personal experiences
with HIF, or you may wish to lodge a
compliment (or complaint) about the
service youve received from our team.
Whatever your feedback relates to, we
address each and every compliment/
complaint and will always respond
accordingly. Your input is a vital part of
ensuring our organisation meets or ideally
exceeds your expectations at all times.
To submit feedback, simply visit
hif.com.au and complete the online
feedback form. Alternatively, you can
email info@hif.com.au or call us on
1300 13 40 60.
Providing feedback
or making a
complaint
HIF is committed to providing our members
with access to the highest possible level
of service and we value the feedback that
our members provide. As part of HIFs
commitment to continuous improvement
if you have a concern regarding your HIF
membership, our products, benefits or our
service we would be happy to hear from
you.
If you have a complaint or concerns, you
can discuss this with one of our Customer
Service Representatives on 1300 13 40 60
or email your complaint to info@hif.com.au
and we will:
Treat you with respect and deal with your
concerns promptly
Resolve any complaints at the first point of
contact, wherever possible
Your privacy
The personal information you provide to
us will be primarily used by HIF to deliver
health insurance products and services
as requested by you. The information
supplied by you will remain confidential.
This information may be disclosed to third
parties and authorised government
agencies in order to facilitate the delivery
of services associated with your health
insurance. Failure to provide personal
information may result in the failure to
process or deliver the service requested.
For a complete HIF Privacy Policy brochure,
please contact us on 1300 13 40 60 or
download a copy at hif.com.au
47
48
49
Glossary
Unchanged
Tier 1
Tier 2
Tier 3
Single
<$90,000
$90,001 - 105,000
$105,001 - 140,000
>$140,001
Families
<$180,000
$180,001 - 210,000
$204,001 - 280,000
>$280,001
Age
Under 65
29.04%
19.36%
9.68%
0%
65 - 69 years
33.88%
24.20%
14.52%
0%
70 and over
38.72%
29.04%
19.36%
0%
All ages
0%
1.5%
Medicare Levy
Accident
An accident is an unforeseen event, occurring
by chance and caused by an external force or
object which results in an injury to the body.
An accident as defined above and requiring
immediate medical treatment in hospital
within 24 hours of the accident. If further
hospital treatment (as an admitted patient)
is required, the patient must be re-admitted
to a hospital within 90 days of the initial
hospital treatment.
Admission
Couples
1.0%
AccessGap Cover
Extras
Basic benefit
When the benefit payable is equivalent to the
benefits available if the service was provided
in a shared room in a public hospital.
Benefit
The payment due to the primary member for
services received by an approved provider.
50
Dependant
51
Inpatient
Policy holder
Primary member
52
Qualifying periods
Any period occurring immediately after
joining the fund or joining a higher benefiting
table, during which either some or all fund
benefit is not payable.
Recognised educational institution
An Australian educational institution such
as a school, college or university, recognised
by the Commonwealth, State or Territory
Governments.
Restricted service
Hospital services which are only covered for
payments at the basic benefit level.
Transfer certificate
The document transferred between
registered health funds, detailing the
members fund history (including Certified
Age at Entry), confirmation of the financial
status of the member and claims history.
Waiting periods
The standard period which applies before a
member becomes eligible for benefit.
For more glossary terms, visit hif.com.au
53
Follow us on
1300 13 40 60
info@hif.com.au