Important information

Standard information statements

Standard Information Statements provide a brief summary of your level of cover to help you review your existing policy and compare other health funds. Your health fund is required by law to issue you a Standard Information Statement when you first join and for every year you continue to be covered. 

For more information about Standard Information Statements you can phone on 1800 804 950.

You can view each health fund’s Standard Information Statements by visiting privatehealth.gov.au

Suspending membership

Members may apply for suspension of their membership if they have held private health insurance cover for at least 12 months and paid all contributions due as of the application date.

Suspension of membership can be approved on two grounds:

  • The member’s absence from Australia for 28 days and up to two years.
  • The member’s financial hardship for 1 to 6 months.

Periods of suspension of hospital cover do not count towards the cumulative absence allowed by Lifetime Health Cover legislation.

If a member reinstates membership within 30 days of the period suspension ending and pays contributions from the end of the suspension period, there will be no new waiting periods to be served.

For details of what information you will need to provide in your application for suspension of membership, call us on 1800 804 950.

Ceasing membership

If you choose to cease your hospital cover, your future hospital health cover premiums will be subject to the Lifetime Health Cover provisions dealing with periods of absence.

Please note that high income earners will be subject to the Medicare Levy Surcharge (MLS) during a period of suspended hospital cover.

Recognised/approved treatment providers

HCI can only pay benefits to members that use providers who are recognised and approved by HCI. Recognition of providers  by HCI is subject to change without notice.  If you are not sure about a provider’s approved status with HCI, call us on 1800 804 950 to check before arranging treatment.

Services provided by family members

Unless a member has received prior  approval from the General Manager, HCI will not pay benefits for services or goods provided to a person covered by a membership where those services or  goods are supplied by a family member.

Overseas treatment

HCI will not pay a benefit for services, treatment or appliances provided or purchased overseas. HCI will only pay a benefit towards services, treatment and appliances by approved providers and/or suppliers registered within Australia only.

Compensation and damages

HCI does not pay benefits for services or treatment where you are entitled to receive compensation or damages from another source. Where an accident or illness is caused by the actions of another party, HCI expects that you will pursue a claim for compensation or damages from the party concerned. HCI may, however, make provisional payments where compensation or damages are claimable by you, provided you agree to repay such payments from your final settlement.

If you become involved in circumstances where compensation or damages may be claimable by you, please call us on 1800 804 950 to seek clarification of your benefit entitlements.

30 day money back guarantee

Our 30 day money back guarantee lets you cancel your membership within 30 days with a full refund of any contributions you have paid. Your 30 day cooling-off period starts as soon as you join. However, your cooling off period is no longer available if a claim under your policy has been made during the cooling-off period.

Payment default

Should your contributions fall more than two months in arrears, your membership may be ceased. Acceptance of arrears payments after two months is not automatic, so please talk to us if you need time to pay. It should be noted that benefits are not payable for treatment if your contributions are in arrears.

Benefit limitation periods

Some private health insurers will apply Benefit Limitation Periods (BLP) for certain  types of treatments and hospital policies. 

BLP are periods applied after your waiting period has already been served and a lower benefit is paid than the normal benefit. HCI does not apply BLP for members.

Feedback

At HCI we value your opinion and if a product or service does not meet your expectations, we want to know about it. Talk to us - our team is here to listen. We want your feedback and aim to solve any questions or concerns on the spot.  You can call us on  1800 804 950 or alternatively you can write to us at enquiries@hciltd.com.au or  

PO Box 931, Burnie TAS 7320 
In managing your complaints 
HCI will seek to: 

  • Resolve your matter at first point of call 
  • Keep you informed of the process 
  • Investigate your complaint and respond to you within 5 business days 
  • Provide you with a final response within 45 days