For procedures identified as Minimum Benefits, we will pay the rate set out by the Commonwealth as the minimum shared room benefit and benefits for Government approved Prostheses List items, if applicable.
Waiting Period: 1 day
This is a service where Minimum Benefits apply, which means that we will pay the rate set out by the Commonwealth as the minimum shared room benefit, and benefits for Government approved Prostheses if applicable.
Waiting Period: 2 months
This is a service where Minimum Benefits apply, which means that we will pay the rate set out by the Commonwealth as the minimum shared room benefit, and benefits for Government approved Prostheses if applicable.
Members who have held hospital cover for at least 2 months and upgrade to HCF Hospital Gold to receive hospital psychiatric services as covered services may not be required to serve the waiting period for hospital psychiatric services. This exemption can only be accessed once in a member's lifetime.
Waiting Period: 2 months
This is a service where Minimum Benefits apply, which means that we will pay the rate set out by the Commonwealth as the minimum shared room benefit, and benefits for Government approved Prostheses if applicable.
Waiting Period: 2 months
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Minimum benefits covered
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
If you have hospital cover, you can claim benefits for things like accommodation and operating theatre fees when admitted to hospital as an inpatient for dental surgery. You may have out-of-pocket costs depending on the hospital and dental surgeon you choose.
If you have eligible extras, you can claim benefits for dental surgery received out of hospital. You may have out-of-pocket costs depending on your annual limits and the services and treatments included in your extras cover.
Waiting Period: 2 months
(12 months pre-existing)
Limited benefits apply. Minimum Benefit level payable by HCF for Hospital accommodation as determined under the Private Health Insurance Act and the cost of prosthesis (as listed on the Prosthesis List). No benefit is payable for podiatric surgeon fees. Ensure you have Informed Financial Consent prior to your treatment, for any out-of-pocket expenses.
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 12 months
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
The waiting period for pre-existing ailments is 12 months. The waiting period for hospital psychiatric services, rehabilitation services and palliative care is 2 months. A pre-existing ailment, illness or condition is one where the signs or symptoms existed in the six months before joining HCF or upgrading your cover.
Waiting Period: 12 months
In Australia, hospital cover is categorised as either Gold, Silver, Bronze or Basic. Hospital cover gives you more control if you need to go to hospital – like getting treated sooner by a doctor of your choice. We offer cover for singles, couples and families. If your situation changes down the track we can help you find cover that suits your new needs.
Hospital waiting periods vary according to the type of treatment or service. If you’re new to private health insurance, rejoining after a break in cover, upgrading to a higher level of cover, or changing your excess, you’ll have to wait before claiming on certain treatment and services.
When you take out hospital cover you’ll be asked to choose your excess. This is the amount you agree to pay if you’re admitted to hospital for planned treatment.
If you choose a higher excess, you’ll lower the cost of your cover. Choosing a lower, or zero excess, means you’ll pay less if you go to hospital, but the cost of your cover will be more.
Max 2 check ups, 2 scale and clean, and 1 fluoride treatment per person, per year
| Service | Benefits |
|---|---|
| Examinations | $32 - $73 |
| Single film x-rays | $31 |
| Removal of plaque / calculus | $36 - $64 |
| Application of fluoride | $28 |
Year 1 $800 limit
| Service | Benefits |
|---|---|
| Direct fillings (1-2 surfaces) | $85 - $105 |
| Direct fillings (3 or more surfaces) | $128 - $177 |
| Simple extractions | $95 - $143 |
| Indirect fillings | $298 - $671 |
| Surgical extractions | $165 - $260 |
| Treatment of tissue surrounding teeth | $23 - $374 |
| Treatment of root canals | $27 - $248 |
| Placing of crowns and bridges | $244 - $1,000 |
| Dentures and/or components (partial and complete) - Limits renew every 3 years | $25 - $1,100 |
$700 LIMIT for ORTHODONTISTS ($350 LIMIT if general dentist)
Lifetime limit $2,100 or $1,050 for services by dentists, other than orthodontists
| Service | Benefits |
|---|---|
| Orthodontics - orthodontist / other dentists | Up to $700/$350 |
| General Dental | 2 months |
| Major Dental | 12 months |
| Orthodontic | 12 months |
$250 limit
| Service | Benefits |
|---|---|
| Spectacle frames | 100% of fee up to annual limit |
| Spectacle lenses - pair (excludes add-ons such as high index material, coatings and tinting) | 100% of fee up to annual limit |
| Contact lenses - pair | 100% of fee up to annual limit |
| Optical | 2 months |
Year 1 $350 limit
| Service | Benefits |
|---|---|
| Physiotherapy – initial / subsequent (group / class consultations covered under Health Management Program) | $58 / $49 |
| Exercise physiology (group / class consultations covered under Health Management Program) | $33 |
Year 1 $350 limit
| Service | Benefits |
|---|---|
| Occupational therapy | $62 |
| Psychology (after Medicare Mental Health Treatment Plan used up) includes group consultations | $26/$85 |
| Psychology (when member does not have any unused Medicare Mental Health Treatment Plan in the calendar year) includes group consultations | $18/$49 |
| HCF-approved counselling & accredited mental health social worker includes group consultations | $15/$41 |
| HCF-approved Online Cognitive Behavioural Therapy courses | $35 - $59 |
Year 1 $250 limit
| Service | Benefits |
|---|---|
| Chiropractic - initial / subsequent | $40 / $33 |
| Osteopathy - initial / subsequent | $48 / $38 |
Year 1 $250 limit
Sub-limit $250 per therapy service
| Service | Benefits |
|---|---|
| Remedial massage and myotherapy - initial / subsequent | $36 / $31 |
| Acupuncture and Chinese herbal medicine consultation - initial / subsequent | $36 / $31 |
Year 1 $200 limit
| Service | Benefits |
|---|---|
| Dietetics - initial / subsequent | $45 |
| Audiology - initial / subsequent | $60 |
| Speech pathology - initial / subsequent | $60 |
| Podiatry (including 1 pair of foot orthotics per person per year) | $35 / $30 |
| Orthotist/Prosthetist and Pedorthist | $20-$100 |
| Therapies (excluding foot orthotics) | 2 months |
Max $200 per policy
| Service | Benefits |
|---|---|
| Travel and Accommodation (200km round trip) | $40 |
$180 limit
| Service | Benefits |
|---|---|
| HCF approved pharmacy (After PBS equivalent co-payment subtracted) | Up to $50 per script |
Max $150 per policy
| Service | Benefits |
|---|---|
| Artificial aids (HCF approved e.g. low vision aids) | $45 - $150 |
$600 - $1,600 limit
| Service | Benefits |
|---|---|
| Hearing aids | $600 (benefits accrue and renew every three years) |
$150 per person max $300 per policy
| Service | Benefits |
|---|---|
| Health Management Programs (HCF approved e.g. exercise classes) | Up to $150 per person |
$150 per eligible child
| Service | Benefits |
|---|---|
| School Accident Benefit | Up to $150 per eligible child |
| Travel and Accommodation | 2 months |
| Vaccines and Immunisations | 2 months |
| Artificial aids | 12 months |
| Hearing aids | 12 months |
| Health Management Programs | 2 months |
| School Accident Benefit | 2 – 12 months |
| Foot orthotics | 12 months |
Extras cover helps reduce out-of-pocket expenses that come with managing or improving your health. Depending on which extras cover you choose, you can claim on a range of services like dental, optical, physio, weight management programs and more. Waiting periods apply and vary according to the type of service.
If you have extras cover, we’ll pay up to a set amount for extras services (like dental or optical), depending on your annual limits. The amount we’ll pay also varies depending on your level of cover. You’ll need to pay the difference between what your extras provider charges and the benefits we pay: this is an extras gap.
Getting the most out of your extras cover means more money saved, and a boost to your family’s health and wellbeing. Preventive health checks are important at any age and our wide network of extras providers makes accessing care easy. Depending on your level of cover and which service you choose, you could get 100% back** through our no-gap providers.
Included means services and treatments are covered and you'll have less out-of-pocket expenses.
For procedures identified as Minimum Benefits, we will pay the rate set out by the Commonwealth as the minimum shared room benefit and benefits for Government approved Prostheses List items, if applicable.
Waiting Period: 1 day
This is a service where Minimum Benefits apply, which means that we will pay the rate set out by the Commonwealth as the minimum shared room benefit, and benefits for Government approved Prostheses if applicable.
Waiting Period: 2 months
This is a service where Minimum Benefits apply, which means that we will pay the rate set out by the Commonwealth as the minimum shared room benefit, and benefits for Government approved Prostheses if applicable.
Members who have held hospital cover for at least 2 months and upgrade to HCF Hospital Gold to receive hospital psychiatric services as covered services may not be required to serve the waiting period for hospital psychiatric services. This exemption can only be accessed once in a member's lifetime.
Waiting Period: 2 months
This is a service where Minimum Benefits apply, which means that we will pay the rate set out by the Commonwealth as the minimum shared room benefit, and benefits for Government approved Prostheses if applicable.
Waiting Period: 2 months
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Minimum benefits covered
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
If you have hospital cover, you can claim benefits for things like accommodation and operating theatre fees when admitted to hospital as an inpatient for dental surgery. You may have out-of-pocket costs depending on the hospital and dental surgeon you choose.
If you have eligible extras, you can claim benefits for dental surgery received out of hospital. You may have out-of-pocket costs depending on your annual limits and the services and treatments included in your extras cover.
Waiting Period: 2 months
(12 months pre-existing)
Limited benefits apply. Minimum Benefit level payable by HCF for Hospital accommodation as determined under the Private Health Insurance Act and the cost of prosthesis (as listed on the Prosthesis List). No benefit is payable for podiatric surgeon fees. Ensure you have Informed Financial Consent prior to your treatment, for any out-of-pocket expenses.
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 12 months
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
Waiting Period: 2 months
(12 mths pre-existing)
In Australia, hospital cover is categorised as either Gold, Silver, Bronze or Basic. Hospital cover gives you more control if you need to go to hospital – like getting treated sooner by a doctor of your choice. We offer cover for singles, couples and families. If your situation changes down the track we can help you find cover that suits your new needs.
Hospital waiting periods vary according to the type of treatment or service. If you’re new to private health insurance, rejoining after a break in cover, upgrading to a higher level of cover, or changing your excess, you’ll have to wait before claiming on certain treatment and services.
When you take out hospital cover you’ll be asked to choose your excess. This is the amount you agree to pay if you’re admitted to hospital for planned treatment.
If you choose a higher excess, you’ll lower the cost of your cover. Choosing a lower, or zero excess, means you’ll pay less if you go to hospital, but the cost of your cover will be more.
Max 2 check ups, 2 scale and clean, and 1 fluoride treatment per person, per year
| Service | Benefits |
|---|---|
| Examinations | $32 - $73 |
| Single film x-rays | $31 |
| Removal of plaque / calculus | $36 - $64 |
| Application of fluoride | $28 |
Year 1 $800 limit
| Service | Benefits |
|---|---|
| Direct fillings (1-2 surfaces) | $85 - $105 |
| Direct fillings (3 or more surfaces) | $128 - $177 |
| Simple extractions | $95 - $143 |
| Indirect fillings | $298 - $671 |
| Surgical extractions | $165 - $260 |
| Treatment of tissue surrounding teeth | $23 - $374 |
| Treatment of root canals | $27 - $248 |
| Placing of crowns and bridges | $244 - $1,000 |
| Dentures and/or components (partial and complete) - Limits renew every 3 years | $25 - $1,100 |
$700 LIMIT for ORTHODONTISTS ($350 LIMIT if general dentist)
Lifetime limit $2,100 or $1,050 for services by dentists, other than orthodontists
| Service | Benefits |
|---|---|
| Orthodontics - orthodontist / other dentists | Up to $700/$350 |
| General Dental | 2 months |
| Major Dental | 12 months |
| Orthodontic | 12 months |
$250 limit
| Service | Benefits |
|---|---|
| Spectacle frames | 100% of fee up to annual limit |
| Spectacle lenses - pair (excludes add-ons such as high index material, coatings and tinting) | 100% of fee up to annual limit |
| Contact lenses - pair | 100% of fee up to annual limit |
| Optical | 2 months |
Year 1 $350 limit
| Service | Benefits |
|---|---|
| Physiotherapy – initial / subsequent (group / class consultations covered under Health Management Program) | $58 / $49 |
| Exercise physiology (group / class consultations covered under Health Management Program) | $33 |
Year 1 $350 limit
| Service | Benefits |
|---|---|
| Occupational therapy | $62 |
| Psychology (after Medicare Mental Health Treatment Plan used up) includes group consultations | $26/$85 |
| Psychology (when member does not have any unused Medicare Mental Health Treatment Plan in the calendar year) includes group consultations | $18/$49 |
| HCF-approved counselling & accredited mental health social worker includes group consultations | $15/$41 |
| HCF-approved Online Cognitive Behavioural Therapy courses | $35 - $59 |
Year 1 $250 limit
| Service | Benefits |
|---|---|
| Chiropractic - initial / subsequent | $40 / $33 |
| Osteopathy - initial / subsequent | $48 / $38 |
Year 1 $250 limit
Sub-limit $250 per therapy service
| Service | Benefits |
|---|---|
| Remedial massage and myotherapy - initial / subsequent | $36 / $31 |
| Acupuncture and Chinese herbal medicine consultation - initial / subsequent | $36 / $31 |
Year 1 $200 limit
| Service | Benefits |
|---|---|
| Dietetics - initial / subsequent | $45 |
| Audiology - initial / subsequent | $60 |
| Speech pathology - initial / subsequent | $60 |
| Podiatry (including 1 pair of foot orthotics per person per year) | $35 / $30 |
| Orthotist/Prosthetist and Pedorthist | $20-$100 |
| Therapies (excluding foot orthotics) | 2 months |
Max $200 per policy
| Service | Benefits |
|---|---|
| Travel and Accommodation (200km round trip) | $40 |
$180 limit
| Service | Benefits |
|---|---|
| HCF approved pharmacy (After PBS equivalent co-payment subtracted) | Up to $50 per script |
Max $150 per policy
| Service | Benefits |
|---|---|
| Artificial aids (HCF approved e.g. low vision aids) | $45 - $150 |
$600 - $1,600 limit
| Service | Benefits |
|---|---|
| Hearing aids | $600 (benefits accrue and renew every three years) |
$150 per person max $300 per policy
| Service | Benefits |
|---|---|
| Health Management Programs (HCF approved e.g. exercise classes) | Up to $150 per person |
$150 per eligible child
| Service | Benefits |
|---|---|
| School Accident Benefit | Up to $150 per eligible child |
| Travel and Accommodation | 2 months |
| Vaccines and Immunisations | 2 months |
| Artificial aids | 12 months |
| Hearing aids | 12 months |
| Health Management Programs | 2 months |
| School Accident Benefit | 2 – 12 months |
| Foot orthotics | 12 months |
Extras cover helps reduce out-of-pocket expenses that come with managing or improving your health. Depending on which extras cover you choose, you can claim on a range of services like dental, optical, physio, weight management programs and more. Waiting periods apply and vary according to the type of service.
If you have extras cover, we’ll pay up to a set amount for extras services (like dental or optical), depending on your annual limits. The amount we’ll pay also varies depending on your level of cover. You’ll need to pay the difference between what your extras provider charges and the benefits we pay: this is an extras gap.
Getting the most out of your extras cover means more money saved, and a boost to your family’s health and wellbeing. Preventive health checks are important at any age and our wide network of extras providers makes accessing care easy. Depending on your level of cover and which service you choose, you could get 100% back** through our no-gap providers.
Restricted means hospital benefits are limited and you may have higher out-of-pocket expenses for these services and treatments.
The waiting period for pre-existing ailments is 12 months. The waiting period for hospital psychiatric services, rehabilitation services and palliative care is 2 months. A pre-existing ailment, illness or condition is one where the signs or symptoms existed in the six months before joining HCF or upgrading your cover.
Waiting Period: 12 months
In Australia, hospital cover is categorised as either Gold, Silver, Bronze or Basic. Hospital cover gives you more control if you need to go to hospital – like getting treated sooner by a doctor of your choice. We offer cover for singles, couples and families. If your situation changes down the track we can help you find cover that suits your new needs.
Hospital waiting periods vary according to the type of treatment or service. If you’re new to private health insurance, rejoining after a break in cover, upgrading to a higher level of cover, or changing your excess, you’ll have to wait before claiming on certain treatment and services.
When you take out hospital cover you’ll be asked to choose your excess. This is the amount you agree to pay if you’re admitted to hospital for planned treatment.
If you choose a higher excess, you’ll lower the cost of your cover. Choosing a lower, or zero excess, means you’ll pay less if you go to hospital, but the cost of your cover will be more.
Max 2 check ups, 2 scale and clean, and 1 fluoride treatment per person, per year
| Service | Benefits |
|---|---|
| Examinations | $32 - $73 |
| Single film x-rays | $31 |
| Removal of plaque / calculus | $36 - $64 |
| Application of fluoride | $28 |
Year 1 $800 limit
| Service | Benefits |
|---|---|
| Direct fillings (1-2 surfaces) | $85 - $105 |
| Direct fillings (3 or more surfaces) | $128 - $177 |
| Simple extractions | $95 - $143 |
| Indirect fillings | $298 - $671 |
| Surgical extractions | $165 - $260 |
| Treatment of tissue surrounding teeth | $23 - $374 |
| Treatment of root canals | $27 - $248 |
| Placing of crowns and bridges | $244 - $1,000 |
| Dentures and/or components (partial and complete) - Limits renew every 3 years | $25 - $1,100 |
$700 LIMIT for ORTHODONTISTS ($350 LIMIT if general dentist)
Lifetime limit $2,100 or $1,050 for services by dentists, other than orthodontists
| Service | Benefits |
|---|---|
| Orthodontics - orthodontist / other dentists | Up to $700/$350 |
| General Dental | 2 months |
| Major Dental | 12 months |
| Orthodontic | 12 months |
$250 limit
| Service | Benefits |
|---|---|
| Spectacle frames | 100% of fee up to annual limit |
| Spectacle lenses - pair (excludes add-ons such as high index material, coatings and tinting) | 100% of fee up to annual limit |
| Contact lenses - pair | 100% of fee up to annual limit |
| Optical | 2 months |
Year 1 $350 limit
| Service | Benefits |
|---|---|
| Physiotherapy – initial / subsequent (group / class consultations covered under Health Management Program) | $58 / $49 |
| Exercise physiology (group / class consultations covered under Health Management Program) | $33 |
Year 1 $350 limit
| Service | Benefits |
|---|---|
| Occupational therapy | $62 |
| Psychology (after Medicare Mental Health Treatment Plan used up) includes group consultations | $26/$85 |
| Psychology (when member does not have any unused Medicare Mental Health Treatment Plan in the calendar year) includes group consultations | $18/$49 |
| HCF-approved counselling & accredited mental health social worker includes group consultations | $15/$41 |
| HCF-approved Online Cognitive Behavioural Therapy courses | $35 - $59 |
Year 1 $250 limit
| Service | Benefits |
|---|---|
| Chiropractic - initial / subsequent | $40 / $33 |
| Osteopathy - initial / subsequent | $48 / $38 |
Year 1 $250 limit
Sub-limit $250 per therapy service
| Service | Benefits |
|---|---|
| Remedial massage and myotherapy - initial / subsequent | $36 / $31 |
| Acupuncture and Chinese herbal medicine consultation - initial / subsequent | $36 / $31 |
Year 1 $200 limit
| Service | Benefits |
|---|---|
| Dietetics - initial / subsequent | $45 |
| Audiology - initial / subsequent | $60 |
| Speech pathology - initial / subsequent | $60 |
| Podiatry (including 1 pair of foot orthotics per person per year) | $35 / $30 |
| Orthotist/Prosthetist and Pedorthist | $20-$100 |
| Therapies (excluding foot orthotics) | 2 months |
Max $200 per policy
| Service | Benefits |
|---|---|
| Travel and Accommodation (200km round trip) | $40 |
$180 limit
| Service | Benefits |
|---|---|
| HCF approved pharmacy (After PBS equivalent co-payment subtracted) | Up to $50 per script |
Max $150 per policy
| Service | Benefits |
|---|---|
| Artificial aids (HCF approved e.g. low vision aids) | $45 - $150 |
$600 - $1,600 limit
| Service | Benefits |
|---|---|
| Hearing aids | $600 (benefits accrue and renew every three years) |
$150 per person max $300 per policy
| Service | Benefits |
|---|---|
| Health Management Programs (HCF approved e.g. exercise classes) | Up to $150 per person |
$150 per eligible child
| Service | Benefits |
|---|---|
| School Accident Benefit | Up to $150 per eligible child |
| Travel and Accommodation | 2 months |
| Vaccines and Immunisations | 2 months |
| Artificial aids | 12 months |
| Hearing aids | 12 months |
| Health Management Programs | 2 months |
| School Accident Benefit | 2 – 12 months |
| Foot orthotics | 12 months |
Extras cover helps reduce out-of-pocket expenses that come with managing or improving your health. Depending on which extras cover you choose, you can claim on a range of services like dental, optical, physio, weight management programs and more. Waiting periods apply and vary according to the type of service.
If you have extras cover, we’ll pay up to a set amount for extras services (like dental or optical), depending on your annual limits. The amount we’ll pay also varies depending on your level of cover. You’ll need to pay the difference between what your extras provider charges and the benefits we pay: this is an extras gap.
Getting the most out of your extras cover means more money saved, and a boost to your family’s health and wellbeing. Preventive health checks are important at any age and our wide network of extras providers makes accessing care easy. Depending on your level of cover and which service you choose, you could get 100% back** through our no-gap providers.
Excluded means no hospital benefits are payable and you'll pay all out-of-pocket expenses for these services and treatments.
In Australia, hospital cover is categorised as either Gold, Silver, Bronze or Basic. Hospital cover gives you more control if you need to go to hospital – like getting treated sooner by a doctor of your choice. We offer cover for singles, couples and families. If your situation changes down the track we can help you find cover that suits your new needs.
Hospital waiting periods vary according to the type of treatment or service. If you’re new to private health insurance, rejoining after a break in cover, upgrading to a higher level of cover, or changing your excess, you’ll have to wait before claiming on certain treatment and services.
When you take out hospital cover you’ll be asked to choose your excess. This is the amount you agree to pay if you’re admitted to hospital for planned treatment.
If you choose a higher excess, you’ll lower the cost of your cover. Choosing a lower, or zero excess, means you’ll pay less if you go to hospital, but the cost of your cover will be more.
Max 2 check ups, 2 scale and clean, and 1 fluoride treatment per person, per year
| Service | Benefits |
|---|---|
| Examinations | $32 - $73 |
| Single film x-rays | $31 |
| Removal of plaque / calculus | $36 - $64 |
| Application of fluoride | $28 |
Year 1 $800 limit
| Service | Benefits |
|---|---|
| Direct fillings (1-2 surfaces) | $85 - $105 |
| Direct fillings (3 or more surfaces) | $128 - $177 |
| Simple extractions | $95 - $143 |
| Indirect fillings | $298 - $671 |
| Surgical extractions | $165 - $260 |
| Treatment of tissue surrounding teeth | $23 - $374 |
| Treatment of root canals | $27 - $248 |
| Placing of crowns and bridges | $244 - $1,000 |
| Dentures and/or components (partial and complete) - Limits renew every 3 years | $25 - $1,100 |
$700 LIMIT for ORTHODONTISTS ($350 LIMIT if general dentist)
Lifetime limit $2,100 or $1,050 for services by dentists, other than orthodontists
| Service | Benefits |
|---|---|
| Orthodontics - orthodontist / other dentists | Up to $700/$350 |
| General Dental | 2 months |
| Major Dental | 12 months |
| Orthodontic | 12 months |
$250 limit
| Service | Benefits |
|---|---|
| Spectacle frames | 100% of fee up to annual limit |
| Spectacle lenses - pair (excludes add-ons such as high index material, coatings and tinting) | 100% of fee up to annual limit |
| Contact lenses - pair | 100% of fee up to annual limit |
| Optical | 2 months |
Year 1 $350 limit
| Service | Benefits |
|---|---|
| Physiotherapy – initial / subsequent (group / class consultations covered under Health Management Program) | $58 / $49 |
| Exercise physiology (group / class consultations covered under Health Management Program) | $33 |
Year 1 $350 limit
| Service | Benefits |
|---|---|
| Occupational therapy | $62 |
| Psychology (after Medicare Mental Health Treatment Plan used up) includes group consultations | $26/$85 |
| Psychology (when member does not have any unused Medicare Mental Health Treatment Plan in the calendar year) includes group consultations | $18/$49 |
| HCF-approved counselling & accredited mental health social worker includes group consultations | $15/$41 |
| HCF-approved Online Cognitive Behavioural Therapy courses | $35 - $59 |
Year 1 $250 limit
| Service | Benefits |
|---|---|
| Chiropractic - initial / subsequent | $40 / $33 |
| Osteopathy - initial / subsequent | $48 / $38 |
Year 1 $250 limit
Sub-limit $250 per therapy service
| Service | Benefits |
|---|---|
| Remedial massage and myotherapy - initial / subsequent | $36 / $31 |
| Acupuncture and Chinese herbal medicine consultation - initial / subsequent | $36 / $31 |
Year 1 $200 limit
| Service | Benefits |
|---|---|
| Dietetics - initial / subsequent | $45 |
| Audiology - initial / subsequent | $60 |
| Speech pathology - initial / subsequent | $60 |
| Podiatry (including 1 pair of foot orthotics per person per year) | $35 / $30 |
| Orthotist/Prosthetist and Pedorthist | $20-$100 |
| Therapies (excluding foot orthotics) | 2 months |
Max $200 per policy
| Service | Benefits |
|---|---|
| Travel and Accommodation (200km round trip) | $40 |
$180 limit
| Service | Benefits |
|---|---|
| HCF approved pharmacy (After PBS equivalent co-payment subtracted) | Up to $50 per script |
Max $150 per policy
| Service | Benefits |
|---|---|
| Artificial aids (HCF approved e.g. low vision aids) | $45 - $150 |
$600 - $1,600 limit
| Service | Benefits |
|---|---|
| Hearing aids | $600 (benefits accrue and renew every three years) |
$150 per person max $300 per policy
| Service | Benefits |
|---|---|
| Health Management Programs (HCF approved e.g. exercise classes) | Up to $150 per person |
$150 per eligible child
| Service | Benefits |
|---|---|
| School Accident Benefit | Up to $150 per eligible child |
| Travel and Accommodation | 2 months |
| Vaccines and Immunisations | 2 months |
| Artificial aids | 12 months |
| Hearing aids | 12 months |
| Health Management Programs | 2 months |
| School Accident Benefit | 2 – 12 months |
| Foot orthotics | 12 months |
Extras cover helps reduce out-of-pocket expenses that come with managing or improving your health. Depending on which extras cover you choose, you can claim on a range of services like dental, optical, physio, weight management programs and more. Waiting periods apply and vary according to the type of service.
If you have extras cover, we’ll pay up to a set amount for extras services (like dental or optical), depending on your annual limits. The amount we’ll pay also varies depending on your level of cover. You’ll need to pay the difference between what your extras provider charges and the benefits we pay: this is an extras gap.
Getting the most out of your extras cover means more money saved, and a boost to your family’s health and wellbeing. Preventive health checks are important at any age and our wide network of extras providers makes accessing care easy. Depending on your level of cover and which service you choose, you could get 100% back** through our no-gap providers.
