Understanding your cover FAQs

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Who’s covered on a policy? 

Please make sure you understand who's covered under your policy. Review it at least once a year to identify changes in your circumstances that could affect your health cover needs. If your family situation changes, let us know so that we can suggest adjustments to your cover. 

Policyholder.
Partner listed on the policy.
Dependants listed on the policy.

Only the policyholder can determine who's covered under a membership. 

The dependants listed on your membership are automatically covered at no extra cost under your family cover until the day before they turn 22.

If your dependants are full-time students, rely on you for maintenance and support, and aren't married or in a de facto relationship, simply register them as student dependants at the start of each academic year, and they'll be covered for no extra cost until the day before they turn 31 or when they're no longer eligible (e.g. stop full-time study), whichever comes first.

If your dependants aren't full-time students but rely on you for maintenance and support, and aren't married or in a de facto relationship, you can also continue to cover them until they turn 31 with Extended Family Cover which is only available on some levels of HCF cover, and a surcharge will apply. Otherwise, your adult dependants will need to take out their own cover.

All new dependants must serve waiting periods, unless they're transferring from another membership or another health fund where they've already completed their relevant waiting periods. In this case they'll need to request an Interfund Transfer Certificate from their previous fund when they join HCF.

Policyholder.
Dependants listed on the policy.

Single parent family cover premiums are generally lower than other family covers (approximately 20% less than the family rate) for certain levels of hospital and extras cover.

Policyholder.
Partner listed on the policy.

Policyholder.

Family cover

Policyholder.
Partner listed on the policy.
Dependants listed on the policy.

Only the policyholder can determine who's covered under a membership. 

Cover for your dependants

The dependants listed on your membership are automatically covered at no extra cost under your family cover until the day before they turn 22.

Single parent family cover

Policyholder.
Dependants listed on the policy.

Single parent family cover premiums are generally lower than other family covers (approximately 20% less than the family rate) for certain levels of hospital and extras cover.

Couples cover

Policyholder.
Partner listed on the policy.

Singles Cover

Policyholder.

Until what age can dependants stay on their family's health cover?

To make healthcare more affordable for our members, government reforms have been implemented that let dependants stay covered on their family’s health cover for longer.

You can now keep dependants on your family’s HCF health cover until they turn 31, providing they meet the following criteria:

They're full-time students.
They still rely on you for maintenance and support.
They aren’t married or in a de facto relationship.

If your dependants aren't full-time students but rely on you for maintenance and support, and aren't married or in a de facto relationship, you can also continue to cover them until they turn 31 with Extended Family Cover, which is only available on some levels of HCF cover, and a surcharge will apply.

Does my health insurance cover my dependants?

If they're listed on your policy, your dependants are covered under your family cover until the day before they turn 22. If they're full-time students, single and rely on you for maintenance and support, register them as student dependants, and they'll be covered for no extra cost until the day before they turn 31 or cease being eligible (e.g. stop full-time study), whichever comes first.

What's Extended Family Cover?

If your dependants aren't full-time students but rely on you for maintenance and support and are unmarried or not in a de facto relationship, you can continue to cover them until they turn 31 with Extended Family Cover. This is available on some levels of HCF health cover and will add a surcharge to your premium.

Extended Family Cover isn’t available on the following covers:

Healthmate Ultimate Gold
HealthClub Silver Plus
Healthmate Advanced Silver Plus
Healthmate Starter Silver Plus
Healthmate Essentials Silver Plus
Top Hospital Gold
Healthy First Hospital Silver Plus
HealthStart Hospital Silver Plus
Premier Extras, Healthcover Extras
Smart Extras
HCF Ambulance Cover
HCF My Future Basic Plus
HCF Future Care Basic Plus
Fit and Free Silver Plus
Young Singles and Couples Basic Plus.

When do I need to add my baby to my membership so they're covered?

If you’re on a single or couples membership, it’s important to call to tell us your expected due date as soon as possible. We'll then transfer you to a family membership from the expected date of birth.

This will make sure your baby is covered and won’t have to serve any waiting periods. If you don’t tell us your expected due date, you still have 2 months to transfer to a family membership from the date your baby was born, and your baby will be covered from this date.

Do members need to complete the pre-existing condition assessment?

If you’re an existing HCF member and you recently upgraded your level of hospital cover, you’ll need to serve the 12-month waiting period for new services added to your hospital cover that weren’t covered before your upgrade and for services that have a higher level of benefits. You won’t have to re-serve waiting periods for benefits previously covered under your old level of cover.

New people added to your policy will need to serve their 12-month waiting period for a service if they haven’t already served their waiting periods for that service with another fund (at the same level of benefits) and joined HCF within 30 days of leaving.

What if I’ve already served my waiting periods with my previous fund?

If you’ve served 12 months or more for a service with a previous fund and you join us within 30 days of leaving the other fund on the same level of cover, then you’ll have continuity and won’t need to complete the pre-existing condition assessment. You won’t need to serve waiting periods again at HCF and you can claim instantly for the same benefits you were entitled to with your previous fund.

If your treatment wasn’t covered by your previous fund at the same level or you weren’t covered for a full 12 months, your condition may be pre-existing and you may need to serve the 12-month waiting period or the remaining period of time.

Whenever there's a potential treatment or service you'd like to claim for, it’s always best to contact us first so we can check your cover and provide guidance on waiting periods and how to prepare for your treatment. You can send a message, call us on 13 13 34 (Monday to Friday: 8am to 8pm, Saturday: 9am to 5pm AEST/AEDT) or visit your local branch.  

My condition is considered pre-existing. What does this mean for me?

If your condition has been deemed as pre-existing by our medical practitioner, you’ll need to serve the 12-month waiting period (or the remaining part of the period if you've served some of it with your previous fund) before you can claim for the service or treatment. We won’t pay benefits if you decide to go ahead with the service or treatment before the waiting period has been served. This also means that you can't lodge a claim after the waiting period has ended for a service that was provided within the waiting period.

If you don’t agree with our medical practitioner's assessment, you can request a second review to take place. There must be a valid reason, and we’ll require additional relevant clinical documentation that wasn’t previously supplied in the first review to be provided. If you’d like to enquire about a second review, please contact our Clinical Review team at clinicalreviewemail@hcf.com.au or 02 9290 0256 (Monday to Friday: 8.30am to 5pm AEST/AEDT).

HCF determined my condition is pre-existing, but my doctor disagrees.

You can request a second review to take place. But there must be a valid reason, and we’ll require additional relevant clinical documentation that wasn’t previously supplied in the first review to be provided. If you’d like to enquire about a second review, please contact our Clinical Review team at clinicalreviewemail@hcf.com.au or 02 9290 0256.

We’re always looking for ways to improve our products, services and the overall experience for our members. If you’re unhappy with the outcome of the second review, or would like to provide feedback, you can contact our Feedback and Resolutions team at complaints@hcf.com.au or 13 13 34 (Monday to Friday 8am to 8pm, Saturday: 9am to 5pm AEST/AEDT) or visit your local branch.

Learn more about our complaints process.

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Important Information

Find out about our terms and conditions to use and access this site.

^* Our Life and Recover Cover products are issued by our own HCF Life insurance Company Pty Ltd. ABN 37 001 831 250. AFSL 236 806 (HCF Life). HCF Life is a wholly owned subsidiary of The Hospitals Contribution Fund of Australia Limited ABN 68 000 026 746, AFSL 241414 (HCF). Terms and conditions apply. Please read the relevant Product Disclosure Statement, Policy Document and Financial Services Guide available by calling 1800 560 855 or visiting hcf.com.au/lifeinfo, and consider your financial situation, objectives, and needs before deciding on these products as any advice provided does not take these into account. In addition to these documents, you should also read the Target Market Determination (TMD) for the product, which is available at hcf.com.au/lifeinfo. The premiums for Recover Cover products are paid to HCF Life. HCF receives commission from HCF Life for their sale of up to 40% of the first year’s premium plus an additional commission of 80% of HCF Life’s underwriting profit each year calculated as premiums less claims and expenses. HCF’s staff may receive an incentive depending on the annual premium of these products which they sell. This will not exceed 15% of the first year’s premium.

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Understanding your cover