School Accident Benefit

If your child is in an accident at school, School Accident Benefit helps pay for out-of-pocket expenses relating to extras included in your cover. Log in to check your Product Summary and see if you’re covered. Waiting periods, annual limits and the following conditions apply.
 

ELIGIBILITY

1. A School Accident Benefit will be payable if a dependent child attending before and after school care, primary or secondary school receives general treatment covered under their product as a result of an accident that occurred:
   (a) at school
   (b) on the way to or from school
   (c) on the way to or from a school activity
   (d) at approved and regulated before and after school care.
2. The child must be a dependent child on an eligible HCF extras product that includes School Accident Benefit, at the time the accident occurred. Check your Product Summary to see if School Accident Benefit is included in your cover.
3. All waiting periods must be served prior to the date of service/s being claimed (the waiting periods are the same as the general treatment being claimed).
4. The out-of-pocket costs must not be recoverable from any other source.
5. The general treatment for the accident was received within 12 months of the accident occurring (or 24 months from the date of the accident for HCF Top, Vital, Ultimate, Advanced and Active extras cover).

School Accident Benefit is subject to an annual limit per calendar year.

HOW ARE SCHOOL ACCIDENT BENEFITS PAID?

School Accident Benefits cover out-of-pocket expenses (which is the cost of a service minus the HCF benefit for that item) incurred for general treatment due to an accident that meets the eligibility requirements outlined above.

School Accident Benefits will be paid for out-of-pocket expenses that arise because the HCF benefit is less than that the cost of the service and/or because the child's annual limit for the service has been reached.

EXCLUSIONS

School Accident Benefit is not payable for:

• services not listed as covered under the child’s extras product or for any hospital treatment
• costs that are covered or recoverable from another source, except an HCF Life insurance policy
• general treatment received after 12 months of the accident occurring (or 24 months from the date of the accident for HCF Top, Vital, Ultimate, Advanced and Active extras cover).

MAKING A CLAIM

A claim must be made for an HCF benefit for the general treatment under the child's extras product first and the out-of-pocket expenses must be paid, or if the child has already reached their annual limit, the general treatment must be paid in full.

A claim form must be completed detailing the nature and date of service/s and provider's details, enclosing all receipts for the costs paid for the service.

A detailed report of the school accident from the school must be provided to HCF, including a clear description of the circumstances and extent of the injury sustained and the date the accident occurred.

The school accident report must be on the school’s letterhead and be submitted within 12 months of the accident.