Ambulance andCash Back Cover - PDF document

1 May 2016 AMBULANCE ANDCASH BACK COVER Only available to residents of NSW & ACT 3 2 WHY HAVING AMBULANCE AND CASH BACK COVER MAKES SENSEIf you have an accident playing sport, when you're out and about, or even on the farm, the last thing you want to worry about is a costly ambulance bill. AUSTRALIAN GOVERNMENT REBATE ON PRIVATE HEALTH INSURANCETo help make private health cover more affordable, the Australian Government provides a rebate on your health insurance premium. The rebate is available to people with hospital, extras or ambulance cover and who are registered with Medicare. The rebate is income tested, so your entitlement may change depending on your income and your age.You can take the rebate as:A reduced premiumA tax oset credit in your annual tax returnSee privatehealth.gov.au/healthinsurance/incentivessurcharges for the list of rebate percentages.You may be eligible for a rebate on your Ambulance Cover. Cash Back Cover is not covered by the Australian Government Rebate on private health insurance. CALL USGO TO hcf.com.au branchThree easy ways to contact us An award-winning local call centre, 50+ branches nationwide and great online resources. DID YOU KNOW?Medicare doesn't cover the cost of using an ambulance.Ambulance services don’t come cheap, especially if you live in a remote area. As well as the callout fee, which is several hundred dollars, you’re also charged a per kilometre fee – which can add up to a very costly ride. An air ambulance is even more expensive. And it doesn’t stop there. Other expenses resulting from an accident like surgery, medical bills and childcare can add up quickly.There are two simple and affordable ways to help cover these costs: Please note: Ambulance cover is only available to residents of NSW & ACT. AMBULANCE COVERIdeal if you simply want ambulance coverAMBULANCE AND CASH BACK COVERIdeal if you want ambulance cover plus a cash payment to cover additional expensesMon - Fri 8am - 8pm AESTSat - Sun 9am - 5pm AEST 5 4 WHAT YOU'RE COVERED FORTO OBTAIN A QUOTE ON AMBULANCE OR CASH BACK COVER:Visithcf.com.auAmbulance Cover rates vary according to your circumstancesAmbulance and Cash Back Cover premiums are payable monthly or yearly. Ambulance Cover premiums are only payable yearly in advance.To find out who is covered on your policy, for an explanation of Emergency and Non-Emergency Ambulance Transport definitions and any possible exclusions, see page 6-7.AMBULANCE SERVICE PROVIDERSHCF recognises the following ambulance service providers for the purposes of paying benefits:- ACT Ambulance Service- Ambulance Service of NSW- Ambulance Victoria- Non-Emergency Patient Transportation NSW- Queensland Ambulance Service- South Australia Ambulance Service- St John Ambulance Service NT- St John Ambulance Service WA- Tasmanian Ambulance Service. AMBULANCE COVERCover for emergency ambulance with HCF approved Ambulance Service Providers where you require hospital or on-the-spot treatment in AustraliaUp to $5,000 per person per calendar year for State Government, medically necessary, non-emergency ambulance services where your doctor requests ambulance transport because your condition requires monitoring and support in transitThis cover is only available to residents of NSW and ACT.CASH BACK COVEROnly $2 per week for singles or $4 per week for familiesPays you $5,000 if you suer an accident resulting in surgery Pays you $5,000 if you suer a serious specied medical condition, see page 8 for more detailsClaim multiple times - up to $20,000 for singles and $40,000 for family coverOnly available to permanent Australian residents aged between 16 and 60, with cover extending until 65. CALL USGO TO hcf.com.au branchThree easy ways to contact us An award-winning local call centre, 50+ branches nationwide and great online resources. 30 DAY GUARANTEEYou will receive a 100% refund on your cover if you change your mind or cancel your policy within 30 days, provided you haven’t made a claim.Mon - Fri 8am - 8pm AESTSat - Sun 9am - 5pm AESTCOMBINED FINANCIAL SERVICES GUIDE AND PRODUCT DISCLOSURE STATEMENT A Product Disclosure Statement (page 8) and Financial Services Guide (page 9) for Cash Back Cover is included in this brochure. 7 AMBULANCE COVER So there’s no confusion when you need to make a claim, it’s important to understand who can be covered under your policy.WHO CAN BE COVERED UNDER YOUR POLICY? This cover is only available to residents of NSW and ACT.THE POLICYHOLDER:Is the person in whose name the health insurance policy is held (also known as the Contributor)Is our main point of contactNominates who’s covered by the policyIs entitled to access all records and claims history relating to the membership, including end of year tax statementsMust advise us of any changes to membership Is responsible for payment of the premiums.SINGLE COVERThe person covered under the Single policy is the Policyholder only.COUPLE COVERCovered under this policy are:The PolicyholderThe Policyholder’s Partner listed under the policy.('Partner' means spouse or de-facto partner).FAMILY COVERCovered under this policy are:The PolicyholderThe Policyholder’s Partner listed under the policyThe Policyholder’s and/or Partner’s Child dependant/sThe Policyholder’s and/or Partner’s Student dependant/s.SINGLE PARENT FAMILY COVERCovered under this policy are:The PolicyholderThe Policyholder’s Child dependant/sThe Policyholder’s Student dependant/s.CHILD DEPENDANT MEANS A PERSON WHO:a) Is less than 22 years of age; andb) Isn’t married or in a de-facto relationship; andc) Is primarily reliant on the Policyholder (or Partner listed on policy) for maintenance and support; andd) Is related to the Policyholder (or Partner listed on policy) as a Child, Stepchild, Foster Child or other Child that the Policyholder (or Partner listed on policy) has legal guardianship over.STUDENT DEPENDANT MEANSA PERSON WHO:a) Is aged between 22-24 (inclusive); andb) Is a full time student at school, college or university; andc) Isn’t married or in a de-facto relationship; and d) Is primarily reliant on the Policyholder (or Partner listed on policy) for maintenance and support; ande) Is related to the Policyholder (or Partner listed on policy) as a Child, Stepchild, Foster Child or other Child that the Policyholder (or Partner listed on policy) has legal guardianship over.WAITING PERIODSAll members must serve waiting periods before benefits are payable. The waiting periods for Ambulance Cover are: One day: emergency ambulance (where not for pre-existing ailments or conditions)Two months: medically necessary non-emergency ambulance (where not for pre-existing ailments or conditions)Twelve months: pre-existing ailments or conditions.THE THINGS YOU NEED TO KNOWPRE-EXISTING AILMENTS OR CONDITIONS A pre-existing ailment, illness or condition is one where the signs or symptoms existed during the six months before joining HCF (or upgrading to a higher level of cover), even though a diagnosis may not have been made. If there’s any doubt that an ailment or condition is pre-existing, an HCF-appointed medical practitioner will examine information provided by your doctor, and any other relevant claim details. A 12 month waiting period will apply to members with a pre-existing condition or ailment, if they are a new member or an existing member that has upgraded their cover, or a child not previously added to the policy.AMBULANCE TRANSPORTATIONBenefits for Emergency Ambulance Transport or Non-Emergency Ambulance Transport are payable after any subsidy, discount, waiver or rebate provided by a third party or the Ambulance Service Provider has been deducted. (a) HCF pays benefits towards eligible EmergencyAmbulance Transport and Non-EmergencyAmbulance Transport services provided by anAmbulance Service Provider depending on aMember’s cover and up to their annual limit(either a dollar or service limit), as specifiedin the product information.(b) The Ambulance must be provided by an Ambulance Service Provider and the transportation must be to the nearest appropriate Australian hospital able to provide the level of care required.Emergency Ambulance Transport:(a) Benefits are payable for Emergency Ambulance Transport where transport to the nearest hospital or on-the-spot treatment is required. "Emergency” means an immediate and serious threat to person’s health or life.(b) Benets are not payable for Emergency Ambulance Transport:(i) where Non-Emergency Ambulance Transport is requested;(ii) for transport on discharge from hospital to a Member’s home or nursing home;(iii) where you are covered by another funding arrangement such as a State government scheme;(iv) where you are covered by another third party (such as a State Ambulance subscription or the Ambulance charges are the subject of a compensation claim);(v) for transfers between hospitals;(vi) for transfers to or from medical facilities such as diagnostic imaging, allied health or other health related facilities;(vii) for charges raised for a medical retrieval team escort; and(viii) for Ambulance Service Providers not recognised by HCF.Non-Emergency Ambulance Transport:(a) A limited number of Covers include a Non-Emergency Ambulance Transport Benefit. Members can claim up to a maximum of $5,000 in a calendar year for non-emergency ambulance transport. “Non-emergency” ambulance transport means transport by a State Government providedambulance that is requested because your medical condition requires a level of support and medical monitoring in transit that only an ambulance service can provide. Non-emergency ambulance transport must be requested by your treating doctor to be considered for an HCF benefit.(b) Benefits are not payable for Non-Emergency Ambulance Transport:(i) where the transport does not meet the definition of Non-Emergency Ambulance Transport (such as for general patient transport);(ii) where the transport has been elected by the patient or family for reasons such as choice of doctor or hospital or to be closer to family;(iii) where you are covered by another funding arrangement such as a State government scheme;(iv) where you are covered by another third party (such as a State Ambulance subscription or the Ambulance charges are the subject of a compensation claim);(v) for transfers between hospitals;(vi) for charges made for a medical retrieval escort; and(vii) for Ambulance Service Providers not recognised by HCF. 9 ODUCT DISCLOSURE STATEMENT FOR CASH BACK COVERCash Back Cover is sold by HCF and issued by HCF Life Insurance Company Pty Limited. Any Australian permanent resident aged 16 to 60 can combine this cover with Ambulance Cover. You will receive a policy document once your application has been processed that will give you full details of your cover. A copy is also available on request. If you find this policy does not meet your needs, you then have 30 days to cancel by letting us know in writing. Provided you have not made a claim, any premiums paid will be refunded.Benefits paid:Pays you a cash benet of $5,000 if you or any person covered by your membership suers an accident that requires surgery in an operating theatre within six months of the date of the accidentYou also receive $5,000 for malignant cancer, chronic kidney failure, heart disease requiring bypass surgery, heart attack, stroke, or any disease requiring a major organ transplantA maximum of $20,000 is payable for single cover ($5,000 for up to 4 accidents or serious illnesses) and $40,000 for family cover ($5,000 for up to 8 accidents or serious illnesses) if you or your family have a number of accidents or illnesses during the life of the policy.Benefits are not paid for: Surgery for diagnostic purposes only or not carried out in an operating theatre Conditions which arise during the rst two months of cover Accidents which occur on or before the cover commencement date, or disablements which occur outside Australia, or are covered by workers compensation, social security, an accident scheme or third party liability insuranceDisablements which occur as a result of a pre-existing condition, drugs or alcohol, AIDS or related conditions, intentional self injury, racing, professional sport, military service, private aviation, illegal acts, war or related risks, or terrorism.The cost of HCF Cash Back Cover is $8.65 for singles and $17.30 for families/couples per month. The product is written in HCF Life’s No.1 Statutory Fund and does not acquire a cash value at any time.Your policy expires when one of the following events occur: Upon payment of the total benet amount If you don’t pay your premium When the Policyholder turns 65 Upon the death of the Policyholder. Premiums must be paid when due to prevent policy from lapsing. Premiums can only be increased if the increase applies to all Policyholders and we will give you one month's notice of any increase.Should you have a complaint about your policy, please see the FSG on page 9 in relation tohow we resolve complaints and how you can access our dispute resolution process.TAXATIONUsually, benefits are paid free of personal tax and premiums are not tax deductible. This is a general statement based on present laws and their interpretation. Individual circumstances may vary. HCF Life Insurance Company Pty LimitedABN 37 001 831 250, AFSL 236 806403 George Street, Sydney, NSW, 2000Telephone 13 13 34Dated: 11 May 2016FINANCIAL SERVICES GUIDE FOR CASH BACK COVERThis Financial Services Guide (FSG) relates to the services provided by HCF (we, us or our) in relation to the products issued by HCF Life Insurance Company Pty Limited. It is designedto assist you in deciding whether to use any of the services offered by us in this FSG. It contains information about remuneration paid to us and our staff for the services offered and how complaints against us in relation to these services are dealt with. If we offer or arrange to issue you any of these products, we will provide you with a Product Disclosure Statement relating to that product - where required. This sets out the significant features of the product and will assist you in comparing and making informed decisions about the product.We provide general advice about the suitability of these products for the needs of members. This means we don't take into account individual objectives, financial situations or needs. You should, before acting on that advice, consider the appropriateness of the advice, having regard to your objectives, financial situation or needs. Please read the Product Disclosure Statement before deciding to purchase any of these products. We are licensed to provide general advice about, and arrange the issue of, life and general insurance products. HCF Life is a wholly owned subsidiary of HCF. When we issue you with a policy, we do so under a binder that authorises us to enter into that contract of insurance on behalf of HCF Life. The premiums for the life insurance products are paid to HCF Life. We receive commission from HCF Life for their sale of 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. Our staff receive an incentive, depending on the annual premium of these products which they sell. This will not exceed 20% of the first year’s premium. We are a not-for-profit organisation and all income received is applied for the benefit of our members.HCF and HCF Life are each responsible for the entire contents of this Combined FSG and PDS. We hold Professional Indemnity Insurance that complies with the compensation requirements of Section 912B of the Corporations Act. This includes cover for claims in relation to the conduct of representatives and employees who no longer work for us but who did at the time of the relevant conduct. Should you have a complaint about any of the services we offer in this FSG, please contact us on 13 13 34. If we have not resolved your complaint within 45 days or you are not satisfied with our response, you can contact The Financial Ombudsman Service. Contact details on page 10.This is an independent body available to you free of charge.The Hospitals Contribution Fund of Australia LimitedABN 68 000 026 746, AFSL No. 241 414403 George Street SydneyTelephone 13 13 34 Dated: 11 May 2016COMBINED PRODUCT DISCLOSURE STATEMENT AND FINANCIAL SERVICES GUIDE 11 10 HCF is committed to best practice privacy protection.We collect your personal information including sensitive information such as health information from you and/or the Policyholder who is responsible for your policy and/or from other third parties detailed in our Privacy Policy, so we can:Comply with applicable lawsManage our relationship with youRecord your treatmentProvide health or other insurance, related products and services to you (including through third parties)Manage and pay claims and benets Assess your insurance, health and related lifestyle needsInvestigate fraudulent or improper claims and assess risks Research and develop products, services and benets that may better serve your needsAssess your possible interest in and tell you about such products and servicesAdminister our business and deal with complaints.We may share or disclose your personal information to third parties or individuals, some of which may be located overseas, including:to the policyholder, if you are a dependant or another member (e.g. partner or children) on the policy, for the purposes of your HCF membership. Our contract with the policyholder requires us to have full and free communication with the policyholder on all aspects of the policy, including the benets claimed by any member to organisations that deliver services on our behalf or to us, such as third parties that we contract to assess or process claims, administer programs that we develop for the benet of members, research companies contracted by us (to ask your opinions on improving the Group’s service, benets or product oerings) and other service providers, for example, our advisors;between companies within the HCF group of companies;fraud prevention agencies, government bodies and regulators including law enforcement bodies such as the Police, professional associations and industry bodies;health service providers (where it is used to improve their ability to provide you with health services);other insurers or reinsurers including other health insurers where you have moved your insurance to or from HCF; andwhere disclosure is otherwise authorised or required by or under an Australian law or court/tribunal order.We do not normally give personal information about you to anyone who is not on your membership. You will need to give us written permission if you want someone who is not covered by your membership, such as a friend or carer, to deal with us on your behalf.If you do not provide the personal information we request, we may not be able to provide you with our products or services, including health insurance. You can ask us at any time to stop direct marketing to you by calling 13 13 34or by logging onto the member section at hcf.com.au/membersand updating your preferences.For more information about the personal information we collect and how we handle it, how to access and correct your information or to make a complaint and how we will respond to complaints, please read our Privacy Policy.To view the HCF Privacy Policy:Visithcf.com.au/privacyVisit your local branch.All new Policyholders should ensure that all members on the policy are made aware of the HCF Privacy Policy.OUR PRIVACY STATEMENTChanges to products and pricingPlease read and retain this brochure for future reference. However, we reserve the right to make changes to prices, product specifications and other conditions relating to the products contained in this brochure. Please contact us prior to purchasing any products to make sure that you have the latest information available.PRIVATE HEALTH INSURANCE CODE OF CONDUCTThe Private Health Insurance (PHI) Code of Conduct’s aim is to improve the standards of practice and service in the private health insurance industry. We support this by ensuring you:receive correct information about private health insuranceare aware of the internal and external dispute resolution procedures can make an informed decision about your purchaseyou’re protected in accordance with the privacy principles.For a full copy of the code, visit privatehealth.com.au/codeofconductHAVE A COMPLAINT?If there's a problem with your membership or cover, please contact HCF directly so we can assist in resolving it as quickly as possible.OMBUDSMANIf your complaint isn’t dealt with satisfactorily, you can also contact the relevant Ombudsman - independent bodies formed to help resolve complaints and provide advice and information.If your complaint is about Health Insurance:Private Health Insurance OmbudsmanCall: 1300 362 072Visit: ombudsman.gov.auEmail: phio.info@ombudsman.gov.auOnline: ombudsman.gov.au/making-a- complaint/contact-usWrite: Private Health Insurance Ombudsman, Commonwealth Ombudsman, GPO Box 442, Canberra, ACT, 2601If your complaint is about Life Insurance, Pet Insurance or Travel Insurance:Financial Ombudsman Service AustraliaCall: 1300 367 287 Visit: fos.org.auEmail: info@fos.org.auWrite: Financial Ombudsman Service Limited, GPO Box 3, Melbourne, VIC, 3001HOW YOUR RIGHTSARE PROTECTED HOW TO APPLYWe’re open Mon - Fri 8am - 8pm, Sat - Sun 9am - 5pm (AEST)Visit us in person, nd your nearest branch at hcf.com.au/brancheshcf.com.auThe Hospitals Contribution Fund of Australia Limited. ABN 68 000 026 746 ASFL 241 414MAY16_VAL0123_AMBHead Office: 403 George Street, Sydney NSW 2000 CALL US13 13 34 GO TOhcf.com.au VISIT Abranch DOWNLOADthe HCF app START ENJOYING THE BENEFITS ONLY HCF CAN OFFER JOIN TODAYMon - Fri 8am - 8pm AESTSat - Sun 9am - 5pm AEST