HIFDomesticCoverPDS 2

Our Product Disclosure Statement (PDS)
Your HIF Hospital and Extras health cover in detail.
Visit online to get a quote and join (or switch).

Call 1300 13 40 60
hif.com.au
Australias first certified

Carbon Neutral health fund.
About us and you

HIF is a not-for-profit private health insurer.
That means we dont have shareholders,
so any income we earn after paying for
our members benefits and covering our
operating expenses is available to pay
bigger and better benefits.
And thats a good thing.
Whats inside?
Whats
inside?
A bit about us, this PDS
and health insurance
2-3
HIF Hospital Cover Options
GoldVital Hospital
GoldStarter Hospital
12
GoldSaver Hospital
14
Gold Hospital
16
About this PDS
GoldStar Hospital
18
About our Extras cover
20
Ways to claim
22
Feedback, disputes and privacy
46
Frequently asked questions
48
Glossary
51
Youll find lots of useful info about our

health insurance in this brochure: whats
covered and what isnt; details of different
cover options; explanations about our
services and the terminology we use.
All the stuff you need to know when
comparing, choosing and reviewing your
health cover.
Important Tip
When you join HIF or change your level
of cover, we will send you a Member
Statement confirming your new level of
cover. To avoid confusion, its a good idea
to keep your statement with this brochure.
Keep Updated
A bit about us, this PDS

and health insurance
At HIF, we aim to make choosing smart health insurance simple
and painless. With that in mind, well keep this Product Disclosure
Statement (PDS) as short and sweet as possible. No unnecessary
information. Just the must-know stuff. We want you to be able to
make the right health insurance choice but we dont want you to
fall asleep. So here we go
2
HIF is always reviewing and improving its

services and benefits so to ensure you are
claiming all possible benefits remember
to regularly visit hif.com.au/domesticpds
for an updated version of this PDS.
About Australian private

health insurance
All Australian private health insurers, and
residents and non-residents who pay tax
in Australia, have potential responsibilities,
obligations and entitlements under
Australian health insurance laws.
These laws include directions about

services that can or must be covered,
entitlement to the private health insurance
rebate and obligations to pay the Medicare
Levy Surcharge (MLS) and the Lifetime
Health Cover (LHC) loading.
The legislation or rules that affect your
premiums, cover and membership
obligations include:

Private Health Insurance Act 2007
The
(the PHI Act)

Private Health Insurance
Fairer
Incentives Act 2012

Fairer
Incentives (Medicare Levy Surcharge)
Act 2012

Fairer
Incentives (Medicare Levy Surcharge
Fringe Benefits) Act 2012
Under the PHI Act, we are required to
document our operating guidelines, known
as Fund Rules or Business Rules. All
private health funds have to do this.
These rules detail our obligations as
a private health insurer, as well as the
obligations of our members. As such,
when you become a HIF member, you
agree to be bound by these rules. If you
would like a copy of the rules, simply
email hello@hif.com.au or call us on
1300 13 40 60.
Want more information?

Visit hif.com.au to find out more about our
not-for-profit health fund. Alternatively, if
you would like to know more about us or
the rules and regulations around health
insurance, please email hello@hif.com.au
or call us on 1300 13 40 60.
HIF Hospital Cover Options
Restrictions and exclusions
Cover for in-hospital procedures

GoldStarter
GoldSaver
Gold
GoldStar
Choice of Excess
Product
Restricted
Excluded
GoldStar
Surgery by podiatrists
Cosmetic services*
Gold
Private Room
Services not covered by Medicare*
Private room
(maternity)
(3 days)
Shared room
(5 days)
(unlimited)

GoldSaver
Assisted reproductive technology
Gastric banding and obesity surgery
Theatre Care
Cardiac (heart) conditions, procedures

or monitoring**
Cosmetic services*
Same-day
Accommodation
Eye surgery
Intensive Care
Palliative care
Prostheses
Rehabilitation
Pharmacy Drugs
GoldStarter
AccessGap
Palliative care

Cardiac (heart) conditions, procedures
or monitoring**
Restricted
Restricted
Psychiatric
Restricted
Rehabilitation
Restricted
Restricted
Cardio (heart)**
Psychiatric Care
& Treatment
Psychiatric
Appliances
Palliative Care
Joint replacement
Same-day Theatre
Restricted
Assisted Reproductive
Technology (e.g. IVF)
Restricted
Eye Surgery
(non-cosmetic)
Restricted
Some restrictions and exclusions may apply.
Eye surgery
Joint replacement
Joint Replacement
Gastric banding &

Obesity surgery
Cosmetic services*
Assisted reproductive technology

Obstetrics (maternity)
Cosmetic services*
For restricted services HIF will pay a basic benefit known as the public hospital rate, toward accommodation charges.
All other charges raised by the hospital during the stay will be paid by the member. An excluded service means all
charges raised during the stay will be paid by the member.
* Where a service is deemed by Medicare to be cosmetic and/or does not attract a Medicare rebate, all charges raised
in association with the hospital stay will not be eligible for payment.
**S
ome examples of cardiac (heart) procedures including medical treatment or surgical procedures for cardiac
conditions, are arrhythmias, artery bypass grafts, coronary angioplasty, congenital defects, heart disease, heart
transplants, pacemakers and defibrilators, stent insertion.
Things you need to know about

our Hospital cover
When selecting Hospital cover,
its important to ensure that
you understand how each level
of cover will apply to you, as
well as being aware of details
such as limitations, restrictions
or exclusions that might also
apply to your chosen cover.
AccessGap Cover
AccessGap Cover applies to medical accounts
for members undergoing in-patient hospital
procedures. Its designed to reduce or
eliminate out-of-pocket expenses by allowing
doctors to use the scheme on a patient-bypatient basis. If a doctor uses the scheme, he/
she agrees to charge you a set fee for each
item and will then receive a payment from HIF
and Medicare combined, which is more than
the Medicare Schedule Fee.
To be eligible for AccessGap Cover, doctors
must be willing to participate for your
particular surgery and the account must
be lodged directly with HIF (not Medicare).
To find out more about specific payment
amounts for upcoming procedures, or for
your doctor to register for the scheme,
please call us on 1300 13 40 60.
Healthcare providers
HIF covers extras, medical and hospital
providers throughout Australia. To confirm if
a provider is approved by HIF, go to
hif.com.au, email us at info@hif.com.au or
call us on 1300 13 40 60.
Benefits will not be paid for any hospital
services provided outside Australia, or for
services purchased or provided within Australia
from a non-Australian recognised provider.
Ambulance services
HIF is required under New South Wales
and Australian Capital Territory legislation
to financially contribute toward the cost
of operating state or territory-provided
emergency ambulance services on behalf
of any person who is a permanent state or
territory resident and holds any level of HIF
Hospital cover. Under this arrangement, our
members who are residents of NSW or ACT
and hold HIF Hospital cover may submit
their resident state or territory emergency
ambulance invoice to HIF to claim a benefit
toward the fees charged.
Please note that ambulance benefits may
not be claimable under a NSW or ACT
HIF Hospital cover if the service was not
provided by your local state-controlled
ambulance service, or if the service was not
deemed by the ambulance attendant to be
an emergency (medically necessary).
For more information about this, see page 24
or visit hif.com.au and visit the Ambulance
Cover page within the Health section.
Medical Gap
Different medical providers may charge
different prices for the same procedure. If you
are planning a procedure, we recommend
that you ask your medical provider and any
associated health provider (e.g. anaesthetist
or assistant) if they will participate in our
AccessGap scheme to help you avoid or
minimise your out-of-pocket expenses.
If your health provider does not confirm
your out-of-pocket expenses, we
recommend you contact us with your
providers details, item numbers and
charges and we will provide you
with a benefit estimate.
The Pre-existing Condition Rule

This standard rule is applied across the
health insurance industry. It is designed to
ensure that long-term members are not
financially disadvantaged by new members
who join and claim benefits immediately for
pre-existing conditions.
A
pre-existing condition is defined as an
ailment or condition for which the signs or
symptoms were evident or known at any
time during the 6 months prior to when
the member joins HIF, or upgrades to a
higher level of cover or the same cover
with a reduced or nil excess.
HIF

is not required to pay benefits for a
pre-existing condition during the first 12
months of a new members Hospital cover.
Where an existing member upgrades to
a higher level of cover or the same cover
with a reduced or nil excess, any services
related to the pre-existing condition will
be paid out at the previous level of cover
for the first 12 months.
Restricted services
Where services are noted as restricted in
your Hospital cover, this means that if you
receive them in a private hospital, you will
only be covered at the basic public hospital
benefit rate, which includes:
Workers Compensation and

Dual Insurance
Benefits cannot be claimed and are not
payable by HIF where you have or can claim
benefits or compensation (in full or in part)
for treatment, goods or services from a third
party including Workers Compensation or
Public Liability sources, your employer or
any other Insurance policy.
Transferring and upgrading

your cover
New members who transfer Hospital cover
from another Australian health fund to an
equivalent level of HIF Hospital cover will
not have any waiting periods applied for
the services for which you were previously
covered, providing these were served with
the previous fund.
New members who transfer Hospital
cover from another Australian health
fund to a higher level of Hospital cover, or
equivalent level of cover with a reduced
or nil excess, will have qualifying periods
applied for the higher level of cover and/
or benefits. During these periods benefits
will be payable at the equivalent level of
cover to that of your previous fund.
AccessGap for in-patient medical services
Current HIF members who transfer

Hospital cover to a higher level of
Hospital cover, or equivalent level of
cover with a reduced or nil excess, will
have qualifying periods applied for the
higher level of cover and/or benefits.
During these periods benefits will be
payable at the lower level of cover.
No other benefits are payable for

restricted services, unless specifically
listed in the individual product description
within this brochure.
Any benefits paid by your previous

private health insurer will be considered
when determining rebates for your
future claims.
The

cost of a shared room in a public
hospital
A
benefit towards the cost of surgically
implanted prosthesis
Excluded services
Where services are noted as excluded in
your Hospital cover, this means that you are
not covered and you must pay all costs.
GoldVital Hospital
This is our entry-level option
for young singles and couples
who want cover for vital
medical services. It covers
treatment after an accident,
intensive care and theatre fees,
plus other essential services,
including surgery to remove
tonsils, adenoids, appendix
and wisdom teeth.
GoldVital Hospital
Cover for emergency treatment in
hospital resulting from an accidental
injury*
Surgical removal of wisdom teeth, tonsils,
appendix and adenoids
Minor gynaecological procedures^
Joint reconstruction and investigation
Same-day accommodation and theatre fees
for approved services
No maternity cover
Full cover for the cost of a shared or
private room, theatre fees and charges in
an HIF contracted hospital anywhere in
Australia for approved services
Hospital waiting periods

Treatment received as the result of an
accident one day
General hospitalisation two months
All treatment related to a pre-existing
ailment or condition, but not including
pre-existing conditions for psychiatric care,
rehabilitation or palliative care 12 months
Services covered
GoldVital Hospital will cover the services
outlined in the table on the following page
in a public hospital or contracted private
hospital facility, subject to any waiting
periods which may apply and the Preexisting Ailment Rule. Benefits for noncontracted private hospitals are available
from HIF. Check with us prior to admission
to ensure that the hospital is an HIF
contracted facility.
HIF has negotiated contractual
arrangements with most hospitals and day
hospital facilities throughout Australia. The
benefits listed in the table opposite are
offered to members who are admitted to
those hospitals.
Exclusions
Restricted services
As an entry-level option, GoldVital provides

basic cover for a limited range of vital
medical services and essential emergency
treatment. As such, it only covers the
services listed in the table on page 10 all
other non-emergency and hospital care
services are excluded.
Benefits for the following services will

include basic public hospital rate (only) for
accommodation. However, full AccessGap
coverage for inpatient medical procedures
and benefits will be paid towards prostheses
in accordance with the Commonwealth
Prostheses List. Items on the list (excluding
human tissue) may be subject to a copayment by the patient:
Assisted reproductive technology (eg IVF)

Cardiac (Heart) procedures including
medical treatment or surgical procedures
for cardiac conditions such as, arrhythmias,
artery bypass grafts, coronary angioplasty,
congenital defects, heart disease, heart
transplants, pacemakers and defibrillators,
stent insertion.
Eye Surgery (any procedure on the surface
or within the structures of the eye)
Dialysis
Gastric banding and Obesity surgery
including reversal and adjustment
procedures
Joint replacement
Obstetrics related services
Spinal fusion
Sterility reversals
Services deemed cosmetic by Medicare
and service that do not attract a
Medicare rebate
Psychiatric care or attention

Palliative care
Rehabilitation
No benefits will be payable for other
charges related to these services (e.g. theatre
or some pharmaceutical costs), so significant
out-of-pocket expenses may apply for these
procedures if you are admitted as a
private patient.
Applicable excess
A mandatory excess of $500 per person,
per admission, per year (up to a maximum
of $500 per year single policy or $1,000 per
year couple policy) is applied to GoldVital
Hospital cover to reduce premium costs.
The excess applies to overnight and same
day admissions
Services not listed as include are excluded.
Full AccessGap Cover for inpatient

medical procedures for approved services
Includes an excess to reduce the premium
Restrictions and exclusions apply
Available for singles and couples only
* An accident is an unforeseen event, occurring by chance and caused by an external force or object which
results in an injury to the body requiring immediate medical treatment in hospital within 24 hours of the
accident. If further hospital treatment (as an admitted patient) is required, the patient must be re-admitted
to a hospital within 90 days of the initial hospital treatment.
^ B enefits will be paid for Same Day Procedures only for minor gynaecological procedures.
Description of charges and benefits

Accommodation Charges
Public hospital
Full cover in a shared or private room
Private hospital
Full cover in a shared or private room
Public hospital
Charges are not raised for this service
Private hospital
Full cover for theatre charges
Pharmaceutical drugs (does

not include discharge drugs)
Public hospital
Charges are not raised for this service
Private hospital
Charges vary between hospitals depending on

the contract thats in place. Please check with the
hospital or HIF. Benefits may not apply to, or be
restricted for, non-TGA* approved, experimental
or high cost drugs,
Prostheses and consumables
Public hospital
Benefits will be paid towards prostheses in

accordance with the Commonwealth Prostheses
List. Items on the list (excluding human tissue)
may be subject to a co-payment by the patient.
Prostheses items used in relation to relevant
exclusion services are not covered.
Private hospital

Benefits may not apply or be restricted for
non hospital contract medical treatments or
consumables. Prostheses items used in relation to
relevant exclusion services are not covered.
Theatre Fees charges
10
Outpatient theatre fees

(not emergency department
fees)
Public hospital
No charge raised
Private hospital
Full cover for outpatient theatre fees
Medical Gap
For more details please refer
to the AccessGap Cover
section in this brochure, or
email info@hif.com.au or call
us on 1300 13 40 60
All hospitals and

approved day care
facilities
Admitted patients are entitled to the difference

between the Medicare rebate and the
Commonwealth Medical Benefits Schedule fee for
all medical services performed whilst the patient
is admitted as an inpatient in hospital and may be
entitled to a further refund of the AccessGap cover
amount. Funds are not permitted to pay gap cover
if the patient is treated as an outpatient or when
the patient is not formally admitted to hospital.
Applicable Excess
Mandatory excess
is applied to
GoldVital hospital.
GoldVital - $500 per person in a calendar year to a

max of $1000 per membership. Excess applies to
overnight or same day admissions.
This page has been left blank intentionally
11
This is our basic-level private
Hospital insurance cover. Like
GoldVital, its great value and a
smart choice if youre younger
and less likely to require things
like maternity and cardio
procedures, but it also includes
a broader range of nonemergency care.
charges related to these services (e.g.
theatre or some pharmaceutical costs),
so significant out-of-pocket expenses
may apply for these procedures if you are
admitted as a private patient.
Benefits are not payable for any charges

raised for the following services:
No maternity cover
Assisted reproductive technology (e.g. IVF)
Restrictions and exclusions apply
Cardio (e.g. conditions of the heart

requiring surgery, monitoring or
other procedures)

medical procedures for approved services

General hospitalisation two months
Restricted services
include basic public hospital rate (only)
for accommodation. However, full
AccessGap coverage for inpatient medical
procedures and benefits will be paid
towards prostheses in accordance with the
Commonwealth Prostheses List. Items on
the list (excluding human tissue) may be
subject to a co-payment by the patient:
Palliative care
Public hospital
Full cover in a shared or private room.
Private hospital
The full cost of a shared room. If you occupy

a private room you will be covered up to the
hospital charge for a shared room and you
will be required to meet the balance of the
accommodation charge.
Theatre fee
Public hospital
Charges are not raised for this service.
Private hospital
Full cover for theatre charges.
Pharmaceutical drugs
(does not include discharge
drugs)
Public hospital
Private hospital

or high cost drugs.
Public hospital

Private hospital

consumables. Prostheses items used in relation
to relevant exclusion services are not covered.

fees)
Public hospital
No charge raised.
Private hospital
Full cover for outpatient theatre fees.
Medical Gap
For more details, please refer
us on 1300 13 40 60
All hospitals and

approved day care
facilities

Commonwealth Medical Benefits Schedule fee
for all medical services performed whilst the
patient is admitted as an inpatient in hospital
and may be entitled to a further refund of
the AccessGap cover amount. Funds are not
permitted to pay gap cover if the patient is
treated as an outpatient or when the patient
is not formally admitted to hospital.
Exclusions
Full cover for the cost of a shared

room, theatre fees and charges in a HIF
contracted hospital anywhere in Australia
for approved services
12
Rehabilitation
Accommodation charges
including day patient,
intensive care and
neonatal care
Eye surgery (any procedure on the surface

Joint replacement
Obstetrics
and services that do not attract a
Medicare rebate
Services covered
GoldStarter Hospital will cover the following
services in a public hospital or contracted
private hospital facility, subject to any
waiting periods which may apply and
the Pre-existing Ailment Rule. Benefits
for non-contracted private hospitals are
available from HIF. Check with us prior to
admission to ensure that the hospital is a
HIF contracted facility.
listed benefits are offered to members who
are admitted to those hospitals.
Applicable excess
A mandatory excess is applied to GoldStarter Hospital cover to reduce premium costs:
GoldStarter $200 per person to a max of $400**
* Therapeutic Goods Administration
** Excesses are paid once per person per admission covered under the policy in a calendar year up to the maximum.
Excesses apply to all hospital treatments.
Some examples of cardiac (heart) procedures including medical treatment or surgical procedures for cardiac
13
GoldSaver Hospital
This is our intermediate Hospital
cover and is a step up from
GoldStarter. Its great for
young couples and families
who are likely to need things
like maternity cover but not
services such as cardio and joint
replacement surgery.
Eye surgery (any procedure on the surface

Intermediate Hospital cover
Surgery by a podiatrist
Includes maternity services

charges related to these services (e.g.
theatre or some pharmaceutical costs),
so significant out-of-pocket expenses
may apply for these procedures if you are
admitted as a private patient.
Full AccessGap cover for inpatient medical

procedures
Some restricted services

General hospitalisation 2 months
All obstetric related services 12 months
Restricted Services
include basic public hospital rate (only) for
accommodation. However, full AccessGap
coverage for in-patient medical procedures
and benefits will be paid towards prostheses
in accordance with the Commonwealth
Prostheses List. Items on the list (excluding
Private hospital
Full cover in a shared room. A private room will

be fully covered for up to 3 days for maternity
stays relating to the management of labour
and delivery. If you occupy a private room for
maternity stays greater than 3 days, for the
fourth and additional days you will be covered
up to the hospital charge for a shared room and
you will be required to meet the balance of the
accommodation charge.
Theatre fee and labour

ward charges
Public hospital
Private hospital
Full cover for theatre and labour ward charges.
drugs)
Public hospital
Private hospital

or high cost drugs.
Public hospital

Private hospital

consumables. Prostheses from excluded services
not covered.

fees)
Public hospital
Full cost of the charge raised.
Private hospital
Medical Gap
For more details, please refer
us on 1300 13 40 60
All hospitals and

approved day care
facilities

Commonwealth Medical Benefits Schedule fee
for all medical services performed whilst the
patient is admitted as an inpatient in hospital
and may be entitled to a further refund of
the AccessGap cover amount. Funds are not
permitted to pay gap cover if the patient is
treated as an outpatient or when the patient
is not formally admitted to hospital.
Cardio (e.g. conditions of the heart

requiring surgery, monitoring or
other procedures)
Assisted reproductive technology (e.g IVF)
Private room for up to 3 days for

management of labour and delivery of child
Public hospital
Joint replacement
GoldSaver Hospital
Full cover for the cost of a shared room,

theatre fees and labour ward charges in
a HIF contracted hospital anywhere in
Australia for approved services
14
human tissue) may be subject to a

co-payment by the patient:
intensive care and
neonatal care
Exclusions
Benefits are not payable for any charges
raised for the following services:
and services that do not attract a
Medicare rebate
Services covered
GoldSaver Hospital will cover the following
waiting periods which may apply and the
Pre-existing Ailment Rule. Benefits for noncontracted private hospitals are available
from HIF. Check prior to admission to ensure
that the hospital is a HIF contracted facility.
S
ome examples of cardiac (heart) procedures including medical treatment or surgical procedures for cardiac
Applicable excess
A mandatory excess is applied to reduce premium costs:
GoldSaver $200 per person to a max of $400**
** Excesses are paid once per person per admission covered under the policy in a calendar year, up to the maximum.
Excesses apply to all hospital treatments.
15
Gold Hospital
This is our award-winning top
shared room hospital insurance
cover. Youre fully covered for
theatre fees, ward fees and all
other services. Its especially
great if youre planning on
having a baby, because our
maternity cover includes up to
five days in a private room at
no extra cost.
Gold Hospital
Top Hospital cover
Comprehensive cover for all Medicare
approved items
Private room for up to 5 days for
management of labour and delivery
of child
Full cover for the cost of a shared room,
Australia
medical procedures
Choice of excesses to reduce cost

pre-existing conditions for psychiatric
care, rehabilitation or palliative care
12 months
intensive care and
neonatal care
Public hospital
Private hospital
The full cost of a shared room. A private room will

be fully covered for up to 5 days for maternity stays
relating to the management of labour and delivery.
If you occupy a private room for maternity stays
greater than 5 days, for the sixth and additional days
you will be covered up to the hospital charge for a
shared room and you will be required to meet the
balance of the accommodation charge.

ward charges
Public hospital
Private hospital
drugs)
Public hospital
Private hospital
Charges vary between hospitals depending on the

contract thats in place. Please check with the hospital
or HIF. Benefits may not apply to, or be restricted for,
non-TGA* approved, experimental or high cost drugs.
Prostheses and
consumables
Public hospital

accordance with the Commonwealth Prostheses List.
Items on the list (excluding human tissue) may be
subject to a co-payment by the patient.
Private hospital

subject to a co-payment by the patient. Benefits may
not apply or be restricted for non hospital contract
medical treatments or consumables.

(not emergency
department fees)
Public hospital
No charge raised.
Private hospital
Medical Gap
For more details, please
refer to the AccessGap
Cover section in this
brochure, or email
info@hif.com.au or call us
on 1300 13 40 60
All hospitals and

approved day
care facilities

entitled to a further refund of the AccessGap cover
if the patient is treated as an outpatient or when the
patient is not formally admitted to hospital.
Restrictions
Surgery performed in a hospital by
registered podiatrists is not eligible for
Medicare rebates. However, under this
level of cover HIF will pay limited benefits
toward the podiatrists charges. Hospital
accommodation and theatre charges
will also be limited.
Exclusions
No benefit is payable for services deemed
as cosmetic by Medicare and/or services
that do not attract a Medicare benefit.
Services covered
Gold Hospital will cover the following
waiting periods which may apply and the
Pre-existing Ailment Rule. Benefits for noncontracted private hospitals are available
from HIF. Check prior to admission to ensure
that the hospital is a HIF contracted facility.
Excess options
Optional excesses to reduce premium costs:
Gold Excess 100/200 $100 per person to a max of $200**
16

**E
xcesses are paid once per person per admission covered under the policy in a calendar year, up to the maximum.
The excess is not applied to same-day surgery or to child dependants under the age of 18.
17
GoldStar Hospital
This is our premium hospital
insurance cover, with all the
bells and whistles. Youre
fully covered for everything,
including a private room for
all services, theatre fees and
all ward fees. No worries. Just
total peace of mind for you
and your family.
GoldStar Hospital Cover
Top Hospital cover
Comprehensive cover for all Medicare
approved items
Full cover for the cost of a private room,
Australia
medical procedures
Choice of excesses to reduce cost

pre-existing conditions for psychiatric
care, rehabilitation or palliative care
12 months
Restrictions
Surgery performed in a hospital by
registered podiatrists is not eligible for
Medicare rebates. However, under this
level of cover HIF will pay limited benefits
toward the podiatrists charges. Hospital
accommodation and theatre charges will
also be limited.
intensive care and
neonatal care
Public hospital
Private hospital

ward charges
Public hospital
Private hospital
drugs)
Public hospital
Private hospital
Charges vary between hospitals depending on the

contract thats in place. Please check with the hospital
or HIF. Benefits may not apply to, or be restricted for,
non-TGA* approved, experimental or high cost drugs.
Prostheses and
consumables
Public hospital

subject to a co-payment by the patient.
Private hospital

subject to a co-payment by the patient. Benefits may
not apply or be restricted for non hospital contract
medical treatments or consumables.

(not emergency
department fees)
Public hospital
No charge raised.
Private hospital
Medical Gap
For more details, please
refer to the AccessGap
Cover section in this
brochure, or email
info@hif.com.au or call
us on 1300 13 40 60
All hospitals and

approved day
care facilities

entitled to a further refund of the AccessGap Cover
if the patient is treated as an outpatient or when the
patient is not formally admitted to hospital.
Exclusions
No benefit is payable for services deemed
as cosmetic by Medicare and/or services
that do not attract a Medicare benefit.
Services covered
GoldStar Hospital will cover the following
services provided in a public hospital or
contracted private hospital facility, subject
to any waiting periods which may apply
and the Pre-existing Ailment Rule. Benefits
for non-contracted private hospitals
are available from HIF. Check prior to
admission to ensure that the hospital is
a HIF contracted facility.
Excess options
Optional excesses are available to reduce premium costs:
GoldStar Excess 200/400 $200 per person to a max of $400**
**E
xcesses are paid once per person per admission covered under the policy in a calendar year, up to the maximum.
The excess is not applied to same-day surgery or to child dependants under the age of 18.
18
19
Things you should know about our

Extras cover
Here at HIF, we pride ourselves
on enabling member choice.
So, unlike some health fund insurers who
pay lower benefits if you dont go to their
preferred providers, with HIF youre free to
visit any Extras provider in Australia.
Our only requirement is that members
must visit healthcare providers who are
legally qualified to practise in Australia and
are therefore approved by HIF.
So as long as your preferred doctor, dental
provider, optical provider, physiotherapist,
chiropractor or other type of healthcare
provider is approved by HIF, youre free to
use whichever one you want.
Our Member Loyalty Program

HIF recognises and rewards members
who retain their Extras cover (excluding
Vital Options) each year by providing
increasing benefits or annual limits.
Our dental limits increase every year from
commencement until the maximum limit is
available in your sixth year of membership.
Benefits or limits for services like optical,
physiotherapy, occupational and speech
therapy increase after 5 years and benefits
or limits increase for complementary
therapies, chiropractic, osteopathic and
pharmacy after 3 years.
Where a policy is upgraded to a higher level
of Extras cover (excluding Vital Options),
annual limits and benefits will automatically
move to the next highest loyalty benefit on
the new level of cover and progress each
year until all maximum benefits and limits
are reached.
Annual limits
HIF Extras covers have an annual limit for
most services, which means there is a limit
on how much HIF will pay toward your
claims. Most limits are for the calendar year
(January to December) but each January
your benefit limits will be refreshed, allowing
you to claim benefits again for Extras
services provided in the new year.
Claiming timeframe limitation

Claims must be made within two years of
the service being provided.
Approved consultations
Unless stated, to be eligible for HIF benefits
all services must be provided by a HIF
approved health provider at that providers
registered practice address in a face-toface setting, or as otherwise approved by
HIF. Video, telephone or online facilitated
services, with the exception of HIF approved
Hospital Substitute treatment or Chronic
Health Disease Management programs, are
not approved consultations.
Transferring and upgrading

your cover
New members who transfer Extras cover
from another Australian health fund to an
equivalent level of HIF Extras cover will not
have any waiting periods applied, providing
these were served with the previous fund.
New

members who transfer Extras cover
from another Australian health fund to a
higher level of Extras cover, or equivalent
level of cover with additional or higher
benefits will have qualifying periods
applied for the higher level of cover and/
or benefits. During these periods benefits
will be payable at the equivalent level of
cover to that of your previous fund.
Any

benefits paid by your previous
private health insurer will be considered
when determining rebates for your
future claims.
Vital Options
Vital Options offers great value, entry-level
Extras cover for singles and couples only
(not available for families).
What services are included?

Chiropractic
Dental (General)
Emergency Ambulance
Endodontic
Workers Compensation and

Dual Insurance
Periodontal
Benefits cannot be claimed and are not

payable by HIF where you have or can claim
benefits or compensation (in full or in part)
for treatment, goods or services from a third
party including Workers Compensation or
Public Liability sources, your employer or
any other Insurance policy.
Physiotherapy
Osteopathy
Please note: Benefits are only payable on the following

dental items. There are some items within item code
ranges for which HIF does not pay a benefit, or if they
are performed with another item in the same course of
treatment. If you are planning dental treatment in the
future, please call HIF prior to treatment on 1300 13 40 60
to confirm that you will be covered.

General dental: 011 017, 022 118, 121,
123 171, 311 399, 511 535, 572 597,
911 915, 926, 949 986
Endodontic: 411 458
Periodontal: 213 282
20
Current

HIF members who transfer
Extras cover to a higher level of Extras
cover, or equivalent level of cover with a
reduced or nil excess, will have qualifying
periods applied for the higher level of
cover and/or benefits. During these
periods benefits will be payable at the
lower level of cover.
How much can be claimed?

With a combined annual limit of $800 per
person per year, Vital Options gives complete
choice as to how the limit is used. This could
be used for a quick check-up at the dentist
or visits to a chiropractor, for example. Each
member can choose the services theyd like
to use and Vital Options will pay back 50% on
each service claimed until the maximum annual
limit of $800 is reached.
For example, one member could claim up
to $800 on dental services each year, while
another member chooses to split the limit
across more of the services covered by Vital
Options. For instance, they could choose to
use $250 on dental, $400 on osteopathy
and $150 on chiropractic treatment.
Emergency ambulance services are

included.
If urgent ambulance transport is needed, Vital
Options cover will pay 50% of the bill up to
the maximum annual limit of $800 per person.
This can be a valuable benefit as Medicare
doesnt cover urgent ambulance transport,
which can cost over $900.
21
Ways to claim
Electronic Claiming
Hospital and AccessGap Accounts
Providers with electronic claiming

technology (HICAPS or IBA) can settle your
account with you on the spot. Simply swipe
your HIF membership card and pay any
difference.
Your doctor may send the accounts to

HIF direct. If not, you can send the unpaid
account to us for processing the HIF and
Medicare benefits payable. We will then
send the payment direct to your doctor or
hospital on your behalf. Please call us before
you go into hospital so we can assist you
with your claims.
SmartClaim for mobile

Members who own an Apple or Android
mobile device can now submit paid extras
accounts of $700 or less by using their
mobiles in-built camera to photograph
receipts and invoices. To find out more, visit
hif.com.au or download HIF SmartClaim
now from the Apple App Store or the
Android Market.
Fast-Track e-Claiming (email/fax)

For paid Extras accounts of $700 or less,
try our quick and easy Fast-Track option.
Simply scan your completed HIF claim
form and associated receipts and invoices,
and email a copy to claims@hif.com.au or
fax a copy to (08) 9328 1685. To find out
more, visit hif.com.au
22
Extras waiting benefits

Type of service
Vital
Saver
Special
Super
Premium
Waiting
Period
Ambulance*
2 months
Auxiliary Home Nursing
2 months
Asthmatic Spacers
2 months
Chiropractic
2 months
2 months
Complementary Therapies
Dental - General Unlimited
Limited
2 months
By post
Diabetes Education
2 months
Complete a claim form and post it to:
Dietetics
2 months
Healthy Lifestyle
2 months
Occupational Therapy
2 months
Optical
2 months
Claim forms can be downloaded from

hif.com.au or mailed to you on request.
Orthoptics (Eye Therapy)
2 months
Osteopathy
2 months
For more information on the different ways

to make a claim, check out the How to
Claim page on hif.com.au
Peak-flow Meter
2 months
Pharmacy Drugs
2 months
Physiotherapy
2 months
Podiatry Consultations
2 months
Speech Therapy
2 months
Dental - General Limited**
Up to 12
months
Blood Glucose/Pressure
Monitor
12 months
Dental - Major
12 months
External Prosthesis/
Medical Appliances
12 months
Nebuliser / Humidifier
12 months
Orthotic Appliances
12 months
Psychological
Consultations
12 months
Assisted Reproduction
Drugs
36 months
Hearing Aids
36 months
HIF
GPO Box X2221
Perth WA 6847
From time to time we promote special offers for new members. Visit hif.com.au for more information and
to view our current offers.
* Does not include inter-hospital transfers or transport to home.
** Limited item numbers are covered, please contact HIF for more details
23
Ambulance benefits
Benefit is paid on charges raised for
approved ambulance services. On all our
Extras cover except Vital Options, HIF fully
covers the cost of emergency ambulance
transport for cases classified by approved
ambulance service providers as requiring
urgent attention and where the patient is
admitted to the emergency department
of a hospital.
Vital Options cover will pay 50% of an

emergency ambulance bill up to a maximum
annual limit of $800 per person per
calendar year.
Where a member is eligible for a state or
Federal government subsidy, HIF will pay a
benefit, less this entitlement.
Note: Ambulance services, charges and
levies vary significantly across Australian
states and territories:
A patient co-payment of $50 per service

applies to non-emergency call-outs and
transportation.
Premium Options
24
Ambulance
As above
Residents who hold HIF Hospital cover

are covered for unlimited emergency
ambulance services provided in their home
state by their state government or territory
ambulance service. Interstate emergency
services may also be covered if under a
reciprocal state agreement.*
In all other locations and circumstances,

emergency ambulance services may be
claimable from HIF Options covers, subject
to the services being provided by the
recognised St John or state government
controlled ambulance organisation and the
service being deemed as medically necessary
by the attending ambulance officer.
Residents are covered for unlimited

emergency services provided by their
respective state governments. Interstate
ambulance service charges for these
residents may not apply if reciprocal
agreements are in place with the other states
where the ambulance service was required.
Benefits are not payable for off road or air

ambulance.
Additional
information
All other emergency services
QLD & TAS
Benefits are not payable for transportation

from a hospital to your home, nursing home
or other hospital, or for transportation for
ongoing medical treatment.
Type of service
NSW and ACT
Super Options
Benefit
Person limit
Membership
limit
Emergency:
100%
N/A
N/A
Benefit
Emergency:
100%
Special Options
Person
limit
Membership
limit
N/A
N/A
Saver Options
Benefit
Person limit
Membership
limit
Emergency:
100%
N/A
N/A
Benefit
Person limit
Membership
limit
Emergency:
100%
N/A
N/A
Nonemergency
call-outs and
transportation:
100% with
a $50
co-payment
Nonemergency
call-outs and
transportation:
100% with
a $50
co-payment
Nonemergency
call-outs and
transportation:
100% with
a $50
co-payment
Nonemergency
call-outs and
transportation:
100% with
a $50
co-payment
Interhospital
transfers:
No benefit
Interhospital
transfers:
No benefit
Interhospital
transfers:
No benefit
Interhospital
transfers:
No benefit
25
26
Super Options
Membership
limit
Benefit
Person limit
2 per person
per year
No limit
$18
2 per person
per year
No limit
$120
$1,800 per
year
No limit
$75
$1,800 per
year
No limit
A letter of
recommendation from
the patients treating
practitioner is required.
75% of cost
1 of either
monitor every
3 years
No limit
75% of cost
1 of either
monitor every
3 years
No limit
Benefits are paid for

spinal manipulation
or spinal adjustments
carried out by a
registered chiropractor
approved by HIF.
Spinal
adjustment
manipulation
Type of service
Additional information
Benefit
Person limit
Asthmatic
spacers
N/A
$18
Auxiliary Home
Nursing
Benefits must be
ordered by a medical
practitioner. Contact us
for conditions.
Blood glucose
or
blood pressure
monitor
Chiropractic
Max: $200
Max: $200
First visit:
$30
Visits 2-10:
$29
Visits 10+: $18
X-ray: $110
Membership
limit
Extras benefits
Premium Options
Combined
annual limit
(chiropractic
and
osteopathic)
Combined
annual limit
(chiropractic
and
osteopathic)
Up to 3 years:
$650
Up to 3 years:
$1300
Over 3 years:
$750
Over 3 years:
$1500
Spinal
adjustment
manipulation
First visit:
$28
Visits 2-10:
$23
Visits 10+: $14
X-ray: $85
1 x-ray per
year
Combined
annual limit
(chiropractic
and
osteopathic)
Combined
annual limit
(chiropractic
and
osteopathic)
Up to 3 years:
$550
Up to 3 years:
$1100
Over 3 years:
$650
Over 3 years:
$1300
1 x-ray per
year
Special Options
Saver Options
Type of service
Benefit
Person limit
Membership
limit
Benefit
Person limit
Membership
limit
Asthmatic
spacers
N/A
N/A
N/A
No limit
N/A
N/A
No limit
Auxiliary Home
Nursing
Benefits must be
ordered by a medical
practitioner. Contact us
for conditions.
N/A
N/A
No limit
N/A
N/A
No limit
Blood glucose
or
blood pressure
monitor
A letter of
recommendation from
N/A
N/A
No limit
N/A
N/A
No limit
Chiropractic
Benefits are paid for

spinal manipulation or
spinal adjustments
carried out by a
registered chiropractor
approved by HIF.
Spinal
adjustment
manipulation
Combined
annual limit
(chiropractic,
osteopathic,
physiotherapy,
podiatry and
complementary
therapies)
$900
Spinal
adjustment manipulation:
Visits 10+: $10
Combined
annual limit
(chiropractic,
osteopathic,
physiotherapy,
podiatry and
complementary
therapies)
$450
X-ray: $70
1 x-ray per year
Combined
annual limit
(chiropractic,
dietetics,
healthy
lifestyle,
complementary
therapies,
pharmacy,
osteopathic,
physiotherapy
and podiatry)
$350
Combined
annual limit
(chiropractic,
dietetics,
healthy
lifestyle,
complementary
therapies,
pharmacy,
osteopathic,
physiotherapy
and podiatry)
$700
First visit:
$26
Visits 2-10: $21
First visit:
$26
Visits 2-10: $21
Visits 10+: $10
X-ray: $65
1 x-ray per year
27
28
Super Options
Type of service
Benefit
Person limit
Complementary
therapies
- Naturopathy
- Homeopathy
- Acupuncture
- Traditional
Chinese
Medicine
- Remedial
massage
therapy
- Myotherapy
Benefits are not payable

on medicines provided
by the practitioner.
Visits 1-6: $25
Up to 3 years:
$500
Visits 7+:
$17
The treatment must

be provided by a
practitioner who is
registered with HIF in
the speciality for which
the charge is raised.
Membership
limit
Benefit
Person limit
No limit*
Visits 1-6: $20
Up to 3 years:
$250
Visits 7+:
$13
Over 3 years:
$600
Dental
Membership
limit
$700
Over 3 years:
$350
Extras benefits
Premium Options
See page 44 for more details
Diabetics
education
For consultations or
information sessions
held by Diabetes
Association in relation to
diabetes.
First visit: $36
Dietetics
Benefits are paid on

consultations carried out
by a registered dietician
approved
by HIF.
First visit:
$40
Subsequent:
$18
6 visits per
year
No limit
$324 per year
No limit
First visit: $36

Subsequent:
$18
First visit: $36

Subsequent:
$18
Subsequent:
$20
6 visits
per year
No limit
$324
per year
Group: $10
Group: $12
Special Options
Saver Options
Type of service
Benefit
Person limit
Complementary
therapies
- Naturopathy
- Homeopathy
- Acupuncture
- Traditional
Chinese
Medicine
- Remedial
massage
therapy
- Myotherapy
Benefits are not payable

on medicines provided
by the practitioner.
Visits 1-6:
$16
Up to 3 years:
$100*
Visits 7+:
$11
Over 3 years:
$200*
The treatment must

be provided by a
practitioner who is
registered with HIF in
the speciality for which
the charge is raised.
Dental
Membership
limit
$400*
Benefit
Person limit
Membership
limit
Visit 1-6:
$15
Up to 3 years: $50#
$200 #
Over 3 years: $100 #
Visits 7+:
$10
Diabetics
education
For consultations or
information sessions
held by Diabetes
Association in relation to
diabetes.
N/A
N/A
No limit
N/A
N/A
No limit
Dietetics

consultations carried out
by a registered dietician
approved by HIF.
First visit: $36
$252 per year
No limit
First visit: $36
Combined annual
limit (chiropractic,
dietetics, healthy
lifestyle,
complementary
therapies,
osteopathy,
pharmacy,
physiotherapy and
podiatry) $350
Combined annual
dietetics, healthy
lifestyle,
complementary
therapies,
osteopathy,
pharmacy,
physiotherapy and
podiatry) $700
Subsequent:
$18
Subsequent:
$18
Group: $10
Group: $10
29
*S
ubject to combined overall person limit of $450 and membership limit of $900 for complementary therapies, chiropractic incl. 1 X-ray
per year per person, osteopathic, physiotherapy and podiatry.
# Subject to combined overall person limit of $350 and membership limit of $700 for complementary therapies, chiropractic incl. 1 X-ray
per year per person, dietetics, healthy lifestyle, pharmacy, osteopathic, physiotherapy, and podiatry.
30
Type of service
Benefit
Person limit
External
Prosthesis/
Medical
Appliances
Benefits are paid on HIF

approved prosthetics
items such as artificial
limbs, wigs and external
mammary prostheses
and approved medical
devices such as a Tens
machine, Circulation
Booster and Cam
Walker.
75% of fee
$1,500 per
year.
Super Options
Membership
limit
Benefit
Person limit
No limit
75% of fee
$1,500 per
year.
Note: sub
limits apply
depending
upon item.
Membership
limit
No limit
Note: sub
limits apply
depending
upon item.
Conditions apply so
please contact us
for details prior to
purchasing item.
Healthy Lifestyle
- Health
management
program
- Weight loss
program
- Quit smoking
plan
- Health
assessments
- Skin cancer
screening
Benefits are payable for

HIF approved programs
delivered by registered
providers only.
Single: $125
$125
Single: $100
Family: $250
$100
Family: $200
Please contact us prior

to commencing the
program or paying
subscriptions to
ascertain if the program
is eligible for a rebate.
Special Options
Saver Options
Type of service
Benefit
Person limit
Membership
limit
Benefit
Person limit
Membership
limit
External
Prosthesis/
Medical
Appliances
Benefits are paid on HIF

approved prosthetics
items such as artificial
limbs, wigs and external
mammary prostheses
and approved medical
devices such as a Tens
machine, Circulation
Booster and Cam
Walker.
N/A
N/A
No limit
N/A
N/A
No limit
Single: $75
$75
Single: $50
$50
Combined
annual limit
(chiropractic,
dietetics, healthy
lifestyle,
complementary
therapies,
osteopathic,
pharmacy,
physiotherapy
and podiatry)
$700
Conditions apply so
please contact us
for details prior to
purchasing item.
Healthy Lifestyle
- Health
management
program
- Weight loss
program
- Quit smoking
plan
- Health
assessments
- Skin cancer
screening
Benefits are payable for

HIF approved programs
delivered by registered
providers only.
Please contact us prior
to commencing the
program or paying
subscriptions to
ascertain if the program
is eligible for a rebate.
Family: $150
Family: $100
Extras benefits
Premium Options
31
32
Type of service
Benefit
Person limit
Hearing aids

replacement hearing
aids after 5 years from
date of supply.
Up to 5 years:
$550
Up to 5
years: 1
5 to 10 years:
$600 per ear
Over 5 years:
1 per ear
Membership
limit
No limit
Super Options
Benefit
Person limit
Up to 5 years:
$550
Up to
5 years: 1
5+ years:
$550 per ear
Over 5 years:
1 per ear
Membership
limit
No limit
10+ years:
$700 per ear
Humidifier or
nebuliser
A letter of
recommendation from
75% of cost
1 of either
monitor every
3 years.
Maximum
$180.
No limit
75% of cost
1 of either
monitor every
3 years.
Maximum
$140.
No limit
Occupational
therapy

consultations carried
out by a registered
occupational therapist,
approved by HIF.
First Visit $60
Combined
limit
(orthoptics,
physiotherapy
and speech
therapy)
No limit
First visit: $45
Combined
limit
(orthoptics,
physiotherapy
and speech
therapy)
No limit
Subsequent
$27
Group $10
Optical
Orthotics
Subsequent:
$25
Group: $10
Up to 5 years:
$1200
Up to 5 years:
$900
Over 5 years:
$1500
Over 5 years:
$1100

items carried out by a
registered podiatrist
or orthotic supplier,
approved by HIF#.
75% of cost
$240 1
every
2 years from
date of
supply ^
No limit
75% of cost
$200 1 every
2 years from
date of
supply ^
No limit
# Note: benefits are not available for orthotics which are not specifically modified and fitted for the individual members condition.
^ Orthotic limit includes associated services such as muscle testing, ROM testing and gait analysis.
Special Options
Saver Options
Type of service
Benefit
Person limit
Membership
limit
Benefit
Person limit
Membership
limit
Hearing aids

replacement hearing
aids after 5 years from
date of supply.
N/A
N/A
No limit
N/A
N/A
No limit
Humidifier or
nebuliser
A letter of
recommendation from
N/A
N/A
No limit
N/A
N/A
No limit
Occupational
therapy

out by a registered
occupational therapist,
approved by HIF.
N/A
N/A
No limit
N/A
N/A
No limit

registered podiatrist
or orthotic supplier,
approved by HIF#.
N/A
N/A
N/A
N/A
No limit
Optical
Orthotics

No limit
# Note: benefits are not available for orthotics which are not specifically modified and fitted for the individual members condition.
Extras benefits
Premium Options
33
34
Type of service
Benefit
Person limit
Orthoptics
(eye therapy)

registered orthoptics
supplier, approved by
HIF.
Initial: $50
Combined
limit with
occupational
physiotherapy
and speech
therapy
Osteopathic
Peak Flow
Meter

registered osteopath,
approved
by HIF.
N/A
Subsequent:
$25
First visit: $30

Visits 2-10:
$29
Visits 10+: $18
$30
Super Options
Membership
limit
Benefit
Person limit
No limit
Initial $50
Combined
limit with
occupational
physiotherapy
and speech
therapy
Subsequent
$25
Up to 5 years:
$1200
Up to 5 years:
$900
Over 5 years:
$1500
Over 5 years:
$1100
Combined
annual limit
(chiropractic
and
osteopathic)
Combined
annual limit
(chiropractic
and
osteopathic)
Up to 3 years:
$650
Membership
limit
No limit
Combined
annual limit
(chiropractic
and
osteopathic)
Combined
annual limit
(chiropractic
and
osteopathic)
Up to 3 years:
$1300
Up to 3 years:
$550
Up to 3 years:
$1100
Over 3 years:
$750
Over 3 years:
$1500
Over 3 years:
$650
Over 3 years:
$1300
1 per year
No limit
1 per year
No limit
First visit: $28

Visits 2-10:
$23
Visits 10+: $17
$30
Special Options
Saver Options
Type of service
Benefit
Person limit
Membership
limit
Benefit
Person limit
Membership
limit
Orthoptics
(eye therapy)

registered orthoptics
supplier, approved by
HIF.
N/A
N/A
No limit
N/A
N/A
No limit
Osteopathic

registered osteopath,
approved
by HIF.
First visit: $26
Combined
annual limit
(chiropractic,
physiotherapy,
osteopathic
and podiatry)
$450
Combined
annual limit
(chiropractic,
physiotherapy,
osteopathic
and podiatry)
$900
First visit: $26
Combined
annual limit
(chiropractic,
dietetics,
healthy lifestyle,
complementary
therapies,
osteopathic,
pharmacy,
physiotherapy &
podiatry) $350
Combined annual
dietetics,
healthy lifestyle,
complementary
therapies,
osteopathic,
pharmacy,
physiotherapy
and podiatry)
$700
N/A
N/A
N/A
No limit
N/A
N/A
No limit
Peak Flow
Meter
Visits 2-10:
$21
Visits 10+: $16
Visits 2-10:
$21
Visits 10+: $16
Extras benefits
Premium Options
35
36
Type of service
Benefit
Person limit
Pharmacy
Not payable on
contraceptives or NHS
(PBS) prescriptions or
over the counter items
purchased with or
without a prescription.
Member
pays PBS
contribution.
Benefit is 100%
of balance up
to $80 per
script item.
Up to 3 years:
$200
Benefits are paid

on items carried
out by a registered
physiotherapist,
approved by HIF.
First visit: $45
Combined limit
(occupational,
orthoptics
and speech
therapy)
Physiotherapy
Visits 2-10: $40

Visits 10+: $30
Hydrotherapy:
$15
Antenatal: $15
Group: $15
Super Options
Membership
limit
No limit
Over 3 years:
$400
No limit
Benefit
Person limit
Member
pays PBS
contribution.
Benefit is 100%
of balance up
to $80 per
script item.
Up to 3 years:
$200
First visit: $35
Combined limit
(occupational,
orthoptics
and speech
therapy)
Visits 2-10: $29

Visits 10+: $20
Hydrotherapy:
$13
Up to 5 years:
$1200
Antenatal: $13
Over 5 years:
$1500
Group: $13
$600 sublimit
for
hydrotherapy,
antenatal and
group.
Benefit
Person limit
Membership
limit
Pharmacy
Not payable on
contraceptives or NHS
(PBS) prescriptions or
over the counter items
purchased with or
without a prescription.
Member
pays PBS
contribution.
Benefit is
100% of
balance up to
$80 per script
item.
$200
Physiotherapy
Benefits are paid

on items carried
out by a registered
physiotherapist,
approved by HIF.
First visit: $32
Antenatal: $13
Combined
annual limit
(complementary therapies,
chiropractic,
physiotherapy,
osteopathic and
podiatry)
Group: $8
$450
Hydrotherapy:
$13
$400 sublimit
for
hydrotherapy,
antenatal and
group.
Over 3 years:
$400
No limit
Up to 5 years:
$900
Over 5 years:
$1100
Saver Options
Type of service
Visits 10+: $19
No limit
$500 sublimit
for
hydrotherapy,
antenatal and
group.
Special Options
Visits 2-10: $24
Membership
limit
Benefit
Person limit
Membership
limit
No limit
Member
pays PBS
contribution.
Benefit is
100% of
balance up to
$80 per script
item.
Combined
annual limit
(chiropractic,
dietetics,
healthy lifestyle,
complementary therapies,
osteopathic,
pharmacy,
physiotherapy
& podiatry)
$350
Combined
annual limit
(chiropractic,
dietetics,
healthy
lifestyle,
osteopathic,
pharmacy,
physiotherapy
and podiatry)
$700
Combined
annual limit
(complementary therapies,
chiropractic,
physiotherapy,
osteopathic
and podiatry)
$900
First visit: $32
Combined
annual limit
(chiropractic,
dietetics,
healthy lifestyle,
osteopathic,
pharmacy,
physiotherapy
and podiatry)
$350
Combined
annual limit
(chiropractic,
dietetics,
healthy
lifestyle,
osteopathic,
pharmacy,
physiotherapy
and podiatry)
$700
Visits 2-10: $24

Visits 10+: $19
Hydrotherapy:
$13
Antenatal: $13
Group: $8
$300
sublimit for
hydrotherapy,
antenatal and
group.
Extras benefits
Premium Options
37
38
Membership
limit
Benefit
Person limit
$382
includes
podiatry
surgery
performed
in the
podiatrists
registered
rooms only.
No limit
First visit: $32
$354
includes
podiatry
surgery
performed in
the podiatrists
registered
rooms only
No limit
$1,000 per
year
No limit
$740 per year
No limit
Combined limit
(occupational,
orthoptics and
physiotherapy)
No limit
Type of service
Benefit
Person limit
Podiatry*

out by a registered
podiatrist, approved
by HIF.
First visit: $32
Maximum of 2 sessions
will be paid on the
same date if there is a
minimum of 2 hours
between sessions.
out by a registered
psychologist, approved
by HIF.
First visit: $100

items carried out by
a registered speech
therapist, approved by
HIF.
First visit: $75
Psychology
Speech therapy
Subsequent:
$25
Consultations
that are not
performed in
the podiatrists
registered
practice: $12
Subsequent:
$55
Super Options
Subsequent:
$23
Consultations
that are not
performed in
the podiatrists
registered
practice: $12
Subsequent:
$55
Group: $30
per person to
a max of $75
per session
Subsequent:
$45
First visit: $75
Membership
limit
Group: $25
per person to
a max of $75
per session
Combined
limit
(occupational,
orthoptics and
physiotherapy)
No limit
First visit: $75

Subsequent:
$45
Up to 5 years:
$900
Up to 5 years:
$1200
Over 5 years:
$1100
Over 5 years:
$1500
* Benefits not payable when provided as part of treatment provided in, or arranged by a hospital (including surgery).
Special Options
Saver Options
Type of service
Benefit
Person limit
Membership
limit
Podiatry*

out by a registered
podiatrist, approved
by HIF.
First visit: $32
Combined
annual limit
(chiropractic,
physiotherapy,
osteopathic
and podiatry)
$450
Psychology
Maximum of 2 sessions
will be paid on the
same date if there is a
minimum of 2 hours
between sessions.
out by a registered
psychologist, approved
by HIF.
N/A
Speech therapy

items carried out by
a registered speech
therapist, approved by
HIF.
N/A
Subsequent:
$23
Consultations
that are not
performed in
the podiatrists
registered
practice: $12
Benefit
Person limit
Membership
limit
Combined
annual limit
(chiropractic,
physiotherapy,
osteopathic
and podiatry)
$900
First visit: $32
Combined
annual limit
(chiropractic,
dietetics,
healthy lifestyle,
osteopathic,
pharmacy,
physiotherapy
& podiatry)
$350
Combined
annual limit:
(chiropractic,
dietetics,
healthy
lifestyle,
osteopathic,
pharmacy,
physiotherapy
and podiatry)
$700
N/A
No limit
N/A
N/A
No limit
N/A
No limit
N/A
N/A
No limit
Subsequent:
$23
Consultations
that are not
performed in
the podiatrists
registered
practice: $12
* Benefits not payable when provided as part of treatment provided in or arranged by, a hospital (including surgery).
Extras benefits
Premium Options
39
Extras benefits: Optical

Type of service
Optical
Most common services

listed below. Contact us
for other services and
benefits.
Memberships up
to 5 years
Memberships over
5 years
Memberships up to
5 years
Memberships over
5 years
Memberships up to
5 years
Memberships over
5 years
Memberships up to
5 years
Memberships over
5 years
Benefits are
paid on items
carried out by
a registered
optometrist or
optical provider,
approved by HIF.
Frames (item no 110):
$90
$112.50
$70
$87.50
$55
$60.50
$50
$55
Pair Single Vision Lenses

(item no 212):
$75
$93.75
$70
$87.50
$45
$49.50
$40
$44
Pair Bifocal Lenses

(item no 312):
$100
$125
$95
$118.75
$60
$66
$55
$60.50
Pair Trifocal Lenses
$150
$187.50
$145
$181.25
$60
$66
$55
$60.50
$150
$187.50
$145
$181.25
$60
$66
$55
$60.50
$170
$212.50
$150
$187.50
$110
$121
$100
$110
$280
$350
$260
$325
$140
$155
$110
$121
Frames sub-limit
$110
$140
$85
$110
$65
$71.50
$55
$60.50
Pair frequently replaced
$170
$215
$150
$190
$110
$121
$100
$110
Benefits are not

paid on
non-prescription
safety glasses,
protective
glasses, tinting,
sunglasses,
cosmetic glasses
or cosmetic
contact lenses,
or frames not
purchased via
a registered
Australian optical
provider.
Premium Options
Super Options
Special Options
Saver Options
(item no 412):
Pair Progressive Lenses
(item no 512):
Pair Frequently Replaced
Contact Lenses
(item no 852):
Limit per person
Annual limit, all services
(including frames and
contacts)
contact lenses sub-limit
40
41
Extras benefits: SmartTeeth
How will my SmartTeeth dental

rebate be calculated?
Our top 24 SmartTeeth dental services

Item
Number
Description
Subsequent Visits
First Visit
011 or 012
Oral examination
100%
80%
111 or 114 or 115
Removal of plaque, stain or calculus
100%
80%
121
Topical application of remineralising

agent
100%
80%
151 or 153
Provision of a mouthguard
100%
80%
We will pay a percentage of the dentists

fee, up to a set maximum benefit for each
item of service^. For example, with our
Premium Options Extras cover you get:
1 Top 24 general dental services: 80% to
100% of the fee, up to a set maximum
benefit per item.
Please note: These benefits are payable on all our Extras products. The actual benefit amount cannot exceed our
set maximum beneft for each dental item, service sub limits or annual dental limit. See the example on page 8 for
more information.
Item
Number
Description
Premium
Options
Super
Options
Special
Options
Saver
Options
013
Emergency oral examination
80%
70%
65%
65%
014
Consultation
80%
70%
65%
65%
022
Intraoral periapical or bitewing

radiograph
80%
70%
65%
65%
118
Bleaching, external per tooth
80%
70%
65%
65%
161
Fissure sealing per tooth
80%
70%
65%
65%
311
Removal of permanent tooth
80%
70%
65%
65%
512
Metallic restoration two surfaces

direct
80%
70%
65%
65%
513
Metallic restoration three surfaces

direct
80%
70%
65%
65%
521
Adhesive restoration one surface

anterior
80%
70%
65%
65%
522
Adhesive restoration two surfaces

anterior
80%
70%
65%
65%
523
Adhesive restoration three

surfaces anterior
80%
70%
65%
65%
531
Adhesive restoration one surface

posterior
80%
70%
65%
65%
532
Adhesive restoration two surfaces

posterior
80%
70%
65%
65%
533
Adhesive restoration three

surfaces posterior
80%
70%
65%
65%
575
Pin retention per pin
80%
70%
65%
65%
577
Cusp capping per cusp
80%
70%
65%
65%
2 All other general dental services:

benefit per item*.
3 All other (i.e. major) dental services:
benefit per item*.
^ Benefits may be limited where potential rebates
exceed dental service sub limits or annual limit.
*C
ontact us on 1300 13 40 60 for details
of these services.
This does not apply to Vital Options please
see page 21 for more details.
Please note: The actual benefit amount cannot exceed our set maximum benefit for each dental item, service sub
limits or overall annual limit.
42
43
Extras benefits: Dental annual limits

Premium
Options
Item
Number
General Unlimited
022
311 - 314
511 - 535
Year 2
Year 3
Year 4
Year 5
After 5
Years
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
Item
Number
Year 1
Year 2
Year 3
Year 4
Year 5
After 5
Years
General Unlimited
022
311 - 314
511 - 535
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
General Limited
011 - 017
025 - 171
322 - 399
572 - 597
911 - 949
961 - 986
$800
$950
$1,150
$1,350
$1,550
$1,750
Inlay/Onlay
541 - 555
$500
$600
$700
$800
$900
$1,000
Denture, Crown,
Bridge *
611 - 691
711 - 779
$600
$700
$800
$900
$1,000
$1,100
Periodontic &
Endodontic
213 - 282
411 - 458
$300
$400
$500
$600
$700
$800
Orthodontic
(Lifetime
Limit *)
811 - 878
$1,000
$1,200
$1,400
$1,600
$1,800
$2,000
$1,000
$1,200
$1,400
$1,600
$1,800
$2,000
Year 1
Year 2
Year 3
Year 4
Year 5
After 5
Years
011 - 017
025 - 171
322 - 399
572 - 597
911 - 949
961 - 986
$1,500
Inlay/Onlay
541 - 555
$1,000
$1,100
$1,200
$1,300
$1,400
$1,500
Denture, Crown,
Bridge *
611 - 691
711 - 779
$1,200
$1,300
$1,400
$1,500
$1,600
$1,700
Periodontic &
Endodontic
213 - 282
411 - 458
$700
$800
$900
$1,000
$1,100
$1,200
Orthodontic
(Lifetime
Limit* )
811 - 878
$1,500
$1,800
$2,100
$2,400
$2,700
$3,000
Total annual
limits per
person
$1,500
$1,800
$2,100
$2,400
$2,700
$3,000
Saver
Options
Item
Number
General Unlimited
022
311 - 314
511 - 535
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
General Limited
011 - 017
025 - 171
322 - 399
572 - 597
911 - 949
961 - 986
$750
$850
$950
$1,050
$1,150
$1,250
Inlay/Onlay
541 - 555
Not
covered
Not
covered
Not
covered
Not
covered
Not
covered
Not
covered
Denture, Crown,
Bridge *
611 - 691
711 - 779
Not
covered
Not
covered
Not
covered
Not
covered
Not
covered
Not
covered
Periodontic &
Endodontic
213 - 282
411 - 458
Not
covered
Not
covered
Not
covered
Not
covered
Not
covered
Not
covered
Orthodontic
(Lifetime Limit*)
811 - 878
Not
covered
Not
covered
Not
covered
Not
covered
Not
covered
Not
covered
$750
$850
$950
$1,050
$1,150
$1,250
General Limited
Total annual
limits per
person
Super
Options
Item
Number
General Unlimited
022
311 - 314
511 - 535
$1,800
$2,100
$2,400
$2,700
$3,000
Year 1
Year 2
Year 3
Year 4
Year 5
After 5
Years
No Limit
No Limit
No Limit
No Limit
No Limit
No Limit
011 - 017
025 - 171
322 - 399
572 - 597
911 - 949
961 - 986
$1,150
Inlay/Onlay
541 - 555
$700
$800
$900
$1,000
$1,100
$1,200
Denture, Crown,
Bridge *
611 - 691
711 - 779
$900
$1,000
$1,100
$1,200
$1,300
$1,400
Periodontic &
Endodontic
213 - 282
411 - 458
General Limited
Orthodontic
(Lifetime
Limit *)
Total annual
limits per
person
44
Year 1
Special
Options
811 - 878
$500
$1,350
$600
$1,550
$700
$1,750
$800
$2,050
$900
$2,350
$1,000
$1,300
$1,500
$1,700
$1,900
$2,200
$2,500
$1,300
$1,500
$1,700
$1,900
$2,200
$2,500
Total annual
limits per
person
* For more information about replacement periods and lifetime limits refer to "Important information about your dental
cover" on page 46
45
Important information about

your dental cover
Benefits are only paid on accounts rendered
by a registered dentist or dental prosthetist.
The dentist or dental prosthetist must be
in private practice. Dental prosthetists
are allowed to perform a limited range of
services for benefit purposes.
There are some items within item code
ranges for which HIF does not pay a benefit,
or if they are performed with another item in
the same course of treatment. Limits apply
to the number of times some items, such as
bleaching, attract a benefit.
Benefits for replacement dentures and
partial dentures are not paid within three
years of previous supply.
The applicable benefit is payable on the

date the service is rendered e.g. the date
braces are fitted.
If you are unsure of your entitlements,
please contact us before commencing a
course of treatment with full details of the
necessary dental items as provided by your
dental provider and we will provide you with
a benefit estimate.
Annual limits are refreshed on 1 January
each year, so if youre planning a course
of treatment it may be financially
advantageous to stagger services over two
calendar years.
Orthodontic limits are lifetime limits per

person. Benefits are not payable in excess
of the annual limit shown and include
benefits paid under another health
insurance policy."
Feedback, disputes and privacy

Our Code of Conduct
The Private Health Insurance Code of
Conduct is a self-regulatory code with
the primary goal of enhancing regulatory
compliance. We support and apply these
industry standards in four fundamental
ways:
1. Our employees are trained in private
health insurance;
2. The information we provide to you is
communicated in a way that is easy to
understand and allows you to make an
informed decision;
46
3. We openly communicate our procedures

for resolving any concerns you may have
about your HIF membership and private
health cover; and
4. We ensure that any information you
provide to us is maintained in accordance
with our privacy policy.
To download a full copy of the Code of
Conduct, please visit hif.com.au
Cooling Off Period

When you have applied for a HIF
membership, you have 30 days to read your
policy. If you decide during this time that you
do not wish to take up the cover, you may
cancel the policy and HIF will give you a full
refund, provided you have not made a claim.
Compliments and
complaints
Your feedback is valuable to us, so dont
be afraid to get in touch. You may wish to
comment on your personal experiences
with HIF, or you may wish to lodge a
compliment (or complaint) about the
service youve received from our team.
Whatever your feedback relates to, we
address each and every compliment/
complaint and will always respond
accordingly. Your input is a vital part of
ensuring our organisation meets or ideally
exceeds your expectations at all times.
To submit feedback, simply visit
hif.com.au and complete the online
feedback form. Alternatively, you can
email info@hif.com.au or call us on
1300 13 40 60.
Providing feedback
or making a
complaint
HIF is committed to providing our members
with access to the highest possible level
of service and we value the feedback that
our members provide. As part of HIFs
commitment to continuous improvement
if you have a concern regarding your HIF
membership, our products, benefits or our
service we would be happy to hear from
you.
If you have a complaint or concerns, you
can discuss this with one of our Customer
Service Representatives on 1300 13 40 60
or email your complaint to info@hif.com.au
and we will:
Treat you with respect and deal with your
concerns promptly
Resolve any complaints at the first point of
contact, wherever possible
Escalate complaints (if necessary) and

resolve them swiftly, within two business
days
Invite you to further escalate complaints
which could not be resolved to your
satisfaction to HIFs formal Ex-gratia
Committee (you should address your
complaint in writing to Executive Manager
Operations, Health Insurance Fund of
Australia, GPO Box X2221, Perth WA,
6847)
Openly share our complaints with you,
including external resolutions options,
like involving the Private Health Insurance
Ombudsman (you can contact the
Ombudsman on 1800 640 695 or
write to: Suite 2, Level 22, 580 George
Street, Sydney NSW, 2000) or Privacy
Commissioner
Resolve complaints in an equitable
manner, with the best interests of all
members in mind
Use feedback to improve our products and
services by passing it on to our Product
Development Committee.
Your privacy
The personal information you provide to
us will be primarily used by HIF to deliver
health insurance products and services
as requested by you. The information
supplied by you will remain confidential.
This information may be disclosed to third
parties and authorised government
agencies in order to facilitate the delivery
of services associated with your health
insurance. Failure to provide personal
information may result in the failure to
process or deliver the service requested.
For a complete HIF Privacy Policy brochure,
please contact us on 1300 13 40 60 or
download a copy at hif.com.au
47
Frequently asked questions

How long can children remain on
family policies?
What is the Medicare Levy Surcharge

(MLS)?
With HIF, dependants are covered up until

the age of 21, or up to 25 years of age for
those registered as full-time students at a
recognised educational institution.
The Medicare Levy Surcharge (MLS)

is levied on Australian taxpayers who
earn above a certain income and dont
have private Hospital cover. The MLS is a
Federal Government initiative designed to
encourage individuals to take out private
Hospital cover and, where possible, to use the
private hospital system to reduce demand on
the public system.
If I have health insurance can I still

be admitted to hospital as a public
patient?
Yes. Every public hospital is required to
ask if you wish to be treated as a public or
private patient. Its your choice if you use
your insurance or not.
Which bills should I claim from HIF

and which ones should I claim from
Medicare?
If you dont have health insurance, Medicare
pays benefits for all medical accounts. For
example, accounts for doctors, specialists,
eye examinations, X-rays and pathology.
However, if you have HIF Hospital cover, well
process your hospital accounts. We also pay
up to one quarter of the Medicare schedule
fee for any medical accounts resulting from
your time as a private inpatient in a hospital.
If you have HIF Extras cover, we also process
all your bills for extras services, such dental,
physiotherapy or optical treatments.
48
Is the Federal Government Rebate

on Private Health Insurance means
tested?
Yes, since 1 July 2012, the Federal
Government Rebate on Private Health
Insurance is means tested, as is the Medicare
Levy Surcharge (MLS). There are effectively
four annual income tiers for single people
and couples/families. The rebate you receive
for holding private health insurance and
the size of the MLS you pay are dictated by
your age and annual income.
For instance, if youre a single person
under the age of 65 and youre earning
less than $90,000 a year, you will receive
a 30% rebate on the cost of your health
insurance. Furthermore, while you have to
pay the Medicare Levy (everyone does),
you dont have to pay the MLS. On the
other hand, if youre classified as a high
income Tier 3 earner, you will be taxed 3%
of your income if you dont have private
Hospital cover (1.5% MLS plus the standard
1.5% Medicare Levy that everyone pays).
See table on page 50.
What is the Lifetime Health Cover

loading (LHC)?
The Federal Government introduced
the Lifetime Health Cover loading to
encourage Australians to take out private
Hospital cover at a younger age. Basically,
it recognises the length of time youve had
private health insurance and rewards that
loyalty by offering lower premiums so
the earlier you take out health cover, the
cheaper your premiums.
Does everyone have to pay LHC

loading?
No, you wont incur the loading if you:
Had Hospital cover on 1 July 2000 and
have maintained it since then; or
Were born on or before 1 July 1934.
How is the loading applied?

For every year over the age of 30 that
you dont have private Hospital cover, a
2% loading is applied to the cost of your
insurance (and increases each year until it
reaches 70%). For example, a single
37 year old would pay 14% LHC loading so
it really pays to take out private Hospital
cover sooner rather than later.
For couples and families, however, the
loading is initially calculated based on your
respective dates of birth and then halved.
For example, a couple aged 33 and 36 years
would generate a combined loading of 18%
initially (6% + 12%), so the final loading that
is applied to their joint policy is 9%.
If you find that you will incur a loading, you
will be required to pay this on top of the
base premium that youre initially quoted for
your Hospital cover. If you decide to join HIF,
your loading will automatically be applied to
the quoted amount once you provide your
date of birth.
What if Im already over 31?

If youre over 31, it still makes sense to take
out Hospital cover. Remember, the sooner
you join, the smaller the loading you will pay.
And once youve held continuous private
Hospital cover for 10 years, your loading
will be removed (as per the Private Health
Insurance Act 2007).
What isnt covered by private health

insurance?
Private health insurance doesnt cover you
for outpatient services. These services
include visits to your GP and consultations
with specialists, as well as X-rays and blood
tests (unless theyre taken once youre
admitted to hospital).
What are waiting periods?

Waiting periods are the time you need to be
a member of a health fund before you can
claim a benefit. Theyre there to protect the
fund and its existing members from people
who simply join a fund to make a big claim,
only to cancel their membership afterwards.
But theres good news. If you join us from
another Australian health fund and take out
an equivalent level of cover with us, you
dont have to re-serve any waiting periods
that youve already served. Even better, its
really easy to switch well take care of all
the paperwork for you.
The waiting periods for Hospital and Extras
cover can be found in our health insurance
brochure or at hif.com.au
To read all these FAQs (and more) online,
visit hif.com.au/faqs
49
Federal Government Rebate
Glossary
Federal Government Rebate (Refers to FAQ on page 42)

Annual Income Thresholds
Policy Type
Unchanged
Tier 1
Tier 2
Tier 3
Single
<$90,000
$90,001 - 105,000
$105,001 - 140,000
>$140,001
Families
<$180,000
$180,001 - 210,000
$204,001 - 280,000
>$280,001
Age
Under 65
29.04%
19.36%
9.68%
0%
65 - 69 years
33.88%
24.20%
14.52%
0%
70 and over
38.72%
29.04%
19.36%
0%
All ages
0%
Medicare Levy Surcharge (applicable if Hospital cover is not held)

1.25%
1.5%
Medicare Levy
A couples membership includes one Adult

member and Partner only. It does not include
dependents.
Accident
An accident is an unforeseen event, occurring
by chance and caused by an external force or
object which results in an injury to the body.
An accident as defined above and requiring
immediate medical treatment in hospital
within 24 hours of the accident. If further
hospital treatment (as an admitted patient)
is required, the patient must be re-admitted
to a hospital within 90 days of the initial
hospital treatment.
Admission
1.5% for everyone

Note: The thresholds increase annually, based on growth in Average Weekly Ordinary Time Earnings. Single
parents and couples (Including de facto couples) are subject to the family tiers. For families with children, the
thresholds are increased by $1,500 for each child after the first.
* This will be updated July each year.
Couples
AccessGap Cover is our Medical gap cover

arrangement, designed to minimise or
eliminate out-of-pocket expenses for medical
services when youre an inpatient in a
registered overnight hospital or day facility.
Accident - GoldVital Hospital
Applicable Private Health Insurance Rebate
1.0%
AccessGap Cover
The period of time during which a person

is admitted as an inpatient for a condition
or illness into an approved hospital/day
facility for the purpose of receiving hospital
treatment until the time they are discharged
from the hospital/day facility.
Annual limit
The maximum limit of benefits payable to a
member in a calendar year, commencing
1st January and ending 31st December.
A person dependent upon the primary

member. This includes:
Domestic partners, your own children,
stepchildren, legally adopted children to
whom the primary member is the legal
guardian (they must be under the age of 21,
unmarried and not in a de facto relationship,
nor the child of a dependant child).
Student dependants children,
stepchildren, legally adopted children and
children to whom the primary member is
the legal guardian, where the dependant is
under the age of 25 years, unmarried, not
in a de facto relationship and enrolled in a
full-time course of study at a recognised
educational institution.
Excess
The amount selected on a Hospital cover
which the primary member agrees to pay
before a benefit will be payable.
Excluded service
Services that are not covered by a benefit, so
all costs will be paid by you.
Approved service provider
Extras
A provider or service thats approved by HIF.

If youre unsure about the status of a hospital,
medical or extras provider, contact us on
1300 13 40 60. Unless stated, extras services
are not approved unless the health provider
and HIF member (patient) are both physically
present in the health providers registered
practice at the time of a consultation.
At HIF, we call ancillary cover Extras its

our name for all those day-to-day health care
services, such as dental, optical and physio,
plus a whole host more, including emergency
ambulance cover.
Basic benefit
When the benefit payable is equivalent to the
benefits available if the service was provided
in a shared room in a public hospital.
Benefit
The payment due to the primary member for
services received by an approved provider.
50
Dependant
Federal Government Rebate

The proportion of private health cover
premiums that the Government contributes
for permanent Australian residents.
HICAPS/ISOFT
Providers with HICAPS or ISOFT technology
can electronically claim your benefit directly
from HIF.
51
Inpatient
Policy holder
Primary member
A person who has been admitted into an

approved hospital or day facility, allocated a
bed and then discharged following treatment.
A holder of an insurance policy who is

referable to HIF. A holder of a HIF insurance
policy is referred to as the primary member.
Lifetime Health Cover Age
Practitioners in private practice
The age that each member of a health fund

is assigned when they first purchase Hospital
cover from a registered health fund. The
certified age at entry is based on a persons
actual age at the time of joining a hospital
fund table.
A practitioner who does not:
The first named member, irrespective of who

pays contributions to HIF for the provision
of health cover. The primary member also
holds the legal responsibility to ensure the
membership is kept financial at all times, and
holds the right to add or remove dependants
from the membership. In the instance that
the primary member wishes to provide
authority for another person to act on their
behalf, a spousal/agents authority is required.
Medicare Benefit Schedule (MBS)

The schedule of benefits produced by the
Department of Health and Aged Care, listing
eligible services, fees and benefits for Medical
Services, including inpatient services. The MBS
is used to calculate the 75% Medicare benefit
payable in respect to inpatient services.
Non-contracted hospital
A private hospital not contracted by the
Australian Health Services Alliance or HIF to
provide services to HIF members. Out-of-pocket
costs cannot be guaranteed in these hospitals
(basic default benefit applies).
Out-of-pocket
The amount remaining to be paid by the
member after the HIF and/or Medicare
benefits have been paid.
Outpatient
An outpatient is someone who has received
medical treatment in a doctors surgery
or casualty department and has not been
admitted into hospital. Benefits for outpatient
services are only payable by Medicare
Australia.
Partner
Means a person who lives with a Fund
Member of the same or different gender in
a marital or de facto relationship and who is
covered under the same Fund Membership
notwithstanding the Primary Fund Member
and a Partner may live apart temporarily.
52
a) Use any publicly funded hospital, clinic,

health centre or other such facility,
including a facility provided by a municipal
authority for, or in connection with, the
provision of an extras service for which a
benefit is claimed under the extras table
b) Receive publicly funded assistance or
support, whether by way of remuneration,
subsidy or otherwise, in connection with
the provision of the extras service, except
where the extras service is provided at the
clinics of strategic alliance partners, joint
ventures or HIFs clinics
Pre-existing condition
In accordance with HIFs Fund Rules and The
National Health Act, a pre-existing condition
is an ailment, illness or condition of which
the signs or symptoms, in the opinion of
a medical practitioner appointed by HIF,
existed at any time during the 6 months
ending on the day on which the member
commenced cover with HIF for:
1. Benefits in accordance with the applicable
benefits arrangement; or
2. If applicable, benefits in accordance with a
previous benefits arrangement.
In forming an opinion referred to above,
the medical practitioner appointed by
the organisation must have regard to any
information relating to the ailment, illness or
condition that was given to him or her by the
medical practitioner who treated the ailment,
illness or condition.
Qualifying periods
Any period occurring immediately after
joining the fund or joining a higher benefiting
table, during which either some or all fund
benefit is not payable.
Recognised educational institution
An Australian educational institution such
as a school, college or university, recognised
by the Commonwealth, State or Territory
Governments.
Restricted service
Hospital services which are only covered for
payments at the basic benefit level.
Transfer certificate
The document transferred between
registered health funds, detailing the
members fund history (including Certified
Age at Entry), confirmation of the financial
status of the member and claims history.
Waiting periods
The standard period which applies before a
member becomes eligible for benefit.
For more glossary terms, visit hif.com.au
This rule applies whether the ailment, illness or

condition was known to the member or not.
53
Follow us on
At HIF were all

about choice.
Call, email or contact us online.

hif.com.au

1300 13 40 60
info@hif.com.au

GPO Box X2221 Perth WA 6847
Australias first certified

Carbon Neutral health fund.
The information in this brochure is correct as at 1 February 2014. Minor changes may occur after that date. If major
changes occur, a separate insertion will be included in the brochure or the brochure will be reprinted. HIF members are
encouraged to regularly download the latest copy of this brochure from hif.com.au, or contact us and we will send
one to you.
Health Insurance Fund of Australia Ltd (HIF) ACN 128 302 161
An Australian public company limited by guarantee. A registered private health insurer.

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Our Product Disclosure Statement (PDS)

Your HIF Hospital and Extras health cover in detail.

Visit online to get a quote and join (or switch).

Australias first certified

About us and you

HIF Hospital Cover Options

About this PDS

About our Extras cover

Feedback, disputes and privacy

Frequently asked questions

Youll find lots of useful info about our

A bit about us, this PDS

HIF is always reviewing and improving its

About Australian private

These laws include directions about

Want more information?

HIF Hospital Cover Options

Restrictions and exclusions

Cover for in-hospital procedures

Services not covered by Medicare*

Services not covered by Medicare*

Assisted reproductive technology

Gastric banding and obesity surgery

Cardiac (heart) conditions, procedures

Gastric banding and obesity surgery

Services not covered by Medicare*

Some restrictions and exclusions may apply.

Gastric banding &

Assisted reproductive technology

Things you need to know about

The Pre-existing Condition Rule

Workers Compensation and

Transferring and upgrading

AccessGap for in-patient medical services

Current HIF members who transfer

No other benefits are payable for

Any benefits paid by your previous

Hospital waiting periods

As an entry-level option, GoldVital provides

Benefits for the following services will

Assisted reproductive technology (eg IVF)

Psychiatric care or attention

Services not listed as include are excluded.

Full AccessGap Cover for inpatient

Description of charges and benefits

Full cover in a shared or private room

Full cover in a shared or private room

Charges are not raised for this service

Full cover for theatre charges

Pharmaceutical drugs (does

Charges are not raised for this service

Charges vary between hospitals depending on

Prostheses and consumables

Benefits will be paid towards prostheses in

Benefits will be paid towards prostheses in

Theatre Fees charges

Outpatient theatre fees

Full cover for outpatient theatre fees

All hospitals and

Admitted patients are entitled to the difference

GoldVital - $500 per person in a calendar year to a

This page has been left blank intentionally

Benefits are not payable for any charges

Services not covered by Medicare*

Services not covered by Medicare*

Assisted reproductive technology

Gastric banding and obesity surgery

Cardiac (heart) conditions, procedures

Gastric banding and obesity surgery

Services not covered by Medicare*

Assisted reproductive technology

Current HIF members who transfer

Any benefits paid by your previous

Assisted reproductive technology (eg IVF)

Services not listed as include are excluded.

Full AccessGap Cover for inpatient

Cardio (e.g. conditions of the heart

Full AccessGap Cover for inpatient

Full cover for the cost of a shared

Eye surgery (any procedure on the surface

Eye surgery (any procedure on the surface

Full AccessGap cover for inpatient medical

Cardio (e.g. conditions of the heart

Private room for up to 3 days for

Full cover for the cost of a shared room,