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Despite the financial assistance offered by Medicare, private health cover is an essential consideration for all Australians. It helps cover the cost of a wide range of health care services and general treatments, while at the same time giving you much more freedom of choice when it comes to treatment options. ACA Health Benefits Fund is a not-for-profit fund for employees and families of the Seventh-day Adventist Church. It covers more than 11,000 people and pays out $17 million of benefits each year. If you qualify for membership and are looking for private health cover, consider the hospital and extras cover options available from ACA Health Benefits Fund.
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Who can join ACA?
Membership of ACA Health Benefits Fund is open to the following people:
- Current and past employees of the Seventh-day Adventist Church in Australia (including any of its institutions such as the Sydney Adventist Hospital, Adventist Retirement Villages and Adventist Schools)
- The spouse, partner, dependent, sibling, parent or grandchild of an eligible person mentioned above
- Past members of the ACA Health Benefits Fund.
To join, all you have to do is download an application form from the health fund website, fill it out and then submit it via email or post. A Member Service Representative will then contact you when processing your application to discuss your health cover needs. Joining a private health fund offers many benefits, including private hospital accommodation and treatment, your choice of doctor or specialist, cover for the Medical Gap and cover for a wide range of general treatments. There are also financial benefits to be had by gaining the Australian Government Rebate and avoiding a Lifetime Health Cover premium loading and a Medicare Levy Surcharge.
What is covered?
ACA fund members can choose to take out standalone hospital or extras cover, or to combine the two forms of cover in a packaged policy. Available hospital cover options include:
- Basic Hospital. Cover for the basics. With this policy, you'll get a shared room in a public hospital and private treatment in a public hospital, and get covered for specialist doctor, anaesthetist, pathology and radiology fees.
- Bronze Essentials Hospital. With Bronze Essentials, you'll get cover for all Bronze level cover, such as lung and chest, blood, back, neck and spine and more.
- Gold Private Hospital. Comprehensive cover that includes all 38 clinical categories required for gold. You need to pay a co-payment out of your own pocket if you need to go to hospital.
- Gold Deluxe Hospital.This is the same as Gold Private Hospital but there is no co-payment. As a result, it'll likely cost a little more than Gold Private Hospital.
General treatment cover options available through the ACA Health Benefits Fund include:
This is the fund’s comprehensive extras cover option, providing cover for an extensive range of ancillary treatments and covers:
- Ambulance transport
- Glasses and contact lenses
- Natural therapies
- Occupational therapy
- Hearing aids
- Midwife services.
This extras option is more affordable but does not offer a broad a range of benefits or as generous benefit limits as Complete Ancillary Cover. However, it does cover treatments such as ambulance transport, general dental, glasses and contact lenses, physiotherapy, remedial massage and more.
What is not covered by ACA?
Your ACA Health Benefits Fund claim will not be paid if:
- It is for a surgeon’s fees for podiatric surgery
- Hospital accommodation for nursing home type patients
- Services for which Medicare does not pay a benefit, such as for cosmetic surgery
- Your membership is in arrears
- It is for a service rendered before you had sat out a specified waiting period
- It is for service you receive as an outpatient, for example in a hospital’s emergency department
- It is for a service which you are entitled to claim the cost of under compensation insurance
- It is for services received more than two years prior to your claim
- It is for services provided in countries outside Australia
- It is for ambulance charges when it is not medically necessary for you to be transported in an ambulance
- Your hospital requests an ambulance transfer because it does not have the medical facilities to treat you.
How much will it cost you?
A wide range of factors can influence the cost of your ACA Health Benefits Fund health insurance premiums, including:
- The level of cover you choose
- Whether you choose standalone cover or combined cover
- Whether you take out a single or family policy
- Whether you elect to pay your premiums weekly, monthly or yearly
- When you take out cover, as you may have to pay a premium loading under the Lifetime Health Cover Scheme
- How much you earn, as this influences your eligibility for the Medicare Levy Surcharge.
ACA Health Benefits Fund premiums can be paid via direct debit, credit card, payroll deduction, by mail or in person at the ACA Health Office.
How do I make a claim with ACA
ACA aims to make the claims process as quick and easy as possible. Many general treatment claims can be processed on the spot at the provider using electronic claiming, all you have to do is swipe your membership card. Where electronic claiming is not available, fill out an ACA Health claim form and submit it, along with the relevant receipt or invoice, to ACA via mail. For hospital claims, the hospital will request your private health insurance details whenever you are admitted. You can simply present your membership card and everything else will be taken care of. When you need to make a medical claim (for doctors’ charges and tests as an inpatient), providers that participate in the Access Gap Cover scheme will typically bill the health fund directly. When you visit a provider that does not participate in Access Gap Cover you will need to first claim your reimbursement from Medicare and then fill out a claim form to claim the remaining gap from ACA Health. You can also submit a claim online by logging in to your account or via the ACA Health Claiming app. You can download the app from the Apple Store or Google Play Store.
Got questions about ACA?
Question. Can I claim benefits as soon as I join?
- A. If this is the first time you have joined a health fund, you will have to serve the relevant waiting periods (detailed in your policy schedule) before you can make a claim. If you transfer to ACA Health from another fund you will immediately be able to make a claim up to the same level of benefits you had in your previous fund.
Question. Can I claim the cost of a visit to my GP?
- A. No. Health funds in Australia are not allowed to cover the cost of outpatient services.
Question. Does the ACA Health Benefits fund cover treatment in any hospital?
- A. Yes, the fund provides cover for treatment you receive in any Australian hospital. However, if you visit a hospital that is not contracted with the fund through the Australian Health Service Alliance, the fund cannot guarantee to cover 100% of your costs.
Question. How long do I have to lodge my claim?
- A. The maximum time limit on when you can make a claim is up to two years after you receive services.
Question. For how long are my children covered under my ACA Health Benefits Fund membership?
- A. If you have a family ACA membership, your children are covered as dependents until they reach 21 years of age. Once your children reach 21, they can be covered on your policy up to the age of 25 if they are a full-time student, unmarried and earning less than the tax-free threshold.
Question. Does the ACA Health Benefits Fund offer a loyalty benefit?
- A. ACA Health Benefits Fund members who hold some form of general treatment cover can take advantage of the fund’s partnership with the Luxottica Group to offer optical discounts. With discounts available at OPSM and Specsavers, members can enjoy savings on glasses, frames and lenses.
Compare health insurance policies today
If you’re eligible to become a member of the ACA Health Benefits Fund, take some time to consider the range of features and services it offers to applicants. It’s also a good idea to compare these benefits with those of other health funds before choosing the right private health cover option for your individual needs.
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