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ACA Health

ACA is a restricted health fund for staff of the Seventh Day Adventist church and their families. Its hospital coverage puts up some good numbers, but it's not for everyone.

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Pros

  • ACA is the equal best fund for hospital related charges covered, tied only with HBF.
  • It's also tied second place for the percentage of hospital services available with no gap. It's tied with HBF, and second only to RT health Fund, another restricted fund.

Cons

  • As a restricted health fund, not everyone is eligible to join ACA. Membership is only open to current and past staff of the Seventh Day Adventist church.

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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:

Hospital cover

  • 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:

Complete Ancillary

This is the fund’s comprehensive extras cover option, providing cover for an extensive range of ancillary treatments and covers:

  • Ambulance transport
  • Dental
  • Orthodontics
  • Glasses and contact lenses
  • Physiotherapy
  • Natural therapies
  • Pharmacy
  • Chiropractic
  • Occupational therapy
  • Acupuncture
  • Dietetics
  • Hearing aids
  • Midwife services.

Ancillary Lite

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.

Frequently asked questions

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Tim Bennett is a Finder insurance & utilities expert. For over 10 years he's reported on news, politics, finance and other topics as a journalist and radio presenter. Tim's roles have included radio news reader and breakfast at the ABC, news producer for SBS and producer for Fairfax Media. Tim regularly appears as a health insurance expert on programs like Sunrise and SBS news, as well as in the Australian, The Daily Telegraph, The Courier Mail and more. See full bio

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