Health Care Insurance

Health Care Insurance

Health Care Insurance offers hospital and extras cover to suit any need or budget. Compare its policies online and receive a quote.

Health Care Insurance (HCI) has been looking after the health cover needs of Australians since 1938. With an aim of providing quality cover and value for money, Health Care Insurance is wholly owned by its members.

Private health insurance is all about peace of mind and Health Care Insurance offers cover options for singles, couples, families and single parents. You can choose from Hospital Cover, two levels of extras cover, and one combined package to suit different budgets and cover requirements.

Compare Health Care Insurance's policy range

Full list of services covered by Health Care Insurance policies

Health Care Insurance offers three types of health insurance policies:

  • Hospital cover. For treatments and procedures that require admittance to hospital.
  • Extras cover. For out of hospital services such as dental and optical.
  • Combined cover. A mix of both hospital and extras cover.

Select the type of policy you are interested in to get a more detailed look at what each Health Care Insurance product offers.

Policy titlePolicy features
  • Premier Hospital
  • Treatment in a private hospital or as a private patient in a public hospital
  • Hospital and theatre fees
  • Maternity services and infertility treatments
  • Cost of hospital pharmacy prescriptions
  • Surgically implanted prostheses
  • Surgical tooth extraction
  • Any other treatment that is clinically necessary and is eligible for a Medicare benefit
  • Option to choose an excess of $0, $250, $500 or $1,000 per adult
  • Includes Access Gap Cover to reduce out-of-pocket expenses
Policy titleTreatments and services covered
  • Premier Extras
    • Acupuncture
    • Ambulance transport
    • Audiology
    • Chiropractic, physiotherapy and osteopathy
    • General dental, major dental and orthodontics
    • Diabetes education
    • Diabetes Australia Membership
    • Dietetics
    • Funeral
  • Health screening checks
  • Home nursing
  • Hydrotherapy
  • Laser eye surgery
  • Medical appliances and hearing aids
  • Natural therapy 
  • Non-surgical prostheses
  • Occupational therapy
  • Optical
  • Orthotics
  • Pharmacy
  • Podiatry and chiropody
  • Psychology
  • Weight loss and quit smoking programs
  • Speech therapy
  • Surgical footwear
  • Travel and accommodation 
  • Active Life Extras
  • Acupuncture
  • Chiropractic, physiotherapy and osteopathy
  • General dental and major dental
  • Natural therapy 
  • Optical
Policy titlePolicy features
  • Premier Package
  • Provides all the cover benefits of Health Care Insurance's top hospital and comprehensive extras policies.
  • Premier Hospital with Active Life Extras
  • A more affordable combined policy which includes Health Care Insurance's top hospital policy and Active Life Extras.

Are there any excluded treatments or services?

Health Care Insurance will not pay a benefit in the even that:

  • Your claim is for cosmetic surgery.
  • Your claim is for treatment received outside of Australia.
  • Your claim is for services that are not included in the agreement between Health Care Insurance and your hospital.
  • Your claim is for personal expenses you incur in hospital, for example phone calls and TV rental.
  • Your claim is for a hospital service that is not eligible for Medicare benefits.
  • Your claim is for pharmaceutical items supplied or prescribed on discharge.
  • Your claim is for services received more than two years previously.

What are the waiting periods on claims?

When you join a health fund for the first time you should also consider the waiting periods that apply to your cover. These are the periods of time you must wait after joining before you can receive any benefits, and they are in place to stop people simply jumping in and out of health funds when it suits them.

Health Care Insurance applies a standard two month waiting period to the majority of hospital and extras benefits. However, for certain services you are required to wait longer.

ServiceIncluded in which policy type?Waiting period
Treatment for pre-existing conditionsHospital cover
  • 12 months
ObstetricsHospital cover
  • 12 months
IVF and assisted reproductive servicesHospital cover
  • 12 months
General dentalExtras cover
  • 6 months
Major dentalExtras cover
  • 12 months
Hearing aidsExtras cover
  • 24 months
Laser eye surgeryExtras cover
  • 12 months
Non-surgical prosthesesExtras cover
  • 12 months
OpticalExtras cover
  • 6 months

Does Health Care Insurance offer any excess options?

Health Care Insurance's hospital policy allows you to contribute an excess when you go to hospital, which is effectively your way of contributing to the cost of your accommodation and treatment. This policy is available with four excess options:

  • $0
  • $250 per adult and $500 per policy
  • $500 per adult and $1,000 per policy
  • $1,000 per adult and $2,000 per policy

The larger the excess you choose, the lower your premium payments will be. You should also note that the excess per adult is only payable once every calendar year, while there is no excess required for day surgery. Finally, you will not have to pay an excess when a dependent child under 18 years of age is admitted to hospital.

How do I lodge a claim with Health Care Insurance?

There are several options available when you need to claim a benefit from Health Care Insurance. These include:

  • HICAPS claiming system. Many funds will offer electronic claiming through HICAPS. To receive your benefits just swipe your membership card at the relevant terminal.
  • Smartphone. You can submit your claim via mobile using the Health Care Insurance app. It is available on both iOS and Android and can be downloaded below.
  • Email, fax or post. Submit a completed claim form (which are available for download from the Health Care Insurance website) to the health fund via email, post or fax.
  • In person. If you are a resident of Burnie in Tasmania you can drop off a form in person at Health Care Insurance's head office.
  • Hospital claims. Your hospital should forward the details of your claim directly to the Health Care Insurance. If you receive a bill from your doctor for medical treatment you received in hospital, you’ll need to lodge your claim with Medicare first before submitting it to Health Care Insurance.

Download the Health Care Insurance app

AppAndroidiOS
Health Care Insurance
Google-play
Apple-app-store

How do I become a member?

If you would like to join Health Care Insurance you can do so quickly and easily online. You will need to provide the following details when filling out a membership application form:

  • The details of everyone who will be covered.
  • Your bank account or credit card details.
  • Information concerning your previous health fund (if applicable).

Further information about this health fund

You can include your spouse or de facto partner, your unmarried children under 23 years of age, your student dependents (aged 23-25 who is a full-time student and financially dependent on you) and unmarried children aged from 23-25 (conditions apply).

You can upgrade your level of Health Care Insurance cover at any time. However, keep in mind that waiting periods will apply before you are eligible to receive benefits for new services or for services that now have a higher level of cover.

Aside from electronic claiming which gives you instant access to your benefits, Health Care Insurance pays benefits to its members either by direct credit or cheque.

No, Australian private health funds are unable to offer cover for services, treatments or medical appliances that you receive or purchase overseas.

You can get cover for medical expenses while overseas by taking out travel insurance, and it is strongly recommended that you do so. Travel insurance covers a wide range of costs including overseas medical expenses, lost or stolen luggage, cancellation fees and more. Health Care Insurance has also negotiated a range of travel insurance package deals for its members with QBE Insurance.

Yes, it is possible to apply to have your membership temporarily suspended if you are planning to travel overseas or if you are experiencing financial hardship (conditions apply).

Yes they do. You can call Health Care Insurance on 1800 804 950 to check on a funds approved status.

Compare policies and obtain a quote from Health Care Insurance

Was this content helpful to you? No  Yes

Related Posts

Compare health insurance on finder.com.au

Ask an Expert

You are about to post a question on finder.com.au:

  • Do not enter personal information (eg. surname, phone number, bank details) as your question will be made public
  • finder.com.au is a financial comparison and information service, not a bank or product provider
  • We cannot provide you with personal advice or recommendations
  • Your answer might already be waiting – check previous questions below to see if yours has already been asked

Finder only provides general advice and factual information, so consider your own circumstances, read the PDS or seek advice before you decide to act on our content. By submitting a question, you're accepting our Terms and Conditions and Privacy Policy.
Ask a question
feedback