Health Care Insurance

Health Care Insurance not-for-profit health fund review and comparison

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 cover is a must. From cover for hospital admissions and procedures to cover for the cost of optical, dental and many more general treatments, private health insurance offers a huge range of benefits to health fund members. does not currently have access to this health insurance brand. You may wish to compare options available on the health insurance homepage.

Health Care Insurance options

Health Care Insurance is a not-for-profit fund that is run to benefit its members. In addition to value for money cover, it prides itself on offering a high level of personalised service to 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.

How do I sign up?

If you’d like to join Health Care Insurance you can do so quickly and easily online. You’ll 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)

Health Care Insurance levels of cover

Health Care Insurance Premier hospital cover allows you to receive treatment in a private hospital or as a private patient in a public hospital, and it doesn’t exclude or restrict any treatments that are clinically necessary and also eligible for a Medicare benefit.

This means it covers your accommodation, intensive care, treatment in critical or high dependency care units, operating theatre costs, doctor’s services, physiotherapy, surgically implanted prostheses and more. Because Health Care Insurance has agreements in place with more than 500 private hospitals and day surgeries around the country, you have plenty of choice when it comes to treatment.

Finally, Hospital Cover is available with four choices of excess: Nil, $250, $500 or $1,000 per adult.

For those members who want extras cover, Health Care Insurance offers two levels of cover:

  • Premier Extras. Providing comprehensive cover for a long list of services, this is the highest level of extras cover available from Health Care Insurance. It includes benefits for acupuncture, ambulance, audiology, chiropractic, general and major dental, diabetes education, dietetics, eye therapy, hearing aids, home nursing, laser eye surgery, natural therapies, optical, occupational therapy, orthodontics, osteopathy, pharmacy, physio, psychology, speech therapy and more.
  • Active Life Extras. For those not looking to bank there's Active Life Extras, which includes cover for acupuncture, chiro, general and major dental (excluding dentures and orthodontic), natural therapies, optical, osteopathy and physio.

Finally, if you want a broad range of benefits offered by combined hospital and extras cover, consider the following policy options:

  • Premier Package. This package combines Health Care Insurance’s Hospital Cover policy with Premier Extras Cover.
  • Active Life with Premier Hospital. For a lower level of cover, this policy combines Premier Hospital with Active Life Extras.

General exclusions, waiting periods and excesses

There are certain situations and treatments for which Health Care Insurance will not pay a benefit. These include:

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

What are the waiting periods like?

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

With Health Care Insurance, a two-month waiting period applies to the majority of hospital and extras benefits. However, there are certain services which will require you to serve longer waiting periods, including:

  • General dental: 6 months
  • Major dental: 12 months
  • Hearing aids: 24 months
  • Laser eye surgery: 12 months
  • Non-surgical prostheses: 12 months
  • Optical: 6 months
  • Treatment for pre-existing conditions: 12 months
  • Obstetrics: 12 months
  • IVF and assisted reproductive services: 12 months

Health Care Insurance Excess

Health Care Insurance Hospital Cover requires 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:

  • Nil
  • $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 make a claim

There are several options available when you need to make a Health Care Insurance extras claim. Many providers will offer electronic claiming through the HICAPS claiming system, all you have to do to receive your benefits is swipe your membership card at the relevant terminal. If this option is not available you can submit a completed claim form (forms are available for download from the Health Care Insurance website) to the health fund via email, post or fax. You can also drop off a form in person to the fund’s Burnie office.

When it comes to hospital claims, your hospital should forward the details of your claim directly to the health fund. If you receive a bill from your doctor for medical treatment you received in hospital, you’ll need to first lodge your claim with Medicare before submitting it to Health Care Insurance.

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Frequently asked questions about Health Care Insurance

Q. Who else can be included in my cover?

  • A. You can also include your spouse or defacto partner, your unmarried children under 23 years of age, your student dependents (aged 23-25, a full-time student and financially dependent on you) and unmarried children aged from 23-25 on your Health Care Insurance policy (conditions apply).

Q. What happens if I want to upgrade my level of cover?

  • A. 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 your new, higher level of benefits.

Q. How will my benefits be paid?

  • A. Aside from electronic claiming which gives you instant access to your benefits, Health Care Insurance pays benefits to its members in two ways: direct credit or cheque.

Q. Will Health Care Insurance cover me when I’m overseas?

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

Q. So how can I receive medical cover when I’m on an overseas holiday?

  • A. Experts strongly recommend that you take out travel insurance when you travel abroad. This 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.

Q. Can I suspend my cover for a limited period of time?

  • A. Yes, it’s possible to apply to have your membership temporarily suspended for the following reasons: if you are travelling overseas or if you are experiencing financial hardship (conditions apply).

Q. Does Health Care Insurance have a list of recognised and approved providers?

  • A. Yes, and you can call Health Care Insurance on 1800 804 950 to check on a provider’s approved status.
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