Overview

Established in 1938, Health Care Insurance Limited (HCI) is a non-profit fund owned entirely by its membership base of over 10,000 Australians.

HCI started out as a regional health fund in Tasmania and has since expanded across the nation, but still prioritise investing back into their local communities.

Key features

• Dental network partnership with smile.com.au.
• Partnership with Best Doctors for members to seek second medical opinions.
• Free access to the Nourish Baby program.

Hospital cover

Nobody chooses to go to hospital. But when you do, appropriate hospital cover will help you get the treatment you need, where and when you want it. It also helps to pay the bills, as fees for hospital rooms and specialists can add up.

Think about what services you’re likely to need, in line with your budget. If you earn over $90,000 individually or $180,000 as a couple, you could avoid paying the Medicare Levy Surcharge.

HCI offers three straightforward hospital policies: bronze, silver and gold.

All hospital policies include:

• Up to 100% of hospital accommodation costs and theatre fees in all contracted hospitals and day surgery facilities for covered services.
• Private room accommodation, if available.
• Up to 100% of the cost of most hospital prescriptions relating to the admission, subject to hospital agreements.
• Dental theatre costs for surgical tooth extraction.
• 100% of the cost of the difference between the Medicare refund and the Commonwealth Medical Benefit Scheme (CMBS) fee for medical services provided during a hospital admission.
• Access Gap scheme that covers up to 100% of the cost of medical services provided during a hospital admission where the doctor charges above the CMBS fee.

Bronze Hospital

HCI’s cheapest level of cover provides peace of mind across a wide range of areas at an affordable price. Comes with $750 excess.

Key inclusions:

• Chemotherapy, radiotherapy and immunotherapy
• Gynaecology
• Joint reconstructions
• Kidney and bladder

Silver Plus Hospital

HCI’s mid-tier hospital policy features some significant inclusions for people looking for a wider range of cover, although it doesn’t include pregnancy-related items or insulin pumps.

Key inclusions:

• Heart and vascular system
• Lung and chest
• Back neck and spine
• Dental surgery

Gold

HCI’s top tier Gold cover includes everything standard in a policy, as well as access to the Nourish Baby program for parents-to-be.

Key inclusions:

• Pregnancy and birth
• Assisted reproductive services
• Weight loss surgery
• Insulin pumps

Ambulance cover

Unusually for a health insurer, you’ll need to take out the Healthy Extras or Premier Extras package to receive ambulance cover, and there’s a two month waiting period. If you’re a Tasmanian or Queensland resident, your state covers the cost of ambulance trips. Read our guide for more information.

Extras cover

Extras
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From dental, to optical, to chiro and more, extras insurance helps cover the bills for routine treatments with rebates of up to 100%.

While we’ve summarised the key points of each plan below, it’s always worth digging a little deeper into any gap fees, how much you can claim back, and whether your preferred healthcare provider, such as your local dentist, is recognised by the health fund.

Take the time to work out what you need and what you’re prepared to pay. If this feels a bit overwhelming, you can speak to one of our experts.

HCI offers three straightforward extra plans, which we’ve detailed below.

Waiting periods

Waiting periods are there to stop people from signing up, claiming and then cancelling their cover. It means once you take out a new plan, you may have to wait a certain amount of time before receiving your benefit.

When you switch to HCI from another provider, you won’t have to re-serve your waiting periods, unless your new policy covers something you didn’t have before or has improved annual extras benefits and/or limits.

Member benefits

HCI partners with Best Doctors, giving all HCI members access to a second opinion from the world’s leading medical specialists. It’s a confidential service which complements the care your own doctor is providing.

HCI also has a partnership with smile.com.au. You can receive 15%-40% off dental treatments from a smile.com.au approved provider – on top of your usual extras benefit.

There’s also a Nourish Baby program for parents-to-be and new parents, including a sleep helpline for mums and dads who struggle to get their bub sleeping properly.

How to claim

Hospital
Simply tell the hospital you are a member of a HCI policy. Your hospital account will be sent directly to HCI for them to assess on your behalf.

Extras
You can swipe your membership card to claim directly on the spot with your provider’s HICAPS or iSOFT terminal.

You can also receive a copy of the invoice and claim through the HCI Claiming App, or fill out the claim form and send it via email or post. In most cases, claims are processed on the same day they are received.

Hospital agreements

HCI has agreements with most hospital and day surgery providers across Australia. When comparing policies, it’s worth checking if your preferred local hospitals and clinics are covered.

Customer service

From 1 January to 31 March 2020, the Private Health Insurance received just one complaint from an HCI member. HCI has a market share of 0.1%.
Source: Private Health Ombudsman

FAQs