HBF Private Health Insurance Review
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If you’re considering HBF private health insurance, but unsure what services and benefits you can expect, this article will help you decide whether the health fund meets your requirements.
HBF Health Insurance is one of Australia’s largest not-for-profit health funds. The fund is owned by its members, meaning any profits made from premiums received gets re-invested back into new or improved benefits for you. HBF serves more than a million members across Australia with Hospital and Extras policies you can mix and match to suit your lifestyle and budget.
About the Hospital Benefit Fund (HBF)
The not-for-profit health fund was founded in 1941 and is today Western Australia leading health insurer. With over 75 years’ experience, HBF offers a variety of health insurance products, from basic budget plans to comprehensive protection.
According to the funds 2019 Annual report, they returned 90 cents to their members as benefits, for every dollar they received in premiums.
Recent HBF health insurance changes
HBF has implemented the below Australian Government reforms:
- Standardised hospital categories: HBF has grouped all their private Hospital cover plans into four tiers: Gold, Silver, Bronze and Basic, each including a set number of clinical categories.
- Selected natural therapies are removed from Extras cover: HBF will no longer provide benefits for specific natural therapies, including aromatherapy, pilates, yoga, naturopathy and reflexology.
- Increased maximum Hospital excess levels: You can now choose an excess amount that meets your budget. The health fund offers you the choice of $250, $500 or $750 for singles and $1,000 to $1,500 for couples — generally, the higher your agreed excess, the lower your premium.
- Discounts for young Australians: Health funds may offer 18 to 29-year-olds up to 10% off their Hospital cover. However, HBF has chosen not to implement this discount.
- Travel and accommodation benefits for rural members: HBF is still deciding whether they’ll implement this change. HBF Hospital policies, however, cover the cost of accommodation and meals for loved ones staying with you, while you recover in hospital.
- Upgrading Mental Health cover: If your HBF in-hospital mental health treatment is not fully covered by your policy, you can now upgrade to a higher tier without serving a waiting period.
What does HBF health cover?
HBF’s health insurance offers five Hospital Cover options; Basic, Bronze, Silver, Silver Plus and Gold. You also have the choice of 5 Extras options, varying from the affordable basic to the comprehensive option that includes a broad list of benefits with higher limits. You can mix and match Hospital cover with Extras and create a package that suits your requirements.
HBF Hospital cover
Hospital insurance provides benefits for in-hospital services as a private patient in a public or private hospital, generally covering the cost of accommodation and theatre fees. Contributions paid towards the costs of your hospital stay varies according to your chosen cover option: Basic, Bronze, Silver or Gold.
HBF has an extensive network of Member Plus Hospitals across Australia, which may minimise your out-of-pocket costs.
Important: Even when opting for a Member Plus Hospital, you may still need to pay an excess or a co-payment according to your policy option. You can generally select an excess of $250, $500 and $750 for a single policy.
Basic Hospital Plus
This Basic Hospital Plus plan is a low-cost Hospital option covering a few essential services, including accidents. If you’re on a tight budget and considering Hospital cover, this might be a good starting option, especially as it typically includes some additional clinical categories not required by the Australian Government.
- Private room at a Member Plus Hospital
- Unlimited urgent ambulance by road.
- Accident related services
- Dental Surgery
- Knee and Shoulder Reconstructions
- Tonsils, adenoids and grommets
- Joint reconstructions
- Hernia and appendix
- Gynaecology treatments
Restricted benefits for Rehabilitation, Hospital psychiatric services and Palliative care
Excludes air ambulance and 30 other clinical categories, such as heart and vascular system, joint replacement and back, neck and spine.
Bronze Hospital Plus
For a slightly higher premium, the Bronze Hospital Plus is still a budget-friendly option, possibly suited to a young couple that doesn't want children yet. This Hospital cover option generally covers a more extensive selection of 26 clinical categories. It includes everything in the Basic Plus Option, with the following additional benefits:
- Full coverage for palliative care
- Brain and nervous system
- Eyes (not cataracts)
- Ear, nose and throat
- Bone, joint and muscle
- Kidney and bladder
- Male reproductive system
- Digestive system
- Gastrointestinal endoscopy
- Miscarriage and termination of pregnancy
- Chemotherapy, radiotherapy and immunotherapy for cancer
- Medically necessary breast surgery
- Diabetes management, insulin pumps excluded
- Lung and chest
- Blood work
- Back, neck and spine treatments
- Medically necessary plastic and reconstructive surgery
- Pain management device
- Sleep studies
Restricted coverage for Hospital psychiatric services and Rehabilitation. The Bronze Plus option excludes cover for 10 clinical categories, including joint replacement, insulin pumps and weight loss surgery.
A step up from the Bronze Hospital Plus, this option includes cover for 30 clinical categories. It covers all the services listed under the Bronze Hospital Plus plan, as well as the following:
- Heart and vascular
- Podiatric surgery performed by a registered podiatric surgeon
- Implantation of hearing devices
- Insulin pumps
- Unrestricted palliative care
Hospital psychiatric services and rehabilitation are restricted, and 6 clinic categories are excluded, such as cataracts, joint replacements and dialysis of chronic kidney failure.
Silver Hospital Plus
The Silver Hospital Plus cover option is similar to the Silver Hospital policy, but also covers:
- Joint replacements
- Treatment of cataracts
- Full rehabilitation care
Hospital psychiatric services are restricted, and cover is not provided for pregnancy and birth-related services, assisted reproductive services, dialysis of chronic kidney failure and weight loss surgery.
The Gold Hospital Cover is a top Hospital option, covering all 38 clinical categories, and is usually ideal for those wanting to start or grow their family. The Gold Hospital plan includes all the benefits of the Silver Hospital Plus plan, as well as:
- Pregnancy and birth-related services
- Assisted reproductive services
- Weight loss surgery
- Full coverage for hospital psychiatric services
- Dialysis of chronic kidney failure
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Extras insurance covers you for general treatments and services received outside of the hospital, for example, dental, physio and optical. With HBF, you can choose between Basic, Saver Flexi, Standard, Flexi and Top Extras. Taking out Extras to suit your lifestyle, will generally help prevent significant out-of-pocket expenses.
All HBF Extras options usually have no annual limit on preventative dental, unlimited urgent ambulance by road assistance, flu vaccinations and health checks at selected pharmacies, as well as providing you with a pair of glasses annually.
This is an entry-level, low-cost policy typically covering your basics such as general dental, optical and five other common services. The Basic Extras also includes:
- General dental
- Physiotherapy, Chiropractic and Osteopathy with a combined limit
- Urgent ambulance
- Healthy living programs
Saver Flexi Extras
Saver Flexi Extras covers you for two essential services, as well as two more general treatments of your choice. You can typically choose from the following treatments: major dental, optical, physio, chiro, osteo, healthy living programs, non-PBS pharmaceuticals, podiatry and remedial massage.
- Preventative and restorative general dental
- Urgent ambulance
- Two more services of your choice
Standard Extras covers 19 common services, including:
- General Dental (sub-limits apply)
- Major dental combined with endodontic cover (sub-limits apply)
- Optical (sub-limits apply)
- Flu vaccination and health checks at selected pharmacies.
- Chiropractic and osteopathy combined (sub-limits apply)
- Non-PBS pharmaceuticals
- Optical (sub-limits apply)
- Clinical psychology
- Hearing aids
- Blood glucose monitors
- Occupational therapy combined with Eye therapy and speech therapy
- Health management Optical
Excludes benefits for acupuncture, and remedial massage.
Flexi Extras gives you great flexibility by providing you the choice of 10 general treatments and services. Unlimited urgent ambulance by road usually only applies here if selected as an Extras option.
The Top Extra is HBF’s highest level of Extras cover. This option covers a full range of treatments, including all the benefits listed in the Standard Extras option, plus:
- General psychology
- Remedial massage
- Chinese medicine
- Exercise physiology
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Depending on the level of cover you choose, HBF Health Fund generally covers emergency road transport to any destination within Australia, when provided by a recognised state-based ambulance organisation or approved HBF provider.
You will typically be covered for emergency treatment and urgent ambulance transport by road within Australia. 'Urgent ambulance', usually refers to those circumstances where you may need immediate attention, including instances where may need treatment in the emergency department. Generally, 'urgent' also refers to on-site attendance, not requiring transportation.
Those who have concession cards may have a subsidised ambulance service depending on the state they live in.
Urgent Ambulance is not available for sale to QLD or TAS residents as their state-based schemes cover residents.
Waiting periods for Hospital and Extras
- Rehabilitation: 2 months
- Palliative care: 2 months
- Hospital psychiatric care: 2 months
- Pre-existing conditions: 12 months
- Pregnancy and birth services: 12 months
- Accident cover: 1 day
- Psychology: 2 months
- Foot orthoses: 12 months
- Major dental: 12 months.
- Orthodontics: 12 months
- Hearing aids and appliances: 12 to 36 months
- All other services: 2 months
How to make a claim?
After a Hospital procedure, the hospital will generally submit your expense statement directly to the HBF Health Insurer. You may be charged for any out-of-pocket expenses before you leave.
If your treatment is with an Extras HBF preferred provider, a dentist, optometrist or physio, for example, you will generally be able to claim on-the-spot through HICAPS.
HBF Health Insurance usually also offers access to alternative claiming methods such as through the myHBF online portal and the HBF Health app. Alternatively, you can visit your nearest HBF branch or claim via email.
Frequently asked questions and answers
Visit the HBF website, select the cover you're interested in and apply or switch online. Alternatively, you can call them directly, send an email request, visit a branch or book an appointment.
Yes, HBF offers Momentum Member Benefits, affording members discounts on essential lifestyle choices. For example, a 1-month free gym membership at HIF Arena, 15% off running gear online and 5% off PSM lens and lens extras.
HBF offers a large network of HBF preferred providers, including dental, optical, pharmacy and Hospital providers. These are Member Plus HBF providers that have entered into an agreement with HBF to minimise out-of-pocket expenses associated with treatment. Visit the fund's website and search for selected providers in your region.
HBF Member Plus Hospitals strive to offer members value for money. HBF member benefits usually cover accommodation and theatre fees for all agreed services, less any co-payment or excess payable.
Contact HBF Health insurance via their website's email address form or directly on 133 423.
HBF was established in 1941, as the Metropolitan Hospital Benefit Fund of Western Australia, with the core purpose of providing affordable health services to Western Australians.
HBF health members can save up to 10% at the HBF Stadium on when on a gym membership. Members may also receive 5% off on casual entry to group fitness classes, pools and the creche.
Yes, HBF has branches all over Australia. As of July 2019, the majority of members (878,492) are situated in WA, 39,072 live in NSW and 36,480 in VIC. There are over 29,000 members across NT, SA, QLD, ACT and TAS (HBF 2019 annual report).
Yes. If the student's country has a Reciprocal Health Care Agreement with Australia, the student can usually request coverage from HBF. Alternatively, HBF provides health insurance for overseas visitors and those on working visas.
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