HCF Health Insurance Review
HCF is Australia’s largest not-for-profit health fund, providing health insurance to more than 1.5 million members. HCF re-invests the premiums you pay them back into the company. Their vision is to make private health insurance understandable, affordable and customer-centric.
The health fund operates in all states and territories in Australia and has over 50 branches.
What does HCF stand for?
HCF stands for the Hospitals Contribution Fund of Australia. However, when it was established in 1932, under the name Metropolitan Hospitals Fund.
With over 85 years of experience, HCF protects over 1.5 million Australians with a wide range of products that serves to manage and improve member’s health and lifestyle. Besides private health insurance, they also offer life cover, travel insurance and pet insurance.
Overview of HCF health insurance products
The HCF health fund is the third largest private health insurer in Australia, with 10.4% of the market share, as of 2018 and the largest not-for-profit health fund. They offer a variety of Hospital and Extras policies, as well as a few convenient package options that combine Extras and Hospital cover for singles, couples and families.
HCF Hospital cover options
For an HCF Hospital policy from HCF insurance, you can choose an Excess of either $250, $500 or $750. All Hospital cover options provide you with in-hospital treatments as a private patient in a public or private hospital.
Basic Plus
The cheapest option to help you avoid the LHC loading and Medicare Levy Surcharge.
- Accident cover.
- Emergency ambulance.
- Restricted cover for rehabilitation, palliative care and hospital psychiatric services.
Bronze Plus
Affordable, but includes more hospital procedures than the Basic options, for example:
- Full palliative care.
- Joint reconstruction.
- Dental surgery.
- Male reproductive system.
- Gynaecology, for example, endometriosis.
- Miscarriage and termination of pregnancy.
- Medically necessary breast surgery.
- Hernia and appendix.
- Tonsils, adenoids and grommets.
- Ear, nose and throat.
- Lungs and chest.
- Blood, for example, blood clotting.
- Diabetes management, excluding insulin pumps.
- Skin, like minor wounds and melanoma.
- Eyes, for example, eye infections.
- Brain and nervous system.
- Kidney and bladder.
- Gastrointestinal endoscopy.
- Digestive system.
- Chemotherapy, radiotherapy and immunotherapy for cancer.
- Pain management.
Silver
Comprehensive coverage for those wanting to start or grow their family.
Includes everything listed in the Bronze package, plus:
- Pregnancy and birth-related services.
- Full rehabilitation cover.
- Heart and vascular system.
- Medically required plastic and reconstructive surgery.
- Podiatric surgery.
- Implantation of hearing devices.
- Sleep studies.
Gold
Top level Hospital insurance for complete peace of mind.
You'll be covered for everything in the Silver Hospital plan, plus:
- Full hospital psychiatric services.
- Joint replacements, like hip & knee.
- Cataract surgery.
- Dialysis.
- IVF & other assisted reproductive services.
- Weight loss surgery, for example, gastric banding.
- Insulin pumps.
- Pain management with devices.
Podiatric surgery will be restricted.
Source: HCF health insurance website (27 September 2019)
When you have an HCF Hospital policy, you won't pay any excess when your children need to go to a hospital, regardless of how many kids you have or how frequently they need to go to the hospital.
HCF Extras cover
HCF offers a variety of Extras policies, from the cheapest Starter option to the more expensive and comprehensive Top Extras policy. Please remember, while HCF Extras cover some or all of the costs associated with general treatments received outside of the hospital, it does not exempt you from the Lifetime Health Cover loading or Medicare Levy Surcharge.
Starter Extras
Generally, for those that have a strict budget looking to cover the essential services, including general dental, physiotherapy and ambulance services. With this Extras option, you'll get 100% back on 1 dental check-up, 1 scale and clean and 1 fluoride treatment per person per year if done at a participating provider.
For an extra fee, you can have the Starter option that includes cover for Optical.
Mid Extras
The policy includes benefits for optical treatments, as well as increased limits on general and major dental and selected therapies, including physiotherapy.
You can also claim benefits toward HCF approved vaccines and immunisations, and you'll be granted access to the insurer's Health Management Programs.
Vital Extras
This policy might be suitable for families with kids as it includes orthodontics, occupational therapy and the school accident benefit. However, Vita Extras might also be beneficial for senior Australians that want coverage for hearing aids, osteopathy and dentures.
Receive benefits for a wide range of general treatments and therapies, including 2 dental check-ups, 2 scale and clean and 1 fluoride treatment per person per year if done at a participating provider. Additionally, you’ll receive a benefit for:
- Travel and accommodation,
- Non-PBS pharmaceuticals,
- Artificial aids, for example, HCF approved low vision aids
- Hearing aids,
- School accident benefit, and
- Access to Health management Programs.
Top Extras
The most comprehensive Extras policy includes everything listed in the Vital Extras option, but with higher benefit limits.
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Combined Packages
This health fund offers you the convenience of choosing a combined Hospital and Extras package suited to your specific stage of life: Young and single, starting a family or established family.
HCF's most popular health insurance packages
My Future 500 Basic Plus
Created for the budget-conscious young single or couple. Combines Basic Hospital ($500 excess) and Extras cover, to include:
- Emergency ambulance services.
- Joint investigation & reconstruction.
- Treatment & removal of hernia, tonsils, adenoids, and appendix.
- Ear, nose and throat.
- Bone, joint and muscle.
- Skin for example, abscess and melanoma.
- Dental surgery.
- Sleep studies.
- General & Major dental with a combined $750 limit.
- Optical with a $180 limit.
- Physiotherapy and chiropractic.
- HCF approved vaccines and immunisations.
This package does have some exclusions and restrictions. For example, there's a minim benefit applied to rehabilitation, palliative care and hospital psychiatric services.
My Family Silver Plus
Designed for those planning to start or grow their family; combines a Silver Hospital policy with a Mid-level Extras cover. It includes everything in the Basic Plus package, as well as:
- Full coverage for rehabilitation and palliative care.
- Pregnancy and birth-related services.
- Gynaecology, for example, endometriosis.
- Miscarriage and termination of pregnancy.
- Medically necessary breast surgery.
- Male sterilisation and help with prostate cancer.
- Heart and vascular system.
- Lunch and chest.
- Eyes, for example, eye infections.
- Brain and nervous system.
- Back, neck and spline.
- Kidney and bladder.
- Gastrointestinal endoscopy.
- Digestive system.
- Chemotherapy, radiotherapy and immunotherapy for cancer.
- Pain and diabetes management (excluding insulin pumps).
- Medically necessary plastic and reconstructive surgery.
- Implantation of hearing devices.
- $800 combined limit for General, Major and Endodontic dental.
- Optical with a $200 limit.
- Non-PBS pharmaceuticals.
- Psychology.
- Health management programs.
You’ll also have limited benefits applied to podiatric surgery and hospital psychiatric services.
Hospital Gold and Mid Extras
A comprehensive package for complete peace of mind. Covers everything listed in the My Family Silver Plus option, but also includes:
- Full coverage for rehabilitation and palliative care.
- Assisted reproductive services.
- Removal of cataracts.
- Joint replacements.
- Weight loss surgery.
- Dialysis of chronic kidney failure.
- Cochlear implant surgery.
- Insulin pumps.
- Occupational and speech therapy.
- Dental combined limit of $650 per year.
- Optical with a $200 limit.
- Health management programs.
Source: HCF health insurance website (27 September 2019)
Take note: Before choosing a policy you might want compare HCF reviews with other major health brands in Australia to determine which one meets your requirements and budget.
Special offers and benefits for HCF members
The insurer has launched their Thank You program that rewards members the longer they stay with the fund. You’ll receive savings from a wide range of national brands, for example, Coles, Woolworths, Meyer and David Jones.
- Diamond members: 25+ years with HCF. Access a growing range of discounts and rewards while enjoying VIP experiences.
- Ruby members: HCF member for 10 to 24 years. Get special offers and rewards, as well as exclusive access to unique events.
- Emerald members: 5 to 9 years with HCF. Access discounts and privileges from partner brands.
- Opal members: Brand new member to 4 years with HCF. Receive a certain amount of offers and rewards.
Diamond and Ruby members can also use HCF Assist, which includes Clinical Triage and Home Assistance.
Members can view the offers and rewards they have access to by logging into the HCF online member service on the company’s website.
HCF provider networks
One of the benefits of joining the HCF health fund is that they enable you to get up to 100% back on selected Extras from over 10,000 participating program providers, depending on your level of cover and annual limits.
You can claim money back on services for your:
- Teeth: Up to 100% back on specific dental services when visiting an HCF Dental Centre or participating provider.
- Eyes: Get 100% back on a range of prescription glasses from participating providers, HCF Eyecare, Specsavers and Dresden Optics.
- Hearing: Get up to 100% back on high-quality hearing aids from Blamey Saunders Hears and participating hearing aid providers.
- Back: 100% back on initial consultation from participating chiropractors and osteopaths, for new and eligible health conditions, including flare-ups not treated in the previous 3 months. Claimable once per year.
- Feet: Receive 100% back on your initial consultation with a participating podiatrist for new feet related health conditions, including flare-ups not treated in the last 90 days. Claimable once per year.
- Muscles: Up to 100% back on your initial consult with participating physiotherapist across Australia. Claimable once per year for eligible health conditions that are new or a flare-up that did not receive treatment from a provider in the last 3 months.
HCF waiting periods
| Waiting period | Service |
|---|---|
| 1 Day | Emergency ambulance |
| 2 Months |
|
| 12 Months |
|
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Frequently asked questions and answers
To become an HCF member, you need to choose a policy (Hospital, Extras or Package) that suits your requirements and apply online, through the mail or call them directly. Alternatively, you can also visit one of their branches.
You can call HCF customer service on 13 13 34 Monday to Friday 8 am to 8 pm (AEST/AEDT) and 9 am to 5 pm Saturdays and Sundays. Alternatively, visit their website to send an email or go directly to on of the HCF branches.
Yes, HCF provides emergency ambulance cover via their Hospital and Extras policies. They are also one of the few health funds that offer Ambulance only coverage to Australian residents not fully covered by their state government and wanting ambulance services. However, an ambulance only policy from HCF does not include non-approved ambulance providers or non-emergency services, for example, patient transport between hospitals.
HCF is a mutual organisation, not owned by shareholders. As a not-for-profit health fund, the insurer aims to lower your premiums and improve its product offering by reinvesting the premiums they receive back into their members.
You can find your nearest health provider by either using the My Membership app or visiting the HCF website.
To find a participating hospital, go to hcf.com.au/locations/participating-hospitals and enter your suburb or postal code to find the nearest participating hospital near you.
For general treatments and services, visit hcf.com.au/locations/find-a-participating-provider and enter the service you’re interested in, plus your suburb or postal code.
Hospital claims: Non-participating public and private hospitals will send your bill directly to HCF. When you've been treated at a participating private hospital, complete and sign the HCF claim forms before being discharged and your bill will be sent straight to HCF.
Should you receive a bill, you need to take it to Medicare and complete the Medicare Two-Way form. After that, visit an HCF brand and complete a Medicare claim form, as well an HCF claim form.
Extras claims: If you’ve gone for a treatment or service after you waiting period, you can claim on your Extras cover by either:
- Swiping your membership card on the spot when visiting a participating provider.
- Completing an HCF online claim via their website or the HCF mobile app, available for Android and Apple devices.
- Presenting your membership card and original receipt at any HCF branch.
- Posting the completed claim form and receipts to an HCF branch.
Take note: You can also use the HCF My Membership app to manage your cover, update your payment details, find your nearest health provider and estimate your benefits.
HCF members with a Vital or Top Extras policy can claim money back on a range of services, up to a maximum limit. The longer you are a member, the higher your benefit limit. For example, if you have a Top Extras policy for more than 3 years, then you can claim physiotherapy up to $900.
Specific HIC health insurance policies include benefits for Health Management Programs, which allows you to claim money back towards programs such as:
- Weight management programs, helping you achieve and maintain a healthy weight.
- Exercise or gym programs recommended by your doctor or physiotherapist.
- Child birthing education programs run by HCF-recognised childbirth educators.
- Breastfeeding consultation from a lactation specialist that is an AHPRA-registered nurse and midwife.
- Swimming lessons run by certain swim schools.
- Bowel cancer testing if you're between 50 and 74.
To claim on these programs, you’ll need to complete an HCF claim form, which you can find on their website, and include your original receipt. Download the HCF app on your smartphone or tablet and submit your claim.
Yes, HCF provides private health insurance for international visitors visiting or temporarily living in Australia. You can generally get overseas visitors health cover (OVHC) when you’re over the age of 18 and have a valid work or holiday visa.
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36 Comments
I am currently with BUPA. As I am a senior, I have occasional treatment which is quite expensive. Just yesterday had two syndics’ injections into my knees for therapeutic reasons. I am soon to have an ablation on facet joints which are inflamed and BUPA’s gap is fairly substantial.
My question is, would I be better to change to your company for my cover. I am currently in top hospital cover and pay a co-payment of $50 per night at the hospital up to a cap of $200 per stay. I also have the usual dental, physiology, podiatry, optical etc. cover.
Further down the track, I might be looking at bi-lateral knee replacement or if possible, stem cell treatment for my knees, if there are sufficient breakthroughs in that treatment.
Hi Anne,
Thank you for reaching out. I’m sorry to hear about your knee problems.
As I’m sure you’re aware, if you have a Commonwealth senior’s health card you can subsidise the cost of certain medical treatments and services. It might be worth asking your doctor if he offers discounts to cardholders and request bulk-billing your appointments.
Comparing only two health funds might limit your options of finding the best health insurance for your specific requirements. You might want to start by first reviewing the best seniors’ health insurance options available.
If you would like a specialist to assist you in finding a health fund specific to possible knee replacement surgeries please fill in the form above.
Good day.
We have the opportunity to come across to Australia on a sponsored visa for my husband. Our problem however is that I am HIV+ and his company will not sign the medical waiver.
Would there be any insurance that would cover the condition and the Anti-retroviral that I need to take for the condition? Even if it is treated as an existing condition and I can’t claim for 12 months?
Your help would be greatly appreciated.
Kind Regards
Hello,
Thank you for reaching out. Your question is dependent on a number of factors, including whether you are from a country that has a Reciprocal Health Care Agreement (RHCA) with Australia, as well as the level of cover you want, for example basic, mid-level or comprehensive.
Most private health insurance companies provide coverage for out-patient type medications under their member’s Extras cover. You’ll want to look for coverage that includes pharmaceuticals. It’s best to talk with a consultant to provide you with a step-by-step guide.
You can fill in the form above or give them a call on 1300 786 328, or if you prefer you can start comparing health funds providing cover for visa holders. Make sure your medications are not on the health insurer’s exclusion list.
You’ll also generally need to get a prescription from an Australian registered medical practitioner to claim for medications.
I am so confused with all the different hospital health fund information. I am considering Gastric sleeve surgery. I have been told I qualify to have this done by the surgeon but have no hospital cover.
I can join one for 12 months waiting period, but I am scared that they will not pay out or charge me huge hidden gap costs. HCF seem the cheapest but have been warned they have hidden costs and they are difficult to pay out a claim.
I read bad reviews about HBF and Medibank private too. HCF has given me a quote on an ultimate hospital which seems reasonable, but can they reject my claim with fine print somewhere? I’m so scared of getting the wrong cover.
Can they charge extra for your cover if you mention you’re interested in Gastric sleeve surgery?
I’m very scared and confused about choosing one and having problems.
Please help.
Hi Lynda.
Thank you for reaching out. Alright, let’s start with the basics.
1. Your doctor or specialist must deem your weight loss surgery to be medically necessary and not classify it as ‘cosmetic’ for most private health fund to pay your benefit.
2. As rightly stated you’ll most certainly require a mid to top level health insurance plan from a private health insurance company.
3. You will have to serve a 12 month waiting period before claiming such a benefit.
4. Private health insurance providers may not refuse health cover because of your health status or charge you more because of your pre-existing condition.
Your insurer will usually help pay for your private hospital stay, theatre, atheist fees and post-op doctor’s fees. You’ll also receive a small rebate from Medicare; Gastric sleeve surgery falls under Medicare Benefit Schedule item 31575.
However, there will usually be an amount not covered by your health fund, this is your out-of-pocket cost. The out-of-pocket costs for someone getting gastric sleeve surgery with private health insurance cover is typically between $2,000 and $7,000, depending on your surgeon and level of cover.
You might want to first go for a consult with a weight loss surgeon, whereupon they’ll provide you with an upfront quote, including the surgery numbers so you can check with the health insurer before you commit to them.
If you need help, please do not hesitate to contact our health insurance specialists on 1300 786 328.
Which HCF plan is suitable for me? Family of 3 (including 1 child of 5 years).
Hello Gautam.
The best health insurance plan for you depends on various factors, including the state you live in, your current health and whether you have a family history of health-related problems that you’d like cover for and if you’re planning to grow your family etc.
Before choosing a private health insurance company and policy type, a good place to start might be in comparing Australia’s top health funds.
Have a read of our article about the best family health insurance and when you’re ready you can fill in a health insurance quote form and a specialist will give you a call to help you find the right policy.
What cover is provided for SMILE eye Surgery?
Hi Fred,
Corrective laser eye surgery will generally fall into the category of a combined Hospital and Extras cover, where Optical is usually under your Extras options. Look for a policy offering cover for ‘eye lens procedures’, for example:
• Bupa’s Ultimate Health Cover policy for $446.60 per month.
• Medibank’s Ultra Health Cover for $464.30 per month.
Take note; there will generally be a 12-month waiting period before you can claim for this procedure, dependent on the insurer you choose.
Hi there. I want to get a private health fund for me and my 1-year-old son. I am a single mother on Centrelink pension so I can’t afford an excessive amount.
I’m looking at getting the basic hospital cover + silver plus extras policy. Can you give me a quote on how much per month that would cost me and what exactly it covers? I also would like to know if I would have to be in a lock-in contract or not.
Hello Emily.
To provide you with a proper quote from a variety of private health funds we require a bit more information, for example, which state you live in. Please fill in the quote form above or contact the health insurance specialists directly on 1300 786 328.
When purchasing a private health insurance policy, you are not locked into a contract and can switch health funds at any time.
Per the HCF website, as of November 2018, an HCF Basic Hospital with Silver Plus Extras package for an individual living in NSW start at about $48.80 per week.
Hi. My wife and I want to apply for a visa to Australia (type 408).
Is your insurance ok when applying for a visa? Will it cover all unexpected problems (medical) for us?
Can we pay week by week after arriving at AU?
Regards,
Hi Ali,
Please note that ComparingExpert is a comparison website and not an insurer. By filling in the quote form above a specialist will give a call and provide you with health quotes best suited to your circumstances. Yes, you can usually pay your premiums on a week to week basis if you prefer; however, you’ll probably need to activate your policy before the visa will be granted and this might require starting premium payments.
Plenty of private health funds in Australia offers policies specifically for visa applicants and generally you’ll have different levels of coverage to choose from, depending on your requirements.
HCF, in particular, have a few overseas visitors health insurance options which you can review by visiting their website or contact them directly on +61 29290 0100.
Hi. I am a single man 60 years of age. I have a budget hospital with $500 excess and silver extras. I am not sure if this is good or bad. What can you offer me at what monthly price?
Hi Kym.
Whether your budget hospital and silver extras plan is a good or bad fit for you, depends on your specific requirements and what you can afford. For example, how is your health, in which state do you live and do you have a medical history that might require additional assistance in future? Your health insurance should suit your individual needs. Please fill in the quote form above and a specialist will give you a call to help you feel confident in your choice of health plan.
I’m wanting ambulance cover only please. I’m a 58 yr old female working part time,no health care card. My daughter is 19 and working part time and living at home. We live in NSW. Would it be more economical to purchase 2 single or a combined cover?
Hi. Thanks for reaching out.
Seeing as NSW residents generally get 49% of your emergency ambulance services subsidised, you’re right in considering some additional coverage. However, the right policy for you and your daughter depends on your unique requirements. To provide you with a quote, please fill in the above form and a health insurance specialist will assist you.
Hi there, I live in NSW now but planning to move to VIC. Will this will affect my insurance?
Hi.
Generally, moving interstate might have an impact on your health insurance coverage. For example, residents of Victoria do not receive ambulance services by their state government and thus residents might want a health insurance policy that includes ambulance coverage. Additionally, your health insurance premium might be lower or higher depending on where you’re moving to.
Please contact your health fund and inform them of your address change, so they may help you with any adjustments needed to your coverage.
Good luck with the move.
I am aged 80 and very confused with all the different health funds and options available.
I am looking for cover for hospitals and extras private hospital cover for joint replacement, heart condition, cataract and Mid extras – dental, optical.
How do I find out who the participating providers are for these treatments?
Hello Androulla. Thank you for reaching out.
I agree, choosing a private health insurance policy can be a daunting task. You might want to speak to a specialist who can help provide clarity on your options. Please call 1300 795 560 for immediate assistance.
If you’re wondering where to find participating providers for HCF specifically, you can visit the list here.
Hi, I will be moving to Australia soon, and my visa requires my health insurance to have a per annum per person minimum benefit of AUD1,000,000. How do I find out which insurance companies offer this?
Many thanks
Hi Lis.
I’m not sure to which benefit you are referring to; is this for Hospital cover or general treatments? Also, because you mention $1 million coverage, it makes me think you might be referring to life insurance.
Please feel free to reach out to our specialists on 1300 743 254 for clarification.
Does HCF cover emergency road and air ambulance transport
Hi. Ambulance services provided by HCF will depend on where in Australia you live, as well as the type and level of coverage you purchase. Generally, if you fall outside of a state-based ambulance arrangement, HCF Hospital and Extras will provide coverage for emergency ambulance transport via air, land and sea. However, please review your policy documents or contact the insurer directly for relevant details.
I am currently a Silverplus hospital only customer. My question is; what does restricted cover for Hospital Psychiatric Services look like. What does it cover? How much out of pocket expenses might I have if I have to go into hospital for psychiatric review of medication.
Hi Glen.
According to the HCF website, Restricted Psychiatric treatment is classified as a service where a minimum benefit is payable. Meaning, they will pay the rate set out by the Commonwealth as the minimum shared room benefit. Please note, you have to wait 2 months, after applying for this policy, before you can access the benefit.
It’s always best to contact your health fund directly so they can advise you on the specifics of your cover.
Take note, HCF classifies a Psychiatric Patient to mean ‘a patient who is admitted by a specialist in psychiatric medicine to a psychiatric program approved by HCF at a Hospital recognised by HCF as a psychiatric Hospital or as having a psychiatric Service’.
How do I get a HCF app to claim for services?
Hello Alan.
You can download HCF’s My Membership app from the Google Play or Apple App store.
I am member number 24002*** GRAHAM CHARLES JONES.
I am claiming exemption from NSW AMBULANCE fees but cannot find an expiry date for my membership which shows s 12/17 as the issue date. Can you help me, please?
Hi Graham.
For health insurance card queries, please contact your health fund directly.
Hi there
We are a family of 2 adults and 3 children and are moving to Australia in September on a 482 working visa. I am looking for a quote for health cover for all of us but I’m so confused on the best cover for us. I want to be covered for general gp appointments and hospital cover and maybe orthodontics. Would you be able to give me some more info and a price for a yearly cover for us all?
Hi Victoria.
You might want to visit iman Australian Health Plans (aushealth.com) for a quote specialising in overseas health insurance.
I’m in the USA moving to Australia Jan 5. I need insurance ahead of time. How can I set it up? I don’t have a phone number there, just my work one 61 2 9101 ****
Thanks
Hi Georgeanne.
Seems like you’ll have quite an interesting 2020.
We do not currently compare working visa health insurance options. However, please have a look at hcfvisitorhealthcover.com or for more options allianzassistancehealth.com.au.