Health Care Insurance

HEALTH CARE INSURANCE

HEALTH CARE INSURANCE

Health Care Insurance (HCI) is a nonprofit health fund established in 1938. Based in Tasmania, it’s owned entirely by its members and has more than 10,000 members.

It Is non-profit insurance and its complaints rating from members is very low. When they score policies they give each fund a complaints rating, based on the number of complaints and serious disputes that is dealt with. They take into account the size of the fund, so big funds don’t get automatically penalized for having more complaints.

The ratings are Low, Medium and High. A Low rating is better than a High rating – it means the fund has fewer complaints and fewer serious disputes for its size.

HCI’s hospital gap cover

A medical gap is a difference between Medicare’s recommended fee and what the doctor actually charges for a treatment or service.

Health funds have agreements with particular doctors and hospitals to cover all of the gap, which is called ‘no gap agreements’, or part of that gap, which is called ‘known gap agreements’ (these will have lower out-of-pocket costs, usually less than $500).

How many hospital agreements does HCI have in a state?

The benefit amount a fund pays for hospital services depends not only on the type of cover bought but also whether the fund has an agreement with the hospital where treatment is given.

HEALTH CARE INSURANCE HOSPITAL AGREEMENTS WITH STATES

Note that public hospitals don’t have agreements with specific funds and are generally treated as though they’re agreement hospitals.

 

QLD

Private hospital agreements

(Industry maximum) 57 (57 )

Day hospital agreements

(Industry maximum) 51 (51 )

NSW

Private hospital agreements

(Industry maximum) 101 (101 )

Day hospital agreements

(Industry maximum) 96 (96 )

ACT

Private hospital agreements

(Industry maximum) 5 (8 )

Day hospital agreements

(Industry maximum) 9 (9 )

TAS

Private hospital agreements

(Industry maximum) 5 (8 )

Day hospital agreements

(Industry maximum) 4 (6 )

NT

Private hospital agreements

(Industry maximum) 2 (2 )

Day hospital agreements

(Industry maximum) 1 (1 )

VIC

Private hospital agreements

(Industry maximum) 84 (84 )

Day hospital agreements

(Industry maximum) 73 (76 )

SA

Private hospital agreements

(Industry maximum) 29 (29 )

Day hospital agreements

(Industry maximum) 27 (27 )

WA

Private hospital agreements

(Industry maximum) 21 (23 )

Day hospital agreements

(Industry maximum) 26 (26 )

 

HCI  discounts

Discount for direct debit: None

Discount for annual prepay: None

Total discount for annual prepay via direct debit: None

But HCI offers ambulance cover, HCI Premier Extras and Premier Package policies have emergency ambulance.

 Ambulance cover

It depends on members residence, it may not be necessary to have ambulance cover

In Queensland or Tasmania, emergency ambulance services are covered by your state government.

In NSW and the ACT, all hospital policies come with emergency ambulance cover – so members are covered with any hospital or combined policy they select.

In South Australia, Victoria and the Northern Territory members can buy emergency ambulance cover directly from the ambulance service. Alternatively, some health fund policies will cover an ambulance in a state or territory or refund at least part of the cost of the ambulance service cover.

Rural WA: members can buy emergency ambulance cover directly from the ambulance service. Alternatively, some health fund policies will cover an ambulance or refund at least part of the cost of the ambulance service cover.

Metropolitan WA: If a member wants to be covered for an ambulance, they will need to buy a health insurance policy with ambulance cover.

HCI claims are done only via email or app (iOS and Android). No online claiming.

 

CHOICE Community and HCI

This is the online forum for Australian consumers, open to CHOICE members and supporters, members can also Join the conversation about Health Care Insurance to share their experiences or gain more insights into this health fund (CHOICE).

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CONCLUSION:

It is important to understand that the higher the percentage of medical services that Health Care Insurance covers with no gap, the more effective the fund’s gap scheme is in a state or territory.