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Read our HCF health insurance review
This company behaves unconscionably. It forced us to pay more than $3,600 in pre-admission costs to a private hospital, when in fact our policy covered the full cost all along. Itâs customer service is woeful. Avoid insuring with this fund.
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It seems a Private patient in a Private room at a Public Hospital is different to a Private Patient in a Private room at a Private Hospital. According to the following article âHCF, the nationâs largest non-profit fund, advised members on Monday it was clawing back higher fees charged by public hospitals in NSW and the ACT, leaving members there with out-of-pocket expenses of $320 per nightâ. It seems the Public NSW & ACT Hospital systems charge $752 per night for a private patient compared to around $450 a night in other States. I am not sure of what the bed cost per day in NSW in a Private Hospital is so canât compare like to like but CHOICE may have some information on that.
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HCF Health Insurance review.
After being with AHM for nearly 30 years, decided to switch to HCF after seeing an offer for some weeks free and giftcard.
After paying two lots of premiums, phoned to clarify that we can make extras claims, the rep says no clearance certificate received.
Check email from 19th April that says HCF will request the certificate, also says cannot claim until HCF have certificate. Ask to speak to supervisor, rep just repeats herself, I attempt to interject and she hangs up on me. Phoned again, asked to speak to supervisor and hung up on again. Third attempt to speak to supervisor, on hold for over 40 minutes, finally get some answers.
If you enjoy being on hold for hours, being hung up on, dealing with reps that have no product knowledge, a fund that cannot get or at least follow up on a clearance certificate after joining, potentially not being able to claim when premiums are paid, then HCF is for you. If not, then go elsewhere.
Lastly, if you expect any extras refunds, you can ONLY use providers listed by HCF. Goodbye regular dentist! This is not mentioned on the sales page of their website that I could see
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Welcome to the Community @AndL24, I moved your post into this existing topic albeit older one about HCF.
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Looking at the linked information, one can still use their âfavourite dentistâ, however, if they arenât part of the HCF No-gap Network, one may incur gap payments at each consultation. The gap being the difference between what the dentist charges and the benefit.
Possibly have a chat to your âfavouriteâ dentist to see if they are part of the HCF No-gap Network, and if not, if they will do a standard 6 monthly scheduled visit for no gap.
Many health funds have a network of providers which offer no-gap services to their policy holders. When changing health funds, the list of no-gap providers can change.
Sorry, I think you are incorrect. This is not what the customer service rep said to me today. I was quite surprised that members cannot expect any refund if you use service providers that are not part of the HCF network.
I even asked on a specific scenario where one might visit for a dental checkup at one of their listed service providers and as per the website, there should be no charge. I then asked if that dentist said a filling was required and the patient thought they would feel more comfortable using a dentist they have used for fillings before and whether that would be covered, it was a definite no. This surprised me as when with AHM we paid the gap.
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According to the HCF Fund Rules the dental service is only covered when the member uses a HCF Dental Centre
E3.6 Dental Services are provided at HCF Dental Centres for Members whose Policy entitles them to dental Benefits provided that:
(a) Premiums on the Policy are not in arrears;
(b) the Policyholder has paid all charges raised by HCF for any prior Services or failure to attend an appointment; and
(c) the Member understands that any Services provided at an HCF Dental Centre are part of their annual dental Benefit entitlement and HCF will process a claim against their dental Benefits and Limits (where applicable).
E3.7 Some dental Services provided by HCF may be subject to fees and charges not claimable as a dental Benefit and any such charges will be payable by the Member.
E3.8 Information concerning charges for Services is provided (where possible and practicable) in writing to enable informed financial consent to be given by the Member prior to the commencement of the Services.
E3.9 Members from time to time may be invited to participate in or access additional services provided by HCF or arranged by HCF in relation to Services and subject to the Private Health Insurance Act. Amounts paid to deliver such services to Members will be considered to be Benefits.
E3.10 HCF may decide that Benefits will no longer be payable in respect of Services supplied by a provider whose status as a Recognised Provider has been terminated by HCF in accordance with the Recognised Provider terms and conditions.
E3.11 In these cases outlined in Rule E3.10, Benefits will not be payable for any Service supplied by that provider unless HCF is satisfied that the Member claiming Benefits was not aware of the decision at the time the Service was provided, or HCF otherwise considers that the Member would suffer hardship if the Benefits were not paid.
E3.12 The provider identified in Rules E3.10 and E3.11, will thereafter no longer be considered to be an HCF Recognised Provider.
AND
The following waiting periods apply where these services are covered under your policy:
THINGS YOU NEED TO KNOW
EXTRAS WAITING PERIODS
1 DAY Emergency ambulance.
12 MONTHS Crowns, bridges, dentures, endodontics, occlusal therapy, surgical extractions, oral surgery, complex fillings, periodontics, prosthodontics,
dental bleaching, veneers, orthodontics, artificial aids, foot orthotics, minor podiatric procedures and hearing aids.
2 MONTHS All other extras services.WHATâS NOT COVERED?
There are a number of situations where our health insurance doesnât cover you, including for example:
⢠claims for services by providers not recognised by HCF, and that do not meet HCFâs criteria as set out in the Fund Rules
⢠claims made 2 years or more after the date of service
⢠more than 1 therapy service performed by the same provider in any 1 day.
Please refer to the HCF Member Guide or Fund Rules for a comprehensive list of exclusions.
AND finally
All in all they can only use a HCF approved provider, if not on their list even if a qualified Dental care provider then no benefit is payable. As it is in the fund rules it is most likely not going to be a situation a member can win in any appeal to say AFCA or similar.
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I didnât go into the rules. The website link provided doesnât indicate benefit is limited to a HCF Dental Centre. This is a bit deceptive as the only limitations indicated are their no-gap network providers. One would expect the website to be very clear of these limitations, rather than relying on having to read the fine print.
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Probably time for @AndL24 to consider a change to another provider who allows the use of non-affiliated Providers (that would need careful reading of each PDS (Product Disclosure Statement) and/or fund rules to determine that.
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Looks like they have a sunset/cooling off clauseâŚ
Cancel within 30 days and get a 100% refund (if you havenât claimed)++
++ Available if you change your mind and cancel your HCF policy within 30 days of joining, and havenât made a claim in that period.
Hopefully it is within the 30 days to get a refund on the premium.
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From the original post they had paid two premiums and then rang about the Extras. They were told no certificate received so they checked their email from HCF that they had received on 19th of April about the changeover to the fund. So I am guessing they are well outside the cooling off period and all they can do is accept the rules or change funds again 
Really not a satisfactory outcome but it is feeling like we are becoming more like some funds in the USA where you use only the services of the funds providers or there is no cover.
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Glad you read between the lines to get the point I was attempting to make.
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Even worse is that when I phoned about joining I was told it was effectively the same cover we had at AHM; even the plan names incorporate the word âsilverâ. At no stage do they tell you in sales mode that you can only use their providers.
How they are " Winner of three times more Canstar Awards than any other Health Insurer in 2023."?! Good grief, people must have low expectations.
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HCF gets some positive comments helping their leaving member get back on track with them after some bad experiences with Compare Club.
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