Claims
Membership
ACA Health admin
Generally no. If, when you join ACA Health, it is the first time you have had private health insurance you will first need to serve waiting periods before you can make a claim. This is to prevent people from simply joining to make a claim and then dropping their cover, and therefore preventing higher costs for everyone.
If you have transferred from another fund you will be able to claim benefits straight away, up to the level of benefits you had in your previous cover for the waiting period time. After the waiting period is over, benefits will be paid at your new ACA Health levels.
A pre-existing condition is an ailment or illness where, in the opinion of a medical practitioner appointed by ACA Health, the signs or symptoms existed at any time during the six months before the day which a member joins private health insurance or upgrades to a higher level of cover.
Pre-existing conditions have an extended waiting period - 12 months - before hospital and major ancillary benefits will be paid on treatment relating to the condition.
No. Health Funds are not legally permitted to pay benefits on 'out-patient' medical treatments. Patients are only eligible for the 85% Medicare rebate on medical services incurred out of a hospital.
Cosmetic Surgery is not covered under any of ACA Health's hospital or ancillary products. Prior approval for this type of service must be obtained from the Fund committee and must be recommended by a Registered Medical Practitioner.
Depending on your level of hospital cover, there may be some out of pocket expenses (a 'gap') for your hospital accomodation. Call ACA Health to confirm your cover and inquire about any gaps that you may have to pay.
If you are having a procedure performed in hopsital, you can ask your surgeon to provide you with a quote. This information should notify you of any gaps you will need to pay towards the surgeon's fees and the associate doctors for your procedure.
Yes, ACA Health will provide cover for any treatment in any hospital in Australia. However, for hospitals that are not contracted with us through the Australian Health Service Alliance (AHSA), we cannot guarantee you for the full 100% of the cost as we can for contracted hospitals.
Yes. ACA Health is a national fund and can pay benefits for treatments administered anywhere in Australia.
ACA Health require that all claims for benefits need to be received at our office within 24 calender months from the date of service.
All you need to do is complete a Membership Change Form with the details of the new dependant to be covered, and return it to our office. Alternatively, you can add them to your membership using Online Member Services.
Yes, defacto partners can be covered under a family membership.
Your children can be covered as a dependent on your family membership up until the age of 21. After the age of 21, your children can still be covered provided they are a full-time student, not married and earning less than the tax-free threshold per year. Student dependents will be covered up until the age of 25 or until the date they no longer meet the definition of a student dependent.
If your child over 21 stops studying, goes to part-time study, gets married, or starts earning over the tax-free threshold, you need to tell us in writing and they can no longer be covered by your membership. Your child can choose to join in their own right if they wish, with no waiting periods provided they join up within one month of coming off your membership.
Alternatively, if you have a child over 21 (and less than 25) who commences full-time study you can add them back onto your membership by advising us.
Members are still eligible to remain with the Fund when moving overseas, and are still eligible to receive benefits for treatments received in Australia. However, it is strongly recommended that Private Health Insurance Cover is organized within the country of residence to take care of treatments received overseas.
Members of the Fund who are moving overseas for more than 4 months may instead wish to request ACA Health have their membership suspended.
If you lose your membership card, don't panic! Just contact us and let us know and we will order you a new card.
If you are unhappy with the treatment you have received from ACA Health you first need to contact us and we will attempt to find a satisfactory resolution. If you are still unsatisfied after exhausting our internal complaints resolution options (view our Complaints Policy), you are welcome to contact the Private Health Insurance Ombudsman (www.phio.org.au).
You will need to complete a Request for Claims History form which will list all the claims and benefits paid on your membership. Privacy laws require that all persons on the membership need to give permission for the release of their claims information (within reason for age purposes).