Frequently Asked Questions

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You are able to submit a claim using our Email Claiming process.

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Check with ACA Health as soon as your pregnancy is confirmed, your current level of hospital cover and whether you are still under any waiting periods (12 months for obstetrics). You may need to upgrade to a family membership.

Single hospital membership for mothers only cover the cost of the birth of the baby but doesn’t cover any costs incurred by the baby. For a baby to be eligible for benefits immediately from birth, the mother must have contributed to a family membership for at least 2 calendar months prior to the infant’s birth. (Regardless of whether or not the infant is premature)

When the baby is born, he/she will be considered an out-patient and as such, Medicare pays the first 85% of the scheduled fee and you must meet all costs not covered by Medicare. ACA Health is not permitted to pay benefits on these out-patient fees.

Your newborn (nine days old or less) is only classified as an ‘admitted patient’ if the baby:

• is admitted to an Australian Government approved neonatal intensive care unit; or
• is the second or subsequent baby born in a multiple birth; or
• is in hospital without his/her mother.

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In NSW or ACT, you are covered in full for ambulance transportation with hospital or extras cover. In all other states, ambulance is covered only under general treatment products.

If you go to an emergency department of a private hospital, you will be classed as an ‘out-patient’ and as such ACA Health is not legally permitted to pay benefits on these services or any blood tests or x-rays that may be taken at this time. These fees are instead reimbursed by Medicare, as services provided to “not admitted patients”, at 85% of the Medicare Schedule Fee.

Many private hospitals also charge a ‘facility fee’ for attendance at their emergency department to help off-set their running costs. ACA Health does pay a benefit towards this fee.

If, after emergency treatment, you require admission to the hospital, you will then be covered by your Hospital cover with ACA Health (provided all waiting periods are served and the treatment is covered by your hospital cover).

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If you need hospital treatment, we recommend the following steps to determine your benefit and the amount of gap fees you may need to pay:

1. Contact us straight away to find out your level of hospital cover and whether you will be covered for the treatment you need.
2. Ask your doctor(s) whether they participate in the Access Gap Cover Scheme and if so, to bill your accordingly. This may help you avoid or lower your out-of-pocket expenses.
3. Check that the private hospital is contracted with ACA Health through the Australian Health Service Alliance (AHSA) by using our Hospital Search.

If your hospital stay is longer than 35 days and your doctor considers that you no longer need acute care, you will need to pay a contribution to your living costs in much the same way as nursing home type residents contribute to the cost of their care. The patient contribution is payable by public and private hospital patients and ACA Health is unable to pay benefits on this fee. Contact us for more information.

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You can download your claims history from within your member account portal. This 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).

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ACA Health require that all claims for benefits need to be received at our office within 24 calendar months from the date of service.

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ACA Health has a partnership with QBE Travel Insurance, offering ACA Health members travel insurance at a 25% discount! See QBE Travel Insurance for more information.

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You can change your healthcare provider at any time. If you do choose to change healthcare providers you will be required to get a tax statement from each provider to complete that year’s tax return.

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Yes, as long at the treatment provider is appropriately qualified and registered with their relevant association.

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The majority of claims are processed within 5 working days, and with your ACA Health membership card, many extras claims can be made automatically at the time of your service.

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Many general treatment providers offer on-the-spot electronic claiming (called HICAPS), which means by using your ACA Health membership card, you’ll know on the spot what we pay on the claim and all you need to do is pay the difference. If your healthcare provider does not offer electronic claiming, you will need to post or deliver your original invoice/receipt along with an ACA Health Claim Form to us for assessment. Your claim will be processed within 3−5 business days and paid by direct deposit to your nominated account or by cheque to the address listed on your membership. If your claim is unsuccessful, it will be returned to you with a letter explaining why it cannot be paid.

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HICAPS (Health Industry Claims and Payments Service) is an electronic health claims system now used throughout many healthcare providers. It allows you to automatically claim benefits on the spot by using your ACA Health membership card.

By using HICAPS you will save time, as you will no longer have to lodge your claim via the post. And, more importantly, you will save money because you won’t be out of pocket during the time it takes to claim the benefit back from us.

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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.

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If you lose your membership card, don’t panic! Just contact us to let us know and we will order you a replacement card.

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If your child aged 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 as they can no longer be covered under your standard family membership.

Your child can choose to have their own policy, with no waiting periods, provided they join with ACA Health within one month of coming off your membership.

Alternatively, the Dependent Extension product allows unmarried children over the age 21 and under 25 years who are no longer studying full-time, to stay on the Family Membership.

The extension option is available for;

• Deluxe Hospital and Complete Ancillary
• Deluxe Hospital and Ancillary Lite
• Private Hospital and Complete Ancillary
• Private Hospital and Ancillary Lite
• Bare Essentials and Complete Ancillary

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Yes, defacto partners can be covered under a family membership.

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All you need to do is complete a Membership Change Form with the details of the new dependent to be added by logging onto your member account via Online Member Services.

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Members of ACA Health are eligible for a number of discounts at a range of optical providers on both prescription and non-prescription products. Simply present your ACA Health membership card when making a purchase.

QBE Travel Insurance also offers members travel insurance at a 25% discount!

Members of ACA Health are also eligible for a number of discounts at a range of optical providers on both prescription and non-prescription products.* Simply present your ACA Health membership card when making a purchase. Please click on the links below to see the discounts available:

• Specsavers
• OPSM

*ACA Health Benefits are only paid on prescription services, however you may still be eligible for any applicable discounts on non-prescription products.  Please contact the appropriate optical provider for more information on the offers.

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Members are still eligible to remain with ACA Health 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 organised within the country of residence to take care of treatments received overseas.

Members of ACA Health who are moving overseas for more than four months may instead wish to request ACA Health have their membership suspended, which can be lodged through online member services.

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With ACA Health’s Online Member Services you can access a range of online services at a time convenient to you, including:

• check your ‘limit usage’ − how much you have already claimed for extras items, and how much you still have left for that calendar year
• change your contact details
• change your payment/bank account details
• change your type of cover
• add a partner/child to your membership
• make a credit card payment
• view your membership details
• make a claim
• find a provider
• download your tax statement or claims history.

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All you need to do is complete an online Membership Change Form with the details of the new dependent/person to be added or removed from the policy.

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The Medicare Levy Surcharge (MLS) encourages high income earners to take out private hospital cover, and where possible, to use the private system to reduce the demand on the public system.

Where high-income earners do not take out private health insurance, they are charged an additional 1% on their taxable income on top of the usual 1.5% Medicare Levy.

For more information, click here.

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In the past, large out-of-pocket expenses were often part of any hospital stay for people with private health insurance. To help improve this, ACA Health offers you the Access Gap Cover Scheme as part of our hospital cover.

Medical (doctor/specialist) services provided to hospital in-patients are charged separately from hospital accommodation/theatre fee charges. Medicare pays 75% of the Medicare Schedule Fee and ACA Health pays the remaining 25%.

Some doctors/specialists charge an amount above the Medicare Schedule Fee. These costs are generally referred to as out-of-pocket expenses, and in the past, health funds were unable to pay benefits on these amounts.

Now, out-of-pocket doctor/specialist expenses for hospital patients can be eliminated completely or dramatically reduced with our ‘Access Gap Cover’ payment and billing scheme.

Doctors/specialists who choose to participate in the ‘Access Gap Cove’ scheme agree to charge for services with either no out-of-pocket expenses or a predetermined amount, which is capped. In return, ACA Health can pay the doctor above the Medicare Schedule Fee.

ACA Health has “Access Gap Cover” arrangements with over 11,000 Doctors Australia wide, established on our members’ behalf by the Australian Health Service Alliance (AHSA). You can find out which doctors are using the scheme by logging into your Member Portal and clicking the “Find a doctor” button at the bottom of the page (click here to login). Not all doctors in the scheme have agreed to have their names listed, so keep this in mind when you are looking.

Finally, your doctor will usually lodge your claim for you − making the whole process even easier.

Please note: ACA Health is unable to provide recommendations on health care providers, hence the search function is not intended as a list of ‘preferred providers’.

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The Federal Government provides a rebate on health insurance to all Australians eligible for Medicare who are members of a registered health fund, in recognition of the contribution that those with private health insurance are making to their own health care costs.

This rebate is now age and income tested. This rebate is available on all ACA Health hospital and extras products.

Please visit the Private Health Website to check if a rebate applies to your age and income level.

As a member of ACA Health Benefits Fund you can choose the rebate claiming method that best suits you. You need to decide whether you want to receive the reduced premium or if you want to have it reimbursed at tax time, if you are eligible for the rebate.

You can receive the rebate as either:

• A premium reduction through ACA Health; or
• A refundable tax rebate in your annual tax return

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Lifetime Health Cover is a Government initiative that rewards those who take out and maintain hospital cover at a younger age with lower premiums throughout their life (compared to someone who joins later in life).

To lock in the lowest premiums for life under Lifetime Health Cover, a person needs to take out hospital cover with a registered fund before the first July 1 following their 31st birthday. After 31, the younger you join, the lower your premiums will be.

Under Lifetime Health Cover, health funds are required to charge people who were not members of a hospital cover prior to 1 July 2000, 2% extra on top of the normal premiums for every year they are aged over 30 when they first take out hospital cover.

For more information on Lifetime Health Cover, please contact us or refer to the government website.

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Depending on your level of hospital cover, there may be some out-of-pocket expenses (‘gap’) for your hospital accommodation. Call ACA Health on 1300 368 390 to confirm your cover and inquire about any gaps that you may have to pay.

If you are having a procedure performed in hospital, you can ask your surgeon to provide you with a quote first. This information will inform you of any out-of-pocket expenses that you may incur for your surgeon’s fees as well as any other associate doctors/specialists fees for your procedure.

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Cosmetic Surgery is not unconditionally covered under any of ACA Health’s hospital or extras products. Prior approval for this type of service must be obtained from the Fund committee and must be recommended by a Registered Medical Practitioner.

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These include pacemakers, defibrillators, joint replacements and other devices that are surgically implanted during a stay in hospital. There are often a number of different choices available with any particular prosthesis, which can vary in cost and benefits.

The Department of Health and Aging has set a Prosthesis List with the majority as ‘No Gap’ which means you do not need to pay any out-of-pocket expenses. You and your surgeon will be able to choose a prosthesis for every Medicare procedure from the prosthesis list that will be fully covered by ACA Health.

In the situation where a more expensive prostheses is available for your surgery, and you elect to use one of these, you will have to pay the gap amount.

Before you have any surgery, check with ACA Health that you will be covered under your current policy.

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Yes. ACA Health is a National fund and will pay benefits for treatments and services administered anywhere in Australia.

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Yes. ACA Health provides cover for the member, as well as the member’s nominated partner and/or dependents.

Children are considered dependent until the age of 21, or 25 if they are an unmarried full-time student and earning less than $20,000 per year.

The Dependant Extension product allows unmarried children over the age 21 & under 25 who are no longer studying full-time to stay on the Family Membership. By taking out the Dependant Extension, the membership premium is increased by 30%. The Dependant Extension is only available on combined covers with Deluxe or Private Hospital cover.

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Our Deluxe Hospital cover and Private Hospital cover means you can choose to be treated 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.

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ACA Health is able to give you the choice of cover you need with a wide range of benefits without the confusion of too many options. Our Complete Extras is an excellent product, often offering higher benefits than comparable products at many other funds. It offers generous benefits on a large number and wide range of services including:

• general and high cost dental
• orthodontics
• optical including glasses and contact lenses
• ambulance
• physiotherapy/hydrotherapy
• chiropractic/osteopathy
• pharmacy
• speech therapy
• orthoptics
• acupuncture
• remedial massage
• general appliances, e.g. CPAP machine, wheelchair
• hearing aids
• audiology
• occupational therapy
• natural therapies.

For more information on our Extras cover, click here.

Why not give our quick quote option a try to find the right coverage for your needs.

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Definitely. We have a range of policies that cover you across the many different stages of your life, including pregnancy.

Under our Complete Extras family cover, mothers-to-be and new mothers can now access a range of new benefits to help families meet the costs associated with having a baby. These include:

• pre- and post-natal classes
• settling classes
• lactation consultations
• appliances for hire or purchase (e.g. breast pump)
• infant sound and respiratory monitor (to help in the prevention of SIDS).

Benefits available are 80% of the cost, up to a maximum of $500 per family membership.

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We have a choice of 3 hospital covers:

• Deluxe Hospital
• Private Hospital
• Basic Hospital

Any of these can be combined with an Extras cover to suit your health needs and financial commitment.

Extras cover helps you take care of the costs for all the extras − like dental, optical, physio, chiro, and pharmacy prescriptions.

We offer you two excellent choices for Extras cover:

• Complete Extras
• Extras Lite

Either of these products can be used alone, or combined with Hospital cover to meet your health needs and financial commitment.

Click here to find out the best coverage for your needs.

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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 Procedure and Policy), you are welcome to contact the Private Health Insurance Ombudsman (www.phio.org.au).

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ACA Health may disclose your personal information to third parties in order to provide and administer its products and services. This may include disclosures to:

• hospitals and health service providers from whom you have sought, or from whom you intend to seek treatment
• health management providers who offer health management and chronic disease management programs under an arrangement with ACA Health
• Government agencies such as the Australian Tax Office, Medicare Australia, the Private Health Insurance Administration Council, the Private Health Insurance Ombudsman and the Department of Health
• other private health insurers, for instances where you transfer to or from another private health insurer
• the Fund’s information technology and software system providers
• third party advisers and service providers to the Fund (such as auditors, actuaries, consultants and legal advisers).

Refer to our Privacy Policy for more details.

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ACA Health is committed to maintaining the privacy of individuals. The personal information we collect is in accordance with the Australian Privacy Principles set out in the Commonwealth Privacy Act and other applicable privacy legislation. Refer to our Privacy Policy for more details.

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ACA Health will allow any consumer who has not yet made a claim, to cancel their policy and receive a full refund of any premiums paid within a period of 30 days from the commencement date of their policy.

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We want to make the payment of your contributions as painless and easy as possible. You can choose a number of different payment methods and are able to nominate whether you would like deductions to be made monthly, quarterly or yearly.

You can choose to pay via:

• direct debit
• credit card − MasterCard and Visa only
• payroll deduction (option only available to selected organisations)
• by mail or in person, with cash or cheque.

You can nominate your preferred payment option on your application form. However, you can change your payment method at any time through the online member portal.

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It’s easier than you think. Joining ACA Health is as simple as filling out our online application form – click here.

When we are processing your application, a Member Service Representative will contact you to talk through the details of your new membership.

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On joining health insurance for the first time, waiting periods must be served before benefits will be paid on all hospital and general treatment covers with ACA Health. The exception to this is where you have an accident, not related to pre-existing condition, and you require hospital and/or ambulance treatment.

If you transfer from another fund within 60 days of terminating your old cover, then normal waiting periods are waived and our benefits up to the level of your previous cover may be paid immediately, subject to financial continuity.

Waiting periods

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On joining health insurance for the first time, waiting periods must be served before benefits will be paid on all hospital and general treatment covers with ACA Health. The exception to this is where you have an accident, not related to pre-existing condition, and you require hospital and/or ambulance treatment.

If you transfer from another fund within 60 days of terminating your old cover, then normal waiting periods are waived and our benefits up to the level of your previous cover may be paid immediately, subject to financial continuity.

If changing to a higher level of cover, normal waiting periods will apply before the higher benefits will be paid.

If adding a spouse to a membership (changing from single to family membership), normal waiting periods will apply for the spouse, unless they are transferring from another fund in which the rule above will apply.

If adding a child dependent to a membership, the child would be subject to the normal waiting periods, unless they are transferring from another fund in which the rule as above will apply.

If adding a newborn to a family membership, the baby will be covered immediately.

Please note: – If you are planning to have a baby and are currently on a singles cover, you will need to upgrade your cover to a family membership at least 2 months prior to the actual birth of the baby to ensure that your newborn will have immediate cover as part of your membership.

Waiting periods

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If 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 transfer from another fund within 60 days of terminating your old cover, then normal waiting periods are waived and our benefits up to the level of your previous cover may be paid immediately, subject to financial continuity.

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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 that 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 extras benefits will be paid on treatment relating to the condition.

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Joining ACA Health is as simple as filling out our online application form – click here.

Alternatively, you can print out a copy of the application form and once completed you can return it to us by:

Post: Locked Bag 2014, Wahroonga, NSW 2076

Email: info@acahealth.com.au

Fax: 02 9847 3357

You can also contact us on 1300 368 390 to discuss any details of your application.

When we receive your form, one of our friendly Member Service Representative will contact you to talk through the details of your new membership. As ACA Health is open to current and past employees of the Seventh-day Adventist Church and its incorporated institutions, we may ask you some questions about your personal or family connection to verify your eligibility.

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We offer:

• benefits of up to 4 times your annual fee
• unbeatable range of extras with per treatment payments over double other health funds
• 100% of our operating surplus goes back to members
• ACA Health is only for members of the Seventh Day Adventist Employee Community
• impressive 99% member satisfaction from Discovery Australia
• part of the Members Own Health Funds – an alliance of 18 like-minded not-for-profit funds
• Our Infinite Hospital Promise means that we help lessen out-of-pocket expenses on Medicare approved hospital items with no restrictions, limits or exclusions
• ACA Health is large enough to make these generous payouts when you really need it, not 6 months later.

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Having a parent who was a past employee of an Adventist company means that you are definitely welcome to join us. When you apply to join, you will be asked to provide details of your father’s employment such as employment period and company details.

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Yes. You may also want to contact one of our friendly consultants about limiting or preventing access to some areas of your membership for privacy purposes.

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Definitely, as an employee we would welcome you as our valued member.

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Yes, you would be eligible to join. When you apply to join, you will be asked to provide details of your sister’s employment such as employment period and company details.

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Partners/ spouses, dependants, siblings, parents and grandchildren of eligible persons are welcome to join. Eligible persons include present and past employees of incorporated companies affiliated with the Seventh-day Adventist Church in Australia. See Who can join? for more information.

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No. Membership with ACA Health is open to:

• present and past employees of incorporated companies affiliated with the Seventh-day Adventist Church in Australia including:
  • Sanitarium Health and Wellbeing Company
  • Sydney Adventist Hospital
  • Signs Publishing Company
  • Adventist Development & Relief Agency
  • Adventist Schools
  • Adventist Retirement Villages
• partners/ spouses, dependants, siblings, parents and grandchildren of eligible persons mentioned above are also welcome to join.

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Membership with ACA Health is open to:

• past members
• present and past employees of incorporated companies affiliated with the Seventh-day Adventist Church in Australia including:
  • Sanitarium Health and Wellbeing Company
  • Sydney Adventist Hospital
  • Signs Publishing Company
  • Adventist Development & Relief Agency
  • Adventist Schools
  • Adventist Retirement Villages
• partners/ spouses, dependants, siblings, parents and grandchildren of eligible persons mentioned above are also welcome to join.

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We are pleased to announce that our new partner QBE Travel Insurance is now offering ACA Health members travel insurance at a 25% discount!

Purchase QBE Travel insurance now or get a quote.

Whether you are travelling in Australia or overseas, travel insurance saves you the worry of unexpected medical and travel expenses if things do not go according to plan.

QBE Travel Insurance covers you for the following:

• overseas medical and dental expenses
• cancellation or holiday deferment
• emergency travel arrangements and accommodation
• lost or stolen luggage, personal effects, travel documents and money
• rental vehicle accident excess
• claims excess options
• most sporting/entertainment activities
• extra travel covers also available, including travel delay, missed connection, legal expenses and more.

Terms, conditions and acceptance criteria apply.

Remember, ACA Health can’t pay benefits on medical expenses incurred overseas or for the items listed above, so for peace of mind, it’s a good idea to invest in travel insurance that covers you while travelling both internationally and within Australia.

Please note that the special 25% discount is only available to ACA Health members who purchase this travel insurance online.

If you are travelling overseas for more than 4 months, you could also save money by suspending your ACA Health membership by calling the team on 1300 368 390 or completing a suspension form.

When making decisions about your travel insurance, please read and consider the provider’s Product Disclosure Statement carefully.

Policy arranged by ACA Health Benefits Fund Limited (AR number 341511) an Authorised Representative of QBE Insurance (Australia) Limited. Policy underwritten by QBE Insurance (Australia) Limited ABN 78 003 191 035 (AFSL 239545).

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In recognition of the contribution that those with private health insurance are making to their own healthcare costs, the Federal Government provides a rebate on health insurance to all Australians eligible for Medicare.

You can receive the rebate as either:

• a premium reduction through ACA Health Benefits Fund; or
• a refundable tax rebate in your annual tax return

The rebate is age and income tested. Please click here for age and income tier levels.

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Medicare offers you treatment in a public hospital and that may mean a long waiting list. You will also not be able to choose your own healthcare provider.

If you choose to be a self-insured private patient, Medicare pays a percentage of the schedule fees for private inpatient medical treatment such as those provided by surgeons and anesthetists. As their fees can often be well above the scheduled fees, the resulting gap for you to pay can sometimes be quite large.

Finally, Medicare doesn’t cover those ‘extras’ which arise in life such as dental, optical, and physio treatments.

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Only private health insurance can give you the freedom and control to decide when, where and by whom, hospital and general treatments will be provided to you and your family.

With private health insurance, you gain the benefits of:

• shortened or no waiting lists
• coverage for the ‘medical gap’ balance – the payment required after the Medicare benefit and the schedule for private in-hospital medical services
• extras, such as dental, optical and orthodontic, physiotherapy, ambulance and many other important services.

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We regularly update our website with exciting news. We also keep in contact with our members through monthly newsletters and other publications, so make sure you have your email details up to date.

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We invest 100% of our profits back into making our policies better so our valued members are happier. You and your family are at the core of everything we do, rather than the focus being on what benefits the shareholders, Governments or overseas investors.

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It is our focus on “ethics before profits” which means you can be confident that we are always here to assist and support you, when and where you need it most.

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ACA Health provides you with the support you need by offering well-priced, quality products and benefits of up to four times your annual premium. In addition, you will find that our benefit payments on claims are over double that of other health funds.

Our support extends to exceptional local customer service, online membership management plus the peace-of-mind knowing that we are here to assist you to receive the services you require when you need them.

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We care about our valued members and not profits, giving 100% of the surplus back to you. We provide extras that pay up to twice as much as the big three health funds on optical, dental and orthodontic.

You make the decision on the health provider you need to see and the type of treatment you receive. We are all about choices, value for money, great service and providing you with peace of mind.