Not So Fine Print

We like to be upfront and honest with our members at all times. Here’s some important information that we think you should know about our membership and policies.

Membership eligibility

ACA Health welcomes membership from past members, and those who currently work or who have worked for incorporated companies affiliated with the Seventh-day Adventist Church and appointed Local Church Officers in Australia. This includes your partner/spouses, dependents but also other family members, i.e. siblings, parents and grandchildren.

Please note that most Adventist organisations were incorporated between 2000 and 2004. If you were employed by an Adventist entity before 2000, you may not be eligible to join ACA Health. Please contact us to confirm your eligibility before joining.

For more information on joining ACA Health, please contact us.

Waiting periods

All private health insurers have waiting periods to ensure people don’t constantly move funds, which would result in higher costs for everyone.

At ACA Health, there are certain situations where there is no waiting period if:

• you leave another fund and join ACA Health within 2 months. You may be able to claim immediately up to the level of your previous cover (subject to financial continuity).
• you add a newborn to a family membership, the baby would be covered immediately. However, if you are on a singles cover, you would need to upgrade your cover to a family membership at least 2 months prior to the actual birth of the baby to ensure immediate cover.

ACA Health’s waiting periods on all hospital and general treatment apply if:

• you are joining a health fund for the first time. However, this does not apply if you have an accident and require hospital and/or ambulance treatment if it is not related to a pre-existing condition/s.
• you already have a medical condition/s (pre-existing condition) when you join ACA Health. There will be a 12-month waiting period before benefits can be paid on claims relating to that condition.

• you add a spouse or dependent child to a membership (changing from single to family membership). Unless they are transferring from another fund within 2 months (as outlined above).

See waiting periods for more information or contact 1300 368 390.

Cover Limitations

Private Hospital Cover

When choosing this quality level of service, co-payments will be applied for accommodation and theatre if you actually need to go into hospital.

To find out more, click here for the full product summary.

Basic Hospital

This level of cover allows treatment in a public hospital as a private patient. If you are admitted to a private hospital, be prepared for significant out-of-pocket expenses.

To find out more, click here for the full product summary.

Extras Cover

We’ve kept the range of benefits to just the essentials you told us you wanted, so this helps to keep the cost of the premiums down on our general treatment products. For more information on policy limits, click Complete Ancillary or Ancillary Lite here to go to the full product summary.

For all of our policies, please refer to the ‘What’s not covered’ section included in the ‘Individual Product Summaries’ located at the bottom of each product summary on the Products page.

Other important policy information

Lifetime Health Cover – The government introduced the Lifetime Health Cover to encourage people to take out private insurance earlier in life and maintain their cover. If you are over the age of 31 and haven’t had consistent private health cover, you may have to pay more for your health insurance. See Lifetime Health Cover for more details.

Cooling Off Policy – If you are a new member, you may like to consider ACA Health’s Cooling Off Policy (within a period of 30 days from the commencement date of your policy).

Claims Declaration

I declare and warrant that all information gathered regarding to my claims are true and correct.

I authorise the provider or any other authorities concerned with my or my dependant’s injury, disease or ailment, or the treatment or diagnosis, to supply all relevant information to the fund, including for the purposes of audit, if required by the fund.

Benefits & Conditions Benefits for the same service and person are not payable on more than one policy.

The payment of benefits is subject to ACA Health Benefits Fund Rules and policies, as amended from time to time.

The Fund Rules contain the terms and conditions of your membership.

A summary of the main fund rules is contained in our Policy Booklet. A copy of our policy booklet is available from our office or downloaded from our online policy guide.