- Privacy Statement for Members
- Personal information collection and use
- Contact us
- Acceptance of terms
- User obligations
- Material posted by users
- Intellectual property
- Third party websites and content
- Termination of membership
- Changes to this site
- Governing law
- How to contact us
- New membership join process
- Online claiming process
- Other important information
- Product information
- Customer satisfaction
- Complaints and concerns
- Private health information
What legal information do I need to know?
As much as having a detailed legal page goes against our simple nature, you need to know exactly what you’re signing up to when taking out health insurance.
That’s why we’ve covered the legals that you should be aware of in one area for you to read through.
Before you join or transfer your health insurance to Frank we recommend you read Frank’s Fund Rules.
Frank Health Insurance is brought to you by GMHBA Limited. In this privacy statement, references to ‘Frank Health Insurance’ are references to GMHBA Limited.
This website and the services offered through this website ("Site") are provided by GMHBA Limited trading as Frank Health Insurance ("GMHBA").
References to "we", "us" and "our" are references to GMHBA.
This Site is intended solely for use by Australian residents and holders of valid Australian visas who are eligible to purchase our health insurance products. The materials on this Site have been prepared for general information purposes only. While we have taken reasonable care in compiling this Site, we are not responsible for any action taken by any person or organisation, wherever they are based, as a result, direct or otherwise, of information contained in or accessed through this Site whether such information is provided by us or by a third party. Nothing on this Site should be construed as the giving of advice or the making of any recommendation. This Site should not be relied upon in any way.
The information on this Site may not always be complete and up to date. To the extent permitted by law, we make no warranties, representations or give any undertakings whether express or implied about any of the content on this Site including (without limitation), the timeliness, currency, accuracy, completeness or fitness for any particular purpose of such content or that the results which may be obtained from the use of the Site will be error free or reliable. You agree that your access and use of this Site and its content is at your sole discretion and risk.
To the extent permitted by law, we and any party involved in creating, producing or delivering this Site will not, in any circumstance, be liable for any damages, loss (whether direct or consequential), costs or expenses of any kind arising out of, or referable to, the completeness, timeliness, currency, suitability or accuracy of anything on this Site, or the inability to use this Site, whether caused by our negligence or otherwise.
If you are a Member and have been issued with a username and password to access your online portal on this Site ("Online Portal Rights"), you acknowledge that your Online Portal Rights are personal to you and you must therefore not share your Online Portal Rights with any other person. You agree to keep the username and password secure and confidential and you agree to:
- (a) notify us immediately upon becoming aware of any unauthorised disclosure or use of your username and/or password; and
- (b) be liable for any loss or damage resulting from such unauthorised use or disclosure.
As a User of this Site, you undertake:
- (b) not to knowingly or recklessly contravene, in the course of using this Site, the provisions of any legal or regulatory requirements of any competent authority having jurisdiction over you or over any activity you undertake;
- (c) not to use this Site to make unauthorised attempts to access any of our systems or third party networks;
- (d) not to use this Site to conduct any business or activity or solicit the performance of any activity that is prohibited by law;
- (e) not to use this Site for the transmission or posting of any material such as data, text, software, images, audio and video, including links to that material ("Material") which:
- (i) is defamatory, offensive, or of an abusive, obscene or menacing nature; or
- (ii) infringes third party rights; or
- (iii) is misleading or deceptive;
- (f) not to use this Site for the purpose of causing annoyance or inconvenience to any third party including to other Users;
- (g) not to use this Site to:
- (i) transmit, directly or indirectly, commercial electronic messages (as that term is defined in the Spam Act 2003 (Cth)) which are unsolicited ("Spam") or bulk communications that include Spam; or
- (ii) harvest information about our Users for the purpose of sending, or to facilitate the sending of, Spam;
- (h) to inform us immediately of any claim or action against you for any use of this Site and, on request from us, to immediately cease the act complained of; and (i) to inform us immediately of any changes affecting your details stored in your online portal (such as your address). It is your obligation to ensure that your details stored in your online portal are kept up to date.
Some of the services offered through this Site may allow you to submit, upload, post or transmit Material that may be accessed and viewed by others, including the internet audience in general. By submitting, posting or uploading Material you represent and warrant that you have rights to and are legally entitled to post that material on the internet.
You acknowledge that anything you post onto the Site may appear elsewhere on the internet and/or remain on the internet after you have ended your Online Portal Rights and you accept that while we provide various privacy controls, we cannot guarantee that your Material will not appear elsewhere, be copied, downloaded or used otherwise. If you are concerned about posting any personal and/or private content, you are advised to not use these services.
You are solely responsible for:
- (i) the Material that you post, provide or transmit on or through the Site;
- (ii) any Material that you transmit to other Users; and
- (iii) your interaction with other Users.
We have not assumed, and do not assume, any obligation to monitor any Material posted on our Site. However, you acknowledge and agree that we reserve the right to review, reprint, modify, distribute, remove or delete any Material posted on our Site.
We do not control the Material posted by other Users and as such do not guarantee the accuracy, integrity or quality of such Material.
The opinions expressed by Users on the Site reflect solely the opinions of the individuals who submitted such opinions, and do not reflect our opinions. We are not responsible for the accuracy or reliability of information provided by Users. Any reliance on or use of any Material posted by other Users is at your own risk. Under no circumstances will we, or our employees, officers, directors, shareholders, agents, representatives or affiliates, be liable for any loss or damage caused by your reliance on or use of any Material posted by Users on our Site.
By using our Site you understand and agree that you may be exposed to Material posted by other Users that may be offensive, indecent or objectionable. We will use reasonable efforts to remove any such Material from our Site should you notify us by email here. You acknowledge and agree that we are not liable for either the opinions or the behaviour of other Users, including any Material posted and any defamatory statements or offensive conduct.
We do not claim ownership of any Material that you may post on the Site. However, you agree that by posting any Material on the Site, you grant us, our affiliates and distributors, a royalty free, perpetual right to use, reproduce, modify, adapt, publish, translate, create derivative works from, distribute, publicly perform and display such content worldwide in any medium.
You may not post, provide, transmit, modify, distribute, or reproduce in any way any copyrighted material, trademarks or other proprietary information belonging to others on or through our Site without obtaining the prior written consent of the owner of such proprietary rights.
The copyright in this Site, including, without limitation, in all documents, files, text, images, graphics, devices and code contained in it and in this Site's general "look and feel" is owned, controlled or licensed by or to us. You are authorised to copy and print extracts or documents from this Site (except for any third party owned content which has been identified as such) for your non-commercial use only or to use such extracts or documents as permitted by the Copyright Act 1968 (Cth), provided any such copy, print or other use retains all copyright or other proprietary notices and any disclaimer contained within them. Other than as specifically mentioned above, reproduction of part or all of the content of this Site in any form, including framing, creating any derivative works based on this Site or its content, incorporation into other Sites, electronic retrieval systems or publications is prohibited. No links to this Site may be included in any other Site without our prior written permission.
We cannot guarantee that you have any right to use third party owned content which is available on this Site and you must obtain permission from the third party owner before using or downloading such content. Content which is copyright protected may not be changed (except as permitted by the Copyright Act 1968 (Cth)) nor may any author attribution notice or copyright notice appearing on such content be altered without first obtaining the appropriate consents.
Except for the limited permission set out above, nothing on this Site should be construed as granting any other right or licence.
Our trade marks
Our name and logo have been trade marked and may not be used or reproduced without prior written consent.
This Site may contain third party owned content (e.g. articles or data feeds) and may also include hypertext links to third party owned websites. We provide such third party content and links as a courtesy to Users (and subject to the terms set out above under the heading Copyright). We have no control over any third party owned websites or content referred to, accessed by, or otherwise available on this Site and, therefore, we do not endorse, sponsor, recommend or otherwise accept any responsibility for such third party websites or content, or for the availability of such websites. In particular (but without limitation), we do not accept any liability arising out of any allegation that use or other exploitation of any third party owned content (whether published on this Site or any other website) infringes the intellectual property rights of any person or any liability arising out of the use of or reliance on any information or opinion contained on or in, or an omission from, such third party website or content.
All personal information submitted to us through the Site will be dealt with in accordance with the terms of our Privacy Statement for Members which can be accessed above.
You agree to defend, indemnify and hold us (including our directors, officers and employees) harmless from any and all liability, cost and expense, including reasonable legal fees, relating to:
- (b) to the extent permitted by law, your use of this Site;or
- (c) your violation of any rights (including intellectual property rights) of a third party.
We may, in our sole discretion, terminate or suspend your access to all or any part of this Site for any reason.
These terms and conditions are governed by and must be construed according to the law applying in Victoria. By visiting and using this Site, you unconditionally submit to the jurisdiction of the courts in Victoria.
You can contact us by e-mail, phone or webchat. See our contact page for details.
In these terms, "you" or "your" refers to GMHBA Limited, and "I" or "my" refers to you as the Policy Holder.
By typing “yes” I acknowledge and declare that:
- I have read and accept your terms and conditions of membership (as outlined in the Other Important Information);
- I understand the conditions relating to pre-existing conditions, waiting periods, exclusions, restrictions, excesses and limits;
- I have read and accept your Privacy Statement for Membersand I consent to the use and disclosure of my personal information in accordance with this policy;
- The information I have provided to you via this online application for membership is true and correct;
- The information in this online application for membership is provided with the consent of the individual(s) to whom it relates. I confirm that I have the authority to act on behalf of the individual(s) named in this online application and I have brought your Privacy Statement for Membersto their attention;
- I will make all claims under this policy and will ensure that each claim includes the sensitive information of a spouse/partner or dependant aged 16 years and over only with their consent;
- I understand that my application for membership at the payment of benefits may be declined if any of the information I have provided to you is false;
- I understand that you have the right to accept or refuse my application for membership and upon acceptance of my application for membership I will have engaged you to provide health insurance to me in accordance with my chosen level of cover;
- I understand that cover does not commence until payment is received;
- I am responsible for this policy and I will communicate to all current and future individuals covered by it, the information contained in your terms and conditions of membership, the existence of the Fund Rules, and the fact that those terms, conditions and rules apply to all of your members; and
- I understand that you have the right to amend your terms and conditions of membership and your Privacy Statement for Members.
Declaration by the Policy Holder
In these terms, "you" or "your" refers to GMHBA Limited, and "I" or "my" refers to you as the Policy Holder.
By typing “Yes” I make a claim for services provided and I declare that:
- I have paid for or am liable to pay for the expenses associated with this claim;
- I have no entitlement to claim compensation for the expenses detailed in this claim from a third party including TAC, or WorkSafe;
- The information provided in this claim is made with the consent of the individual(s) to whom it relates and I have the authority to act on behalf of the individual(s) named in this claim;
- I have read and accept your Privacy Statement for Members (as amended from time to time) and have brought the Privacy Statement for Members to the attention of the individual(s) named in this claim;
- I consent to the use and disclosure of the personal information of the individual(s) named in this claim in accordance with the Privacy Statement for Members and the terms and conditions of membership (detailed in Other Important Information) and I have the authority of the individual(s) named in this claim to provide such consent;
- The services were not for the purposes of health screening, superannuation or life insurance entry or a health examination requested by an employer of the individual(s) the subject of the claim;
- I authorise any medical practitioner, hospital or other health service provider to give you full and complete details of all or any medical treatment, hospitalisation, injury, disease, diagnosis, or other personal information (including sensitive information and health information) about me, my spouse/partner or my dependants for the purpose of assessing this claim. I have the consent of the individual(s) named in this claim to give this authority of their behalf; and
- All information supplied with this claim is true and correct.
- I acknowledge your terms and conditions of membership (detailed in the Other Important Information) in making this claim, and confirm that you may deduct monies for unpaid premiums or over payment from any monies due to me.
Frank Health Insurance is a business of GMHBA Limited. In this section, references to "Frank" or "Frank Health Insurance" are references to GMHBA Limited trading as Frank Health Insurance.
Application for membership with Frank
When you sign up for health insurance with Frank it’s important that you provide us with all the information requested to allow us to maintain an accurate record of your membership. It is also important that the information you provide is true and correct. Frank will consider your membership void if you provide false or incorrect information on your membership application. If your membership is terminated, then premiums received in advance for coverage beyond the termination date will be refunded.
You can make changes to your membership anytime.
Frank uses the terms ‘member’, 'spouse/partner' and ‘dependant’ to define the people covered by a membership. Only the person nominated as the ‘member’ can authorise changes to the membership unless the member has previously authorised the spouse/partner to make such changes. Similarly, correspondence issued by Frank will be addressed to the member and it is the member’s responsibility to notify Frank of any change of address by maintaining the address records in the member area. The completion of the application process and the payment of any premium constitutes an acceptance of any conditions laid down in the regulations of the fund, including the Fund Rules and any fund policies, in force at that time or as they may be amended from time to time. A copy of the Fund Rules can be accessed on request by emailing Frank here, but be prepared – the Fund Rules are comparable in size to a telephone directory, and you will need to print it yourself.
Frank reserves the right to refuse admission to membership of any level of health insurance.
In the event of any member or person named on the member’s membership is convicted in a court of law of assault or similar offence against a staff member related to that staff member’s performance of their duties, has obtained or attempted to obtain an improper advantage, for themselves or for any other member or is convicted in a court of law of fraud against Frank, the Board may in its discretion, declare the member’s membership void. The status of the member’s membership will be assessed with any outstanding claims being honoured and any premiums shall be refunded. Any other rights accrued to the member will be forfeited.
When you sign up with Frank Health Insurance, you’ll receive a membership card that identifies you as a member. The card shows your membership number and who is covered. Frank’s contact details are listed on the back of the card. Have your membership card on hand when you arrange admission to hospital, visit a participating provider or when you call Frank with any questions.
A new card may be issued when you make changes to your membership. Please note that an existing card will become invalid whenever a new membership card is issued. Keep your card safe and please advise Frank if your card is lost or stolen.
Communications from Frank by webmail
Frank understands that paperwork is time-consuming, tedious, and bad for trees. On the other hand, Frank understands that members want to be able to access information relevant to their membership easily and quickly.
Frank will provide you with a great deal of information upon joining, including your:
- Membership certificate
- The Private Health Information Statement (PHIS) for the product/s you have bought
- A detailed description of the coverage provided by the products you have bought
- Other Important Information relating to your coverage and your membership
Frank understands that you will need this material one day, which may be years after you join, so Frank will be communicating with members via a secure Webmail. Webmail is contained within the Member area and is accessible only with your Member Number (which is on the back of your member card) and password. The information that Frank sends you this way can be viewed in screen, copied to your hard drive or printed out. Information sent to you via Webmail can be personally sensitive so Frank recommends that you guard your password carefully.
As well as the material listed above, Frank will send to your Webmail account your:
- Annual product and rate change email
- Annual Tax Statement and Lifetime Health Cover Statement
- Any other notifications relevant to your membership
You will be asked to consent to receiving communications electronically during the sign-up process. This is the only way that Frank can communicate with you, and acceptance of this is a condition of membership. Receiving these notifications by snail mail is not an option.
Check your cover
Please contact Frank to check what you’re going to get back before having treatment or going into hospital. Frank has a range of health insurance options at different levels.
Frank members are responsible for ensuring their accounts have sufficient funds available on their nominated direct debit date. Membership will cease when premiums fall into arrears of more than 2 months after the premium due date. To claim benefits a member must be financial at the time of incurring the expense for the service or treatment.
Liabilities of members to Frank
A member can be liable to Frank for unpaid premiums and for overpayments. Overpayments can be made by Frank to a member, either through an error in completing a claim, or an error in processing a claim. If an overpayment is made, the member is liable to repay the amount of the overpayments to Frank on demand. If a member is liable to Frank for unpaid premiums or overpayments then Frank has the right to deduct the amount of that liability from any monies due by Frank to the member on any account.
Frank undertakes audit activities in order to protect members’ assets and contain costs. And as we have online extras claiming with no need to send in receipts we need you to keep your receipts somewhere safe for two years, like your bottom drawer just in case our Audit team wants to check up. But don’t send them to us unless we ask. And from time to time, in the general interest of members, a Frank representative may contact you with a request for assistance to monitor costs – whether relating to benefits paid or charges raised by health care providers. Your co-operation with such requests is critical to our cost containment efforts, and will be treated in a completely confidential manner.
You may cancel your Frank Health Insurance cover at any time, please note:
- If you cancel your Frank Health Insurance cover within 30 days of joining, you will receive a full refund of any premiums received. The refund will be paid into the same account or card that was used to Debit. Please refer to our Direct Debit service agreementfor more information.
When to contact Frank
If you have less than 12 months membership on your current hospital cover, make sure you contact us before you are admitted to hospital and find out whether the pre-existing condition waiting period applies to you. We need about 5 working days to make the pre-existing condition assessment, subject to the timely receipt of information from your treating medical practitioner/s. Make sure you allow for this time frame when you agree to a hospital admission date. If you proceed with the admission without confirming benefit entitlements and we subsequently determine your condition to be pre-existing, you’ll have to pay all outstanding hospital charges and medical charges not covered by Medicare.
Waiting periods exist to protect members from claims made by those who join Frank or increase their level of cover because they have a condition or illness that may require treatment.
Waiting periods will apply to:
- New memberships (previously uninsured);
- Additions to a membership (unless the addition/s has already served all waiting periods with Frank or another insurer) except newborns and adopted and permanent foster children where the family membership has been in existence for at least 2 months, and where the addition/s has already served all waiting periods with Frank or another insurer,
- Existing Frank memberships, and transfers to Frank from another insurer where:
(i) the level of cover and/or benefit entitlement is upgraded or increased; (ii) any hospital or extras service was not covered by the previous insurer and/or; (iii) the waiting periods have not been completed.
Where a member is transferring from another product or from another health insurer, waiting periods for hospital treatment that was not covered under the old policy are:
- 12 months - obstetric or pre-existing condition (other than for psychiatric, rehabilitation or palliative care).
- 2 months - psychiatric, rehabilitation or palliative care.
- 2 months - any other benefit for hospital treatment.
- 0 days (accidents must occur after joining) - accidents.
Where a member is transferring from another product or from another health insurer, waiting periods for extras that were not covered under the old policy are:
- 12 months - major dental, podiatric surgery, orthotics, hearing aids and blood glucose monitors (where offered in the cover).
- 6 months - optical benefits.
- 2 months - any other extras benefit.
The above waiting periods also apply to previously uninsured members. For treatment that was covered under the old policy, at the same or higher level than the new policy, waiting periods are no longer than the balance of any unexpired waiting periods for the benefit that applied to the person under the policy.
For treatment that was covered under the old policy but at a lower level, the member is entitled to the lower benefits on their old cover during the waiting period.
Existing members with at least 12 months membership in total across their old and new cover are entitled to the lower benefits on their old cover during the waiting period.
In an emergency, we may not have time to determine if you are affected by the pre-existing condition rule before your admission. Consequently if you have less than 12 months membership on your current hospital cover you might have to pay for some or all of the hospital and medical charges if:
- you are admitted to hospital and you choose to be treated as a private patient; and
- we later determine that your condition was pre-existing.
Pre-existing conditions (PEC)
A pre-existing condition is one where signs or symptoms of your ailment, illness or condition, in the opinion of a medical practitioner appointed by Frank (not your own doctor), existed at any time during the six months preceding the day on which you purchased your hospital insurance or upgraded to a higher level of hospital cover and/or benefit entitlement.
The only person authorised to decide that a condition is pre-existing is the medical practitioner appointed by Frank. However, the medical practitioner appointed by Frank must consider any information regarding signs and symptoms provided by your treating medical practitioner/s.
The pre-existing condition rule still applies even if your ailment, illness or condition was not diagnosed prior to joining the hospital cover. The only test is whether or not, in the 6 months prior to joining your current hospital cover signs and symptoms:
- were evident to you; or
- would have been evident to a reasonable general practitioner if a general practitioner had been consulted.
Waiting periods – PEC
A special waiting period applies to obtain benefits for hospital treatment for new members who have pre-existing conditions. Waiting periods also apply to existing members who have recently upgraded their level of hospital cover. If the ailment, illness or condition is considered pre-existing:
- new members must wait 12 months for any hospital benefits (other than psychiatric, rehabilitation and palliative care).
- members transferring/upgrading to a higher hospital cover must wait 12 months to get the higher hospital benefits (other than psychiatric, rehabilitation and palliative care).
Existing members with at least 12 months membership in total across their old and new cover are entitled to the lower benefits on their old cover.
- Previously insured with Frank Child and student dependants are covered up until they turn 25 years of age. After their 25th birthday they have 2 months to organise health insurance, but their new membership will start from the date they turned 25. They won’t have to serve waiting periods when transferring to an equivalent or lower level of insurance.
- Previously insured with another insurer Student dependants whose parents are members of another registered health insurer and were previously insured with their parents, may sign up with Frank within 30 days of ceasing to be a dependant, on a level of cover equal to or less than that held by their parents, without serving waiting periods. An acceptable transfer certificate and claims history must be received by Frank.
Planning for a child
If you’re planning for a family and want private hospital cover for obstetrics, you’ll need to be on Frank's Top Hospital (Silver+) for at least 12 months before you have a child to make sure that all of your waiting periods have been served.
If you’re currently on a singles membership and would like your baby to be covered by Frank, you will need to upgrade to a single parent or family membership from the date your baby is born. Your baby will not incur waiting periods. If you’re currently on a couples membership, you can add your baby when he or she is born and your membership will automatically update to family cover. You’ll need to contact Frank to add your baby to your cover.
Excess - Hospital only
An excess is the fee you pay in return for lower premiums. An excess applies when you are admitted into hospital as a private patient.
For example, if Frank’s full benefit for a hospital stay was $5,000 and your excess is $500 the benefit will be adjusted to $4,500. If the same person is admitted into hospital again in the same year they would not pay another excess. When Frank says ‘year’ Frank means calendar year (Jan 1 to Dec 31).
The most you'll pay for excess each calendar year varies based on your level of cover. Please refer to your product information for further details.
You cannot claim for the following:
- Benefits are only payable on itemised and original account/s. Account/s which have been altered in any way will not be accepted. Providers are required to re-issue any account/s or endorse any alterations.
- Natural remedies (includes Modifast & Optifast).
- Food supplements.
- Dental procedures carried out and charged direct to the member/dependant by a dental mechanic, other than an advanced dental technician.
- A range of dental procedures when provided on the same day e.g. a filling on a tooth that has been removed.
- Dental procedures where a limit on the number you can have has been exceeded.
- Dental procedures unless tooth identifications (ID) are supplied by the provider.
- Services/treatment for which the member and/or dependant has a right to claim damages or compensation from any other person or body.
- Treatment where the member and/or dependant is eligible for free treatment under any Commonwealth or State Government Act.
- Services/treatment rendered more than 12 months prior to the date of claiming.
- Services/treatment which is not covered by your membership and/or is rendered while the membership is in arrears or is suspended.
- Services/treatment rendered by a practitioner not in private practice and/or not recognised by bodies approved by Frank.
- Hiring of equipment (unless otherwise stated).
- Services not rendered face to face (e.g. remotely over the phone).
- Foot orthotics unless they are custom made and provided by a registered podiatrist.
- Additional medical gap benefits where the medical service is rendered by a medical practitioner employed full-time in the public sector.
- Benefits for lifestyle related services that primarily take the form of sport, recreation or entertainment.
- Benefits, payable under a hospital or extras cover shall not exceed the fees and/or charges raised for any treatment and/or services covered for benefits under the relevant cover, after taking into account benefits paid from any other source.
- Benefits for services on treatment received overseas.
Restrictions Benefits may not be paid or may be paid at a lower level where:
- you have already claimed the maximum allowable benefits during a specified period.
- you have transferred to a Frank extras cover from an extras cover by a different insurer and have previously claimed for the service/ treatment.
- the health care account has been incompletely, incorrectly or inappropriately itemised.
- you have an excess to pay on your chosen level of cover.
- Frank believes that a patient, following a review of the case (on the basis of information provided by the hospital either internally or using an agreed independent source), is not receiving acute care after 35 days continuous hospitalisation. If this is the case, Frank benefits will be reduced to Nursing Home Type Patients benefits and will be paid in accordance with the default benefit determined by the Department of Health & Ageing. All Nursing Home Type Patients are required to pay part of the cost of hospital accommodation.
- the service/s is subject to a waiting period or other limit which has not been served/met.
- surgery is performed in hospital by a registered podiatrist/podiatric surgeon. Contact Frank for details.
- no MBS item number is provided by the GP/specialist e.g. cosmetic surgery.
- professional services are provided to the provider or members of the provider’s family or to a provider’s business partner’s family members or any other people not independent from the practice. Family members include: wife/husband, brother/sister, children, parents, grandparents, grandchildren. If this is the case, only wholesale material costs involved in the provision of the service are subject to benefits.
- the claim is for cosmetic surgery. Limited benefits may apply on hospital covers for cosmetic surgery, depending on the medical justification for the surgery.
- the claim is for additional medical gap benefits, where the medical service is rendered by a medical practitioner employed full-time in the public sector.
- there is more than one claim made to the same provider on the same day. But you can claim for more than one service on the same day if performed by different providers. Confused…? It’s simple, want to go to Spiro the chiro and Jenny the massage therapist on the same day? You can with Frank.
You can suspend your Frank cover for periods of overseas travel provided you:
- have at least 12 months continuous unsuspended cover with Frank prior to departure; and
- plan to be overseas for at least 2 months; and
- have paid premiums to the date of departure; and
- apply for suspension of your cover prior to departure.
You’ll be required to resume your suspended cover within 2 months of returning to Australia and premiums must be paid from the date of re-entry. Your passport, boarding pass or a statutory declaration may be required to be presented to Frank as proof of travel.
A 3 year maximum cover suspension period for overseas travel applies. Only the balance of outstanding waiting periods need to be served upon resumption of your membership.
Please note that your Certified Age of Entry (CAE), for the purposes of calculating Lifetime Health Cover (LHC) loading, may be affected by periods of absence of 3 years or longer. See the LHC section for details.
Frank Health Insurance has negotiated special agreements with participating private hospitals which provide members (subject to any exclusions and/or restrictions) with hospital cover for accommodation (shared and/or private room depending on level of hospital cover), theatre, delivery suite, intensive/coronary care and a range of services provided by the hospital (subject to any excess). These agreements aim to maximise your cover and minimise your out of pockets. Find an up to date list of participating private hospitals here, however it is subject to change without notice. Check with us on 1300 4 FRANK (37265) before confirming your hospital admission.
Fixed benefits are payable for hospitalisation in non-participating private hospitals. Contact Frank on 1300 4 FRANK (37265) for further details as treatment in a non-participating private hospital will result in out-of-pocket expenses. Limited benefits may apply to cosmetic surgery and high cost drugs. Drugs purchased outside of the hospital are not included.
Preventative Dental Sublimit
Preventative dental includes general dental treatment like checkups, cleaning and fluoride treatments but does not include x-rays or fillings.
This sublimit applies to dental item numbers: 011, 012, 013, 014, 015, 016, 017, 018, 111, 113, 114, 115 and 121.
Other preventative dental rules:
- Maximum of one examination or consultation item per visit. Examination and consultation items include 011-017
- Maximum of 3 checkups per person per calendar year. Checkups include items 011, 012 and 014.
- Maximum of 3 scale and cleans per person per calendar year applies. Scale and cleans includes items 111, 114 and 115.
The preventative dental limit is included within the overall dental limit.
Crown & Bridge Sublimit
Crowns cover the tooth completely, fitting just at the gum line to protect the remaining tooth. Crowns become necessary when teeth that are severely broken down from decay or fracture and can’t support a filling.
Crowns include items 611-629
Bridgework is used to replace missing teeth by bridging the gap with a false tooth using the surrounding teeth as a support.
Bridgework includes items 642-643
Indirect restorations are a type of filling that is made outside of the mouth by using a plaster cast model of your tooth.
Indirect restorations include items 541-555
Other things you need to know about dental cover
Frank doesn’t cover the following items:
- 018 - Written report (not elsewhere included). Benefits are payable when billed by a specialist dentist or orthodontist and not included in another item number billed by them.
- 019 - Letter of referral
- 044 – Collection of specimen for pathology examination
- 047 – Saliva screening test
- 061 – pulp testing
- 085 - Electromyographic recording
- 086 - Electromyographic analysis
- 119 - Bleaching, home application - per arch
- 122 - Topical remineralizing and/or cariostatic agents, home application - per arch
- 123 - Concentrated remineralizing and/or cariostatic agents, application - single tooth
- 131 - Dietary advice
- 141 - Oral hygiene instruction
- 165 - Desensitizing procedure - per visit
- 237 - Guided tissue regeneration – membrane removal Benefits are payable when billed by a specialist dentist
- 238 - Periodontal flap surgery for crown lengthening - per tooth Benefits are payable when billed by a specialist dentist
- 332 - Ostectomy - per jaw Benefits are payable when billed by a specialist dentist. A maximum of 2 per visit applies.
- 384 - Repositioning of displaced tooth/teeth
- 664 - Fitting of bar for denture - per abutment
- 666 - Prosthesis with metal frame attached to implants - per tooth
- 668 - Fixture or abutment screw removal and replacement
- 669 - Removal and reattachment of prosthesis fixed to implant(s) - per implant
- 711* Complete maxillary denture
- 712* Complete mandibular denture
- 719* Complete maxillary and mandibular dentures
- 721* Partial maxillary denture - resin base - 1-4 teeth
- 721A* Partial maxillary denture - resin base - 5-8 teeth
- 721B* Partial maxillary denture - resin base - 9 or more teeth
- 722* Partial mandibular denture - resin base - 1-4 teeth
- 722A* Partial mandibular denture - resin base - 5-8 teeth
- 722B* Partial mandibular denture - resin base - 9 or more teeth
- 727* Partial maxillary denture - cast metal framework - 1-4 teeth
- 727A* Partial maxillary denture - cast metal framework - 5-8 teeth
- 727B* Partial maxillary denture - cast metal framework - 9 or more teeth
- 728* Partial mandibular denture - cast metal framework - 1-4 teeth
- 728A* Partial mandibular denture - cast metal framework - 5-8 teeth
- 728B* Partial mandibular denture - cast metal framework - 9 or more teeth
- 927 - Provision of medication/medicament
- 941 - Local anaesthesia
- 944 - Relaxation therapy
- 949 - Treatment under general anaesthesia/sedation
- 981 - Splinting and stabilisation - direct
- 982 - Enamel stripping - per visit
- 990 - Treatment not otherwise included (specify)
- 999 – GST
* Frank Extras 50% and Frank Simple Essentials 60 Bundle $750 (Basic +) do pay a benefit on these item numbers.
There are also some dental procedures that Frank won’t cover when claimed with other items, eg if your bill says you had a tooth filled and removed on the same day, Frank won’t pay for the filling.
It’s complicated and we don’t come across it often so we decided not to bore you with these rules here. If you’re worried about what your out-of-pocket dental expenses might be, contact Frank for information on your refunds. Just make sure you know the dental item numbers for the treatment you’re getting - Frank will need them to identify the relevant refunds.
You can’t claim on the following:
- Dental procedures carried out and charged direct to the member/dependant by a dental mechanic, other than an advanced dental technician.
- A range of dental procedures when provided on the same day e.g. a filling on a tooth that has been removed.
- Dental procedures where a limit on the number you can have has been exceeded.
- Dental procedures unless tooth identification numbers (ID) are supplied by the provider.
If you go into hospital, and have surgery performed by an orthopaedic surgeon, then this is all taken care of with your hospital cover. Your extras cover doesn't get used.
If the surgery is performed by an approved podiatric surgeon (there are only a few in Australia), then your Lots Extras cover will help cover their fees. The hospital expenses, theatre, etc. are still covered by your hospital cover.
Frank’s approved podiatric surgeons are:
- BOURS, Paul NSW
- BRYANT, Alan WA
- BRYANT, Jennifer WA
- COOK, Leah NSW, QLD
- DOBIE, Valerie C. SA
- GILHEANY, Mark ACT, NSW, VIC
- GRAY, Lee WA
- HERMANN, Robert QLD,SA,TAS
- HORTA, Mario WA
- KINGSFORD, Andrew Charles NSW, QLD, VIC
- LAFFERTY, Damien A. NSW
- MARINO, Nicolas WA
- OZCAN, Haydar NSW
- PETERS, Jeff WA
- PICKERING, John R SA
- PIGLIADO, Frank WA
- SALERNO, Angelo SA
- SMITH, Simon E. VIC
- TARANTO, Julie WA
- TARANTO, Michael J. WA
- VAN ESSEN, Andrew SA
- WADE, Paul SA
- WEIR, John L. SA
Frank Health Insurance is brought to you by GMHBA Limited, proud to be a compliant member of the Private Health Insurance Code of Conduct. The Private Health Insurance Code of Conduct is designed to help you by providing clear information and transparency in your relationships with health insurers. The Code covers four main areas of conduct in private health insurance ensuring:
- You receive the correct information on private health insurance from appropriately trained staff;
- You are aware of the internal and external dispute resolution procedures with Frank Health Insurance;
- Policy documentation contains all the information you require to make a fully informed decision about your purchase and all communications between you and Frank Health Insurance are conducted in a way that ensures appropriate information flows between the parties; and
- All information between you and Frank is protected in accordance with national and state privacy principles.
You can download the Code at www.privatehealthcareaustralia.org.au/codeofconduct/
Frank Health Insurance is required to comply with Community Rating. Community Rating means Frank will not discriminate between members on the basis of their health or any other reason described below - basically equal opportunity for private health insurance.
When making decisions in relation to members, Frank will disregard the following:
- The suffering by the member of a chronic disease, illness or any other medical condition.
- The gender, race, sexual orientation or religious belief of a person.
- The age of a member, except in relation to Lifetime Health Cover loadings.
- Any other characteristic of a person (including but not just matters such as occupation or leisure pursuits) that are likely to result in an increased need for extras or hospital treatment.
- The frequency with which a person needs extras or hospital treatment.
- The amount, or extent, of the benefits to which a member becomes, or has become, entitled during a period.
We value the relationship between Frank and our members. An important part of this relationship is our commitment to protecting the personal information entrusted to us by our members. This commitment is documented in our Privacy Statement for Members
Frank thinks that honesty is the best policy. Frank wants you to share what is on your mind so we can help resolve it.
Just so you know what to expect of Frank this is the process for dealing with complaints:
- Talk to a Frank representative. You can talk to a representative by calling 1300 516 450 or emailing [email protected]. We respond to all our phone calls immediately, and will follow up all e-mails within 2-5 working days.
- Write to us. We will provide an acknowledgement within 5 working days for written correspondence. Where the matter is complex we will attempt to finalise within a month. However where the difficulty of the matter precludes this, we will inform you of the progress.
- Write to the Member Services Review Committee (MSRC). If after receiving our response you are still not satisfied, you can write to the Member Services Review Committee (MSRC). We have appointed a panel of senior management who meet weekly to discuss any issues received from members. The aim of the MSRC is to listen to you and to provide decisions that are fair and equitable for all our members. You will receive an acknowledgement of your correspondence within five working days of the committee’s weekly meeting. You are welcome to write to the MSRC by email to [email protected].
- Contact our Customer Relationship Team. If you require further clarification about the decision made at the MSRC, please email us at [email protected]. We will acknowledge your correspondence within five days of receipt. Where the matter is complex we will attempt to finalise within a month, however where the complexity of the matter precludes this, we will keep you informed of the progress.
If you’re still dissatisfied with the outcome, free independent advice is available from the Private Health Insurance Ombudsman. To make a complaint, contact the Commonwealth Ombudsman at www.ombudsman.gov.au.
State of the health funds report
The Private Health Insurance Ombudsman publishes an annual State of the Health Funds Report. This independent report compares service and productivity of private health insurers.
Download the report from www.ombudsman.gov.au/about/private-health-insurance
Private Health Information Statements
A Private Health Information Statement (PHIS) is available for every product of Frank. Upon joining, the PHIS' for the Frank products which you have purchased will be sent to your Frank Webmail, and you will receive a notification stating that the PHIS' are available in your Webmail. An up to date PHIS will be forwarded to your Webmail at least once per year from where it can be read or printed.
Recommendation or endorsement
Frank does not offer health or medical services or advice. Frank does not recommend or endorse any medical practitioner, dentist, therapist, hospital, health or medical service provider, treatment, therapy or the use of any appliance or prosthetic. Frank does not endorse or make any representation whatsoever as to the appropriateness or effectiveness of any service or goods for which a benefit is paid. Members should make and rely on their own enquiries and seek any assurance or warranties directly from the provider of the service or product.
Medicare Levy Surcharge
The Medicare levy surcharge (MLS) is a surcharge on individuals and families on higher incomes who don’t have eligible private hospital cover.
The MLS is an additional tax that Aussies need to pay if they don’t have eligible private hospital cover and have a taxable income over $90,000 as a single or 180,000 as a couple/family. It used to be an extra 1% tax for all high-income earners, but now it can be up to 1.5% extra tax depending on your income. The surcharge is in addition to the normal 2% Medicare Levy.
People may have to pay the Medicare levy surcharge if they or any of their dependants do not have eligible cover and they are:
- A single person - without dependent children - with a taxable income (including any reportable fringe benefits of $1,000 or more) greater than $90,000
- A family - including a couple and single parent - with a combined taxable income (including any reportable fringe benefits of $1,000 or more) greater than $180,000 (increasing by $1,500 per dependent child, after the first child).
|Medicare Levy Surcharge|
|Nothing to pay||Tier 1||Tier 2||Tier 3|
|Singles||$90,000 or less||$90,001-105,000||$105,001-140,000||$140,001 or more|
|Couples/Families (Increases by $1,500 per child after your first)||$180,000 or less||$180,001-210,000||$210,001-280,000||$280,001 or more|
|Medicare Levy Surcharge|
|All ages||0.0%||1.0% (unchanged)||1.25%||1.5%|
Note: The income tiers will increase each year. We'll let you know what they are when the Government decides.
If you’re thinking about dropping your hospital cover, be aware if you do change your mind and want to take it out again then whichever health insurer you join then you may need to re-serve your waiting periods plus Lifetime Health Cover loading may apply.Contact your tax adviser or the Australian Taxation Office for further details about the Medicare levy surcharge.
The Australian Government Rebate on Private Health Insurance
The Australian Government Rebate on Private Health Insurance is available to those who have full Medicare eligibility and earn under $140, 000 for singles and $280,000 for families/couples or single parents. The table below gives you the full details.
|If you are:||And your combined taxable income is:|
|Single||$90,000 or less||$90,001 - $105,000||$105,001 - $140,000||$140,001 or more|
|Couple/Family/Single Parent (increases by $1,500 per child after your first)||$180,000 or less||$180,001 - $210,000||$210,001 - $280,000||$280,001 or more|
|Then your Federal Government Rebate Tier is:|
Note: The income tiers will increase each year. We'll let you know what they are when the Government decides.
You can claim the rebate as a reduction to your premiums, as a tax rebate when you lodge your annual tax return or as a direct payment from the Government through any Medicare office.
The easiest way for you to claim the rebate is to complete the application form for the Australian Government Rebate on Private Health Insurance during the application process with Frank. Frank will then deduct the rebate from your premiums.
If you don’t have eligible private hospital insurance and earn over $90,000 for singles and $180,000 then you’ll have to pay the Government’s Medicare Levy Surcharge. So Frank’s low cost covers might even save you tax.
Lifetime Health Cover loading
The Federal Government introduced the Lifetime Health Cover (LHC) initiative on the 1st of July 2000. From this date, anyone who joins a hospital cover of a registered health fund will be given a Certified Age at Entry (CAE) status - which represents their age when they first joined a hospital cover after the 1st of July 2000.
If you joined a hospital cover before this date you are assigned a CAE of 30 and you’ll pay the base rate (the lowest premium) for your hospital cover. The premiums returned on the Quick Quote are quoted at base rates. If you joined after this date and are aged 31 or over, and therefore have a CAE of over 30, you’ll pay a 2% loading for each year your CAE is above 30 to a maximum loading of 70%. Where you have had to pay a LHC loading, and have done so for a continuous period of 10 years, the loading will no longer apply on the day after the last day of the 10 year period. If you’re over the age of 30, the sooner you take out hospital cover, the less you’ll pay later.
In summary, the Federal Government’s LHC loading applies if you were aged 31 or over on the 1st of July just passed and are taking out hospital cover for the first time. Under LHC, in addition to the rates on the Quick Quote, a 2% loading is applied for each year you are aged over 30 when you join. The Australian Government Rebate on Private Health Insurance may apply to your total premium depending on your income, including any LHC loading. Lifetime health cover applies to hospital cover and does not apply to extras.
For more information explaining Lifetime Health Cover click here.
Age-Based Discounts on Private Health Insurance *format the heading to be same as all the others*
Australians aged 18-29 years of age will be eligible to receive up to 10% discount on their private hospital insurance premiums
- From 1 April 2019, insurers can offer a discounted premium on hospital cover of 2% each year you are aged under 30 from when you first purchase hospital insurance. This discount is up to a maximum of 10% for 18-25 year olds
- For a member on a $1,200 policy the savings will be up to $120
- You can retain your age-based discount until you’re 41 providing you remain on the same cover. These discounts will then be gradually phased out after you turn 41.
- The discount is only available on selected products but is available to new and existing policy holders.
For more information explaining Age-Based Discounts click here*.
Periods of absence
As members may need to discontinue their hospital cover membership for brief periods, lifetime health cover allows a period or periods of absence through a member’s lifetime without affecting their CAE. However, after a total of two years absence, their CAE will increase by one year for each additional full year of absence. Members will need to re-serve waiting periods when they return to Frank.
Approved periods of suspension, which will not affect a member’s CAE are explained under ‘Suspensions’ in the Product Information section
All about Claiming
Damages or compensation
Where you or your dependants have a right to claim damages or compensation from any other person or body, you are required to pursue that entitlement prior to lodging a claim for benefits with Frank. A claim should only be lodged with Frank if action at law is unsuccessful. A letter of denial is required. This includes WorkCare, TAC, public liability and third party claims.
How to claim with Frank:
- Hospital claims - are paid from Frank direct to the hospital. You will need to present your membership card upon admission, and you will not need to contact Frank in most cases. Details of all claims paid on your behalf can be viewed in your online member area.
- Extras Claims - When you have Frank extras cover you can use your Frank membership card to claim electronically on-the-spot when this facility is available at your health care provider. After the service has been provided, your membership card will be swiped through the terminal, your claim details entered and your claim will usually be processed electronically within seconds. Once your claim is authorised by Frank, you simply pay any difference between the full fee for the treatment and the amount paid by Frank. If there is an unexpected rejection of your claim at the point of service, your provider should contact Frank on 1300 4 FRANK (37265) to clarify the issue at the time of the service taking place.
- If your service provider does not have an electronic terminal, you will need to pay your account with your service provider in full and then claim online with Frank. Simply visit the Frank website and log in to your member area. You will need to keep your receipt for 2 years and send to Frank if requested during an audit in this time.
- In some situations you may not be able to claim on-line, and you will need to submit your claim via snail mail. You will need to submit your claim via snail mail if the service occurred more than 6 months before the date of claiming, or the service was for orthodontic treatment.
To submit a claim by snail mail, Frank needs the following information:
- A completed claim form; and
- The fully itemised health care account/s, and the original receipt/s. Photocopies/facsimiles of accounts and/or receipts cannot be accepted.
Paid accounts/ bills
Benefits for paid accounts will be deposited directly into the members’ previously nominated bank account.
Unpaid accounts (other than hospital accounts)
Claims for unpaid accounts will not be paid.
Medical benefits cover your fees payable to surgeons, anaesthetists and other professionals who may bill you separately from your hospital bills. If your medical practitioner chooses to use the Access Gap Cover scheme, the medical practitioner will bill Frank directly and then Frank will pay the medical practitioner. If your medical practitioner chooses not to use Access Gap Cover, claims for medical benefits can only be paid after your claim for medical services has been assessed by Medicare and your claim for hospital benefits has been assessed and paid. Our benefits are not payable for services rendered when the patient is not a hospital inpatient.
Important Information prior to signing up
Transferring from another health insurer
You can transfer your health insurance from another health insurer to Frank without serving any new waiting periods provided that you:
- have served all waiting periods with your previous health insurer; and
- transfer to any equivalent or lower level of cover within 30 days of your membership ceasing with your previous health insurer.
Frank recommends that your cover starts immediately after your previous cover ends. If your new cover with Frank provides higher benefits or benefits for services not covered by your previous health insurer, you’ll be regarded as a new member for those higher benefits, and/or additional services, and will be required to serve the waiting periods - but only for the higher benefits/additional services.
If you transfer to Frank from another health insurer before completing the waiting periods with your previous health insurer, you’ll need to serve the balance of the waiting periods with Frank (see earlier heading ‘waiting periods’).
When you transfer to Frank your benefit entitlements may be adjusted by benefits already paid by your previous health insurer. Under lifetime health cover, continuity of a member’s/partner’s certified age at entry (CAE) is possible when transferring from another Australian registered private health insurer.
Membership for non-residents of Australia
Frank hospital covers are designed for people who have full Medicare eligibility. These covers will not meet the cost of public or private hospital treatment, medical treatment or diagnostic services for people who do not have full Medicare eligibility. People who do not have full Medicare eligibility should contact Frank on 1300 4 FRANK (37265) to discuss appropriate health insurance arrangements.
Frank congratulates you on migrating to Australia and hopes that it all works out for you. Again, you will want to be eligible for Medicare before you sign up to any of Frank’s products.
Migrants who sign up with Frank within 2 months of arriving in Australia shall receive the following concessions:
- No 2 month waiting period for any level of hospital cover.
- No 12 month waiting period for pre-existing conditions/illnesses will apply to Basic Hospital (Basic+) cover.
All other waiting periods for hospital and extras will apply. Proof of residency may be required by Frank. Lifetime health cover regulations also apply to migrants. Contact Frank for details.