Legals

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.

Fund Rules

Before you join or transfer your health insurance to Frank we recommend you read Frank’s Fund Rules.

Privacy Statement for Members

Frank Health Insurance is brought to you by GMHBA Limited. In this privacy statement, references to ‘Frank Health Insurance’ are references to GMHBA Limited.

View our privacy statement for members

Direct Debit Service Agreement

View our direct debit service agreement

Digital Platform Terms of Use

View our digital platform terms of use

How to contact us

You can contact us by e-mail, phone or webchat. See our contact page for details.

New membership join process

Acknowledgement

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:

1. I have read and accept your terms and conditions of membership (as outlined in the Important Information Guide);
2. I understand the conditions relating to pre-existing conditions, waiting periods, exclusions, restrictions, excesses and limits;
3. I have read and accept your Privacy Statement for Members and I consent to the use and disclosure of my personal information in accordance with this policy;
4. The information I have provided to you via this online application for membership is true and correct;
5. 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 Members to their attention;
6. 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;
7. 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;
8. 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;
9. I understand that cover does not commence until payment is received;
10. 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
11. I understand that you have the right to amend your terms and conditions of membership and your Privacy Statement for Members.

Online claiming process

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:

1. I have paid for or am liable to pay for the expenses associated with this claim;
2. I have no entitlement to claim compensation for the expenses detailed in this claim from a third party including TAC, or WorkSafe;
3. 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;
4. 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;
5. 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 Important Information) and I have the authority of the individual(s) named in this claim to provide such consent;
6. 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;
7. 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
8. All information supplied with this claim is true and correct.
9. 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.

Other Important Information

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.

Membership card

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.

Arrears

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.

Audits

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.

Refunds

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 agreement for more information.

Product 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

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.

Emergency admissions

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.

Dependants

1. 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.
2. 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.

Exclusions

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.

Suspensions

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.

Participating providers

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.

Non-participating hospitals

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.

Dental Rules

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

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.

Podiatric Surgery

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.

Customer Satisfaction

Code of Conduct

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/

Community Rating

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:

1. The suffering by the member of a chronic disease, illness or any other medical condition.
2. The gender, race, sexual orientation or religious belief of a person.
3. The age of a member, except in relation to Lifetime Health Cover loadings.
4. 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.
5. The frequency with which a person needs extras or hospital treatment.
6. The amount, or extent, of the benefits to which a member becomes, or has become, entitled during a period.

Privacy

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

Complaints or concerns

So you know what to expect of Frank, here is our process for dealing with complaints.
Frank thinks that honesty is the best policy. Share what is on your mind so we can help resolve it.

1. Talk to a Frank representative.
   Call us on 1300 4 FRANK (37265) or email frank@frankhealthinsurance.com.au. A Frank representative will respond to phone calls immediately, and will follow up e-mails within 2-5 working days.
   
   
2. Write to us.
   Frank will provide an acknowledgement within five working days for written correspondence. For complex matters, we will attempt to finalise within a month. However where the difficulty of the matter precludes this, we will keep you informed of the progress.
   
   
3. Write to the Member Services Review Committee (MSRC).
   If Frank has responded and you are still not satisfied, you can write to the Member Services Review Committee (MSRC). Frank has appointed a panel of senior management who meet weekly to discuss any feedback 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. Frank will provide 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 frank@frankhealthinsurance.com.au.
   
4. Contact our Customer Relationship Team.
   If you require further clarification about the decision made at the MSRC, please email us at frank@frankhealthinsurance.com.au. Frank will provide an acknowledge your correspondence within five days of receipt. For complex matters 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.

Private health information

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) applies at tax time for 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 $93,000 as a single or $186,000 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. This surcharge is in addition to the standard 2% Medicare Levy.

People may have to pay the Medicare Levy Surcharge if they or any of their dependants do not have eligible hospital 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 $93,000
• 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 $186,000 (increasing by $1,500 per dependent child, after the first child).

Income threshold rates from 1 July 2023 to 30 June 2024

If you are:	And your combined taxable income is:
Single	$93,000 or less	$93,001 - $108,000	$108,001 - $144,000	$144,001 or more
Couple/Family/Single Parent (threshold increases by $1,500 per child after your first)	$186,000 or less	$186,001 - $216,000	$216,001 - $288,000	$288,001 or more
Then your income tier is:	Base Tier	Tier 1	Tier 2	Tier 3
And your Australian Government Rebate percentage is:
Under 65	24.608%	16.405%	8.202%	0.00%
65-69	28.710%	20.507%	12.303%	0.00%
70+	32.812%	24.608%	16.405%	0.00%

Note: The income tiers will be changing on 1 July 2024. From 1 July 2024 to 30 June 2025, the income thresholds used to determine your eligibility for the rebate will be based on the following table. Note that the rebate percentage levels remain unchanged for the period 1 April 2023 to 31 March 2025.

Income threshold rates from 1 July 2024 to 30 June 2025