TERMS AND CONDITIONS FOR HCF RECOGNISED …

1 TERMS AND CONDITIONS . FOR HCF RECOGNISED PROVIDERS. OF general treatment . 1. general (c) any court, tribunal, commission, board, committee or body that hears complaints relating to a breach of Providers of Ancillary Services may be RECOGNISED by HCF professional standards by members of the for the purpose of paying benefits to Members that have RECOGNISED provider 's profession. received Ancillary Services provided by those providers ( RECOGNISED Providers). By accepting the payment of Recognition Criteria' means: benefits from HCF on behalf of a Member or facilitating a (a) the standards in the Private Health Insurance claim for benefits by a Member (eg. displaying a provider (Accreditation) Rules 2011 (Cth); and number on a receipt), RECOGNISED Providers agree to be (b) any other criteria that HCF considers reasonable.

2 Bound by these TERMS and the addendum referred to in Recognition Requirements' means the additional . clause (if any) (Agreement). By making a payment requirements that HCF reasonably determines for each of benefits for Ancillary Services provided by a profession. RECOGNISED provider , HCF agrees to be bound by the Agreement with respect to that RECOGNISED provider . Related Body Corporate' has the meaning given in The Agreement commences on the date a claim is first section 9 of the Corporations Act 2001 (Cth). made for benefits for Ancillary Services provided by the RECOGNISED provider and ends when either HCF or 3. INTERPRETATION. the RECOGNISED provider terminates the Agreement in (a) If there is any inconsistency between an Agreement accordance with these TERMS .

3 And the TERMS of any other agreement between HCF. 2. GLOSSARY and the RECOGNISED provider , the Agreement will prevail to the extent of that inconsistency;. Ancillary Services' has the same meaning as the term (b) a reference to a person' includes a natural person, general treatment ' in section 121-10 of the Private body corporate and body politic;. Health Insurance Act 2007 (Cth) or any amendment or (c) a reference to a party or a body includes the party's replacement of it. or the body's executors, administrators, successors Fund Rules' means HCF's fund rules which determines a and permitted assigns and substitutes;. Member's entitlement to benefits under their HCF cover. (d) a reference to a provision of a law, statutory HCF' means The Hospitals Contribution Fund of instrument or determination includes a reference Australia Limited ABN 68 000 026 746 and any of its to an amendment, consolidation, re enactment, or Related Bodies Corporate that are registered private replacement.

4 Health insurers. (e) a reference to a document or instrument includes Member' means a person who is a financial member of the document or instrument as novated, altered, an HCF health fund with cover for Ancillary Services and supplemented or replaced from time to time;. in the case of a family membership, includes all partners (f) another grammatical form of a defined word or and dependents covered by that membership. expression has a corresponding meaning;. (g) the meaning of a general word is not limited by Private Practice' means a professional practice (whether . specific examples introduced by including', for sold, partnership or group) that is self-supporting and example' or similar expressions; and where its accommodation, facilities and services are not provided, funded or subsidised by another Hospital or (h) headings are for ease of reference only and do not publicly funded facility.

5 Affect interpretation. HCF T&C'S FOR HCF RECOG PROV OF GEN TREAT 0617. Professional Body' means: 4. RECOGNISED provider 'S OBLIGATIONS. (a) any registration board(s) that register health A RECOGNISED provider must: professionals under relevant Federal, State or Territory legislation and is relevant to the RECOGNISED (a) be a health professional, a supplier of health services provider 's profession; or similar that provides Ancillary Services in Private (b) any professional association relevant to the Practice;. RECOGNISED provider 's profession; and (b) comply with the Recognition Criteria and Recognition Requirements that apply to the class of Ancillary the RECOGNISED provider is participating in an HCF. Services the RECOGNISED provider provides to participating provider program that allows the Members; RECOGNISED provider to charge a higher fee or they (c) comply with all standards, guidelines, obligations and have HCF's express written permission).

6 Legislation relevant to the RECOGNISED provider 's RECOGNISED Providers must notify HCF immediately: profession and the Ancillary Services provided to Members; (a) if they have not complied with any of their (d) provide HCF with evidence, on request, of all obligations under clause or a Professional Body is relevant permissions, approvals, registrations, investigating the RECOGNISED provider , or has placed accreditations, qualifications, memberships, licenses, any restrictions or limitations on the RECOGNISED certifications and other forms of recognition or provider 's registration or membership of the information referred to in the application form to Professional Body; or become a RECOGNISED provider or required under the (b) of any material change in the way they provide Recognition Criteria or Recognition Requirements; goods or services to Members or any other (e) continuously hold current professional indemnity information which could impact on their recognition insurance along with public and product liability as a RECOGNISED provider ' with HCF including the insurance to a minimum value of $1 million per claim, RECOGNISED provider 's compliance with clauses expressly for the Ancillary Services the RECOGNISED (m) and (n).

7 provider offers to Members; . RECOGNISED Providers agrees to allow HCF and its (f) not allow another person to perform the Ancillary agents to: Services (for example, students working under (a) make enquiries of any Professional Body, educational the RECOGNISED provider 's supervision and/or institution, professional association, registration instruction) and/or invoice HCF or Members using body, government department or agency, statutory, the RECOGNISED provider 's provider number (with the semi-government or other body regarding the exception of services performed by dental therapists, RECOGNISED provider 's professional education hygienists and oral health therapists where HCF have and qualifications and/or professional and ethical not issued separate provider numbers and where the conduct including any applications for membership, law permits this practice).

8 Accreditation, registration, licensing, certification or (g) comply with any reasonable request from HCF; other form of recognition, whether such application (h) comply with the TERMS of any other agreements or was successful or not and whether such application contracts that exist between the RECOGNISED provider was withdrawn or not. RECOGNISED Providers further and HCF; consent to and authorise any such body to release (i) repay within 30 days of HCF's written request, to HCF or its agents copies of all documentation, any benefits or monies paid to the RECOGNISED applications or reports related to those enquiries; and provider where HCF reasonably determines that the (b) release any information received under clause (a).

9 RECOGNISED provider , or the Member who received or contained in the HCF application form to become the Ancillary Services, was not entitled to it under the a RECOGNISED provider , to an independent third party Agreement or the Fund Rules; for assessment. (j) not use any of HCF's brands, names or trademarks, including representing that the RECOGNISED provider 5. PAYING BENEFITS. is endorsed by HCF, without HCF's express written . HCF must pay benefits for Ancillary Services provided by consent; RECOGNISED Providers to Members if: (k) be able to communicate swiftly and effectively in both written and spoken English with HCF, Members (a) benefits are payable to the Member under the and emergency services; Fund Rules;. (l) if a RECOGNISED provider obtains goods from outside (b) the RECOGNISED provider has complied with the Australia for Members, not provide those goods to Agreement.

10 Members until the RECOGNISED provider has received (c) the circumstances in clause 6 do not apply;. the goods and ensured their safety and quality (d) the Member has lodged an eligible claim for the and that they comply with applicable Australian Ancillary Services or the RECOGNISED provider has standards; submitted an eligible claim electronically and directly (m) comply with the Australian Consumer Law and in to HCF; and relation to goods obtained from outside Australia, (e) the RECOGNISED provider has the Member's consent have a returns policy that includes the obligations in for HCF to access their patient records held by the clause (l); and RECOGNISED provider for audit purposes. (n) not discriminate against Members because they are covered by private health insurance or their membership with HCF including charging Members more than the standard fee that the RECOGNISED provider set for their goods or services (unless 6.)