ACA Health Benefits Fund Review

Founded in 1934, ACA Health is a restricted access private health fund, available to past and current employees of Seventh-day Adventist Church and their families.

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by Gary Andrews

Last update 15 Apr 2021

Overview

A not-for-profit fund, their founding purpose is to benefit the health and wellbeing of their members.

Key Points

100% member-owned with over 86 years of history
Mix and match hospital and extras policies
Members are free to choose their own providers

ACA Health isn't on our panel but we're confident we can get you a great deal on your health cover.

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Hospital cover

Nobody chooses to go to hospital.

But when you do, hospital cover will help you get the treatment you need, where and when you want it.

It also helps to pay the bills, as fees for hospital rooms and specialists can add up.

Think about what services you're likely to need, in line with your budget.

If you earn over $90,000 individually or $180,000 as a couple, you could avoid paying the Medicare Levy Surcharge.

ACA Health offers four hospital cover plans, ranging from a budget Basic Hospital option, through to two Gold hospital policies that offer comprehensive cover.

Basic Hospital

ACA Health's budget option allows you to be treated as a private patient in a public hospital.

This means that you can choose your own doctor and have shared room accommodation.

Key inclusions:

  • Avoids the Medicare Levy Surcharge
  • Public hospital psychiatric services, palliative care, and rehabilitation
  • Medical gap cover

Bronze Essentials Hospital

An affordable hospital plan designed for younger singles, couples and families on a budget.

Comes with the option of $500 or $750 excess and includes a large number of items usually found in Silver policies.

Key inclusions:

  • Gastrointestinal endoscopy
  • Hernia and appendix
  • Chemotherapy, radiotherapy and immunotherapy for cancer
  • Gynaecology

Gold Private Hospital

ACA's Gold Private Cover provides top tier comprehensive hospital cover.

However, it also comes with some co-payments, meaning you'll face some out-of-pocket expenses if you do need to be treated in hospital.

Key inclusions:

  • Heart and vascular system
  • Pregnancy and birthing
  • Weight-loss surgery
  • Dental surgery

Gold Deluxe Hospital

Gold Deluxe Hospital is ACA's most expensive policy and has no exclusions and no co-payments.

It includes everything covered in the Gold Private Hospital package.

Key inclusions:

  • No excess or co-payments
  • Cataracts
  • Joint replacements
  • Insulin pumps

Ambulance Cover

In NSW or ACT, you are covered in full for ambulance transportation in your state with hospital cover, and all across Australia with extras cover.

For WA, SA, VIC and NT residents, you'll need to get one of ACA's eligible extras packages for Ambulance Cover at home and across Australia.

Tasmania covers its residents for ambulance journeys at home, but not on the mainland. ACA's extras packages will cover this.

QLD residents are covered by their state government for ambulance transportation all across Australia.

Ambulance cover in Australia can appear a bit complex, but our state-by-state guide will help you understand what you are and aren't covered for, depending on where you live.

Extras cover

Extras reset

From dental, to optical, to chiro and more, extras insurance helps cover the bills for routine treatments with rebates of up to 100%.

While we've summarised the key points of each plan below, it's always worth digging a little deeper into any gap fees, how much you can claim back, and whether your preferred healthcare provider, such as your local dentist, has an agreement with the health fund.

Take the time to work out what you need and what you're prepared to pay.

If this feels a bit overwhelming, you can speak to one of our experts who can talk you through what's included in each extras policy.

ACA Health offers two types of extras cover: Ancillary Lite for common treatments at a affordable price and Complete Ancillary for more comprehensive cover with greater benefits.

Both extras policies can be combined with any hospital policies for a reduced premium.

Still overwhelmed? Chat to one of our trusted advisers to get a clearer idea of what extras you will actually need.

Ancillary Lite

ACA Health's Complete Ancillary Extras provides top tier cover with up to 80% back on most services, as well as high annual limits.

It can be combined with Gold Deluxe Hospital for fully comprehensive health coverage.

Key inclusions:

  • $1,700 annual limit per person on all dental items
  • $400 annual limit on optical Audiology
  • Implants and dentures

Complete Ancillary

Includes all the basics, plus major dental and orthodontics, which is worth considering if your kids need braces.

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Waiting periods

To stop people signing up, claiming, then cancelling their health insurance, all insurers apply waiting periods. Generally, the more expensive the treatment, the longer you'll wait. But keep an eye out for special deals with waiting periods reduced or waived.

When you switch to ACA Health from another provider, you won't have to re-serve your waiting periods, unless your new policy covers something you didn't have before.

  • No waiting period -- Accident requiring hospitalisation
  • 4 months -- Ambulance
  • 4 months -- Optical
  • 9 months -- Dental
  • 12 months -- Obstetrics
  • 12 months -- Hearing aids and health appliances
  • 12 months -- Treatment relating to a pre-existing condition
  • 2 months -- All other services (including psychiatry, rehabilitation and palliative care)

Member benefits

ACA runs a Shop & Share Savings scheme, which gives members access to e-discount cards at well-known shops such as Bunnings, Rebel Sport and Harvey Norman.

How to claim

Hospital

Simply tell the hospital you are a member of an ACA Health policy. Your hospital account will be sent directly to ACA Health for them to assess on your behalf.

Extras

You can swipe your membership card to claim directly on the spot with your provider's HICAPS terminal.

You can also claim via the ACA Health claiming app, through online member services or fill out the claim form and send it via email or mail.

Hospital agreements

ACA Health has agreements with most hospital and day surgery providers across Australia.

When comparing policies, it's worth checking if your preferred local hospitals and clinics are covered.

Customer service

ACA Health is one of the few insurers who the Private Health Ombudsman received 0 complaints about, as reported in the Ombudsman's latest complaint report covering June to September 2020.

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FAQs

Is ACA Health a not-for-profit fund?

Yes – all profits are diverted back into the fund, for increased benefits to members.

Who can apply? Are there any restrictions?

ACA Health is a restricted health fund, although you don't need to be an Adventist to join.

Membership is only available to current and past employees plus families of the Seventh-day Adventist Church and affiliated companies. You can see a complete list of eligible employers on ACA's site.

Is it easy to switch to ACA Health?

ACA isn’t on our panel but we’re confident we can find you a great deal on your health insurance.

You’ll need to contact ACA directly if you’re interested in switching to one of their policies.

Do I need to re-serve waiting periods?

You can switch to an equivalent or lower level of cover without re-serving waiting periods.

You will only be required to serve waiting periods if you have upgraded to a higher level of cover.

Can I change my level of cover?

Yes, you can choose a lower or higher level of cover to suit your different life stages.

If you move to a higher level of cover, you will usually need to serve waiting periods on the extra services and/or higher benefits.

Do I get the government rebate?

For every dollar of private health insurance premiums, the Australian Government provides eligible Australians with a rebate of up to 33.4% (depending on your age and income).

Do I have to pay the Lifetime Health Cover loading?

If you're 31 or over, you usually need to pay 2% loading for each year you've gone without hospital cover since the 1st July following your 31st birthday.

You can find out more here.

What age are children covered up to?

Children can remain on your ACA Health policy until they’re 21, or 25 if they’re studying full time.

How do I get in contact with ACA?

Phone: 1300 368 390 Email: info@acahealth.com.au Post: Locked Bag 2014, Wahroonga NSW 2076

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This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.