ACA Health Benefits Fund Review

Overview

 ACA Health Benefits Fund is a closed fund, open to families of the Seventh Day Adventist Church, as well as past and current employees of incorporated companies in federation with the Seventh-day Adventist Church in Australia.

Sanitarium Health and Wellbeing Company, Signs Publishing Company, Adventist Development & Relief Agency, Sydney Adventist Hospital, Adventist Schools, Adventist Retirement Villages as well as its employees ‘eligible family members can apply for ACA cover.

Health Fund Key Facts

Founded: 1394

For-Profit or Not-For-Profit?: For-Profit

Private Hospital Agreements Nationwide: 287

Day Hospital Agreements Nationwide: 270

Head Office: Wahroonga, NSW

Health Deal Represented?: No

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A Health Benefits Fund Hospital Cover

ACA has a range of private hospital cover options. The main difference between their Gold Private & Gold Deluxe hospital plans is that Gold Private requires a $100 co-payment per day you are admitted into hospital.  

ACA Health offers 4 Hospital policies:

  • Basic Hospital
  • Bronze Essentials Hospital
  • Gold Deluxe Hospital
  • Gold Private Hospital

ACA Health Benefits Fund Extras Cover

Extras Cover looks after the day-to-day medical services that are not generally covered by Medicare, such as dental services, prescription glasses, and physiotherapy.

ACA Extras:

  • Ancillary Lite
  • Complete Ancillary

ACA Health Benefits Fund Hospital Wait Periods

ACA recognises the waiting periods you may have already served with a previous health fund. For first-timers taking out a policy, the waiting periods below will have to be served before members can benefit from their health scheme. However, if members are switching health funds, waiting periods will not need to be re-served.

The standard hospital wait periods are:

  • Ambulance services: 1 Day
  • Accidental Injury: 1 Day
  • New Conditions: 2 Months
  • Pregnancy and birth-related services: 12 months
  • Pre-existing conditions: 12 months
  • Rehabilitation & Palliative care: 2 months
  • Weight Loss Surgery: 12 months

How Do You Claim Extras With ACA Health Benefits Fund?

Claiming for extras is very easy with ACA. Members of ACA Health have the following options to claim:

  • On the spot: You can swipe your ACA Health membership card at almost 20,000 health care providers that support the HICAPS electronic claims system. This allows you to have your claim processed immediately.
  • Online: You can log into your online account through acahealth.com.au and lodge your claim by uploading a scanned copy of the official receipt or invoice issued by the hospital, doctor or company.
  • By post: You can download and fill out a claim form and submit it along with your receipt from the provider to: ACA Health Benefits Fund, Locked Bag 2014, Wahroonga NSW, 2076.

What Is ACA Health Benefits Fund Gap Cover Like?

Their gap cover scheme is called, Access Gap Cover.

When you use a medical service, your fees are split between Medicare (75%) and your health fund (25%).

Your doctor can, however, charge you more than the standard Medicare Benefits Schedule (MBS) and the difference will have to come out of your pocket. That difference is ‘the gap’.

Some doctors and hospitals have agreements with health funds to cover the complete gap. This is called a ‘no gap agreement’. An agreement to cover a partial gap is known as a ‘known gap agreement’ and will usually cost you less than $500.

Access Gap Cover is an arrangement designed between ACA and physicians to minimise or completely remove out-of-pocket medical expenses for its customers. With Access Gap Cover (AGS) doctors are encouraged to claim directly from ACA (including the Medicare benefit), which means less queuing for patients.

Gap cover Ratings By State

You can gauge how efficient a gap scheme is by comparing health funds in the same state or territory and determining which of the fund offers a greater proportion of medical services covered at no gap. While it is more likely that a medical service covered under your fund can be utilised at no personal cost to the customer, it is entirely the choice of the physician whether or not to participate in the gap scheme. 

Medical Services with No Gaps: The percentage of claims that were fully refunded.

Medical Services with No or Known Gaps: The percentage of claims that were fully refunded, or where the policy holder knew the cost before the surgery was performed. 

The information below outlines the percentages of services covered under no-gap and known-gap.

ACA Health Benefits  Medical Services with No Gap: 89.2%

Industry Average 79.1%

ACA Health Benefits  Medical Services with No or Known Gap: 95.4%

Industry Average: 90.5%

ACA Health Benefits  Medical Services with No Gap: 91.1%

Industry Average: 89.5%

ACA Health Benefits  Medical Services with No or Known Gaps: 97.1%

Industry Average: 95.7% 

ACA Health Benefits  medical services with No Gap: 93.5%

Industry Average: 86.7%

ACA Health Benefits  medical services with No or Known Gap: 99.1%

Industry Average: 95.1%

ACA Health Benefits medical services with No Gap: 94.0%

Industry Average: 89.2%

ACA Health Benefits  medical services with No or No or Known Gap: 98.2%

Industry Average: 94.5%

ACA Health Benefits  medical services with No Gap: 93.9%

Industry Average: 89.5%

ACA Health Benefits medical services with No or Known Gap: 99.7%

Industry Average: 96.6%

ACA Health Benefits  medical services with No Gap: 92.9%

Industry Average: 84.4%

ACA Health Benefits medical services with No or Known Gap: 97.8%

Industry Average: 96.2%

ACA Health Benefits Medical Services with No Gap: 95.4%

Industry Average: 90.2%

ACA Health Benefits Medical services with No or Known Gap: 100%

Industry Average: 96.7%

ACA Health Benefits Medical Services with No Gap:

Industry Average: 84.2%

ACA Health Benefits Medical Services with No or Known gap:

Industry Average: 93.8%

What Is ACA Health Benefits Fund Ambulance Cover?

ACA provide ambulance coverage as a standard benefit on all of their policies.

Medicare does not provide ambulance cover, and while some states provide a subsidy for emergency transportation, others may require ambulance usage to be an out-of-pocket expense, usually around $900.

Do you need ambulance cover?

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