| HCF | |
|---|---|
| Registered insurer | The Hospitals Contribution Fund of Australia Ltd (HCF) |
| Who can join | Open to anyone |
| Business structure | Member-owned mutual, not-for-profit |
| Hospital policies (30 June 2025) | 842,024 (13.7% of all hospital policies), covering 1,821,414 people. Figure is for HCF, which includes RT Health |
| Hospital tiers on sale (1 September 2026) | Gold, Silver Plus, Bronze Plus, Bronze, Basic Plus, Basic |
| Excess options on open hospital policies | $250, $500, $750 |
| Age-based discount (18-29) | Not offered on its open hospital policies |
| Ambulance | Emergency ambulance on its open hospital policies; some also cover non-emergency transport |
| Question | What the official data shows |
|---|---|
| Out-of-pocket costs in hospital | 85.4% of in-hospital medical services had no gap for the member (industry 87.1%), and 88.3% of hospital charges were covered (industry 89.0%), 2024-25 |
| Waiting periods and pre-existing conditions | The legal maximums apply: 12 months for a pre-existing condition (signs or symptoms in the 6 months before you joined or upgraded) and for pregnancy and birth, 2 months for other hospital treatment. Every hospital policy open to new members in the Government's data at 1 October 2026, at every fund, used the 12-month pre-existing wait |
| Switching from another fund | Waits you've already served on the same or a lower level of cover carry across to HCF, and from it. Ask your old fund for a clearance certificate and keep the break between policies short |
| The Medicare Levy Surcharge | Excess options on its open hospital policies go up to $750, so all are within the $750 singles limit, and every policy was flagged as meeting the surcharge rules in the Government's data at 1 October 2026 |
| Adult children (dependants) | Up to age 30, studying or not, in the fund's own record (Government data, 1 October 2026). Adult dependants often need an extended family option |
| Claims experience | 12.1% of Ombudsman complaints about insurers on a 12.8% market share (ratio 0.95), and 23.6% of the complaints the Ombudsman investigated, 2024-25 |
General advice only. This information doesn't take into account your objectives, financial situation or needs. Consider whether the product is right for you and read the Product Disclosure Statement (PDS) and Target Market Determination (TMD) before you decide. We don't compare every product in the market, and we may earn a commission if you take up a product through our links.
Structure: a Sydney-based mutual
PrivateHealth.gov.au describes HCF as a mutual organisation operating on a not-for-profit basis, based at George Street, Sydney. The fund says it was established in 1932. RT Health is a division of HCF and is reported within its figures. HCF sells in every state and territory and offers overseas visitors and corporate products as well as retail cover.
Benefits: more of each premium dollar back to members
HCF paid 87.8% of its premium income back as benefits in 2024-25, above the industry's 84.5%, and the highest of the five largest insurers. Its management expenses were 12.4% of contribution income against an industry 10.9%. Hospital charges covered were 88.3% (industry 89.0%), and 85.4% of in-hospital medical services had no gap (industry 87.1%).
Complaints: in proportion, but more investigations
HCF drew 12.1% of all Ombudsman complaints about insurers in 2024-25, slightly below its 12.8% market share. But its share of complaints the Ombudsman went on to investigate was 23.6%, nearly double its market share and the highest of any insurer. An investigated complaint is one the Ombudsman couldn't resolve by referring it back to the fund. The State of the Health Funds report is the place to read what those complaints were about.
Member retention was 83.7%, a little below the industry's 85.0%.
What HCF sells
HCF's open hospital policies at 1 September 2026 cover Gold, Silver Plus, Bronze Plus, Bronze, Basic Plus and Basic, with $250, $500 and $750 excess options. None were listed with the age-based discount. Emergency ambulance is included on its open hospital policies; some also include non-emergency transport.
What regulators and consumer groups have said
The official measure of complaints is the Private Health Insurance Ombudsman's. In 2024-25 HCF drew 12.1% of all complaints about insurers, slightly under its 12.8% market share, but 23.6% of the complaints the Ombudsman went on to investigate, the highest share of any insurer that year.
In its 2025 Shonky Awards, the consumer group CHOICE named HCF over what it calls policy phoenixing. CHOICE reported that in February 2025 HCF closed its Premium Gold hospital policy to new members and opened a near-identical Gold policy at a higher price. At the time the Health Minister's approval of premium rises applied only to existing policies, so the new price didn't need approval. CHOICE also reported HCF's response: that it reviews products so they remain financially sustainable, which can mean closing some to new members and offering alternatives.
Parliament has since acted on the practice. The Health Legislation Amendment (Improving Choice and Transparency for Private Health Consumers) Act 2026 received Royal Assent on 18 September 2026. Its explanatory memorandum says Schedule 2, 'Regulating premiums', requires insurers to seek the minister's approval for the premiums of new products as well as changes to existing ones, to stop insurers closing a product and reopening a near-identical one at a higher premium.
HCF against the industry: 2024-25 data
Every year the Private Health Insurance Ombudsman compares all insurers on the same measures, and PrivateHealth.gov.au republishes the results on each insurer's profile. The table below is HCF's (reported at the level of the registered insurer), with the industry result beside each figure. Its complaints-to-market-share ratio was 0.95: a figure of 1.00 means complaints exactly in proportion to size.
| Measure | HCF | Industry | Reading |
|---|---|---|---|
| Share of all Ombudsman complaints | 12.1% | Market share 12.8% | In proportion to its size |
| Share of investigated complaints | 23.6% | Market share 12.8% | |
| Member retention (hospital cover) | 83.7% | 85.0% | Weaker than industry |
| Benefits paid as % of premiums | 87.8% | 84.5% | Better than industry |
| Management expenses % of premium income | 12.4% | 10.9% | Weaker than industry |
| Hospital charges covered | 88.3% | 89.0% | Weaker than industry |
| Medical services with no gap | 85.4% | 87.1% | Weaker than industry |
| Medical services with no gap or a known gap | 96.8% | 97.1% | In line with industry |
| Extras (general treatment) charges covered | 50.7% | 50.7% | In line with industry |
HCF vs Bupa: the official data side by side
Here are both insurers' 2024-25 figures on every measure the Ombudsman publishes, with the industry result beside them. In 2024-25, HCF (incl. RT Health) had the stronger figure on benefits paid as a share of premiums; Bupa on member retention, management expenses, hospital charges covered, the no-gap rate and extras charges covered. They were level on complaints relative to size. Neither set of figures is a price, and the right policy depends on what it covers.
| Measure | HCF (incl. RT Health) | Bupa | Industry |
|---|---|---|---|
| Share of all Ombudsman complaints | 12.1% | 25.2% | - |
| Market share | 12.8% | 25.5% | - |
| Complaints ÷ market share (1.00 = in proportion) | 0.95 | 0.99 | 1.00 |
| Share of investigated complaints | 23.6% | 16.4% | - |
| Member retention (hospital cover) | 83.7% | 86.1% | 85.0% |
| Benefits paid as % of premiums | 87.8% | 82.4% | 84.5% |
| Management expenses % of premium income | 12.4% | 11.3% | 10.9% |
| Hospital charges covered | 88.3% | 89.0% | 89.0% |
| In-hospital medical services with no gap | 85.4% | 90.2% | 87.1% |
| Medical services with no gap or a known gap | 96.8% | 97.8% | 97.1% |
| Extras charges covered | 50.7% | 51.3% | 50.7% |
| Private hospital agreements, all states | 258 | 273 | - |
| Day hospital agreements, all states | 248 | 273 | - |
| Hospital policies (30 June 2025) | 842,024 | 1,498,193 | 6,125,068 |
Read our Bupa review, or see the five largest health funds side by side.
How to read it: complaint share is the fairest single comparison of service across funds of different sizes, because it's measured against market share. Benefits as a % of premiums shows how much of the premium pool went back to members as claims; a mutual that returns more is not necessarily cheaper, and a fund can move this figure by changing prices. The gap measures show how often members avoided an out-of-pocket medical bill after a hospital stay, which is what most people mean by "good cover".
Hospital agreements
| ACT | NSW | VIC | QLD | SA | WA | TAS | NT | |
|---|---|---|---|---|---|---|---|---|
| Private hospitals | 5 | 92 | 66 | 52 | 17 | 18 | 7 | 1 |
| Most held by any insurer | 7 | 95 | 73 | 63 | 17 | 23 | 7 | 1 |
| Day hospitals | 9 | 95 | 47 | 44 | 22 | 20 | 10 | 1 |
| Most held by any insurer | 11 | 109 | 73 | 58 | 35 | 28 | 12 | 2 |
What to check before you join HCF
- HCF's share of investigated complaints (23.6%) was well above its market share in 2024-25. Keep records of claims and correspondence.
- No age-based discount on HCF's open hospital policies, so under-30s may find the discount elsewhere.
- RT Health policies are HCF products under a different name; compare them as separate products.
- Over 31 and joining for the first time? Work out your Lifetime Health Cover loading first, and if you earn over the threshold, check the Medicare Levy Surcharge you'd avoid.
Common questions about HCF
Is HCF a not-for-profit health fund?
Yes. PrivateHealth.gov.au lists HCF as a mutual organisation that operates on a not-for-profit basis. By hospital policies it is the largest not-for-profit insurer in APRA's June 2025 data.
How much of its premiums does HCF pay out?
87.8% of premium income was paid as benefits in 2024-25, against an industry result of 84.5%.
Is RT Health part of HCF?
Yes. RT Health is a division of The Hospitals Contribution Fund and shares its reported figures.
Which is better, HCF or Bupa?
Neither is better across the board, and the answer depends on the policies you're comparing. In 2024-25 HCF paid back more of its premiums as benefits (87.8% against Bupa's 82.4%), while Bupa had a higher no-gap rate (90.2% against 85.4%) and a far smaller share of investigated complaints relative to its size. The side-by-side table on this page has every official measure.
What is the best rated health insurance in Australia?
There is no official rating of health funds. Award and star ratings come from commercial publishers using their own methods. The official, like-for-like measures are the Ombudsman's: complaints and investigated complaints against market share, benefits paid, and how often members avoid a medical gap. We publish them for every insurer on our health fund comparison.
Which health insurance company denies the most claims?
No official figure for denied claims is published. The nearest official measure is each insurer's share of the complaints the Ombudsman investigates. In 2024-25 that was 23.6% for HCF against a 12.8% market share, the highest share of any insurer.
Does HCF cover dental and physio?
On its extras policies, yes. In the Government's data at 1 October 2026, all 18 HCF extras-only policies open to new members covered general dental and physiotherapy, each with a standard two-month wait, and 13 of them covered major dental, with a 12-month wait. Hospital-only policies don't cover dental or physio outside hospital. The benefit and annual limit differ by policy, so check its information statement.
Until what age does HCF cover adult children?
HCF's record in the Government's data at 1 October 2026 lists dependants covered up to age 30, whether or not they're studying, once they're past the age it treats as a child dependant. Whether your policy covers adult dependants depends on its membership type, and a dependant who marries or enters a de facto relationship needs their own policy.
Other fund reviews
See every registered health insurer compared on complaints and benefits, or read how the private health insurance rebate and hospital cover tiers work.
General advice only. It doesn't consider your circumstances. Read the PDS and TMD before you decide.
This review is general information based on published government and regulator data. We don't rate or rank funds, and it doesn't consider your circumstances. Check a policy's Private Health Information Statement before you buy.