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Please indicate how you prefer to receive our information *
How did you find out about Health Link Consultants? *
Title *
Given name *
Surname *
Address *
Town/Suburb *
Postcode *
State *
Home phone *
Work phone *
Email *  
Employer
Status *
Your date of birth Your date of birth is required to determine if a Lifetime Health Cover loading applies. *  
Are you entitled to full Medicare benefits? In order to join Australian health insurance you must be entitled to full Medicare benefits. If you are not a permanent resident with full Medicare eligibility, you should indicate "No" for this question and then enter your Visa sub class number in the following section. *
Do you earn above the Medicare Levy Surcharge threshold? The Medicare Levy Surcharge (MLS) is a Federal Government initiative designed to encourage higher income earners to take out health insurance. For the 2010-11 year, the MLS applies to singles earning a taxable income of over $77,000 pa and for couples/families earning more than $154,000 pa (taxable income includes reportable fringe benefits). If you do not hold eligible private hospital cover and you are a higher income earner you will be charged an additional tax of 1% of your taxable income (the MLS) when your tax return is assessed. *
What is your primary reason for taking out Health Cover? *
   
       
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