Member number: 42526930

21 October 2021

Mr Q Chen
128 Guildford Rd
GUILDFORD NSW 2161

Dear Qing,
As requested, please find enclosed your Private Health Insurance Tax Statement for the 2020/21 financial year. The statement
reflects our records for the period of the Tax Statement as at the date of this letter. As such, the information may differ from any
statement previously issued to you (or previously notified to the ATO).
If you need another copy or would like access to other tax statements, simply login to hbf.com.au/myHBF. If you haven’t used
myHBF before, registration only takes a few minutes and once you’re logged in, you can submit health claims, update your details
and access important documents anytime you like.
At HBF, we are here to help you understand and make the most of your cover. If you have any questions, please call us on 133 423,
visit your nearest HBF branch or go to hbf.com.au. We’ll be happy to help.

Best regards,
Your HBF team

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€E$5B R/Sf"h/V
HBF Health Limited ABN 11 126 884 786 Telephone 133 423 Postal address GPO Box C101, Perth WA 6839 Online hbf.com.au
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 Private Health Insurance Statement
1 July 2020 to 30 June 2021 (This is not an invoice)

Mr Q Chen
128 Guildford Rd
GUILDFORD NSW 2161 Printed date: 21 October 2021

The following information is relevant to the completion of your 2021 income tax return

The table below provides details of your 2020/21 private health insurance policy. If your policy has more than one Private Health
Insurance Incentive Beneficiary, this statement will only display your share amounts.
The Australian Government determines the way the rebate is calculated and applied to premiums. Rebate percentages are
adjusted on 1 April each year. If you paid premiums for your policy before and on or after 1 April, the table below will contain at
least two lines of information. Where more than one line of information has been provided, the information from each line must be
entered separately at the corresponding labels on the income tax return at Private health insurance policy details.

You will need to nominate a tax claim code when completing the Private health insurance policy details section of your tax return.
Read the tax return instructions to determine the tax claim code appropriate for your situation.

Australian Government Rebate on private health insurance

Your premiums Your Australian
Other adult beneficiaries
Health insurer ID Membership Number eligible for Australian Government rebate Benefit code
for the policy
Government rebate received
B HBF C H07351105 J $178 K $45 L 30 Mei Guan
B HBF C H07351105 J $165 K $48 L 35 Mei Guan
B HBF C H07351105 J $116 K $33 L 36 Mei Guan

IMPORTANT - If you have more than one line of information in the table above, make sure each line is input separately into your
income tax return. Do not add-up amounts reported in any column or row and input a total.

For legislative purposes, any amounts detailed in the table above are rounded to a whole dollar and exclude Lifetime Health Cover
Loading (if applicable).
If you and all your dependants (including your spouse) did not have an appropriate level of private patient hospital cover for the
full financial year (365 days) you may be liable for the Medicare Levy Surcharge - see 2021 Individual tax return instructions
question M2.

Number of days this policy provides an appropriate level of private patient hospital cover A 0

If you have any questions about this statement, please visit hbf.com.au/tax, or you can call us on 133 423.

€#f1u] B s Ek+

€E$5B R/Sf"h/V
HBF Health Limited ABN 11 126 884 786 Telephone 133 423 Postal address GPO Box C101, Perth WA 6839 Online hbf.com.au
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