We know claiming is an important part of your health insurance, so we’ve made sure there are many ways you can get your claims paid as quickly as possible.
WAYS TO CLAIM ON YOUR HEALTH INSURANCE
YOUR HEALTH COVER CLAIMS CHECKLIST
Before claiming, make sure you:
- have given us your bank details so we can pay your claims
- are covered for the treatment or service (view cover details) and have served any relevant waiting periods
- have already had the treatment or service (you can’t claim in advance) and are within two years of the service you’re claiming for
Please keep in mind, we may ask you for some extra information to help with the claim.
Claiming for extras, hospital and ambulance
Claiming on your extras cover
Most extras services can be claimed on the spot at your appointment with a system like HICAPS, but you’ll need to take along your membership card.
Claiming on your hospital cover
If you’re having treatment in hospital, there’ll be different parts involved in claiming. Usually, the hospital where you’ve had your treatment will take care of claiming for the costs for things like accommodation, theatre-room hire and prostheses.
You’ll be given a claim form to complete and sign, and the hospital will then send the bill to us. If there’s an excess, or any other out-of-pocket expenses, you’ll usually pay the hospital directly.
But there are also medical costs, like surgeons and anaesthetists, not handled by the hospital. Your doctor and anaesthetist will create their own invoice and you’ll need to first claim through Medicare who’ll give you a Medicare Benefit Statement.
We’ll need this Medicare Benefit Statement so we can process our portion of the claim. Sometimes your doctor and anaesthetist will lodge your claim to Medicare and HCF on your behalf, so ask your practitioner about their billing so you know what to do next.
HEALTH INSURANCE CLAIMS: FREQUENTLY ASKED QUESTIONS
What happens if I don’t have my HCF membership card when I’m at my provider?
If you want to claim on your extras cover on the spot, you’ll need your membership card. If you’re without your card on the day of your appointment, you’ll have to pay for your service upfront and then make a claim with us later.
You can do this either through the My Membership app, with online member services, in a branch or by post. Please keep in mind, you’ll get the same benefit amount as you would if you claimed on the spot at the provider.
What can I claim through the app and how do I do it?
You can claim on your extras and ambulance cover with the My Membership app and with online member services in just a few quick and easy steps. Just head to the "claims" section on the app's home screen, then find "make a claim".
You can take a picture of the invoice as well as any other information you think we may need, and we'll do the rest.
What’s a benefit?
A benefit is the amount we’ll pay back to you for a service or treatment you had.
How do I know how much I’ll get back from an extras claim?
It will depend on a few things like:
- the item number
- your level of cover
- the remaining limits in the calendar year.
You can run a benefit estimate in our app with the details of your claim to find out how much this will be.
How long does it take for a claim to be processed?
Claims are usually processed and paid within 7 working days. We'll deposit the benefit into your chosen bank account.
How do I claim for telehealth services?
You can claim for eligible telehealth services the same way as you claim for extras claims, but you’ll need to attach the completed telehealth claim form.
How do I update my bank details to get my claims paid?
You can update your bank details in our My Membership app and online member services. Go to 'Payments' then 'Update payment details'. When you claim online, you’ll also be asked to review and confirm your bank details, which means you’ll also have the option to change the bank account we’ll pay claims into.
What do I need to make a medical claim?
If you’re submitting a doctor’s bill after a hospital stay, HCF needs a Statement of Medicare Benefits that contains the:
- Medicare item number
- Medicare Benefit paid
- Medicare Schedule Fee.