Doc claim

Health insurance claims

Confused about how to claim on your private health insurance? Find out how to go about lodging health insurance claims.

Private health insurance provides financial protection against a wide range of medical costs, including everything from hospital accommodation and theatre fees to visits to the dentist. But do you know how to claim on your private health cover?

The health insurance claims process can be a little bit confusing and varies depending on the type of service you are claiming, so let’s take a closer look at what you need to do to ensure that your medical costs are covered.

Compare your health insurance options online

What are the different options available for people wanting to claim?

The options available when you need to make a claim vary depending on the type of claim you want to make and your health fund. You can make an extras claim in the following ways:

  • At the health care provider. All you have to do is swipe your health fund membership card when you need to pay for the service.
  • Online. Many funds offer online claiming services where you can submit the details of your claim and any receipts.
  • Via an app. An increasing number of private health funds offer dedicated claims apps.
  • Via email. Some health funds allow you to submit claim details via email.
  • Via post. You also have the option to download a claims form from your health fund’s website, print it out and complete and sign it before returning the form back to your fund via post.
  • At a branch. Some health funds also allow you to make health insurance claims by visiting a branch.

If you wish to make a claim for medical costs or bills from your surgeons and doctors, the process you need to follow will differ depending on whether or not the doctor participates in your fund’s gap cover scheme. If they do, the doctor will automatically send your bill to Medicare and your health fund for payment.

However, if your doctor doesn’t participate in your health fund’s gap cover scheme, you will be sent the bill. You will then need to take the relevant paperwork to Medicare before forwarding the claim on to your health fund.

Finally, if you are hospitalised for a procedure that is covered by your policy, the only payment you will have to make will be to cover any excess or co-payments that apply.

Claiming options for funds in the finder.com.au panel

Do you need to make an extras claim with your health fund? The table below lists the options available for lodging a claim with several of Australia’s leading health funds.

FundHow to lodge health insurance claims with Aussie fundsMore info
 hifThere are three ways you can lodge an extras claim with HIF:

  • On the spot. Claim electronically by swiping your HIF membership card at your health care provider.
  • By smartphone, email or fax. Claims of up to $700 per day can be submitted via HIF’s SmartClaim mobile app, or you can submit a completed claim form by email or fax.
  • By mail. You also have the option to download and complete a claim form and then post it along with any receipts to the insurer.

More info

ahmAHM offers three options for lodging an extras claim:

  • On the spot. You can have your benefit processed on the spot at a health care provider by swiping your AHM membership card.
  • Online. If you’re registered for AHM Member Services you can lodge your claim online.
  • Post. You can download a claim form from the AHM website and post the completed form back to the insurer.

More info

Australian UnityAustralian Unity offers the following extras claiming options:

  • On the spot. You simply need to swipe your Australian Unity membership card on the spot at the health care provider.
  • App or online. Australian Unity allows you to claim up to $300 per claim either through its mobile claiming app by uploading photos of receipts, or by logging into your online account.
  • On the phone. You can phone Australian Unity to have your claim processed over the phone.
  • Mail, email or fax. Download and complete a claim form from the Australian Unity website, attach your receipts to the form and post, email or fax it back to the insurer.

More info

GMHBAYou can claim extras using the following methods:

  • On the spot. All you have to do is swipe your membership card on the spot at the health care provider to have your extras claim processed automatically.
  • Online. Login to the GMHBA online member self service centre and provide the details of your claim.
  • In a branch. If you want to lodge a claim in person, visit your nearest GMHBA branch and present an itemised receipt or account.
  • By post. Download a claim form from the GMHBA website. Post the completed claim form and your itemised receipt or account to the insurer.

More info

HCFHCF offers the following options when you need to make an extras claim:

  • On the spot. This is the most convenient way to claim – all you have to do is swipe your membership card at your health care provider.
  • Online. You can lodge your claim online through the HCF Member Services portal.
  • Via an app. HCF’s mobile app allows you to submit a claim form with a photo of your receipt.
  • By mail. Complete a claim form and send it and the itemised account/receipt to HCF.
  • In person at any branch. You will need to present your membership card and the itemised account/receipt for the service you are claiming.
  • At Medicare. Under HCF’s two-way agency agreement with Medicare, you can leave your HCF claim form and accounts/receipts at a Medicare office to be forwarded to HCF.

More info

health.com.auExtras claims with health.com.au can be lodged in the following ways:

  • On the spot. You can swipe your membership card at the health care provider to have your claim processed using the HICAPS system.
  • Online. Most services can be claimed online at health.com.au as long as they have been received in the past two months.

More info

nibnib offers several options when you need to make an extras claim:

  • Swipe your card. Simply swipe your nib membership card when you visit a health care provider.
  • Online. Claim on extras 24/7 using the nib Online Claiming service.
  • Via an app. nib’s iPhone, iPad and Android apps allow you to claim on the go.
  • At an nib retail centre. You can claim in person by visiting your nearest nib retail centre.
  • By mail. Complete a claim form and then post the form and any receipts to the health fund for processing.

More info

Transport HealthYou can use any of the following methods to claim an extras service with Transport Health:

  • On the spot. Simply scan your membership card at any provider that offers the HICAPS system.
  • Via the Transport Health Insurance app. The app is available for Apple and Android devices and allows you to claim by taking a photo of your receipt.
  • By email. Download and print a claim form, complete it and then email a scanned copy back to Transport Health.
  • By post. You also have the option to post your completed claim form back to the insurance provider.

More info

Want to claim through your fund's app?

Check out the table below to see if you fund has a health insurance app:

FundAndroidiOS
Australian UnityGoogle-playApple-app-store
BupaGoogle-playApple-app-store
CUAGoogle-playApple-app-store
Defence HealthGoogle-playApple-app-store
HBFGoogle-playApple-app-store
HCFGoogle-playApple-app-store
Health Care InsuranceGoogle-playApple-app-store
HIFGoogle-playApple-app-store
MedibankGoogle-playApple-app-store
Mildura Health FundGoogle-playApple-app-store
nibGoogle-playApple-app-store
PeoplecareGoogle-playApple-app-store
Phoenix Health FundGoogle-playApple-app-store
Police HealthGoogle-playApple-app-store
Reserve Bank Health SocietyGoogle-playApple-app-store
St.LukesHealthGoogle-playApple-app-store
Teachers Health FundGoogle-playApple-app-store
Transport HealthGoogle-playApple-app-store
TUHGoogle-playApple-app-store

How to claim the Private Health Insurance Rebate

The Private Health Insurance Rebate is a Federal Government incentive that was introduced to encourage more Australians to take out private health insurance. The rebate makes the cost of health insurance more affordable and it applies to hospital, extras and ambulance cover policies.

You’ll need to satisfy an income test to qualify for the rebate, so check the table below to see what level of rebate you are eligible for in the current financial year.

The rebate levels applicable from 1 April 2016 to 31 March 2017 are:

Singles≤$90,000$90,001-105,000$105,001-140,000≥$140,001
< Age 65
26.791%
17.861%
8.930%
0%
Age 65-69
31.256%
22.326%
13.395%
0%
Age 70+
35.722%
26.791%
17.861%
0%
Families≤$180,000$180,001-210,000$210,001-280,000≥$280,001
< Age 65
26.791%
17.861%
8.930%
0%
Age 65-69
31.256%
22.326%
13.395%
0%
Age 70+
35.722%
26.791%
17.861%
0%

The rebate can be claimed every year in one of two ways:

  • You can opt for a discounted premium from your health fund. You will need to inform your insurer how much income you earn in order to receive the correct rebate.
  • You can claim it on your income tax return. Your insurer provides you with a statement at the end of each financial year that you can use to apply for the correct rebate.

Compare health insurance policies from funds in the finder.com.au panel

Rates last updated December 6th, 2016
Details Features
Base Hospital
Base Hospital
A base hospital product providing affordable cover for the essentials for healthy people.
  • Cover starting from $17.39 weekly
  • Accidental injury cover
  • Emergency Ambulance cover
  • $500 hospital excess
More info
White starter
White starter
White starter provides cover for hospital treatment and some of the rehabilitation.
  • Accident
  • Ambulance
  • Rehabilitation
  • Psych
Enquire Now More info
Basic Hospital
Basic Hospital
Basic Hospital takes care of the essentials and is Australian Unity's most affordable Hospital Cover.
  • Can help to avoid extra tax
  • Emergency ambulance transportation
  • No excess for accidents
  • Appendix removal
Enquire Now More info
GoldVital
GoldVital
Available for singles and couples looking for vital medical treatment cover. Save 4% when you pay for 12 months of your cover upfront.
  • Cover for the essentials
  • Surgical removal of wisdom teeth, tonsils and adenoids
  • Intensive care
  • Standard $500 excess per person
Get Quote More info
Basic Hospital
Basic Hospital
Basic hospital cover for the essentials with the option to choose own doctor or specialist. Restricted fund: Only current and former employees of the Commonwealth Bank of Australia Group and their eligible families can join.
  • Theatre and labour ward fees waived
  • Emergency ambulance cover
  • Excess options available
  • Access to gap cover
Enquire Now More info
Bronze Hospital
Bronze Hospital
Entry level hospital cover.
  • Public hospital accommodation
  • Shared room
  • Accidental injury
  • Joint reconstructions and investigations
Enquire Now More info
Basic Hospital Cover
Basic Hospital Cover
Entry level hospital cover for the essentials including accidental injury, ambulance and joint procedures.
  • $250 / $500 excess options
  • Unlimited emergency ambulance cover
  • Dental surgery cover
  • Joint surgery cover
Enquire Now More info
Basic Hospital Cover
Basic Hospital Cover
Basic hospital cover tailored for the healthy and budget conscious.
  • No excess for kids
  • No excess for accidents
  • Emergency ambulance cover
  • Cancer-related services
Enquire Now More info
Public Hospital
Public Hospital
Transport's health budget hospital cover offering protection as a private patient in a shared ward of a public hospital. Choice of doctor also included.
  • Emergency ambulance cover
  • Govt. approved prostheses for covered services
Enquire Now More info

Picture: Shutterstock

Richard Laycock

Richard is the senior insurance writer at finder.com.au and is on a mission to make insurance easier to understand.

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