HICAPS is an electronic health claims and payments system used in Australia.
It allows patients to claim their private health insurance benefits at the time of service, reducing out-of-pocket expenses.
HICAPS is available at participating health care providers, including doctors, dentists, and other medical professionals.
What is HICAPS?
HICAPS (Health Industry Claims and Payments Service) is an electronic health claims system that lets you claim Medicare, WorkSafe Victoria or private health Extras benefits when you pay for treatment, rather than wait to be reimbursed.
When a service provider gives you the bill for your treatment, you hand them your Medicare, WorkSafe Victoria or health-fund membership card and they swipe it through an electronic HICAPS machine. The machine then automatically processes your claim. If you're claiming from your health fund, its contribution will be processed on the spot and you pay the remaining gap if applicable.
How does HICAPS work?
There are three main ways you can make a claim with HICAPs:
Private health insurance
If you visit a healthcare provider such as a dentist or optician that offers HICAPS and you have extras cover, you can give them your health insurance card and they'll swipe it through the HICAPS terminal. This automatically pays the amount your health fund covers. You don't need to send them receipts and wait to be reimbursed; you just need to pay the remaining fee, if it's not totally covered by your insurance.
Medicare
Medicare Easyclaim is the HICAPS system used by Australia's public healthcare system. This lets you lodge your claim and receive rebates through the HICAPS terminal. It's available with many bulk billing services and other patient services across Australia including Chronic Disease Management.
WorkSafe Victoria
The WorkSafe Victoria scheme allows healthcare providers to lodge invoices for injured workers via a HICAPS terminal. To do this, you'll need to provide your Medicare provider number and HICAPS claim number. This service is for lodging invoices only, not payment, so you won't receive an on the spot payment.
Which funds use HICAPS?
HICAPS is a service provided by most Australian health funds. These include:
The following list summarises the services that can be claimed through HICAPS by many of the leading health funds.
Acupuncture
Chiropractor
Clinical psychology
Dentistry
Dietitian
Exercise physiology
Myotherapy
Naturopathy
Occupational therapy
Optometry
Osteopathy
Physiotherapy
Podiatry
Psychology
Remedial massage therapy
Speech pathology
What is the HICAPS Go app?
HICAPS Go is designed to be a one-stop healthcare app that allows you to find health services, get quotes, pay for your consultation and claim your private health benefit from your smartphone or mobile device.
It lets you access allied health services such as physiotherapists, chiropractors and remedial massage therapists in the greater Melbourne area. With it, you can:
Find a preferred provider in your area using location services
Get a quote and see your benefit contribution and any out-of-pocket costs upfront
Make an appointment and manage your booking
After the consultation, instantly claim your benefit and pay only the gap portion
How much does health insurance cost?
We ask hundreds of Australians what they're paying for health insurance every month. Here's what they told us in July 2024.
Basic: $99
Bronze: $141
Silver: $183
Gold: $221
Price based on 1,000+ responses for single hospital insurance.
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Depending on your age, you may be eligible for an
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rebate.
Under 65
65 - 69
70 or older
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This is the combined income you and your spouse earn before tax. It's needed to calculate the correct Australian government rebate.
$93,000 and under
$93,001 to $108,000
$108,001 to $144,000
$144,001 and over
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*Prices updated March 2024, in line with Finder's
database of health insurance policies. Prices are based
on a single individual with less than $93,000 income and
living in Sydney with a $750 excess.
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Preventative & general dental
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FAQs about HICAPS
HICAPS is an acronym for the Health Industry Claims and Payments Service. It's an Australian electronic health payment system that lets you claim Medicare, WorkSafe Victoria and private health insurance benefits when you make a payment for a health service you've received.
When you visit a health provider like a dentist or physiotherapist, and you have extras health insurance, give the receptionist your health fund membership card and they'll swipe it through the HICAPS machine to give you your rebate. Then, you'll only need to pay the difference between what the health provider charges and your health insurance covers.
Yes, many health funds, including Medibank, ahm, Bupa, HBF and Nib now offer digitised membership cards to members with mobile devices, so you can claim your benefit with no card via HICAPS.
Existing Medibank and AHM customers can start using HICAPS Go straight away. Simply download the app from the Apple App or Google Play store.
Yes, HICAPS is confidential. The details of your treatment can only be viewed either by your health fund or healthcare provider.
You can make a medicare claim using HICAPS via the Medicare Easyclaim system to lodge your claim and receive your rebate. In this instance you will generally be asked to pay, then your Medicare card will be swiped through the HICAPS machine and the rebate will be paid to your bank account.
If you have a private health insurance extras policy, present your card when paying for your service and they will swipe it through the HICAPS terminal.
Following this, details will be sent to your health fund, instantly processed and if your extras policy covers the cost of your treatment then you won’t need to make any further payments. If you do have any further payments, you can pay the remainder via credit card or EFTPOS.
Gary Ross Hunter was an editor at Finder, specialising in insurance. He’s been writing about life, travel, home, car, pet and health insurance for over 6 years and regularly appears as an insurance expert in publications including The Sydney Morning Herald, The Guardian and news.com.au. Gary holds a Kaplan Tier 2 General Advice General Insurance certification which meets the requirements of ASIC Regulatory Guide 146 (RG146). See full bio
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Gary Ross has written 725 Finder guides across topics including:
Richard Laycock is Finder’s insights editor after spending the last five years writing and editing articles about insurance. His musings can be found across the web including on MoneyMag, Yahoo Finance and Travel Weekly. Richard studied Media at Macquarie University and The Missouri School of Journalism and has a Tier 1 Certification in General Advice for Life Insurance. See full bio
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You pay nothing. Finder is free to use. And you pay the same as going direct. No markups, no hidden fees.
You save time. We spend 100s of hours researching health insurance so you can sort the gold from the junk faster.
You can trust us. We say it like it is. We aren't owned by an insurer and our opinions are our own.
