HICAPS - Health Industry Claims and Payments Service - is an electronic claims system that lets you claim private health insurance benefits and some Medicare rebates at the very moment you're paying for healthcare. Instead of paying the full amount and then claiming rebates or benefits later, those benefits are deducted from your bill or paid instantly.
This system is extremely popular as it makes healthcare more accessible and affordable for patients, while also making payment processing easier and more convenient for practitioners. Over 100,000 registered healthcare providers across Australia use HICAPS and it is accepted by 100% of private health funds.
How does HICAPS work?
When you visit a healthcare provider that uses HICAPS, the process is slightly different depending on whether you're claiming Medicare rebates or private health insurance benefits.
Private health insurance
You receive your treatment as normal.
When it's time to pay, you'll be presented with a HICAPS terminal that looks just like a standard card machine.
You tap or insert your private health insurance card. Both digital and physical versions are usually accepted.
The healthcare provider enters the treatment details and costs into the HICAPS terminal, which then communicates with your health fund in real-time.
Within seconds, the system confirms your coverage level and calculates your rebate amount. If the rebate doesn't cover the entire bill, you pay the remaining amount.
You're done! There is no paperwork to fill out or claims to submit later.
Medicare rebates The relationship between Medicare and HICAPS is more complicated and only some rebates, for limited services, can be claimed instantly. Here's what you can expect:
You receive your treatment as normal.
When it's time to pay, you provide your Medicare card.
If the provider offers bulk-billing for the service you received, you won't have to pay anything and can leave.
If the provider does not offer bulk-billing, you may be required to pay the entire cost up-front.
If the provider is registered with Medicare Easyclaim, and you are eligible for a rebate, they can process your rebate claim on-the-spot via the HICAPS machine.
The rebate will be paid into your bank account, linked via Medicare.
Not all providers or services are eligible for Medicare Easyclaim. Make sure your bank account is linked with Medicare via myGov so claims can be processed instantly.
What is HICAPS used for?
HICAPS is used across a wide range of health services, including physiotherapy, dental, optometry, chiropractic care, podiatry, and psychology. It is most commonly used for processing private health insurance claims that are covered by extras policies. Hospital treatments typically involve a different claiming process and HICAPS can only be used for some Medicare rebates, in specific circumstances.
Not all healthcare providers have HICAPS without around 100,000 registered providers in Australia. Larger clinics and group practices are more likely to have HICAPS terminals because they process higher volumes of insurance claims.
HICAPS and Medicare
HICAPS can help you claim instant Medicare rebates in some situations, although this is not as common as claiming private health insurance benefits via HICAPS and there are limitations to be aware of. For example, you can only claim an instant Medicare rebate via HICAPS if:
The healthcare provider is registered with HICAPS and has enabled Medicare Easyclaim.
The service you received is eligible for a Medicare rebate.
You have a valid referral or plan for the service you received.
Unfortunately, many Medicare rebates still require a separate claiming process, particularly for specialist consultations and diagnostic tests. These can be claimed through Medicare's online services, mobile app, or at Medicare offices.
For some Medicare-covered services, providers offer bulk billing which means they accept the Medicare rebate as full payment. In these situations, patients aren't required to pay anything out of their own pocket so HICAPS isn't necessary.
Is HICAPS available everywhere in Australia?
HICAPS is extremely common across Australia, with over 100,000 healthcare providers registered with the service and over 41 million claims made via HICAPS every year.
It is widely available in large cities as well as small towns and rural areas. However, HICAPS is not a mandatory requirement for healthcare providers, so not all providers will offer the service.
How to use HICAPS
Using HICAPS is simple, and the healthcare service provider will manage much of the process for you. However, there are a few things you can do to make the process more streamlined:
Register your bank account with Medicare, via myGov
When you book a healthcare appointment, ask if they offer HICAPS
Always take your Medicare card and private health insurance card to appointments
Let reception staff know that you'd like to use HICAPS for claiming if it's available.
The healthcare provider can confirm whether your specific treatment is covered and what your expected out-of-pocket costs will be. During the payment process, you'll need to present your cards and may need to enter your PIN. The process typically takes just a few minutes, and you'll receive a receipt showing the original cost, rebate amount, and your final payment.
If a provider doesn't have HICAPS, you can still claim your rebates or benefits later. This may be through your health insurance's website or app, Medicare's online services or app, or by submitting paper forms.
Expert quote
Our expert says
"HICAPS was a game-changer for health insurance customers when it was introduced, offering an easy way to claim right away, so they were truly never out-of-pocket. Occasionally I still have to make a manual claim, and while even that is easier than it used to be, it's so much more effort than just swiping my membership card."
Sarah tore her ACL and requires weekly physio sessions, costing $120 each. Medicare covers up to $60.30 per session and Sarah's private health insurance covers up to $50 per session.
Sarah chooses a physio that offers HICAPS, with Medicare Easyclaim enabled, and links her bank account to Medicare. After her first session, Sarah asks to pay via HICAPS. She swipes her health insurance card and $50 is immediately deducted from her bill.
Sarah tells the receptionist she is also eligible for a Medicare rebate and the receptionist enters her Medicare card information into HICAPS. Sarah pays the remaining $70 bill but the Medicare rebate is processed instantly and $60.30 arrives in Sarah's bank account later that day.
Since Sarah chose a provider that offered HICAPS, she doesn't have to wait weeks for a rebate or insurance claim to be approved, she doesn't have to plan for a large expense every week, and she doesn't need to fill in any paperwork.
This case study is fictional and used for demonstrative purposes only.
HICAPS refers to the Health Industry Claims and Payments Service. It is an electronic claims system that lets people claim private health insurance benefits and some Medicare rebates on-the-spot, so they don't have to be out-of-pocket for healthcare expenses.
Yes, in some situations, you can use HICAPS with Medicare. However, you should check with your healthcare provider to see that they have Medicare Easyclaim enabled and to see if you, and the treatment you require, are eligible.
No, not all healthcare providers accept HICAPS. However, most do. You can contact your healthcare practitioner to check before you attend your appointment.
When you scan your private health insurance card using the HICAPS terminal, the benefit offered by your policy is immediately deducted from your bill. This means you don't have to worry about an inconvenient claims process or being out of pocket while you wait for approval.
HICAPS does not cost the patient or client anything to use. However, healthcare practitioners do need to pay a monthly rental fee for the HICAPS terminal and merchant service fees for credit card and EFTPOS transactions may apply.
Yes, many dental and optical service providers accept payment via HICAPS. Check with your healthcare provider first.
You can ask your healthcare provider if they accept HICAPS payments. You may want to call them ahead of your appointment to avoid an unexpected cost.
Nicola Middlemiss is a journalist with nearly a decade of experience in personal finance and insurance. She has contributed to Domain, Yahoo Finance, Money Magazine and Insurance Business Australia, offering in-depth insights into commercial insurance in the Australian market. Nicola holds a Bachelor’s degree in English from the University of Leeds and a Tier 1 General Insurance (General Advice) certification, which complies with ASIC standards.
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