Avoid the switch with these claiming tips and benefit facts!

Sometimes it’s easy to fall out of love with your health fund. And if you’re anything like our Member Rochelle who was questioning the value of her health insurance before an accident confirmed she had made the right choice to keep it, now might be the time to experience the real value we offer our Members.

Claiming tips

  • Claiming for the first time? Contact us prior to claiming for a service, treatment or item. We can let you know if a benefit is payable and if any supporting documentation is required to ensure your benefit is paid quickly.
  • For an easy way to claim and manage your usage download our Mobile App. Use our App to:
    • Check your benefit limits. You can review your benefit limits online and can see when one is reached to avoid an unexpected rejection. Don’t worry, your benefits refresh back to the start every Membership Year (the date you joined us). If you can’t remember the date that you joined, you can find this noted on your Membership Card.
    • Take a photo of your receipt to submit a claim – it’s that easy!
    • Order new Membership Cards, so you can swipe and claim straightaway if your healthcare provider has HICAPS or CSC HealthPoint (an electronic claiming facility). The HICAPS or CSC HealthPoint system processes your claim much like an EFTPOS transaction, meaning you only pay the difference and your claim is finalised on-the-spot.
    • Review your policy and understand what you’re covered for. You can then plan for some much needed ‘me time’, like booking that dental appointment or scheduling that remedial massage. A great way of making the most of your cover is by setting health and wellbeing goals. Read our tips.
  • The sooner you put a claim in the better. But we understand life admin tasks can easily fall off the to-do list, but make sure you submit a claim before the opportunity expires. We’ll accept a claim up to two (2) years from the date in which the service or therapy occurred.

Benefit facts

  • If you have been referred for surgery, reduce your out-of-pocket expenses by checking if your specialist will participate in our Access Gap Scheme. You can search doctors who have participated in the scheme here.
  • Get to know the industry jargon. We’ll do our best to avoid using the jargon to help make your cover easy to use and understand. But there are some terms that are tricky to ignore. We recommend getting to know the difference between ‘inpatient’ and ‘outpatient’ services. Hospital accommodation and medical benefits can only be paid if you’re an ‘inpatient’ and admitted to hospital or day surgery at the time of treatment.
  • We reward our Members for their commitment to health insurance and for choosing staying with us. Once you've held cover under either Essential or Premium Extras for a year, we automatically increase your overall annual claim limits for dental services (excluding orthodontics) and our full range of therapies by $50 per year for five years, and then honour this for the life of your policy. Learn more.
  • Did you know we offer complimentary cover reviews? For some of our Members they strongly value the peace of mind that private health insurance provides and others like to make use of their Extras Cover, so does your cover suit how you use it? We can check and confirm if you need to upgrade or downgrade your cover to ensure it’s still the right fit. You can do this over the phone.