Things to remember when claiming

We agree claiming should be easy! Whether it be claiming online, in the app or in person. Here are a few things to remember when claiming to ensure your claim is lodged and paid efficiently.

  • Claims must be lodged within two years of the date of the service. Unfortunately we won’t pay benefits if a claim is lodged after this period.
  • To help us assess your claim, make sure that all invoices and receipts are the originals or provider endorsed duplicates. These must include the:
    • appropriate item number or full description of the service or product
    • patient’s name
    • date of service
    • fee charged
    • provider’s name, qualifications and practice address, and provider number (if applicable)
    • tooth numbers are required on dental accounts where treatment has taken place on individual teeth.
  • Benefits and limits are assessed having regard to the date on which the services were rendered or product supplied, except for courses of orthodontic treatment.
  • Limits reset on the anniversary date of your membership.
  • Services must be provided by approved practitioners in private practice, or salaried doctors in public hospitals.
  • All documents submitted in connection with a claim become the property of Territory Health Fund, unless otherwise agreed, by the Health Fund.
  • Benefits are not payable for claims for services rendered while premiums are in arrears or the membership is suspended.
  • Benefits are not payable, or may be payable at a reduced rate, during any applicable waiting periods.
  • Benefits are not payable for claims for services rendered outside Australia or, for items purchased or hired from overseas suppliers.
  • Benefits are not payable on claims subject to compensation, third party or other liability provision.
  • Benefits are not payable for treatment rendered by a provider to the provider’s partner (spouse or de facto) or dependent children or partner’s dependant children if a legally enforceable debt is not raised.
  • Benefits for gym membership, personal training and aquatic exercise/rehabilitation* under Healthy Living benefits will only be payable on referral by your health care professional for you to participate in this health management program where it is to address or improve a specific health or medical condition.
  • Supporting documentation in the form of a Health Management Program Benefit Approval Form is to be completed by your health care professional and is required to be lodged along with a completed claim form.

If you have any questions when lodging a claim please don't hesitate to contact the team on 1800 623 893 or [email protected]

* Aquatic exercise/rehabilitation includes pool entry and exercise classes (excludes swim classes/lessons)