Want to claim on your health insurance quicker? HICAPS allows you to claim on the spot for some treatments.

If you already claim on private health insurance extras treatments such as dental, optical, chiro or remedial massage, chances are you’ve already taken advantage of HICAPS.

However, for those new to private health insurance in Australia and have no idea what HICAPS is, you’ll find this guide useful. We’ll share how HICAPS works, which health funds offer it and the type of services you can claim with the system.

Understanding HICAPS could see you claiming on your health services quicker, reducing the entire process to just a few seconds. It also saves you the hassle of submitting your claim after the treatment and waiting for your payment to arrive in your bank account.

HICAPS is designed to help Australians better manage and claim their healthcare expenses.

If you utilise HICAPS and have health cover that suits your needs, you’ll be making the most of your private health insurance to cover the costs.

If you can already see the advantages of HICAPS, you can begin the hunt for a better private health cover right now using our online comparison tool.

The Members Own comparison tool allows you to compare a range of hospital cover and extras cover options from 18 not-for-profit health funds in just a few minutes.

Our funds exist solely to give members more benefits and better coverage, while investing a higher percentage of your premiums to improve services and keep you happy. In fact, over one million Australians are already with one of our not-for-profit or mutual funds.

What is HICAPS and how will it benefit you?

HICAPS stands for Health Industry Claims & Payments Service. It’s an electronic system your Australian healthcare provider uses to instantaneously process your health claims at the time of payment. This includes your Medicare, private health insurance and WorkSafe Victoria claims.

HICAPS functions similarly to an EFTPOS machine but instead of communicating with a financial institution, it communicates with the government or your individual insurer. The processing system has been designed to streamline how you manage and claim your healthcare expenses.

By allowing you to claim on the spot, HICAPS makes claiming on healthcare services much simpler and quicker than previous processing methods.

How does HICAPS works?

Ever noticed your health service provider swiping your health care card when finalising your bill? They are probably a HICAPS provider using the electronic claiming system. This enables you to walk away without paying any out of pocket expenses or only paying the gap rather than the entire bill.

Here’s how a typical HICAPS transaction works.

Picture this, you’ve just received a clean and check up with your dentist who is a HICAPS provider. When it comes time to pay for your treatment, you swipe your health fund card through the HICAPS electronic terminal.

This machine immediately sends the details of your claim to your health fund or insurer. In a few seconds, you’re claim is processed.

If the entire cost of your treatment is covered by your provider, then you won’t need to make any further payment. If it only covers part of the service, you’ll need to pay the remaining gap.

HICAPS is widely available through a variety of healthcare providers including GPs, dentists, physios, chiropractors and optometrists.

Which Members Own funds support HICAPS?

The HICAPS service is provided by many of the Members Own not-for-profit health funds, including:

What service providers can I use HICAPS to claim with?

Most ancillary or extras services are covered by HICAPS however, this will depend on your individual health fund so it’s always good to double check these details before you sign on the dotted line.

Some of the common services you can make HICAPS claims for include popular extras cover services, such as:

  • Acupuncture

  • Chiropractic

  • Dental

  • Dietetics

  • Exercise Physiology

  • Myotherapy

  • Naturopathy

  • Occupational Therapy

  • Optical

  • Osteopathy

  • Physiotherapy

  • Podiatry

  • Psychology

  • Remedial Massage Therapy

  • Speech Therapy

Who has access to HICAPS payments?

If you have a Medicare card or are a member of a private health insurance fund who provides HICAPS, you can take advantage of this electronic claim processing service.

If you are an overseas visitor and can’t get a Medicare card or take out private health insurance, you won’t be able to utilise HICAPS. Those who hold an Overseas Student or Visitor policy also may not be able to claim.

What is the HICAPS Medicare Easyclaim?

Medicare Easyclaim is an initiative that allows Medicare patients to process their claims on health care services through the HICAPS terminal. They’ll also receive their rebates through the same system.

Medicare Easyclaim can be used for bulk bill services and/or claims including Enhanced Primary Care.

It works in the same way as claiming on your private health insurance. Let's say you’ve had a consultation with your GP. At the time of payment, your Medicare card is swiped through the HICAPS electronic terminal. If you’re paying your account in full, your rebate is paid directly into your nominated bank account almost immediately.

What is the difference between an HICAPS and EFTPOS terminal?

You may have seen two terminals on the front desk at your GP or healthcare provider and wondered what the difference is between them is.

  • EFTPOS terminal

    An EFTPOS (Electronic funds transfer at point of sale) machine communicates between your healthcare provider, such as your GP or dentist, and the nominated financial institution you’re using to pay for the treatment.

  • HICAPS terminal

    A HICAPS machine communicates between your healthcare provider, such as your GP or dentist, and whoever you are making the claim with. This could be your private health insurer, Medicare or WorkSafe Victoria.

Are my treatment details kept confidential claiming with HICAPS?

Absolutely! Treatment details of all patients are kept confidential and are sent directly to your health fund through the HICAPS terminal. These can only be viewed by your healthcare provider and your health fund using a secure encryption protocol. This fully protects your privacy.

How can I submit a private health insurance claim?

Typically, there are four methods for you to lodge a claim with your private health insurance provider. These include:

  • Electronically on the spot

    Following your consultation or treatment with your healthcare provider, you can lodge your claim with your health fund as you’re paying for the service.

    All you need to do is swipe your membership card in the provider’s HICAPS terminal. Your claim is then checked against your fund’s system and the rebate is automatically calculated.

    Depending on your policy and the treatment received, you may not have to pay anything. Otherwise, you’ll only have to pay the difference between the provider’s fee and your insurance rebate.

    If your healthcare provider or insurer, doesn’t offer the HICAPS service, you’ll have to make your claim through one of the other methods.

  • Online or via an app

    Once you’ve paid the bill for your treatment, you can submit a claim through your health fund’s website. Depending on your individual fund, you may need upload a copy of your receipts or just the amount with your provider’s number and item code. These details will be found on the account of your healthcare provider.

    This process is still largely automated, however an insurance consultant will be involved in reviewing your claim. Your insurance rebate will be refunded into your nominated bank account generally within days of lodging your claim.

  • In person or by post

    After finalising the bill for your treatment, you can fill out a claim form from your insurer or Medicare and submit it at your nearest branch or by post. You’ll also need to include the receipts from your healthcare provider and an itemised account for the service you received.

    This process is handled by your insurer’s data entry staff and possibly an assessor. Your insurance rebate will be refunded into your nominated bank account within weeks of lodging your claim.

  • Through your hospital

    If you’ve received treatment in the hospital, the hospital will submit the claim on your behalf. You’ll be required to present your insurance membership card on admission. Your insurer then pays the hospital and you are only required to pay the difference if applicable.

What could delay your claim?

The time it takes to process your claim is different from fund to fund. Some funds will be quicker to provide you with a rebate and others will take a little longer. You can check with your individual provider to find out how long you’ll have to wait before any money is in your account.

That’s why claiming through HICAPS is so great. The claim is processed immediately and you won’t have to incur any out of pocket expenses if approved for the treatment.

There are a few common reasons your claim could be delayed, including:

  • Your healthcare provider isn’t a HICAPS provider.
  • Your insurance premiums are not up-to-date.
  • You’re still serving the waiting period for the treatment.
  • You’re not covered for that service under your current policy.
  • You’ve reached your annual limit for that service.

What’s next with your HICAPS?

If you wish to take advantage of the HICAPS processing system, you’ll need to check if your individual insurer and chosen healthcare service is a HICAPS provider.

After that, taking advantage of HICAPS is as simple as swiping your membership card!

To make the most of HICAPS it’s also important to find the best private health insurance policy that meets your health needs while offering the most value.

You can easily compare policies by using the Members Own comparison service. This online tool has been designed to take out all the the stress of comparing either hospital or extras cover. Within minutes, you’ll be able to compare the policies of over 15 not-for-profit health funds and find out which offer the best value for your individual needs and budget.

All you need to do is jump onto the Members Own online comparison site and within a few minutes, you’ll be presented with a range of options across hospital cover, extras cover and ambulance. It could see you enjoying the benefits of private health insurance in no time!

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If you have any questions or queries with your hospital cover, extras cover or how HICAPS works, we have friendly staff who are all health insurance experts. You can call one of our team on 13 10 66.

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