On-the-spot claiming is available at a range of extras providers via electronic claiming terminals such as HICAPS or HealthPoint. To claim your benefit, simply swipe your membership card and your claim is processed straight away. All you have to pay is the balance. You can check if your provider offers HICAPS below.
Claiming via HICAPS is unavailable for nutrition, audiology and pharmacy or Health management benefits.
Simply log in to our member portal and follow the instructions to submit your claim. There’s no need to send in receipts. Just keep all receipts for twelve months after you claim in case we need to check them.
Make a claim by uploading photos of your receipts in less than a minute, or upload other documents and instantly submit them via our smartphone app.
We will retain all documents unless you indicate otherwise.
Any account or receipt submitted must be on an official receipt or account form, and bear the provider’s official stamp. It must be legible and display the provider’s name, provider number, practice address, ABN/ACN, the date of service, a description of the service, the name of the patient and the cost. Cash register dockets will not be accepted.
All claims are subject to private health insurance laws, Fund Rules and policies and procedures.
Medical expenses while in hospital
If your doctor or specialists have agreed to charge you under the Access Gap Cover Scheme, they'll charge us directly for your hospital treatment.
If your doctor doesn't use Access Gap Cover, they may send you an account. You can take this to Medicare and then to us for payment. Just use our claim form and make sure you include the “Statement of Benefits” from Medicare with your claim. Medicare will pay 75% of the Medicare Benefits Schedule (MBS) Fee and we will pay the remaining 25% of the MBS Fee. You will need to pay any amount the doctor charges above the MBS Fee.
What is not covered?
We pay benefits in accordance with the law and TUH Fund Rules and policies. The items that we do not pay extras benefits for include, but are not limited to
services where a benefit is payable by Medicare
treatments by providers not recognised by us for benefit purposes
services that took place two years or more before the date you lodge the claim