Private health insurance can help you cover the costs of a range of medical procedures, but how you can go about claiming these benefits really depends on the type of treatment you are receiving. Treatments can be broken up into two basic areas: hospital and extras.


How you make a claim for an extras treatment will vary from fund to fund, though generally you should be able to claim either on the spot, in person, with an app, online, over the phone or by mail.

On the spot

Claiming on the spot using HICAPS (an instant claims solution) is the fastest and most efficient way to make a claim on your extras cover. All you have to do is hand your membership card over to your physio or dentist, they’ll swipe it and the benefit amount you’re entitled to will automatically be deducted from the fee so that all you have to pay is the difference.

In person

If your service provider doesn’t have HICAPS or you don’t have your membership card with you when you go in for your treatment, you can head into one of your health fund’s branches to make a claim. All you’ll need to bring is your membership card and a copy of your original receipt. Once processed, your fund will deposit the benefit amount into your bank account.

Using an app

A growing trend for health funds is to have their own claims app, which allows members to lodge a claim by uploading a photo of their treatment receipt to the app. Once approved, your fund will deposit the benefit amount into your bank account.


Claiming online is similar to claiming through an app, except you’ll need to log into your health fund’s member portal online and upload an image of your receipt there.

Over the phone

If you’re after a low-tech way of processing your claim, you can still lodge it over the phone. The phone agent will be able to walk you through the process of filing a claim and they will process it right there on the phone.

By mail

You can still file a claim by mail. What you’ll need to do is find and complete your health fund’s claim form, attach any supporting documentation such as your treatment receipt and send it to your health fund.


Claiming for a hospital treatment is a little trickier. Hospital costs can be broken down into two areas: accommodation costs and medical costs.

For accommodation costs, if the hospital you’re visiting is one of your health fund’s participating hospitals, you’ll only have to pay for any co-payments or excesses, provided the treatment you’re having isn’t excluded from your policy. In most cases, the hospital will send the bill straight through to your health fund and you won’t have to do anything.

Claiming for your medical costs will vary depending on whether or not your doctor participates in your health fund’s gap scheme. If your doctor is part of the scheme, they’ll send their bill off to Medicare and your health fund and you won’t hear from them unless there is any money owing outside of what is covered by your health fund and Medicare.

You can find a health professional that participates in your health fund’s gap scheme by using’s search and selecting your health fund. 

If your doctor is not part of your health fund’s gap scheme, you’ll need to head to Medicare yourself once you’ve left the hospital and present them with your medical paperwork. They’ll issue you a cheque for your doctor. You’ll then need to complete a claim form for your health fund and your fund will provide you with a cheque to cover their portion of your treatment. Finally, you’ll need to send the cheques off to your doctor and pay any outstanding costs not covered by your health fund and Medicare.

This article was written by Richard Laycock, an Insurance expert from

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