It’s not ideal being out of pocket while you wait for your insurer to process your health insurance claim – especially if the bill is quite substantial.
Knowing this, many healthcare practitioners offer HICAPS – a system that provides a simpler way to claim on your policy in a matter of seconds.
HICAPS (which stands for Health Industry Claims and Payments Service) is an electronic system that your healthcare provider (e.g. physiotherapist or dentist) can use to process your private health insurance, Medicare or WorkSafe Victoria claims instantaneously.
Instant claims processing means that you receive your health insurance benefit on the day of your treatment, rather than being out of pocket until your insurer assesses your claim.
While HICAPS functions similarly to an EFTPOS machine, it communicates to insurers or the government instead of your bank.
Once you’re ready to pay for your appointment, you first swipe your health fund card through the HICAPS terminal. Immediately, the machine sends the details of your claim to your insurer. In seconds, your claim should be processed.
If your claim covers the entire cost of your treatment, you won’t need to pay anything further. If your insurer’s contribution only covers part of your treatment, you’ll need to pay the remainder out of pocket (also known as a gap payment). You would pay the gap using EFTPOS or another method that suits you and your healthcare professional.
If you have either a Medicare or a private health insurance member card, you can take advantage of HICAPS as long as the service you receive is covered under your policy.
Overseas visitors may not be able to use HICAPS, as they aren’t eligible for Medicare and – ultimately – hospital insurance from a private insurer. However, overseas visitors with an extras policy can claim on the services listed on their policy, up to the limits of the cover.
You can typically claim most extras services (out-of-hospital services) through HICAPS. However, not every practitioner may offer HICAPS, so double check before going if you don’t want to wait for your claim to be assessed.
Practitioners that typically offer HICAPS include:
At the time of writing, it appears all Australian health insurers use HICAPS.1 However, you might not be able to use HICAPS for every type of treatment.
As such, it’s important to check your policy and chat to your insurer before making an appointment.
| Here are the health insurers and brands that have partnered with HICAPS, according to the HICAPS official website: | |
| AAMI | Mildura Health Fund |
| ACA Health | Medibank |
| AHM Health Insurance | National Health Benefits Australia Pty Ltd (onemedifund) |
| API insurance services | Navy Health |
| Apia Health Insurance | NIB Health Funds Ltd |
| Australian Defence Force Family Health | Nurses & Midwives Health |
| Australian Unity Health Ltd | Peoplecare Health Insurance |
| Budget Direct | Phoenix Health Fund Ltd |
| Bupa Australia | Police Health |
| CBHS Corporate Health | Qantas Health Insurance |
| CBHS Health Fund Limited | Queensland Country Health Fund Ltd |
| CUA Health Limited | Railway and Transport Health Fund Ltd |
| Defence Health Limited | Reserve Bank Health Society |
| Emergency Services Health | St Lukes Health |
| Frank Health insurance | Suncorp |
| GMHBA Limited | Teachers Health Fund |
| Grand United Health (GU Health) | Territory Health Fund |
| HBF Health Fund | The Doctors’ Health Fund |
| HCF | Transport Health Pty Ltd |
| Health Care Insurance Ltd | TUH |
| Health Partners | Uni Health |
| Health.com.au | Union Health |
| HIF | Westfund Ltd |
| Latrobe Health Services | |
| Source: HICAPS.com.au, current at 2/10/2020 | |
The HICAPS Go app lets you (if you’re a member of a participating health fund):
At the time of writing, the following health funds are participating in the HICAPS Go app:
Source: Medipass.com.au, current at 2/10/20.
HICAPS represents a leap forward in helping Australians better manage their healthcare expenses. It’s also worth noting that you can squeeze even more value from healthcare providers by finding competitive private health insurance to cover the costs.
With that in mind, you can start your hunt for a great-value policy today by using our handy comparison service. With our free tool, you can compare a range of policies from some of Australia’s top insurers to see how their premiums, cover options and features stack up (and help ensure you’re getting value for your money).
Best of all, it takes only minutes to compare policies, as they’re all stacked side-by-side in one place.
Alternatively, call our experts and they’ll do the legwork for you. Simples!
If your health fund membership card doesn’t have a magnetic strip, your fund may not be linked with HICAPS, or you may have an older card. As such, you should contact your insurer.
Yes, your details are kept confidential, as they’re sent straight to your health fund and only viewable by your healthcare practitioner and your insurer.
On top of this, HICAPS says it uses a ‘secure encryption protocol’ to safeguard your privacy.2
1 HICAPS. ‘HICAPS Participating Health Funds & Health Insurance Brands.’ Accessed 11/12/19.
2 HICAPS. ‘FAQs.’ Accessed 11/12/19.
