Home / Compare Health Insurance / Health Insurance About / What is HICAPS and how c…
Many healthcare practitioners these days use HICAPS, a system that provides a simpler way to process health fund claims in a matter of seconds. Here are a few things you need to know about HICAPS:
Health Industry Claims and Payments Service (HICAPS) is an electronic health claims system that your healthcare provider (e.g. physiotherapist or dentist) can use to process your private health insurance, Medicare, WorkSafe Victoria and Insurance Commission of Western Australia claims instantaneously.
With instant claims processing, you receive your health insurance benefit on the day of your treatment, rather than being out of pocket until your insurer assesses your claim.
HICAPS functions similarly to an EFTPOS machine, except it communicates with your insurer or the government instead of your bank.
Our health insurance expert, Steven Spicer, has some tips on how HICAPS can help make claiming on your health insurance even easier.
While most healthcare providers will have HICAPS terminals available to health fund members, there are still some that don’t. If this happens, consider looking for funds that have other great claiming methods (such as mobile apps or branches) that help make claiming easy.
Have you noticed that some people swipe their membership cards on the HICAPS terminal and don’t have to pay a gap? That’s because some health funds offer no gap benefits with select providers, or 100% back on eligible services (such as optical) up to the annual limit. By comparing health insurance, you might be able to find a policy that offers no gap benefits for the extras services that matter to you!
Eligible members of selected health funds can now claim by tapping their smart phones and watches on HICAPS terminals instead of using their membership card. This makes it easier and even more convenient to claim.
Once you’re ready to pay for your appointment, all you need to do is swipe your health fund card through your service provider’s HICAPS terminal. The machine immediately sends the details of your claim to your insurer, and your claim should be processed in seconds.
If your extras cover policy pays the entire cost of your treatment, you won’t have to do anything else. If your insurer’s contribution only covers part of your treatment, you’ll need to pay the remainder out of your own pocket (known as a gap payment). You can pay the gap using a debit or credit card through EFTPOS, or another method that suits you and your healthcare professional.
The HICAPS terminal can process up to 24 Medicare Benefit Schedule (MBS) item numbers per transaction.1 However, the actual maximum amount of item numbers per transaction can vary between health funds, so remember to check with your insurance provider before receiving treatment.
When you’re entitled to a Medicare rebate for your treatment, you can scan your Medicare card at your providers HICAPS terminal and Medicare will deposit your rebate amount into your bank account via their Easyclaim system.
If you have either a Medicare or a private health insurance member card, you can take advantage of HICAPS as long as you’re eligible for a rebate on the service you receive.
Depending on their health fund, overseas visitors should be able to use HICAPS for most out-of-hospital services, provided the service is included on their extras or Overseas Visitor Health Cover (OVHC) policy. Since overseas visitors typically don’t have access to Medicare unless their home country has an Reciprocal Health Care Agreement (RHCA), they won’t be able to use HICAPS for Medicare claims.
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, all Australian health insurers use HICAPS.2 However, you might not be able to use HICAPS for every type of treatment.
As such, it’s useful 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 | Medibank Private Ltd |
ACA Health Benefits Fund | Mildura Health Fund |
AHM Health Insurance | National Health Benefits Australia Pty Ltd (onemedifund) |
AIA Health Insurance | Navy Health Limited |
Apia Health Insurance | NIB Health Funds Ltd |
Australian Defence Force Family Health | Peoplecare Health Insurance |
Australian Unity Health Ltd | Phoenix Health Fund Ltd |
Bupa Australia | Police Health |
CBHS Corporate Health Limited | Qantas Assure Health Insurance |
CBHS Health Fund Limited | Queensland Country Health Fund Ltd |
Defence Health Limited | Railway and Transport Health Fund Ltd |
Emergency Services Health | Reserve Bank Health Society Limited |
Frank Health Insurance | see-u by HBF |
GMHBA Limited | St.LukesHealth |
Grand United Health | Suncorp |
HBF Health Limited | Teachers Health Fund |
HCF | The Doctors’ Health Fund |
Health Care Insurance Ltd | Transport Health Pty Ltd |
Health Insurance Fund of Australia Ltd (HIF) | TUH |
Health Partners | Uni Health |
Hunter Health Insurance | Union Health |
La Trobe Health Services | Westfund Ltd |
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. If the latter is the case, you should contact your insurer to request a new one.
Yes, your details are kept confidential, as they’re sent straight to your health fund and only viewable by your healthcare practitioner and insurer.
On top of this, HICAPS states it uses a ‘secure encryption protocol’ to safeguard your privacy.1
As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.
1 HICAPS. ‘FAQs.’ Accessed April 2023.
2 HICAPS. ‘HICAPS Participating Health Funds & Health Insurance Brands.’ Accessed April 2023.