What is HICAPS and how can it benefit you?

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A guide to HICAPS

Updated 11 March, 2024
Written by Joshua Malin
Reviewed by Steven Spicer

What is 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.

Expert tips for using HICAPS

Our health insurance expert, Steven Spicer, has some tips on how HICAPS can help make claiming on your health insurance even easier.

Steven Spicer
Executive General Manager – Health, Life & Energy

Look out for convenient claiming methods

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.

Pay less with your fund’s no gap scheme

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!

Leave your membership card at home

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.

How does HICAPS work?

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.


Who has access to HICAPS payments?

Which healthcare practitioners offer HICAPS?

Which health funds have partnered with HICAPS?

Can I still use HICAPS if my health fund card doesn’t have a magnetic strip?

Are my treatment details kept confidential when I’m claiming my health fund rebate?

What’s the difference between EFTPOS and HICAPS terminals?

Meet our health insurance expert, Steven Spicer

Steven Spicer
Executive General Manager – Health, Life & Energy

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.