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No one wants to go through a drawn-out claims process when they’re seeking treatment. Knowing this, healthcare providers utilise an electronic claims system called HICAPS, which enables customers to make on-the-spot private health insurance or Medicare claims in seconds.

What is HICAPS?

HICAPS (or Health Industry Claims & Payments Service) is a system that your healthcare provider can use to instantaneously process private health insurance, Medicare, or WorkSafe Victoria claims. It functions in a similar manner to an EFTPOS machine but communicates to insurers or the government instead of financial institutions.

Here’s how a typical transaction would occur. Let’s say you go to a dentist who has HICAPS set up in their clinic. Once it’s time to pay for your visit, you swipe your health fund card through the HICAPS terminal, and it immediately sends the details of your claim to your insurer. In less than a minute, your claim should be processed.

If the claim covers the entire cost of your treatment, no further payments need to be made. If it only covers part of your treatment, you’ll need to pay out of pocket expenses, known as a gap payment.

The details of your treatment are kept confidential and you are not obligated to pay any of your fee before a claim is made. Best of all, HICAPS is widely available through GPs, dentists, optometrists, physios, and more.

Who has access to HICAPS payments?

If you have either a Medicare or a Private Health Insurance member card, you can take advantage of HICAPS. The only people who may not be able to utilise HICAPS are overseas visitors, who cannot get Medicare or insurance from a private insurer.*

* Overseas Student & Visitor policies may not be supported through HICAPS

What is the difference between EFTPOS & HICAPS terminals?

  • HICAPS machines communicate between the healthcare provider and your insurer, Medicare or WorkSafe Victoria.
  • EFTPOS machines communicate between your healthcare provider and whatever financial institution you wish to use to pay for your treatment.

Which health funds support HICAPS?

Many insurers are partnered with HICAPS, which means it’s likely you’ll be able to make a claim as soon as your treatment is complete. While the following funds all allow you to make claims, this may not be possible for every type of treatment.

ACA HealthLa Trobe Health Services
Australian Defence Force Family HealthMedibank Private Ltd
AHM Health InsuranceMildura District Hospital Fund Ltd
Apia Health InsuranceNational Health Benefits Australia Pty Ltd (onemedifund)
Australian Unity Health LtdNavy Health
Budget DirectNIB Health Funds Ltd
Bupa AustraliaNurses & Midwives Health
CBHS Health Fund LimitedPeoplecare Health Insurance
CUA Health LimitedPhoenix Health Fund Ltd
Defence Health LimitedPolice Health
Emergency Services HealthQantas Assure Health Insurance
Frank Health insuranceQueensland Country Health Fund Ltd
GMF HealthRailway and Transport Health Fund Ltd
GMHBA LimitedReserve Bank Health Society
Grand United HealthSt Lukes
HBF Health FundThe Doctors’ Health Fund
HCFTeachers Health Fund
Health Care Insurance LtdTransport Health Pty Ltd
Health Insurance Fund of Australia Ltd (HIF)TUH
Health PartnersUni Health
Health.com.auWestfund Ltd
Source: HICAPS.com.au, current as of 14/03/2017

HICAPS and health insurance

HICAPS represents a leap forward in helping Australians better manage their healthcare expenses. It’s worth noting that you can squeeze even more value from healthcare providers by finding better value private health insurance to cover the costs.

With that in mind, you can start your hunt for better private health insurance today by using our comparison service. Alternatively, call our experts and they’ll do the legwork for you, or read a little more about health insurance cover tiers here on the website. Simples!

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