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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.

What is HICAPS?

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.

How does HICAPS work?

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.

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 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.

Which healthcare practitioners offer HICAPS?

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:

  • acupuncturists
  • chiropractors
  • clinical psychologists
  • dentists
  • dietitians
  • exercise physiologists
  • myotherapists
  • naturopaths
  • occupational therapists
  • optical dispensers
  • optometrists
  • osteopaths
  • physiotherapists
  • podiatrists
  • psychologists
  • remedial massage therapists
  • speech pathologists.

Which health funds have partnered with HICAPS?

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:
AAMIMildura Health Fund
ACA HealthMedibank
AHM Health InsuranceNational Health Benefits Australia Pty Ltd (onemedifund)
API insurance servicesNavy Health
Apia Health InsuranceNIB Health Funds Ltd
Australian Defence Force Family HealthNurses & Midwives Health
Australian Unity Health LtdPeoplecare Health Insurance
Budget DirectPhoenix Health Fund Ltd
Bupa AustraliaPolice Health
CBHS Corporate HealthQantas Health Insurance
CBHS Health Fund LimitedQueensland Country Health Fund Ltd
CUA Health LimitedRailway and Transport Health Fund Ltd
Defence Health LimitedReserve Bank Health Society
Emergency Services HealthSt Lukes Health
Frank Health insuranceSuncorp
GMHBA LimitedTeachers Health Fund
Grand United Health (GU Health)Territory Health Fund
HBF Health FundThe Doctors’ Health Fund
HCFTransport Health Pty Ltd
Health Care Insurance LtdTUH
Health PartnersUni Health
Health.com.auUnion Health
HIFWestfund Ltd
Latrobe Health Services
Source: HICAPS.com.au, current at 2/10/2020

Claiming through the HICAPS Go app

The HICAPS Go app lets you (if you’re a member of a participating health fund):

  • calculate out-of-pocket costs before you book your appointment
  • claim your treatment and pay any out-of-pocket costs in only seconds.

At the time of writing, the following health funds are participating in the HICAPS Go app:

  • AAMI
  • ahm
  • Apia
  • Bupa
  • Defence Health
  • Emergency Services Health
  • Frank
  • GMHBA
  • Health.com.au
  • Healthcare Insurance
  • hif
  • Medibank
  • nib
  • Nurses and Midwives Health
  • Phoenix
  • Police Health
  • Qantas Health Insurance
  • St Lukes Health
  • Suncorp.

Source: Medipass.com.au, current at 2/10/20.

Woman looking at the HICAPS Go app

Get even more out of your health insurance policy

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!

Frequently asked questions

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

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.

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

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

What’s the difference between EFTPOS and HICAPS terminals?

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

Sources

1 HICAPS. ‘HICAPS Participating Health Funds & Health Insurance Brands.’ Accessed 11/12/19.
2 HICAPS. ‘FAQs.’ Accessed 11/12/19.

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