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.
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.
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
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 Health||La Trobe Health Services|
|Australian Defence Force Family Health||Medibank Private Ltd|
|AHM Health Insurance||Mildura District Hospital Fund Ltd|
|Apia Health Insurance||National Health Benefits Australia Pty Ltd (onemedifund)|
|Australian Unity Health Ltd||Navy Health|
|Budget Direct||NIB Health Funds Ltd|
|Bupa Australia||Nurses & Midwives Health|
|CBHS Health Fund Limited||Peoplecare Health Insurance|
|CUA Health Limited||Phoenix Health Fund Ltd|
|Defence Health Limited||Police Health|
|Emergency Services Health||Qantas Assure Health Insurance|
|Frank Health insurance||Queensland Country Health Fund Ltd|
|GMF Health||Railway and Transport Health Fund Ltd|
|GMHBA Limited||Reserve Bank Health Society|
|Grand United Health||St Lukes|
|HBF Health Fund||The Doctors’ Health Fund|
|HCF||Teachers Health Fund|
|Health Care Insurance Ltd||Transport Health Pty Ltd|
|Health Insurance Fund of Australia Ltd (HIF)||TUH|
|Health Partners||Uni Health|
|Source: HICAPS.com.au, current as of 14/03/2017|
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!