Make a claim
Extras services
There are many ways to claim your extras benefit:
Electronic claiming services
On-the-spot claiming is available at a range of extras providers via electronic claiming terminals such as HICAPS or HealthPoint. To claim your benefit, simply swipe your membership card and your claim is processed straight away. All you have to pay is the balance. You can check if your provider offers HICAPS below.
Claiming via HICAPS is unavailable for nutrition, audiology and pharmacy or Health management benefits.
Online
Simply log in to our member portal and follow the instructions to submit your claim. There’s no need to send in receipts. Just keep all receipts for twelve months after you claim in case we need to check them.
Smart phone
Make a claim by uploading photos of your receipts in less than a minute, or upload other documents and instantly submit them via our smartphone app.
We will retain all documents unless you indicate otherwise.
Any account or receipt submitted must be on an official receipt or account form, and bear the provider’s official stamp. It must be legible and display the provider’s name, provider number, practice address, ABN/ACN, the date of service, a description of the service, the name of the patient and the cost. Cash register dockets will not be accepted.
We pay claims under the understanding that:
The costs involved are not recoverable from a third party (eg. workers compensation, or other insurance/damages). If treatment costs are reimbursed by a third party you must repay any benefits we have paid for the claim.
To ensure correct payment of benefits, we will use your personal information in accordance with our Privacy Policy. Unless you tell us otherwise, this may include contacting your health service provider to request information about the treatment you received and the charges raised.
All claims are subject to private health insurance laws, Fund Rules and policies and procedures. For further details please contact us for a copy of our Fund Rules.
Medical expenses while in hospital
If your doctor or specialists have agreed to charge you under the Access Gap Cover Scheme, they'll charge us directly for your hospital treatment.
If your doctor doesn't use Access Gap Cover, they may send you an account. You can take this to Medicare and then to us for payment. Just use our claim form and make sure you include the “Statement of Benefits” from Medicare with your claim. Medicare will pay 75% of the Medicare Benefits Schedule (MBS) Fee and we will pay the remaining 25% of the MBS Fee. You will need to pay any amount the doctor charges above the MBS Fee.
What is not covered?
We pay benefits in accordance with the law and TUH Fund Rules and policies. We do not pay hospital benefits for:
Admissions that occurred during your waiting period
Booking fees including cancellation fees
Treatment that is excluded from your policy
Treatment provided as part of an aged care service
Elective procedures that are not considered to be medically necessary e.g. cosmetic surgery
Treatment provided in an emergency department or associated short stay unit of a hospital
Treatment for which you have received compensation or damages
Restrictions may apply for multiple treatments on the same day.
