Ways to claim on your health insurance

• On the spot: You can use your or digital or physical membership card to claim on the spot at selected extras providers^*. You'll need to pay any difference that's owing. 
• Online: You can upload your extras or ambulance claim with our My Membership app or online in member services in a couple of easy steps.
• In a branch: Drop into your local HCF branch with your membership card and your original receipts and we’ll take care of the rest.
• By post: Send your completed claim form and original receipts to HCF, GPO Box 4242, Sydney NSW 2001.

Your health cover claims checklist

To make a claim you can log in to our My Membership app or online member services. Before claiming, make sure you:

• have given us your bank details so we can pay your claims. Go to ‘Payments’ and then ’Update payment details’.
• are covered for that treatment or service and have served any relevant waiting periods. Go to 'My cover' and then 'Cover details'
• have already had the treatment or service (you can’t claim in advance) and are claiming within 2 years of receiving the treatment or service you’re claiming for
• have read and agreed to HCF’s Privacy Policy and ticked the declaration.

Please keep in mind, we may ask you for some extra information to help with the claim.

Claiming on your hospital cover

If you're having hospital treatment, there'll be different aspects of your claim. The hospital will usually take care of claiming for things like accommodation, the theatre room hire and prostheses. 

You’ll be given a claim form to complete and sign, and the hospital will then send the bill to us. If there’s an excess, or any other out-of-pocket expenses, you’ll usually pay the hospital directly.

But there are also medical costs, like surgeons and anaesthetists, not handled by the hospital. Your doctor and anaesthetist will create their own invoice and you’ll need to first claim through Medicare who’ll give you a Medicare Benefit Statement.

We’ll need this Medicare Benefit Statement so we can process our portion of the claim. Sometimes your doctor and anaesthetist will lodge your claim to Medicare and HCF on your behalf, so ask your practitioner about their billing so you know what to do next.

Claiming on your extras cover

Most extras services can be claimed on the spot at your appointment with a system like HICAPS or CommBank Smart Health, but you’ll need to take along your physical membership card or use your digital membership card for Android.

Otherwise, you can claim for your extras with the HCF My Membership app, online in member services, in a branch or by post. To claim online, go to 'Claims' and then 'Make a claim'.

Claiming on your ambulance cover

If you need to make an ambulance claim, you can you do it through:

• our My Membership app
• online in member services 
• in a branch 
• or by post.

Ambulance cover will vary from state to state:

NSW & ACT members
If you live in New South Wales or Australian Capital Territory, a levy is included in the hospital component of your private health cover. This entitles you to free ambulance transport under the state government ambulance transport schemes.

If you're sent an invoice for ambulance transport, send it to us and we'll settle it. If you have pension or social security entitlements in NSW or the ACT complete that section on the back of the invoice and return it to the ambulance service.

If you fall outside the state-based arrangement for ambulance services and aren’t otherwise covered, you can claim under your HCF cover for state government-provided emergency ambulance services.

QLD & TAS members
If you live in Queensland or Tasmania, you’re covered under your state ambulance service scheme.

If you fall outside your state-based arrangement and aren’t otherwise covered for emergency ambulance services, you can claim under your HCF cover for state government-provided emergency ambulance services.

VIC, SA, NT & WA members
If you live in Victoria, South Australia, the Northern Territory or Western Australia and don’t have an ambulance subscription with your state ambulance service and aren’t otherwise covered (including under another state-based arrangement) you can claim under your HCF cover for state government-provided emergency ambulance services.

How long does it take for a claim to be processed?

Claims are usually processed and paid within 7 working days. If you have your physical or digital membership card for Android with you, you can claim on the spot at your appointment with many different extras providers who use HICAPS or CommBank Smart Health terminals and you pay any difference that’s owing.

How will I be paid for my claim?

When you claim online, you’ll need to confirm what bank account you’d like to use. If you haven’t linked a bank account to your claim, our team will contact you directly.

How to claim extras on the spot using your Android device

If you have a supported Android mobile device*, you can use your digital membership card to claim on the spot at selected providers. You can use either tap-and-go or the QR code.

You’ll need:

• your Android mobile device
• the most recent version of the My Membership app. Download it from Google Play
• an internet connection.

Tap-and-go

Use it at extras providers with a HICAPS VX, HICAPS Trinity or CommBank Smart Health payment terminal.

1. Make sure you’re connected to the internet. Go to your device settings, search for NFC, and make sure it’s switched on.
2. Open your My Membership app and tap the card icon in the top right corner. Your digital card will appear on-screen.
3. To claim, hold your device near the terminal at your provider. You’ll hear a beep.
4. Your claim will be processed. The provider will let you know if your claim has been approved. You’ll need to pay any difference that’s owing.

QR code

Use it at extras providers with a HICAPS Trinity payment terminal.

1. Make sure you’re connected to the internet.
2. Open your My Membership app and tap the card icon in the top right corner. Your digital card will appear on-screen. Select ‘Show QR code’.
3. To claim, scan the QR code by holding it in front of the terminal camera. You’ll hear a beep.
4. Your claim will be processed. The provider will let you know if your claim has been approved. You’ll need to pay any difference that’s owing.

If you’re having trouble accessing or finding your digital card, try reinstalling the My Membership app.

If you’re still experiencing issues, call us on 13 13 34 or email service@myhcf.com.au and we’ll look into it.

How to claim extras on the spot using your Apple device

If you have a supported Apple mobile device*, you can use the QR code on your digital membership card to claim on the spot at selected providers. 

You’ll need:

• your Apple mobile device
• the most recent version of the My Membership app. Download it from the App Store
• an internet connection.

Use it at extras providers with a HICAPS Trinity payment terminal.

1. Make sure you’re connected to the internet.
2. Open your My Membership app and tap the card icon in the top right corner. Your digital card will appear on-screen.
3. To claim, scan the QR code by holding it in front of the terminal camera. You’ll hear a beep.
4. Your claim will be processed. The provider will let you know if your claim has been approved. You’ll need to pay any difference that’s owing.

If you’re having trouble accessing or finding your digital card, try reinstalling the My Membership app.

If you’re still experiencing issues, call us on 13 13 34 or email service@myhcf.com.au and we’ll look into it.

How can I make a payment?

You can make a payment through our My Membership app or in our online member services or call 13 14 39 during the following hours:

• Mon–Fri: 8am–8pm (AEST/AEDT)
• Sat: 9am–5pm (AEST/AEDT).

You can also set up direct debit or make a one-off payment.

The different ways to make a payment are:

Direct debit and direct credit

How can I set up direct debit?
You can set up direct debit for your premium payments in the My Membership app or in online member services. Just go to ’Payments’ then ‘Update payment details’.

If you can’t do this online, to set up direct debit to pay your premiums, or to change your current direct debit payment details, please call 13 14 39 during the following hours:

• Mon–Fri: 8am–8pm (AEST/AEDT)
• Sat: 9am–5pm (AEST/AEDT).

You can pay your premiums through direct debit from a bank, building society or credit union account. Complete and submit a payment authority form.

Why doesn’t my first direct debit match my quoted premium?

Your first direct debit can differ from your quoted premium for a number of reasons, including Lifetime Health Cover loading, rebate tiers, rate changes or your level of cover.

Your first direct debit may also include an additional 1-day premium, which is a one-off charge on top of your first payment.

Your membership commences at 12am on your join date. Your first direct debit covers your chosen frequency (weekly, fortnightly, monthly, quarterly, half-yearly or yearly) and any additional days if you’ve chosen a direct debit date after your join date.

Your first payment may also include an additional 1-day premium to cover your chosen frequency plus the direct debit date itself. This is to ensure that your direct debit date is also covered for on-the-spot claiming. The direct debit date only needs to be covered once in the first payment, which is why your first payment may look different to subsequent payments.

For example, your membership commences on 1 January and your payment frequency is weekly. Your direct debit date is also 1 January. Your first payment covers you from 1 January to 8 January inclusive, which is 8 days of premium. Your next payment on 8 January covers you from 9 January to 15 January inclusive, which is 7 days of premium. The first payment had an additional 1-day premium to ensure the direct debit date was also covered for on-the-spot claiming.

As long as no other changes apply to your membership, the subsequent direct debits will match your quoted premium.

If you have any further questions, please call 13 13 34.

At what frequency can I make a payment?
You can pay your payments yearly, half yearly, quarterly, monthly, fortnightly or weekly, depending on your cover, but keep in mind we don't allow direct debit dates from 28–31 of each month.

What are the advantages of direct debit?
You can save time and hassle by setting up an automatic direct debit to pay your premiums.

Who can change direct debit and direct credit payment details?
When using our online member services or the My Membership app, only the policyholder can update these details.

Can I edit these payment details at any time?
Yes, once it's set up you can edit your direct debit and direct credit payment details at any time. If you can’t do this online, to set up direct debit to pay your premiums, or to change your current direct debit payment details, please call 13 14 39.

Can I get my claims paid to my credit card?
Unfortunately, we can't pay your claims to a credit card, only a bank account.

We'll advise you if your payment isn't made, and what you need to do to keep your membership up to date. Please note: If your account becomes overdrawn, some financial institutions may charge you a fee.

We guarantee to abide by the Direct Debit Customer Service Agreement so we can maintain a trusting relationship with you.

Making a payment online

If you have a health and/or life insurance policy with us, you can make a secure payment in the My Membership app or in online member services under ’Payments’ then ‘Make a payment’.

You can pay up to 18 months in advance, depending on your cover. We accept credit cards (MasterCard, Visa, Amex) for payments.

Payroll deduction

Payroll deduction is an automatic payment from your wages or salary. If your employer participates under an HCF Payroll Scheme, you can arrange to have your contributions paid directly from your salary or wages.

Please keep in mind, if you have one of our Recover Cover products, you can’t use payroll deduction.

If you're unsure whether your company has a scheme, ask your Human Resources or Payroll team, or call us on 13 14 39.

Phone

We accept American Express, MasterCard and VISA. Just call 13 14 39.

BPAY

With BPAY, you can make payments for your health and Recover Cover life insurance policies any time online or over the phone on 13 14 39.

What are waiting periods?

Waiting periods must be served before you can claim for a service. They apply to:

• members that are new to private health insurance
  
• existing HCF members who upgrade to a higher level of cover or reduce excess payable (you need to serve the necessary waiting period for the higher entitlement)
• members who switch from another fund who haven't already completed the required waiting period for equivalent benefits
• new dependants, unless they switch from another fund where they've completed the required waiting period for equivalent benefits
• treatment of a pre-existing ailment or condition
• members who cancel their policy for a period of time and then rejoin HCF without having cover with another insurer during the gap period.

Waiting periods vary according to the type of treatment or service and are as follows:

Hospital waiting periods:

• Palliative care: 2 months 
• Hospital Psychiatric Services^{^}: 2 months
• Rehabilitation: 2 months 
• Pre-existing ailments or conditions: 12 months 
• Pregnancy & birth: 12 months 
• All other hospital services, including treatments under Accident Safeguard: 2 months.

Extras waiting periods:

• Health management programs: 2 months 
• Artificial appliances (e.g. CPAP machine, blood glucose monitors): 12 months 
• Dental bleaching, bridges and crowns: 12 months 
• Dentures: 12 months 
• Endodontics: 12 months 
• Hearing aids: 12 months 
• Occlusal therapy: 12 months 
• Oral surgery: 12 months 
• Orthodontics: 12 months 
• Periodontics: 12 months 
• Pre-existing ailments & conditions: 12 months 
• Prosthodontics: 12 months 
• Veneers: 12 months 
• School accident benefit: 2 to 12 months 
• All other extras services: 2 months.

Ambulance waiting periods:

• Emergency ambulance (where not for pre-existing ailments): 1 day
• Medically necessary non-emergency ambulance (where not for pre-existing ailments): 2 months
• Pre-existing ailments: 12 months.

If you joined during an HCF waiver offer, waiting periods are only waived for extras with waiting periods equal to or less than the waiver. All other waiting periods in excess of the waiver apply.

Waivers are only available to new members taking both hospital and extras cover. All hospital services (including the same day excess) and ambulance services are excluded from the waiver offer.

What is restricted cover?

Restricted cover is where certain services are specified as being restricted services under a hospital product and where minimum benefits are applicable.

• In a private hospital: These benefits wouldn't cover all hospital costs and are likely to result in large out-of-pocket expenses.
• In a public hospital: If the minimum benefits are less than what your chosen public hospital charges, you may have out-of-pocket expenses to pay.

What are pre-existing ailments or conditions?

A pre-existing ailment or condition is an ailment, illness or condition where the signs or symptoms existed during the 6 months before you joined HCF or upgraded to a higher level of cover, even though you may not have been diagnosed.

If there's any doubt as to whether an ailment or condition is pre-existing, we'll appoint a medical practitioner to examine information provided by your doctor, together with other relevant claim details.

What's an exclusion?

If you need treatment for any procedures listed as an exclusion on your hospital cover, you won't receive any benefits from us and may have significant out-of-pocket expenses.

Ensure you've reviewed the exclusions list before buying your cover.

What's an excess?

An excess is the amount you choose to pay if you're admitted to hospital for planned treatment. Depending on your level of hospital cover, you can reduce your premium by opting for a higher excess or pay a bit more to get a lower excess.  

You won’t pay a hospital excess for dependant children. 

You pay only one hospital excess amount per person per calendar year if an excess is applicable. 

* To use the digital card, you'll need an Apple or Android device and the My Membership app. Supported Android devices run Android 9 or later. Supported Apple devices run iOS 13 or later. Eligible extras providers have HICAPS VX, HICAPS Trinity or CommBank Smart Health payment terminals.

^{^} Members who have held a hospital cover for at least 2 months and upgrade to receive hospital benefits (or a higher level of hospital benefits) for hospital psychiatric services may elect to be exempted from the 2 month waiting period for hospital psychiatric services that usually applies to members when they upgrade their hospital cover. Members who have held a hospital cover for less than 2 months may elect to serve a reduced waiting period of 2 months minus the length of time that the member held hospital cover. This exemption or reduction can only be accessed once in a member’s lifetime.

** dependent on no other changes being applied on the policy