Making claims
We offer a range of claiming methods that are fast, easy-to-use and, if you choose, even paperless.
// CLAIMING
Lodging a Claim is easy!
HCi extras cover helps cover your health expenses away from hospital.
Once you have used a service, you simply let us know via a completed claim form or the HCi App.
// CLAIMING EXTRAS
HCi App
The HCi claiming app allows you to easily claim via your smart phone.
When it’s time to claim, simply take a photo of the receipts and submit!
// CLAIMING EXTRAS
Electronic claiming
HCi members have access to a simple and convenient way to claim benefits.
Electronic claiming systems let you claim your extras benefit on the spot, after the consultation with health service providers such as dentists, optometrists, chiropractors, physiotherapists, and podiatrists.
With one swipe of your HCi membership card through an EFTPOS style terminal, your health service provider can have the cost of your consultation assessed electronically. Based on your level of cover, entitlements will be authorised immediately. You will need to pay the difference (if any) between your Extras cover, which HCi pays directly to the practitioner, and the fee charged.
If your claims are not processed at the point of treatment through an electronic swipe card system, you can forward your claims to us by:
HCi OMS
Login and submit the invoice – easy!
PO Box 931, Burnie, TAS 7320
HCi App
Download from your favourite app store
In person
Extras claims are usually processed the day they are received, assuming they include all the necessary information.
// CLAIMING PAYMENTS
Receiving payments
Direct Credit to you
If you have paid the account, your benefit can be paid electronically into your nominated bank account. You will receive separate notification as to the payment details.
Payment to a provider
If you have not paid the account, a direct credit will be made to the practitioner who provided the treatment.
// WHEN CLAIMING FROM HCi
It’s important to remember:
All accounts and receipts must include the appropriate item number and a full description of the services / products being claimed and must be accompanied with a completed claim form.
All services / products must be provided by practitioners who are operating in private practice and who are approved by HCi. Unless our CEO gave prior approval, HCi will not pay claims for services or goods provided by a family member.
// WHEN CLAIMING PRODUCTS FROM HCi
You need to provide a doctor or specialist letter with a claim for:
Medical appliances including CPAPs, Blood Pressure Monitors, Blood Glucose Monitors, Circulation Boosters, Tens machines, and Nebulisers
Medical botox or medicinal cannabis
Contraceptive medication used to treat medical conditions when supported by a doctors letter (we do not cover contraception).
Non-surgical prostheses such as breast prostheses, surgical bras, and surgical stockings
Custom made and/or fitted Medical braces such as Cam walkers, wrist/knee/Ankle brace, or a post-surgical brace
Custom made and/or fitted wigs
Custom made and/or fitted surgical footwear
//Claiming questions
Here are answers to some common claiming questions we are asked:
How do I lodge a claim?
If your claims are not processed at the point of treatment through an electronic swipe card system, you can complete our simple claims form and return it via:
- the ‘submit documents’ feature within OMS
- Email to enquiries@hciltd.com.au
- In person at 25 Cattley Street, Burnie
Or you can submit directly within OMS or download the HCi App to make it even easier and quicked!
In most cases extras claims are processed on the day they are received, assuming they include all the necessary information.
How do I make a medical claim?
If you receive bills from your doctor for medical treatment you received whilst in hospital, you must lodge your medical claims at a Medicare office first, before submitting with us. Please note you cannot claim your out-of-pocket expenses.
What are my waiting periods?
First-time health cover
If you are taking out private health insurance for the first time, you have to serve full waiting periods before any claims can be paid.
Transferring (switching) from another health fund (portability)
If you already have health cover with another health fund, you can switch to HCi at any time. If you join within 2 months of your previous cover ending, you will not have to serve any new waiting periods for the same or lower level of HCi cover.
HCi’s normal waiting periods will be applied, including the pre-existing ailments rule, to benefits not covered by your previous fund cover.
Can I make a claim if the service was provided by a family member?
Unless our CEO gave prior approval, HCi will not pay claims for services or goods provided by a family member.
What to do if I have out-of-pocket expenses?
You cannot claim out of pocket expenses. HCi pays towards treatment provided to you by a doctor whilst you are a patient in hospital. As a private patient in a public or private hospital, Medicare pays 75% of the Commonwealth Medical Benefits Schedule (MBS) fee and HCi pays 25% of the MBS fee.
If your doctor chooses to charge above the MBS fee, you may have to pay the gap.
However, if your doctor chooses to use HCi’s Access Gap Cover, you will have either reduced or no out-of-pocket expenses.
To search for doctors who have agreed to participate in our Access Gap Scheme, click here.
What pharmacy items can I claim?
Our pharmacy claims fact sheet provides more information on these claims. But, in simple terms, you can claim some prescription medications not on the PBS.
For a benefit to be paid, the Non-PBS item must be equivalent to an S4 item or above, not listed on the PBS, and only be obtained with a prescription.
Having HCi extras cover can help offset the cost of Non-PBS medications. HCi has a co-payment* per prescription and pays 100% over and above this amount up to $100.00, depending on the cover you have.
*The Federal Government sets and applies the co-payment amount annually. As of 1 January 2024, the co-payment amount is $31.60.