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How can I make a claim?

On the spot: You can use your 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.

What do I need to make a claim?

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. 

^* Android and Apple users with a supported device can scan the QR code on their digital card at providers with HICAPS Trinity payment terminals. Android users can also use tap-and-go (NFC) at providers with HICAPS VX, HICAPS Trinity or CommBank Smart Health payment terminals. Supported Apple devices run at least iOS 13. Supported Android devices run at least Android 8.

How do I make a claim with my 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. 

How can I claim using my extras cover ?

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'.

How to claim extras on the spot using my Android or Apple device

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 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.

Make sure you’re connected to the internet. Go to your device settings, search for NFC, and make sure it’s switched on.
Open your My Membership app and tap the card icon in the top right corner. Your digital card will appear on-screen.
To claim, hold your device near the terminal at your provider. You’ll hear a beep.
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.

Make sure you’re connected to the internet.
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’.
To claim, scan the QR code by holding it in front of the terminal camera. You’ll hear a beep.
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. 

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

QR code

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

Make sure you’re connected to the internet.
Open your My Membership app and tap the card icon in the top right corner. Your digital card will appear on-screen.
To claim, scan the QR code by holding it in front of the terminal camera. You’ll hear a beep.
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. 

Making a claim using my 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:

If you live in NSW or ACT, 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 the relevant section on the back of the invoice and return it to the ambulance service provider to settle the account.

If you live in Qld, you’re covered under your state ambulance service scheme Australia-wide and benefits for ambulance services aren't payable under your HCF policy.

If you're a resident of Tas, you're covered by your state ambulance service scheme for ambulance services within Tasmania. In other States and Territories, the scheme generally covers road ambulance services only. The scheme doesn't cover the cost of ambulance services in Qld and SA.

You may be able to claim for emergency ambulance services not covered by your State scheme under your HCF cover.

If you live in Vic, SA, the NT or WA and don’t have an ambulance subscription with your State ambulance service and aren’t otherwise covered under your State scheme (e.g. concession card holder) you may be able to claim under your HCF cover for emergency ambulance services.

NSW and ACT members

Qld members

If you live in Qld, you’re covered under your state ambulance service scheme Australia-wide and benefits for ambulance services aren't payable under your HCF policy.

Tas members

You may be able to claim for emergency ambulance services not covered by your State scheme under your HCF cover.

Vic, SA, NT and WA members

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 with you, you can claim on the spot at your appointment with selected extras providers*. You’ll need to 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. 

Can I claim on dental surgery?

In-patient dental surgery, like dental implants or wisdom teeth removal, can be claimed on both your hospital cover (for things like accommodation and operating theatre fees) as well as on your extras cover (your dental surgeon’s fees).

You must hold eligible extras cover if you want to claim benefits for dentist or dental surgeon’s fees performed in hospital. Depending on your annual limit you may still have out-of-pocket costs, however this cost will be higher if you don’t hold eligible extras cover.

For more information on dental implant surgery or wisdom teeth extraction call us on 13 13 34. 

What are prostheses and can I claim for that?

Prostheses are items used in surgery to augment or replace a part of the body (e.g. pacemakers or joint replacement devices).

We cover government approved, non-cosmetic prostheses that are surgically implanted. Ask your doctor which prosthesis is best for you and whether a no-gap option is available. 

I'm about to start insulin pump therapy – can I claim for this? 

If this is the first time you're having insulin pump therapy, and you're being treated as an outpatient, we'll pay 100% of the amount listed on the Australian Government Prescribed List of Medical Devices and Human Tissue Products when we receive your completed insulin pump claim form.

Am I eligible to claim for a replacement insulin pump? 

You're eligible if:

you've been on any of the below HCF covers for at least 12 months
have held a health insurance product that covers insulin pumps and hospital treatment for diabetes with HCF or another private health fund continuously since the date you received your current pump (if you held a different type of cover but meet the other criteria, we may still pay 50% of the amount listed on the Australian Government Prescribed List of Medical Devices and Human Tissue Products)
it's been at least 5 years since you received your current pump.

If you're eligible, you can claim up to 100% of the insulin pump price listed on the Australian Government Prescribed List. This means you might have no out-of-pocket costs if you’re an HCF member with one of the following covers:

Fit and Free Silver Plus
HCF Corporate Gold
HCF Hospital Gold
Healthclub Silver Plus
Healthmate Advanced Silver Plus
Healthmate Essentials Silver Plus
Healthmate Starter Silver Plus
Healthmate Ultimate Gold
HealthStart Hospital Silver Plus
Healthy First Silver Plus
Hospital Advanced Savings Silver Plus
Mid Hospital Silver Plus
Top Advanced Hospital Gold
Top Advanced Shared Gold
Top Hospital Gold
Young Singles and Couples Basic Plus.

The 5 year period imposed by HCF doesn't reflect the manufacturer’s warranty period and is the reasonable life expectancy of an insulin pump. If you wish to replace your insulin pump before the 5 year period since the date you received your current pump, a pro-rata benefit may be offered depending on your circumstances and provided the pump isn't under the manufacturer's warranty. Please note that we don't replace damaged, lost, or stolen pumps or pay for consumables for insulin pumps, which are available through the National Diabetes Services Scheme.

How do I claim for a replacement insulin pump?

Complete and submit a replacement insulin pump claim form and send it via email to clinicalreviewemail@hcf.com.au

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^* Our Life and Recover Cover products are issued by our own HCF Life insurance Company Pty Ltd. ABN 37 001 831 250. AFSL 236 806 (HCF Life). HCF Life is a wholly owned subsidiary of The Hospitals Contribution Fund of Australia Limited ABN 68 000 026 746, AFSL 241414 (HCF). Terms and conditions apply. Please read the relevant Product Disclosure Statement, Policy Document and Financial Services Guide available by calling 1800 560 855 or visiting hcf.com.au/lifeinfo, and consider your financial situation, objectives, and needs before deciding on these products as any advice provided does not take these into account. In addition to these documents, you should also read the Target Market Determination (TMD) for the product, which is available at hcf.com.au/lifeinfo. The premiums for Recover Cover products are paid to HCF Life. HCF receives commission from HCF Life for their sale of up to 40% of the first year’s premium plus an additional commission of 80% of HCF Life’s underwriting profit each year calculated as premiums less claims and expenses. HCF’s staff may receive an incentive depending on the annual premium of these products which they sell. This will not exceed 15% of the first year’s premium.

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