CLAIMS AND PAYMENTS FAQS
- Ways to claim on your health insurance
- Your health cover claims checklist
- Claiming on your hospital cover
- Claiming on your extras cover
- Claiming on your ambulance cover
- How long does it take for a claim to be processed?
- How can I make a payment?
- Direct debit and direct credit
- Making a payment online
- Payroll deduction
- Payments over the phone
- Payments via BPAY
Ways to claim on your health insurance
- On the spot: If you have your membership card, many extras providers can claim at your appointment and you 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: If it’s safe for you to do so, 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.
- 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
Please keep in mind, we may ask you for some extra information to help with the claim.
If you’re having treatment in hospital, there’ll be different parts involved in claiming. Usually, the hospital where you’ve had your treatment will take care of claiming for the costs for things like accommodation, 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, but you’ll need to take along your membership card.
Claiming on your ambulance cover
If you need to make an ambulance claim, you can you do it through:
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?
We’re currently experiencing longer than usual call wait times and claims processing is approximately 3-8 business days (from when you submit your claim online). We’ve expanded our service teams to respond to increased volumes and appreciate your patience as we work to get our regular services back to normal.
How can I make a payment?
- Mon–Fri: 8am–8pm (AEST/AEDT)
- Sat: 9am–5pm (AEST/AEDT)
- Sun: 9am–1pm (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
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 1800 845 077 during the following hours:
- Mon–Fri: 8am–8pm (AEST/AEDT)
- Sat: 9am–5pm (AEST/AEDT)
- Sun: 9am–1pm (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.
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.
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 1800 845 077.
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
You can pay up to 18 months in advance, depending on your cover. We accept credit cards (MasterCard, Visa, Amex) for payments.
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 1800 845 077.
We accept American Express, MasterCard and VISA. Just call 1800 845 077.
With BPAY, you can make your health insurance payments any time online or over the phone on 1800 845 077. If you have one of our Recover Cover life insurance policies, you won’t be able to pay with BPAY.
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
- hearing aid benefits for members switching from another health fund, irrespective of the previous cover held
- 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.
*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.