What is HICAPS and how can it benefit you?
What is HICAPS?
Health Industry Claims and Payments Service (HICAPS) is an electronic health claims system that your healthcare provider (e.g. physiotherapist or dentist) can use to process your private health insurance, Medicare, WorkSafe Victoria and Insurance Commission of Western Australia claims instantaneously.
With instant claims processing, you can receive your health insurance benefit on the day of your treatment, so you’re not out of pocket until your insurer assesses your claim.
HICAPS functions similarly to an EFTPOS machine, except it communicates with your insurer or the government instead of your bank.
Expert tips for using HICAPS
Our health insurance expert, Steven Spicer, has some tips on how HICAPS can help make claiming on your health insurance even easier.
Steven Spicer
Executive General Manager – Health, Life & Energy
Look out for convenient claiming methods
Alongside HICAPS, there are a range of other useful claiming methods. For example, many health funds have their own app you can use to claim instantly on the spot.
Pay less with your fund’s no gap scheme
Some health funds offer no gap benefits with select providers, or 100% back on eligible services (such as optical) up to the annual limit. By comparing health insurance, you might be able to find a policy that offers no gap benefits for the extras services that matter to you!
Make a HICAPS claim without a card
Eligible members of selected health funds can now claim by tapping their smart phones and watches on HICAPS terminals instead of using their membership card. This makes it easier and even more convenient to claim.
How does HICAPS work?
Once you’re ready to pay for your appointment, all you need to do is swipe your health fund card through your service provider’s HICAPS terminal. The machine immediately sends the details of your claim to your insurer, and your claim should be processed in seconds.
If your extras cover policy pays the entire cost of your treatment, you won’t have to do anything else. If your insurer’s contribution only covers part of your treatment, you’ll need to pay the remainder out of your own pocket (known as a gap payment). You can pay the gap using a debit or credit card through EFTPOS, or another method that suits you and your healthcare professional.
The HICAPS terminal can process up to 24 Medicare Benefit Schedule (MBS) item numbers per transaction.1 However, the actual maximum amount of item numbers per transaction can vary between health funds, so remember to check with your insurance provider before receiving treatment.
When you’re entitled to a Medicare rebate for your treatment, you can scan your Medicare card at your provider’s HICAPS terminal and Medicare will deposit your rebate amount into your bank account via their Easyclaim system.
Using HICAPS
Who has access to HICAPS payments?
If you have either a Medicare or a private health insurance membership card, you can take advantage of HICAPS as long as you’re eligible for a rebate on the service you receive.
Depending on their health fund, overseas visitors should be able to use HICAPS for most out-of-hospital services, provided the service is included on their extras or Overseas Visitor Health Cover (OVHC) policy. Since overseas visitors typically don’t have access to Medicare unless their home country has an Reciprocal Health Care Agreement (RHCA), they won’t be able to use HICAPS for Medicare claims.
Which healthcare practitioners offer HICAPS?
You can typically claim most extras services (out-of-hospital services) through HICAPS. However, not every practitioner may offer HICAPS, so double check before going if you don’t want to wait for your claim to be assessed.
Practitioners that typically offer HICAPS claiming include:
- Acupuncturists
- Chiropractors
- Clinical psychologists
- Dentists
- Dietitians
- Exercise physiologists
- Myotherapists
- Occupational therapists
- Optical dispensers
- Optometrists
- Osteopaths
- Physiotherapists
- Podiatrists
- Psychologists
- Remedial massage therapists
- Speech pathologists.
Which health funds have partnered with HICAPS?
Currently, all Australian health insurers use HICAPS.2 However, you might not be able to use HICAPS for every type of treatment. You can always check your policy and chat to your insurer before making an appointment to be sure.
Here are the health insurers and brands that have partnerships with HICAPS:
| AAMI | Medibank Private Ltd |
| ACA Health Benefits Fund | Mildura Health Fund |
| AHM Health Insurance | National Health Benefits Australia Pty Ltd (onemedifund) |
| AIA Health Insurance | Navy Health Limited |
| Apia Health Insurance | NIB Health Funds Ltd |
| Australian Defence Force Family Health | Peoplecare Health Insurance |
| Australian Unity Health Ltd | Phoenix Health Fund Ltd |
| Bupa Australia | Police Health |
| CBHS Corporate Health Limited | Qantas Assure Health Insurance |
| CBHS Health Fund Limited | Queensland Country Health Fund Ltd |
| Defence Health Limited | Railway and Transport Health Fund Ltd |
| Emergency Services Health | Reserve Bank Health Society Limited |
| Frank Health Insurance | see-u by HBF |
| GMHBA Limited | St.Lukes Health |
| Grand United Health | Suncorp |
| HBF Health Limited | Teachers Health Fund |
| HCF | The Doctors’ Health Fund |
| Health Care Insurance Ltd | Transport Health Pty Ltd |
| Health Insurance Fund of Australia Ltd (HIF) | TUH |
| Health Partners | Uni Health |
| Hunter Health Insurance | Union Health |
| La Trobe Health Services | Westfund Ltd |
Can I still use HICAPS if my health fund card doesn’t have a magnetic strip?
If your health fund membership card doesn’t have a magnetic strip, you may have an older card. If this is the case, you should contact your insurer to request a new one.
Are my treatment details kept confidential when I’m claiming my health fund rebate?
Yes, your details are kept confidential, as they’re sent straight to your health fund and only viewable by your healthcare practitioner and insurer.
On top of this, HICAPS uses a secure encryption protocol to safeguard your privacy.1
What’s the difference between EFTPOS and HICAPS terminals?
- HICAPS machines communicate between the healthcare provider and your insurer, Medicare or WorkSafe Victoria.
- EFTPOS machines communicate between your healthcare provider and whatever financial institution you wish to use to pay for your treatment.
Meet our health insurance expert, Steven Spicer
As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.
Want to know more about health insurance?
1 Hicaps.com.au. ‘FAQs.’ Accessed June 2024.
2 Hicaps.com.au. ‘HICAPS Participating Health Funds & Health Insurance Brands.’ Accessed June 2024.