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Guide

How to make a private health insurance claim

Reviewed and updated 3 April 2024

How to make a claim on your private health insurance policy depends on your health insurer and the type of claim you are making.


Making a Hospital Cover claim

If you are making a claim under your Hospital Cover, your health insurer usually pays the hospital directly.

On admission to hospital, you need to show your health fund membership and pay any excess. This is so hospital staff can check your cover and submit your claim.

You could receive a bill from the hospital for the difference between their fee and the amount covered under your insurance policy.


Making an Extras Cover claim

There are 4 ways to make a claim under your Extras Cover.

Option 1:

Make a claim on the spot

If your healthcare provider has a HICAPS machine or similar tool, you can swipe your health insurer membership card when paying for the service. Your rebate will be automatically deducted from the healthcare provider’s fee. You will be charged the difference between their fee and how much the insurer pays under your policy.

Option 2:

Make a claim online

Most insurers allow you to claim through their website. Just follow the process set out on their site.

Option 3:

Make a claim via an app

Many insurers now offer an app to submit your claim.

Option 4:

Make a claim by post

You can lodge a claim by post. Print out the claim form and post to your insurer. Your rebate will be paid into your nominated bank account.

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