What is HICAPS and how does it work with private health insurance?

You have probably seen the word HICAPS at your dentist, physio, optician, podiatrist and other healthcare providers. But what is HICAPS and what does it mean?

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by Gary Andrews

Last update 15 Apr 2021

Overview

Claiming your health fund benefits on your extras can be a bit tedious.

You can claim online, by post or queue at a branch. But there is another way: HICAPS payments.

It's a way to get your benefits back immediately when you pay for extras.

How does it work and what health funds use HICAPS? We'll take you through the ins and outs in our guide.

Key Points

HICAPS is a way to quickly process health insurance claims.
Only Australians with a specific membership card can use HICAPS.
Many healthcare providers and practitioners offer HICAPS.
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What is HICAPS?

HICAPS stands for Health Industry Claims and Payments Service.

It's an electronic health claims system that is similar to an EFTPOS machine that a healthcare provider such as a GP, dentist, optometrist, or physiotherapist can use to process your claims at the time of payment.

We'll go into more detail on how this works later in this guide.

How does HICAPS work?

If a healthcare provider accepts HICAPS, you just need to swipe your health fund, Medicare, or WorkSafe Victoria membership card through the terminal and your claim is processed and returned deposited to your bank account almost immediately.

The terminal operates almost the same as an EFTPOS machine.

The main difference is that a HICAPS machine communicates with the government or private health insurance provider instead of a bank.

You don't have to worry about additional expenses if your claim covers the full cost of the treatment.

However, you may have out-of-pocket expenses, known as a gap payment, if your issuer's contribution only covers a portion of the costs.

Who can use HICAPS?

Anyone in Australia who has private health insurance, a Medicare, or WorkSafe Victoria membership card can use HICAPS at participating healthcare providers.

Overseas visitors will only be able to use HICAPS if they have appropriate health cover.

Who offers HICAPS?

HICAPS has signed up over 85,000 healthcare providers, including GPs and medical centres, as well as many allied health professionals -- these include dentists, opticians podiatrists, dieticians, and other services that you'll often access out of hospital and claim on your extras cover.

Not every health service offers HICAPS, though, so it's best to double-check beforehand, especially if you're worried about your own cash flow.

How much does HICAPS cost?

Health providers just have to pay a monthly rental fee to use the terminal plus a merchant fee for EFTPOS and credit card transactions. There's annual fees, installation, or set up costs.

There's no cost to patients for using HICAPS.

How do I claim Medicare on HICAPS?

You can use the Medicare Easyclaim system when visiting a healthcare provider to process your claim and receive your rebate.

Your Medicare card will be swiped through the HICAPS terminal, and your rebate will be paid immediately to your bank account.

Which health funds use HICAPS?

HICAPS has partnered with all Australian health insurers as well as Medicare and WorkSafe in Victoria.

How do I make a WorkSafe Victoria claim using HICAPS?

Healthcare providers create an invoice through their HICAPS terminal. You just have to provide your claim number.

The receptionist will input it into the HICAPS terminal, then the details of your claim will be sent to WorkSafe Victoria.

A quick note: unlike earlier examples, you won't get immediate payments for WorkSafe claims because it needs to be assessed first by WorkSafe Victoria.

Is HICAPS confidential?

Yes. Your details are kept confidential and only viewed by your health fund and healthcare provider.

Aside from this, HICAPS uses a secure encryption protocol that ensures your privacy is safeguarded.

What is HICAPS Go?

HICAPS Go is a smartphone app that allows you to book an appointment with your healthcare provider, claim your treatment, and pay any out-of-pocket expenses using only your mobile phone.

Instead of swiping your health insurance card on a HICAPS terminal, your phone will receive an SMS, giving you the option to complete the process.

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This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.