Claiming your benefits is no drama with ACA Health Benefits Fund.
The majority of claims are processed within 5 working days, and with your ACA Health HICAPS card, many ancillary claims can be made automatically at the time of your service.
General Treatment (Ancillary) Claims
Download a claim form (201kb PDF)
At the time of hospitalisation, the hospital will request details of your private health insurance fund - so keep your ACA Health membership card handy and present this to the hospital when you are admitted.
On discharge, check that all your details on the account are correct and then sign the hospital claim form confirming that your details are correct and giving the hospital authority to claim directly from ACA Health on your behalf.
From then on, we take care of the rest!
The benefit cheque will be forwarded to the hospital in payment of the account. If you have paid the account yourself, we would then send the cheque to you.
For providers participating in the ACCESS GAP COVER
In most cases members will have no out-of-pocket expenses. The exception is where a doctor informs you of an out-of-pocket expense, which is limited to a maximum of $400 per item (or $800 in the case of obstetrics).
Usually doctors participating in ACCESS GAP COVER will bill the fund directly for the medical claims - so keep your ACA Health membership card handy to present to the doctor for easy processing.
Alternatively the doctor may give you the account, which you would then need to attach to a claim form and send into the ACA Health office.
To find out which doctors participate in ACCESS GAP COVER, go to our Doctor Search
For providers not participating in the ACCESS GAP COVER Scheme
If your doctor chooses not to have an arrangement with the Fund, we will pay the difference between your Medicare reimbursement and the Medicare Benefits Schedule Fee for hospital and day facility in-patient services.
Normally the doctor will give you the account, and it is up to you to first go to Medicare Australia to claim the Medicare reimbursement. After lodging the claim with Medicare Australia, they will issue a statement which is then used, along with a signed claim form, to claim the gap with ACA Health.
Alternatively, you may fill out a Medicare Australia Two-Way Form when lodging your claim with Medicare Australia, and they will send the claim with the statement directly to ACA Health on your behalf.
For providers participating in HICAPS
All you need is your ACA Health membership card and claims can be made on-the-spot at the time of treatment.
After the consultation your card is swiped through the HICAPS terminal, and the claim is lodged for authorisation. Once the claim is authorised by the ACA Health system, the terminal prints a receipt, which you would need to check the details and sign confirming that the transaction is correct and keep the copy as a record of the claim.
All that's left to pay is the difference between your ACA Health benefit and the full cost of the treatment.
To find out which providers participate in HICAPS, go to our HICAPS Search
For providers without HICAPS
Attach the receipts and/or invoices from the provider to an ACA Health claim form, fill it in and don't forget to sign it. When this is done simply mail the claim to us.
Once we receive your claim we'll give it priority and have your payment made to you most often within 3- 5 working days.