What Do I Need To Know When Claiming On My Private Health Insurance?

Make sure you know what you are covered for

Once you have gone to all the effort of finding the best health cover, the last thing you want is to not know how to claim on your cheap health insurance plan. We know health cover can be complicated and frustrating, but if you have our cover, you would know already that we are different. We want health cover to be cheap, affordable and simple. Working out how to claim on your cheap health insurance plan should be just as simple. Despite this, there are a few things you still need to know. There are different ways to claim your hospital and extras covers. Hospital insurance could cover you when you are admitted to hospital for either an injury or emergency, or an elective treatment.

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We have hospital policies that allow you to be treated in either a private or public hospital as a private patient. Private health cover can also include extras cover, which provides benefits for treatments not offered in hospital, such as dental, physio, optical and chiro. Our two extras policies offer benefits of either 50% or 80%, which is important. We also believe that simple and affordable health cover should also offer choice and flexibility. And there is little doubt when you are working out how to claim on your cheap health insurance plan, it should also be flexible. Before you claim, and hopefully before you go to hospital or arrive at your extras appointment, it’s important to know exactly what you are covered for. Use our webchat or give us a call if you aren’t sure. There would be nothing worse than thinking you are covered for a treatment and find out afterwards that you aren’t.

How do the charges work?

Before you work out how to claim on your cheap health insurance plan it is important to know how the charges work. It is different for hospital and extras covers. When it comes to hospital, the first thing to do is before you go into private hospital, check it is on our participating hospitals list. Before you agree to any procedure, you also need to obtain written financial consent – this means your doctor needs to tell you about all of the fees payable as part of your procedure and let you know about any out of pocket costs that you might face.

But that’s not all you need to know about how to claim on your cheap health insurance plan after hospital treatment. There will also be doctors’ or specialists’ bills. We pay these medical bills based on a set fee created by Medicare called the Medicare Schedule (MBS) fee. When you go to hospital, Medicare pays 75% of the MBS and we pay the other 75%. However, doctors can charge more. We have gap cover which could cover you for a further 20% of the cost. Anything above that is an out of pocket cost which you will need to pay. Make sure you talk with your doctor or specialist about this before you go under the knife.

As mentioned above, when it comes to extras cover, we provide benefits of either 50% or 80% for treatments. So, if your dentist charges you $100, you can claim either $80 or $50 up to your annual limits. So, why would you take the 50% option over the 80% option? Well, the main reason has to do with annual limits. Annual limits are a cap on how much you can claim back in a calendar year.  If you have our Lots extras policy, for example, the annual limits are the same, and you can choose either 50% or 80% benefit. This is designed simply for more choice. If you think you will visit the dentist a lot, for simple treatments, then having the 50% option will mean that the limit will last longer across the year. If you have the 80% option, the limits will be used quicker. 

How do I claim?

After you have been treated in hospital, the first few bills to pay will be yours. If you have excess or co-payments, then you have to pay them first. The hospital will then bill us for the rest of their agreed costs, for things like accommodation. Doctors or specialists will send their bills directly to us and Medicare. If there are any fees above the MBS, then they will send that bill to you. How to claim on your cheap health insurance plan when it comes to extras is even easier. The most convenient way is to claim is using the electronic claims and payment system (HICAPS). This way the claim can be processed on the spot at your appointment, and you just pay the difference. HICAPS is like an eftpos machine, and we will give you a card when you sign up.

However, not all providers have this facility so another way to claim is through your online member area. All you have to do is lodge a claim application through the member area. You can snap a photo of the receipt and attach it to the online claim or not. If you don’t attach the receipt, you’ll just have to hold onto it for 5 years in case your claim is audited. If your claim is approved, the benefit will be paid into your nominated bank account. When working out how to claim on your cheap health insurance plan, whether it be for hospital or extras, there are a few final things to remember. Make sure your premiums are paid up to the date of the service and that all waiting periods have been served.

w what’s covered and what’s not. We make claiming easy and are here to assist you every step of the way. Ensure you don’t just get cheap health insurance but the right health cover for you with Frank!

Join Frank on combined hospital and extras cover online from June 22 – 30 and get 6 weeks free*.

Get a quote *Pay first month to get 6 weeks free. Available to new members and valid for online joins only.