Claiming

Claiming options

Making a Health Insurance claim should be easy. After all, that’s why we have Health Insurance.

If your provider uses HICAPS and Health Point you can claim on-the-spot with your membership card, otherwise, there are four easy ways you can make a claim:

Health Partners App

1. Download the app
2. Register or login
3. Upload a photo of your account/receipt

Most claims submitted via the app are paid within 5 business days.

Learn more about the Health Partners app.

Online

1. Login to the Health Partners portal
2. Select 'Submit claim'
3. Upload a photo of your itemised account/receipt
4. Submit

Post

1. Download and complete a Member Claim form
2. Send claim form and copy of itemised account/receipt to:
   Health Partners Claims Assessor
   Reply Paid 1493
   Adelaide SA 5001

Email

1. Download and complete a Member Claim form
2. Send in your claim form and photo of the itemised account/receipt by contacting us online
   

What you must include with your claim

Claims must be supported by an itemised account(s), receipt(s) (required for payment of claim) if paid, and/or Medicare Statement(s). We cannot pay benefits on quotes.

Itemised accounts and/or receipts (required for payment of claim) must show the following information:

• The provider’s name, provider number and address.
• The patient’s full name and address.
• The date of service.
• The description of the service, including any item numbers.
• The amount charged.

Please remember to also check for any additional documentation that may be required to support your claim in the Health Partners Member Guide, particularly in relation to Wellness programs, Health Aids and Appliances. General information about claiming and benefits can also be found in this document.

How to claim for Gym and Fitness
How to claim for Aids and Appliances
How to claim for Orthodontic Treatment

Payment of claims

Member claims are deposited by direct credit directly into your preferred bank account.

As a policyholder, your direct credit should already be set up from when you first joined. If you are a partner/spouse or dependant, you can nominate to have the payment of your claim paid into a bank account of your choice. The easiest way for policyholders to update this information is to login to the Health Partners portal. You can also update your bank details using the Member Claim form or by simply calling us on 1300 113 113.'

You only need to supply these details once – the next time you submit a claim (either via our app or the claim form), simply tick the direct credit box and we will transfer your benefit to the same account.

Once direct credit payments have been processed, a statement will be sent to you outlining benefits paid.

By default, cheques (if not receiving your benefit via direct credit bank transfer) will be made out to the policyholder, or to the provider if the account is unpaid.

Medicare Statement of Benefits

When you submit a medical claim to us, you’ll need to include a copy of your Medicare Statement of Benefits. A Medicare Statement of Benefits is a document that provides a detailed breakdown of what Medicare has paid for a service or treatment when you claim with them.

The information on your Medicare Statement of Benefits that we need includes:

• The patient’s name
• Medicare item numbers
• Date/s of service
• Provider number
• The amount/s charged
• Medicare Schedule Fee
• Medicare benefit.

How do I get a Medicare Statement of Benefits?

If you haven’t claimed with Medicare: Fill out a Medicare Claim form and submit it to Medicare using one of the options listed on the form.

If you have claimed with Medicare: If you haven’t received a Medicare Statement of Benefits, call Medicare on 132 011 to request a copy. Alternatively, login to your MyGov account and check if one has been sent to your Inbox.

How to send us your Medicare Statement of Benefits

Simply include it in your claim when you submit it through the Health Partners app or attach it with your completed Claim form when you email or post it to us.

A heads up: We know health admin can add up, but please make sure you send us your Medicare Statement of Benefits, not the Medicare Claims Summary (a simple mistake, but it happens more than you think!). Only the Medicare Statement of Benefits has all the information we need to process your claim.