Decode extras claiming

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Have health insurance but don’t know how to use it? You’re not alone. In fact, lots of you told us you’re confused by private health in our recent Member Satisfaction Survey. Part of the problem is that it’s complicated. Really complicated. Tax law complicated. Bad enough to make lawyers’ eyes glaze over and actuaries cry for their mothers. Avoid the pitfalls with our hard-earned lessons learned.

3 Extras claiming mistakes to avoid

1. Getting the photo claim wrong

Taking a photo of your extras receipt and claiming through our member app or Online Member Services is the best. Gone are the days of time-consuming claim forms and scanning – or worse – snail mail. Here are some quick tips to get it right first time:

  • Be sure to take a clear photo that’s easy for us to read
  • Just send us the provider receipt. We don’t need to see anything from HICAPS
  • Check your name on the receipt matches the name on your policy

2. Missing out on CDMP claiming

Chronic Disease Management Plans (CDMPs) are for chronic conditions that have lasted for at least six months. CDMP claiming allows you to get help from both the government and Peoplecare if you follow our steps.

How does it work?

Your GP writes the plan for services that you can claim on Medicare first. Usually Medicare provides benefits for five visits. For the sixth and subsequent visits you can then claim from your extras cover and start drawing down on your limits.

What can you claim for?

Lots of services. That’s why extras cover is so handy. These are some of the most popular ones:

  • Chiro
  • Dietetics
  • Exercise physiology
  • Eye therapy (orthoptics)
  • Occupational therapy
  • Osteo
  • Physio
  • Podiatry
  • Psychology
  • Speech therapy

3. Purchasing before diagnosis

To get the most out of your extras cover, you need to know how to get the most out of your Health Management Benefits. Unfortunately folks this isn’t a chicken or egg question. To claim for the following things you need a diagnosis of a medical condition first from a medical professional:

  • Gym equipment
  • Fitness programs
  • Health aids
  • Medications usually used as contraceptives

How to claim

To let us know about your diagnosis, you can fill out our Declaration of condition form or simply call us on 1800 808 690. You don’t need your medical practitioner to sign it – simply declare when you were advised to start your plan and by whom.

Tip: Gym equipment and fitness programs require your doctor to recommend a health management plan for them to be claimable. If you’re thinking ‘Why can’t I claim gym expenses? Won’t it make me healthier and save you money?’, we can surely empathise with that. There’s some sense in it. Despite any merit of that argument, we’re not allowed by law. (If you’re keen for the detail, see Private Health Insurance (Health Insurance Business) Rules 2017 part 3 sub 11 (1)).