How to get a Medicare Statement of Benefits

In short

To submit a Hospital medical services claim with health insurers like Police Health, you need to submit a Medicare Statement of Benefits. 

On this page

Using a Medicare Statement of Benefits to claim with Police Health

To submit a hospital medical service claim with Police Health, you need to; 

  1. Get a Medicare Statement of Benefit
  2. Submit your claim through the Police Health app (Android / iPhone) 

Please note that we can’t accept a History of Medicare Statement of Benefits or Digital Statement of Benefits.  

Only the Medicare Statement of Benefits has the information we need to process your claim. 

The Medicare Statement of Benefits will show; 

  • The patient’s name
  • The provider’s name or provider number
  • Date of service
  • Item number
  • The amount charged
  • The Medicare Benefits Schedule fee
  • The benefit that Medicare paid
  • An explanation confirming whether this was an inpatient or outpatient service
  • The payment recipient 

What you need to do if you have already claimed for the Hospital medical service with Medicare

If you’ve already claimed through Medicare, or your provider has claimed on your behalf, you’ll need to contact Medicare and request a Statement of Benefits. 

Medicare will then lodge a manual request. This usually takes around 10 days to process. 

Once available, you can download your Statement of Benefits by logging into your Medicare account through myGov. 

Click here for information about how to access your Medicare account via MyGov. 

What you need to do if you haven't submitted a Medicare claim for the Hospital medical services

If you haven’t claimed with Medicare, you’ll need to submit a Two-way claim form (MS001) to Medicare. 

You can learn how to submit a Two-way claim form here. 

If you’re submitting your claim by mail or in person at a service centre, use the Medicare Claim form (MS014). 

Once Medicare has processed their portion of the claim, they’ll forward it to us on your behalf. 

If you’re eligible for a benefit, we’ll assess and pay it*. There’s nothing further you need to do. 

*All benefits may be subject to Waiting Periods, Limits and other conditions. Review the cover tables on the Combined, Hospital and Extras pages, and your State Premium and Benefit Guide or contact us for more information.