What can you claim on private health insurance?
On this page
- What can you claim on private health insurance?
- What you can claim on Extras cover
- What you can claim on Hospital cover
- How to claim private health insurance
- Claiming Extras on the spot
- Claiming through the App or Member Portal
- A simple example
- Claiming on Hospital cover
- Things to keep in mind
- Frequently asked questions
What can you claim on private health insurance?
Private health insurance helps with two main types of cost: services that Medicare doesn't usually cover like dental, optical and physio, and hospital treatment..
What you can claim depends on the cover you hold.
Extras cover helps with out-of-hospital healthcare services like dental, optical and physio. Hospital cover helps with the cost of being treated as an admitted patient in hospital.
With Police Health, you can hold these as Rolling Extras, Gold Hospital, or both together as Gold Combined*.
New to how it all fits together? Our guide on what Police Health insurance is is a good place to start.
What you can claim on Extras cover
Police Health's Rolling Extras covers a wide range of everyday services, including:
- Dental: check-ups, cleans, fillings and more
- Optical: prescription glasses and contact lenses
- Physiotherapy
- Psychology
- Chiropractic and complementary therapies
- Pharmacy items (some conditions apply)
On most Extras services you'll get up to 80% back, up to the item limit. The exact services and limits depend on your cover and your state.
What you can claim on Hospital cover
Police Health's Gold Hospital helps with the cost of being treated as an admitted patient in a hospital.
This can include theatre and accommodation costs, and the medical fees of your doctor and anesthetist.
Because Police Health only offers Gold-level Hospital cover, you're covered across all 38 clinical categories, with no excess and no co-payments.
How to claim private health insurance
The way you claim depends on whether it's an Extras service or a hospital stay.
The good news is most claims are quick, and many happen automatically.
Claiming Extras on the spot
For most Extras like dental and optical, your provider can process the claim on the spot using HICAPS or HealthPoint terminals.
You simply present your Police Health membership card and approve the service. The claim is lodged automatically, and Police Health pays the provider directly.
That means you usually only pay any gap rather than the full fee upfront. In fact, most eligible Extras claims are made this way.
Claiming through the app or Member Portal
If your provider doesn't offer on the spot claiming, you can claim through the Police Health App or online Member Portal.
You'll usually need some proof of payment from your provider, which you can take a photo of an upload as part of your claim. Your benefit is then paid directly into your nominated bank account. See how to claim for step-by-step guides.
A simple example
Say you visit the dentist for a check-up and clean.
You present your membership card, the dentist processes the claim on the spot, and you only pay any gap before you leave.
Later that year you need physio after an injury. Same again: claim on the spot, and walk out having paid only the difference.
Claiming on Hospital cover
Hospital claims are usually even simpler, because they often come straight to Police Health.
For hospital costs, the hospital generally lodges the claim with us and we pay them directly, so there's nothing extra for you to do.
For your doctor's and anaesthetist's fees, they can claim directly with us if you've given them your Police Health details. If you're asked to pay upfront, you'll lodge a claim with Medicare first, then send us your Medicare Statement of Benefit through the app or Member Portal. Our guide to getting a Medicare Statement of Benefits shows you how to do this.
Things to keep in mind
A few simple things help your claims go smoothly:
- Your provider needs to be recognised by Police Health
- Waiting periods, annual limits and other conditions can apply
- Claims must be lodged with Police Health within two years of the date of service
- Keep your bank and membership details up to date so benefits are paid quickly
Frequently asked questions
How do I claim on private health insurance?
Most Extras claims are made on the spot at your provider using your membership card. You can also claim through the Police Health App or Member Portal. Hospital claims usually come straight to us from the hospital or provider.
Do I have to pay upfront?
For most on the spot Extras claims, no. You generally pay only the gap. For some services, or for hospital medical fees, you may need to pay first and claim the benefit back.
How long do I have to claim?
Claims must be lodged with Police Health within two years of the date of service.
How is my benefit paid?
On the spot claims are paid to your provider. Claims made through the app or Member Portal are paid into your nominated bank account, so make sure your details are current.