Get more value and benefits from your private health insurance, without the hassle.
Lodging claims with Emergency Services Health is easy. Depending on the service and provider, there are a number of ways to claim which have been listed below.
How to claim for Extras
On the spot claims on extras services
With the majority of extras claims such as dental and optical, health providers can process your claim on the spot using EFTPOS-style claiming facilities provided by HICAPS and iSOFT HealthPoint.
These are often referred to as "On the spot" claiming. On the spot claiming has become the preferred option for most policyholders, with more than 85 percent of eligible claims being processed this way.
All you have to do is swipe your membership card and sign to validate the service. Your claim will be automatically lodged with Emergency Services Health and we pay the provider directly.
There is no need to pay the full consultation fee up-front and then wait for reimbursement of your benefit. Just present your Emergency Services Health membership card, pay any out of pocket gap and you're done.
Who offers on the spot claiming?
To find out if your health provider offers on the spot claiming simply look for the HICAPS & iSOFT logo or contact your health provider.
You can also search online for health providers that offer HICAPS.
While Emergency Services Health accepts most claims on the spot, the service is not available for pharmacy, health appliances (including hearing aids), counselling and eye therapy. By handling these claims manually, we are able to deliver better and fairer benefits to our members for these services.
There may also be situations where benefits cannot be processed on the spot, or where there is no benefit entitlement. In these situations, you will be asked to contact Emergency Services Health.
Emergency Services Health Mobile Claiming App
As a member of Emergency Services Health, we’ve got your back. Our Emergency Services Health App lets you manage your health cover 24/7.
Use the app to:
Easily make a claim for you or your dependents
Access benefit limits and cover details
View your claims history
Update your contact details
Who can use the Emergency Services App?
Anyone can access general fund information via the app, but to use features relating to your membership, you must be an Emergency Services Health Member and have registered your online membership account.
How to claim for Hospital
Hospital claims generally come directly to us from the hospital and we send the claim payment back to the hospital. This means you don't have to make a claim.
Cheques covering medical or extras services are made payable to you if you've paid the account or, if you haven't, to the provider of the service. In both instances, the cheques are sent to you (naturally if the payment is in your favour you can elect to have the payment direct credited to your financial institute).
If the account has not been paid, forward the cheque to the provider together with your portion of the payment.
How to fast-track your claims payments
If you have already paid the invoice from your medical or extras provider, Emergency Services Health offers PromptPay to ensure fast payment of your claim. With PromptPay your benefit is paid directly to your financial institution account as a direct credit.
Download our claim form, simply write "YES" in the box `Please Pay To My Bank Account Yes/No' and then fill in your nominated financial account details.
Guide To Hospital
Find out what you should know and what you should ask before a planned trip to the hospital.
Find out if you have waiting periods before you’re eligible to claim on certain procedures or services.
Access Gap Cover
Under our Access Gap Cover, you may never have to pay a doctor's bill. Your doctor can forward all accounts to us.
Did you know we have agreements with most private hospitals likely to be accessed by members?