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.
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 policy holders, with more than 85 per cent 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 orthodontic, 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.
Other extras services claims
Not all extras claims can be lodged on the spot. For extras claims that cannot be lodged on the spot simply fill out an Emergency Services Health claim form and send it with the relevant accounts and receipts to any of the three options:
- Email: firstname.lastname@example.org (Include your membership number in the email subject line)
- Mail: Emergency Services Health, Reply Paid 84966, Halifax St SA 5000
- Free Fax: 1300 151 152.
Alternatively if you are happy for the money to be paid into your nominated contributor account you can download the Emergency Services Health Mobile Claiming App.
To make your claim simply:
- Download the free App to your smart phone.
- Register your details in the App.
- Photograph your account items.
- Submit your claim, no claim form required!
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.
Access Gap Cover
Doctors billing under our Access Gap Cover will normally forward their account directly to Emergency Services Health. We then claim your Medicare entitlements and pay that, together with your Emergency Services Health benefit, directly to the doctor.
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 insitute).
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.
Lodgement of Claims
Claims must be lodged with Emergency Services Health within two years of the date of service. Claims older than two years will not be accepted.