How HICAPS Works and Where You Can Use It

What is HICAPS?

HICAPS is a handy system that lets people claim Medicare, WorkSafe Victoria and Private Health Insurance benefits when they fix up the bill for a health service. And if you’re wondering what it means – HICAPS stands for the Health Industry Claims and Payments Service. 

Great! But what does HICAPS actually do? Well, it allows registered healthcare providers to process your claims instantly. This is also good for you; it means you receive the benefits you’re entitled to on the day you get treated.  

Generally when using HICAPS at the GP, you pay the whole fee upfront and then your Medicare rebate is paid back into your bank account shortly afterwards. 

If you have Private Health Insurance and you use HICAPS for Extras services like the dentist or physio, your rebate is generally deducted first, and then you pay the difference. 

So while there’s a slight difference between how HICAPS works at the GP versus for Extras, either way for most (eligible) claims, you won’t have to pay in full upfront, wait for your claim to get assessed and then paid back manually. 

WorkSafe Victoria claims are the only exception to the rule here. Those claims get lodged through the HICAPS terminal but are then sent to WorkSafe Victoria for assessment.  

How does HICAPS work?

Most healthcare providers use HICAPS so that they can process private health insurance and Medicare claims for their patients on the spot (and lodge WorkSafe Victoria claims for assessment) 

How do they do this? Through a HICAPS Terminal, a small device that looks a lot like your run-of-the-mill EFTPOS machine. The big difference is that it communicates with Medicare (or your private health insurance provider) rather than your bank. 

The process for claiming your benefits also depends on whether you’re making a private health insurance, Medicare or WorkSafe Victoria claim—but we’ll touch on that in a bit more detail below.

Helpful Tip:

When it comes to Private Health Insurance, you’ll typically only deal with HICAPS when you’re claiming on an Extras policy. These policies can cover you for some of the medical services you get outside of hospital: like physiotherapy, dental work, optical services and many other treatments. The services, procedures and operations covered by a Hospital policy usually take place inside a hospital when you are admitted as a patient. In such cases, the hospital will usually bill your private insurer and Medicare directly and you will pay any out of pocket expenses (including excess and gap fees).

Dr. Jill Gamberg

GP, Coach and Lifestyle Medicine Coach

How do I make an Extras claim with my Private Health Insurance provider using HICAPS?

Let’s imagine you go to a dentist that uses HICAPS. And—even better—you have an Extras policy with dental benefits. 

When you’re paying for your service, the receptionist will ask if you have private health insurance. You can simply present your card and they’ll swipe it through the HICAPS terminal. 

Details of your claim will be sent to your health fund and – like magic – it will be processed instantly. If your extras policy covers the cost of your treatment, you won’t need to make any further payments. 

If only part of the cost of your treatment is covered, you’ll need to pay for the remainder of the service yourself by cash, EFTPOS or credit card.  This is often called ‘the dental gap’.

How do I make a Medicare claim using HICAPS?

If you’re visiting a healthcare provider for a treatment that’s either fully or partially covered by Medicare, like a GP, you can use the Medicare Easyclaim system (fulfilled via a HICAPS terminal) to lodge your claim and receive your rebate. 

Generally, you’ll be asked to pay your account in full using EFTPOS; your Medicare card will then be swiped through the HICAPS machine, and your rebate paid directly back into your bank account.   How quickly it is paid back can depend on what type of card you use, as credit cards can take a little longer (generally 1-2 days).

What’s the difference between Medicare Easyclaim and HICAPS?

Medicare Easyclaim is honestly very similar to HICAPS. Like HICAPS, it’s an electronic system that lets you claim benefits. However, it’s dedicated entirely to Medicare claims. 

You can use Medicare Easyclaim through HICAPS terminals as well as EFTPOS machines. Using these terminals, patients can lodge claims and receive payments on-the-spot at their healthcare provider (if the account is fully paid).

How do I make a WorkSafe Victoria claim using HICAPS?

As part of the WorkSafe Victoria scheme, Healthcare providers can also lodge invoices for injured workers through HICAPS. You’ll just need to provide your claim number, which the receptionist will enter into the terminal. 

Your claim will then be sent to WorkSafe Victoria for assessment. Again, just remember that you won’t receive an on the spot payment for WorkSafe claims. So, you might need to wait a while before it arrives.

Who can use HICAPS?

Anyone who has a Medicare card, or a Private Health Insurance membership card, can use HICAPS at participating healthcare providers. You just need to present your card at the time of payment. 

Of course, your Private Health Insurance membership card will need a magnetic strip or an embedded microchip so that the terminal can read it. Alternatively, some HICAPS terminals can also read digital membership cards—which means you can use your smartphone to make a claim!

Where can I use HICAPS?

Many healthcare providers—from dentists to dieticians, optometrists and physiotherapists—allow you to lodge a benefits claim via HICAPS. You can claim instantly using HICAPS at registered: 

• Acupuncturists
• Chiropractors 
• Clinical psychologists 
• Dentists 
• Dietitians 
• Exercise physiologists 
• Myotherapists 
• Occupational therapists 
• Optical dispensers 
• Optometrists 
• Osteopaths 
• Physiotherapists 
• Podiatrists 
• Psychologists 
• Remedial massage therapists 
• Speech pathologists 

Is HICAPS confidential?

Yes. The details of your treatment can only be viewed by your healthcare provider and your health fund. HICAPS uses a secure encryption protocol to ensure your privacy is protected.

Which Health Insurance providers support HICAPS? 

Good news! 100% of health insurance providers are HICAPS partners, which means regardless of which insurance provider you use, you should be able to make an Extras claim on-the-spot following treatment at a participating healthcare provider with a HICAPS terminal. 

Just keep in mind that this also depends on what kind of medical service you receive and whether it’s covered by your Health Insurance policy. That’s why it’s always a good idea to read your policy brochure or check with your insurer beforehand.

What is HICAPS Go?

HICAPS Go is a smartphone app that lets you make bookings with your healthcare provider, claim the cost of the treatment with your private health fund, and pay any out-of-pocket expenses using your mobile phone. 

Users can also check their out-of-pocket expenses before making a claim.

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