How to claim extras (optical, dental, physio & more)

The most popular and convenient way to submit your extras claim is through HICAPS. Ask your extras provider if they are connected to HICAPS. If they are, they can process your claim on the spot, and only pay them the difference between the amount of the claim and the amount of their bill.

There are other ways you can make a valid claim for extras:

Making a valid claim

A valid claim must include a:

  • valid claim form, authored by the claimant or other authorised person
  • itemised valid tax invoice
  • receipts of any monies paid toward the supplied tax invoice

A valid claim form is:

  • a HICAPS transaction
  • a Doctors' Health Fund smartphone app claim
  • the claim form available on the Doctors' Health Fund website at the date of making a claim

A valid tax invoice:

  • is on the treating practitioners official letterhead (or endorsed with their official stamp)
  • includes the treating practitioners' ABN, practice address, contact details and name
  • is endorsed with the invoice date and, where a reprint of the original, the date of printing and the word 'duplicate'
  • itemises the name of the patient, a description or recognised item number of each treatment and the date of service of each treatment.

If you have any questions about your claim, please contact our expert Member Services Team on 1800 226 126 or info@doctorshealthfund.com.au

Doctors’ Health Fund does not provide benefits on any level of extras cover for services that are not medically proven. This includes chiropractic, natural therapies or exercise physiology and acupuncture when it is not part of a Health Management Program.

Claims for extras are not payable where:

  • they are submitted more than two years after the date of service of the claimed treatment
  • the provider is not qualified to supply the treatment under the Fund Rules
  • more than one ‘like’ treatment is claimed for the same date of service (e.g. massage and physiotherapy are not payable on the same day)
  • the patient and the treating practitioner are related
  • the policy is unfinancial or suspended at the date of service
  • the relevant waiting periods have not been served at the date of service
  • an amount is, or a right exists for an amount to be, paid or payable from a third party
  • the service was for health screening, superannuation entry or employer requested health check
  • false or inaccurate information is supplied
  • the service is excluded or restricted on your cover
  • you have exceeded the relevant claims limits on your cover
  • the date of service was prior to the patient joining the fund, or after the patient left the fund
  • the treatment or appliance was supplied outside Australia
  • aids, appliances, glasses, contacts, pharmaceuticals or hearing aids are not accompanied by a prescription from the patient’s usual practitioner
  • the treatment does not meet the standards and requirements of the Private Health Insurance Act 2007 or its associated instruments
  • the treatment was not delivered in person
  • a treatment was supplied whilst an in-patient in hospital
  • an ailment, illness or condition is not being treated, managed or cured
  • the treatment has not yet been supplied
  • there was no legally enforceable debt for the supply of the treatment