Simply swipe your RBHS card and your benefit will automatically be deducted off the price of your service. On-the-spot claiming, called HICAPS, is available at most health providers like dentists, optometrists, physiotherapists, chiropractors and more.
There is no need to lodge a claim form or pay for the whole account as the fund pays your benefit directly to the practitioner.
Please note: You must treat this service like you would a credit card and only sign for services provided. Make sure that you maintain personal control over your RBHS card at all times. Additional cards are available for other members of your family upon request. Please report any lost or stolen cards to RBHS immediately.
This is what you do if you cannot use your RBHS card or you forgot it.
First of all, make sure you get a receipt with the following details on it:
- Patient’s name
- Provider’s name and number
- Date of service
- Service provided
- Amount paid
Once you have the receipt with all those details, send your claim to us via the RBHS app. Simply open the app and take a photo of your receipt or upload a photo or PDF document and hit submit.
Bonus photo tip: Turn off the flash if using your phone to take a photo of your receipt.
How to make a pharmacy claim
Want to learn more about how and when you can make a pharmacy claim?
Before you start, make sure you read the explainer above on How to make an extras claim: your options.
Key points on pharmacy claiming
- You are unable to use your membership card to claim
- You will need a receipt to claim with detailed information on it (see below)
RBHS needs the following details on your pharmacy receipt:
- Patient’s name
- Pharmacy’s details
- Medication name & script details
- Dispense date
- Amount paid
RBHS can only pay a benefit on medicines that are:
- above the PBS co-payment amount ($42.50 as of 1 January 2022);
- approved by the Therapeutic Goods Administration;
- not excluded by the health fund (for instance, medicines for contraception are excluded);
- prescription only medicines (you cannot claim medicine you can get without a prescription); and
- purchased less than two years ago.
The types of medications members typically claim through RBHS are the many drugs that have been deemed safe by the Therapeutic Goods Administration but have not yet made it on to the PBS.
*A 2-month waiting period applies.
An eligible pharmacy claim might look like this example for someone who has not yet used any of their annual limit:
|Medicine cost = $110|
|minus PBS co-payment amount before calculating benefit = $68.7|
|Benefit rate||100% above the PBS amount to $160 per script|
|Annual limit (resets 1 January)||$1000 per person|
Mistakes to avoid
Here are some quick tips to get it right first time:
- If you’re uploading or taking a photo, make sure it’s easy for us to read.
- Send us the provider receipt (jump to the top of the page to see the receipt details we need). We do not need to see anything from HICAPS.
- Check your name on the receipt matches the name on your policy.
Chronic Disease Management Plans (CDMPs) are for chronic conditions that have lasted for at least six months. CDMP claiming allows you to get help from both the government and RBHS if you follow our steps.
How does it work?
Your GP writes the plan for services that you can claim on Medicare first. Usually Medicare provides benefits for five visits. For the sixth and subsequent visits you can then claim from your extras cover and start drawing down on your limits.
What can you claim for?
Lots of services. That is why extras cover is so handy. These are some of the most popular ones:
- Exercise physiology
- Eye therapy (orthoptics)
- Occupational therapy
- Speech therapy
To get the most out of your extras cover, you need to know how to get the most out of your Health Management Benefits. To claim for the following services you will require a signed diagnosis of a medical condition first from a medical professional (that is our Declaration of Condition form):
- Gym equipment
- Fitness programs
- Health aids
- Medications usually used as contraceptives