You pay us money and we pay you money, here's how it all works

Extras cover – 7 things to check before your appointment

#1 Check that you're covered
Make sure you're covered for the product, service or treatment you're planning to claim.
How? Check the cover guide for the type of cover you have, or ask our member care team on 1300 886 123 or help@rthealthfund.com.au.
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#2 Check your claims
Check that you haven't already used up your available annual limits for the product, service or treatment you're having. How? Check your past claims in our online member centre, or ask us.
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#3 Check your waiting periods
Make sure you've served any waiting periods that apply to you. How? All waiting periods are specified in our cover guides, and of course you can always ask us.
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#4 Find out how much you'll get back
Find out how much you expect to get back when you make your claim, so there'll be no surprises. How? Again, take a look at the cover guide for the type of cover you have. In some cases, especially when it comes to dental benefits which can't all be listed, or where it's something you haven't claimed before, it's best to ask us. Call 1300 886 123 or email help@rthealthfund.com.au.
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#5 Check that your practitioner is registered
If you are going to be claiming for a type of treatment or consultation, check that the practitioner you are going to is registered with us. How? Ask them or ask us.

In brief, you are covered for services provided by: allied health practitioners with a Medicare provider number, dentists registered with the Australian Dental Association, registered optometrists or ophthalmologists, licensed optical dispensers and natural therapists registered with the Australian Regional Health Group (ARHG). In a handful of cases, natural therapists must be registered with their professional industry association rather than the ARHG. Read more about 'registered providers' in your A-Z membership guide, available in the library of our online member centre.
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#6 Check where the company is based
If you're buying a product online, make sure that the company you are purchasing from is operating within Australia. You are not covered for purchases you make where the transaction occurs overseas.
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#7 Check that your contributions are up-to-date
This is especially important if you are going to use your rt membership card to make an electronic claim, if your contributions are out of date, your electronic claim will not be accepted.
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3 things to keep in mind when you're ready to make your claim
#1 There are two ways you can make your claim: electronic claim at the time you're paying the bill for your treatment, or send in a claim form.

  • Electronic, on-the-spot claims – if your practitioner uses either the HICAPS or iSOFT payment systems, you can make your health insurance claim instantly, at the time you're paying your bill. They'll swipe your card through a special terminal which sends all the information about what you're claiming directly to us. The claim is lodged right there on the spot and all you pay is any difference between the amount of your rt rebate and the cost of the treatment. It's brilliant – there's no paperwork to fill in and you aren't out-of-pocket while you wait for your claim to be paid.
  • Claim forms – if on-the-spot claiming isn't available, you do it the old fashioned way: fill in a claim form, send it in with your receipts or account, and we'll send you a cheque – or even better – drop the money straight into your bank account. You can send your claim forms and receipts by scanning and emailing, faxing or posting. Remember, we'll keep whatever documentation you send to us, so if you are sending in your original receipts it’s a good idea to keep a copy for your own records.

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#2 These days you don't need to send in original receipts, but you must keep them handy in case we ask you for them.
We've tried to make things easier for you by now accepting copies, scans or faxes of receipts, which means you can get your claims to us faster and you get to keep the originals for your own records. Please be aware that we do have an ongoing, random audit of claims made though, so it is possible that we will ask you to provide us with your originals as part of that process. Please hang on to them, even after you've made your claim.
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#3 You have up to two years from the date you have the service or treatment (or purchase the product) to lodge your claim.
If you have a box of old receipts lying around, have a rummage through for anything you might have forgotten about. If it's less than two years old, and you've had cover with us the whole time, send it in.

Claim form

You can download a pdf of the claim form above, or if you prefer, we can post some to you. Just email or call our member care team and we’ll have some in the mail to you today. Email email help@rthealthfund.com.au or call 1300 886 123.

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Hospital cover – x things you should know before you go into hospital

#1 Hospital cover includes four different types of costs
When you go to hospital there are a range of different services involved in your care, and there are four different things you are covered for by your hospital cover: the hospital's bills, your doctors' bills, bills for any prostheses or pharmaceuticals, bills for any ambulance transport. We strongly encourage you to read more about how your hospital cover works, and to know what level of cover you have, by reading or individual cover guides and the section on hospital cover in your A-Z of membership (available in the library of our online member centre).

Generally, when you go to hospital all of the hospital’s accommodation charges will be billed directly to us rather than to you, but you will receive accounts from the doctors who treat you.

Claims for doctors’ fees are shared between Medicare and us: Medicare pays 75% of the Medicare Benefits Schedule (MBS) fee and we pay the remaining 25%. If your doctor has charged you an amount that is higher than the MBS fee, the additional amount will be an out-of-pocket expense that you’re responsible for paying unless he or she agreed in advance to participate in our Access Gap Cover.

  • If your doctor agreed to participate in our Access Gap Cover, send your accounts and a completed claim form directly to us.
  • If your doctor didn’t use Access Gap Cover, take your accounts to Medicare and submit a ‘two-way’ claim form. Medicare will pay 75% of the MBS fee and will forward the account to us for payment of the remaining 25%. Alternatively, you can send the two-way claim form to us yourself after you’ve been to Medicare, just attach a copy of your Medicare statement (that’s what they’ll give you after they’ve paid their portion of the claim) to your completed rt claim form.

You can download a claim form here.

One of the unfortunate things about hospitals sending their bills directly to us is that you don’t get the chance to see what amazing value your hospital cover provides. People are usually stunned when they realise that the cost of their hospital stay has run into thousands, if not tens of thousands, of dollars. You’re welcome to call us following a hospital stay to find out exactly how much we paid on your behalf, and if the amount of your hospital claim is more than $3,000 you’ll receive a benefit statement from us showing how much we paid.

If you’re interested in knowing more about just how much some common medical procedures actually cost, check out this article from our be well magazine ...

how much stuff costs
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Need to make an ambulance cover claim?
If you are treated or transported by ambulance, you’ll receive an account from the ambulance service. All you need to do is complete the details requested on the back of the account, and send it in to us along with a completed claim form. You can download a claim form here.

Please make sure you understand exactly what you're covered for. Ambulance cover comes included with all rt hospital covers, but the level of cover you have depends entirely on where you live. Please speak to our member care team if you're not certain what you're covered for in your state.

TELEPHONE 1300 886 123   :  DISCLAIMER   :  PRIVACY POLICY  : © 2014 railway + transport health fund ltd (abn 93 087 648 744) is a registered health benefits organisation
The materials on this website have been prepared for general information only. The information on this website, or any other website accessed via this website or otherwise, may not be accurate, complete or current. rt health fund ltd does not accept any liability to any person for the information that is provided.