Here's the nuts and bolts of it all
You pay us money and we pay you money,
here's how it all works.
Want to make an extras cover claim?
First, make sure that the product, service or treatment you're planning to claim is covered. If you're not 100% certain, please ask us. We can also let you know how much you're likely to get back too, so there'll be no surprises.
Extras cover benefits are paid where:
- the service is provided in Australia
- by a recognised provider
- after all relevant waiting periods have been served, and
- where the treatment is necessary or appropriate to the condition.
You have up to two years from the date you pay for the product, service or treatment 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.
When you're ready to make a claim, there are a couple of different ways you can go about it:
Use your rt membership card to claim on the spot.
If your practitioner uses either HICAPS or iSOFT, they'll swipe your card through a special terminal when you're about to pay your bill. The info gets sent 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.
Send us a claim form.
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. Please remember that we'll keep whatever documentation you send to us, so if you are sending in your originals it’s a good idea to keep a copy for your own records. You can download a claim form here.
claim form
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Need to make a hospital or medical claim?
Generally, when you go to hospital all of the hospital’s charges will be billed directly to us, but you will receive accounts from the doctors who treat you.
There are two ways you can settle your doctors' fee claims:
- Take the accounts to Medicare and submit a ‘two-way’ claim form. Medicare will pay 75% of the Medicare Benefits Schedule (MBS) fee and will forward the account to us to pay the remaining 25%.
- Alternatively, you can send the two-way claim form in 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. Please note, we retain all original documents relating to your claim, so it’s a good idea to keep a copy for your records before sending in your paperwork.
If your doctor has charged 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, AGC).
One of the unfortunate things about the hospital sending the 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 the costs of their hospital stay have run into the thousands, if not tens of thousands. You’re welcome to call us following a hospital stay to find out exactly how much was paid on your behalf.
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Need to make an ambulance cover claim?
If you are 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. Please note that we retain all original documents, so it’s a good idea to keep a copy for your records before sending in your claim.
