We receive a lot of questions from members about all aspects of their health cover.

Here are 7 random, but frequently asked questions, and the answers from our experts.

1. I can’t use my card for HICAPS in enough places, why don’t you have HICAPS with more practitioners?
HICAPS is a payment option that individual practitioners may choose to provide, or not; a bit like they might choose to accept payments using some types of credit cards, but not others. The organisation that operates it is called HICAPS (which stands for Health Industry Claims and Payments Service), and practitioners go to them to get set up if they want to make it available. Once it’s in place, most members of most health funds can use their membership card to make the on-the- spot claims that are so convenient.

If a practitioner you like to go to doesn’t have HICAPS, let them know you’d value that service. And if you’re interested in finding practitioners that already offer HICAPS, you can look them up on the HICAPS website, visit www.hicaps.com.au and in the left-hand menu, click on ‘providers with HICAPS’.

Some practitioners now offer a similar claims and payment service called iSoft, which works in exactly the same way as HICAPS. If you see a practitioner offering the iSoft facility, you can use your rt membership card to make your claim on the spot.

2. It doesn’t make sense to me that you cover podiatry under my extras, but you won’t cover me for the surgical podiatry I need. Why not?

Generally, surgical podiatry can’t be claimed under either extras or hospital cover and understandably, that causes confusion. Here’s how the process works, and why it slips through the cracks.

Surgical podiatry is performed in hospital, either as an overnight stay or, more commonly, as a same day procedure, and legislation says that health funds can’t pay benefits on in-hospital procedures under extras cover.

So, why can’t you claim it under your hospital cover? Hospital cover is restricted, again by legislation, to only paying benefits for procedures that you can claim under Medicare. Specifically, where the procedure you’re having, and where the person performing it for you, are both recognised by Medicare. In most cases, surgical podiatrists are not recognised by Medicare for the provision of that service. That means they can’t give you a bill that you can take along to Medicare and make a claim with, and because of that, the full extent of your hospital cover can’t come into play. We can pay a small benefit on some of the hospital’s costs (this is called a ‘default benefit’), but in most cases, you will have fairly substantial out-of-pocket expenses for this procedure.

3. We have a family membership and I need a lot of physiotherapy but my wife doesn’t use any. Why can’t I use her limits after mine are finished?
The short answer is because it would cost you a great deal more than you currently pay to effectively double your limits for physiotherapy.

Here’s the long answer. With most health covers, the amount you pay for a single cover is exactly half the amount that a family pays. A couples/family cover is really two single covers stuck together, which is why you have annual limits per person that are exactly the same as they would be if each person had a single level of cover. The price is worked out on the basis of the claims involved if each person were to use the ‘normal’ proportion of benefits for each of the things covered – and of course, not all people claim everything they can for everything that is available every year, and that’s how the whole system remains viable. In simple terms, the basis of any type of insurance is that lots of us pay for cover that we don’t end up using, which is where the money comes from to pay the claims for those people who do end up claiming. The benefit limits are set per person to enable that careful balance to take effect, and if we went down the path of enabling one person within a family to claim everything the whole family is collectively covered for, the cost of providing that level of cover would be astronomical. Which is why no health fund does it.

4. How can I find out more about what I’m covered for?
We have some very good resources available to help you understand more about how your cover works and exactly what you’re covered for. We often have people tell us that they don’t know what they’re covered for, but they also haven’t looked at any of the information available … and that’s ok. If you like to read things yourself, these are the resources we can offer, and if you prefer to chat to a real person, give us a call anytime, even if it’s just for a general talk about how your cover works.

Your best sources of information are:
Our website
There are two areas of the website that might be of interest:
‘rt members’
You’ll find a lot of general information about your cover in the ‘rt members’ part of the site, which you get to by clicking on ‘rt members’ from the homepage. Here, you’ll find information about:

  • Latest news for members
  • What you can do in our online member centre
  • The free health and wellbeing programs available
  • How to make claims and payments
  • How to find more information about your cover
  • And, you can download the forms you might need from time to time ‘online member centre’

If you’re after more specific information, you can look up your own membership in our online member centre, which you can get to by clicking on ‘member login’ at the very top of the homepage screen.
Once inside, you can see all the details about your membership, including the type of cover you have, who’s covered, when you’re paid up until, your contact and bank account information, as well as some correspondence and recent claims history. You can make some changes to your membership, such as updating your contact information or bank account details, but there are still some things we need your signature on a piece of paper to do, which is why you might not be able to do everything you’d like.

Registering for access to the online member centre is quick and easy – you provide a few simple details on the registration screen, and within a minute or two you will receive an email with your login information. If you haven’t already had the chance, login and have a look around.

The A-Z of Your Membership
This is a very comprehensive guide to how your cover works, think of it like your ‘policy booklet’. It’s quite long, but it’s divided up into small sections relating to different topics, so you can hone in on the information you’re after, and it’s written so real people can understand it! It’s available online at www.rthealthfund.com.au/ atozofrt.html. Because this can be updated from time-to-time, if new information or a better explanation of how something works needs to be added, it’s best to refer to the online version, which will always be the most up to date. Of course, that’s not practical for everyone, so if you do prefer the printed booklet, just remember to check with us that the version you’re referring to is the latest before relying on the information in it.

Cover guides
We have a detailed cover guide for each type of hospital or extras cover we offer. Each one provides you with specific information about what you’re covered for, what your benefit limits are and how much you’re likely to get back when you make a claim. You can download copies from the online member centre (just login and click on ‘library’ in the left-hand menu), or ask us to email or post one out to you. These don’t tend to change during the year, so the versions you received in June will remain current until April 2012, which is when any product changes and improvements for the next year will be introduced. We’ll send you updated cover guides when they are available next year.

There is a lot of information to get through when it comes to your health cover, and it helps not to feel too concerned about knowing everything off the top of your head – even people who work in the industry have to look things up and ask questions! If you feel generally informed about your cover, and most importantly, know where to look for more information and when to get in touch with us, you’ll be absolutely on the right track. If we can send copies of any of these items to you, please let us know, 1300 886 123 or email help@rthealthfund.com.au.

TELEPHONE 1300 886 123   :  DISCLAIMER   :  PRIVACY POLICY  : © 2015 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.