We know how important it is that your claims get paid as quickly (and easily) as possible – especially the unexpected ones that you might not have budgeted for.

Whether it’s optical, dental, physio, chiro or another of our Extras benefits you want to claim for, you can do it in several easy and convenient ways.

But it’s important to know the ins and outs of what you can and can’t claim for, and how to claim – to help make the process as smooth as possible.

Remember, incorrect claiming slows the process down for everyone. We want to pay your claims as quickly as possible (so the money is back in your pocket), so please take the time to review your product sheet and understand what your cover includes.

And don’t forget, you can keep an eye on your Extras limits (annual and lifetime) in Online Member Services.

It’s important to remember that you can only claim for services received from recognised Australian providers. So double check your provider with us before starting any treatment.

When it comes to pharmaceuticals, we can only pay benefits for drugs that:

• ARE prescribed by a doctor
• ARE approved by the Therapeutic Goods Administration (TGA – the regulatory authority responsible for medicines and vaccines)
• ARE NOT covered by the Pharmaceutical Benefits Scheme (PBS – a government program that subsidises medicines to make them more affordable).

So in a nutshell, if your doctor prescribes a drug that isn’t on the PBS, your Teachers Health cover might be able to help as long as the drug is approved by the TGA. You can claim a benefit for the difference between the cost of the item and the PBS amount – up to a maximum of $60 per item (sub-limits and yearly limits apply).

We know this can be confusing, so your doctor is the best person to explain whether the drugs they’re prescribing fit the bill for claiming through your private health insurance.

There are a few options to choose from – you can pick whichever works best for you and your life.

On the spot (HICAPS)

This is the easiest way to claim. If your provider has HICAPS, just present your membership card to be swiped at the time of service and your claim will be processed automatically – easy! You’ll only have to pay the balance remaining after your health fund benefit has been paid. (To avoid any confusion, it’s best to ask your service provider if they have HICAPS before starting your treatment.)

Mobile app (the dos and don’ts!)

Simple and easy claiming… it’s also intended to be really quick. But unfortunately incorrect claims sent to us by members do slow the process down for everyone. So how can you help to keep claims moving quickly?

Once you’ve downloaded the mobile app (for your Apple or Android device) all you need to do is take a photo of your official receipt and submit your claim. And hey presto, it’s done! (Just make sure that you keep your original receipts for two years, in case we need to do an audit.)

But to keep it this simple, it’s really important to send us the correct info and only claim for things you can receive benefits for (e.g. this doesn’t include a taxi to a physio appointment!). So remember to review your product sheet before you claim.

The basics (official receipts)

An official receipt is vital – no official receipt, no claim. Need a refresher on what this includes? It must be on an official letterhead or stamped with a provider stamp which includes the name, address and provider or registration number of the provider. Then the receipt needs to be itemised with:

• your name (or the name of the patient receiving the service if it wasn’t you)
• the date the service was provided
• the type of service provided
• the cost of the service provided.

Remember, you’ll need this for each individual service. And don’t forget, we can’t accept handwritten provider details or alterations to receipt or accounts.

P.s. we’re working hard behind the scenes to keep improving our mobile app – look out for our refreshed app coming soon!

Other ways to claim

There are a couple more ways to claim – online (in Online Member Services) or by submitting a claim form. For more info on these, visit Claiming for Extras.