How to claim on Health Insurance

Choose the type of service or treatment you want to claim for:

EXTRAS TREATMENT

Make a claim

EMERGENCY AMBULANCE

Make a claim

HOSPITAL PROCEDURES

Make a claim

Note that when sending original documents by mail, we recommend that you keep a copy for your own records.

Claim on extras treatments


Extras treatments include things like dental, optical, physiotherapy, remedial massage and acupuncture.

Not sure which extras you can claim on or how much you can claim? Log into your account or check your Fact Sheet to find out what’s included for your cover.

Any benefit will be paid into your nominated bank or credit union account in 3 or more business days.

What you'll need to make a claim

Unless you can claim on the spot, you'll need to provide evidence to support your claim. For extras claims, we need to see an itemised invoice for the service you received. It cannot be more than 2 years old.

The invoice must include:

  1. the name of the person who received the service
  2. date of service and type of service, plus item number if relevant
  3. provider’s name and practice address
  4. at least one of the following:
    • provider number
    • provider phone number
    • practice name
    • provider’s association number or ABN

For some claims - including preventative health, sickness travel and accommodation benefits, and items like orthotics or TENS machines—you may need to provide different documentation to support your claim.

See what's required:

What's required to make a claim

  1. An invoice, which includes the name of the person the item was for and details of where it was purchased.
  2. A referral letter from an approved healthcare practitioner for the item, or for the referral details to be included on the invoice.
  1. An invoice, which includes the name of the person who received the service/program.
  2. A completed preventative health cover claim form.
  3. A referral letter from an approved healthcare practitioner (if claiming for 'Personal coaching', or ‘Bone density scan’).
  1. An invoice for the purchase (or repair of an existing device). It must include the name of the person the item was for and details of where it was purchased (or repaired).
  2. A referral letter from an approved healthcare practitioner, or for the referral details to be included on the invoice.
  1. An invoice for the purchase (or repair of an existing device), which includes the name of the person the item was for and details of where it was purchased (or repaired).
  1. An invoice, which includes the name of the person who participated in the support program.
  2. A letter from a healthcare practitioner may be required, explaining that the activity is to improve an illness or condition. This letter must include the type of illness or condition. (No letter is required for birth and lactation classes, and diabetes education.)
  1. Itemised receipts or bills relating to the travel and accommodation.
  2. When claiming for ‘Travel, sickness and accommodation’, a letter from a healthcare practitioner describing the travel and accommodation as necessary for the required treatment.
  1. An invoice for the purchase, which includes the name of the person the item was for and details of where it was purchased.
  2. For garments, we may request a letter from a healthcare practitioner explaining the condition for which the item is required, or for the referral details to be included on the invoice. Please see your Fact Sheet or contact us for more details on whether a referral is required.

Ways to claim


On the spot

If your extras provider has a HICAPS or CSC machine, simply swipe your Australian Unity membership card on the spot.

Once your claim is authorised, you simply pay any difference between the Australian Unity benefit and your provider’s fee.


App or online
  1. Log into your Australian Unity health app or Online Member Services (online account).
  2. Head to ‘Make a claim’ and select ‘Extras services’.
  3. Answer each question in the online form, making sure to upload your itemised invoice from the provider and any other documents required to support your claim.
  4. Once we’ve processed your claim, we’ll make a payment into your nominated bank or credit union account. If you haven’t paid your provider, it will be your responsibility to pass it on.
  5. If there’s any amount outstanding after our payment to you, you’ll need to pay this.

Mail, email or fax
  1. Complete a health cover claim form.
  2. Attach your itemised invoice from your health service provider, and any other documents that are required to support your claim.
  3. Send it all to Australian Unity. You can find the reply-paid postal address and email address on the claim form.
  4. Once we’ve processed your claim, we’ll make a payment into your nominated bank or credit union account. If you haven’t paid your provider, it will be your responsibility to pass it on.
  5. If there’s any amount outstanding after our payment to you, you’ll need to pay this.

Claim on emergency ambulance

Depending on your level of cover, you may be able to claim for emergency ambulance transportation or for ambulance attendances where you are not taken to hospital. Please note, coverage can vary depending on which state you live in and where you received the service.

Not sure whether you can claim on emergency ambulance or attendances? Log into your account or check your Fact Sheet to view details about your health cover.

Any benefit will be paid directly to the ambulance provider in 3 or more business days.

Ways to claim


App or online
  1. Log into your Australian Unity health app or Online Member Services (online account).
  2. Head to ‘Make a claim’ and select ‘Extras services’ or ‘Other services’.
  3. Answer each question in the online form, making sure to upload your itemised invoice from the ambulance provider. The invoice must include the name of the person who received the service.
  4. Any benefit will be paid directly to the ambulance provider.
  5. If there’s any amount outstanding after our payment, you’ll need to pay this.

Mail, email or fax
  1. Complete a health cover claim form.
  2. Attach your itemised invoice from the ambulance provider to the form. The invoice must include the name of the person who received the service.
  3. Mail or email the completed claim form and invoice to Australian Unity. You can find the reply-paid postal address and email address on the claim form.
  4. Any benefit will be paid directly to the ambulance provider.
  5. If there’s any amount outstanding after our payment, you’ll need to pay this.

Claim on hospital procedures

The hospital procedures (including day surgeries) that you can claim on will vary depending on your level of cover.

Not sure which hospital procedures you can claim on? Log into your account or check your Fact Sheet to view details about your health cover.

Before booking treatment, you should contact us to ask about the benefits you can expect to receive and any out-of-pocket expenses you might incur.

Accommodation and theatre fees

You shouldn’t be charged for accommodation or theatre fees (or prosthesis, if needed) if you’re “Covered” for your procedure at that hospital (your Fact Sheet will tell you which treatments are “Covered” and at which type of hospital); and you’ve completed any applicable waiting periods.

In most cases, the hospital will bill Australian Unity directly. You’ll only receive an invoice if an excess or co-payment applies to your cover (and you haven’t already paid it). If you do happen to receive an invoice for the full amount, please call us on 13 29 39.

If your procedure is “Covered” but is in a “non-agreement” private hospital or a private room of a public hospital, you may incur large out-of-pocket costs. This may include theatre fees, intensive or coronary care costs and accommodation. If your cover provides for “Restricted” benefits, Australian Unity will only pay the basic default benefit[1] for your accommodation and prosthesis (if needed). You will not be covered for any other accommodation and theatre fee costs relating to your procedure, and may incur large out-of-pocket costs. For medical costs, see below.

For any charges not covered by Australian Unity, you will need to contact the hospital and confirm how to pay.

Medical costs

The way you claim the bills from your surgeons and other doctors will vary depending on whether they’re participating in Australian Unity’s Gap Cover scheme.

If your policy includes Gap Cover - and your doctor agrees to participate in the scheme for your procedure—they should deal directly with Medicare and Australian Unity. You should only receive an invoice from them if there are out-of-pocket costs (which can still arise, depending on how much your doctor charges). These costs are not covered by Australian Unity. It’s the responsibility of your treating doctor and hospital to advise you of potential out-of-pocket costs before you’re admitted into hospital. If they don’t provide an estimate of those costs, it is your right to ask for informed financial consent.

Ways to claim (non Gap Cover claims)

If your doctor isn’t participating in Gap Cover, you’ll receive an invoice from them. You can either claim your Australian Unity benefits through Medicare or come to us. Either way, you’ll still need to go to Medicare first.

Option 1: Claim through Medicare

You can submit a Medicare Two-way claim form to Medicare. If payable, Medicare will process its part of the claim and organise payment to you. Medicare will then forward the details to Australian Unity so we can process our part of the claim. We’ll make any payment into your nominated bank or credit union account.

Option 2: Claim through Australian Unity

App or online

  1. Submit your paperwork to Medicare. You’ll receive a cheque, or some other form of payment, for your doctor and a statement of Medicare benefits for Australian Unity.
  2. Hold onto the payment from Medicare. Then log into your Australian Unity health app, or Online Member Services (online account).
  3. Head to ‘Make a claim’ and select ‘Medical services’. Complete the online form. Make sure to include your statement of Medicare benefits and any other documents relevant to your claim.
  4. Once we’ve processed your claim, we’ll make a payment into your nominated bank or credit union account.
  5. Pass the payment from Australian Unity, and the Medicare payment, onto your doctor. If there’s any amount outstanding, you’ll also need to pay this.

Mail or email

  1. Submit your paperwork to Medicare. You’ll receive a cheque, or some other form of payment, for your doctor and a statement of Medicare benefits for Australian Unity.
  1. Complete a health cover claim form. Attach your statement of Medicare benefits to the form.
  2. Mail or email the completed form and other documents to Australian Unity. You can find the reply-paid postal address and email address on the claim form.
  3. Once we’ve processed your claim, we’ll make a payment into your nominated bank or credit union account.
  4. If there’s any amount outstanding, you’ll need to pay this.

If your doctor asks you to pay upfront, you can follow the same processes outlined above. Just make sure to show Medicare your proof of payment. Medicare will then pay you directly. Medicare will still issue you a statement of Medicare benefits and you’ll need to include this in your Australian Unity claim. 

For all claims

If you’re sending documents by mail, please send us copies and keep the originals for your own records.

If you have questions or need help submitting your claim, call Australian Unity:

1800 807 144
Monday to Friday, 8:30am to 5pm AEST/AEDT