How to claim

To submit a claim you must complete the Health Partners Member Claim Form. Forms are available at Health Partners locations or click here to download. If you have any questions about your benefit entitlements or require more information on how to make a claim please call Member Services on 1300 113 113.

When to claim

You can submit your claim when you have not received your entitled benefit on-the-spot.

We recommend that claims are submitted at your earliest convenience however, you have up to two years from the service date to claim any benefit(s) available on your level of cover. Please note, benefits paid count towards limits for the year in which the service was provided.

What you must include with your claim

Claims must be supported by an itemised account(s) and/or Medicare Statement(s). We cannot pay benefits on quotes. Itemised accounts must show the following information:

• The providers name, provider number and address
• The patient’s full name and address
• The date of service
• The description of the service, including any item numbers
• The amount charged.

Claims for Doctors’ bills in hospital

If your treating specialist(s) participate in Access Gap Cover, they are likely to bill Health Partners direct. We will then send you a statement detailing how much we’ve paid. Some doctors may bill you direct which will require you to complete a Member Claim Form.

A Medicare Statement is required to claim inpatient medical benefits. Benefits are not payable for outpatient services, emergency department fees or where the patient was classified as a ‘public patient’.

Claims for Health Management Benefits

To claim new Health Management Benefits such as Weight Watchers & Quit Smoking, please ensure that relevant ‘certificates of completion’ are attached to the claim form together with your receipts to claim the maximum benefit.

You must write the name of the organisation (eg. Weight Watchers) or the program you completed (eg. 12-Week Quitline program) in the Claim Details section on the Member Claim Form.

Photocopies of certificates are accepted.

Claim payments

Claims are payable by Cheque or Direct Credit (one account per membership only).

If you select Direct Credit payment, you must supply your bank account details on the Member Claim Form. You only need to supply these details the first time – the next time you submit a claim, simply tick the direct credit box and we will transfer you benefit to the same account.

Once Direct Credit payments have been processed a statement will be sent outlining benefits paid.

By default, cheques will be made out to the main member, or to the provider for unpaid accounts. 

Where to lodge a claim

Claim forms can be submitted via the following methods:

1. Post (no stamp required): 
   Health Partners Claims Assessor
   Reply Paid 1493
   Adelaide SA, 5001
2. Fax: (08) 8223 1108

3. In person: 76 Pirie St, Adelaide. 

When a claim will not be paid

• Benefits are not payable during waiting periods, or if your membership is unfinancial or was suspended at the time of treatment.
• If the goods, service or treatment was provided outside Australia or by a non-recognised provider.
• Claims for apparatus are only payable when accompanied by a letter from your medical practitioner.
• If the claim is submitted after 2 years from the date of service.
• Not all benefits are payable on all covers. For details on benefits specific to your cover please call Health Partners Member Services on 1300 113 113.