What expenses are there if I go into hospital?

Once you leave the hospital and the bills start arriving you need to know how to submit your claims.

There are usually two types of accounts that need to be paid: the hospital accounts (for accommodation, all that yummy food etc.), and the doctor’s accounts. Each of these are claimed slightly differently.

How do I claim hospital accounts?

If your cover has an excess, co-payments, or both, you should have already paid your part directly to the hospital.

The hospital then bills your health insurer directly for the remainder of the cost (as long as the procedure is not excluded from your cover). If the hospital sends you an account, ask them to send the bill directly to us.

If you’re admitted into a public hospital as a private patient, the public hospital may choose to charge more than the benefits that we pay. Public hospitals can do this because they’re not contracted to charge a set amount for a private patient. This doesn’t happen most of the time but we need to let you know in case it does. If the hospital charges more than the benefit that we pay, you’ll need to pay the amount on top of your excess and any co-payments that apply.

How do I claim doctor’s (medical) accounts?

Hospital cover also includes benefits for the bills you receive from doctors as part of your hospital stay (as long as the treatment is not excluded from your cover). In some cases your doctor or specialist will bill Frank and Medicare directly, so the only account you will get from them will be for any out of pocket expenses.

If the doctor sends you the entire bill, you will need to submit the claim through Medicare using ‘two-way' claiming for Frank and Medicare to pay benefits.

If you haven’t paid the bill, Medicare will pay their benefit directly to the doctor and forward the account to Frank so that we can pay our benefit. If you have paid the account, Medicare will pay the benefit directly to you and forward the account to Frank so that we can pay our benefit. Once the doctor receives their payments, they'll send you a new account for any out-of-pocket expenses which you will need to pay.

If you have already claimed at Medicare and didn't use the two way claiming system, forward the Medicare benefit statement that you would have got when you claimed along with a claim form to:

Frank Health Insurance, Reply Paid 69, Geelong VIC 3220

Important: In this case, we need the original Medicare benefit statement, not a copy. We don’t need a copy of the original doctor’s invoice.

What are out of pocket costs and why do they exist?

When you go into hospital as a private patient, your doctor will charge for their service. Health insurers pay medical benefits based on a set fee for specific services created by Medicare (known as the Medicare Schedule fee or MBS fee).

When you’re admitted to hospital, Medicare covers 75% of the MBS fee and your health insurer pays for the additional 25% (so the full MBS fee is covered) for the doctor’s service.

Doctors don’t have to charge this amount and sometimes they will choose to charge more than the MBS fee or the amount covered by your health insurer.

Frank pays an additional 20% as part of their Gap Cover to help reduce your medical gap. If your doctor charges above 120% of the MBS fee you will need to pay the gap (difference between 120% of the MBS fee and the total bill) which is an out of pocket cost.

Your doctor or specialist should have discussed any of pockets with you before the procedure, so there shouldn’t be any nasty surprises.

Claiming extras

How do I claim extras expenses?

A lot of providers use a HICAPS machine (which is like an EFTPOS machine) which makes claiming really easy.

You just swipe your membership card via HICAPS when you receive a service and your health insurer pays the provider directly. Then you get charged the remainder of the bill.

What if my provider doesn’t have HICAPS?

If the provider doesn't have HICAPS, you can pay the account in full then submit a claim to us for the refund. With Frank you can usually lodge the claim online or you may need to submit a claim form with your receipt.

Claiming Orthodontics

How do I claim orthodontic expenses?

Claiming for orthodontic work is a little more complicated than claiming for other extras.

Your specialist needs to complete a form called an orthodontic treatment plan. To claim, you need to send a scanned copy of this plan along with a signed claims form and your paid receipts to us. You can send these documents by:

Email: frank@frankhealthinsurance.com.au

Or

Mail: Frank Health Insurance, Reply Paid 69, Geelong VIC 3220.

How much can I claim on orthodontic treatments?

How much you can claim on orthodontic treatment depends on:

  • The type of treatment (e.g. braces or a plate)
  • The length of treatment (how long you have to wear them for)
  • How long you have had cover for orthodontic treatment (how many years)
  • Who actually provides the treatment (whether it's a registered dentist or specialist orthodontist)
  • Your level of cover.

If you have Some Extras

You get back either 50% or 80% of your cost (depending on your cover) up to a maximum of $300 per year. You can continue to claim for orthodontic treatment for up to 3 years max, if your treatment goes for that long. (When the treatment stops, so do our refunds.)

If you have Lots Extras

Both registered dentists and specialist orthodontists can provide orthodontic treatment. Who you see and what they do will determine how much we can pay.

If your Provider is a...And the treatment type is...Then the benefit will be...
Registered dentist Any orthodontic treatment 50% or 80% of your cost (depending on your cover) up to $380 per year. You can continue to claim for orthodontic treatment for up to 3 years depending on the length of treatment specified on your orthodontic treatment plan.
Specialist orthodontist Removable appliances (e.g a plate)
Fixed appliances (e.g. braces) How much you get back depends on:
  • The "type of treatment" (are they upper and lower braces, upper braces only or lower braces only), and
  • How long you have had cover for orthodontic treatment when treatment starts (including any continuous cover with another health insurer if you switched to Frank).

You can claim back 50% or 80% of your cost (depending on your cover) up to the limits listed in the Specialist Orthodontist Benefits table below. You can claim a benefit for up to 3 years if your treatment goes for that long.

Specialist Orthodontist Benefits

Years of membershipFull Upper AND Lower BracesUpper OR Lower Braces
1-3 years $450 per year $380 per year
4 years $550 per year $430 per year
5 years $600 per year $480 per year
6 years $650 per year $530 per year
7 years $700 per year $580 per year
8 years $750 per year $630 per year
9 years $800 per year $680 per year
10+ years $850 per year $730 per year

If you have a Starter Bundle

You get back 60% of your cost (depending on your cover) up to a maximum of $300 per year (combined with Major Dental). You can continue to claim for orthodontic treatment for up to 3 years max, if your treatment goes for that long. (When the treatment stops, so does Frank's refunds.) An orthodontic lifetime limit of $1,100 applies.

If you have an Essentials Bundle

You get back 60% of your cost (depending on your cover) up to a maximum of $500 per year. You can continue to claim for orthodontic treatment for up to 3 years max, if your treatment goes for that long. (When the treatment stops, so does Frank's refunds.) An orthodontic lifetime limit of $1,700 applies.