CLAIM FORM
Important Information
• Membership contributions must be up to date.
• HCF reserves the right to exclude from payment or to recover any benefits payable where, in our
opinion, there is an entitlement to claim compensation or damages from another source.
• Claims must be lodged within two years of the goods and/or services being provided.
• A claim may not be made for any goods and/or services until they are actually provided.
• Goods and/or services received overseas are not claimable.
• Benefits are only payable for goods and or services given by HCF recognised providers in
private practice.
• Benefits are not payable for ancillary services that you are claiming or intend to claim from Medicare.
• Please attach original receipts/accounts (not photocopies) to the claim form which should include:
– the service provider’s/supplier’s full details on official stationery.
– the full name and address of the recipient of the services.
– the item number(s) and or description(s) of the services.
– the cost of each service.
– the date of each service.
– the amount paid and balance owing.
For us to process certain types of extras claims, we need some more information. So, where you have
sufficient cover, and you want to make a claim for travel/accommodation, psychology, gym/exercise
regimes or the HWFL program, you will need to complete a different claim form. You can get this
information from any HCF branch or on www.hcf.com.au/forms or by calling 13 13 34.
Optical Claims:
Please attach the prescription for glasses and contact lenses.
Medicare Gap Claims:
To claim the Medicare gap for in-hospital services, attach the top portion of Medicare Statement
of Benefit to this claim form. The claim will be paid when the related hospital claim has been processed.
Direct Credit:
Benefits for goods and/or services you have already paid can be deposited directly to your bank,
building society or credit union account so you receive your refund quicker. Complete Section 4 -
Direct Credit account detail