Health Insurance - Optical Benefits, Covers & Claims

Medibank - If you are a recognised provider, and payment for an optical appliance is made in full on the date of order and processed, the rebate may be claimed electronically by the provider on the date of order. The practice must have a documented refund policy which includes a full refund of the benefit Medibank has paid. For non-collection the refund must be processed within six weeks of the order date and in the case of order cancellation the refund must be processed immediately.

NIB - If payment for an optical appliance is made in full on the date of order, the rebate may be claimed on the date of order.

Bupa - Bupa does not support the use of health fund benefits at the time of ordering, even if paid in full. However, the date of ordering can be entered into HICAPS/Health Point for claiming purposes on the day of appliance collection.

HCF - HCF’s fund rules exclude benefits for goods and services that have not been received at the time of claiming.

Doctor's Health Fund - If payment for an optical appliance is made in full on the date of order, the rebate may be claimed on the date of order.

Australian Unity - We cannot prevent optical providers from completing a claim through HICAPS on the date of order.

HBF - HBF does process optical claims using the date of order as the service date. Electronic claims are eligible to be made on the date of order.

GMHBA - If payment for an optical appliance is made in full on the date of order, the rebate may be manually claimed on the date of order directly through the health fund. NOTE: HICAPS cannot be processed on date of order.

Medibank - Patients may not use their rebate over two claiming periods for the same product. For example, they cannot use their December frame rebate towards an optical frame and their January rebate on the same frame.

NIB - Splitting of optical appliance claims over two claiming periods is permissible where the date of frame purchase can be input on HICAPS/Health Point using a particular year’s benefits (e.g. December) and the lenses in the following year (e.g. January).

Bupa - No. Splitting of optical appliance claims over two claiming periods is not permissible unless the patient is purchasing the frame and lenses from different providers.

HCF - A rebate will not be provided unless a complete product is delivered to the patient. Splitting of optical appliance claims is not permissible.

Doctor's Health Fund - Patients may not use their rebate over two claiming periods for the same product.

Australian Unity - A product can be purchased over two claiming periods so long as the item is paid for and collected in the year it is being claimed on.

HBF - Patients are not eligible to claim over 2 years for the same service at the same provider. If the patient purchases frames and lenses from different providers they may be eligible to claim a benefit over 2 years.

GMHBA - Patients are not eligible to claim over 2 years for the same service at the same provider. If the patient purchases frames and lenses from different providers they may be eligible to claim a benefit over 2 years.

Medibank - Patients are able to purchase an optical frame and receive a benefit under item 110 only and subsequently order their lenses from another provider. They must however have a valid prescription and a copy of the valid prescription must be on file at the practice.

NIB - Patients are able to purchase their frame and receive a benefit under item 110 only and subsequently order their lenses from another provider.

Bupa - Patients are able to purchase their frame and receive a benefit under item 110 only and subsequently order their lenses from another provider.

HCF - A frame only is not considered a complete optical or medical appliance and the patient must pay in full with no rebate claimed in store / no code 110 listed on receipt. Once the patient has lenses glazed in the frame and has a receipt indicating that, the patient may receive a rebate in full from the HCF office.

Doctor's Health Fund - Patients are able to purchase an optical frame and receive a benefit under item 110 only and subsequently order their lenses from another provider. They must however have a valid prescription and a copy of the valid prescription must be on file at the practice.

Australian Unity - Patients are able to purchase an optical frame and receive a benefit under item 110 only and subsequently order their lenses from another provider.

HBF - Patients are able to purchase an optical frame and receive a benefit under item 110 only and subsequently order their lenses from another provider.

GMHBA - A frame only is not considered a complete optical or medical appliance and the patient must pay in full with no rebate claimed in store / no code 110 listed on receipt. Once the patient has lenses glazed in the frame and has a receipt indicating that, the patient may receive a rebate in full from the GMHBA office.

Medibank - If a patient orders prescription sunglasses, plano lenses removed from the frame must be retained for a minimum of six months, labelled with the customer name and available for auditing purposes.

NIB - Plano sunglass lenses DO NOT need to be retained by the provider if a patient orders a complete pair of prescription sunglasses.

Bupa - Bupa recommends that the practice retains plano sunglass lenses. Benefits are only payable for prescription spectacles or contact lenses (optical appliance) that are designed and manufactured with the sole purpose of correcting a refractive error or ameliorate a refractive abnormality or defect of sight.

HCF - Plano sunglass lenses DO NOT need to be retained by the provider if a patient orders a complete pair of prescription sunglasses.

Doctor's Health Fund - Plano Lenses do not need to be retained by the provider if the patient orders a complete pair of prescription sunglasses.

Australian Unity - Plano Lenses do not need to be retained by the provider if the patient orders a complete pair of prescription sunglasses.

HBF - Plano Lenses do not need to be retained by the provider if the patient orders a complete pair of prescription sunglasses.

GMHBA - Plano Lenses do not need to be retained by the provider if the patient orders a complete pair of prescription sunglasses.