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Health fund optical benefit claiming
Health fund optical benefit claiming

Health Insurance - Optical Benefits, Covers & Claims

Here at 1001 Optical, we pride ourselves on providing our customers with affordable eyecare and eyewear. It is important to us that we ensure you get the best services and products both online and in store. 

Bulk Billed Eye Tests with Medicare - 

If you have a Medicare card, your eye test may be completely covered. To see if your eye test qualifies to be Medicare Bulk-Billed, visit or contact your nearest store to find out and get your eyes tested to stay updated with your ocular health. Click here to find your nearest store. 

Private Health Insurance Covers for Optical Benefits - 

Want to get the most out of your private health insurance cover for optical rebates in Australia?

If you have a private health insruance with optical cover, you may be able to claim benefits for your prescription glasses, sunglasses or contact lenses. However, this depends on the level of your cover. Optical covers are usually valid for a period of 12 months per calendar or financial year. Any benefits that are not used will expire at end of the 12 months period. Contact your private health fund provider today for more details on your optical benefits. If you do not claim your rebate, you might lose a benefit you have already paid for.

Steps to claim your health insurance optical benefit 

Please note: Claiming benefits are valid only for the purchase of glasses, sunglasses or contacts that have prescription lenses. The benefits can only be claimed for the individual who will purchase and use the respective eyewear. Non-prescription eyewear are not covered and hence we do not process related claims. 

AHM / Medibank Members

If you are an AHM / Medibank Private Member, you may not be able to claim your optical benefits on your prescription lenses for online purchases that have:

·         Multifocal / Bifocal lenses

·         Prescriptions that are greater than +/- 3.00

·         Orders for children under the age of 16

Please contact AHM/Medibank to confirm your benefit entitlements prior to your orders. 

 

Important Health Insurance Rebate Rules for Specific Health Funds:

1) Can a rebate be used as partial payment at time of ordering if the product is paid in full? 

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.

 

2) Can a product be purchased over 2 years (frames & lenses) to maximise rebate?

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.

 

3) Can a rebate be provided on a frame ONLY if they choose to get lenses elsewhere?

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. 

 

4) Do plano lenses need to be retained if a patient purchases a complete pair of prescription sunglasses?

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. 

 

Some of our major health insurance partners are: 

(You can click on the logo to visit the respective health fund provider's website.) 


 Medibank Private - Health FundAHM - Health FundAustralian Unity - Health FundBupa - Health FundCBHS - Health FundCUA - Health FundDefence - Health FundGMHBA - Health FundGU - Health FundHCF - Health FundHealth.com - Health FundNIB - Health FundRT - Health FundTeachers - Health FundWestfund - Health Fund