HCi Factsheet – medicinal cannabis claims
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Claiming for medicinal cannabis products
12 September 2025
You may be able to claim medicinal cannabis from your HCi policy.
Some members may be prescribed medicinal cannabis as part of their treatment plan. HCi covers certain prescribed medicinal cannabis products through eligible Extras cover. This cover is designed to support evidence-based treatments that are lawfully supplied.
HCi cover for medicinal cannabis
Members with Top Extras, Premier Extras, or Healthy Extras cover are covered for medicinal cannabis.
How much is covered?
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- Top Extras and Premier Extras: up to $100 per prescription (after the PBS-equivalent co-payment, currently $31.60), subject to an annual sub-limit of $600.
- Healthy Extras: up to $75 per prescription (after the PBS-equivalent co-payment, currently $31.60), subject to an annual sub-limit of $450.
Please note: Medicinal cannabis compounded products made by a compounding pharmacy are generally excluded from cover.
What you need to provide when claiming
When making a claim, you can submit it and all supporting documents via OMS at any time. Otherwise, you need to complete a HCi claim form as well.
Either way, you’ll need to give us:
- a completed Medical Eligibility Declaration form (HCi can hold this on file for 12 months)
- an official pharmacy receipt from the dispensing pharmacy
- evidence of TGA approval: If the product is not listed on the TGA website as approved, you must provide either a Special Access Scheme (SAS) approval letter or an Authorised Prescriber (AP) letter. Your provider should be able to give you this evidence and HCi can hold these on file for 12 months.
Further guidance is available in the HCi pharmacy claims factsheet.
Waiting periods for medicinal cannabis
A 12-month waiting period applies to medicinal cannabis benefits.
This waiting period applies if you:
- are new to HCi, or
- upgrade your Extras cover, or
- transfer from another fund, unless your previous fund can confirm you already served a 12-month wait specifically for medicinal cannabis benefits (not general pharmacy).
Things to remember
- Medicinal cannabis is usually not listed on the PBS, so there is no government subsidy. If a medicinal cannabis product is ever PBS-listed, the law prevents HCi from paying claims for it.
- The Therapeutic Goods Administration (TGA) must approve your treatment. This ensures the product is legally prescribed and dispensed.
- Without TGA approval, claims cannot be paid by law.
If you have questions or need help with a medicinal cannabis claim, you can
- call us on 1800 804 950
- email enquiries@hciltd.com.au
- chat to us using HCi Chat on our website
HCi – Helping you access safe and evidence-based treatments.
HCi used its best endeavours to ensure this information was accurate at the time of publication. From time to time, circumstances relating to the subject matter may change which may impact the accuracy of the information. This information is also general in nature and does not take into account any specific health or financial situation. Before making any decisions in relation to this information, you should consider your own financial and health situation and seek professional advice. Health Care Insurance Ltd ABN 43 009 579 088. A Registered Private Health Insurer.
