HCi Factsheet – Understanding medical eligibility
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Understanding your medical eligibility
1 July 2025
Some medical aids, appliances and medications need a doctor declaration to be eligible for extras cover. For such items, members must provide a medical eligibility declaration before HCi can assess those claims.
Some HCi extras cover includes various medical aids, appliances and medications. However, some of these items require medical eligibility checks as part of the claim assessment – this means eligible claims can only be assessed if we are notified that a suitable medical professional certifies them as necessary for a specific condition.
For your claims to be assessed, you need to provide relevant receipts and a medical eligibility form completed by you and your health care provider. You can download the form at any time and either email it to us or submit it securely via OMS. Once received, we will assess your claim as quickly as possible and let you know if more information is required or your claim is not accepted.
Unfortunately, HCi can no longer accept a doctor’s letter or medical certificate to show eligibility for these claims.
When do I need to use the medical eligibility form?
It is important to check your specific cover and the relevant product summary for details on what you are eligible to claim. If you have appropriate HCi cover and are otherwise eligible (eg have served waiting periods and premiums are current), you will need to provide eligibility certification to claim items such as:
- CPAP machine
- Blood pressure monitor
- Blood glucose monitor*
- Medicinal cannabis
- Nebuliser
- TENS machine
- Non-surgical prostheses
- Compression garments
- Hearing aids
Note that general eligibility terms will apply, such as limits and sublimits, and purchasing only from Australian suppliers.
Using the medical eligibility form
The medical eligibility declaration has two parts. You need to fill in page one with your details and declare your eligibility for the claim. Then ask your doctor or specialist to complete page two to certify you need the item for a specific medical condition.
Both a claim form and the medical eligibility form will be required if you email these to us. Or you can submit the medical eligibility with the relevant receipts as part of making a claim through OMS – easy and secure!
You may need to submit this form each time you claim for these items, even if you have claimed the same item previously. For some items we may hold the declaration on file for up to 12 months – check with us to see if this applies in your situation.
Please contact our friendly HCi team if you have questions or are unsure if the medical eligibility form is required for your specific claim.
* Continuous blood glucose monitoring (known as CGM) systems are specifically excluded from cover – refer to the National Diabetes Services Scheme for possible subsidies and information.
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.
