How to Claim on Overseas Visitors Health Cover (OVHC) in Australia

Getting medical care while visiting Australia can be stressful, and working out how to claim on your Overseas Visitors Health Cover (OVHC) adds another layer. This guide walks you through a sensible order of steps – from the moment you need treatment to following up on your claim. It does not replace your policy document, but it gives you a clear framework to work with.

OVHC is health insurance taken out by people on temporary visas who aren’t covered by Medicare. It helps with the cost of hospital treatment, doctors’ services, ambulance and some medicines. Each insurer runs its own claims process, so the details will differ, but the general sequence is remarkably consistent.

Before you claim: check what your policy actually covers

The single most useful thing you can do is look at your policy before you need to lodge a claim. Most OVHC policies give you cover for in-hospital treatment, out-of-hospital medical services (such as GP visits and blood tests), and emergency ambulance. Some go further and include a limited benefit for prescription medicines, but the amounts and rules vary.

Check your waiting periods too. Australian law allows insurers to apply up to 12 months for pregnancy and pre-existing conditions, and two months for psychiatric, rehabilitation or palliative care even when the condition existed before you joined. If you’ve held cover with another Australian health fund before switching, your new insurer generally has to recognise the time you’ve already served, which can shorten those waits.

A quick review now can save you from the frustration of lodging a claim that can’t be paid.

Step 1 – collect the right paperwork at the time of treatment

Good claims start with good records. Keep or request:

• The invoice or account from the doctor, specialist or hospital.
• A copy of the referral letter if you saw a specialist.
• The pharmacy receipt showing the medication name, price and date (if your policy includes pharmacy benefits).
• The ambulance invoice if you used one.
• Your membership number and personal details, exactly as they appear on your policy.

If you were admitted to hospital, ask for a detailed discharge summary or an itemised hospital account that describes the services and the MBS item numbers where applicable.

Step 2 – submit the claim as soon as you can

Every insurer has a preferred way to receive claims: through a mobile app, an online member portal, by email, or sometimes by post. Don’t guess – check your insurer’s website or the back of your membership card for the exact method.

Most will ask you to fill in a standard claim form and attach clear photos or scans of your receipts. When you log your claim matters: some policies have time limits for telling them about an episode, and lodging early helps avoid missing a deadline.

Step 3 – track what you’ve sent and follow up

After you submit a claim, you should get an acknowledgement – often a reference number. Keep that number somewhere safe. If you haven’t heard back within one business week, a polite follow-up is reasonable.

When the insurer processes the claim, they usually send you an explanation: how much was claimed, what benefit they paid, and whether there’ll be a gap you need to cover yourself. Some funds pay the benefit directly to the hospital or doctor if you’ve assigned the benefit to them; otherwise the money comes to you.

What to do if a claim is partly or fully declined

A claim may be reduced or declined for a few common reasons: the treatment was excluded from your cover, you hadn’t finished a waiting period, or you were in arrears on your premium. If you don’t understand the reason, ask the insurer for a plain-English explanation.

If you think the decision is wrong, you have a right to complain. Start with the insurer’s internal complaints process – their contact details must be on their website. If you’re still not satisfied, you can take the matter to the Australian Financial Complaints Authority (AFCA). AFCA provides free, independent dispute resolution and can be accessed by anyone with a complaint about an Australian financial services provider.

A few practical details that often trip people up:

• Public hospitals may charge an emergency department facility fee that your OVHC may or may not cover in full.
• If you have a Reciprocal Health Care Agreement from the UK, Sweden, the Netherlands, Belgium, Slovenia, Italy or New Zealand, you might also be able to access Medicare for some episodes – but that doesn’t change how your OVHC claim works.
• Your insurer cannot legally include a buy-out clause that swaps ongoing cover for a one-off lump sum.

We can help you find your way if you’re unsure which insurer holds your OVHC or you need a pointer to the right contact page. If you’d like someone to call you back to discuss your OVHC options, leave your details and phone number through our enquiry form. We’ll pass your details on to a partner who can support your OVHC application and we aim to get back to you within one business day.

Next step: If you need to locate your insurer’s claims portal or want to check what’s included before you lodge, get in touch through OVHC.net.au and we’ll help get you pointed in the right direction.