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Everything you need to know about claiming

Depending on the claim being made, there are different ways to claim.

Prior approval

If you don't receive prior approval before the surgery/procedure you'll need to pay the full costs yourself and then claim them back by completing a claim form and submitting original itemised receipts.

You must contact us for prior approval if the cost of your healthcare service is likely to be over $1,000 or if you need to be hospitalised - including day stay or in-patient surgery regardless of the cost. You should do this at least 5 working days before the healthcare service being provided. After your healthcare service, send us your completed claim form along with all the invoices.

More information about prior approval

Affiliated Providers

Affiliated Providers include surgeons, specialists and facilities who provide certain procedures at agreed prices, and who streamline the prior approval and claims processes for members. Ask to be referred to a Southern Cross Affiliated Provider whenever possible.

Search for a Provider in your area

How to claim for surgery

If your procedure was performed by an Affiliated Provider, then you don't need to submit a claim, the Provider will do this for you.

If the procedure is not done through an Affiliated Provider, send us your completed claim form along with all the invoices for your surgery.

To speed up your claim refund, make sure you give us your bank account number so we can credit your account straight away.

Download a blank claim form

Other claim forms

Download a hospital cash allowance form

Download a funeral allowance claim form

Easy electronic claiming with your member card

Now at selected pharmacies, branches of OPSM, Lumino The Dentists, Bay Audiology, and Active Physio, you can use your member card to claim for eligible healthcare services at the time of purchase, without completing a claim form.

More information about Easy-claim

Low claims reward

Find out about our low claims reward