Hospital providers

Whether you are a Member Plus, Non-Member Plus or a public hospital, this page will help you navigate any general queries you may have for our members’ admissions.

Hospital query forms

Eligibility queries

Hospitals can check a member’s level of cover to determine if they are eligible to claim for an upcoming procedure.

The type of provider relationship you have with HBF will determine the process you need to follow to check member eligibility.

Member Plus hospital

As one of our Member Plus hospital providers, you have access to the online eligibility checks (OEC) through Eclipse or via an in-house system.

While this can be a simple and easy way to check your patient’s eligibility, we recommend having your OEC manual and code descriptions available to assist you.

Non-Member Plus hospital

To determine a member’s eligibility, as a Non-Member Plus hospital we require the completion of our Non-Member Plus hospital eligibility form.

Once completed, the form can be submitted via email to eligibility@hbf.com.au within 7 calendar days prior to the date of admission.

View our Non-Member Plus hospital eligibility form

Public hospital

To determine if a member is eligible to be admitted as a private patient in a public hospital for a pre-booked admission, we require the completion of our public hospital eligibility form, as well as the signed private patient election form.

Once completed, both documents can be submitted via email to eligibility@hbf.com.au within 7 calendar days prior to the date of admission.

HBF does not provide an eligibility check once a patient has attended hospital (ED).

View our public hospital eligibility form

Medical provider

If you are a medical provider and wish to determine if a member is covered for an upcoming procedure, we recommend you confirm the member's coverage directly with the hospital where the patient is being admitted.

If this is not possible, we can provide an overview of the members cover effective as at the date the information is provided only. To receive an overview of the member's cover we require the completion of the member level of cover verification below.

Once completed, the form can be submitted via email to eligibility@hbf.com.au

View our medical provider eligibility form

Common eligibility FAQs

What does an eligibility check tell me?

An eligibility check can tell you many things including:
  • If treatment is covered or not
  • The members level of cover
  • Any exclusions or restrictions that apply
  • If the policy is financial i.e., premiums have been paid to date
  • How much excess needs to be paid and if any co-payment applies

Who can access the online eligibility checks (OEC)?

All of our Member Plus hospital providers will have access to the OEC for HBF members.

What should I do if I can’t understand what the eligibility check is telling me?

You can contact the eligibility team for assistance. We are available 8am-4pm WST Monday to Friday, excluding public holidays.

If I don’t have access to the OEC, how can I do an eligibility check?

Providers including public hospitals, Non-Member Plus hospitals, and all medical providers can submit a check via email by using the relevant forms as seen above.

Who do I contact if OEC is unavailable?

If you are experiencing a system issue, please contact your IT department first.

If your IT department have confirmed your systems are not working, please contact your contracts manager who will contact HBF’s contract manager to organise an alternative option.

If you do not understand the response the OEC is giving you, then you can contact the eligibility team for assistance. We are available 8am-4pm WST Monday to Friday, excluding public holidays.

Please note: The eligibility team is not able to provide you with a verbal confirmation until a known error has been reported by the contract’s manager to our contract’s manager.

What do the different rejection codes on the OEC mean?

All your rejection codes will be listed as part of your OEC manual. If you do not have a list of these you can find the eclipse manual under our helpful resources.

What should I do if the OEC check shows the member is unfinancial?

You will need to contact the member directly and advise they are unfinancial at the expected treatment date. The member will then need to contact HBF to make a payment before eligibility can be confirmed via an OEC.

Please ask them to contact HBF to speak with one of our member experience consultants on 133 423 as payments made online are not applied instantly to the policy.

Once the member has contacted you to confirm payment has been processed, please complete a new OEC check.

Will the OEC check advise what out of pocket costs the member will have?

The OEC check will only advise any co-payments or excess that is to be paid. It will not advise any other costs from the hospital or medical providers.

Can I get a verbal eligibility check over the phone?

Our eligibility team is unable to provide verbal eligibility checks over the phone except in the event the HBF contract manager has previously approved an exception.

Can a member check their eligibility?

Yes, they can. We encourage members who are having pre-booked treatments to contact our membership team or visit a branch for a quote.

Why do public hospitals have to provide an election form as well as the eligibility form?

We request a signed patient election form completed by the member to confirm they have given their permission to go into a public hospital as a pre-booked private patient. This form needs to be signed and dated within 7 days before admission. No eligibility checks will be given without this consent form.

Where do you send the eligibility forms and how long will it take to get back?

All eligibility checks go to eligibility@hbf.com.au. The eligibility team will return your email provided all details have been provided correctly within 2 business days. 

Helpful resources

Contact details

Our eligibility and hospital team can help you help our members, get in touch here:

Eligibility

(08) 9265 8877 8am-4pm AWST*
eligibility@hbf.com.au

*Monday – Friday – Closed public holidays

Hospital

(08) 9265 8823 8am-4pm AWST*
hosprelations@hbf.com.au

*Monday – Friday – Closed public holidays

Pre-Existing Officer

(08) 9265 8600 8am-4pm AWST*
pre-existing@hbf.com.au

*Monday – Friday – Closed public holidays