Online Members Services

1800 291 029

RACQ Health Insurance

Member Number*

Password*

Forgotten password

* required fields

APPLICANTS DETAILS Details about what you have to do.
CONTACT DETAILS Phone number and address details
PEOPLE COVERED Details of people covered by the policy
REBATE TIER Applicants should nominate a rebate tier based on their estimated income
CLAIMANT’S DECLARATION Indicate you have read and understood the declarations

AUSTRALIAN GOVERNMENT REBATE

Application to receive the Australian Government Rebate on Private Health Insurance as a reduced premium

All the people listed on the policy must be eligible to claim Medicare for you to receive the rebate as a reduced premium.

If at any stage you wish to nominate a new income tier or stop receiving the Australian Government Rebate as a reduced premium, you must notify your health fund as soon as possible.

Are you covered by this policy?

YesNo

(If No) Applicants not covered by the policy cannot claim the Australian Government Rebate on Private Health Insurance (excluding child only policies) and employers and trustees of organisations cannot claim the Australian Government Rebate on Private Health Insurance on policies paid on behalf of employees.

Name of private health fund

Health Fund Membership Number

Your full name as it appears on your Medicare card (required)

Family Name (required)

First Name (required)

Date of Birth - dd/mm/yyyyy (required)

Gender (required)

Male Female

Your Medicare Card Details Number (required)

Valid To (required)

Please enter dd/mm/yyyy (interim and reciprocal cards) or mm/yyyy for permanent residents

Permanent address

Line 1 (required)

Line 2

Suburb (required)

State (required)

Postcode (required)

Daytime Phone Number (required)

Postal address (if different to above)

Same as home

Yes

Provide details of all people covered by the policy (do not include yourself).

Family Name (required)

Given Name(s) (required)

Date of birth (required)

Gender (required)

Male

Female

Dependent child (required)

Yes

Family Name (required)

Given Name(s) (required)

Date of birth (required)

Gender (required)

Male

Female

Dependent child (required)

Yes

Family Name (required)

Given Name(s) (required)

Date of birth (required)

Gender (required)

Male

Female

Dependent child (required)

Yes

Family Name (required)

Given Name(s) (required)

Date of birth (required)

Gender (required)

Male

Female

Dependent child (required)

Yes

Family Name (required)

Given Name(s) (required)

Date of birth (required)

Gender (required)

Male

Female

Dependent child (required)

Yes

All people listed on the policy must be eligible to claim Medicare for you to receive the rebate as a reduced premium. If you are unsure whether you are eligible for Medicare, go to https://www.humanservices.gov.au/customer/services/medicare/medicare-card for more information.

Are all the people on the policy listed on a Medicare card or entitled to a Medicare Card?*

YesNo

For more information

For more information about the Australian Government Rebate on Private Health Insurance, go to privatehealth.gov.au Questions about Medicare eligibility can be made at any Human Services’ Service Centre or by calling 132 011.

Note: Call charges apply – calls from mobile phones may be charged at a higher rate.

Applicants must nominate a rebate tier based on their estimated income for the financial year from the rebate tier below.

Tier	Single	Family
Base Tier
Tier 1
Tier 2
Tier 3

Date premium reduction to commence

Privacy Notice

Your personal information is protected by law (including the Privacy Act 1988) and is collected by the Australian Government Department of Human Services for the assessment and administration of payments and services. This information is required to process your application or claim.

Your information may be used by the department, or given to other parties where you have agreed to that, or where it is required or authorised by law (including for the purpose of research or conducting investigations).

You can get more information about the way in which the department will manage your personal information, including their privacy policy, at www.humanservices.gov.au/privacy

Claimant’s declaration

I declare that:

the information I have provided in this form is complete and correct.

I understand that:

giving false or misleading information is a serious offence.

Please check this box to indicate you have read and understood the declarations.

Date of Declaration

Cancel your rebate application?

Submit Form

A summary of your health plan is displayed below. If you would like to change your level of cover, please contact the RACQ member services team on 1800 291 029

Health Insurance Member Number

Member Name

Join Date

Current Cover start date

Paid to Date

Hospital Tier

Health Product

Health Coverage

Other Product

Other Coverage

Benefit Payment Method

Last Claim

View Claims History

Terms of use
RACQ Privacy policy
MO Health Privacy policy
AIA Australia Privacy policy

RACQ Health Insurance is issued by MO Health Pty Ltd ABN 32 611 323 034, a registered private health insurer, trading as RACQ Health Insurance, for which RACQ Operations Pty Ltd ABN 80 009 663 414 receives commission. RACQ Health Insurance lets you claim 100% back on optical up to annual limit from any recognised provider, after a six month waiting period. RACQ Health Insurance pays up to 70% back on all claims from recognised practitioners up to annual limits, waiting periods apply. Conditions, limits and exclusions apply. Please see the Product Fact Sheet for further details or contact us for a copy.

AIA Vitality partners, benefits and rewards are subject to change at any time. For the most up-to date information and to view the AIA Vitality Terms and Conditions see aiavitality.com.au. Partner terms and conditions may also apply.