Private health fund rebates for counsellors: HICAPS vs client self-claim

The registration bar

Clinical Registration specifically, not just membership

For counsellors, health fund recognition generally means PACFA or ACA Clinical Registration specifically — a higher bar than standard membership, and one each fund sets for itself rather than a shared industry standard. As at October 2026, PACFA holds direct agreements with Medibank, AHM, Bupa and HCF, plus the ARHG group — an umbrella covering around 16 smaller funds including GMHBA, Westfund, HBF, Teachers Health, Phoenix Health, Defence Health, Police Health and Nurses & Midwives Health. That's not every major fund (nib, for example, isn't part of either list), and fund participation changes — PACFA's own private health funds page is the current source of truth, not this page or any other secondhand list.

Two claiming models

HICAPS on-the-spot, or client self-claim

A worked example

What the rebate actually looks like on a $150 session

Rebate amounts and annual limits are set individually by each fund and each policy tier, so there's no single industry-standard figure — but the shape of it is consistent. Take a $150 session with a client on an extras policy that covers counselling:

The specifics vary widely by insurer: Bupa's Super Extras Active cover, for example, pays up to 60% of the session fee toward counselling, capped at a $300 annual limit for that benefit — once a client has claimed $300 in a policy year, further sessions aren't rebated until the next year starts, regardless of how many sessions remain. Medibank and HCF both pay a benefit for counselling under their respective "Mental health" extras categories, again subject to the client's specific policy and annual limit. None of these numbers are fixed industry-wide — a client should check their own policy's extras schedule, specifically for "counselling" or "mental health" cover, rather than assume what a friend's fund pays also applies to them.

Getting set up

What you need on file before a client can claim

Clients can't claim a health-fund rebate on an invoice that's missing the right detail, and funds vary slightly on exactly what they want to see — but at minimum an invoice generally needs your full name, your registration body and membership/registration number, the item or service description, the session date, and your provider number if the fund requires one for recognition. Before taking on health-fund clients at all, it's worth confirming two things up front: that your Clinical Registration (not just standard membership) is current with your association, and that you're actually listed in the specific fund's recognised-provider records where that applies — being Clinically Registered with PACFA or ACA doesn't automatically mean every individual fund has you on file, so check rather than assume.

If a client asks whether you're "on HICAPS," that's really two separate questions: whether you have a HICAPS merchant facility at all, and whether you hold a provider number with their specific fund — both are needed for on-the-spot claiming, and either one missing means the client falls back to the self-claim path instead.