Health Funds
Health Funds Overview
Practitioners and Health Funds
ATMS is a ‘professional organisation’ within the meaning of section 10 of the Private Health Insurance Accreditation Rules 2011. This potentially allows ATMS accredited members to be recognised as approved providers by the various private health funds. Approved health fund provider status is, however, subject to each individual health fund’s eligibility requirements.
Association membership does not guarantee health fund provider status. Health funds maintain their own requirements for provider status. Health funds do not recognise qualifications delivered substantially online, by distance, through correspondence or externally. They also do not recognise overseas qualifications.
The only Modalities Health Funds rebate are Acupuncture, Chinese Herbal Medicine, Remedial Massage and Nutrition.
Health Funds require a full street address, no PO BOXES as clinic addresses.
Phone number and Email address are also required.
Medibank/AHM only accept electronic receipts.
Accredited members who wish to have health funds provider status are required to have a current Senior First Aid certificate. A copy of the Certificate must be sent with the application form.
First Aid needs to be renewed every 3 years. The course is officially called Provide First Aid HLTAID011. Please renew it in advance and email it through to info@atms.com.au approx. 2 weeks prior to the expiry date to maintain continuity of health fund registration.
https://www.gsaib.com.au/associations/australian-traditional-medicine-society-ltd-atms
ATMS have partnered exclusively with GSA Insurance Brokers to tailor a policy for your unique business needs with:
- 15 months for the price of 12 in your first year
- Excellent Insurer security with ProRisk
- Quick and simple online policy application
- Access to 1 hour free legal advice per policy period – Australia wide
- Low $250 excess to apply for all PI and PPL claims
- Regular educational webinars
- Cover for a broader list of modalities
- Award winning claims service
- Employee Fidelity Cover1
- Statutory Liability Cover2
- 84 months free automatic run off cover3
- New ATMS Enquiries Phone Number for GSA: (02) 8274 8199
GSA Insurance email ATMS a weekly list of members who have purchased or renewed their insurance policy. Members are still required to email ATMS a copy of your insurance policy for auditing purposes.
Members may need to upgrade their qualification if there is a 4 week gap or more in insurance, first aid, membership, or non-compliance in your CPE if you hold an older qualification.
The requirements for health fund registration do change and may have changed from the time you registered so you may need to meet them under their current educational standard.
Minimum amount of professional indemnity insurance for Remedial Massage therapists to hold is $2million.
Minimum amount of professional indemnity insurance for Chinese Medicine Practitioners to hold is $5million.
Practitioners, please renew your insurance and first aid in advance and email it email it to ATMS on info@atms.com.au to maintain continuity with the health funds.
All Accredited members must fully participate in the ATMS Continuing Professional Education Program and maintain evidence of their Continuing Professional Education activities.
CPE is not only required as an ATMS Accredited Member, but it is also required for Health Funds. Health Funds only accept CPE that is relevant to the modality you are registered for. For e.g., if you are registered for Remedial Massage and you do a webinar/seminar on Nutrition, it cannot be counted toward your CPE for Health Fund. You can use it towards your ATMS CPE, not towards Health Fund CPE as what Health Funds and ATMS accept are different.
The only Modalities Health Funds rebate are Acupuncture, Chinese Herbal Medicine, Remedial Massage and Nutrition.
A full list of health funds which rebate on specific modalities can be viewed below. Updated information on health funds changes is also published in both the Journal of the Australian Traditional-Medicine Society as well as on the ATMS website.
PDF: Health Fund Table Mar 2024
For health funds to rebate on the services of Accredited members, it is important that a proper invoice be issued to patients. The information which must be included on an invoice is also listed on the ATMS website. It is ATMS policy that only Accredited members issue their own invoice. An Accredited member must never allow another practitioner, student or staff member to use their provider details, as this constitutes health fund fraud. Misrepresenting the service(s) provided on the invoice also constitutes health fund fraud. Health fund fraud is a criminal offence which may involve a police investigation and expulsion from the ATMS Register of Members.
Please email ATMS directly for any clinic changes on info@atms.com.au
Allow approx. 6 weeks for all funds to receive and update their information with your clinic changes and also to get back to ATMS with provider numbers.
Please be advised that Medibank Remedial Massage have a minimum of 3 clinic addresses.
Bupa have a limit of 4 clinic addresses regardless of the modality.
If you are registered for GMHBA/Frank Health, you will need to email them directly on registration@gmhba.com.au for any clinic changes.
What is a Health Fund?
In Australia, a health fund, also known as a private health insurance fund or health insurance provider, is an organisation that offers private health insurance policies to individuals and families. These policies provide coverage for a wide range of healthcare services, including hospital treatments, medical consultations, and some ancillary services like dental care, optical care, allied health services and natural medicine treatments.
Health funds in Australia are regulated by the government to ensure they meet certain standards and provide value to policyholders. People can choose from a variety of health insurance policies offered by different funds based on their needs and preferences. The government also provides incentives, such as the Medicare Levy Surcharge and the Private Health Insurance Rebate, to encourage individuals to take out private health insurance.
Regarding natural medicine practitioners and rebates, private health insurance policies in Australia often provide coverage for certain complementary and alternative therapies, including services provided by natural medicine practitioners.
These services may include:
- Acupuncture: Acupuncture involves the insertion of thin needles into specific points on the body to stimulate energy flow and promote healing.
- Chinese Herbal Medicine: Chinese Herbal Medicine is a traditional therapeutic approach that has been used for centuries in Chinese culture and medicine. Practitioners of Chinese Herbal Medicine utilise a wide range of natural herbs, roots, minerals, and animal products to create herbal formulations tailored to individual health needs.
- Nutrition: Nutrition is the science of how the body utilises food and nutrients for growth, maintenance, and overall health.
- Remedial Massage: Remedial massage therapists use various techniques to alleviate musculoskeletal issues and promote relaxation.
If you have private health insurance that covers these services, you may be eligible for rebates or benefits when you visit natural medicine practitioners. The rebate amount and specific conditions can vary between health funds and policies, so it’s essential to check your policy details and contact your health fund directly to understand how much you can claim for each visit.
It’s also worth noting that the government regulates health funds and sets guidelines for which natural medicine services are eligible for rebates. Practitioners often need to meet specific qualifications and be registered with relevant professional bodies to be eligible for coverage under private health insurance policies.
Keep in mind that private health insurance can be complex, and policies vary widely, so it’s essential to carefully review the terms and conditions of your policy and consult with your health fund to understand your coverage and potential rebates for natural medicine services.
Health Funds We Cover
A full list of all the health funds and what modalities they recognise is below.
- View the Health Fund Table here
PDF: Download Table
- Health Funds News Info
PDF: Download Info Table
Educational Requirements For Health Fund
MEDIBANK/ahm, BUPA, HCF, ARHG, AUST UNITY, NIB/GU HEALTH
New applications all require a minimum of a Government Accredited Diploma Remedial Massage HLT 50307/52015/52021.
Further to the above, Medibank/AHM, HCF and ARHG require the Diploma to be:
- 12 months full time (or academic year) or 18 months part time.
- No overseas qualifications
- 50% of the course delivery must be done on campus face to face.
Medibank/ahm require 20% of the total course hours to be on campus and supervised clinic.
HCF and ARHG require 200 hours to be completed as on campus and supervised clinic.
A letter from your college with the start and end date and all the above stated and declared with total course hours and, the number of clinical hours is required.
CBHS require a minimum of a Certificate IV Massage
MEDIBANK/ahm, NIB/GU HEALTH and Australian Unity all require a minimum of a Government Accredited Advanced Diploma.
ARHG (HBF, QLD Country, Pheonix Health, West fund, Health Partners and Mildura District Hospital Fund) require a minimum Bachelor qualification Health Science Nutrition with a minimum of 200 hours of on campus supervised clinical practice.
Current AHPRA Registration required with no conditions.
Medibank/ahm Minimum Australian Government Accredited Advanced Diploma
NIB Minimum Australian Government Accredited Advanced Diploma
CBHS Minimum Australian Government Accredited Advanced Diploma
HCF, BUPA AND ARHG Require Bachelor qualification Health Science Acupuncture or Bachelor qualification Health Science Chinese Medicine as a minimum.
ARHG Government Accredited Advanced Diploma
NIB Government Accredited Advanced Diploma
CBHS Government Accredited Advanced Diploma
MEDIBANK PRIVATE Government Accredited Advanced Diploma
ARHG recognise Chinese Remedial Massage as Remedial Massage.
If members hold an Australian Government Accredited HLT Diploma Chinese Medicine Remedial Massage, then they are classified under the R status using AT the member number then R as their provider number.
Medibank and Bupa recognise Chinese Remedial Massage, members must hold an Australian Government Accredited HLT Diploma qualification.
As per ARHG:
“ARHG do not recognise Chinese Remedial Massage as a modality in its own right and therefore do not list Chinese Massage or Oriental Massage.
We do however, recognise one of the Chinese massage qualifications for recognition to be registered with ARHG for Remedial Therapy (REM) which is the Diploma of Traditional Chinese Medicine Remedial Massage (An Mo Tui Na). ”
Members that are registered as an Acupuncturist or Remedial Massage Therapist and hold a Medibank Private provider number are eligible to apply for HICAPS registration.
Ph: 1300 650 852
You will need to supply them with proof of your ATMS membership and a copy of the Medibank letter you received from ATMS with your Medibank provider number stated for HICAPS registration.
Overseas qualifications will need the below documents from VETASSES:
- http://www.vetassess.com.au/
- An equivalency letter to state your qualification is equivalent to the Australian Bachelor of Chinese Medicine (Acupuncture)
- A genuine letter to state your qualification is genuine.
BUPA will require the below if your qualification was studied overseas in a language other than English.
- IELTS Level 7 in English (only Bupa require the level 7 in English competency)
Health Funds Eligibility
ATMS Accredited Modalities & Health Fund Requirements
ATMS is a ‘professional organisation’ within the meaning of section 10 of the Private Health Insurance Accreditation Rules 2011. This potentially allows ATMS accredited members to be recognised as approved providers by the various private health funds. Approved health fund provider status is, however, subject to each individual health fund’s requirements. Consequently, membership of ATMS does not automatically guarantee provider status with all health funds.
The only Modalities Health Funds currently recognise are Acupuncture, Chinese Herbal Medicine, Remedial Massage and Nutrition. Not every health fund covers every one of these.
To be eligible for health fund provider status, an Accredited Member of ATMS must:
- Fill out the Health Fund Application & Declaration Form
PDF: Click Here - Be in private practice.
- ATMS and the Health Funds define Private Practice as ‘Independent private practice means a professional practice (whether sole, partnership or group) that is self-supporting. This means that its accommodation, facilities and services are not provided or subsidised by another party such as a public hospital or publicly funded facility.
- Have current Provide First Aid on file with ATMS at all times.
- Have current Professional Indemnity Insurance on file with ATMS at all times
- Comply with the ATMS Continuing Professional Education (CPE) Policy
- Have a clinic address (mobile services must have an invoice address and Full street address, no PO Box addresses are accepted)
- Hold accreditation with ATMS in the relevant modality.
- Meet the health fund provider status requirements for that modality, which may differ between funds.
The eligibility requirements are explained below. It is the responsibility of the member to provide the required information in order for ATMS to assess the members’ eligibility. ATMS reserves the right to request additional documentation as required in order to assess your eligibility for health fund provider status.
If you have existing provider numbers, please provide each provider number against each clinic and modality. ATMS will then verify with the health funds that these provider numbers are still valid.
Lapsed membership, insurance or first aid or non-compliance with continuing education requirements, will result in a member being removed from the health funds list. As health funds change their provider eligibility requirements from time to time, upgrading qualifications may be necessary to be re-instated with some health funds.
Please be aware that whilst a health fund may indicate that they provide a rebate for specific modalities, this rebate may only be claimable if the client has the appropriate level of health cover with that fund and has not exceeded any limits on how much they are eligible to claim back over a certain period of time. Rebates are only claimable for the consultation (not the medicines or remedies); however this does not extend to mobile work including markets, corporate or hotels or online or phone consultations. Home visits however are eligible for rebates.
All practitioners looking to gain health fund provider status must be familiar with the terms and conditions of provider status with all of the health funds. Being a Provider implies acceptance of the Terms and Conditions for the health funds
FAQ
As a member you now have the ability to log in to the Member Portal and update your information. You can add, edit and delete your residential address, clinic addresses, phone numbers, email and website addresses. Please make sure that if you change email addresses you then check your spam and make sure you update your system to allow emails from ATMS as spam filters are becoming more effective.
You can still email the address changes to the office at info@atms.com.au. Please allow up to 5 days for the changes to be updated to your profile and also be aware that clinic address changes will be updated on either a fortnightly or monthly basis to the relevant 43 health funds.
Health Funds request clinical records to be kept in English for Health Fund auditing purposes.
Be sure to keep adequate clinical records for auditing purposes. Please include the below:
- Client Name
- Date of Birth
- Contact Details
- Emergency contacts
- Full case history on first consultation
- Date of Treatments/consultation on each visit
- Nature of illness/injury/treatment or area of the body treated (acupuncture points, areas of the body massaged)
- Treatment Plan
- Details of referrals if given
- Any advice or instruction given
- Treatment time
- Outcome of previous Treatment
- Provider’s signature, initials or electronic signature
Medibank/ahm only accept electronic receipts.
The below MUST be on a receipt stamped or pre-printed on the receipt:
- Practitioner Name
- Clinic address and clinic phone number
- ABN number
- Invoices need to be numbered.
- ATMS Member
- Provider Number
The below can be handwritten and MUST be stated on the receipt:
- Date of Service
- Consultation Type Initial or Subsequent
- Amount Paid
- GST Amount if you are registered for GST
- Client Name
- Your Signature (electronic signature for electronic receipts)
You can only give a receipt for health fund rebate for one modality per day for e.g., if you are an acupuncturist registration for both acupuncture and remedial massage and your client sees you for both you can only give a health fund rebate for one of those modalities.
Duplicate Receipts: If a client loses their receipt and asks you for another, please state DUPLICATE or COPY on the receipt.
Scolina Services sell receipt books with the ATMS logo and stamps should you request them. https://www.scolina.com.au/ Ph 02 4311 6044
View a sample receipt here
PDF: Receipt-Sample-1
When you become a provider for a health fund you are agreeing to abide by their terms and conditions. For the convenience of our members, we have listed those below:
Medibank
- Recognition Criteria for other ancillary health care providers
Click Here - Recognition Criteria for AHPRA registered ancillary health care providers (Acupuncturists)
Click Here - Ancillary Billing Standards
Click Here - Patient Record Standards
Click Here
HCF
- HCF Ancillary Click Here
- Terms and Conditions Click Here
- De-Registration Policy Click Here
- Terms and Conditions for Recognised Providers of Extras Services July 2022
Click Here
NIB
- Terms and Conditions
Click Here - Acupuncture nib provider recognition criteria
Click Here - Chinese Herbal Medicine nib provider recognition criteria
Click Here - Myotherapy nib provider recognition criteria
Click Here - Nutrition nib provider recognition criteria
Click Here - Remedial Massage Therapy nib provider recognition criteria
Click Here - Traditional Chinese Medicine Massage Tui Na nib provider recognition criteria
Click Here
Bupa
- Terms and Conditions
Click Here - De-Registration Policy
Click Here
HBF
- Terms and Conditions
Click Here - Collection Statement: Providers / Health Practitioners
Click Here
Australian Unity
- Health Ancillary Provider Terms and Conditions
Click Here - De-registration Policy
Click Here