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.

General Health Fund Info

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.

First Aid Certificate

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.

Professional Indemnity / Public & Products Liability Insurance

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.

Continuing Professional Education (CPE)

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.

Health Fund Rebates

The only Modalities Health Funds rebate are Acupuncture, Counselling, Chinese Herbal Medicine, Remedial Massage, Myotherapy, Hypnotherapy, Nutrition and Traditional Chinese Remedial Massage (Chinese Massage).

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.

Health Fund Table

PDF: Health Fund Table Feb 2025

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.

Clinic Changes

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.

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

Remedial Massage

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

Nutrition

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.

Acupuncture/Chinese Herbal Medicine

Current AHPRA Registration required with no conditions.

AU, Medibank/ahm Minimum Australian Government Accredited Advanced Diploma.

CBHS Minimum Australian Government Accredited Advanced Diploma

NIB, HCF, BUPA AND ARHG Require Bachelor qualification Health Science Acupuncture or Bachelor qualification Health Science Chinese Medicine as a minimum.

Myotherapy

ARHG Government Accredited Advanced Diploma

NIB Government Accredited Advanced Diploma

CBHS Government Accredited Advanced Diploma

MEDIBANK PRIVATE Government Accredited Advanced Diploma

Chinese Remedial Massage

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). ”

Counselling

Medibank – Diploma in Counselling

Hypnotherapy

Government Accredited Diploma

Hicaps

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 for Acupuncture/Chinese Herbal Medicine:

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

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
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

Health Fund Registration FAQ

How do I register as a provider with health funds through ATMS?

For most health funds, names and details of eligible ATMS members will be sent directly to the fund, and provider numbers will be populated in your member portal. In some cases, you may need to contact the fund directly to register as a provider.

Which health funds ATMS send provider numbers directly to the member portal?

Australian Health Management (AHM)
BUPA
Medibank Private
HCF
NIB (including APIA, AAMI Health Insurance, Qantas Health Insurance, and GU Health)

How do I register with Australian Unity?

You need to contact Australian Unity at 1800 035 360 to register as a provider. Once registered, you will receive your provider number from them.

What do I use as my provider number for CBHS Health Fund Limited?

Use your ATMS member number as your provider number, e.g., ATMS23345.

For Acupuncture and Chinese Herbal Medicine services, use your AHPRA number minus the zeros (e.g., CMR1731686).

What do I use as my provider number for Doctors Health Fund?

Doctors Health Fund uses the ARHG provider list to recognise the provider.

Use your ARHG provider number, which you can obtain from the ARHG provider list.

How do I register with GU Health?

You must contact GU Health directly at 1800 249 966 to register as a provider and receive your provider number.

What is the ARHG provider number and how do I get it?

The ARHG provider number is based on your ATMS member number with additional letters. To calculate your ARHG provider number:

Add AT to the front of your ATMS member number.
If your ATMS number has fewer than five digits, add leading zeros to make it five digits (e.g., 123 becomes 00123).
Add the letter corresponding to your accredited modality at the end of your provider number.
Example: If your ATMS number is 123 and you’re accredited in Acupuncture, your ARHG provider number will be AT00123A.

What should I do if my modality is Remedial Massage under ARHG?

For Remedial Massage under ARHG, use the ‘R’ status for most health funds. Some health funds may prefer the ‘M’ status. Please refer to the health funds table for more details.

What should I do if I have a Diploma in Chinese Remedial Massage?

If you hold a Government Accredited HLT Diploma of Chinese Remedial Massage (HLT50102, HLT50107, or HLT50112), you are required to use the ‘R’ status for Remedial Massage under ARHG.

Are there any special conditions for Remedial Massage?

Yes, special conditions apply for Remedial Massage under the following funds under ARHG:

Defence Health
GMHBA (Including Frank Health Fund)
HBF
AIA Health

What if I am accredited in multiple modalities?

If you are accredited in more than one modality, make sure to use the appropriate letter corresponding to the modality for your provider number (e.g., A for Acupuncture, C for Chinese Herbal Medicine, etc.).

Your Guide to Health Fund Terms and Conditions

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

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

What are the key requirements to remain registered with health funds?

The 4 Pillars to remain current with Health Fund Registration

Maintain ATMS Membership
Maintain current First Aid
Maintain current Professional Indemnity Insurance
(Chinese Medicine practitioners require a minimum of 5 million and Remedial Massage practitioners require a minimum of $2 million)
CPE (continuing professional education) ATMS accept CPE’s completed that enhance clinical practice however Health Funds require CPE to be modality specific)

Do Acupuncture and Chinese Herbal Medicine practitioners need any additional qualifications?

Yes, Acupuncture and Chinese Herbal Medicine practitioners must hold current AHPRA (Australian Health Practitioner Regulation Agency) registration.

Do I need a Working With Children Check (WWC)?

If you are working with minors (under 18 years old), you must hold a current WWC for your practicing state. You must send a copy to ATMS for verification.

What happens if I fail to renew my membership, insurance, or other certifications?

Failure to keep your membership, insurance, first aid, or qualifications up to date will result in removal from the health fund provider list. You may also need to upgrade qualifications to be re-instated with some health funds.

What are the clinical record requirements for 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

Can I submit handwritten receipts for claims?

No. As of April 2021, Medibank/AHM does not accept handwritten receipts. They must be electronic, numbered, and contain the necessary details.

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

Can I treat my family members and claim a health fund rebate?

Health funds do not allow rebates for treatments provided to a practitioner’s family, partner, or business partner.

Can I offer health fund rebates for home visits?

Only a few health funds, including Australian Unity, CBHS, GU Health, and NIB, accept rebates for home visits. Ensure that your receipt includes a stamp or pre-printed note indicating the visit was at home.

Can I offer health fund rebates for online or phone consultations?

No. Health funds do not recognize online or phone consultations for rebates, only face-to-face treatments are eligible.

What are the clinic address requirements for health funds?

You must provide a full clinic address (street number, street name, suburb, state, postcode, phone number, and email). PO Boxes are not acceptable.

*Note Medibank have a limit of 3 clinic addresses for Remedial Massage practitioners and Bupa have a limit of 4 clinic addresses regardless of the modality.

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.

Is it allowed to share my provider number with others?

No. Sharing provider numbers constitutes fraud and is illegal. It may result in police investigation and removal from the ATMS register.

Are gift vouchers accepted for health fund rebates?

Most health funds do not accept gift vouchers for rebates, as the recipient has not paid for the service directly.

What happens if I have overseas qualifications in Acupuncture or Chinese Herbal Medicine?

If you have overseas qualifications, the health fund will require:

A VETASSESS letter verifying the qualification is equivalent to an Australian BA Health Science TCM/Acupuncture.
A Genuine Letter stating the authenticity of the qualification.
IELTS English competency (Band Level 7) is required by Bupa.

How do I register with specific health funds?

Medibank Private, AHM, Bupa, HCF, NIB, and others will automatically add your provider details based on your ATMS membership.
Australian Unity requires you to register directly by contacting their provider services.
For ARHG and other specific funds, follow their detailed registration process for your accredited modality.

Can I use HICAPS for health fund claims?

To use HICAPS, you must register directly with them. HICAPS does not cover all health funds and modalities, so check their website www.hicaps.com.au or call 1800 805 780 for further information.

Can I treat clients in non-traditional settings like markets, hotels, or corporate events?

Health funds do not cover treatments provided in mobile or non-traditional settings like markets or hotels. Only face-to-face treatments in private practice are eligible for rebates.

Are there special conditions for specific health funds?

Yes, certain health funds like Defence Health, GMHBA, HBF, and AIA Health have unique conditions, especially for Remedial Massage providers. Be sure to check the specific requirements for each fund.