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When Do Benefits Cease?

Benefits are not payable on any services rendered subsequent to a member’s last financial paid to date, the date on which a membership is cancelled or when a membership is in suspension.

When Are Benefits Not Payable?

Benefits are not payable when:

  • claims are over 2 years from the date of service;
  • the provider is not recognised in a private practice or for Natural Therapies the provider is not recognised by the Australian Regional Health Group (ARHG) or HICAPS;
  • the service forms any part of a payment from Workers’ Compensation, Third Party or any other liability provision. Navy Health reserves the right to seek full reimbursement on any benefits paid in these circumstances;
  • the procedure does not have an assigned Commonwealth Medical Benefits Schedule item number;
  • the claim is within a specified waiting or replacement period or annual/sub limits have been reached;
  • Access Gap providers submit medical claims 2 years after the date of service, unless approved by Medicare Australia for benefits;
  • services performed, or products from outside of Australia;
  • cosmetic surgery;
  • during a period of suspension or when membership is in arrears.

Overseas Benefits

Navy Health will not pay benefits on any services, treatments or products received outside of Australia. As a consequence, we strongly advise all members consider Navy Health Travel Insurance when travelling overseas to cover emergency expenses when outside of Australia.

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