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Claiming

 

Making claims

By Post, Email & Fax

A completed Navy Health claim form must accompany all claims submitted. You can receive payment by direct deposit into a nominated bank account (within Australia and excluding credit cards). Receipts forwarded for benefits will be held by Navy Health on your behalf. Receipts will not be returned to the member.

Electronic Claiming

All you need is your Navy Health membership card to use the electronic claiming system. After a consultation your card can be swiped through the electronic claiming facility by the service provider. They will enter the claim details and process the transaction on your behalf.

Once the transaction has been authorised by Navy Health electronically you simply pay the balance amount. This is the difference between the fee charged for the treatment and the amount paid by Navy Health. Ask your provider if they are connected to an electronic claiming system.

Online Claiming

You can make claims for all extras services (excluding Orthodontic, Ambulance, MPAs and Pharmacy) through Online Member Services

Natural Therapies and Recognised Providers

Natural therapies include Acupuncture, Aromatherapy, Chinese Herbal Medicine, Homeopathy, Myotherapy, Naturopathy, Remedial Massage Therapy, Remedial Therapy, Western Herbal Medicine and Exercise Physiology.

Benefits are only payable for services rendered by a recognised provider in a private practice. Benefits are not payable on any prescribed medications, herbal or dietary preparations, or organised weight reduction programs.

The provider registration process for Natural Therapy services, including the issuing of provider numbers, is managed by the Australian Regional Health Group (ARHG) or Exercise and Sports Science Australia (ESSA) on behalf of Navy Health Limited.

Natural Therapy providers must be eligible members of an association that the ARHG recognises or a member of ESSA for benefits to be payable.

Medically Prescribed Appliances (MPA)

MPA claims must be accompanied by a referral from a registered practitioner. The following are examples of items that can be claimed under the MPA category: Nebulisers*, Humidifiers*, Blood Glucose Monitors*, Heart Rate/Blood Pressure Monitors*, Support Aids/Mobility Aids, Compression Garments, Non-cosmetic Prosthesis (Premium Extras only), and TENS Machine/Circulation Booster*.

The MPA category also covers hire and repairs to appliances that are covered under the category and up to the annual limit.

* Any three (3) year period. The maximum three year replacement period applies to any three year rolling period from the first date of purchase.

Department of Veterans’ Affairs

Gold Card Holders

Members who are, or become Department of Veterans’ Affairs (DVA) Gold Card holders have the option of retaining or cancelling their cover with Navy Health. Where a member chooses to retain their coverage, benefits will be paid on out-of-pocket costs incurred after the DVA payment, however the benefit must not exceed the total charge or the Navy Health benefits and annual limits.

Where a member with a DVA Gold Card has Premium Hospital coverage, Navy Health will pay the supplement (top up) benefit for a private room in a private hospital, as DVA already cover the cost of a shared ward.

Where a member chooses to cancel their coverage, they must advise Navy Health in writing of the issue date. The cover will be cancelled from the date Navy Health receives written notification. The person holding the DVA Gold Card may then re-apply for membership to Navy Health without waiting periods or penalties, as they are deemed to have continuity of cover.

Any person who has previously held a DVA Gold Card is entitled to join Navy Health without serving any waiting periods. Proof of previous DVA Gold Card status is required.

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