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Coverage

 

Exclusions

No benefits are payable by Navy Health for cosmetic surgery or where Medicare doesn’t pay a benefit. 

Waiting Periods

Waiting periods for extras items are detailed on the website and in the health cover brochure and need to be read carefully in conjunction with the conditions of the selected cover.

Hospital benefits are payable after two months of membership on the selected level of cover, excluding pre-existing conditions.

Maternity (or admissions related to the management of) and IVF procedures attract a 12 month waiting period at the selected level of cover.

If you transfer to a higher level of cover new waiting periods will be applied, however benefits at the previous level will still be available whilst the new waiting periods are being served.

Transfers between or from products containing a lesser level or predetermined excess will result in additional waiting periods being applied. Any excess applicable to a higher excess product from which a member is transferring will continue to be applied for a period of up to 12 months after transfer. Dependants are required to complete waiting periods of the same length as members.

Pre-existing Conditions*

The pre-existing condition waiting period provides protection for existing members against people joining or upgrading cover only when they require treatment. This assists Navy Health in keeping premiums as low as possible. Claims and benefits within the first 12 months of joining the insurer or increasing to a higher level of cover are subject to the pre-existing condition rule.

A pre-existing condition is where signs or symptoms of an ailment, illness or condition, in the opinion of a medical practitioner appointed by Navy Health existed at any time during the six months preceding the day on which you joined the insurer or transferred to a higher benefit cover. This is irrespective of whether your medical practitioner, you and/or your dependants were aware of the condition or ailment.

The pre-existing condition rule also applies when resuming a suspended membership and symptoms or signs developed during the suspension period.

* Excludes Psychiatric, Rehabilitation & Palliative care.

Transfer from other insurers

There are no qualifying periods if you are accepted for membership after transferring a current membership from another Australian Registered Private Health Insurer and had an equivalent level of cover, and completed all waiting periods.

Normal waiting periods will apply to those aspects of Navy Health cover not covered previously by your previous insurer, and for those items specifically nominated within the products as requiring extended waiting periods.

Navy Health will not pay immediate benefits at a higher level than those provided by the previous insurer. Navy Health annual limits will be reduced by the amount of benefit already paid by the previous insurer for similar services in the current benefit year of transfer. The Clearance Certificate Application may assist you with your transfer to Navy Health.

Hospital Excess

The excess applies to the cost of in-patient hospitalisation in either a private, public or day hospital facility. The member excess is payable per membership and is deducted from the first or subsequent claims for hospitalisations.

For singles, the excess is only payable once in any rolling 12 month period (once the excess is paid in full). From the day you go into hospital, Navy Health will not charge another excess for a minimum of 12 months, or a partial excess amount if you have not yet paid a full excess amount for that 12 month period.

For families, the excess is payable per admission up to the family maximum of 2 admissions, in any rolling 12 month period.

Note: Reducing your excess is considered to be “upgrading” your membership.

Online Member Services

Navy Health members can use Online Member Services to view details of their membership, claims history, update contact details, change coverage, etc.

Preferred Optical Providers

If a member uses one of Navy Health’s Preferred Optical Providers, they can receive an additional benefit (subject to the annual maximum). Follow the link to view the list of Preferred Optical Providers . The Preferred Optical Provider list is subject to change without notice. 

Prosthetic Appliances

Prosthesis appliances or devices surgically implanted during a hospital stay are subject to two benefit types, either ‘no gap’ or ‘gap permitted’. These items are listed on the Commonwealth Prosthesis Schedule .

When a ‘gap permitted’ benefit applies the insurer will pay the recommended minimum benefit as shown on the Schedule. The Schedule will have at least one no gap prosthesis or device item for every in hospital procedure on the Medical Benefit Schedule (MBS) for which the insurer provides cover.

No benefit is payable where the hospital charges for a prosthetic appliance or device not listed on the Schedule.

Podiatry surgery

Limited benefits are available when Podiatric Surgery is performed in a contracted hospital by an Australian Government Accredited Podiatrist. For further information, please call Navy Health Member Services on 1300 306 289.

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