When are Benefits not payable?
Benefits are not payable when:
|•||claims are over 2 years from the date of service|
|•||from the date the membership has been cancelled or transferred to another fund|
|•||where the supplier does not have a current ABN|
|•||where an item attracts a GST|
|•||the service performed is not included in your policy|
|•||the condition is deemed to be a pre-existing condition|
|•||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|
|•||during a period of suspension or when membership is in arrears|
Navy Health will not pay benefits on any services, treatments or products received outside of Australia. As a consequence, we strongly advise all members to consider travel insurance when travelling overseas to cover emergency expenses when outside of Australia.
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