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 consider Navy Health Travel Insurance when travelling overseas to cover emergency expenses when outside of Australia.
Was this article helpful?
Stay on-top of your wellbeing with the latest promotions, news, tips and expert advice on how to get the most out of your private health insurance.
Get the latest sent directly to your inbox.