When are Benefits not payable?
Benefits are not payable when:
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claims are over 2 years from the date of service |
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from the date the membership has been cancelled or transferred to another fund |
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where the supplier does not have a current ABN |
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where an item attracts a GST |
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the service performed is not included in your policy |
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the condition is deemed to be a pre-existing condition |
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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 |
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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 |
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the procedure does not have an assigned Commonwealth Medical Benefits Schedule item number |
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the claim is within a specified waiting or replacement period or annual/sub limits have been reached |
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Access Gap providers submit medical claims 2 years after the date of service, unless approved by Medicare Australia for benefits |
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services performed, or products from outside of Australia |
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cosmetic surgery |
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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 to consider travel insurance when travelling overseas to cover emergency expenses when outside of Australia.
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