Benefits

Members

13/07/2018

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
•	cosmetic surgery
•	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.