Benefits
Benefits
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.