Benefits

When are Benefits not payable?

Benefits are not payable where:

Claims are over 2 years from the date of service
Claims post-date the date the membership has been cancelled or transferred to another fund
The supplier does not have a current ABN
An item attracts 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 1 year after the date of service, unless approved by Medicare Australia for benefits
services performed, or products used are from outside of Australia
The treatment is cosmetic surgery
The claim is from 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.