health insurance claims

Applying for prior approval means you can be confident you’ll be covered before undertaking treatment. We will also arrange to pay your providers directly, subject to any policy excess. 

If you don’t receive prior approval before the procedure then you’ll need to pay the costs yourself and then claim them back by submitting a claim and providing itemised receipts.

• There are some benefits for which prior approval is mandatory.
• There may be costs, treatments or procedures that are not covered, obtaining prior approval ensures you understand what will be covered.

You request prior approval by submitting a claim through the usual process, as described above. You should do this at least five working days before the procedure, and you’ll need to include the following documents:

A referral letter confirming the history of your symptoms or condition, and if treatment is required please also provide all specialist reports and estimate of cost.  

If it’s a claim that ACC has accepted or declined, then a copy of that letter is required. If this information isn’t obtained, then it may delay the assessment of your claim.

If you submit your request online or by email then you can upload a scanned copy or clear photograph of these documents. The maximum file size is 10MB.

Your prior approval is valid for six months from the date it was issued. 

We process and pay any claim refunds as quickly as possible – usually within 3-5 working days. 

To accurately assess your claim we need to know the symptom or condition that required you to contact your doctor. We need to be able to see if these symptoms or conditions are covered under your policy, and that they aren’t related to a pre-existing condition or general policy exclusion. 

The quickest and easiest way to submit a claim is online. Alternatively, you can download and complete a paper claim form and send it to us by email, post or fax. The process for all of these options is described above. You will need to include the following documents:

A referral letter confirming the history of your symptoms or condition, and if treatment is required please also provide all specialist reports and estimate of cost.  If you have a referral letter containing the date of first consultation, history of condition and treatment received, then this can be used instead.

If it’s a claim that ACC has accepted or declined, then a copy of that letter is required. If this information isn’t obtained, then it may delay the assessment of your claim.

Any receipts or invoices. We will reimburse the treatment provider(s) directly unless receipts are received. Reimbursement of receipts are made by direct credit to your bank account.

If you submit your request online or by email then you can upload a scanned copy or clear photograph of these documents. The maximum file size is 10MB.

Simply submit your claim in the usual way and include any invoices or receipts that need to be paid. We will reimburse the treatment provider(s) directly unless receipts are received. Reimbursement of receipts are made by direct credit to your bank account. 

When your invoices have been received, we will pay the providers, less any excess, and confirm this in writing to you. The letter will state who you will need to pay. The treatment provider will usually invoice you for the excess after payment is received from AIA. 

ACC is the primary insurer for any treatment relating to an accident. If ACC declines your claim, please enclose a copy of the letter from ACC with your claim form. If ACC is paying a part of the claim, AIA may be able to top this up. We also need a copy of ACC’s letter outlying their contribution to treatment. 

If your claim is accepted, the payment(s) will be made to you, or your medical provider as directed.  This will be less any excess that may be applicable.

If we are unable to accept your claim we will send you confirmation of why your claim is not payable at this time and you will have the opportunity to provide any further information.