Insurance Claims

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  In most cases a Prior Approval is required before a claim for surgery will be paid. This is to confirm the nature and cost of the treatment in advance.

Fastest way to do this is online but still allow 7 days for PA to be granted

1.Referral letter from GP to Specialist – Note in some cases the Specialist must be an Approved Provider 

2. Specialist Diagnostic report  

3.Estimate of Cost from Private Hospital, Surgeon & Anaesthetist (x3 quotes) 

4.If everything checks out, PA is granted and allows 6 months to complete the surgery 

5.Submit all invoices to the insurer for payment either direct or via adviser. Excess normally paid to hospital and deducted from invoice  

  Single one-off claim payments

1.Notify insurer of death of policy holder – complete claim form and include death notice or similar 

2.Insurer will pay advance Funeral Benefit (circa $20K) normally within a week of notification 

3.Provide insurer with death certificate, verified ID and confirmation of bank account 

4.Claim settlement is paid to beneficiary (Policy Owner or nominated beneficiary)  

  Key Requirements include:-

1.Personal claim form. 

2.Doctors claim form. 

 3.Financial evidence. 

4.Completion of waiting period. 

5.Claim is paid monthly until you are fit to return to work or your claim benefit ends 

6.Adviser and claims manager to advise on supporting policy benefits  

  Single one-off claim payments

1.Personal claim form. 

2.Supporting evidence – medical diagnosis confirming condition and severity. 

3.This is compared against policy wording – if it meets the wording the claim is approved. 

4.Payment typically made within 7 days after acceptance.