Member Benefits
Learn more about the range of benefits available to AIA Health Insurance members.
We’re here to help protect your family, your lifestyle and your future.
For Individuals
For Business
Helps protect your loved ones if you are diagnosed with a terminal illness or pass away.
A lump sum benefit if you can’t work due to injury or illness
Helps ease the financial burden should you suffer a traumatic event.
Can provide you with a monthly income if you become disabled due to injury or illness.
Plan for a more comfortable tomorrow.
AIA Vitality is a personalised, science-backed health and wellbeing program that supports you every day to make healthier lifestyle choices.
The AIA Vitality Content Hub is your go to for science-backed, health and wellbeing inspiration and advice.
We strive to assist you for all your inquiries with high touch customer service.
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{{label}}We understand that when you need to make a claim it may be a difficult time for you or your loved ones. We know you want the process to be as fast, easy and transparent as possible.
Our priority is to support you through the process, ensuring that you understand what’s happening every step of the way and that you get what you need as soon as possible.
Call us
1800 333 004
Between 8am and 6pm (AEST) Monday to Friday.
Or follow the steps below for health insurance extras, hospital and medical claims.
For life insurance, income protection, total and permanent disablement or crisis recovery claims, please contact us via the dedicated phone number listed in the ‘Life Insurance Claims’ section above.
Health insurance extras claims
As a health insurance member you can claim by using one of the methods listed below:
AIA Health Insurance
Att: Health Insurance Claims
PO Box 7302
Melbourne VIC 3004
Our health insurance claim form is available here. A copy of your paid invoice is required to process your claim.
Hospital claims
Hospital treatments included in your policy are covered in all agreed private hospitals and/or day facilities with AIA Health.
In most instances your hospital will ask you to complete a claim form on admission, which they’ll send to AIA Health directly. The only upfront cost will be your excess that applies to your cover, this is paid on the day of your hospital admission to the hospital.
For full details about your cover, please refer to your Product Fact Sheet by logging onto your Online Member Portal.
Medical claims
You can claim medical costs charged by specialists involved in your hospital treatment, like surgeons and anaesthetists.
Your medical benefits vary dependent on whether your specialist participates in the Access Gap Cover. If your specialists participate in the Access Gap Cover, it will help you to reduce or remove out of pocket costs related to your procedure.
Doctors can choose to opt in and out of the Access Gap Cover on a patient-by-patient basis, so it’s important to ask them upfront.
Participating Doctors
If your doctor has agreed to participate in the Access Gap Cover, following the medical procedure, they will send your bill to Medicare and AIA Health for payment. Once this has been processed, if there are any remaining costs, this is considered as your out-of-pocket expense. Before you receive any treatment, please consult with your doctor on how much your treatment would cost, including any extra money you may have to pay out of your own pocket.
Non- Participating Doctors
If your doctor doesn’t participate in any level of gap cover, you’ll need to pay the total costs charged over the standard MBS fee.
You can complete this by following these easy steps:
Note: Some doctors request full payment up front where the process described above also applies. Simply provide proof of payment for Medicare to reimburse accordingly.
What is the difference between an inpatient and outpatient service?
To be covered for treatment under your hospital cover, you’ll need to be treated as a private inpatient. An inpatient is someone who has been admitted into hospital for a medical service.
Outpatient services are medical services provided without a hospital admission, such as a consultation with a Specialist, Surgeon, General Practitioner (GP) or visits to an Emergency Department. Pathology and dialogistic imaging are also considered outpatient services where there is no admission.
Health funds are unable to provide cover for outpatient services; however, you may be eligible to receive a benefit from Medicare.
How long will it take for my Extras claim to be assessed?
For Extras claims, your claim will be assessed within five business days from the date your claim is received.
What is an agreement hospital?
AIA Health Insurance is partnered with the Australian Health Service Alliance Ltd (AHSA), which provides our members with access to most Private Hospitals and Day Surgeries in Australia. When you are treated for a service included under your policy in an agreement hospital, we will cover the associated hospital costs less any excesses.
Do I have to pay an excess?
All AIA Health Insurance products have a $500 or $750 excess, however, you may be eligible to have your full excess refunded if you hold an AIA Vitality status of Silver or above. There are no excesses for dependents.
What is Excess Refund?
AIA Health Insurance rewards its members for taking an active role in their health and wellbeing. If you have held an eligible product for a minimum of six months and have an AIA Vitality status of Silver or above on the day you’re admitted into hospital, we will refund your excess.
Excess Refund is not available when claiming on services within the following clinical categories: Cataracts, Joint replacements, Dialysis for chronic kidney disease, Pregnancy and birth, Assisted reproductive services, Weight loss surgery, Insulin pumps, Pain management and Sleep Studies.
How do I know what my out of pocket costs will be?
To understand what you’re covered for and any associated out of pocket costs, please contact our Member Services team on 1800 333 004.
What is Access Gap?
If your doctor participates in Access Gap, they’ll agree to either remove (No Gap) or reduce (Known Gap) your out-of-pocket medical expenses. Where a Known Gap has been agreed, you will be made aware of your costs as part of your Informed Financial Consent.
Doctors can choose to opt in or out on a patient-by-patient basis so it’s important to ask them upfront.
What happens if I have an accident?
All AIA Health Insurance products include cover for accidents. An accident is an unforeseen event – occurring by chance and caused by an external force or object – which results in involuntary injury to the body requiring immediate treatment. An accident does not include any unforeseen conditions the onset of which is due to medical causes nor does it include pre-existing conditions, falling pregnant or accidents arising from surgical procedures. For an accident to be covered, treatment must be sought through a Doctor or an Emergency Department within 48 hours of sustaining the injury.
What happens if I have a pre-existing condition?
A pre-existing condition (PEC) is one where signs or symptoms of your ailment, illness or condition, in the opinion of a medical practitioner appointed by AIA Health Insurance (not your own doctor), existed at any time during the six months preceding the day on which you commenced cover for the relevant service.
If you have transferred from another health insurer without a break in cover, you do not need to re-serve hospital waiting periods you have previously completed. However, if you are adding or upgrading your hospital cover, you do need to complete waiting periods for the new or upgraded items. This includes reducing a hospital excess.
Pre-existing conditions related to palliative care, psychiatric and rehabilitation services will serve a two month waiting period. If you have less than 12 months membership on your current hospital cover, you’ll need to contact us by phone or email before being admitted so we can determine whether the waiting period for pre-existing conditions applies. It can take up to five working days to complete this assessment, so make sure you factor this in when you book your stay. If you go ahead with your admission without confirming your entitlements and we subsequently determine your condition to be pre-existing, you’ll have to pay all outstanding hospital and medical charges not covered by Medicare.
Call us
1800 333 613
Between 8am and 6pm (AEST) Monday to Friday.
Or contact your financial adviser directly.
AIA Australia is a signatory to the Life Insurance Code of Practice. You can access the Code from the Financial Services Council website here: https://www.fsc.org.au/policy/life-insurance/code-of-practice
Who is entitled to receive the proceeds from my life insurance policy when I die?
The Nominated Beneficiary or the Policy Owner’s estate.
Why is it important to have a will?
A will is your chance to say what you want to happen to your estate after you have died. You can choose an executor and beneficiaries and decide how your assets are to be distributed.
What does ‘certified’ copy mean?
A copy of the original document, sighted alongside the original and certified as a true copy of the original by a Justice of the Peace, solicitor or anyone else who is able to certify documents in the relevant jurisdiction.
Why do I need to send in proof of age when it is on the death certificate?
The date of birth recorded on a death certificate is given verbally and no proof is required when the death certificate is completed.
What is the difference between the Life Assured and Policy Owner?
Life Insured: person who is insured.
Owner: person who gets proceeds of the claim.
Who has access to personal information on my policy including medical information?
Generally, AIA and the Life Insured only. If AIA has received an Authority form, completed by the Life Assured and giving consent to release information to another specific person, then we can release information to that person. There are certain exceptions under privacy legislation relating to the disclosure of personal information which can apply. Please note that this does not apply to death claims.
What is the difference between an executor and a beneficiary?
Executor: administers the estate and ensures the deceased’s will is followed.
Beneficiary: benefits from the estate as per the wishes of the will-maker or nomination by the Life Insured.
What if I need additional help?
You can review our policy for supporting customers requiring additional support.
What does ‘certified’ copy mean?
A copy of the original document, sighted alongside the original and certified as a true copy of the original by a Justice of the Peace, solicitor or anyone else who is able to certify documents in the relevant jurisdiction.
Who has access to personal information on my policy including medical information?
Generally, AIA and the Life Insured only. If AIA has received an Authority form, completed by the Life Assured and giving consent to release information to another specific person, then we can release information to that person. There are certain exceptions under privacy legislation relating to the disclosure of personal information which can apply.
What does total permanent disablement mean?
This will depend on the wording of your policy, including the type of cover you have taken out and any exclusions on your policy. Generally, total permanent disablement means that you are, after consideration of medical and other evidence, so incapacitated that you are unlikely to ever be able to work (depending on the cover you have taken out, this will either mean working in your usual occupation, or in any occupation).
For the full definition please refer to your policy document. For more information on our current Total Permanent Disablement product, see our product page for this cover.
What is the difference between the Life Insured and Policy Owner?
Life Insured: person who is insured.
Owner: person who gets proceeds of the claim.
What if I need additional help?
You can review our policy for supporting customers requiring additional support.
What does ‘certified’ copy mean?
A copy of the original document, sighted alongside the original and certified as a true copy of the original by a Justice of the Peace, solicitor or anyone else who is able to certify documents.
Who has access to personal information on my policy including medical information?
Generally, AIA and the Life Insured only. If AIA has received an Authority form, completed by the Life Assured and giving consent to release information to another specific person, then we can release information to that person. There are certain exceptions under privacy legislation relating to the disclosure of personal information which can apply.
What conditions am I covered for?
Please refer to your policy schedule for the full list of conditions and the specified definition that you are covered for.
What is the difference between the Life Insured and Policy Owner?
Life Insured: person who is insured.
Owner: person who gets proceeds of the claim.
What if I need additional help?
You can review our policy for supporting customers requiring additional support.
Call us
13 10 56
Between 8am and 6pm (AEST/AEDT) Monday to Friday.
Or contact your financial adviser directly.
AIA Australia is a signatory to the Life Insurance Code of Practice. You can access the Code from the Financial Services Council website here: https://www.fsc.org.au/policy/life-insurance/code-of-practice
How to make a claim (for policies previously offered by CommInsure)
The last thing you want to do at claim time is spend time chasing up your claim. We aim to assess all claims within five business days of receiving your completed form. Your claim decision may be deferred if we need additional information to complete the claim assessment.
Claims philosophy
In all of our claims assessments we seek to embody the AIA Operating Philosophy of Doing the Right Thing in The Right Way with the Right People. This is underpinned by our Claims Philosophy which is simple - helping people when they need it most.
We’re in the business of paying claims as promised by our products and will treat our customers with empathy, compassion and respect. We will guide our customers through the claim process in a quick and simple manner.
Rehabilitation services
If you’ve been out of action due to illness or injury, getting yourself back into the workforce can be a hard task on your own. As an AIA income protection customer, our full time in-house rehabilitation consultants can offer a managed process with appropriate and timely services, at no cost to you.
Our commitments to you at claim time
In all of our claims assessments we seek to embody the AIA Operating Philosophy of Doing the Right Thing in The Right Way with the Right People. This is underpinned by our Claims Philosophy which is simple - helping people when they need it most.
In processing claims, we promise to:
If we’re considering declining a claim, we will always offer you an opportunity to give us any information that might help us to reach a different decision. If we still decline the claim, we will offer you an opportunity for an independent review of our decision.
In addition, in the current situation, we will:
We have one of the largest and most experienced claims teams in Australia and we will guide you through the claim process in a quick and simple manner.
Our claims philosophy is simple – helping you when you need it most, making sure every claim that should be paid is paid promptly and that we always treat you with empathy, compassion and respect.
We also understand that everyone has different needs and your health and wellbeing goes beyond payments. That’s why we offer supported return to work, work-readiness and wellness programs that are evidence backed and results driven, at the right time for you.