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    Making a claim

    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.


    • Health Insurance Claims
    • Life Insurance Claims
    • Tailored Protection Claims
    For claims related to health insurance

    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:

    • Using your HICAPs card at your registered provider
    • Online, by logging in to our Online Member Services portal. 
    • Email, by completing our health insurance claim form and sending to Health.Claims@aia.com.au
    • Post, by completing our claim form and posting to:


    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

    Following a hospital admission, the hospital will send the bill directly to us, which we will pay on your behalf. You may be required to pay an excess prior to your admission.


    Medical claims

    You can claim for provider fees by either:

    • Paying in full and then claiming your Medicare benefit. Medicare will provide you with a Statement of Benefits, which you can provide to us to complete your claim.
    • Paying in full and then completing a two-way claim with Medicare. Medicare will initiate your claim with us.
    • Completing a Medicare and two-way claim with Medicare. Once Medicare confirm you have not paid, we will pay the claim amount to your provider via direct deposit or cheque.


    If your provider has opted for the Access Gap Scheme, they will bill us directly. You may be required to pay the gap (if applicable) to the provider first.


    FAQ


    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.


    For claims related to life insurance, income protection, total and permanent disablement or crisis recovery

    Call us
    1800 333 613
    Between 8am and 6pm (AEST) Monday to Friday.
    Or contact your financial adviser directly.

     

    FAQ


    Making an insurance claim - life

    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.


    Making an insurance claim - disability

    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.


    Making an insurance claim - critical conditions (trauma)

    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.


    FOR CLAIMS RELATED TO AIA TAILORED PROTECTION (PREVIOUSLY COMMINSURE PROTECTION)

    Call us
    13 10 56
    Between 8am and 6pm (AEST/AEDT) Monday to Friday.
    Or contact your financial adviser directly.


    How to make a claim (for policies previously offered by CommInsure)

    1. Notify us of your claim by phoning AIA on 13 10 56 immediately after you become disabled. Your claim will be directed to a Case Manager who will spend some time discussing your situation and explaining how we assess the claim and what information we may need.

    2. We send you a claim kit, generally by email or post, within 48 hours. This pack will include a letter explaining the next steps, relevant claim forms and FAQs.

    3. Our Case Managers will review the information you have provided in the claim form and start the assessment of your claim. Please keep in mind that some waiting periods may apply, depending on the specifics of your policy, which will be clearly indicated on your policy documentation.

    4. We let you know the outcome of your claim. For accepted claims, we pay your benefit.

    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:

    • look to promptly pay, not avoid
    • integrate our partners into the process for their members
    • listen, communicate openly and simply
    • be empathetic, respectful and care
    • offer supported return to work and wellness journeys
    • be fair and reasonable in our process
    • understand every member has different needs
    • innovate, learn and look for new ways to improve for our claimant 

    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:

    • be flexible in our claims assessment process, including how we obtain medical information
    • assist with urgent financial need – if you tell us you urgently need the benefits you are covered for under your policy, and provide relevant supporting documents, we will:
    • prioritise our assessment and decision in relation to your claim; and/or
    • make an advance payment to you to help ease your immediate hardship

    If you have any questions, please contact your financial adviser, or call us on 13 10 56, Monday to Friday, 8am to 6pm (AEST/AEDT), excluding public holidays.


    We make claims easy

    Making claims easy image

    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.

    Contact AIA

    1800 333 613

    PO Box 6111
    Melbourne VIC 3004

    infohub@aia.com

    AIA Global aia.com

    Contact AIA

    1800 333 613

    PO Box 6111
    Melbourne VIC 3004

    infohub@aia.com

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    Copyright © 2021. AIA Group Limited and its subsidiaries or affiliates. All rights reserved. Priority Protection and Priority Protection for Platform Investors products are issued by AIA Australia Limited (ABN 79 004 837 861, AFSL 230043). AIA Vitality, a personalised, science-backed program that supports members every day to make healthier choices, is available with eligible products issued by AIA Australia. AIA Health with AIA Vitality is issued by AIA Health Insurance Pty Ltd ABN 32 611 323 034, a registered private health insurer governed by the Private Health Insurance Act 2207, Private Health Insurance Rules 2007 and the AIA Health Insurance Pty Ltd Fund Rules. The information on this website is current as at 1 April 2021 and may be subject to change. It is general information only and is not intended in any way to be financial, legal, tax, health, medical, nutritional or other advice. You should consider your own personal circumstances and needs and view the relevant product documents, fact sheets, fund rules and terms and conditions before making a decision to acquire such products. If necessary you should obtain professional advice from a financial, tax, medical or health professional. Unless expressly stated, any views or expressions of opinion (including any video content) do not represent the opinion of AIA.
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