of the consultation or diagnostic procedure where possible. By purchasing this policy, you authorise AIA to do this. AIA may request that you seek a second opinion for the consultation or diagnostic procedure from an alternative health service provider. We can supply a list of providers near you that you can seek a second opinion from. If AIA is unable to negotiate a reduction in the cost and you choose to continue with the consultation or diagnostic procedure with the particular health service provider: You will be responsible for any difference between the reasonable charge and the cost of your medical consultation or diagnostic procedure, regardless of the relevant benefit’s maximum cover . You will be responsible to pay any costs that exceed the reasonable charge directly to your health service provider.
costs.
AIA will not pay for any MRI or CT scans or other specialised imaging procedures recommended by a registered medical practitioner within seven days of an accidental injury claim being lodged with ACC . If ACC does not cover the claim due to the policy owner’s or the life assured ’ s failure to properly make a claim with ACC or comply with ACC’s claims requirements, we will deem this to mean that the policy owner or life assured has not made reasonable efforts to secure cover with ACC and so is not able to claim under this policy.
5. Claims on other insurers
It is your responsibility to advise AIA if there is another insurer, who is responsible under any contract of insurance or indemnity to pay for any costs for which you make a claim under this policy. You must make every reasonable effort to make a claim or seek recovery of costs from that insurer for any expenses recoverable. Any expenses covered by another insurer in this way will not be covered by AIA under this policy. However, if there are other expenses that are not covered by your other insurer please send details of the level of payment to us along with your claim. We will deduct the payment made by your other insurer then reimburse you for the remaining costs in accordance with this policy. If you have two or more policies with AIA you cannot claim for, or be reimbursed for, an amount higher than the total cost of your medical services.
Excess
The excess is the amount that you will be responsible to pay towards the cost of any procedure or benefit you are entitled to claim, or be reimbursed for under this policy for a life assured . The excess applies separately for each life assured and is applicable per policy year . At the start of each policy year the excess will reset to its full value for each life assured . The available excess amounts are $0 or $250. The excess will apply to each benefit available under the Specialist and Testing Support Benefit unless:
otherwise specified in the benefit; or
6. AIA ’s Right to Amend Policy Terms
the full value of the applicable excess has already been paid by you for the life assured in the applicable policy year , in which case the excess will be waived for any further claims within the same policy year . You may request AIA to change the excess applicable to your policy. If you would like to reduce the excess for a life assured , they may be required to provide further health information before we agree to this.
It is AIA ’s business practice to review this policy over its lifetime. This is to ensure it continues to provide cover for current consultations and diagnostic procedures for common medical conditions at the time. It is also to ensure the insurance product remains commercially viable for AIA . Any changes to the terms of this policy will apply across all lives assured with the same policy. AIA will not make any changes to the terms of an individual policy owner’s policy (except for age related premium increases based on the existing schedule of premium rates) without the policy owner’s consent. The following are examples of circumstances when AIA may wish to change the terms of this policy across all lives assured: To increase the level of benefits under the policy or to add new benefits. To move all lives assured to a refreshed policy document with a new drafting style/layout and similar levels of benefits.
4. Claims involving ACC
This policy does not cover any costs arising from procedures for accidents or injuries including treatment injuries (medical misadventure) that ACC is legally responsible to pay. It is your responsibility to submit any accident-related claim to ACC in the first instance. When ACC agrees to contribute to the life assured ’ s costs, AIA may cover additional costs up to the reasonable charges or maximum cover of this policy. You must obtain AIA’s prior approval before incurring costs. If ACC declines the claim AIA reserves the right to require that the life assured applies to ACC for a review of that decision, before AIA has any obligation to consider a claim under this policy. If ACC upholds their decline decision AIA may cover your costs up to the reasonable charges or maximum cover of this policy. You must obtain AIA’s prior approval before incurring
To take account of changes in the laws in New Zealand.
To allow for an unexpected increase in the type or level of claims that will not be sustainable long term based on the current schedule of premium rates or at any premium rates (uninsurable).
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1118 AL-STS Version 1 Effective 1 October 2025
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