occurred prior to the date the policy ended, please submit the relevant claim form and supporting information within 30 days of the date the policy ended. All benefits, claims and premiums are paid in New Zealand dollars. All benefits and premiums are GST inclusive. What are ‘reasonable charges’? For benefits covered by your policy, AIA will pay the reasonable charges of health service providers, subject to the maximum amounts that apply for those benefits. We will not pay more than the reasonable charges in order to limit excessive or unreasonable charges by health service providers in private practice. AIA determines reasonable charges by regularly reviewing: > Health service providers’ charges for particular services. > AIA’s own claims statistics. > AIA’s experience of the New Zealand health market. > International benchmarks of the relative value of health services. If the proposed cost of your medical treatment is greater than the reasonable charges : AIA will negotiate with the health service provider on your behalf to facilitate a reduction in the proposed cost of the treatment or procedure where possible. By purchasing this policy, you authorise AIA to do this. AIA may request that you seek a second opinion for the treatment or 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 treatment or procedure with the particular health service provider: > You will be responsible for any difference between the reasonable charge and the cost of your medical treatment or 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. Excess The excess is the amount that you will be responsible to pay towards the cost of any treatment, procedure, or benefit that you are entitled to claim, or be reimbursed for under this policy for a life assured. The excess applies separately to 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. 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. Please see section ‘Part F: Changes to your policy’ on pages 7-8 for more details.
ensure that the claim number is quoted on all claims correspondence and any invoices or accounts relating to the pre-approved claim that are sent to AIA . There may be certain costs, treatments or procedures that are not covered by this policy. Obtaining prior approval ensures you understand what will be covered and allows AIA an opportunity to negotiate costs with the health service provider or discuss alternatives with the registered medical practitioner or specialist . Reimbursement of treatment you have paid for If you have not applied for prior approval and you have paid for your treatment you will need to complete the steps below for reimbursement. Ask your registered medical practitioner to complete the relevant section of the claim form or to provide you with a referral letter as well as any relevant clinical notes that may be useful to assist us to assess whether the medical treatment or procedure was medically necessary and falls within the terms of this policy. Submit your claim to AIA online, by email, post or fax, with the referral letter and original invoices and receipts as proof of payment. Please be aware that by paying for your treatment and seeking reimbursement afterwards there may be costs that are not covered by the policy including for example your excess or costs that exceed the maximum cover . If you seek prior approval, we can let you know what these are before any treatment takes place. AIA’s Healthcare Partnership Programme If the life assured’s treatment is being provided by one of AIA’s Healthcare Partnership Programme providers there is no need for you to seek prior approval or send us any claims information, the provider will do this on your behalf. AIA will then pay the provider directly, who will advise you of any costs you need to pay to them directly (e.g. costs not covered by the policy, your excess , or costs that exceed the maximum cover ). For all claims All claims must relate to a life assured under this policy. Unless expressly stated in the relevant benefit, the medical treatment or procedure must be medically necessary . AIA may request supporting evidence, including a second opinion, in order to satisfy itself that the treatment or procedure is medically necessary . AIA will only pay the costs incurred for medically necessary treatments or procedures covered under this policy up to the respective benefit's maximum cover . You are responsible for payment of the excess as well as any costs that are not covered by this policy. Please submit all claims to AIA within 12 months of the medical treatment or procedure. If this policy is cancelled for any reason and there are any outstanding claims relating to any medical treatment, procedure or other event covered under this policy that
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1300 APH-UMB version 6 Effective 17 April 2025
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