SECTION F - PRIOR APPROVAL PROCEDURE AND MAKING A CLAIM
PRIOR APPROVAL
1
To have Your claim pre-approved: • Call Us on 0800 800 242 for a claim application form or log on to Our website www.aia.co.nz • On acceptance of Your claim, We will send You a pre-approval advice. You can then forward the Hospital's, Surgeon's or
Anaesthetist's account to Us and We will settle the claim with the service provider directly. Any shortfall in payment, such as any stated excess, is Your responsibility. In order for a claim to be paid where We have provided You with pre-approval advice, Your Policy must be in force on the date You have the medical treatment or procedure. • Pre-approval requires five (5) working days to be processed provided all requested information is submitted. Please be aware it may be necessary to request further information before completing assessment of Your claim. 2 To claim: • Call Us on 0800 800 242 for a claim form or log on to Our website www.aia.co.nz • Once You have completed the claim form, return it to Us along with the original receipts and invoices (photocopies or duplicates are not acceptable). • The claim form must be received by Us within twelve (12) months of the date of the insured event(s).
CLAIMING AFTER SURGERY OR HOSPITALISATION
OR AFTER A DIAGNOSTIC PROCEDURE
Any costs involved in completing the claim form and where appropriate providing an attached medical report (or any additional information We may request) will be at Your expense. Additional information may be requested by Us in order to assess and pay Your claim. Please refer to the checklist contained within the claim form to ensure You have supplied all of the requirements to Us . If You become aware, in respect of any health or medical procedure for which You have cover under this Policy that there has been a "medical misadventure" (as defined in the Injury Prevention, Rehabilitation and Compensation Act of 2001 or any replacement legislation) then: You must notify Us of that event together with all material details which are known to You . Those details must include: 1. the cause of the medical misadventure 2. the names and addresses of the health service providers(s) at fault 3. the level of increased fees caused by the medical misadventure 4. whether You have notified ACC and, if so, whether ACC has accepted cover. To this extent and where practical You must not: 1. pay the fees of any of the negligent health service provider(s) 2. pay the extra fees of the other health service provider(s) without Our written consent. If You are sued by the health service provider(s) We will conduct the defense at Our sole cost, but You must co-operate fully with Us throughout the proceedings. If We have paid any amounts to You in respect of health service provider fees for a health or medical procedure which
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PC-S3HC-04/2022
[AIA – INTERNAL]
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