AIA Real Health Personal Policy Wording

REAL Health

SECTION D – PRIOR APPROVAL AND MAKING A CLAIM

PRIOR APPROVAL

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 or email Us nz.claims@aia.com  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 provide further information before completing assessment of Your claim. To claim:  Call Us on 0800 800 242 for a claim form or log on to Our website www.aia.co.nz or email Us nz.claims@aia.com  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 . 3 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 Accident Compensation Act 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 provider(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. If a medical misadventure occurs as a result of a claim under this Policy then We are entitled to withhold claims, seek recovery of any claims paid, or pursue Your entitlement to future treatment expenses from ACC .

UNEXPECTED EVENTS ARISING FROM TREATMENT RECEIVED UNDER THIS POLICY (“MEDICAL MISADVENTURE”)

Please note for claims while residing in Australia, call collect on +64 9 488 8800. Please refer to the Claims Form checklist to ensure all relevant information is supplied to Us.

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