How to make a health insurance claim

It’s simple to make a claim or arrange prior approval for a treatment with ASB health insurance. What’s more, a dedicated claims team will be on-hand to help, whenever you need it.

Prior approval lets you know you’ll be covered before starting treatment. It also means AIA will pay your providers directly (subject to any policy excess).

Your prior approval is valid for six months from the date it is issued.

The alternative to obtaining prior approval is that you pay the costs yourself and then submit a claim form. If you do this, you’ll need to provide itemised receipts to support your claim.

Please note, prior approval is required for some benefits. Please refer to your policy documents for further information or call us on 0800 500 108.

The prior approval process

You can request prior approval using the same process as you do for making a claim.

The quickest and easiest way to make a claim is online. The online claim form (this can’t be accessed from mobile) takes about 10 minutes to fill out, and Claims assessments are completed within 3 to 5 working days.

Or you can also complete a printable claim form. It usually takes 5 to 10 working days for us to assess your claim once we've received your form.

You should do this at least five working days before the procedure. Please include the following with your application:

• Either a medical certificate completed by your medical practitioner, or a referral letter containing the date of the first consultation, history of the condition, and treatment received.
• If it’s a claim that ACC has accepted or declined, you’ll also have to include a copy of the letter from ACC. If you don’t send a copy of this letter there may be a delay in assessing your claim.
• An estimate of costs.
  

Scanned copies

If you’re submitting your request online or via email, just send scanned copies of these documents. Your prior approval is valid for six months from the date it is issued.

Prior to assessing claim, AIA will check that the symptoms or condition that you’re claiming for are covered in your policy, and not related to a pre-existing condition or a policy exclusion, for which you are not covered.

To make sure this can be done as quickly as possible, please complete your claim form with the details of the symptoms or condition that required you to contact your doctor. Any information you provide will be treated as strictly confidential.

In New Zealand, the Accident Compensation Corporation (ACC) scheme is the primary insurer for any treatment relating to an accident. ACC will help cover medical and treatment fees as well as rehabilitation costs for most injuries. So if you have an accident at work, at home or on the ski slopes (or anywhere else), you should contact ACC first.

However there are exceptions. Should ACC decline your claim, you can still claim on your ASB health insurance. You will need to send AIA a copy of the letter from ACC together with your claim form. If ACC is paying part of your claim, AIA may be able to top it up, so send a copy of your letter from ACC outlining their contribution to the treatment.