| Fund Rule | Prior to 1 May 2022 | From 1 May 2022 |
|---|---|---|
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G.1.4 Assessment of a claim |
The Company may request information from a Member about their healthcare provider prior to or after the payment of a Benefit for a claim. Information requested by the Company will be directly related to a claim where the Member has acknowledged either verbally or in writing a declaration requesting Benefit entitlements to be paid to the Member or their healthcare provider. Such information may include but is not limited to:
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The Company may request and review personal information (including sensitive information) from a Member (or someone acting on their behalf), or their provider, prior to or after the payment of a Benefit for a claim. The information that may be requested is information necessary to assist in reviewing the claim. By submitting a claim, the Member provides consent for the Company to obtain such personal information (including sensitive information) from the relevant provider(s), which may include but is not limited to:
Where adequate information is not provided and/or the Company is unable to substantiate the requisite details in relation to a claim, Benefits may not be payable, or if already paid, may be recovered in accordance with Fund Rule E.1.4. |
This document contains comprehensive information about the rights and obligations of the health fund and our members. You can view a copy of the current Fund Rules here.
On 1 May 2022, the Fund Rules link above will be updated with the new version.
We must comply with the Australian Consumer Law, the Private Health Insurance Act 2007 (Cth) and the Private Health Insurance Code of Conduct whenever we make changes to our Fund Rules. If you are unsatisfied with the changes, please note that you can cancel your cover at any time and you will be entitled to a refund for any unused portion of premiums paid in advance.
Australian Unity Health Limited - ABN 13 078 722 568
271 Spring Street, Melbourne, Victoria 3000