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Understanding Claims

Understanding Claims

In order to make the most of your insurance, you need to know how to claim and how to claim for everything your policy entitles you to.

Generally, there are two main ways of claiming: Pre-approval and reimbursement.


Pre-approval is usually recommended when an insured person has to go into an approved private hospital. This way you know exactly what your health insurance provider will pay for – and what you need to budget for.

If your pre-approval is accepted for a claim, you will be notified and sent a pre-approval letter. This letter gives the health service provider’s authority to invoice your insurance company direct for the costs covered.


Smaller claims, such as doctor’s accounts, prescription chargers and dental bills, are best paid directly to the health service provider (i.e. GP or chemist). The onus is on you to retain receipts and once these exceed a reasonable amount, say $100, you request a claim for from your insurer.

It almost goes without saying that any information given by, or on behalf of, and insured person must be true, correct and complete. If it is not, the insurer may decline the claim and/or cancel your policy from its commencement date. If your insurer cancels the policy, you may not be reimbursed for any of the premiums already paid.

Source: Sunday Star times – Essential guide to Health Insurance

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