Find out what a claim and pre-approval is, why you might need to get pre-approval for an upcoming procedure or treatment, and how you can claim for your medical costs.
The member portal gives you access to view and edit your personal and policy details online at any time.
Claims and pre-approvals can be submitted through the portal, making the entire process quick and easy and with the option of attaching scanned documents, you get to keep your originals. To register, all you need is your member number and the email address that is listed on your policy.
1) Request Pre-approval
If you haven’t already had the procedure or treatment, and it falls into one of the below categories, then you will need to apply for pre-approval before you have the procedure or treatment.
2) Submit a Claim
If the procedure and/or medical treatment has already taken place, then you will need to submit a claim.
Before you have a procedure or treatment, check to see if your insurance policy covers the procedure or treatment you need.
Pre-approval is when we give you confirmation of whether your procedure or treatment (such as a surgery) is covered under your policy before it occurs, and if there are any conditions that would apply such as an excess. If you think your procedure or treatment is going to cost $1000 or more, or where it will require hospitalisation, you will need to apply for pre-approval. If in doubt, apply for pre-approval.
If you have already had your procedure or treatment, or if it is likely to cost less than $1000, you can make a claim for the procedure or treatment after it has occurred.
As your procedure or treatment is likely to cost $1000 or more, requires hospitalisation or if you just want to make sure that it's covered under your policy, you will need to apply for pre-approval. To do this, you need to send us the following:
Alternatively, you can complete a pre-approval form and email it, along with the above information, to claims@accuro.co.nz. Be sure to write Pre-Approval in the subject line.
To claim for a procedure, treatment or services that has already occurred, you will need to send us a copy of all invoices and receipts related to your procedure, treatment or service.
If the claim is under your surgical or specialist plan, then we will also require a copy of the GP referral letter or a letter from the specialist confirming why the procedure, treatment or service was required. We may also require our Medical report form to be completed by the GP who holds the patient's medical history, if you have not had your policy with us for more than five years. Please give us a call if you are unsure whether you need to provide this or not.
Once we have assessed your claim we will arrange for the payment(s) to be made to your health service provider(s) or reimbursement to yourself. Please be aware that some plans are reimbursement only, so under these you will need to pay the health service provider first, and then we will reimburse you.
Alternatively, you can complete a claim form and send this, along with the above information, to claims@accuro.co.nz.
