Membership Conditions

Who is Covered Under the Membership?

For a Single membership, the cover is for the member only and therefore would have to be adjusted to the family rate if other dependants were to be added. A single membership should be adjusted to the family rate at least two months prior to the expected date of birth of a child if cover for the child is required at birth.

For a Family membership, cover extends to:

  • the member
  • a spouse or partner
  • any unmarried children until they attain the age of 22 years
  • any unmarried children between the age of 22 and 25 years who are full time students attending an education facility within Australia. A dependant who ceases to be eligible for cover under a parent’s membership on attaining the nominated ages is eligible for membership in their own right. Continuity at an equivalent level of cover, without waiting periods will be granted if separate membership is taken out within thirty days.

* For more information go to Dependant Assist Scheme.

When Does Membership Commence?

Membership will only be accepted from the date when the first contribution is received, or on the date on which the application form is received by Navy Health, whichever is the latest. Back-dating of membership is not permitted.

How Can Membership Changes Occur?

Any changes to the status of a membership (i.e. level of cover, adding or deleting dependants) cannot be undertaken without Navy Health receiving written notification of the change. Likewise the change cannot be taken as being actioned without the member receiving written acknowledgement from Navy Health. The application forms supplied in this booklet can be used for that purpose or the member can use the Member Services section on the Navy Health website. The effective date of any change will be the date notification is received by Navy Health.

Upward changes in the level of cover will result in the member and dependants undergoing new waiting periods. Whilst these waiting periods are in force, benefits will still be payable as they would normally have been under the previous level of cover. Higher benefits are not payable for ailments or conditions in evidence at the time of transfer (regardless of whether or not they have been diagnosed) until a waiting period of 12 months has been served. Higher level Maternity (and the management of) benefits will not be payable for a period of 12 months after transfer.

For transfers within the extras products, the waiting periods for higher benefits are those listed for new members. At all times the benefits paid under a previous level of cover are considered when determining residual benefit entitlements.

How are Contributions Paid?

We try to make the payment of contributions as easy as possible and as a result have a number of payment options.

Payment can be made by:

  • automatic credit card deduction
  • automatic bank account deduction
  • Bpay
  • cheque or money order
  • automatic payroll deduction (contact Navy Health to check if employer is an authorised payroll group)

In the case of the first four options, payments can be made either monthly, quarterly, six-monthly or yearly. Payment of contributions are always in advance and if initiated from the Navy Health office will always be deducted on the last working day before the payment is due.

A 2% discount has been calculated for members choosing to pay half yearly and a 4% discount has been calculated for those members choosing to pay yearly.

Navy Health Benefit Year

For Extras the Navy Health benefit year is July 1 to June 30 and a rolling year for any hospital products with an excess (ie. the excess on any of the Top Hospital Saver products is payable once, in full, in any 12 month period).

When Does Membership Cease?

A membership will cease on a date advised and paid to by the member or automatically when contribution payments are two months in arrears.

Memberships will also cease when an allotment is cancelled due to discharge. In this instance the member will need to advise Navy Health of their new payment method. The new payment method will need to be set up for the membership cover to continue.

When Do Benefits Cease?

Benefits are not payable on any services rendered subsequent to a member’s last financial paid to date, the date on which a membership is cancelled or when a membership is in suspension.

When are Benefits Not Payable?

Benefits are not payable when:

  • claims are over 2 years from the date of service;

    the provider is not registered in a private practice or the

  • provider is not recognised by the Australian Regional Health Group (ARHG);
  • the service forms any part of a payment from workers’ compensation, third party or any other liability provision. Navy Health reserves the right to seek full reimbursement on any benefits paid in these circumstances;
  • the procedure does not have an assigned Commonwealth Medical Benefits Schedule number;
  • the claim is within a specified waiting or replacement period.
  • Access Gap providers submit medical claims 6 months after the date of service, unless approved by Medicare Australia for benefits.

Cooling Off Period

Members can choose not to proceed with their Navy Health cover and request to have any premiums reimbursed. This reimbursement is on the provision that the member expresses their request in writing, within 30 days of their cover commencing and that no claims have been lodged or are pending during the 30 day cooling off period.

Suspension of Membership

Navy Health at its absolute discretion may allow, within a clearly defined limited set of circumstances, for a member to suspend their membership for an agreed period. Where the suspension has been approved in writing by the fund, members will be advised of the conditions relating to waiting periods and pre-existing condition rules which may be applied upon reinstatement of membership. The agreed suspension period is not subject to change without written notification to and written confirmation from Navy Health.

Overseas Benefits

When a member incurs a health care expense whilst overseas, health fund benefits are payable according to the level of cover (providing the membership is current). Benefits are based on the Australian exchange rate as at date of service.

Any claims for services rendered overseas must be fully paid, translated in English where applicable and receipted prior to claiming.

We caution members, that these benefits may not be sufficient to give reasonable cover for hospitalisation in many countries. Medicare and Gap Medical Benefits are not payable and as a result the patient is solely responsible for the cost of all associated medical services. As a consequence we strongly advise all members to link their normal health insurance with Navy Health Travel Insurance when travelling overseas. (Refer to Travel Insurance)

Advice regarding countries holding reciprocal Medicare agreements with Australia can be obtained from your local Medicare office.

Natural Therapies and Recognised Providers

Benefits are only payable for services rendered by a recognised provider in private practice.

The provider registration process for Natural Therapy services, including the issuing of provider numbers, is managed by the Australian Regional Health Group (ARHG) on behalf of Navy Health Ltd.

Natural Therapy providers must be eligible members of an Association that the ARHG recognises for benefit.

Member Support Program

Members on Top Hospital, Top Hospital Saver and Pay ‘n’ Save Hospital may be entitled to use the Member Support Program. The Member Support Program is not available at every hospital. You will need to contact your hospital to check if your hospital participates in the Program. Services offered in the Member Support Program may include nursing care, home help, meals, child care and nappy services – all at no extra cost to the member.

Prosthetic Appliances

Prosthesis appliances or devices surgically implanted during a hospital stay are subject to two benefit types, either ‘no gap’ or ‘gap permitted’. These items are listed on the Commonwealth Prosthesis Schedule.

When a ‘gap permitted’ benefit appllies the fund will pay the recommended minimum benefit as shown on the Schedule. The Schedule will have at least one no gap prosthesis or device item for every in hospital procedure on the Medical Benefit Schedule (MBS) for which the fund provides cover.

No benefit is payable where the hospital charges for a prosthetic appliance or device not listed on the Schedule.

Private Patients' Hospital Charter

The Private Patients’ Hospital Charter is a guide to understanding your rights and responsibilities as a private patient in hospital. The Charter is written by the Federal Government and can be viewed on this website. Alternately members can request a copy by calling the Navy Health team on 1300 30 6289 (NAVY).

Code of Conduct

Navy Health abides by the Private Health Insurance Code of Conduct. By subscribing to the Code Navy Health ensures that members receive clear information and transparency in their dealings with Navy Health.

The Code ensures that Navy Health will:

  • Continue to improve standards of practice and service.
  • Provide information to members in plain language.
  • Ensure that policy documentation is full and complete
  • Ensure that Navy Health staff are appropriately trained to provide clear explanations
  • Provide members with access to an internal dispute resolution procedure and advise members of their rights to take an issue to the Private Health Insurance Ombudsman (PHIO).

A copy of the Code may be provided on request.

Private Health Insurance Ombudsman

The Office of the Private Health Insurance Ombudsman (PHIO) has been set up by Government to deal with complaints where the member has not been able to resolve an issue with their fund. Whilst we actively encourage all members to discuss any such matters with our office in the first instance, the PHIO will gladly mediate if required. The PHIO can be contacted on 1800 640 695 or you can write to The Private Health Insurance Ombudsman, Level 7, 362 Kent Street, Sydney NSW 2000.

Members' Feedback/ Complaints Policy

We appreciate any feedback that you may have in regards to the service that you have received from Navy Health. Your valued feedback helps us monitor our performance in meeting our members’ needs.

Navy Health provides an accessible, impartial, free-of charge complaints handling procedure for members. View Navy Health's Members' Feedback/Complaints Policy (pdf) 

Information Collection Statement

Navy Health Ltd is a body corporate established under the Corporations Act.

You may contact Navy Health Ltd by writing to Navy Health Ltd, PO Box 172 Box Hill Vic. 3128, by emailing at query@navyhealth.com.au or by calling 1300 30 6289 (NAVY).

You have the right to gain access to the information held by Navy Health Ltd about you but not about any other member.

The information collected by Navy Health Ltd is only that necessary to provide you with a service or product, such as assessing and processing claims.

Navy Health Ltd may disclose any of this information to the following individuals or organisations:

  • As required by law to a government organisation such as the Department of Health and Aged Care or Medicare Australia (formerly the Health Insurance Commission).
  • To a hospital or provider in helping us administer a claim, which has been made, for services provided.
  • Another organisation who helps us process transactions, access data or provide services, such as contractors who assist us in the provision of customer services.
  • Membership details and benefits paid need to be confirmed to the membership holder.

If you choose not to provide information to Navy Health Ltd we may not be able to provide you with your chosen service or benefit.

Navy Health Ltd policies for the management of personal information are set out in the publication entitled ‘Navy Health Ltd Privacy Policy’ – available from Navy Health Ltd.

Direct Debit Service Agreement

Navy Health will advise you, in writing, of the drawing details for the payment of your premiums. These details will include the amount to be debited, frequency of debit and commencement date.

Navy Health will advise you at least 14 days in advance of any changes to the direct debit arrangements.

For all matters relating to the direct debit arrangements, you will need to send written correspondence to Navy Health, P.O. Box 172, Box Hill, Victoria, 3128 and allow for 10 working days for the amendments to take place.

The member should be aware that direct debiting is not available on all accounts and account details should be checked against a recent statement from your financial institution. If you are in doubt, you should check with your financial institution before completing the drawing authority.

It is your responsibility to ensure that sufficient cleared funds are in the nominated debiting account when the payments are to be drawn.

If the due date for the payment falls on a non-working day or a public holiday, the payment will be processed on the previous business day.

For a returned unpaid transaction Navy Health will notify you in writing and will outline the procedure you must follow.

All member records and account details will be kept private and confidential to be disclosed only at the request of the member or the financial institution in connection with a claim made to an alleged incorrect or wrongful debit.

Navy Health Rules and Constitution

New memberships must be in accordance with the rules and constitution of Navy Health Ltd. Benefits are also paid in accordance with the rules. Members can view Navy Health’s rules on receipt of a written request. All members are bound by the rules of Navy Health Limited.