The following services are not covered under our Extras cover policies:
- Any purported Extras (general treatment) service or circumstances of provision which does not meet the requirements or standards legislated under the Private Health Insurance Act (2007).
- Any treatment or service which is not specifically listed as "included" in an Extras policy
- Any treatment or service provided outside Australia
- Any treatment or service where a patient has the right to claim costs from a third party (e.g., another private health insurer, workers compensation or motor vehicle insurance)
- Treatment or services by a provider who is not recognised by HIF
- Any treatment or service deemed by HIF to be inappropriate or not medically necessary for the patient's condition (based on expert clinical advice).
When will benefits for covered services not be paid?
Benefits will not be paid in the following situations:
- Your policy is not financial (e.g., in arrears and or suspended) when benefit is claimed
- The claim is for a service provided more than two years ago
- The provider of the treatment or service is not recognised such as trainee providers
- Any treatment, service or item which is not listed as Included on a policy (please refer to the listed services for every Extras product on pages xx to xx in this brochure)
- Any amount in excess of the maximum claimable limit or sub-limit for that service and applicable per policy or person covered
- Any treatment, service or item provided within a Waiting Period or prior to joining HIF (e.g., Orthodontic treatment)
- The service is provided as a video, telephone or online consultation
- The service is not provided in the provider's private practice
- The service has already been claimed from another insurer or where another insurer or 3rd party has a liability to cover that service.