What do I have to tell the insurer when I am filling in my application form?
You must answer all questions fully and honestly.
Consider the importance of the ‘catch all’ questions which normally ask for information on ‘any other illness or ailment not already mentioned’ – this is your opportunity to think of anything that you haven’t already disclosed or any medical problem that hasn’t already been covered with a question.
When in doubt always disclose! It is far better for the insurer to have too much information than not enough
What happens if I apply for my insurance and then a few months later remember that I forgot to mention an illness or injury that I have?
The best thing to do here is to contact your adviser or the insurance company straight away and give them all of the details in writing. The insurer will then assess your cover based on this new information and may need to amend the terms, this will depend on the when the illness or injury happened and what the illness or injury is.
How do I know which insurance company is the best one for me?
Use an adviser. An insurance adviser has specialised knowledge and can advise you on which product will best suit your needs. They can also help you to identify what your needs might be. Finally they can arrange with the insurance company to put your cover in place.
How much insurance should I have?
There is no right or wrong answer here – the best question is what do you need in an ‘ideal world’ and then can you afford the premiums for this cover? If not then only you can judge which areas should be trimmed back so that the premium remains within your budget.
What is a pre-existing condition?
A pre-existing condition is an illness or injury that you are aware of and know about prior to taking out insurance cover. Generally companies specifically exclude cover for pre-existing conditions and any associated treatment as they pose a higher risk to the company and a greater potential that a claim will be made.
What is a premium?
A premium is the payment you make to keep your insurance policy active and your cover in force. This payment is made to the insurance company who provides you with the cover. In return for you paying them a premium the insurance company carries your financial risk for the benefits you have taken cover out on.
What is waiver of premium?
When this is not a built in benefit (as with Income Protection) you can choose to add this for an additional cost. It means that if you are unable to work due to sickness or injury the insurance company will waive your premiums for your other insurance benefits e.g. Life Insurance.
What happens if I need to change the ownership of my insurance policy?
There is a change of ownership form included in your original policy documents. This needs to be signed by the existing owner and the new owner (original signatures) and forwarded to the insurance company along with the original policy document. If the original document has been misplaced or destroyed a replacement document can be provided.
What happens if I lose or misplace my policy document?
Contact your adviser or the insurance company and they will send out a ‘lost policy form’. Once you have completed this and sent it back to the insurance company they will issue you with a replacement documents. Note, there may be a small cost for this.
How do I make a claim?
For medical claims you can contact your adviser or the insurance company directly and ask for assistance with your claim.You will need to fill a claim form which can be provided by the Insurance company or your adviser.
Life / Trauma Cover / Total & Permanent Disablement / Income Protection claims:
Contact your adviser immediately and they will request the appropriate documentation and help you to complete it.
Do I need to have a medical for my insurance?
Depending on your age and how much cover you require you may have to have a medical. If you do need to have a medical we suggest that you view it as an opportunity to have a free ‘WOF – warrant of fitness’ and view it as a positive not a negative.
Why is what I do for a job important to the insurance company?
Insurance companies assess different jobs as having different levels of risk – for example a person who sits in an office statistically has a much lower risk of being unable to work than a builder who is out and about, lifting and doing physical work.
What if I start smoking after taking out my policy – do I need to tell the insurance company?
No, you do not need to tell the insurer. When your policy is taken out it is a ‘snapshot’ of your current habits and activities and you are underwritten based on these habits and activities. Consequently, if you take up smoking after the policy is taken out it is not relevant. However, for any additional cover you will be classified as a smoker.
What if I take up a hazardous pursuit after taking out my policy – do I need to tell the insurance company?
No, for the same reasons stated above.
How do I know what is covered under my Medical Insurance?
It depends on your policy, as each company covers different things. Medical Insurance is basically for procedures, testing and/or specialist consultations that are deemed “medically necessary” which means your health would be in jeopardy if it is not done. Routine screening is not generally covered by your insurance (although some companies offer this as a loyalty benefit). If you are unsure of what is covered and can’t find it in your policy documents, we can easily find out for you.
How long does a prior approval or medical claim take to process?
The standard processing time is 5-10 working days, however in some cases urgent prior approvals can be made.
How long does a medical insurance prior approval last?
Generally, prior approvals last for six months from when they are issued. You can usually have this extended for a further six months if you provide an updated estimate of cost.
I got prior approval for my specialist consultation, now I need surgery … what do I do next?
You don’t need to complete another form … simply provide the specialists report and an estimate of costs either to us, or direct to your insurer to have your prior approval continued.
What about follow up consultations?
You can just send through the invoices or receipts for follow up consultations if you already have a claim number – there is no need to complete a further form.
Why has my medical claim been declined?
The most common reason claims are declined is because the condition you are trying to claim for does not meet the policy definitions. We always recommend applying for a prior approval before you go to your appointment, to ensure that you know you will be covered.