Our Information Sheets in our Document Library have quick guides to common issues. Consumer tips and case examples are included.
Our Glossary explains the meaning of technical terms used in tips and cases.
Check out the Financial Services Council (FSC) FSC Code of Conduct* that has the nine standards which fall into three core objectives covering: principle ethical standards, consumer information and communication, and delivering good outcomes to consumers.
(*This is a industry code for FSC Members only (mainly made up of Life & Health Insurers, Investment Funds), and is designed to support the professionalism of the financial services industry and the FSC members. It is about increasing trust and confidence in the providers of financial services and the products they deliver.)
Check your policy
Get a copy of your policy and check what you are, and are not, covered for. Ask questions if you don’t understand.
Look out for policy exclusions
Declined health insurance claims due to exclusions are a common complaint to the IFSO Schemes. Examples of health insurance exclusions might include treatment or procedures for cosmetic, dental or pregnancy-related issues; alternative or experimental treatments; and anything relating to a symptom or health issue you had before you took out the insurance (pre-existing conditions).
Pre-existing conditions will not be covered unless the insurer has agreed to cover them
Pre-existing conditions are commonly defined as any condition, sign, symptom or circumstance that you know about or ought to have reasonably known about. This can be something as simple as having a sore knee or back that you may have discussed with your doctor, was not diagnosed as a medical condition. Health insurers won’t provide cover for pre-existing conditions unless they have specifically agreed to cover them.
Tell your insurer the full details of your medical history, even if you don’t think they are important
Declined health insurance claims due to non-disclosure are a common complaint. Even if you accidentally leave out details about your medical history, your claim could be declined, and your policy treated as though it didn’t exist. If in doubt, tell your insurer everything. It can be helpful to get a copy of your medical notes you can refer to when filling out the insurance application form, or provide a copy to the insurer.
Before you incur medical costs, make a claim to your insurer to make sure it will be covered
If you want to make a claim for the cost of a treatment, procedure or doctor’s visit, you will need to apply to your insurer to make sure it will pay the claim before you have the treatment, procedure or visit. This is called pre-approval.