Claiming Terms and Conditions

Declaration

When submitting a claim you declare and agree that:

 all information supplied in connection with the claim is true and correct;

 you will inform Astute Simplicity Health immediately if you become aware that any details of the claim are incorrect;

 you consent to the handling of the personal and sensitive information provided with the claim in accordance with the Astute Simplicity Health Privacy Policy;

 submission of a claim does not guarantee payment of benefit.  The claim is subject to assessment by Astute Simplicity Health and benefits will be paid in accordance with your level of cover, the Astute Simplicity Health Fund Rules and Membership Conditions.  A summary of Membership Conditions can be found here.

 you, or the person on whose behalf you are submitting this claim, have no entitlement to claim benefit for these services under Repatriation, from another private health insurer, worker’s compensation, motor vehicle accident insurance, damages action, persons liable at law, or any other source;

 the services, treatments or appliances supplied in relation to this claim were provided within Australia;

 Astute Simplicity Health does not guarantee a response or payment of benefit within a particular period;

 you will retain all invoices and receipts related to the claim for 6 months from the date of claim;

 Astute Simplicity Health may require production of relevant invoices or receipts prior to finalising the assessment of any claim and prior to the payment of any benefit in respect of that claim.  If supporting documentation is requested, no benefit will be paid until the requested documentation is produced and assessed by Astute Simplicity Health;

 you authorise Astute Simplicity Health to contact the provider to clarify or verify any details of the attached claim;

 if you are lodging the claim for another person covered by your policy including any Dependant, you declare that you have their consent to lodge the claim and to make the above declarations and acknowledgements on their behalf.

General

By submitting a claim, you are declaring you have authorisation to submit the claim on behalf of both the person and membership for which you are lodging the claim on behalf of. 

A list of the accepted claiming options is available on our Claiming Options webpage.

Mobile Claims

When submitting a claim using the Astute Simplicity Health mobile claiming app (‘the app’), you are agreeing to the Terms and Conditions of the app and consent to providing Astute Simplicity Health with a valid email address, which Astute Simplicity Health may use at its discretion to contact you regarding the claim submitted. If you would like to update your contact details for your membership, please contact our Customer Care Consultants on 1300 090 960 or email astute@stlukes.com.au.

Payments

Your benefit (if one is payable to you) will be paid into the nominated bank account.  If you have not nominated a bank account, we will pay the benefit by cheque.  If you wish to update your bank account details, please contact our Customer Care Consultants on 1300 090 960.

If you have any questions relating to a claim submitted via the app please contact our Customer Care Consultants on 1300 090 960 or email astute@stlukes.com.au.

Version Control

These Terms & Conditions were updated on 14 February 2022.