Claims Made Simple
Your Member Portal is the simplest and fastest way to:
- Submit claims for reimbursement
- Request prior approval
- Update your contact details
- See your Health Plan documents
- Review your claim history
...and more!
Your Member Portal: How to Login or Register
Your Portal depends on the brand your policy was issued under:
UniMed Member Portal
If your policy number starts with a number (not letters), this is your Member Portal.
Go to UniMed Member Portal
Not Sure?
Is your Health Plan:
- Health Positive
- Hospital Select Plus Modules
- UniCare Advantage
- or another originally issued by UniMed?
Accuro Member Portal
If your policy number starts with PL, this is your Member Portal.
Go to Accuro Member Portal
Not sure?
Is your Health Plan:
- SmartCare, SmartCare+, SmartStay
- KidSmart
- Day to Day
- StaffCare, StaffCare+
- or another plan originally issued under the Accuro brand?
Tips for faster claims processing
To process your claims faster, we must be able to clearly read the information on your uploaded receipts and invoices:
- Do not submit EFTPOS receipts - we need a PDF or photo of the invoice or receipt issued by your healthcare provider or facility.
- Only include one invoice or receipt per image that you upload
The receipt or invoice must show:
- The name of your healthcare provider (e.g., a GP/specialist) or facility
- The date and cost of the treatment or procedure
- The medical treatment, procedure or service you’re claiming for
- The name of the Member you're claiming for
Claims: Frequently Asked Questions
How long will it take for my claim to be assessed?
We usually assess claims within 10 working days, and we’ll direct credit any reimbursement to the bank account number you provide with your claim.
Do I need to provide EFTPOS receipts with my claims?
No, you do not need to provide an EFTPOS receipt with your claim. If it is included when you’re uploading a photo or PDF to your Member Portal, make sure it’s not covering anything on the invoice.
How do I make a claim for costs I have already paid?
The simplest way to is to submit your claim through your Member Portal, and these are processed faster than claims sent by email or post.
What is a prior approval?
A prior approval is confirmation of your cover for an upcoming medical procedure or treatment, such as a surgery.
Can I submit a prior approval online?
Yes, submit your prior approval request through your Member Portal. If it’s urgent (for example it’s for something that is scheduled within the next two days), please phone us.
Do I have to get a prior approval?
We recommend that you seek prior approval for all treatments or procedures over $1,000 so you have peace of mind that you are covered and are fully aware of any excess you may need to pay. (You are also welcome to submit requests for less than $1,000 if you want to check you are covered.)
If you don’t seek prior approval, you risk finding out that your claim was not eligible or that the extent of cover is less than you thought.
The best way to submit a request is through your Member Portal, or you can phone us.
How long will it take to assess my prior approval request?
Most prior approvals can be processed within three working days, but it may take up to five working days as more complex surgeries or situations can take longer.
How long is my prior approval valid for?
We issue prior approvals for a period of three or six months, depending on your Health Plan. This will be confirmed in your prior approval letter/email. If your procedure or treatment is rescheduled or falls outside this period, you should contact us to ask for it to be reissued.
In all cases, for a prior approval to be valid your policy must be current on the date of treatment.
Do I have to pay for my surgery or treatment first and then claim it back?
No, if you have prior approval for a surgery or treatment you can ask the healthcare provider to send the invoices directly to us and include your prior approval reference number so the invoice can be processed easily. You can also forward these onto us if you receive them from the healthcare provider.
If you don’t have prior approval, you can still send your invoices to us along with all supporting documentation required. We will assess your claim against your cover, but reimbursement is not guaranteed. The healthcare provider may also require payment up front if they do not have prior approval confirmation from us.
If you are claiming for items under a reimbursement-only plan such as GP visits, dental or optical appointments, these need to be paid upfront by you and then you submit a claim for reimbursement.
I've changed my Health Plan; do I need a new prior approval?
Your prior approval is issued based on the Health Plan we expect you to be holding on the date of the treatment or procedure. If you change your Health Plan in the meantime, you should request a new prior approval as your benefit limits and entitlements might have changed.
I've changed healthcare provider, or I'd like to go to a different hospital. Do I need a new prior approval?
If there are any changes to your healthcare provider or the facility you will go to, you can request a new prior approval be issued. This is especially important if there are changes to any costs or the type of procedure or duration of stay.
I have received invoices for my surgical procedure, what do I do with them?
Usually, the specialist and hospital will send their invoices directly to us, but sometimes they send them to you. As soon as you receive an invoice, send it to us together with your full name, DOB and (if you know it) membership number. We can then pay the invoice directly so you don’t have to pay and then claim. Don’t hold on to invoices for too long as the healthcare provider might start to chase you for payment!
My prior approval letter shows that I must pay some of the costs myself. Why is this?
There are a few reasons that you might have to pay some of the costs; usually it is because you have an excess on your policy or the benefit limits have been reached. There might also be amounts relating to things we don't pay for, such as crutches or appliances.
In some cases, the shortfall could relate to the cost of the procedure being more than the cost which we consider to be “reasonable charges”. In this case you can choose to see a different healthcare provider, or you can pay the difference yourself
How does the excess work?
The excess is the amount of money you need to pay towards the total cost of any claims you submit. We offer different excess options on Health Plans that can help to make your premiums more affordable. The higher the excess, the lower your premium.
When you request prior approval our confirmation letter will include how much excess – if any – you’ll need to pay.
Who do I pay my excess or shortfall to?
Your excess or shortfall is payable directly to the healthcare provider(s) and/or hospital or facility. You will receive an invoice from them after we have made our payment to them.
Why do I have to provide a referral or specialist letter with my prior approval/claim?
A referral letter is the letter that your GP (or referring practitioner) sends to a specialist to explain the medical reason why you are being referred to them.
A specialist letter is a letter from your specialist that provides the details of your specialist consultation and why this was required. This will usually include any relevant medical history or concerns and enables us to assess your request for prior approval or your claim.
When is a medical report required?
A medical report is completed by the GP who holds your medical history and allows us to assess your claim or prior approval and ensure that any symptoms you are experiencing were not present prior to the start date of the policy and therefore deemed as a pre-existing condition. A medical report is usually required for prior approvals or claims made in the first five years of your policy – we’ll let you know if one is needed.
Can I choose any private hospital or specialist, or do you have specific providers that I must use?
Yes, you can choose whichever private hospital or specialist that you would like, however, they do need to be a registered Medical Specialist with the Medical Council of NZ.
What happens if my claim is declined?
There are several reasons a claim may be declined, the most common are:
- The treatment or illness in question is not covered by your Health Plan
- The treatment or illness is for a pre-existing condition or personal exclusion so it is not covered, including something that is deemed to be pre-existing to the policy start date and was not disclosed at the time of application
- You have reached the maximum benefit entitlement under your Health Plan.
If we do decline a claim, we always offer you the option to submit a formal request for review along with supporting medical information.
