Claiming for CT/MRI/PET Scans
Members on Basic and Comprehensive plans can have CT, MRI and PET scans arranged with the provider for direct payment.
Surgical Plan Cover
If you are on our Surgical plan and need a scan to determine whether you need surgery, you will need to pay for the scan. If the scan leads to surgery, and Health Plan approves cover for the procedure, you can be reimbursed for the costs within 4 months of the scan taking place .
How to apply
Once you have your scan booked, complete the Surgical Approval Form form.
Ensure you complete all of the details, including contact details for the health care provider carrying out your scan.
- Open the 'editable online' pdf using either Chrome or Internet Explorer internet browsers for best results
- SAVE it to your computer before you complete the form so you don’t lose your details
- Complete the form, save again, then send the completed form and any receipts and invoices to us (see details below).
Email to firstname.lastname@example.org:, along with any receipts, as attachments (jpeg, png or PDF). Emailing your form means you don't need to post it to us as well.
Please note when scanning your forms and receipts, ensure the documents don’t cover any important information on your other documents.
Process after form is submitted
Our Health Plan team will contact the provider directly to allow them to send the invoice directly to us, if you receive an invoice please send this through to us for payment. This will be deducted from your annual allowance for CT, MRI, PET scans (unless within 4 months of a surgical procedure we have approved) If there is a shortfall on your cover you will be notified of the shortfall amount and where to pay this to after Health Plan has paid their portion. Annual allowances are as follows:
For Basic cover:
CT & MRI Scans: 80% of up to $1,600 per claims year
PET Scans: 80% of up to $2,000 per claims year
For Comprehensive cover:
CT & MRI Scans:100% of up to $2,000 per claims year
PET Scans: 100% of up to $2,500 per claims year
The benefit year runs from 1 July to 30 June.
If you have Basic Cover, or your scan costs more than the maximum amount that you are covered for, we will confirm where to pay the shortfall once we have received the invoice from the provider and have paid Health Plan’s portion of the cost.