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How to make a health insurance claim

It’s simple to make a claim or arrange prior approval for a treatment with ASB health insurance. What’s more, a dedicated claims team will be on-hand to help, whenever you need it.

01

How to claim

To speed up the process of claiming on your ASB health insurance, you’ll deal directly with Sovereign, which underwrites ASB health insurance.

There are several ways to make a claim. The easiest way to make a claim is to use the online claim form (this can’t be accessed from mobile) or download and complete this form and return it to Sovereign.

If you have any questions, please call 0800 272 543 or +64 9 487 9000 if you’re overseas.

02

Requesting prior approval

Prior approval lets you know you’ll be covered before starting treatment. It also means Sovereign will pay your providers directly (subject to any policy excess).

Your prior approval is valid for six months from the date it is issued.

The alternative to obtaining prior approval is that you pay the costs yourself and then submit a claim form. If you do this, you’ll need to provide itemised receipts to support your claim.

Please note, prior approval is required for some benefits. Please refer to your policy documents for further information or call us on 0800 272 543.

The prior approval process

You can request prior approval using the same process as you do for making a claim.

The easiest way to make a claim is to use the online claim form (this can’t be accessed from mobile) or download and complete this form and return it to Sovereign.

You should do this at least five working days before the procedure. Please include the following with your application:

  • Either a medical certificate completed by your medical practitioner, or a referral letter containing the date of the first consultation, history of the condition, and treatment received.
  • If it’s a claim that ACC has accepted or declined, you’ll also have to include a copy of the letter from ACC. If you don’t send a copy of this letter there may be a delay in assessing your claim.
  • An estimate of costs.

Scanned copies

If you’re submitting your request online or via email, just send scanned copies of these documents. Your prior approval is valid for six months from the date it is issued.

03

Claiming after your treatment

If you’ve already had your treatment you can still claim. There are several ways to make a claim. The easiest way to make a claim is to use the online claim form (this can’t be accessed from mobile) or download and complete this form and return it to Sovereign.

You'll need to include:

  • Either a medical certificate completed by your medical practitioner, or a referral letter containing the date of your first consultation, the history of the condition and treatment received.
  • If it’s a claim that ACC has either accepted or declined, you’ll also have to include a copy of the letter from ACC.
  • Any receipts or invoices for the treatment. Sovereign will either reimburse the provider directly, or reimburse you by direct credit to your bank account.

If you're submitting your request online or via email, just send scanned copies of these documents with your claim form.

04

Listing symptoms or conditions on your claim form

Prior to assessing claim, Sovereign will check that the symptoms or condition that you’re claiming for are covered in your policy, and not related to a pre-existing condition or a policy exclusion, for which you are not covered.

To make sure this can be done as quickly as possible, please complete your claim form with the details of the symptoms or condition that required you to contact your doctor. Any information you provide will be treated as strictly confidential.

05

Paying your excess

Provided your claim is approved or accepted, Sovereign will pay for your treatment, but you’ll be responsible for paying the policy excess. The excess you’ll pay will be detailed in your policy document.

If your treatment is being performed by one of our Healthcare Partnership Programme partners they will take care of the prior approval and claiming process, including submitting estimates and invoices, so you can focus on getting well.

06

Accidents and ACC

In New Zealand, the Accident Compensation Corporation (ACC) scheme is the primary insurer for any treatment relating to an accident. ACC will help cover medical and treatment fees as well as rehabilitation costs for most injuries. So if you have an accident at work, at home or on the ski slopes (or anywhere else), you should contact ACC first.

However there are exceptions. Should ACC decline your claim, you can still claim on your ASB health insurance. You will need to send Sovereign a copy of the letter from ACC together with your claim form. If ACC is paying part of your claim, Sovereign may be able to top it up, so send a copy of your letter from ACC outlining their contribution to the treatment.

Make a claim

Make an online claim

Complete and submit your health insurance claim online.

Claim online

Download the form

Download and send a completed version of claim form to:

Email: healthclaims@sovereign.co.nz
Fax: 09 487 8003
Post: Sovereign House, 74 Taharoto Road, Takapuna, Auckland 0622.

Download form

The information contained here is general in nature and is not intended to be advice. If you require advice about your particular circumstances, we recommend that you speak with your ASB Insurance Manager. ASB life, health and disability insurances are underwritten by Sovereign Assurance Company Limited (“Sovereign”). For full details refer to the relevant policy document which is available on request from any ASB branch or by calling 0800 200 252. The availability of insurance cover is subject to your application being approved. Special conditions, exclusions or premium loadings may apply. See further information about Sovereign.

Health insurance How to make a health insurance claim