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Cashless access is a feature of your health insurance policy that lets you receive outpatient treatment (e.g. a doctor visit, a specialist consultation) without paying for it from your own pocket. Instead, the clinic where you receive the treatment sends us the bill.
The cashless access to outpatient treatment service (in what follows, we’ll refer to the service as the cashless service) is a free option on your health insurance policy that lets you receive eligible outpatient treatment (e.g., doctor visits, specialist consultations) without paying for it from your own pocket.
By ‘eligible outpatient treatment’, we mean treatment that your health plan covers—subject to the terms and conditions of your policy.
Your use of the cashless service is made possible by your membership card. Simply present your membership card at a clinic in our network, and you’ll only need to contribute your excess (if you have one on your policy) towards the cost of eligible outpatient treatment that you receive. We’ll settle your medical expenses directly with the clinic.
The clinic may need to pre-authorise your outpatient treatment before treating you. Here are the cases in which our pre-authorisation is necessary:
We recommend that you contact us before you receive any outpatient treatment. Once we’ve confirmed your coverage, we’ll send you a letter confirming our pre-authorisation of the treatment. You can show at the clinic. Alternatively, you can attend the clinic directly and the clinic staff will contact us for pre-authorisation.
If the treatment you’re seeking is not eligible for cover, or if there’s insufficient information for us to confirm your coverage, we won’t provide pre-authorisation and you won’t be able to receive the treatment using the cashless service.
You, and any dependants on your policy, must only use your membership card(s) for eligible outpatient treatment. By applying for and making use of the cashless service, you agree to indemnify William Russell and the insurers in respect of any ineligible outpatient treatment that you receive. If you’re an employer, and your employees and their dependants have access to the cashless service, you agree to indemnify William Russell and the insurers of in respect of any eligible outpatient treatment that they receive.
If you’re in any doubt about whether you’re eligible for a certain type of outpatient treatment, you should contact us before you receive it. It’s very important that you, and any dependants on your policy, understand this obligation. If you’re an employer, it’s very important that your employees and their dependants understand this obligation.
If you, or any dependants on your policy, present your membership card for ineligible outpatient treatment, you’ll be liable for the expenses you incur. The situation could arise, for example, if:
If we discover that you’ve received ineligible outpatient treatment using our cashless service, we (or the clinic) will contact you and ask you to repay the ineligible expenses. If you fail to repay these expenses, we’ll cancel your access to the cashless service and we reserve the right to take legal action to recover the ineligible expenses from you.
We’ll also cancel your access to the cashless service if you, or any dependants on your policy, receive ineligible outpatient treatment on more than on occasion—even if you repay the ineligible expenses.
If we cancel your access to the cashless service, you must return your membership card and those of any dependants on your policy, and you’ll need to submit future claims for outpatient treatment for consideration by our claims team.
If you wish to cancel your health insurance policy, you must return by post your membership card and those of any dependants on your policy. Once we’ve received your memberships card(s), we’ll confirm with the clinics in our network whether you’ve made any claims on your policy.
If you, or any dependants on your policy, have made a claim in your current policy year, we won’t refund your unused premium. If you, and any dependants on your policy, have not made a claim in your current policy year, we’ll issue a pro rata refund for your unused premium.
If you’re an employer, and your employees and their dependants have access to the cashless service, you must return by post the membership cards of all employees and their dependants. Once we’ve received the memberships card(s), we’ll confirm with the clinics in our network whether your employees and their dependants have made any claims on your policy. If any employee, or any of their dependants, have made a claim in your current policy year, we won’t refund your unused premium. If any employee, or any of their dependants, have not made a claim in your current policy year, we’ll issue a pro rata refund for your unused premium.
If you, or any dependants on your policy, lose or damage your membership card, or if a membership card is stolen, we’ll charge you US$10 to provide a replacement.
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