Claiming with Aviva

In Patient Claims

As we currently have direct payment agreements with all of our listed hospitals don’t worry we’ll settle the bill directly for all eligible costs under your plan.

All you’ll need to do is complete and sign a Aviva claim form, given to you by the hospital, which asks questions such as personal information and history of illness.

If you’re ever in any doubt about whether you’re covered for any procedure in particular just call us on 1850 717 717 before receiving any treatment. We’ll make it clear from the outset your exact cover for the procedure you need. Don’t forget to have your membership number ready when you call.

Maternity claims

In patient: Claiming for an in patient maternity stay in hospital, whether it’s for a natural or c-section birth follows the same process as other in patient benefits detailed above.

Unique maternity benefits: The claims process for these benefits listed below take a different approach. Remember that waiting periods apply to some maternity benefits* before you can make a claim for them. Eligible claims are processed on receipt and you don’t have to wait until the end of your policy year to do so - this excludes breastfeeding consultancy and partner benefit which you can claim for at the end of your policy year.

• Cord blood stem cell preservation: Medicare provides a claim form to all Aviva members on receipt of final payment. This claim form needs to be completed and submitted to Aviva no later than 60 days after final payment.
• 4D scans: The providers give all health members with Aviva a claim form on the day of the scan. Fill out the form and send it on with your receipt to us.
• Post natal home help: We settle directly with the provider. All you need to do is sign a time sheet to confirm the hours worked by the PNHH.
• Doula services, Breastfeeding consultancy and Partner benefit: For these benefits you need to keep your receipts, call our customer service team to register the claim and then send in your receipts to us.

*Waiting periods apply to all unique maternity benefits except 4D scans.

If you incur pre/post natal care costs then these expenses are covered under your out patient benefits and follow the same claiming process as all other out patient benefits.

To understand the in patient benefits covered by your health insurance plan with Aviva just look to our health plans section or view our membership handbooks. They detail each benefit covered and the contributions we provide towards them.

Out Patient Claims

At the end of your policy year you just need to call us to register your claim. After this, send us in your clearly marked original receipts to make sure you’re reimbursed for all eligible treatment.

For all out patient benefits you must pay the provider directly. Remember to keep all of your receipts stored in a safe place!

The overall maximum amount of benefits per policy year on out patient costs is €4,000 including out patient scans. Here is an example of how to calculate your excess.

To understand the out patient benefits covered by your health insurance plan with Aviva just look to our health plans section or view our membership handbooks. They detail each benefit covered and the contributions we provide towards them.

If you’ve chosen to add on cover for day-to-day expenses to your plan then you’ll also receive cover under your day-to-day 50 plan for some out patient benefits, which you don’t pay an excess on. The claiming process is the same as for all out patient benefits. You can't claim for both but we'll always process your claim on the basis of the most appropriate option for you.

Overseas Treatment

Aviva is delighted to offer this benefit to our members. Please remember that all procedures carried out outside of Ireland must be pre-authorised by Aviva in advance of travelling abroad.

Overseas pre-approval form

Member benefits

We’ve now made it even easier for you to access many of the member benefits on your plan. Simply present your Aviva health membership card to receive your discount off the benefits below:

• Teeth Whitening
• Orthodontics
• Laser Eye Surgery
• Health Screens with EHA & Charter

Please note that discount can only be processed once treatment is complete and final payment has been made. To understand the lifestyle benefits covered by your health insurance plan with Aviva just look to our health plans section or view our membership handbooks. They detail each benefit covered and the contributions we provide towards them.

Day-to-day claims

For all day-to-day claims you pay the provider/doctor directly. Remember to keep all of your receipts stored in a safe place!

At the end of your policy year you just need to call us to register your claim. After this, send us in your clearly marked original receipts to make sure you are reimbursed for all eligible treatment.

Remember, if you have a day-to-day 50 plan some benefits such as consultant’s fees and pathology and radiology costs are also covered under your out patient benefits. Claiming for these is the same as for all out patient benefits. You can't claim for both but we’ll always process your claim on the basis of the most appropriate option for you.

To understand our day-to-day benefits just look to our health plans section or view our membership handbooks. They detail each benefit covered and the contributions we provide towards them.

Waiting Periods

It’s really important to understand your waiting periods as they may affect your ability to claim. Don’t forget that there are no waiting periods for accident or injury or lifestyle benefits. So remember the following:

1. If you have served waiting periods
If you have already completed your waiting periods, for the benefits highlighted in the table below, with us or another Irish health insurer (with a break in cover of less than 13 weeks), you can make a claim immediately for these benefits.

2. If you haven’t served waiting periods
If you haven’t completed all of your waiting periods, are brand new to health insurance, or have had a break in cover of more than 13 weeks, then waiting periods apply for the benefits listed in the table. These waiting periods are standard across the industry. This means that until you serve your waiting period for a benefit you can’t make a claim for it.

3. If you’ve switched
Aviva has many unique benefits not available with any other insurer. So if you’ve switched your health insurance to Aviva then it’s important to remember that you may have to serve waiting periods on any new benefits that you didn’t have on your previous plan. For e.g. our unique maternity benefit of Doula services is not available with another health insurer and so a waiting period of 42 weeks will apply. Again, this means that until you serve your waiting period for a benefit you can’t make a claim for it.

4. If you’re upgrading
If you’re upgrading your cover, from a Aviva or a competitor plan, then you’ll have to wait 2 years (5 if over 65 years of age) to access any extra benefits for a condition which existed before you took out a higher level of cover. Your cover for these benefits increases when the exclusion period is completed.

Full details of claiming and waiting periods are available in our membership handbooks and can also be found under how to use your plan in our individual & family section. Or you can always call our dedicated customer support team on 1850 717 717.