AIA Specialist and Testing Support: What Does It Cover?
Sometimes getting a diagnosis starts with seeing the right specialist or having the right test. AIA's Specialist and Testing Support Benefit is designed to help with eligible private specialist consultations and diagnostic testing without requiring comprehensive private health cover.
AIA's Specialist and Testing Support Benefit can help cover eligible specialist consultations and diagnostic imaging or tests carried out in New Zealand, subject to referrals, medical necessity, policy limits, reasonable charges, exclusions and other policy conditions.
Sometimes the First Challenge Is Finding Out What's Wrong
When health changes, treatment is not always the first step. Before a treatment plan can be made, you may need a specialist consultation, diagnostic scan or other investigation.
Depending on the test required, accessing private diagnostic services can involve significant costs.
AIA describes Specialist and Testing Support as a way to access eligible specialist consultations and diagnostic testing without necessarily purchasing comprehensive private medical insurance.
This is primarily diagnosis-focused cover. It should not be confused with comprehensive Health Insurance that may also cover eligible surgery, hospital treatment and broader private medical costs.
What Does Specialist and Testing Support Cover?
AIA's current policy wording contains four main benefit areas.
Specialist Consultations
Up to $10,000 per policy yearCovers medically necessary consultations with a specialist when referred by a registered medical practitioner, subject to the policy terms.
Diagnostic Imaging & Tests
Up to $100,000 per policy yearCovers specified medically necessary diagnostic procedures at an approved facility when referred by a registered medical practitioner.
Pregnancy, Maternity & Infertility
Up to $1,500 per policy yearAfter two years of continuous cover, eligible costs can include obstetric care, scans, infertility diagnosis and treatment, and certain accommodation costs. Pregnancy and maternity claims are also limited to $1,500 per pregnancy.
Health Screening Allowance
$500 or $750 with AIA VitalityAvailable after the required continuous-cover period for specified health screening procedures. A shorter qualifying period and higher allowance apply where the life assured is an AIA Vitality member.
What Types of Diagnostic Tests May Be Covered?
AIA's current policy wording lists a broad range of eligible diagnostic procedures where the policy requirements are met.
Examples include:
The policy wording contains the full list, and other diagnostic imaging or testing may also be considered subject to AIA's prior approval.
How Is This Different From Full Health Insurance?
Finding the problem and treating the problem are not the same thing.
Specialist and Testing Support primarily focuses on eligible specialist consultations, diagnostic procedures and the additional allowances described in the policy.
Comprehensive private Health Insurance can provide much broader protection, potentially including eligible surgery, hospital treatment and other medical benefits depending on the policy selected.
For example, someone may use Specialist and Testing Support to obtain an eligible private specialist consultation and diagnostic test, then use the public health system for treatment if further care is required.
Neither option is automatically better. The right level of health protection depends on what you want insured, your budget, existing cover and the financial risk you are comfortable retaining.
What About Preventive Health Screening?
The normal Specialist Consultation and Diagnostic Imaging benefits generally require medical necessity.
The Health Screening Allowance works differently. Once the applicable continuous-cover requirement has been satisfied, certain screening procedures can be covered even when they are not medically necessary.
Eligible screening can include:
Under the current wording, this allowance becomes available after three years of continuous cover, or after two years where the life assured is an AIA Vitality member. The allowance is $500 for each three-year period, or $750 for an AIA Vitality member.
How Does the Excess Work?
AIA currently offers a choice of a $0 or $250 excess.
The excess applies separately to each life assured and resets at the beginning of each policy year.
Once the full applicable excess has been paid for that person in the policy year, further eligible claims in that same policy year do not have another excess, unless a particular benefit says otherwise.
Some benefits are specifically excess-free. The current Pregnancy, Maternity and Infertility Allowance and Health Screening Allowance do not have an excess.
How Does Prior Approval Work?
AIA recommends seeking prior approval as soon as you know a specialist consultation or diagnostic test may be required.
Get Your Referral
The relevant consultation or test generally needs to be referred by a registered medical practitioner and meet the policy requirements.
Request Pre-Approval
Provide AIA with details of the planned service, estimated cost, referral letter and any relevant clinical information requested.
Understand What's Covered
If approved, AIA confirms the pre-approval and identifies any costs that remain your responsibility.
AIA states that it needs at least five working days to issue prior approval. If you use a provider within AIA's Healthcare Partnership Programme, the provider can manage the relevant approval and claim information with AIA on your behalf.
Does AIA Always Pay the Full Provider Charge?
Not necessarily.
AIA pays covered costs based on what it considers to be reasonable charges, subject to the relevant maximum benefit.
If a healthcare provider proposes a cost above AIA's reasonable charge, AIA may try to negotiate a lower amount or discuss alternative providers.
If you choose to proceed with a provider charging above AIA's reasonable amount, you may need to pay the difference yourself. This is another reason prior approval can be valuable.
What Doesn't Specialist and Testing Support Cover?
Like all insurance, Specialist and Testing Support has exclusions and limitations. It is important not to assume that every specialist appointment, screening test or diagnostic procedure will be covered.
Examples of important limitations include:
Other exclusions also apply, so the complete current policy wording should be reviewed before relying on any specific benefit.
What If the Test Is Needed Because of an Accident?
The interaction with ACC is important.
AIA's policy states that costs arising from accidents or injuries that ACC is legally responsible for should be submitted to ACC first.
Depending on ACC's decision and the policy conditions, AIA may consider certain additional eligible costs.
For accident-related investigations, don't assume the AIA policy is the first payer. ACC requirements and AIA's prior-approval rules need to be considered.
Who Might Consider Specialist and Testing Support?
This type of cover may appeal to people who place a high value on private access to specialist consultations and diagnostic testing but do not necessarily want the cost or broader protection of comprehensive private medical insurance.
It may also form part of a wider protection plan alongside Life, Trauma, Income Protection or other personal insurance.
It should not be chosen purely because the premium is lower than comprehensive Health Insurance. First consider which medical costs you actually want to insure and which costs you would be comfortable funding yourself or relying on the public health system for.
Frequently Asked Questions
Is AIA Specialist and Testing Support full Health Insurance?
No. It is focused primarily on eligible specialist consultations, diagnostic imaging and testing, plus specified allowances. Comprehensive AIA Private Health cover provides broader medical benefits, depending on the policy selected.
How much specialist consultation cover is available?
Under AIA's current policy wording, the maximum Specialist Consultation benefit is $10,000 per life assured per policy year.
How much diagnostic testing cover is available?
The current maximum for eligible Diagnostic Imaging and Tests is $100,000 per life assured per policy year.
Does every test need to be medically necessary?
The core Specialist Consultation and Diagnostic Imaging benefits generally require medical necessity. The Health Screening Allowance is different: the eligible screening does not need to be medically necessary once its qualifying conditions have been met.
Can pregnancy costs be covered immediately?
No. The current Pregnancy, Maternity and Infertility Allowance requires two years of continuous Specialist and Testing Support cover before the benefit is available.
Do I need prior approval?
AIA recommends seeking prior approval so you can understand eligibility and any costs you may need to pay before the service takes place. Different arrangements apply where an AIA Healthcare Partnership Programme provider manages the process on your behalf.
Specialist testing or comprehensive Health Insurance — which suits you?
Our advisers can help you understand the difference between diagnostic-focused cover and broader private Health Insurance, compare your existing protection and discuss options that reflect your needs and budget.
Book a Complimentary ReviewThis article provides general information only and is not personalised financial or medical advice. It describes selected features of AIA's Specialist and Testing Support Benefit based on current publicly available policy information. Benefits, limits, reasonable-charge requirements, exclusions, eligibility criteria and policy terms may change. Please refer to the applicable AIA policy wording and obtain personalised financial advice before arranging or changing insurance.