The Pathology Benefit Explained

Pathology
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Get Unlimited Basic Blood Tests

1 Month Waiting Period
Single Benefit Level
Nationwide Network

Your network doctor might need to take a look at your blood. The Pathology benefit gives you unlimited basic blood tests for out-of-hospital events.

Pathology is part of the Day-to-Day Plan with cover for all of this and more.

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What is Covered?

The Pathology Benefit is designed to cover the most common blood tests required by your network doctor or specialist.

The benefit is unlimited which means that it can be used as many times during the year as is medically needed.

Note that your doctor may require more advanced tests that are not on the formulary and which will not be covered. We do not interfere with the treatment plans of the medical providers.

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What Is On the Formulary?

The blood tests covered is a wide range and is actively maintained annually by the product administrators. For this reason it is not practical to publish the list online.

Your network doctor can advise you on what is covered under your benefits but if you are unsure you can always ask us to assist.

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Answers to Your Questions

What does "unlimited" benefit mean?

When a health insurance benefit is "unlimited" it means that the benefit can be used as many times as you need without any specific annual limits.

The only conditions are that the claim or consultation is medically necessary.

Unlimited benefits are usually managed. This means that pre-authorisation is needed after a certain number of times that the benefit is used to ensure that it is you utilising the benefit and that you are getting the proper care that you deserve. You can find more details on the Network page.

What is the Pathology benefit waiting period?

The waiting period on the Pathology Benefit is 1 month.

This means that after the first month of your policy's inception, you can use the benefit.

Where I can find the network pathologists?

There is no network for pathology providers. You can use any practice as long as you have a referral from a network doctor. The Network page has all the information needed.

How are claims paid?

Claims are paid directly to the medical providers. You can find all the details on our claims page.

What are the age limits?

All new members joining a policy must be younger than 65 years on date of application.

Child dependants must be younger than 21 years before they will need to start their own policy.

However, if your child is still a registered full-time student and unmarried, then they may stay on the policy as a child dependant until they turn 26.

How many people can be on a policy?

Episodic health insurance policies can include:

  • you
  • your spouse/partner
  • up to 6 children