Disclosure Asia Pacific

Important notes

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Quotations are valid for 30 days subject to the above details remaining the same and is issued in accordance with Now Health International plan terms, conditions and exclusions.

Please note that we cannot start your plan until we have accepted your application and received payment of your first premium. The premiums quoted have been calculated based on each person’s age at the date of the quotation. Premiums may be subject to change if the age of any person increases prior to the actual start date of your Now Health International plan. The premiums quoted have been based on your Body Mass Index being within normal limits.

By signing this application form you consent to the processing and transfer of information (including sensitive information) described in this notice. Without this consent we will not be able to consider your application.

If you have used an authorised insurance broker you understand, acknowledge and agree that by buying this plan, we will pay the authorised insurance broker commission during the life of the plan including renewals. you also understand that this agreement is necessary for us to proceed with your application.

Declaration and authorisation
I hereby apply for cover on behalf of all the persons named in this application form for a Now Health International plan as specified above.

I have received and read the benefits schedule, terms and conditions, definitions, benefits and exclusions of this plan. I understand that the application form, certificate of insurance, schedule and the members’ handbook incorporating the plan terms and conditions make up the contract between us and all form part of the plan agreement. I am aware that cover shall be provided in accordance with the agreement.

  • I declare that the information given in this application is true and that disclosure in respect of each person included in this application is complete, even if some of the information provided is not in my own handwriting. I understand it is unlawful for me or my dependants to knowingly provide false, incomplete or misleading facts or information to Now Health International for the purpose of defrauding or attempting to defraud Now Health International. Penalties may include imprisonment, fines, denial of coverage, rescission of benefits and legal damages.
  • I understand that I must notify Now Health International of any changes in the facts contained in this application form, such as a change in the state of health of any person named in it.
  • For the purpose of this application I authorise any doctor who has ever treated or advised any of the persons named in this application to provide Now Health International with any information they may require in connection with treatment related to any claim under this plan. I have discussed the terms of this authorisation with my partner and competent adult dependants, and I have obtained their consent to the release of their healthcare information pursuant to this authorisation.
  • If I have indicated that I wish to pay by credit card, I authorise Now Health International to debit my account with the appropriate premiums on or before their due dates, and all subsequent renewal premiums due as invoiced by Now Health International until I give written notice that I wish to terminate this agreement.
  • I understand that Now Health International cannot be liable and therefore will not pay claims if my plan is lapsed should Now Health International be unable to collect my premium for whatever reason and I do not provide Now Health International with an alternate method of payment within seven days of Now Health International requests for alternative methods of payment.
  • I agree that where medical treatment is received within the provider network by me or any of my dependants and, except where previously agreed by Now Health International, it is determined that the treatment or medical condition is not refundable within the terms and conditions of the plan, I agree that I am liable to Now Health International for all claims settled for such medical treatment in connection with any non-covered claim.
  • I understand and confirm that where I have not repaid funds disbursed in good faith by Now Health International in respect of non-covered medical treatment, valid claims may be offset against outstanding funds due to Now Health International and/or plan may be suspended until the outstanding amounts have been settled in full.
  • I acknowledge that if it is determined by Now Health International that a claim was fraudulent my plan may be terminated with immediate effect.
  • I have read the important notes.
  • I agree to the declaration above and understand that cover is provided in accordance with the terms and conditions of the Now Health International plan.
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