Here are the key changes to your UltraCare policy that took effect on 22 October 2024. Please read them carefully so you understand the changes that are being made to your policy.
This information is to help you understand the changes to your plan. Your health insurance policy is made up of a number of documents, including your membership certificate and the policy document. Together all these documents, outline your cover.
You should check your membership certificate to see if you have cover for pre-existing conditions under any previous Southern Cross plans and select those plans to view changes that might affect your cover. Important documents and links below.
A new list of policy variations is being introduced and will form part of your policy.
This list sets out variations to policy terms and conditions that may apply from time to time. These variations include the way we treat some exclusions (as listed in the policy document) and certain benefit terms, or new ways of delivering healthcare services we’re testing. This may mean you can access additional cover while these variations are included on the list of policy variations.
The list of documents that form part of your health insurance policy is being updated.
Your application form, any health insurance medical declarations and the list of policy variations are included in the list of documents that form part of your policy.
We’re changing how we communicate changes to certain documents that form part of your policy.
This means you may not receive direct communications for all changes, and you’ll need to refer to our website for the latest versions of the following information: the eligibility criteria, the list of unapproved healthcare services, the list of Prostheses and Specialised Equipment, and the list of policy variations.
The financial strength rating summary is being updated – no changes to Southern Cross Health Society’s financial strength rating.
To reflect the updates made by our rating agency, we’re removing the ‘R’ (Regulatory Action) and ‘NR’ (Not Rated) ratings from the financial strength rating summary and updating the web address to spglobal.com/ratings/en/about/intro-to-credit-ratings.
References to the Southern Cross Medical library are being removed.
The Medical library on our website is no longer available so any references to it in the policy document are being removed.
References to ‘DHB’ have been updated to ‘Health NZ Te Whatu Ora’.
‘DHB’ was an abbreviation for District Health Board. These have been disestablished. Health New Zealand Te Whatu Ora is the relevant national health entity.
The exclusion for illnesses, injuries, conditions or disabilities related to intoxication is being removed.
The exclusion for substance abuse, intoxication or drug taking has been revised to focus only on the abuse of substances such as alcohol or drugs, rather than intoxication on its own.
Unclaimed monies.
We’re extending the length of time we will hold unclaimed monies for you from 2 years to 4 years.
The 3 month stand-down period for adding newborns without the need to complete a health insurance medical declaration is being removed.
Newborn children can be added without underwriting, provided they were born after the policy start date and the policyholder adds the child within 3 months of the child’s birth date.
Removal of requirement to disclose if your surgical procedure requires a registered nurse first surgical assistant.
When you apply for prior approval, you won’t need to let us know if a registered nurse first surgical assistant will be required as part of your surgery. But you’ll still need to let us know if your surgery requires more than one surgeon, including an assistant surgeon.
The policy exclusions section is being revised to make it clearer.
This includes adding examples to help understanding, removing words where they do not change the meaning, updating terminology and combining some exclusions under the same heading where appropriate.
Exclusion for administrative charges.
Administrative charges are not covered by your policy. A specific exclusion will be added to clarify this.
Clarification on membership certificate and policy document information.
We’re including wording to clarify that if information on your membership certificate contradicts what’s stated in your policy document, the information on your membership certificate takes precedence over the policy document.
Cover under the Obstetrics allowance.
Cover is only for members who receive obstetric care and services directly. It excludes cover for accommodation costs for any support person.
Exclusion for transfusion or injection of autologous blood or blood products.
The exclusion for transfusion or injection of autologous blood or blood products does not apply when used as part of eligible chemotherapy treatment.
Pre-existing conditions exclusions.
The exclusion for pre-existing conditions does not apply to healthcare services covered under the Day-to-day treatment benefit or the Vision and dental benefit.
Cover under the Day-to-day treatment benefit for general practitioner services and nurse services.
Consultations or treatment performed by a nurse at a general practice clinic are covered under general practitioner services to the higher limit of $100 each visit, rather than the limit for nurse services ($30 each visit). If you receive both general practitioner and nurse services during the same visit at a general practice clinic, this will be treated as one visit for the purposes of the general practitioner services policy limit.
Cover for second opinions under the Specialist consultations benefit.
The Specilalist consultations benefit includes cover for obtaining a second opinion regarding a diagnosis or treatment plan from another specialist.
Surgical procedures benefit covers Major diagnostic procedures.
Major diagnostic procedures are covered under the Surgical procedures benefit, including angiograms and endoscopies.
Cover for less invasive procedures and medical treatment.
Cover is available under the Surgical procedures benefit for some less invasive procedures and medical treatments if a specialist considers it more appropriate for your condition.
Underwriting requirements for adult dependants taking out their own policy.
Adult dependants who apply for their own Southern Cross health insurance policy within 1 month of being removed from an existing policy do not need to complete a new health insurance medical declaration if they’re applying for the same or a lower level of cover.
Impact of policy changes on claims year.
Any changes you make to your policy may reset your claims year.
Impact of changes to payment method or frequency on the policy anniversary date.
Changing the payment method or payment frequency may, but will not always, change your policy anniversary date. We advise you to check the policy anniversary date on your new membership certificate if you make any changes.
Updates to Gastric banding/bypass allowance.
The following procedures will be listed under this allowance: endoscopic sleeve gastroplasty, single anastomosis duodeno-ileostomy with sleeve (SADI-S), sleeve gastrectomy, Roux-en-Y and mini gastric bypass.
Termination of Southern Cross membership.
A policyholder’s death is one of the reasons their membership may be terminated. When a policyholder’s membership is terminated, the policy will terminate and the membership of any dependants will also end.
Correction of General Practitioner definition
Correction of the definition for General Practitioner by adding the word ‘or’.
Disclosing pre-existing conditions.
If you haven’t disclosed a pre-existing condition on the application form or relevant health insurance medical declaration, we may decline any cover for healthcare services relating to the pre-existing condition, subject to the policy terms regarding cover of pre-existing conditions after 3 years of continuous cover.
Application of the family history of cancer exclusion under Cancer Cover Plus.
Only the specific cancer which you have a family history of is excluded for cover under Cancer Cover Plus.
Clarification of the term 'Medsafe-Indicated'.
Clarification of the term ‘Medsafe-indicated’ when used in the Chemotherapy for cancer and IV infusion (non-cancer) benefits and Cancer Cover Plus.
Examples of general practitioner minor surgeries.
The removal or resection of ingrown toenails, steroid or cortisone injections and abscess drainage will be added as examples of procedures covered under the GP minor surgery benefit.
Cover for work-related gradual process injuries.
References to work-related gradual process injuries will be included in the Accident and treatment injury top-up benefit.
Terminology under the Accident and treatment injury top-up benefit.
The reference to ‘annual limits’ will be changed to ‘policy limits’ to reflect that different types of limits may apply for example limits per operation, procedure, item, day, lifetime or annual limits.
Your responsibility under the Accident and treatment injury top-up benefit.
The existing requirement to do everything you reasonably can to obtain ACC approval for payment of the cost of any healthcare services which may be covered by ACC, includes signing all necessary documents.
Explanation of the phrase ‘highly increased risk of developing a disease’ under the Prophylactic treatment allowance.
Wording from the existing eligibility criteria will be included in the policy document to increase awareness of what we consider when deciding if you have a ‘highly increased risk of developing a disease’ for the purposes of this benefit.
Update to the definition of eligibility criteria in the Glossary of terms.
The reference to ‘procedure’ will be replaced with ‘healthcare services’ as ‘procedure’ was not sufficiently inclusive.
Removal of unnecessary definitions from the Glossary of terms.
The definitions for ‘lifetime’ and ‘allowance’ will be removed from the Glossary of terms.
Some of these may have already been approved for cover. You can call us to check.
Southern Cross Medical Care Society (trading as Southern Cross Health Society) is a licensed insurer and a licensed financial advice provider. For more information about the financial advice service we provide and a copy of our public disclosure statement please visit southerncross.co.nz/disclosure-statement.
Southern Cross Medical Care Society (trading as Southern Cross Health Society) has an A+ (Strong) financial strength rating given by Standard & Poor’s (Australia) Pty Limited. The rating scale is: AAA (Extremely Strong), AA (Very Strong), A (Strong), BBB (Good), BB (Marginal), B (Weak), CCC (Very Weak), CC (Extremely Weak), SD or D (Selective Default or Default). Ratings from ‘AA’ to ‘CCC’ may be modified by the addition of a plus (+) or minus (-) sign to show relative standing within the major rating categories. Full details of the rating scale are available at www.spglobal.com/ratings/en/about/intro-to-credit-ratings. Standard & Poor’s is an approved rating agency under the Insurance (Prudential Supervision) Act 2010.
