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 exclusion.
The exclusion for pre-existing conditions does not apply to healthcare services covered under the Keeping Well Module, Body Care Module, Day-to-day Module or the Vision and Dental Module.
Cover under the Day-to-day Module 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 $65 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 Specialist consultations benefit includes cover for obtaining a second opinion regarding a diagnosis or treatment plan from another specialist who is an Affiliated Provider.
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 or an Affiliated Provider 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.
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.
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.
Update to the procedure names under Diagnostic imaging and Diagnostic tests benefits.
The names of certain diagnostic imaging and diagnostic tests will be updated to the names they are more commonly known by and abbreviations will be added where appropriate.
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.
