Policy variations

Effective 17 December 2024

This list of policy variations forms part of your Southern Cross health insurance policy. It sets out variations to your policy terms and conditions that may apply from time to time. These variations include the way we treat some exclusions listed in your 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 below.

Variations included in this document may change from time to time as we continuously review how we cover healthcare services and certain technology.

Where a variation listed refers to an existing benefit, your policy must include the benefit that it relates to, in order to have cover under that variation. The terms and conditions of the benefit and any eligibility criteria that apply must be met, unless specified within the variation.

Words in italics are defined in the glossary of terms in your policy document.

Travel and accommodation allowance

Under the travel and accommodation allowance terms and conditions, cover is also available for the following: 

  • Travel costs include ride sharing services such as Uber and companion driving services
  • Accommodation costs include rental accommodation through recognised accommodation providers, for example hospital flats, or hosting platforms such as Airbnb or Bookabach

Prognostic gene testing for breast cancer

This variation provides cover for specified prognostic gene testing for breast cancer. You must be referred by a specialist in private practice.

For prognostic gene tests, eligibility criteria need to be met before we’ll cover them.

We’ll cover the actual costs incurred for the following prognostic gene tests for breast cancer:

  • Prosigna
  • Oncotype DX
  • Mammaprint

No excess or co-payment applies to this cover. Policy limits do not apply.

This cover is not available under the HealthEssentials policy.

Cosmetic procedures and treatment under the surgical procedures benefit

The exclusion for cosmetic procedures and treatment does not apply to the following procedures under the surgical procedures benefit:

  • Reconstructive procedures following resection or removal of a tumour
  • Blepharoplasty and ptosis surgery to correct droopy eyelids that impair vision
  • Open septoplasty (septorhinoplasty) for nasal obstruction
  • Sclerotherapy or embolisation of simple vascular malformation

Healthcare services related to mental health

The exclusion for healthcare services related to mental health does not apply to the following benefits:

  • general practitioner services
  • nurse services
  • prescriptions.

Diagnostic imaging benefit

The exclusion for health screening and maintenance services does not apply to the ‘Diagnostic imaging’ benefit for breast screening ultrasounds when a mammogram alone is unsuitable due to confirmed dense breast tissue. Dense breast tissue must be confirmed by a mammogram or MRI.

Robot-assisted surgery

Robot-assisted ventral hernia repair is removed from the list of exceptions to the robot-assisted surgery exclusion on the following policies:

  • Wellbeing One and Two
  • KiwiCare and RegularCare
  • Wellbeing Starter
  • First Cover Plans
  • Westpac First Cover plan
  • SureCare concessionary.