These procedures must be performed by an Affiliated Provider to be covered under your plan.

• Intravascular lithotripsy for coronary artery disease
• Drug-eluting balloon angioplasty for in-stent restenosis
• Transcoronary ethanol septal ablation (TESA)
• Liposuction for secondary lymphoedema following an oncological intervention
• Thyroid nodule ablation
• Peripheral sensory nerve ablation for cancer-related pain
• Image-guided percutaneous carpal tunnel release
• Image-guided percutaneous trigger finger release
• Robot-assisted knee replacement
• Robot-assisted total hip replacement
• Peroral endoscopic myotomy & Zenker’s peroral endoscopic myotomy (POEM, ZPOEM)
• Implantation of prosthetic iris device
  Prosthetic iris device including custom-made artificial iris
  Prosthesis maximum limit applies: unilateral $10,250
• Minimally invasive glaucoma surgery (MIGS)
  Kahook dual blade goniotomy, iTrack canaloplasty, implantation of trabecular bypass microstent – Glaukos iStent, implantation of minimally invasive subconjunctival filtration device (microshunt) – Allergan XEN or Glaukos PreserFlo, micropulse transscleral cyclophotocoagulation
  Prosthesis maximum limits apply:
  • Category 1 $1,000 (Kahook dual blade)
  • Category 2 $1,500 (iTrack canaloplasty microcatheter, MicroPulse P3 Delivery Device)
  • Category 3 $2,000 (iStent trabecular Micro-bypass stent, PreserFlo MicroShunt, Xen Gel Stent)
• Botulinum toxin for laryngeal dystonia
  Prosthesis maximum limits apply:
  • Botulinum toxin type A for approved procedures only (1 ampoule/100 units) $600
  • Botulinum toxin type A for approved procedures only (2 or more ampoules/200+ units) $1,200
• Temporomandibular joint (TMJ) total joint replacement (TJR)
  Prosthesis maximum limits apply:
  • Unilateral $26,000
  • Bilateral $45,000.

Introduction of cover for prescriptions related to pregnancy and childbirth.
If you are on a First Cover Plan 1 Plus or First Cover Plan 2 Plus policy, prescriptions that are related to pregnancy or childbirth will be covered by your policy (up to the policy limits).

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 Affiliated Provider-only healthcare services is being removed from the Policy.
The list will still form part of your Policy but will only be available on our Affiliated Provider-only healthcare services page. We’re removing this list from the Policy to enable us to update it more regularly. You’ll need to check the website for updates or you can contact us to request a copy of the most up-to-date list.

The list of documents that form part of your health insurance Policy is being updated.
Your application form, any health insurance medical declarations, the list of Affiliated Provider-only healthcare services, the eligibility criteria, the list of unapproved healthcare services, the list of Prostheses and Specialised Equipment 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 Affiliated Provider-only healthcare services, the list of Prostheses and Specialised Equipment, and the list of policy variations.

Policyholders can change their cover at any time.
Update to the Policy amendment section to allow policyholders to change their cover at any time by contacting us.

Removal of change period reference.
The reference to 30 days notice of change period is being removed.

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 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.

Update to the Applications section.
Removed clause 5.6 from the Applications section to clarify that any applications will be for dependants on existing policies only.

A suspension request can happen at any time.
Update to reflect that a suspension request can happen at any time, however it will not be applied retrospectively.

Removal of reference to adding or removing dependants at the Policy Anniversary Date.
Addition or removal of dependants on your Policy can be done at any time.

Update to prior approval requests.
Update to reflect that prior approval requests can happen at any time however we recommend that you apply at least 5 working days before the healthcare service is being provided.

Exclusion for administrative charges.
Administrative charges are not covered by your Policy. A specific exclusion will be added to clarify this.

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.

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 similar or a lower level of cover.

Clarification of the term 'Medsafe-Indicated'.
Clarification of the term ‘Medsafe-indicated’ when used in the IV infusion (non-cancer) 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.

Update to the definition of eligibility criteria.
The reference to ‘procedure’ will be replaced with ‘healthcare services’ as ‘procedure’ was not sufficiently inclusive.