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Sovereign Private Health Benefits

Health insurance policies help protect you against the more costly expenses of private hospitalisation and surgery, which can have a big financial impact. These are examples of the types of costs normally covered under health insurance policies:

  • Surgical costs including surgeon's fees and anaesthetist fees
  • Hospital charges in relation to confinements required for medical illness or surgery
  • Specialist Visits (Optional Extra)
  • Diagnostic Testing (Optional Extra).

This means that lesser day-to-day healthcare costs, such as visits to your GP, are funded by you, and the more unpredictable and significant costs, such as surgery and hospital confinement, are taken care of under your insurance cover. This results in lower premiums for you!

Sovereign Private Health

This is a traditional major medical insurance product. It can provide cover for individuals or the whole family. It is one of the best health insurance products on the market in terms of benefits offered and services provided, and is priced competitively.

Private Health Benefits

This policy provides 100% reimbursement of covered reasonable charges* incurred as a result of a medically necessary procedure up to the maximum cover amounts indicated below. This reimbursement is subject to the exclusions set out in this benefits sheet and may be subject to the application of an excess. The excess applies once per life assured per policy year. The excess applies to all benefits, except those benefits for which the excess is specifically excluded in this benefits sheet.

You may add a Specialist and Diagnostic Testing benefit, providing reimbursement for medically necessary consultations with specialists and expenses associated with diagnostic Diagnostic Testing, imaging or monitoring as indicated. It also provides cover through loyalty benefits designed to support access to routine screening to keep people healthy.

Please note, this is a summary of the benefits of this policy. For the terms and conditions of this policy please refer to the separate policy document.

*Reasonable charges are determined based on Sovereign's claim statistics.

Prior Approval Service: Sovereign recommends that you seek Sovereign's approval prior to incurring costs related to any medical treatment to ensure that the medical treatment is covered under this policy.

Benefit
Maximum Cover
Benefit Entitlement
Private Health Cover and Private Health Plus
SURGERY
$300,000 per life assured per policy year
Covers the cost up to the maximum cover for this benefit of surgical hospitalisation. Surgery must be performed in an approved facility by a registered medical specialist or an oral surgeon . Cover is provided for the following costs:
> Surgeon's fees
> Anaesthetist's fees
> Perfusionist's fees
> Hospital fees including:
  • Accommodation
  • Operating theatre fees
  • Intensive/coronary care unit fees
  • Ancillary hospital charges
  • Disposable laparoscopic equipment
  • Prostheses
> Cardiologist's and radiologist's fees
> Specialist consultations and diagnostic tests directly relating to the approved surgery performed within six months before or after surgery.
The excess applies to any claims under this benefit.
 
 
 
CANCER CARE
$300,000 per life assured per policy year
Covers the cost up to the maximum cover for this benefit of the following treatments and procedures once a diagnosis of cancer has been made.
(This excludes pre-malignant skin lesions).
Cancer surgery
 
> All fees for surgical treatment of cancer are covered under the above Surgery benefit.
Oncologist consultations
 
> Consultations with a registered medical specialist for treatment or procedures relating to the treatment of cancer.
Diagnostic imaging and tests
 
> Diagnostic imaging and tests and procedures in connection with the detection or treatment of cancer including;
  • CT, PET/CT and MRI scans
  • Ultrasounds
  • X-rays, scintigraphy
  • Mammography
  • Laboratory tests
  • Gastrointestinal endoscopy
  • Cystoscopy
  • Hysteroscopy
  • Diagnostic laparoscopy
Chemotherapy
 
> Chemotherapy treatment provided by a registered medical specialist in an approved facility . Includes the cost of materials, hospital accommodation and ancillary hospital charges . Includes the cost of Pharmac and non-Pharmac approved MedSafe indicated chemotherapy drugs, subject to Sovereign criteria . Prior approval must be obtained before the procedure takes place.
Radiotherapy
 
> Radiotherapy treatment provided by a registered medical specialist in an approved facility including planning, shielding and accessories, field setup and simulation, subject to Sovereign criteria . Prior approval must be obtained before the procedure takes place.
Prostate brachytherapy
 
> Implantation of radioactive seeds for the treatment of malignancies of the prostate.
Breast reconstruction following mastectomy
 
> Breast reconstruction of the affected breast only following a mastectomy for the treatment of diagnosed cancer. Prior approval must be obtained before the procedure takes place. Cover is not provided for prophylactic procedures.
Post-cancer treatment care
$500 per life assured per policy year
> Support services, therapies or personal items for the life assured following treatment for cancer. For example, wigs to cover hair loss, bras following a mastectomy, lymphatic massage, or counselling. These support services and personal items do not need to be medically necessary .
No excess is payable for claims under post-cancer treatment care.
Palliative and respite care
$1,500 per life assured per lifetime
> Palliative care, hospice and respite care all payable at the discretion of Sovereign. No excess is payable for claims under palliative and respite care.
Except where it is stated above to the contrary, the excess applies to any claims under this benefit.
 
 
 
NON-SPECIALIST MINOR SURGERY AND OTHER PRCEDURES
 
Covers the cost up to the maximum cover for this benefit of the following minor surgeries and procedures:
Excision of lesions, moles, cysts and ingrown toenails
$250 per life assured per treatment up to a maximum of $500 per life assured, per policy year
> Excision of lesions, moles, cysts and ingrown toenails
Allergy desensitisations, injections, varicose vein treatment and vasectomy
$450 per life assured per treatment up to a maximum of $900 per life assured , per policy year
> Allergy desensitisations, injections, varicose vein treatment and vasectomy.
Cover for vasectomy is only available after one year of continuous cover.
The minor surgery or treatment must be carried out by a registered medical practitioner at an approved facility.
No excess is payable for any claims under this benefit.
 
 
 
MEDICAL HOSPITALISATION
$300,000 per life assured per policy year
Covers the following costs up to the maximum cover for this benefit of hospitalisation in an approved facility for the treatment of a condition which does not require surgery, when referred by a registered medical specialist :
> Hospital accommodation fees
> Registered medical specialist's fees
> Diagnostic fees
> Ancillary hospital charges
Please note that hospitalisation and hospice care costs in relation to cancer are covered under the Cancer care benefit and not this benefit.
The excess applies to any claims under this benefit.
 
 
 
MAJOR DIAGNOSTIC IMAGING AND TESTS
$100,000 per life assured per policy year
Covers the cost up to the maximum cover for this benefit of the following diagnostic tests and imaging at an approved facility when referred by a registered medical specialist irrespective of whether surgery occurs:
> Angiogram
> Arthroscopy
> Capsule endoscopy
> Colonoscopy
> CT scans
> Cytoscopy
> Gastroscopy
> Hysteroscopy
> Laparoscopy
> MRI scans
> Myelogram
> Myocardial perfusion imaging
> PET/CT
> Scintigraphy
The excess applies to any claims under this benefit.
 
 
 
HOME NURSING
$300 per day, up to $3,000 per life assured , per policy year
Covers the cost of home nursing care up to the maximum cover for this benefit where the care is provided by a registered nurse following a surgical or medical procedure covered by this policy, and such care is recommended by a registered medical specialist or registered medical practitioner.
No excess is payable for any claims under this benefit.
 
 
 
WAIVER OF PREMIUM
One year's free cover
Upon the death of a policy owner before they reach age 70, (where the death is not caused by something excluded under this policy), Sovereign will provide cover under this policy for the surviving lives assured covered by the policy at the time of death, free of charge for a period of one year.
No excess is payable for any claims under this benefit.
 
 
 
BEREAVEMENT GRANT
$2,500 per life assured per lifetime
If a life assured dies between the ages of 21 and 59 (inclusive), the bereavement grant will be paid to the policy owner or to the policy owner's estate.
No excess is payable for any claims under this benefit.
 
 
 
TREATMENT AWAY FROM HOME IN NEW ZEALAND
$300 per day, up to $3,000 per life assured , per policy year
When a treatment covered by one of the other benefits of this policy is not available within 100km of your home or usual place of residence, Sovereign will pay for the reasonable cost up to the maximum cover for this benefit of transport and accommodation for the life assured and a support person to travel to obtain that treatment.
No excess is payable for any claims under this benefit.
 
 
 
VOLUNTARY TREATMENT IN AUSTRALIA
Benefit maximum for the applicable benefit applies
When a medically necessary treatment or procedure covered by one of the other benefits of this policy is carried out in Australia at a health service facility approved by Sovereign, this benefit will cover the reasonable charges of that treatment or procedure as if it was provided in New Zealand up to the maximum cover stated for the applicable benefit in New Zealand dollars.
No cover is available for flights or accommodation. Prior approval must be obtained prior to the treatment or procedure taking place.
The excess applies to any claims under this benefit.
 
 
 
TREATMENT OVERSEAS WHERE THE WAITING PERIOD FOR TREATMENT IN AN APPROVED FACILITY IN NEW ZEALAND IS GREATER THAN SIX MONTHS
Benefit maximum for the applicable benefit applies
When a medically necessary treatment or procedure covered by one of the other benefits of this policy is available in New Zealand but is unable to be carried out within six months in an approved facility , and so is carried out in an overseas facility approved by Sovereign, this benefit will cover the reasonable charges of that treatment or procedure as if it was provided in New Zealand up to the maximum cover stated for the applicable benefit in New Zealand dollars.
Cover is also provided for the cost of two return economy class airfares for the life assured and a support person. Prior approval must be obtained prior to the treatment or procedure taking place.
The excess applies to any claims under this benefit.
 
 
 
TREATMENT OVERSEAS WHERE THE TREATMENT IS NOT AVAILABLE IN NEW ZEALAND
$30,000 per life assured per policy year
When a medically necessary treatment or procedure is unable to be undertaken in New Zealand, this benefit covers the cost of that treatment or procedure up to the maximum cover stated for this benefit in New Zealand dollars. The treatment must be at an overseas facility acceptable to Sovereign and is only provided for those treatments and procedures that a registered medical specialist has recommended and is subject to Sovereign’s prior approval. Cover is also provided for the cost of two return economy class airfares for the life assured and a support person. Cover for airfares is included within the maximum cover stated for this benefit. No cover is available for accommodation.
The excess applies to any claims under this benefit.
 
 
 
PUBLIC HOSPITAL CREDIT
One year's free cover
Where a life assured has a treatment or procedure in a public hospital that would otherwise have been covered by a benefit in this policy and that treatment or procedure includes overnight admission of two or more night's stay, Sovereign will credit the amount of the life assured's annual premium to this policy. A copy of the hospital discharge summary must accompany the claim form.
Excludes hospital admissions for treatment of accidents or injuries or maternity admissions.
No excess is payable for any claims under this benefit.
 
 
 
PUBLIC HOSPITAL CASH GRANT
$300 per day up to $3,000 per life assured , per policy year
Provides a lump sum payment up to the maximum cover for this benefit for any life assured who has an overnight admission of three or more nights in a public hospital and where the hospitalisation is publically funded. This benefit is payable after the second night of admission. A copy of the hospital discharge summary must accompany the claim form. Excludes maternity admissions.
No excess is payable for any claims under this benefit.
 
 
 
STERILISATION
Up to $5,000 per life assured per lifetime
Covers the cost up to the maximum cover for this benefit of sterilisation procedures including vasectomy, tubal ligation and hysteroscopic sterilisation. Sovereign’s prior approval must be obtained.
This benefit is available to a life assured after one year of continuous cover under this policy.
The excess applies to any claims under this benefit.
 
 
 
MEDICAL MISADVENTURE
$30,000 per life assured per lifetime
If, during the course of any medical procedure or treatment in an approved facility , a life assured should die directly as a consequence of any erroneous or negligent action, omission or failure to observe reasonable and customary standards by a care provider in that approved facility , the maximum cover of this benefit will be paid, provided:
> the death occurs within 30 days of such a recorded and proven incident
> the incident is verified and confirmed by the relevant Government authority, a court of law, coroner’s inquest or the Medical Council of New Zealand
> the death is independent of any other cause other than the termination of the life support system after brain death has been established.

If you have cover under Private Health Plus then the following additional benefits are available for each life assured. Your schedule will confirm if you have cover under Private Health Plus.

Benefit
Maximum Cover
Benefit Entitlement
Private Health Plus
SPECIALIST CONSULTATIONS
$10,000 per life assured per year
Covers the cost up to the maximum cover for this benefit of consultations with a registered medical specialist .
The excess applies to any claims under this benefit.
 
 
 
DIAGNOSTIC IMAGING AND TESTS
$100,000 per life assured per policy year
Covers the cost up to the maximum cover for this benefit of the following diagnostic imaging and tests at an approved facility when referred by a registered medical practitioner or a registered medical specialist:
> Allergy testing
> Audiology tests
> CT scans
> Capsule endoscopy
> Colonoscopy
> Colposcopy
> Cystoscopy
> Electroencephalography (EEG)
> Electromyography (EMG)
> Exercise/Stress ECG
> Gastroscopy
> Holter monitoring/24 Hour Ambulatory monitoring
> Laboratory tests
> Mammography
> MRI scans
> Myelogram
> Myocardial perfusion imaging
> PET/CT scans
> Scintigraphy
> Sleep studies
> Ultrasound
> Urodynamic assessments
> X-rays
Cover is available for the cost of other diagnostic imaging and tests, subject to Sovereign’s prior approval.
The excess applies to any claims under this benefit.
 
 
 
PREGNANCY, MATERNITY AND INFERTILITY ALLOWANCE
$750 per life assured , per policy year
Covers the cost up to the maximum cover for this benefit of obstetric care (including scans), infertility diagnosis and treatment carried out by a registered medical practitioner or a registered medical specialist at an approved facility. This benefit includes cover for reasonable accommodation costs incurred by a life assured for maternity, pregnancy or infertility related stays in an approved facility .
Pregnancy and maternity care is available to a pregnant life assured only.
Cover under this benefit is only available to a life assured who has had three years of continuous cover under Private Health Plus.
No excess is payable for any claims under this benefit.
 
 
 
HEALTH SCREENING ALLOWANCE
$500 per life assured for each three year period
Covers the cost up to the maximum cover for this benefit of the following procedures performed at an approved facility :
> bone screening (osteoporosis)
> bowel screening
> breast screening
> cervical screening
> heart screening
> prostate screening
> eye tests and / or visual field tests
> hearing tests
> skin checks
> aortic aneurysm screening
Cover under this benefit is only available to a life assured after three years of continuous cover under Private Health Plus.
The health screening test does not need to be medically necessary but the procedure must be performed by or referred by a registered medical practitioner . If as a result of a health screening test, a diagnosis is made for a condition requiring treatment or care that is covered under another benefit in this policy, the costs incurred for the screening will be covered under that benefit and the maximum cover for this benefit will be reinstated.
No excess is payable for any claims under this benefit.

What isn't covered?

To keep premiums affordable, all insurance policies contain some conditions and charges for medical services, which are not covered. For example, here are a few of ours:

  • Routine physical examinations
  • Prescription charges
  • A pre-existing condition, unless the symptom or condition was disclosed at the time of your application and accepted in writing by Sovereign.
  • Any congenital conditions
  • Cosmetic surgical procedures
  • Certifiable mental diseases or illnesses
  • HIV related disorders, including AIDS
  • Reconstructive or reparative procedures relating to an existing condition
  • Illness or injury resulting from:
    • Deliberate self-injury or participation in a crime
    • The influence of alcohol or non-prescription drugs
    • Nuclear contamination
    • The misuse of prescribed drugs
    • War or terrorism
  • Renal dialysis
  • Mole mapping

For full details on exclusions see the Benefit policy wording.