Our low claims reward - a 10% premium reduction - is given to members who have stayed below a specific claims threshold for a period of two years. The reward applies for up to 12 months.

There are rules and conditions to ensure that everyone is treated fairly. The links below will take you through to detailed information about how the low claims reward is assessed and applied.

Questions and answers

Key information about the low claims reward, including who’s eligible, how you can qualify for the reward and how the reward works ►

Terms and conditions

Detailed information about the rules and conditions for the low claims reward ► 

Low claims reward questions and answers

The low claims reward is a simple way to recognise and reward good health.

What’s the value of the low claims reward ►

Who’s eligible for the low claims reward ►

How do you qualify for the low claims reward ►

What is the claims threshold for my plan and age ►

Will you lose the low claims reward if you claim ►

What happens if you don’t qualify for the low claims reward ►

Can you find out if a claim will exceed a low claims reward threshold for your policy ►

Why doesn’t the low claims reward scheme apply to members of subsidised work schemes ►

What if you join a subsidised work scheme ►

What’s the value of the low claims reward?

It is equivalent to 10% of each qualifying member’s individual premium, and is applied for a period of up to 12 months.

Who’s eligible for the low claims reward?

The low claims reward is available to qualifying members paying adult premium rates who are not part of a subsidised work scheme and who have had at least two years continuous membership and claims history with Southern Cross.

How do you qualify for the low claims reward?

Claims thresholds have been established for different age groups and plan types.  If an eligible member’s claims refund total over a two year calculation period is under the relevant claims threshold, the 10% low claims reward is deducted from his or her premiums.  This assessment will normally be done prior to a member’s policy renewal.
What is the claims threshold for my plan and age?
Thresholds vary depending on your plan type and age.  Your threshold will be advised to you at the time of your renewal.  It will be based on  age at the renewal date.  If you change plan, the applicable threshold will be for the plan you have been on for the majority of the two year Calculation Period.  

What is the claims threshold for my plan and age?

Thresholds vary depending on plan type and age. Your threshold will be advised to you at the time of your renewal. It will be based on age at the renewal date. If you change plan, the applicable threshold will be for the plan you have been on for the majority of the two year Calculation Period.

Will you lose the low claims reward if you claim?

Your health is important - delaying or avoiding treatment could cause your health to worsen.  You should seek treatment and make claims when necessary.  If an eligible member’s claim is for surgery, it is likely to exceed the low claims threshold but the value of the claim refund should more than offset the loss of the low claims reward.  If an eligible member’s plan covers day-to-day health care like doctors visits, it’s likely you will be able to make a number of doctor visits without affecting the low claims reward.  Note: qualification for the low claims reward will be based on claims refunds processed by us during the two year calculation period, rather than treatment dates or the dates claims are lodged.

What happens if you don’t qualify for the low claims reward?

Eligible members will be reassessed for the low claims reward before each  renewal. Remember, if you don’t qualify it means you are already getting good value from your health insurance through claim refunds.

Can you find out if a claim will exceed a low claims reward threshold for your policy?

The low claims threshold indicator on this website shows the threshold that applies to your plan and age.  If you want to know what value of claims you have made in the past two years, call Member Services on 0800 800 181.

Why doesn’t the low claims reward apply to members of subsidised work schemes?

If you are a member of a subsidised work scheme, the equivalent of the low claims reward has already been included in your premiums. These lower premium rates reflect actual claims made by members within the work scheme, or actuarial assumptions made about claiming patterns of subsidised schemes.

What if you join a subsidised work scheme?

Your eligibility for the low claims reward would cease on the date of your transfer into a subsidised work scheme, and would be replaced by whatever discounts apply to that work scheme.  If you are transferring from a subsidised work scheme to a non-subsidised scheme or individual membership, you may be immediately eligible for the low claims reward again, provided you have maintained at least two years continuous membership and claims history, and meet other eligibility and qualifying criteria.

Low claims reward terms and conditions

Definitions ►

Eligibility for the scheme ►

Earning a low claims reward ►

Eligibility for low claims reward following a change in membership status ►

Amendment of low claims rewards ►

General ►

The following terms and conditions apply in respect to the Southern Cross Low claims reward

1. Definitions

1.1 In these terms and conditions:

‘Adult Member(s)’ means a Member paying an Adult Premium Rate.

‘Adult Premium Rate’ means the premium or subscription rate for members 21 years of age and over at their policy anniversary date or from time to time.

‘Calculation Period’ means the continuous period of two years membership as close as reasonably practicable (in accordance with Southern Cross Health Society business practice from time to time) prior to the calculation of premiums at the time of Policy Renewal.

‘Dependant’ means a Member who is noted on the Policyholder’s policy or membership as a dependant of the Policyholder in accordance with the Society’s Rules .

‘Eligible Member(s)’ means a Member on an Eligible Plan, paying Adult Premium Rates, who isn’t part of a subsidised group scheme, has at least two years continuous membership and claims history with Southern Cross Health Society coinciding with the Calculation Period, and who has the calculation for the low claims reward applied to their annual premium (except that from time to time group schemes can be otherwise included or excluded from the low claims reward scheme at our sole discretion).

‘Eligible Plan’ means a policy or plan to which the low claims reward scheme applies from time to time.

‘Member’ means a person who is an active current Member of Southern Cross Health Society in any capacity, including as a Policyholder or Eligible Dependant as defined by the Society’s Rules, and on an Eligible Plan.

‘Policy Renewal’ means annual renewal of a policy or any other relevant policy amendment notice from time to time.  For example, a change in circumstances including a change in plan type or leaving/joining a group scheme.

‘Policyholder’ means the principal Member who is noted on a Southern Cross Health Society membership certificate as the policyholder, to whom all official correspondence and invoices related to that membership will be sent.

‘Society’s Rules’ means the Rules of the Southern Cross Medical Care Society approved at the annual general meeting on 14 October 1999 as amended from time to time.

‘Southern Cross Health Society’ means the Southern Cross Medical Care Society, the operator of the low claims reward scheme.

‘Suspension’ means when a Member has been granted Southern Cross Health Society membership suspension for a fixed period of time not exceeding twelve months.

‘Thresholds’ means the aggregate amount of claims refunds including GST an Eligible Member can receive in the Calculation Period before they no longer qualify for the low claims reward (as varied from time to time).

1.2  Terms defined in the  Society’s Rules, unless the contrary appears, similarly defined for these terms and conditions.

2. Eligibility for the scheme

2.1 Entry into the scheme is free and automatic to any Eligible Member on an Eligible Plan.

2.2 Eligible Members are deemed to be bound by these terms and conditions.

3. Getting a low claims reward

3.1 The calculation of the low claims reward for each Member is determined by the claims refunds paid to or on behalf of a Member during the Calculation Period and the Southern Cross Health Society  plan or policy held by the Member for the majority of the Calculation Period.

3.2 The threshold level applied at the time of calculation will be based on the Member’s age at their Policy Renewal date and the Southern Cross Health Society plan or policy as described in clause 3.1 above.

3.3 A Member is not eligible for the low claims reward unless they have had continuous membership and claims history on an Eligible Plan for at least two years corresponding with the Calculation Period.  Members who have suspended their policies, or whose policies have lapsed during that two-year period (including for non-payment of premiums) will be ineligible.

3.4 Southern Cross Health Society can change the Threshold values, percentage rewards, Eligible Plans and other eligibility criteria from time to time without notice.

3.5 The low claims reward and any rights they confer are personal to a Member and cannot be sold, transferred, assigned or otherwise dealt with by a Member or on behalf of a Member.

3.6 The low claims reward has no cash or monetary value that may be paid to a Member.

4. Eligibility for low claims reward following a change in membership status

4.1 If a Member transfers into a subsidised group scheme (or any other group scheme excluded from the low claims rewards scheme) or transfers to a plan other than an eligible plan, they will immediately cease to be eligible for the low claims reward.

4.2 Any change of group or transfer by a Member, excluding clause 4.1 above, will result in that Member’s low claims reward eligibility being reviewed in light of any change to the plan or policy type, Thresholds or other eligibility criteria.

4.3 A Member transferring from one policy to another (i.e. an Adult Dependant or divorced spouse taking a separate policy) will have immediate eligibility for the low claims reward, provided they remain an Eligible Member on an Eligible Plan as defined in these terms and conditions.

5. Amendment of low claims rewards

5.1 Southern Cross Health Society may alter a Member’s qualification for the low claim reward if an adjustment is required to correct any inaccuracy which would have resulted in the low claims reward being incorrectly applied.

6. General

6.1 Southern Cross Health Society will inform Members whether they are eligible for a low claims reward for their coming period as part of their Policy Renewal.

6.2 Any disputes about the low claims reward must be notified to Southern Cross Health Society within one month of the Member receiving their Policy Renewal advice.  Otherwise, the low claims reward eligibility will be taken as correct and binding on the Policyholder and other Members noted on the Policyholder’s membership record. Disputes unless otherwise resolved will be dealt with as a dispute relating to a claim for a benefit under the Society’s Rules .

6.3 A Member shall be deemed to have forfeited any eligibility for a low claims reward they have earned if; (a) the Member ceases to be a Member of Southern Cross Health Society at any time; or (b) the Member ceases to hold an Eligible Plan; or (c) the Member ceases to have continuous cover with Southern Cross Health Society (including Suspension); or (d) the Member does not adhere to the Society’s Rules and suffers disciplinary action in terms of those rules.

6.4 Southern Cross Health Society reserves the right to vary these terms and conditions, or to suspend or terminate the scheme at any time without prior notice to Members.

6.5 Southern Cross Health Society may also at any time and without prior notice change the basis for calculating the Thresholds and / or the plans which are eligible for this scheme and / or the eligibility criteria for Members fixed in accordance with clause 3.1.

6.6 Southern Cross Health Society shall not be liable in any way for: (a) the suspension or termination of the scheme; or (b) any failure to notify a Member of any change in these terms and conditions; or (c) any change in the basis for earning the low claims reward; (d) any accidental failure or omission to give any notice or notification to any Member(s).

6.7 A notice shall be deemed to be given to a Member if it is posted to the last known address of the Policyholder.