List of Surgical Procedures

Applies to UltraCare Base, UltraCare Option 100, UltraCare Option 400, Hospital & SpecialistCare, HospitalCare and SureCare, SuperCare and Wellbeing.

This List of Surgical Procedures forms part of your Southern Cross policy. It should be read in conjunction with your policy document.

An updated List of Surgical Procedures comes into effect for procedures carried out on or after 1 July 2008.

To view the List of Surgical Procedures, click on the link below.  If you would like to request that a copy of this document be mailed to you, please click here.

List of Surgical Procedures July 2008

Adobe Acrobat reader- free download [click here]

The List of Surgical Procedures sets out the surgical procedures covered under the surgical treatment section of the Coverage Tables.

The List of Surgical Procedures is made up of 14 sections:  general surgery, otolaryngology (ear nose and throat), urology, gynaecology, ophthalmology, orthopaedic surgery, peripheral vascular surgery, oral and maxillofacial surgery, cardiac surgery, interventional radiology, neurosurgery, prostheses and tests.

Your plan provides cover for the surgical procedures contained in the List of Surgical Procedures, subject to the policy limits outlined in the Coverage Tables of your policy document, subject to the usual policy exclusions (including pre-existing conditions and other terms and conditions set out in the policy). Refer to the chart under ‘How does my cover work under my policy’ in your policy document for how your refund for eligible healthcare services will be calculated. If you are on a SureCare plan, excesses will apply.

Your refund for eligible cardiac and diagnostic tests will be the actual cost up to the policy limit stated in the Tests section of the Coverage Tables of the Extensive Cover, UltraCare, SuperCare and Wellbeing plans.

If you are intending to have surgery, please call us so that we can guide you through the List of Surgical Procedures and provide prior approval for your claim.

Procedures Not Listed

If a surgical procedure is not included in the List of Surgical Procedures (or specifically included in the Coverage Tables) it will not be covered unless otherwise advised by Southern Cross at the sole discretion of our Chief Medical Officer.  In these circumstances, there is no guarantee of a refund.  If our Chief Medical Officer decides to grant an ex-gratia refund, it is likely to be significantly less than the actual cost.

Median Total Cost For a Procedure

To give you an idea of the total cost that you may be charged, we have included in the List of Surgical Procedures the median total fee that Southern Cross members were charged by providers between 1 January 2007 and 31 December 2007 for each procedure.

This median total charge for each procedure includes the following components (where applicable):

• Surgeon’s fee.
• Anaesthetist’s fee.
• Hospital fees, including accommodation and operating theatre fees, X-rays and sundries.
• Any surgically implanted prostheses (prostheses costs vary considerably depending on need and clinical preference).
• In-hospital post-operative physiotherapy.

In some cases we don’t have enough information from the claims made by our members in 2007 to provide a fair indication of the likely costs. In these cases we have left the field in the table blank.

The median total cost figures provided in the List of Surgical Procedures are not indicative of your likely refund for each component of the surgery.  Your policy limits are outlined in the Coverage Tables in your policy document.

Southern Cross reserves the right to change or update this List of Surgical Procedures from time to time.