Media releases 2013

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Top health insurance claim $160,000

Thursday, 4 April 2013 by Aimee Bourke

Cancer, heart disease and spinal conditions were the causes of the highest health insurance claims paid out by Southern Cross Health Society last year.

 Figures released today show the three largest claims were for spinal surgeries and a larynx removal respectively – paid at $160,000, $151,000 and $100,000. Five further claims paid ranged from $91,000-$98,000.

Peter Tynan, Southern Cross Health Society Chief Executive, says these costs demonstrate what a valuable safety net health insurance can be.

“No one wants to be ill but, if the unexpected happens and you need timely access to treatment, it can be very comforting to have the financial aspect taken care of."

Those receiving the top ten highest claim payments were aged from 64 to 76 years, underlining the heightened demand for health services people have as they age and the increasing complexity of the procedures they require.

“When you’re young and healthy it’s easy to think ‘I’ll deal with it later’. But by the time certain medical conditions develop it is too late to get health insurance to cover them – much like trying to get car insurance after an accident” says Tynan.

However, he stresses that Southern Cross members of all ages benefit from having health insurance, although the reasons can change depending on age and gender.

For example, he says those aged under 30 put in a high number of claims for tonsillectomies and dental procedures, for women aged 20-39 endometriosis surgery is common and after the age of 50, hip and knee replacements, cataract extraction and skin lesion removals are in high demand.

“By committing to health insurance early, people can improve their access to elective services should they require them”, says Tynan. “When you’re living with chronic pain having to wait even a month can seem a life sentence.

“These figures also highlight the cost of medical procedures - how expensive elective surgery can be.Those wanting to go private need to think about how they’ll fund it.

“If they choose to self-insure, people should have realistic expectations of what they’ll need”, says Tynan.

A survey carried out by Southern Cross last year revealed that 79% of New Zealanders think they will have to pay for some of their elective healthcare in retirement. However only one in five had started saving and many thought that savings of less than $10,000 would be sufficient.

In fact, a knee replacement costs between $19,000 - $24,000, cardiac bypass surgery between$43,000 - $50,000 and one course of radiation therapy between $15,000 - $27,000.

“In the half year ending December 2012 Southern Cross paid out 88 cents in claims for every premium dollar received.”


Top surgeries

Funded by Southern Cross Health Society for the 12 months ended 31 December 2012

Spinal surgery
Spinal surgery
Larynx removal
Heart valve replacement
Cardiac bypass
Major oesophagus surgery
Spinal surgery
Extensive facial surgery and reconstruction

Top 3 procedures by age and amount paid

Funded by Southern Cross Health Society for the 12 months ended December 2012


Under 20 Total paid by Health Society


Removal of teeth$4,058,000

Grommet insertion$1,890,000


20-29Total paid by Health Society

Removal of teeth$4,766.000

Endometriosis surgery$1,753,000

Medical consultation$ 921,000


30-39Total paid by Health Society

Endometriosis surgery$2,449,000

Removal of teeth$2,032,000

Hysterectomy $2,022,000


40-49Total paid by Health Society


Colonoscopy (+/- Biopsy / Polyp)$3,761,000

Excision skin lesion$3,071,000


50-59Total paid by Health Society

Hip replacement – Uni$7,536,000

Colonoscopy (+/- Biopsy / Polyp)$7,149,000

Excision skin lesion $4,972,000


60-69 Total paid by Health Society

Knee replacement $13,067,000

Hip replacement$12,444,000

Colonoscopy (+/- Biopsy / Polyp)$ 8,197,000


70+Total paid by Health Society

Cataract extraction and insert ILO$13,765,000

Knee replacement$11,896,000

Hip replacement$11,485,000


Editor Note:

For many Southern Cross policies there is a limit of $100,000 per surgical procedure.In some instances, several surgical procedures can be required per condition.This means that even if a member has a policy with a $100,000 surgical limit, a single claim can exceed this amount for one condition.