To download your application, please enter the below information

Our HTAQ application form has been updated as of 14 July 2026 to clarify the information needed for assessment. Providing complete information upfront will help support a smoother assessment process.


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This information will be used to assess the health technology / procedure you have applied to have covered by Southern Cross and to contact you if we require further information and / or to advise the outcome of the assessment. It will be held at Southern Cross Medical Care Society, Level 1, Te Kupenga, 155 Fanshawe Street, Auckland City 1010 and you are able to access it or request correction by contacting us at [email protected].