Prophylactic or preventative treatment is treatment undertaken to prevent a disease or illness from occurring where there’s an identified high risk. The prophylactic allowance is available on most plans to cover prophylactic procedures and associated costs. It is a lifetime allowance and ranges between $30,000 to $50,000 depending on the plan (eligibility criteria apply). We have included a three year loyalty period and members with a positive genetic test, when they join Southern Cross, will not be covered (unless they have pre-existing cover under their plan).
Those members who were aware of their high-risk status (due to family history) when they joined Southern Cross will also not be covered. This ensures fairness and premium affordability for all members. There is an exception for invasive and in situ lobular carcinoma.
We’re also removing the $100,000 surgical treatment limit on selected plans. By removing the limit, those people who are looking to join us can now easily compare our plans and benefits with other health insurers. We don’t expect this change to materially impact Southern Cross premiums.
In the last two years, we’ve funded 325,000 surgical procedures with just 15 of these claims exceeding $100,000.