ACC means the Accident Compensation Corporation referred to in the Accident Compensation Act 2001 (or its successor).
Accident means an accident as defined in the Accident Compensation Act 2001 (or its successor).
Acute care means care provided in response to a sign, symptom, condition or disease that requires immediate treatment or monitoring.
Adult means a person 21 years of age and over.
Affiliated Provider means a health services provider who has entered into a contract with Southern Cross to provide certain healthcare services at agreed prices.
Allowance means the fixed amount that we will contribute towards the cost of certain eligible healthcare services as specified in the Coverage Tables.
Ancillary hospital charges means anaesthetic supplies, dressings, drugs (which are prescribed and taken in hospital), intravenous fluids, and irrigating solutions, used whilst the member is hospitalised for an eligible healthcare service.
Annual limit(s) means the maximum amount in respect of any one person that can be reimbursed in any 1 claims year.
Approved facility means a certified private facility or other healthcare facility approved by Southern Cross.
Approved treatment means a healthcare service that is necessary for treatment of the health condition involved, is not experimental or unorthodox, and is widely accepted professionally as effective, appropriate and essential based upon recognised standards of the healthcare specialty involved.
Cardiac tests means advanced electrocardiogram (A-ECG), resting ECG, exercise ECG, holter monitoring, echocardiogram, stress echocardiogram, dobutamine stress echocardiogram, or transoesophageal echocardiogram (TOE).
Certified private facility means a private surgical or medical facility certified as such by the Ministry of Health.
Chemotherapy drugs means prescription medicines for the treatment of cancer or neoplastic disease, that are prescribed or recommended by a registered oncologist or haematologist in private practice, Pharmac approved, and not otherwise excluded by the terms of your policy.
Child means a person under 21 years of age.
Chronic conditions means cystic fibrosis, polycystic kidney, marfans syndrome, Loeys-Dietz syndrome, spina bifida, scoliosis, kyphosis, pectus excavatum and pectus carinatum.
Claims anniversary date means the date 12 months following the date the policyholder started on the current plan and the anniversary each 12 months thereafter as specified on the current Membership Certificate.
Claims year means the first 12 months following the policy start date and each successive 12 month period from your claims anniversary date.
Complaints procedure means the complaints procedure and process available to you as set out on page 30.
Congenital condition(s) means congenital anomalies or defects which are present at birth and for which the policyholder or dependant had either:
(a) signs or symptoms of the condition prior to the original date of joining, or
(b) signs or symptoms of the condition within 3 months of birth, as reasonably determined by Southern Cross.
Continuous cover means that the person covered by the policy must have had no break in cover for the particular healthcare service in this plan to which the continuous cover qualification relates for the specified minimum period.
Cosmetic treatment means any surgery, procedure or treatment that improves, alters or enhances appearance, whether or not undertaken for medical, physical, functional, psychological or emotional reasons.
Coverage Table(s) means the table(s) set out on pages 15 to 22 of the policy document, and any subsequent changes we make to those Coverage Tables.
Dependant means the husband/wife or partner (including any former husband/wife or partner) of the policyholder and any child and or any adult dependant (including any stepchildren or adopted children) of the policyholder (or the policyholder’s husband/wife or partner) who are listed on the Membership Certificate.
Detrimental to health means a medical condition that is causing significant problems for the physical health of an individual.
DHB means a District Health Board established under the New Zealand Public Health and Disability Act 2000, or its successor.
Diagnostic tests means ambulatory blood pressure monitoring, ankle brachial index, anorectal physiology study (anorectal motility study), bone marrow aspiration, breath nitric oxide test, caloric reflex/vestibular caloric stimulation test, colposcopy and biopsies (in rooms), compartment pressure study, corneal pachymetry test, corneal topography, electroencephalogram, electromyogram, electrooculogram, electroretinogram, endometrial biopsy (in rooms), full urodynamic assessment, fundus fluorescein angiography, fundus photography, GDx retinal scanning, H. pylori breath test, Heidelberg retinal tomography (HRT), hydrogen breath test, intraocular pressure test (IOP),
laryngoscopy (in rooms), lumbar puncture, lung diffusion study, lung function test, matrix screen, nasendoscopy (in rooms), oesophageal 24hr pH monitoring (gastric function study), oesophageal manometry test, optic disc photos, optical coherence tomography (OCT), overnight pulse oximetry, proctoscopy, retinal photography, segmental pressure test, sigmoidoscopy (in rooms), simple urinary flow study, sleep study, specular microscopy test, spirometry with or without flow volume loops, ultrasounds of the eye, urea breath test, vascular laboratory testing, vestibular evoked myogenic potential, videonystagmography, visual evoked potential, visual fields, or vulvoscopy with or without
biopsy (in rooms).
Disability support service(s) means support service(s) provided where a condition, disability or illness has been, or is likely to be, present for 6 months or more excluding surgical or medical treatment.
Drug(s) means subsidised prescription medicines, (and non-subsidised diabetic test strips and needles only), that are Pharmac approved, and not otherwise excluded by the terms of your policy.
Easy-claim means Southern Cross Health Society Easy-claim which is made available to members via participating health services providers.
Eligibility criteria means any additional terms and conditions we put in place from time to time in respect to a particular procedure, the then current version of which will be available at southerncross.co.nz/eligibilitycriteria or upon request.
Eligible means those private healthcare services which are:
(a) covered under or listed in the Coverage Tables and comply with any applicable terms and conditions (including any eligibility criteria we may specify from time to time); and
(b) approved treatment; and
(c) performed in private practice by a health services provider with registration applicable to the healthcare service; and
(d) a healthcare service for which costs are actually incurred or to be incurred; and
(e) not otherwise excluded under the terms of your policy.
Exclusion(s) means conditions, treatments or situations that are not covered by this policy, as listed in this policy document and /or as specified in the Membership Certificate.
General Practitioner means a Medical Practitioner vocationally registered in General Practice or who has general or provisional general registration and is practising in general practice.
Health screening means diagnostic test(s), investigation(s) or consultation(s) in the absence of any sign or symptom suggesting the presence of the illness, disease or medical condition the screening is designed to detect.
Health services provider means a General Practitioner, Specialist or registered practising member of certain professions allied to medicine practising in private practice who we approve for the provision of healthcare services under this policy.
Healthcare service(s) means any private surgery or other procedure, treatment investigation, diagnostic test, consultation or other private healthcare service including hospitalisation provided by a health services provider or an approved facility.
Hospital fees means hospital costs for accommodation (single room basis excludes suites), operating theatre fees, anaesthetic supplies, intensive care and special in-hospital nursing, in-hospital x-rays and ECG, ancillary hospital charges, laparoscopic disposables and in-hospital post-operative physiotherapy.
Internal medicine means internal medicine, cardiology, clinical immunology, clinical pharmacology, endocrinology, gastroenterology, geriatric medicine, haematology, infectious diseases, medical oncology, nephrology, neurology, nuclear medicine, palliative medicine, respiratory medicine and rheumatology, as defined by the Medical Council of New Zealand (MCNZ).
Lifetime means the duration of a policyholder or dependant’s relationship with Southern Cross whether or not continuous.