1. Home
  2. For members
  3. Making a claim
  4. Affiliated Provider
  5. Affiliated Provider-only healthcare services

Affiliated Provider-only healthcare services

A number of healthcare services are only eligible for cover if they are performed by an Affiliated Provider. This applies to all health policies except UltraCare.

Find an Affiliated Provider

In order to receive cover for the healthcare service you must meet any applicable eligibility criteria and the terms and conditions of their policy at the time the services are provided.

Please be aware that not all healthcare services are available from all Affiliated Providers or in all areas.

Unless otherwise advised by Southern Cross / your Affiliated Provider, we will pay the following:

  • RegularCare, KiwiCare and First Cover plans – 80% of the amount charged by your Affiliated Provider for the healthcare service up to policy limits.
  • All other plans (excluding UltraCare) – 100% of the amount charged by your Affiliated Provider for the procedure up to policy limits.

For full details, please refer to your policy document.

Select the healthcare service you require from the list below to understand what you need to do to confirm cover for your treatment.

For the healthcare services below find an Affiliated Provider here. If you can’t find one please contact us.
  • All specialist consultations

For the healthcare services listed below (unless stated otherwise) check here to find an Affiliated Provider. For prior approval you can apply online through My Southern Cross or if you have any questions or need more information call 0800 800 181. We’re here to help Monday to Friday, 8am to 6pm 

  • Mammography
  • X-ray
  • Ultrasound
  • Digital breast tomosynthesis
  • Nuclear scanning (scintigraphy)
  • Myocardial perfusion scan
    • Please note, must be referred by a specialist in private practice
  • CT angiogram
  • CT coronary angiogram
    • Please note, must be referred by a specialist in private practice
  • MR angiogram
    • Please note, must be referred by a specialist in private practice
  • Computer axial tomography (CT scan) 
    • Please note, cone beam computed tomography (CBCT) must be referred by a specialist in private practice
  • Magnetic resonance imaging (MRI Scan)
    • Please note, must be referred by a specialist in private practice
  • Positron emission tomography / computed tomography (PET/CT)
    • Please note, cover is limited to specific diagnosed cancers and must be referred by a specialist in private practice
    For the healthcare services below find an Affiliated Provider here. If you can’t find one please contact us.
    • Ambulatory blood pressure monitoring (when performed by a specialist)
    • Breath nitric oxide test
    • Corneal topography
    • Fundus fluorescein angiography
    • Fundus photography
    • GDx Retinal scanning
    • Heidelberg Retinal Tomography (HRT)
    • Intraocular pressure test (IOP)
    • Matrix screen
    • Optical Coherence Tomography (OCT)
    • Optic disc photos
    • Visual fields
    • Retinal photography

    For the healthcare services below please call 0800 800 181. We’ll discuss the cover available under your policy and explain the process. We’re here to help Monday to Friday, 8am to 6pm.

    • Chemotherapy treatment
    • Radiotherapy (including radiotherapy planning and radiation treatment)

    For the healthcare services below find an Affiliated Provider or General Practitioner with an Easy-claim agreement here. If you can’t find one please contact us.

    • Drug challenge testing for allergy
    • Food challenge testing for allergy
    • Injection for allergy
    • Skin testing for allergy
    • Desensitisation

    For the healthcare services below find an Affiliated Provider here. If you can’t find one please contact us.

    • Coronary artery bypass graft surgery (CABG) 
    • Valve replacement
    • Valvuloplasty 
    • Bentalls procedure 

    For the healthcare services below find an Affiliated Provider here. If you can’t find one please contact us.

    • Coronary angiogram and / or angioplasty
    • Electrophysiology studies and ablation of cardiac arrhythmias
    • Percutaneous patent farmen ovale (PFO) closure
    • Percutaneous atrial septal defect (ASD) closure
    • Peripheral angiogram and / or angioplasty
    • Advanced electrocardiogram (AECG)
    • Resting ECG (when performed by a specialist)
    • Exercise ECG (when performed by a specialist)
    • Holter monitoring (when performed by a specialist)
    • Echocardiogram (when performed by a specialist)
    • Stress echocardiogram (when performed by a specialist)
    • Dobutamine stress echocardiogram (when performed by a specialist)
    • Transoesophageal echocardiogram (when performed by a specialist)
    • Transcatheter aortic valve implantation/replacement (TAVI/TAVR)
    • Left atrial appendage occlusion

    For the healthcare services below find an Affiliated Provider here. If you can’t find one please contact us.

    • Grommets (insertion and / or removal of grommets in theatre)
    • Aural toilet (when performed by a specialist)
    • KTP Laser ear surgery
      • KTP laser mastoidectomy
      • KTP laser revision mastoidectomy
      • KTP laser tympanoplasty
      • KTP laser second look tympanoplasty
      • KTP laser middle ear adhesiolysis
      • KTP laser stapedectomy
      • KTP laser medial canalplasty
      • KTP laser myringotomy
    • Balloon sinuplasty
    • Endoscopic modified Lothrop
    • Functional endoscopic sinus surgery (FESS)
    • Septoplasty
    • Nasal cautery (when performed by a specialist)
    • Adenoidectomy
    • Tonsillectomy
    • Laser treatment for pharyngeal, laryngeal and oesophageal conditions
    • Transoral robotic surgery

    For the healthcare services below find an Affiliated Provider here. If you can’t find one please contact us.

    • Colonoscopy
    • Cholecystectomy
    • Balloon enteroscopy
    • wireless pH capsule (wireless capsule endoscopy) 
    • Endoscopic ultrasound
    • Gastroscopy
    • Hernia repair (femoral, hiatus, inguinal and umbilical hernia repair
    • Microwave ablation of lung tumour
    • Sacral nerve stimulatior
      • Please note, there will be no reimbursement for the cost of the stimulation device

    • Varicose vein (cover limited to two varicose vein leg procedures per leg, per lifetime)
      • endovenous laser treatment
      • ultrasound guided sclerotherapy
      • varicose vein surgery
      • radiofrequency (RF) endovenous ablation
      • duplex vein mapping
    • Contrain biofeedback and electrostimulation for faecal incontinence
      • Please note, there will be no reimbursement for the cost of the stimulation device

    For the healthcare services below find an Affiliated Provider here. If you can’t find one please contact us.

    • Superficial vascular malformation sclerotherapy and embolisation – simple
      • Please note, cover is limited to two procedure per vascular malformation per lifetime
    • Percutaneous medial branch thermal radiofrequency neurotomy
      • Please note, cover is limited to two procedures per lifetime
    For the healthcare services below find an Affiliated Provider here. If you can’t find one please contact us.
    • Endoscopic third ventriculostomy

    For the healthcare services below find an Affiliated Provider here. If you can't find one please contact us.
    • Bleb needling
    • Cataract surgery
    • Corneal crosslinking
    • Corneal topography
    • Entropion and ectropion repair
    • Excision of pterygium
    • Excision of pinguecula
    • Fundus photography
    • Fundus fluorescein angiography
    • GDx retinal scanning
    • Heidelberg retinal tomography (HRT)
    • Intraocular pressure test (IOP)
    • Intravitreal injections
    • Laser eye treatment
    • Matrix screen
    • Minor eyelid surgery
    • Optic disc photos
    • Optical coherence tomography (OCT)
    • Probing / syringing of lacrimal passage
    • Correction of ptosis
    • Removal of tarsal cyst
    • Retinal photography 
    • Upper eyelid blepharoplasty
    • Visual field tests
    • Posterior vitrectomy

    For the healthcare services below find an Affiliated Provider here. If you can’t find one please contact us.

    • Extraction of unerupted or impacted teeth
      • Please note, no cover for RegularCare and KiwiCare policies

    For the healthcare services below find an Affiliated Provider here. If you can’t find one please contact us.

    • Synthetic ligament repair and reconstruction
    • Carpal tunnel release
    • Hip joint replacement (primary total hip joint replacement)
    • Knee joint replacement (primary total knee joint replacement and primary partial hemi knee joint replacement)
    • Radiofrequency ablation of benign bone lesions 

    For the healthcare services below find an Affiliated Provider here. If you can’t find one please contact us.

    • Mohs surgery (includes cover for excision and closure)
    • Excision of skin lesion
    • Skin biopsy (only applies if under general anaesthetic)
    • Currettage and diathermy (only applies if under general anaesthetic)
    • Cryotherapy (only applies if under general anaesthetic)

    For the healthcare services below find an Affiliated Provider here. If you can’t find one please contact us.

    • Prostate treatment
      • laparoscopic prostatectomy
      • prostate brachytherapy
      • external beam radiotherapy
      • prostate cryotherapy
      • radical retropubic prostatectomy
      • perineal prostatectomy
      • transurethral resection of prostate (TURP)
      • open enucleation of prostate
      • laser resection of prostate
      • robotically assisted laparoscopic prostatectomy
      • prostate biopsy
    • Laparoscopic renal cryotherapy
    • Vasectomy
      • Please note, this is a loyalty benefit, there is no cover on SureCare or SureCare Concessionary policies and no cover for reversals
    • Robotic partial nephrectomy
    • Resection of bladder tumour
    • Nephrectomy
    • Circumcision
    • Ureteroscopy