Affiliated Provider FAQs

What's an Affiliated Provider?

Affiliated Providers are doctors, specialists and medical facilities that is contracted to provide Southern Cross members with certain healthcare services at agreed prices.

When you use an Affiliated Provider:

1

It’s easy. They organise prior approval for the healthcare service you need and claim on your behalf. 

2

It keeps your future premiums more affordable by helping us to keep claims costs down. Claims through Affiliated Providers now account for over 45% of all claims costs.

3

Agreed prices mean you know up-front how much your contribution will be (if any). 

How do I found out if my healthcare service is Affiliated Provider-only?

You can check our list of Affiliated Provider-only healthcare services.

Why are some healthcare services Affiliated Provider-only?

Making healthcare services Affiliated Provider-only is an effective way we can help keep claims costs down. This directly impacts future premium affordability. Using an Affiliated Provider also makes prior approval and claiming quicker and easier for both members and providers.

How can I find an Affiliated Provider?

Search for an Affiliated Provider here, or contact us.

I have a provider that I have been going to for a long time. Can I still see them?

You must see an Affiliated Provider for any healthcare service that is Affiliated Provider-only. If your provider is, or becomes, an Affiliated Provider then you’ll continue to be eligible for cover under your policy.

If your provider performs an Affiliated Provider-only healthcare service but isn’t an Affiliated Provider, you won’t be eligible for cover under your policy. 

It’s important to check first – see Healthcare finder, the list of Affiliated Provider-only healthcare services, or contact us.

How do I know how much cover I have if I see an Affiliated Provider?

Agreed prices mean you know up-front how much, if anything, you will need to contribute to the cost of a healthcare service. An Affiliated Provider will confirm this before the procedure. 

Unless you are advised otherwise by an Affiliated Provider, Southern Cross will pay:

• for RegularCare, KiwiCare and First Cover plans - 80% of the amount charged by your Affiliated Provider for the healthcare service
• for all other plans - the full amount charged by your Affiliated Provider for the healthcare service.

What is a transition period?

A transition period is the time between a healthcare service becoming ‘Affiliated Provider-only’ and, in our view, there being sufficient Affiliated Providers in place to provide that healthcare service. 

In regions where we don't have sufficient Affiliated Providers, we'll continue to issue approvals.

Which healthcare services are in a transition period?

Our list of Affiliated Provider-only healthcare services shows an up-to-date list of healthcare services that are in transition.

How does Southern Cross decide who can become an Affiliated Provider?

Providers must have vocational registration with the New Zealand Medical Council for their area of practice, have a current practising certificate and be working from a facility that meets certain quality standards. In addition, we take into account things like member demand, the  services offered,  areas of expertise, coverage and price.

There are no Affiliated Providers in my area for the healthcare service I need. What should I do?

Firstly, check here to see if your healthcare service is in a transition period. If it is, we’ll continue to cover your healthcare service with non-Affiliated Providers until we’re satisfied there is sufficient coverage. If the healthcare service is no longer in a transition period, contact us.