Specialist consultations 5-visit consult limit change

As at 18 September 2019 we are no longer applying the 5-visit limit on specialist consultations on all plans that had this rule.

The impacted plans are: KiwiCare, KiwiCare Budget, RegularCare, RegularCare Budget, Wellbeing Starter, Wellbeing One and all First Cover plans.

This visit limit was introduced in December 2018 as part of a regular policy update, and entitled members to just five specialist consultations per claims year, within the existing claims year dollar limit. This limit was introduced to address rising premiums from over-use of non-essential specialist consultations. 

The feedback we received from providers and members since implementing this rule has been taken seriously. The impact on members with conditions that require on-going treatment, or members with higher frequency, lower cost consultations was an unintended consequence of this change. The decision was made to remove the 5-visit limit so that members could continue to get access to the cover they need for specialist consultations.

The per claims year dollar limit (including any remaining balance) and the claims year date has not changed. All other terms, conditions and exclusions still apply.

The 5-visit limit will continue to show in policy documents until these are updated in late 2020. The benefit balances showing in My Southern Cross correctly displays the per claims year dollar limit, not the visit count.

Claims for specialist consultations are assessed based on the date of service, so any claims for consultations prior to 18 September 2019 will have the 5-visit limit applied. Claims from 18 September 2019 will not have the 5-visit limit applied.