For members FAQs


Premiums

When we review premiums, we consider aspects such as changes in the healthcare environment – including the increasing number and cost of claims. And because there’s generally a need to claim more often and for greater amounts as we get older, premiums increase with age.

There are three ways you may be able to reduce your premium, including paying by direct debit, adding an excess to your policy, or reviewing your level of cover.

Find out more here.

We have a number of initiatives to help manage premium costs. These include strengthening our Affiliated Provider programme, recovering costs from ACC, regular plan reviews, increasing our online services, and actively promoting better health and wellbeing to our members. See more information.

Members aged 21 or over who claim under a set amount over a 2 year calculation period may qualify for a low claims reward. See more about the low claims reward, or contact us for more information.

Your 2.5% direct debit discount is included in your new premium before any other rewards or discounts are applied.

If you’re part of a work scheme, it’s likely that you receive a discounted rate. You can contact us to confirm this, or check if your employer offers Southern Cross health insurance.

 If you’re part of a work scheme, it’s likely that you receive a discounted rate over private membership rates. This discount is reviewed each year and may take into account:

  • the number of employees in your work scheme.
  • the total claims paid for your work scheme.
  • any subsidy that your employer provides.
  • the way your premium is paid.

If you pay your premium by direct debit, credit card or wage and salary deductions, you don’t need to pay now. Your premium will be updated automatically.

If you pay your premium by invoice, please don’t pay your premium now. We’ll send an invoice soon.

You can set up regular credit card payments by returning a completed payment authority form. See more about setting up regular credit card payments.

See more about the low claims reward.

See more about the healthy lifestyle reward.

See more about the free child discount.

A person under 21 years of age.

Your claims anniversary is the date that any benefits with annual limits, and annual excesses, restart again each year. If you make a change to your plan, your claims anniversary date may change.

You can check your claims anniversary date in My Southern Cross.

Your group ID is a code that relates to your type of membership. You might need your group code when completing payment authority forms.

Your policy anniversary is the date your policy renews each year. Any changes to your policy may affect your policy anniversary date.

You can check your policy anniversary date on your renewal letter or in My Southern Cross.

Your policy renews each year on your policy anniversary date. At this time, we send you a renewal pack detailing your new premium.

FAQs for members

You can update your details in My Southern Cross or by contacting us. 
If your name is changing due to marriage, please send us a copy of your marriage certificate. If you are changing back to your maiden name, please send us a copy of your birth certificate. If you're changing your name by deed poll, please send us a copy of the deed poll certificate. You can post the documents to us, or scan or photograph them and send them to us through our enquiry form. 
Your policy documentation is available in My Southern Cross, on our plan page, or you can contact us and request a copy. If the cost of your healthcare service is likely to be over $1,000 or you need hospital care, you must apply for prior approval. Please get in touch at least 5 working days before the date of your healthcare service. 
If you have an accident, please contact ACC as they're the primary insurer for any treatment you need (including prescriptions).If ACC decline cover for your treatment, or there's any difference between the cost of your treatment and the amount that ACC pay, please contact us and we'll confirm whether you can claim for this under your policy instead. 
Your claims anniversary is the date that any benefits with annual limits, and annual excesses, restart again each year. If you make a change to your plan, your claims anniversary date may change. You can check your claims anniversary date, and your annual benefit balances, in My Southern Cross. 
In general terms, a pre-existing condition is any health condition, sign or symptom that occurred or existed either before your health insurance policy started, or before you upgraded to a plan with higher cover.Usually pre-existing conditions are excluded from cover to ensure fairness and premium affordability for all members. However, some plans include loyalty benefits that cover certain conditions after a set time period.We list the pre-existing conditions that we're aware of on your membership certificate, along with the status of their cover so you have greater certainty about what is and isn't covered under your policy.You can also check your pre-existing conditions and the status of their cover in My Southern Cross. 
Usually pre-existing conditions are excluded from cover to ensure fairness and premium affordability for all members. However, some plans include loyalty benefits that cover certain conditions after a set time period.We list the pre-existing conditions that we're aware of on your membership certificate, along with the status of their cover so you have greater certainty about what is and isn't covered under your policy.You can also check your pre-existing conditions and the status of their cover in My Southern Cross. 
We offer a range of plan options to suit different needs and budgets. See our plans for more information or contact us and we'll take you through the options in more detail. 
You can send us an enquiry or call us on 0800 100 777, 8am-5pm, Monday-Friday. 

My Southern Cross

My Southern Cross is a secure, online service for members of Southern Cross Health Society. 

Once registered, you can make a claim (policyholders only), apply for prior approval, access policy information and check benefit balances, manage how you receive communications from us, and more.
Members who have a health insurance policy can register for My Southern Cross. 

My Southern Cross isn’t available for members with a Critical Illness policy.
Registering should take you no longer than 5-10 minutes.
You can register online provided you have your Member card number or Policy/Membership number handy, and an email address or a phone number that matches our records. 

You can also call us on 0800 800 181 from 8am-6pm, Monday-Friday and we’ll start your registration for you.
To register, we need to verify who you are. This involves contacting you with a unique code on an email address or phone number that matches our records. If your details are being rejected, we may have old contact details on record for you. Please call us on 0800 800 181 from 8am-6pm, Monday-Friday to update your details. While you’re on the phone we can also start your registration for you.

If you prefer, complete our callback form and one of our friendly team members will get in touch with you instead.
It sounds like something we need to resolve over the phone. Please call us on 0800 800 181 from 8am to 6pm, Monday to Friday, or complete our callback form and one of our friendly team members will get in touch.
Yes, you need to register each of your policies. You should have a separate Member card number and policy number for each policy you hold. 

Note: My Southern Cross isn’t available for members with a Critical Illness policy.
My Southern Cross only shows benefits with annual limits. For a full list of your benefits, refer to your policy documentation.
Check ‘My communication settings’ to manage how you receive communications from us. You may still get the occasional letter in the post from time to time until they’re all available online.

My Southern Cross mobile app

You can download it free from the Apple App Store or Google Play.
You'll find the link to download the app inside My Southern Cross, making the set up process easier. HealthEssentials has been designed to provide members with a digital experience across a range of devices. Registering for My Southern Cross sets you up from the start to do this.
A PIN gives you easy access rather than having to enter your full username and password each time you login.
It’s free! You don’t need to buy it.
Data consumption has been kept to a minimum. But you will need to be mindful of the size of the files you upload when submitting a claim.
As a policyholder you can make a claim (non-surgical) and all members can view annual benefits and remaining balances. The app can also be used as a virtual Member card.
Only policyholders can make a claim.
Currently you can make only medical claims (non-surgical) through the app.

To claim, you’ll need to attach the original itemised receipts from your health service provider. Make sure your receipt image clearly shows:

Date of service/treatment
Name of patient
Name of provider/facility
Cost of service/treatment
Ensure EFTPOS receipt is not covering invoice/receipt

So that we receive a quality image please set your phones’ camera settings to a minimum 1600x960 or 1.5 mega pixels and limit the size of what you are taking to that of an A4 piece of paper. From our testing this will take an image that is legible and small (around 50-70Kb).
After sending the image with your claim, the image is deleted from your device. If you want to keep the image please take a separate photo using your device’s camera or do this step first, then load the image from your photo library into your claims submission.
Yes, in certain cases Southern Cross may require you to submit the original receipt to allow us to assess your claim.

Affiliated Providers

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.
Search for an Affiliated Provider here, or contact us
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.
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. 
 
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.

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

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.
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

FAQs for Easy-claim

Your Member card holds both your Member card number and your membership number. Easy-claim providers will need this information to find your details in the Easy-claim system, to make electronic claiming possible. If you do not have your card with you, the provider can use your full name and date of birth to find your details.

You can now also use the My Southern Cross app as your virtual Member card.

If you have misplaced your Member card, call Southern Cross on 0800 800 181 to request a replacement.

To understand the benefits you have on your policy, you need to check your policy document. Policy documents are available on the Southern Cross website.
To find what policy you are on, please check your Membership certificate for details, call Southern Cross on 0800 800 181, or login to My Southern Cross.
When your Easy-claim is processed, your receipt will confirm how much Southern Cross will pay. This amount will be paid to the health service provider directly.            
Yes, Southern Cross has plans to make Easy-claim available through other health service providers.            

Keep your receipts and claim online with My Southern Cross or on the go with the My Southern Cross app.

Alternatively you can complete a claim form. Send your completed form and receipt to us at Southern Cross Health Society, Claims Centre, Private Bag 3216, Waikato Mail Centre, Hamilton 3240. Freepost Authority 1440.

Find out more on how to claim.

Your Member card is an accepted means of identification to electronically claim for qualifying healthcare products and services at selected health service providers.

When you claim electronically for eligible healthcare services for yourself (or anyone else named on the policy) Southern Cross Medical Care Society deems this to be a claim under your policy, and you authorise Southern Cross Medical Care Society to process the claim in accordance with your policy coverage (or the policy coverage for the other person named on the policy) and pay the selected health service provider direct.

The policyholder will receive all communications from Southern Cross Medical Care Society in relation to each electronic claim.

At any time, you may advise Southern Cross Medical Care Society that you do not wish to electronically claim.

Prior approval

Prior approval confirms whether your surgery/procedure is eligible for cover and the conditions that apply. You provide us with estimated charges from the health services provider and we then advise your level of cover.
When applying for prior approval, please fill in all the information requested on the form. It is very important you provide detailed information such as the name of the surgery/treatment, hospital/facility name, surgeon’s name and addresses. This will speed up the application process. 

We will need a breakdown of the total procedure cost estimates (e.g. surgeon fee, anaesthetist fee, prosthesis, hospital costs). Your surgeon/specialist can provide this information to you. For some procedures we need written estimates. We’ll advise you if this is the case. 

We may contact you if we have any questions.
We aim to send a prior approval letter to the policyholder within 3-5 working days. Sometimes we may need more information from you or the provider, so it may take a little longer. 

If you require prior approval in under 5 working days, please call us.
Your policy document outlines the healthcare services covered by your plan.

Click here for a list of
policy documents.

If you have any further questions, please contact us on 0800 800 181. 

Low claims reward

Your eligibility for the low claims reward ends when you transfer into a subsidised work scheme. The low claims reward is replaced by whatever discounts apply to that work scheme. 

If you are transferring from a subsidised work scheme to a non-subsidised scheme or individual membership, you may become eligible for the low claims reward. Your renewal communication will advise if you have qualified for this reward.  

If you are a member of a subsidised work scheme, the low claims reward is already reflected in your premiums. These lower premium rates reflect actual claims made by members within the work scheme, or actuarial assumptions made about claiming patterns of subsidised schemes.

We use the previous two years so there is a long enough assessment period to even out your usage of plan benefits. If we only used one year, the threshold would be much lower and it would be harder for members to get the discount.

It also means that members aren't penalised if they have a health incident that falls across two claims years.  

This is a 'low claims' reward, so you can claim up to certain thresholds and still be eligible for the discount.

Your health is important. Delaying or avoiding treatment could cause your health to worsen. You should seek treatment and make claims when necessary. 

If your claim is for surgery, it is likely to be more than the low claims threshold. However, your claim refund is likely to be greater than any low claims reward.  
If your plan covers day-to-day healthcare, like doctors visits, it’s likely you could make a number of claims for doctors visits without affecting the low claims reward.