Low claims reward

Your reward for good health

The low claims reward is a 10% discount for members who have claimed below a specific claims threshold for two years. The reward applies for up to 12 months.

Eligibility for the low claims reward

Members paying adult premium rates and with at least two years continuous Southern Cross membership are eligible.

It does not apply to:

  • Members who are part of a subsidised work scheme.
  • Members on the HealthAssist plan.
  • The Critical Illness plan.
  • Members under 21 years old.  

How the low claims reward works 

Claims thresholds are set each year for different age groups and plan types.

If a member has claimed below the relevant claims threshold for two consecutive years, a 10% discount is applied to the member’s premium at their policy renewal. 

If a member changes plan, the threshold which applies will be for the plan the member has been on for the majority of the two year calculation period.

We will advise members of the thresholds at policy renewal time.

Qualification for the low claims reward is based on claims refunds processed by us during the two year calculation period, rather than treatment dates or the dates claims are lodged.

FAQs

The low claims reward is a simple way to recognise and reward good health.

Will you lose the low claims reward if you claim?

Can you find out if a claim will exceed a low claims reward threshold for your policy?

Why doesn’t the low claims reward scheme apply to members of subsidised work schemes?

What happens to the low claims reward  if you join a subsidised work scheme?

Why is the low claims reward assessed over two years?

Terms and conditions

Detailed information about the rules and conditions for the low claims reward.

Will you lose the low claims reward if you claim?

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.   

Can you find out if a claim will exceed a low claims reward threshold for your policy?

Yes, call Member Services on 0800 800 181.

Why doesn’t the low claims reward apply to members of subsidised work schemes?

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.

What happens to the low claims reward if you join a subsidised work scheme?

Your eligibility for the low claims reward ends when you transfer into a subsidised work scheme. The low claims rewards 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.  

Why is the low claims reward assessed over two years?

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.  

Low claims reward terms and conditions

Definitions

Eligibility for the scheme 

Earning a low claims reward 

Eligibility for low claims reward following a change in membership status 

Amendment of low claims rewards 

General 

The following terms and conditions apply in respect to the Southern Cross Low claims reward

1. Definitions

1.1 In these terms and conditions:

Adult Member(s)’ means a Member paying an Adult Premium Rate.

Adult Premium Rate’ means the premium or subscription rate for members 21 years of age and over at their policy anniversary date or from time to time.

Calculation Period’ means the continuous period of two years membership as close as reasonably practicable (in accordance with Southern Cross Health Society business practice from time to time) prior to the calculation of premiums at the time of Policy Renewal.

Dependant’ means a Member who is noted on the Policyholder’s policy or membership as a dependant of the Policyholder in accordance with the Society’s Rules .

Eligible Member(s)’ means a Member on an Eligible Plan, paying Adult Premium Rates, who isn’t part of a subsidised group scheme, has at least two years continuous membership and claims history with Southern Cross Health Society coinciding with the Calculation Period, and who has the calculation for the low claims reward applied to their annual premium (except that from time to time group schemes can be otherwise included or excluded from the low claims reward scheme at our sole discretion).

Eligible Plan means a policy or plan to which the low claims reward scheme applies from time to time.

Member’ means a person who is an active current Member of Southern Cross Health Society in any capacity, including as a Policyholder or Eligible Dependant as defined by the Society’s Rules, and on an Eligible Plan.

Policy Renewal means annual renewal of a policy or any other relevant policy amendment notice from time to time.  For example, a change in circumstances including a change in plan type or leaving/joining a group scheme.

Policyholder’ means the principal Member who is noted on a Southern Cross Health Society membership certificate as the policyholder, to whom all official correspondence and invoices related to that membership will be sent.

Society’s Rules’ means the Rules of the Southern Cross Medical Care Society, as amended from time to time.

Southern Cross Health Society means the Southern Cross Medical Care Society, the operator of the low claims reward scheme.

Suspension’ means when a Member has been granted Southern Cross Health Society membership suspension for a fixed period of time not exceeding twelve months.

Thresholds’ means the aggregate amount of claims refunds including GST an Eligible Member can receive in the Calculation Period before they no longer qualify for the low claims reward (as varied from time to time).

1.2  Terms defined in the  Society’s Rules, unless the contrary appears, similarly defined for these terms and conditions.

2. Eligibility for the scheme

2.1 Entry into the scheme is free and automatic to any Eligible Member on an Eligible Plan.

2.2 Eligible Members are deemed to be bound by these terms and conditions.

3. Getting a low claims reward

3.1 The calculation of the low claims reward for each Member is determined by the claims refunds paid to or on behalf of a Member during the Calculation Period and the Southern Cross Health Society  plan or policy held by the Member for the majority of the Calculation Period.

3.2 The threshold level applied at the time of calculation will be based on the Member’s age at their Policy Renewal date and the Southern Cross Health Society plan or policy as described in clause 3.1 above.

3.3 A Member is not eligible for the low claims reward unless they have had continuous membership and claims history on an Eligible Plan for at least two years corresponding with the Calculation Period.  Members who have suspended their policies, or whose policies have lapsed during that two-year period (including for non-payment of premiums) will be ineligible.

3.4 Southern Cross Health Society can change the Threshold values, percentage rewards, Eligible Plans and other eligibility criteria from time to time without notice.

3.5 The low claims reward and any rights they confer are personal to a Member and cannot be sold, transferred, assigned or otherwise dealt with by a Member or on behalf of a Member.

3.6 The low claims reward has no cash or monetary value that may be paid to a Member.

4. Eligibility for low claims reward following a change in membership status

4.1 If a Member transfers into a subsidised group scheme (or any other group scheme excluded from the low claims rewards scheme) or transfers to a plan other than an eligible plan, they will immediately cease to be eligible for the low claims reward.

4.2 Any change of group or transfer by a Member, excluding clause 4.1 above, will result in that Member’s low claims reward eligibility being reviewed in light of any change to the plan or policy type, Thresholds or other eligibility criteria.

4.3 A Member transferring from one policy to another (i.e. an Adult Dependant or divorced spouse taking a separate policy) will have immediate eligibility for the low claims reward, provided they remain an Eligible Member on an Eligible Plan as defined in these terms and conditions.

5. Amendment of low claims rewards

5.1 Southern Cross Health Society may alter a Member’s qualification for the low claim reward if an adjustment is required to correct any inaccuracy which would have resulted in the low claims reward being incorrectly applied.

6. General

6.1 Southern Cross Health Society will inform Members whether they are eligible for a low claims reward for their coming period as part of their Policy Renewal.

6.2 Any disputes about the low claims reward must be notified to Southern Cross Health Society within one month of the Member receiving their Policy Renewal advice.  Otherwise, the low claims reward eligibility will be taken as correct and binding on the Policyholder and other Members noted on the Policyholder’s membership record. Disputes unless otherwise resolved will be dealt with as a dispute relating to a claim for a benefit under the Society’s Rules .

6.3 A Member shall be deemed to have forfeited any eligibility for a low claims reward they have earned if; (a) the Member ceases to be a Member of Southern Cross Health Society at any time; or (b) the Member ceases to hold an Eligible Plan; or (c) the Member ceases to have continuous cover with Southern Cross Health Society (including Suspension); or (d) the Member does not adhere to the Society’s Rules and suffers disciplinary action in terms of those rules.

6.4 Southern Cross Health Society reserves the right to vary these terms and conditions, or to suspend or terminate the scheme at any time without prior notice to Members.

6.5 Southern Cross Health Society may also at any time and without prior notice change the basis for calculating the Thresholds and / or the plans which are eligible for this scheme and / or the eligibility criteria for Members fixed in accordance with clause 3.1.

6.6 Southern Cross Health Society shall not be liable in any way for: (a) the suspension or termination of the scheme; or (b) any failure to notify a Member of any change in these terms and conditions; or (c) any change in the basis for earning the low claims reward; (d) any accidental failure or omission to give any notice or notification to any Member(s).

6.7 A notice shall be deemed to be given to a Member if it is posted to the last known address of the Policyholder.