Eligibility criteria to make health claims
As specified in Southern Cross’ policy documents, certain healthcare services have eligibility criteria which need to be met before a healthcare service will be covered under your policy.
The eligibility criteria for each of these healthcare services can be found in the links below.
If you are unsure about any of the medical terms in the eligibility criteria, please discuss these with your medical practitioner to understand how they apply in your particular circumstance.
Please note that the general exclusions set out in your policy documentation apply to all healthcare services, including those listed below.
Cardiac services (heart disorder diagnosis & treatment)
- Catheter based cardiac procedures
- CT coronary angiogram (CTCA)
- Left atrial appendage occlusion
- Transcatheter aortic valve implantation/replacement (TAVI/TAVR)
Gastroenterology(digestive tract examination)
- Balloon enteroscopy
- Bravo pH monitoring
- Colonoscopy (in adults)
- Endoscopic ultrasound
- Gastroscopy with RFA for Barrett's oesophagus
- Paediatric colonoscopy
- Wireless capsule endoscopy
General surgery (breast, gall bladder, hernia)
- Bilateral breast reduction allowance
- Biofeedback and electrostimulation for faecal incontinence
- Breast revision surgery
- Fat grafting following an eligible mastectomy
- Gastric banding / bypass allowance
- Hernia repair
- Laparoscopic liver resection
- Primary breast reconstruction
- Sacral nerve stimulation for faecal incontinence
- Surgical treatment of hyperhidrosis
Gynaecology (reproductive system)
- Insertion or removal of an intrauterine device
- Periurethral bulking agent
- Removal of submucosal fibroids or uterine polyps using a hysteroscopic morcellation device (eg MyoSure, TruClear)
Imaging (scans)
Internal medicine
Interventional radiology
- Adrenal vein sampling
- Basivertebral nerve ablation
- Image-guided ablation for bone tumours or metastases (including cementoplasty)
- Percutaneous renal cryoablation
- Radiofrequency ablation of bone lesions
- Radiofrequency ablation of thyroid nodules
- Vascular malformation sclerotherapy and embolisation – simple
Neurosurgery
Oncology (cancer diagnosis & treatment)
Ophthalmology (eyes)
- Blepharoplasty and ptosis surgery
- Cataract surgery
- Corneal cross-linking
- Lens extraction for narrow anterior chamber angles
Oral & Maxillofacial
Orthopaedic
Other
Otolaryngology (ear, nose & throat)
- Balloon sinuplasty
- Endoscopic modified Lothrop
- Eustachian tube balloon dilation
- Exostoses removal
- Open septoplasty
- Transoral robotic surgery
- Video-assisted head impulse test (vHIT) and caloric test
Respiratory (lung function tests & sleep studies)
Skin
Urology (kidney, bladder, and prostate)
Vascular surgery (artery & vein surgery)