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)
- Electrophysiology studies - effective 17 December 2025
- 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)
- Breast reduction allowance
- Biofeedback and electrostimulation for faecal incontinence
- Breast revision surgery
- Fat grafting following an eligible mastectomy
- Gastric banding / bypass allowance
- Gastric bypass for gastro-oesophageal reflux disease
- Hernia repair
- Surgical treatment of hyperhidrosis
Gynaecology (reproductive system)
- Labiaplasty
- Periurethral bulking agent
- Removal of submucosal fibroids or uterine polyps using a hysteroscopic morcellation device (eg MyoSure, TruClear)
Imaging (scans)
- Cone beam computed tomography (CBCT)
- Gastrointestinal ultrasound
- Positron emission tomography / computed tomography (PET/CT)
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
- Bite splints
- Temporomandibular joint (TMJ) total joint replacement (TJR)
- Tooth extraction under general anaesthesia - effective 17 December 2025
Orthopaedic
- Single level lumbar disc replacement
- Surgical ligament or tendon repair with a synthetic augmentation device or Neoligaments synthetic ligament prosthesis
Other
Otolaryngology (ear, nose & throat)
- Balloon sinuplasty
- Cochlear implant internal device
- Endoscopic modified Lothrop
- Eustachian tube balloon dilation
- Exostoses removal
- Open septoplasty and septorhinoplasty
- Transoral robotic surgery
- Video-assisted head impulse test (vHIT) and caloric test
Skin
- Mohs surgery
- Skin lesion removal and minor skin surgery
- Surveillance consultations for non-melanoma skin cancers
Urology (kidney, bladder, and prostate)
Vascular surgery (artery & vein surgery)