Policy variations

Effective 1 April 2026

This list of policy variations forms part of your Southern Cross health insurance policy. It sets out variations to your policy terms and conditions that may apply from time to time. These variations include the way we treat some exclusions listed in your policy document and certain benefit terms, or new ways of delivering healthcare services we’re testing. This may mean you can access additional cover while these variations are included below.

Variations included in this document may change from time to time as we continuously review how we cover healthcare services and certain technology.

Where a variation listed refers to an existing benefit, your policy must include the benefit that it relates to, in order to have cover under that variation. The terms and conditions of the benefit and any eligibility criteria that apply must be met, unless specified within the variation.

Words in italics are defined in the glossary of terms in your policy document.

Skin closures and reconstructions following skin procedures

This policy variation clarifies how we cover skin closure and complex reconstructions following a skin lesion healthcare service, or Mohs surgery, when performed under local anaesthetic, oral sedation, IV sedation or general anaesthetic.

Skin closure under the skin lesion services benefit
Skin closure is covered under the skin lesion services benefit where the defect is confined to skin and subcutaneous tissue only, regardless of size, location, or complexity of the closure technique. This includes (but is not limited to) the following procedures:

• Direct or layered closure
• Extensive undermining or tissue mobilisation
• Skin grafts
• Local, regional, advancement, rotation, or transposition flaps

in each case when no deeper anatomical structures are repaired or reconstructed.

Complex reconstruction under the surgical procedures (following skin procedures)
Complex reconstruction performed following a skin lesion healthcare service or Mohs surgery (under local anaesthetic, oral sedation, IV sedation or general anaesthetic), is covered under the surgical procedures benefit, where the reconstruction:

• involves repair, reconstruction, or alteration of anatomical structures beyond the dermis and subcutaneous tissue, or
• affects adjacent organs or functional structures.

In these cases, the service is classified as reconstruction and is not considered a skin lesion healthcare service.

Travel and accommodation allowance

Under the travel and accommodation allowance terms and conditions, the requirement that the eligible healthcare service that the policyholder or dependant needs is not “available” in their hometown or city means there are no health services providers who provide the eligible healthcare service in that person’s hometown or city, or the health services providers located in that person’s hometown or city are not accepting new patients. Wait times to see a health services provider are not considered in determining whether an eligible healthcare service is available in the person’s hometown or city.

Prognostic gene testing for breast cancer

This variation provides cover for specified prognostic gene testing for breast cancer. You must be referred by a specialist in private practice.

For prognostic gene tests eligibility criteria need to be met before we’ll cover them.

We’ll cover the actual costs incurred up to the limits stated below for the following prognostic gene tests/services for breast cancer:

• Prosigna - $4,450
• Oncotype DX - $6,700
• Mammaprint - $8,475
• Processing sample fee - $205

No excess or co-payment applies to this cover. The above limits do not apply to UltraCare plans.

This cover is not available under the HealthEssentials policy.

Cosmetic treatments and procedures

The exclusion for cosmetic treatments and procedures does not apply to the following procedures under the surgical procedures benefit:

• Reconstructive procedures following resection or removal of a tumour
• Blepharoplasty and ptosis surgery to correct droopy eyelids that impair vision
• Open septoplasty (septorhinoplasty) for nasal obstruction
• Sclerotherapy or embolisation of simple vascular malformation

Healthcare services provided outside of New Zealand

The exclusion for costs related to, or incurred as a consequence of, healthcare services provided outside of New Zealand does not apply to cover under the following benefits where the related eligible surgical treatment, chemotherapy, or radiotherapy is provided outside of New Zealand:

• Post-operative home nursing
• Post-operative speech and language therapy
• Post-operative physiotherapy.

Pregnancy and childbirth, and termination of pregnancy 

The exclusions for costs related to, or incurred as a consequence of, pregnancy and childbirth and the termination of pregnancy do not apply to eligible healthcare services that are: 

• required for a non-acute condition present 6 months or more after pregnancy or childbirth, or  
• provided for a condition that is not directly related to, or not present during, pregnancy or childbirth. For example, haemorrhoids, varicose veins, pelvic organ prolapse, or 
• provided to address a non-acute complication of pregnancy which poses a health risk to the member, such as ectopic pregnancy or miscarriage.

Prescriptions

This variation extends cover for drugs to drugs prescribed by any health services provider on the following plans:

• HealthEssentials
• SureCare Concessionary.