Low claims reward terms and conditions


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 


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.