Eligibility for Claiming
To keep premiums affordable, we need to ensure that members’ claims are eligible for reimbursement. Our health insurance plans have been designed to provide cover for a wide range of private healthcare services and treatments whilst sitting alongside and complementing the services available through ACC and the public health system.
We provide cover for many medical conditions and their associated treatments, but not for all. For a medical condition to be eligible, it must meet certain criteria. A different set of eligibility criteria applies for the healthcare service, or surgical procedure. Both these sets of criteria must be met before a claim can be reimbursed.
Please see below checklists of eligibility criteria and other factors that need to be taken into consideration for your treatment (as a guide only). You will also need to consult your Membership Certificate to see if you have any relevant endorsements to be taken into consideration. Full wording is in the Conditions of Membership and our Claims Team would be pleased to check your specific situation and confirm the extent of cover.
We also aim to ensure that the healthcare services we pay for will result in a successful outcome for our members and we do this by requiring that healthcare service providers and facilities are appropriately accredited or registered in New Zealand.
The information on this website is intended as a general guide. Please read your Benefit Schedule, Membership Certificate and Conditions of Membership for the full terms and conditions of your policy.