Working Alongside ACC

Keeping your premium affordable

As a New Zealand resident, you are entitled to access health services through the public health system and ACC. Public health is funded by tax-payers. ACC is funded through levies on earners, employers and motorists. Your UniMed health insurance is designed to complement the health services available through the public health system and ACC but not replace them.

So, if you have an accident or injury and need treatment, or need further treatment in relation to a previous injury, you should contact ACC. As we are committed to keeping premiums affordable, you are required to make a claim with ACC first and your UniMed plan only applies for top-up payments or where ACC has declined your claim.

If you didn’t submit an injury-related claim to ACC first, we will require you to make a claim with ACC before we can proceed with assessing how your UniMed health insurance policy may apply. This ensures that if ACC is responsible for the claim then they pay, reducing the impact on our members’ premiums.

ACC Top-up Fees

For some healthcare services, such as physiotherapy and osteopathy, ACC doesn’t pay the full costs and you will have a top-up fee to pay. If your UniMed plan includes benefits for those healthcare services, you can claim the top-up fee from us within the rules and limits of your plan.

When ACC declines cover

Sometimes ACC declines cover when they believe your current medical condition is not related to or caused by your injury or accident. This is where your UniMed plan applies.

Simply seek prior approval for your treatment providing us with your ACC documentation, including their letter declining cover, and we will adjudicate your claim against your policy to assess eligibility and extent of cover.

ACC Appeals

Sometimes when ACC declines your claim we might consider that their decision should be challenged. In this case we will adjudicate your claim against your policy and provide the appropriate cover provided that you agree (in writing) to UniMed appealing the ACC decision on your behalf.

You’ll receive the required treatment and we will pay the claim in line with your benefit entitlements. We will appeal your claim with ACC. If we are successful, we will notify you and refund to you a proportion of any excess or co-payments you have paid. You will also be able to claim from ACC for the other benefits that ACC provides (subject to their criteria), such as loss of earnings and ancillary costs (GP, ambulances, physiotherapy etc) that have not been paid by UniMed.

Further information

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.