Public health is funded by taxpayers. ACC is funded through levies on earners, employers and motorists. Your UniMed Health Plan is designed to complement the health services available through the public health system and ACC but not replace them.
If you have an accident or injury and need treatment, or need further treatment in relation to a previous injury, you are required to make a claim with ACC first. Your Health Plan only applies for top-up payments or where ACC has declined your claim.
If you don’t submit an injury-related claim to ACC first, we will require you to make a claim with ACC before we can assess how your Health Plan may apply. This ensures that if ACC is responsible for the claim, then they pay. This helps keep our Health Plan premiums affordable for our Members.
ACC top-up fees
ACC doesn't pay the total costs for some healthcare services, such as physiotherapy and osteopathy, and you will have to pay a top-up fee. If your Health Plan includes benefits for those healthcare services, you can claim the top-up fee from us within the rules and limits of your Health 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 Health Plan applies.
Simply seek prior approval for your treatment and provide us with your ACC documentation, including ACC’s letter declining cover, and we will review your claim against your Health Plan to assess eligibility and extent of cover.
Sometimes, when ACC declines your claim, we might consider that their decision should be challenged. In this case, we will review your claim against your Health Plan and provide the appropriate cover if you agree (in writing) to UniMed appealing the ACC decision on your behalf.
You’ll receive the necessary treatment, and we will pay the claim as per your benefit entitlements.
We will appeal your claim with ACC. If we’re successful, we will notify you and refund a proportion of any excess or co-payments you have paid. You will also be able to contact ACC to claim the other benefits that ACC provides (subject to their criteria), such as loss of earnings and ancillary costs (GP, ambulances, physiotherapy etc) that UniMed has not paid.