What's changing?
Existing policy document
(effective until 31 March 2026)
This is a high-level summary to help you understand the key changes to the SureCare Concessionary plan that took effect on 1 April 2026. Please read it carefully so you understand the changes that are being made to your policy.
Your health insurance policy is made up of a number of documents, including your membership certificate, the policy document and the following documents which are updated from time to time: eligibility criteria, the list of unapproved healthcare services, the list of Affiliated Provider-only healthcare services, the list of prostheses and specialised equipment and the list of policy variations. Together, all these documents outline your cover. Terms, conditions and exclusions apply.
You should check your membership certificate to see if you have cover for pre-existing conditions under any previous Southern Cross plans and select those plans to view changes that might affect your cover. To find your membership certificate, visit MySouthernCross, our online member portal or contact us for a copy.
Healthcare services becoming Affiliated Provider-only
We are always considering which healthcare services should only be performed by an Affiliated Provider to be eligible for cover. This helps us to manage overall healthcare costs which supports keeping premiums affordable. It also provides members with a simpler and more certain process:
A list of Affiliated Provider-only healthcare services is available on our website. Please check this regularly as the list will change from time to time.
Gynaecology is becoming Affiliated Provider only
Healthcare services related to Gynaecology are becoming Affiliated Provider-only. We have not set any timeframes as to when this change will happen, but we are notifying our members, so they are aware of the upcoming changes. Please check the Affiliated Provider-only healthcare services list regularly as it will change from time to time, or speak with your health services provider.
We have updated the wording of our policy document to better reflect current practice and to provide greater clarity around the cover available. These updates do not represent new benefits, but rather confirm and clarify the way cover is already applied.
We are removing reference to the specialist’s vocational registration in internal medicine under the ‘Chemotherapy for cancer’ benefits
This change is being made because specialists must work within their scope of practice.
We are removing the standalone exclusion for Dementia and adding it to the ‘chronic conditions’ exclusion
Dementia is a chronic condition so should be included under the 'chronic conditions' exclusions.
We are removing a paragraph regarding pricing for children turning 21 years old
This does not change the cover under your policy because pricing information is not included in your policy. Information on child rates and what happens when children turn 21 can be found on our website.
We are removing the definition of 'approved treatment' from the 'Overseas treatment allowance'
We are making it easier to understand what the requirements are for the ‘Overseas treatment allowance’ by removing the definition of ‘approved treatment’ and instead listing the relevant terms in the allowance wording.
Specialist consultations can be carried out by a health services provider working under specialist supervision
Cover has been extended to include consultations with a health services provider who is working under the supervision of a specialist, if the type of consultation is:
General tidy-up of policy wording
We've made some small changes to our policy documents to fix grammar, tidy things up, and refresh some links.
We are moving some policy variations currently published on the list of policy variations into the policy document
In October 2024, we introduced a list of policy variations that form part of your policy. These variations may provide access to additional cover and outline changes to policy terms and conditions, such as how exclusions are treated, updates to benefit terms, or new ways of delivering healthcare services we’re testing.
Until now, these policy variations have only been available to view on our website. However, we are now removing them from the list of policy variations and incorporating some of them directly into your policy document.
The following variations will now be included in your policy document:
We are updating the ‘Travel and accommodation allowance’ to include ride-sharing services and accommodation hosting platforms
The policy document wording relating to the ‘Travel and accommodation allowance’ will be updated to include cover for less traditional but commonly used travel and accommodation providers such as ride-sharing services and accommodation hosting platforms.
Travel costs include public transport charges for buses, trains, taxis, shuttles, planes, ferries, and ride-sharing services.
Accommodation costs include charges for hotel rooms, motel rooms, or hospital rooming fees for the support person, hospital flats and short-term rentals through recognised accommodation hosting providers.
Cover for in-hospital ultrasounds
The definition of hospital fees is being updated to provide cover for in-hospital ultrasounds under the ‘Surgical procedures’ benefit.
Cover for breast screening ultrasounds where dense breast tissue is confirmed
Cover is included for breast screening ultrasounds where a mammogram alone is unsuitable due to confirmation of dense breast tissue by a mammogram or MRI. In all other circumstances, breast screening ultrasounds are not covered.
Cover for healthcare services related to mental health
We have updated our mental health exclusion wording to make cover clearer. GP services and prescriptions for mental health are covered.
We have removed policy wording which restricted cover to prescriptions issued by a limited type of health services provider
Cover is now included for prescriptions provided by any health services provider. This means that prescriptions issued by a wider range of health services providers are now eligible for cover. These include Optometrists, Dentists, Midwives, Pharmacist prescribers and Nurse practitioners.
We are clarifying how we determine and apply reasonable charges.
Your policy document has been updated to explain how we determine and apply reasonable charges and what it means for you.
Please seek prior approval as early as possible to enable us to determine the extent of your cover.
We are reviewing and clarifying our eligibility criteria to focus on providing healthcare services to those who need them, and we’re adding new eligibility criteria where appropriate.
Certain healthcare services have eligibility criteria which need to be met before a healthcare service is eligible to be covered under your policy. This includes setting clear guidelines for when general anaesthesia can be used.
A list of eligibility criteria is available on our website. Please check this list regularly as the eligibility criteria may change from time to time.
The following documents that form part of your policy are regularly updated as we continually review how we cover healthcare services and certain health technology. It's a good idea to check these documents if you are planning on accessing any healthcare services which you intend to claim for under your policy.
You can refer to our website for the latest versions of these documents or contact us to request a copy.
Southern Cross Medical Care Society (trading as Southern Cross Health Society) is a licensed insurer and a licensed financial advice provider. For more information about the financial advice service we provide and a copy of our public disclosure statement please visit southerncross.co.nz/disclosure-statement.
Southern Cross Medical Care Society (trading as Southern Cross Health Society) has an A+ (Strong) financial strength rating given by Standard & Poor’s (Australia) Pty Limited. The rating scale is: AAA (Extremely Strong), AA (Very Strong), A (Strong), BBB (Good), BB (Marginal), B (Weak), CCC (Very Weak), CC (Extremely Weak), SD or D (Selective Default or Default). Ratings from ‘AA’ to ‘CCC’ may be modified by the addition of a plus (+) or minus (-) sign to show relative standing within the major rating categories. Full details of the rating scale are available at www.spglobal.com/ratings/en/about/intro-to-credit-ratings. Standard & Poor’s is an approved rating agency under the Insurance (Prudential Supervision) Act 2010.
