This page contains a historical record of past updates and changes to our health insurance policy documents. The information presented here is not current and is provided solely for reference and transparency. For the most up-to-date policy information, please refer to the current versions of these documents.
The following healthcare services were amended:
Skin lesion services
This applies to all services under this benefit unless provided by a General Practitioner.
The following eligible treatment of skin lesions when performed under local anaesthetic, no anaesthetic, or oral sedation:
Except for complex reconstruction following an eligible skin lesion healthcare service or Mohs surgery. For more information, see our Skin closures and reconstructions following skin procedures policy variation.
Skin surgery
(Skin lesion removal or Mohs closure under general anaesthetic or IV sedation).
Except for complex reconstruction following an eligible skin lesion healthcare service or Mohs surgery. For more information, see our Skin closures and reconstructions following skin procedures policy variation.
Oral and maxillofacial
The following healthcare services was removed:
The following eligibility criteria were added:
Eligibility criteria for hernia repair was updated:
View eligibility criteria for hernia repair effective before 1 April 2026.
Eligibility criteria for blepharoplasty and ptosis surgery was updated:
View eligibility criteria for blepharoplasty and ptosis surgery effective before 1 April 2026.
As New Zealand’s largest health insurer, we believe health insurance plays an important role in empowering people to live well for longer. We are committed to ensure that our plans stay relevant to our members.
Policy Review is a regular review of the benefits offered by our health insurance policies.
Keeping cover sustainable
We’ve made changes to help manage rising healthcare costs and ensure our plans remain affordable and sustainable for members. This includes clarifying how we apply reasonable charges and continuing to support the use of our Affiliated Provider network.
Product simplification
We’ve simplified some benefits and policy wording to improve clarity and make it easier for members to understand what’s covered. This includes removing or restructuring benefits and aligning wording across policies.
Strategic initiatives
Select a plan below to see the changes that took effect from 1 April 2026:
The following variations were amended from an existing variation:
Travel and accommodation allowance
Under the travel and accommodation allowance terms and conditions, cover is also available for the following:
The following variation was amended to provide transparency on plans impacted:
Prescriptions
This variation extends cover for drugs to drugs prescribed by any health services provider on the following plans:
The following variations were removed:
Healthcare services related to mental health
The exclusion for healthcare services related to mental health does not apply to the following benefits:
Diagnostic imaging benefit
The exclusion for health screening and maintenance services does not apply to the ‘Diagnostic imaging’ benefit for breast screening ultrasounds when a mammogram alone is unsuitable due to confirmed dense breast tissue. Dense breast tissue must be confirmed by a mammogram or MRI.
Robot-assisted surgery
Robot-assisted ventral hernia repair is removed from the list of exceptions to the robot-assisted surgery exclusion on the following policies:
In-hospital ultrasounds
This variation provides cover for in-hospital ultrasounds under the surgical procedures benefit, despite these not being included in the definition of hospital fees.
Hearing tests
This variation extends cover for hearing tests to hearing tests performed by an audiometrist who is a member of the New Zealand Audiological Society.
The following variation was added:
Skin closures and reconstructions following skin procedures
This policy variation clarifies how we cover skin closure and complex reconstructions following a skin lesion healthcare service, or Mohs surgery, when performed under local anaesthetic, oral sedation, IV sedation or general anaesthetic.
Skin closure under the skin lesion services benefit
Skin closure is covered under the skin lesion services benefit where the defect is confined to skin and subcutaneous tissue only, regardless of size, location, or complexity of the closure technique.
This includes (but is not limited to) the following procedures:
in each case when no deeper anatomical structures are repaired or reconstructed.
Complex reconstruction under the surgical procedures (following skin procedures)
Complex reconstruction performed following a skin lesion healthcare service or Mohs surgery (under local anaesthetic, oral sedation, IV sedation or general anaesthetic), is covered under the surgical procedures benefit, where the reconstruction:
In these cases, the service is classified as reconstruction and is not considered a skin lesion healthcare service.
The following healthcare services were added:
Eligibility criteria for gastrointestinal ultrasound changed:
View eligibility criteria for gastrointestinal ultrasound before 12 February 2026.
The following healthcare service was added:
Eligibility criteria for temporomandibular joint (TMJ) total joint replacement (TJR) was updated:
View eligibility criteria for temporomandibular joint (TMJ) total joint replacement (TJR) effective before 15 May 2026.
The following healthcare service was amended by revising the wording from 'in conjunction' to 'when performed simultaneously':
The following healthcare service was added:
The following wording was added to the Eligibility criteria page:
In exceptional circumstances, we may choose (in our absolute discretion) to waive the requirement to meet certain eligibility criteria.
The following healthcare services were added:
The following healthcare service was updated to include 'Open' for procedural clarification:
The following healthcare services were added:
The following healthcare service was added:
The following healthcare service was amended by removing the requirement 'when performed simultaneously with a pudendal nerve block':
The following variations were added:
Hearing tests 
This variation extends cover for hearing tests to hearing tests performed by an audiometrist who is a member of the New Zealand Audiological Society.
Prescriptions 
This variation extends cover for drugs to drugs prescribed by any health services provider.
Ambulance allowance  
This variation extends the cover available under the ambulance allowance to include cover for the actual costs incurred for:
The following variation wording was added to an existing variation:
Travel and accommodation allowance
The requirement that the eligible healthcare service that the policyholder or dependant needs is not “available” in their hometown or city means there are no health services providers who provide the eligible healthcare service in that person’s hometown or city, or the health services providers located in that person’s hometown or city are not accepting new patients. Wait times to see a health services provider are not considered in determining whether an eligible healthcare service is available in the person’s hometown or city.
The following variation was amended to provide transparency on the limits that apply to prognostic testing:
Prognostic gene testing for breast cancer
This variation provides cover for specified prognostic gene testing for breast cancer. You must be referred by a specialist in private practice.
For prognostic gene tests, eligibility criteria need to be met before we’ll cover them.
We’ll cover the actual costs incurred up to the limits stated below for the following prognostic gene tests/services for breast cancer:
No excess or co-payment applies to this cover. The above limits do not apply to UltraCare plans.
This cover is not available under the HealthEssentials policy.
The following variations were amended to align with policy language:
The following healthcare services were amended:
Skin lesion services
This applies to all services under this benefit unless provided by a General Practitioner.
The following eligible treatment of skin lesions when performed under local anaesthetic, no anaesthetic, or oral sedation:
Except for complex reconstruction following an eligible skin lesion healthcare service or Mohs surgery. For more information, see our Skin closures and reconstructions following skin procedures policy variation.
Skin surgery
(Skin lesion removal or Mohs closure under general anaesthetic or IV sedation).
Except for complex reconstruction following an eligible skin lesion healthcare service or Mohs surgery. For more information, see our Skin closures and reconstructions following skin procedures policy variation.
Oral and maxillofacial
The following healthcare services was removed:
The following eligibility criteria were added:
Eligibility criteria for hernia repair was updated:
View eligibility criteria for hernia repair effective before 1 April 2026.
Eligibility criteria for blepharoplasty and ptosis surgery was updated:
View eligibility criteria for blepharoplasty and ptosis surgery effective before 1 April 2026.
As New Zealand’s largest health insurer, we believe health insurance plays an important role in empowering people to live well for longer. We are committed to ensure that our plans stay relevant to our members.
Policy Review is a regular review of the benefits offered by our health insurance policies.
Keeping cover sustainable
We’ve made changes to help manage rising healthcare costs and ensure our plans remain affordable and sustainable for members. This includes clarifying how we apply reasonable charges and continuing to support the use of our Affiliated Provider network.
Product simplification
We’ve simplified some benefits and policy wording to improve clarity and make it easier for members to understand what’s covered. This includes removing or restructuring benefits and aligning wording across policies.
Strategic initiatives
Select a plan below to see the changes that took effect from 1 April 2026:
The following variations were amended from an existing variation:
Travel and accommodation allowance
Under the travel and accommodation allowance terms and conditions, cover is also available for the following:
The following variation was amended to provide transparency on plans impacted:
Prescriptions
This variation extends cover for drugs to drugs prescribed by any health services provider on the following plans:
The following variations were removed:
Healthcare services related to mental health
The exclusion for healthcare services related to mental health does not apply to the following benefits:
Diagnostic imaging benefit
The exclusion for health screening and maintenance services does not apply to the ‘Diagnostic imaging’ benefit for breast screening ultrasounds when a mammogram alone is unsuitable due to confirmed dense breast tissue. Dense breast tissue must be confirmed by a mammogram or MRI.
Robot-assisted surgery
Robot-assisted ventral hernia repair is removed from the list of exceptions to the robot-assisted surgery exclusion on the following policies:
In-hospital ultrasounds
This variation provides cover for in-hospital ultrasounds under the surgical procedures benefit, despite these not being included in the definition of hospital fees.
Hearing tests
This variation extends cover for hearing tests to hearing tests performed by an audiometrist who is a member of the New Zealand Audiological Society.
The following variation was added:
Skin closures and reconstructions following skin procedures
This policy variation clarifies how we cover skin closure and complex reconstructions following a skin lesion healthcare service, or Mohs surgery, when performed under local anaesthetic, oral sedation, IV sedation or general anaesthetic.
Skin closure under the skin lesion services benefit
Skin closure is covered under the skin lesion services benefit where the defect is confined to skin and subcutaneous tissue only, regardless of size, location, or complexity of the closure technique.
This includes (but is not limited to) the following procedures:
in each case when no deeper anatomical structures are repaired or reconstructed.
Complex reconstruction under the surgical procedures (following skin procedures)
Complex reconstruction performed following a skin lesion healthcare service or Mohs surgery (under local anaesthetic, oral sedation, IV sedation or general anaesthetic), is covered under the surgical procedures benefit, where the reconstruction:
In these cases, the service is classified as reconstruction and is not considered a skin lesion healthcare service.
The following healthcare services were added:
Eligibility criteria for gastrointestinal ultrasound changed:
View eligibility criteria for gastrointestinal ultrasound before 12 February 2026.
The following healthcare service was added:
Eligibility criteria for temporomandibular joint (TMJ) total joint replacement (TJR) was updated:
View eligibility criteria for temporomandibular joint (TMJ) total joint replacement (TJR) effective before 15 May 2026.
The following healthcare service was amended by revising the wording from 'in conjunction' to 'when performed simultaneously':
The following healthcare service was added:
The following wording was added to the Eligibility criteria page:
In exceptional circumstances, we may choose (in our absolute discretion) to waive the requirement to meet certain eligibility criteria.
The following healthcare services were added:
The following healthcare service was updated to include 'Open' for procedural clarification:
The following healthcare services were added:
The following healthcare service was added:
The following healthcare service was amended by removing the requirement 'when performed simultaneously with a pudendal nerve block':
The following variations were added:
Hearing tests 
This variation extends cover for hearing tests to hearing tests performed by an audiometrist who is a member of the New Zealand Audiological Society.
Prescriptions 
This variation extends cover for drugs to drugs prescribed by any health services provider.
Ambulance allowance  
This variation extends the cover available under the ambulance allowance to include cover for the actual costs incurred for:
The following variation wording was added to an existing variation:
Travel and accommodation allowance
The requirement that the eligible healthcare service that the policyholder or dependant needs is not “available” in their hometown or city means there are no health services providers who provide the eligible healthcare service in that person’s hometown or city, or the health services providers located in that person’s hometown or city are not accepting new patients. Wait times to see a health services provider are not considered in determining whether an eligible healthcare service is available in the person’s hometown or city.
The following variation was amended to provide transparency on the limits that apply to prognostic testing:
Prognostic gene testing for breast cancer
This variation provides cover for specified prognostic gene testing for breast cancer. You must be referred by a specialist in private practice.
For prognostic gene tests, eligibility criteria need to be met before we’ll cover them.
We’ll cover the actual costs incurred up to the limits stated below for the following prognostic gene tests/services for breast cancer:
No excess or co-payment applies to this cover. The above limits do not apply to UltraCare plans.
This cover is not available under the HealthEssentials policy.
The following variations were amended to align with policy language:
Eligibility criteria for eustachian tube balloon dilation changed:
View eligibility criteria for eustachian tube balloon dilation before 01 April 2025.
The following variation was added:
In-hospital ultrasounds 
This variation provides cover for in-hospital ultrasounds as hospital fees under the surgical procedures benefit, despite these not being included in the definition of hospital fees.
The following healthcare services were added:
The following healthcare services were updated:
The following healthcare service was updated to include additional named devices: 'Tanito Microhook', 'Streamline', 'iStent Infinite' & 'Hydrus Microstent':
The following item descriptions were updated to include additional named devices:
The following healthcare service was added:
The following healthcare service was updated by removing the word 'knee' after 'total':
The following healthcare service was amended to include coverage under exception provisions:
The following healthcare service was added:
The following eligibility criteria were added:
Eligibility criteria for catheter based cardiac procedures changed:
View eligibility criteria for catheter based cardiac procedures before 17 December 2025.
Eligibility criteria for open septoplasty and septorhinoplasty changed:
View eligibility criteria for open septoplasty and septorhinoplasty before 17 December 2025.
Eligibility criteria for mohs surgery changed:
View eligibility criteria for mohs surgery before 17 December 2025.
Eligibility criteria for skin lesion removal and minor skin surgery changed:
View eligibility criteria for skin lesion removal and minor skin surgery before 17 December 2025.
The following healthcare service was updated to include 'in rooms' for procedural clarification:
The following healthcare service was added:
The following healthcare service was amended to specify cover:
The following healthcare services were amended to include coverage under exception provisions:
The following healthcare services were added:
The following healthcare service was removed:
The following healthcare service was removed:
The following healthcare services were added:
The following healthcare service was removed:
The following healthcare services were added:
Eligibility criteria for single level lumbar disc replacement was added.
The following item added:
The following item descriptions were updated:
The following healthcare service was removed:
Eligibility criteria for radiotherapy for cancer care changed:
View eligibility criteria for radiotherapy for cancer care before 30 May 2025.
Eligibility criteria for basivertebral nerve ablation changed:
View eligibility criteria for basivertebral nerve ablation before 31 March 2025.
The following variations were added:
Exclusion for healthcare services provided outside of New Zealand – exception for recovery services following overseas treatment.
Access to cover under the following benefits is available following related eligible surgical treatment, chemotherapy or radiotherapy, this includes where the related treatment is provided outside of New Zealand:
Exclusions for pregnancy, childbirth and termination of pregnancy 
The exclusions for costs related to, or incurred as a consequence of, pregnancy and childbirth and the termination of pregnancy do not apply to eligible healthcare services that are: 
The following healthcare services were added:
The following healthcare services were removed:
Eligibility criteria for eustachian tube balloon dilation changed:
View eligibility criteria for eustachian tube balloon dilation before 01 April 2025.
The following variation was added:
In-hospital ultrasounds 
This variation provides cover for in-hospital ultrasounds as hospital fees under the surgical procedures benefit, despite these not being included in the definition of hospital fees.
The following healthcare services were added:
The following healthcare services were updated:
The following healthcare service was updated to include additional named devices: 'Tanito Microhook', 'Streamline', 'iStent Infinite' & 'Hydrus Microstent':
The following item descriptions were updated to include additional named devices:
The following healthcare service was added:
The following healthcare service was updated by removing the word 'knee' after 'total':
The following healthcare service was amended to include coverage under exception provisions:
The following healthcare service was added:
The following eligibility criteria were added:
Eligibility criteria for catheter based cardiac procedures changed:
View eligibility criteria for catheter based cardiac procedures before 17 December 2025.
Eligibility criteria for open septoplasty and septorhinoplasty changed:
View eligibility criteria for open septoplasty and septorhinoplasty before 17 December 2025.
Eligibility criteria for mohs surgery changed:
View eligibility criteria for mohs surgery before 17 December 2025.
Eligibility criteria for skin lesion removal and minor skin surgery changed:
View eligibility criteria for skin lesion removal and minor skin surgery before 17 December 2025.
The following healthcare service was updated to include 'in rooms' for procedural clarification:
The following healthcare service was added:
The following healthcare service was amended to specify cover:
The following healthcare services were amended to include coverage under exception provisions:
The following healthcare services were added:
The following healthcare service was removed:
The following healthcare service was removed:
The following healthcare services were added:
The following healthcare service was removed:
The following healthcare services were added:
Eligibility criteria for single level lumbar disc replacement was added.
The following item added:
The following item descriptions were updated:
The following healthcare service was removed:
Eligibility criteria for radiotherapy for cancer care changed:
View eligibility criteria for radiotherapy for cancer care before 30 May 2025.
Eligibility criteria for basivertebral nerve ablation changed:
View eligibility criteria for basivertebral nerve ablation before 31 March 2025.
The following variations were added:
Exclusion for healthcare services provided outside of New Zealand – exception for recovery services following overseas treatment.
Access to cover under the following benefits is available following related eligible surgical treatment, chemotherapy or radiotherapy, this includes where the related treatment is provided outside of New Zealand:
Exclusions for pregnancy, childbirth and termination of pregnancy 
The exclusions for costs related to, or incurred as a consequence of, pregnancy and childbirth and the termination of pregnancy do not apply to eligible healthcare services that are: 
The following healthcare services were added:
The following healthcare services were removed:
Eligibility criteria for cochlear implant internal device changed:
View eligibility criteria for cochlear implant internal device before 12 November 2024.
The following healthcare services were removed:
The following variations were added:
Robot-assisted surgery 
Robot-assisted ventral hernia repair is removed from the list of exceptions to the robot-assisted surgery exclusion on the following policies.
The following healthcare services were added:
The following healthcare services were amended to include coverage under exception provisions:
The following healthcare services were removed:
The following healthcare services were added:
The following healthcare services description were amended to correct spelling errors:
The following healthcare service was amended to include drug cover:
The following healthcare services were added:
The following items were added:
As New Zealand’s largest health insurer, we believe health insurance plays an important role in empowering people to live well for longer. We are committed to ensure that our plans stay relevant to our members.
Policy Review is a regular review of the benefits offered by our health insurance policies.
Product simplification for improved understanding, member experience and accelerated product delivery. This includes changes such as removing excesses from some benefits, and plain language policy wording. There is also provision for internal process simplification and clarification of existing cover so that members understand what they already have cover for.
Strategic initiatives
Select a plan below to see the changes that took effect from 22 October 2024:
The following variations were made:
Travel and accommodation allowance
Under the travel and accommodation allowance terms and conditions, cover is also available for the following:
Prognostic gene testing for breast cancer
This variation provides cover for specified prognostic gene testing for breast cancer performed by an Affiliated Provider. UltraCare members do not need to see an Affiliated Provider. You must be referred by a specialist in private practice.
For prognostic gene tests, eligibility criteria need to be met before we’ll cover them. We’ll cover the actual costs incurred for the following prognostic gene tests for breast cancer:
No excess or co-payment applies to this cover. Policy limits do not apply.
This cover is not available under the HealthEssentials policy.
Cosmetic procedures and treatment under the surgical procedures benefit
The exclusion for cosmetic procedures and treatment does not apply to the following procedures under the surgical procedures benefit:
Healthcare services related to mental health
The exclusion for healthcare services related to mental health does not apply to the following benefits:
Diagnostic imaging benefit
The exclusion for health screening and maintenance services does not apply to the ‘Diagnostic imaging’ benefit for breast screening ultrasounds where a mammogram is unsuitable due to confirmed dense breast tissue. Dense breast tissue must be confirmed by a mammogram or MRI.
The description of the following healthcare service was updated:
The following healthcare services were amended to include coverage under exception provisions:
Eligibility criteria for fat grafting following an eligible mastectomy changed:
View eligibility criteria for fat grafting following an eligible mastectomy before 25 September 2024.
Eligibility criteria for prophylactic treatment allowance changed:
View eligibility criteria for prophylactic treatment allowance before 25 September 2024.
Eligibility criteria for bilateral breast reduction allowance changed:
View eligibility criteria for bilateral breast reduction allowance before 9 October 2024.
Eligibility criteria for cochlear implant internal device changed:
View eligibility criteria for cochlear implant internal device before 12 November 2024.
The following healthcare services were removed:
The following variations were added:
Robot-assisted surgery 
Robot-assisted ventral hernia repair is removed from the list of exceptions to the robot-assisted surgery exclusion on the following policies.
The following healthcare services were added:
The following healthcare services were amended to include coverage under exception provisions:
The following healthcare services were removed:
The following healthcare services were added:
The following healthcare services description were amended to correct spelling errors:
The following healthcare service was amended to include drug cover:
The following healthcare services were added:
The following items were added:
As New Zealand’s largest health insurer, we believe health insurance plays an important role in empowering people to live well for longer. We are committed to ensure that our plans stay relevant to our members.
Policy Review is a regular review of the benefits offered by our health insurance policies.
Product simplification for improved understanding, member experience and accelerated product delivery. This includes changes such as removing excesses from some benefits, and plain language policy wording. There is also provision for internal process simplification and clarification of existing cover so that members understand what they already have cover for.
Strategic initiatives
Select a plan below to see the changes that took effect from 22 October 2024:
The following variations were made:
Travel and accommodation allowance
Under the travel and accommodation allowance terms and conditions, cover is also available for the following:
Prognostic gene testing for breast cancer
This variation provides cover for specified prognostic gene testing for breast cancer performed by an Affiliated Provider. UltraCare members do not need to see an Affiliated Provider. You must be referred by a specialist in private practice.
For prognostic gene tests, eligibility criteria need to be met before we’ll cover them. We’ll cover the actual costs incurred for the following prognostic gene tests for breast cancer:
No excess or co-payment applies to this cover. Policy limits do not apply.
This cover is not available under the HealthEssentials policy.
Cosmetic procedures and treatment under the surgical procedures benefit
The exclusion for cosmetic procedures and treatment does not apply to the following procedures under the surgical procedures benefit:
Healthcare services related to mental health
The exclusion for healthcare services related to mental health does not apply to the following benefits:
Diagnostic imaging benefit
The exclusion for health screening and maintenance services does not apply to the ‘Diagnostic imaging’ benefit for breast screening ultrasounds where a mammogram is unsuitable due to confirmed dense breast tissue. Dense breast tissue must be confirmed by a mammogram or MRI.
The description of the following healthcare service was updated:
The following healthcare services were amended to include coverage under exception provisions:
Eligibility criteria for fat grafting following an eligible mastectomy changed:
View eligibility criteria for fat grafting following an eligible mastectomy before 25 September 2024.
Eligibility criteria for prophylactic treatment allowance changed:
View eligibility criteria for prophylactic treatment allowance before 25 September 2024.
Eligibility criteria for bilateral breast reduction allowance changed:
View eligibility criteria for bilateral breast reduction allowance before 9 October 2024.
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.
