Frequency Asked Questions
General
Claims
Membership
Answers
How does a co-operative work?
A co-operative is a non-profit organisation run and jointly owned by its members. Accuro is a co-operative so all the profits we make go back to benefiting our members in some way. This means we're able to keep our premiums low while maintaining a comprehensive health insurance plan that truly benefits our members.
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Do I have rights as a member?
Yes, as a member you have a say in everything we do. You'll be invited to attend an Annual General Meeting and can vote for directors on our Board. You could even get nominated as a director yourself.
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Is there a membership fee?
No
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When does cover start?
From the date your first premium is received (note that Natural Health, GP, Dental Optical have a three-month no-claims period).
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Does my policy cover pre-existing conditions?
Please see your membership certificate for details of what pre-existing conditions are excluded from your policy.
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Does my policy cover acute care?
No. Cover for acute care is provided by the public health system. For the definition of 'acute care' see our general terms and conditions
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Am I covered for all health conditions?
No. You may not be covered for pre-existing conditions - see your membership certificate for more details. There's also a list of other conditions that we don't cover - there's more about this in our terms and conditions.
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Am I covered while I'm overseas?
No.
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When can I start making claims?
Straight away with the Hospital Surgical plan, Specialist plan and NZNO Real Value Plan, and after three months with Natural Health, GP and Dental Optical.
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When is pre-approval required?
To make sure you're covered you must get pre-approval from us for any claim that is likely to exceed $1,000. You can find more details in our make a claim section.
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How do I make a claim for costs I already paid?
Complete a claim form and send your original invoices and receipts to us. You have up to 12 months from the event to claim your costs.
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What prescription drugs are covered?
Only those that are listed on the Pharmac schedule as long as you meet Pharmac's funding criteria. Some drugs are also excluded, such as weight loss medications, sexual enhancement drugs, hair re-implantation products and preventative medications - please see the terms and conditions.
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Who pays the provider?
We pay the provider directly if the procedure has been pre-approved by us. We will reimburse you if the claim is accepted after the event.
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How is the excess paid?
You need to pay the excess directly to your treatment provider as the excess amount is deducted from the invoices we receive from the provider. The amount of your excess is clearly stated in your letter of prior approval.
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When does the claims year start and finish?
It starts and ends on the policy anniversary date for most plans. For those covered by our Basic, Advanced or Value Plus plan your claims year is 1 April to 31 March.
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How does Accuro Health Insurance work with ACC?
If it's an accident then ACC needs to be approached first. There's more about this in our terms and conditions.
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Are there any additional fees for claims?
Only for those covered by the Major Medical, Real Value, Basic, Advanced or Value Plus plan.
If you're covered by the Major Medical or Real Value plan and you make a claim for hospital cover of more than $2,000, you'll be charged a non-refundable processing fee of $100.
If you're covered by the Basic or Advanced plan, you'll be charged a processing fee for every claim you make (excluding special benefits and grants). The first claim you make in the claims year of 31 March to 1 April will have a processing fee of $20, the second claim will be $40, and the third and subsequent claims will be $50. The fee is non-refundable and is deducted from the total claim amount.
If you're covered by the Value plus plan, you'll be charged a $20 processing fee for every claim you make (excluding special benefits and grants). The fee is non-refundable and is deducted from the total claim amount.
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Up to what age can children come under my policy?
Up to 25 years of age, as long as they are still dependent on you. Dependent children up to 25 will be covered on child premium rates and you can add them to your policy any time. Just get in touch with us via the contact us page, and we'll set it up for you.
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How do I remove children from the policy?
By letting us know in writing.
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What are my options for paying my premiums?
You can pay twice-monthly or monthly by direct debit, or yearly by cheque or credit card.
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Will premiums increase?
Yes, as you and those who are covered on your policy get older. We also review our premiums each year and any increase depends on inflation and the amount of claims made in a year. Your premiums won't increase just because you've made a claim.
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Can I put my cover on hold?
Yes, for two to twelve months if you're travelling overseas, or for two to six months if you stop working. If you stop working because you're on maternity leave you can put your cover on hold for up to twelve months. Proof will be required for each case.
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How do I cancel my policy?
By writing to us at Accuro Health Insurance, PO Box 10075, Wellington.
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What happens if I forget to pay my premium?
You'll receive a reminder from us - and if we don't receive your premium within three months your policy will be cancelled.
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Can I change or upgrade my plan?
Yes - what you need to do depends on which plan you're currently on. If you're on our Major Medical or Real Value plan you can switch to SmartCare by simply filling in a transfer form. For a change from a Basic, Advanced or Value Plus plan to SmartCare a full application form will be required.
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What is a primary plan?
The Basic, Advanced and Value Plus Plans. In addition Natural Health, GP and Dental Optical are often referred to by Accuro Health Insurance as Primary Plans.
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