What is an excess?
An excess is the amount of money you need to pay towards the total cost of any claims you submit per person in a policy year. Many of our products offer different excess options that can help to make your premiums cheaper.* The higher the excess, the larger the discount on your premium as you are taking on some of the risk yourself.
It’s easy to increase your excess but please note that if you want to reduce your excess at a later date that this will require underwriting as you are reducing your level of risk and returning it to Accuro. This may result in exclusions and/or stand down periods being applied to your policy. Talk to our team and/or your financial adviser if you are considering changes to your excess.
*Excess options are not available on primary only plans or fully subsidised group plans.
How does excess work at Accuro?
We only apply an excess once per individual that is insured, per policy year.*
For example, if the excess on your plan is $250 and we accept a claim for a CT scan costing $2,000, we’ll pay $1,750 and you would pay the excess balance of $250. If you then require an MRI within the same policy year costing $1,200, we'll pay the full amount because you’ve already paid the excess.
Different excess amounts may apply to your main surgical plan and other add on plans such as the Specialist plan.
If you have our Major Medical or Real Value plan you would pay 20% of accepted claims until you have paid your excess level for the year. This means you would not pay more than 20% of accepted claims, and you would not pay more than your excess level per person per year.
*A Policy year is the 12-month period that starts from midnight on your policy start date and ends at midnight on the first annual renewal date. You can find your policy start date on your membership certificate.
Will my policy be impacted if I have the Covid-19 vaccine?
No. Having any Medsafe approved vaccine will not impact your Accuro Health Insurance policy.
If you require treatment as a result of receiving a vaccine, this will be covered by the public health care system.
If you need more information on the Covid-19 Pfizer vaccine, there are full details on the ministry of health’s website.
Will my premiums remain the same each year or increase?
Health Insurance premiums generally go up annually due to a number of factors such as the increasing age of members on the policy and the rising claim costs that come with advancements in medical procedures, technology and treatments. As Accuro is a not-for-profit member based cooperative, we genuinely strive to keep these increases to a minimum as best we can.
Increasing your excess will help to reduce the cost of your premium but please read the information on what is an excess and how that comes into effect at claim time.
What is an exclusion?
There are two types of exclusions:
General exclusions - these are general things such as a medical condition or service that is not covered under a policy. These are listed out in the what's not covered section of your policy document and apply to every person who has that policy.
If you have the Major Medical, Real Value, Basic, Advanced or Value Plus plan then these are found in our General Terms and conditions here.
Personal exclusions - these are specific to an individual and are based on their medical history (pre-existing conditions). Not all pre-existing conditions will require an exclusion, however our team do need to know about all previous and current signs, symptoms and conditions. Personal exclusions are excluded for different lengths of time (from 1 year to life) depending on the medical condition and will be listed on your membership certificate under each individual.
What is a pre-existing condition?
A pre-existing condition is any sign, symptom, health condition or health event that happened before you started your policy. Health insurance is set up to cover the unexpected, so we ask that you tell us about all of your pre-existing conditions, current or previous. Not all pre-existing conditions will be excluded from cover, however, to be able to tell you what isn't covered you will need to be honest about your medical history in your application form to us. If a pre-existing condition isn’t declared when you apply for cover and you submit a claim for that condition, it could be declined so it is always best to declare everything as best you can.
What is a congenital condition?
A congenital condition is a health anomaly or defect that is present at birth. We don’t provide cover for congenital conditions that are recognised at birth or diagnosed within the first 3 months of life, including any investigation or treatment related to it.
What is a stand-down period?
A stand-down period is applied to some policies or plans such as our Dental & Optical plan that doesn’t allow you to claim for services within an initial period when you take out cover. These stand-down periods are detailed in your policy document and once your stand-down period has ended you will be informed that you are now able to submit claims for services used after the stand-down period.
What is an Active Benefit?
An Active Benefit is a service or product that is provided free of charge to members as part of their policy cover. SkinVision and Health Hub are Active Benefits that are available to every Accuro member. Accuro Virtual Clinic and Mental Health Navigator are benefits available under specific policies and plans.
For more information go to our Active Benefits page.
What is a Loyalty Benefit?
A Loyalty Benefit is a service or product that is provided free of charge to members when they reach a period of time such as 3 years continual cover. We have a variety of Loyalty Benefits under different policies and plans. To find out what Loyalty Benefits you are entitled to, check your policy cover on the Accuro Member Portal.
Excess does not apply to Loyalty Benefits.
I can’t find my policy name listed on the website!
We only provide details on our website of the policy products that are available to purchase now. If yours is not listed then it is likely to be a policy that is no longer on sale, however, you will be able to access your policy document and details of your cover through the Accuro Member Portal.
If you have not yet registered for the portal, please go to our How to Register for the Portal page and follow the simple instructions.
Can you recommend a Specialist for me?
If you would like some help in finding a specialist that is an expert on your condition, then you can use the Find an Expert service provided by Accuro Virtual Clinic – call 0800 425 005.
You can also search for a registered specialist on the Medical Council of NZ website https://www.mcnz.org.nz/registration/register-of-doctors/
Accuro Virtual Clinic is available to all Accuro members with hospital cover - find out more here.
Why do we need your email?
We have many free benefits that are available to Accuro members. We are always looking at how we can provide value to our members, and we predominantly use email to communicate the latest news and information about these benefits. However, if we don't have an email for you, we suspect you could be missing out.
Find out more here
These FAQs are designed for general information purposes only. For full terms and conditions of your policy, please refer to your Policy Document, Membership Certificate and Accuro's General Terms and Conditions.
All about Claims
Find out what a claim and pre-approval is, why you might need to get pre-approval for an upcoming procedure or treatment and what documents are required to claim for your medical costs.
What is and isn't covered?
Many surgery procedures are covered under our hospital plans but general day to day costs are not, there are add-on plans that provide for that.