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.
An excess is the amount of money you need to pay towards the total cost of any claims you submit. We offer you different excess options that can help to make your premiums cheaper. The higher the excess, the larger the discount on your premium.
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. Processing fees for claims over a certain amount may also be applicable on these plans.
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.
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.
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.
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. Best Doctors and Mental Health Navigator are benefits available under specific policies and plans.
For more information go to our Active Benefits page.
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.
Health Insurance premiums go up annually due to the increases in medical inflation and in line with each member’s age. To ensure that you can get the cover that you need when you need it, we need to increase premiums to match the growth of medical inflation. As a not-for-profit 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.
Medical inflation is the rising cost of medical care. In New Zealand, this is usually much higher than the general inflation rate, which is managed by the Reserve Bank.
What causes the cost of medical care to increase? Simply, it is the costs associated with the advances in medical procedures, technology and medication. An example of this is robotic and keyhole surgery. These procedures are much less invasive than traditional surgery and result in a faster recovery time for the patient, however the costs associated with these types of surgeries is much higher.
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.
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 Best Doctors – 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/
Best Doctors is available to all Accuro members with hospital cover - find out more here.