{ "vertical": "health", "insurer": { "slug": "accuro", "name": "Accuro", "brand_family": "accuro" }, "product": { "slug": "kidsmart", "name": "KidSmart", "status": "active", "positioning_summary": null }, "wording": { "version": "2026-05-16", "ingested_at": "2026-05-16T11:25:31.600737+00:00", "pdf_hash": "2122ef2cf6da755b3136099cc253a24c1cc3cd8f8d7286bcd6a4d09134e72d1a", "source_url": "https://production-media-accuro.s3.ap-southeast-2.amazonaws.com/public/Collateral/Policy-Documents/2025/Health-Plan-Documents-1-September/KidSmart-Sept-2025.pdf", "page_count": null }, "confidence_tier": "inferred", "facts": { "ivf_cover": "Treatment, investigation, and diagnosis of infertility and assisted reproduction is explicitly excluded.", "exclusions": [ "attention-deficit or hyperactivity disorder", "autism spectrum disorder", "dyslexia", "geriatric care including geriatric hospitalisation", "intellectual disability (intellectual developmental disorder)", "motor disorders (including but not limited to Tourette's disorder)", "pre-senile dementia", "senile illness or dementia", "specific learning disorders", "Any acute care", "Any long-term care", "Palliative care as defined by us (except where this policy specifies otherwise)", "Any pre-existing conditions, unless accepted by us", "Any condition connected with the use of non-prescription drugs", "AIDS or HIV infection or any condition arising from the presence of AIDS, HIV infection or sexually transmitted diseases", "Congenital conditions diagnosed within 3 months of birth; this includes but is not limited to the investigation, treatment, or complications of any residual issues", "Any health condition as a consequence of war, invasion, act of foreign enemy, terrorism, hostilities (whether war is declared or not), civil war, rebellion, revolution, or military or usurped power", "Pregnancy, childbirth, miscarriage, or any associated conditions or complications for the mother, or foetus or child", "Treatment, investigation, and diagnosis of infertility and assisted reproduction", "Sterilisation or contraception of any kind, or intrauterine devices (except a Mirena when used for medical reasons)", "Termination of pregnancy", "preventative healthcare services and treatments, maintenance or health surveillance testing, genetic-testing, employment-related examinations or screening", "vaccination against any disease or condition", "convalescence", "Dental care: orthodontic, endodontic, orthognathic (jaw correction), periodontal treatment, implants, or tooth exposure", "Correction of visual errors or astigmatism — for example, consultations, surgery or laser treatment, surgically implanted intraocular lens(es), radial keratotomy, photo-reactive keratectomy, or any related complications", "Specialised transfusion of blood, blood products, or treatment for renal failure or renal dialysis", "Organ donation and receipt", "Specialised tertiary treatments such as transplants. This includes but is not limited to heart, lung, kidney, liver, bone marrow and stem cell transplants", "Cosmetic procedures or other enhancement or appearance medicine as defined by us", "Procedures or treatment relating to obesity or weight loss, performed for any reason", "Breast reduction or treatment of gynaecomastia, regardless of whether medically necessary", "Gender affirmation surgery/treatment or gender dysphoria", "Sleep disturbances, snoring, or sleep apnoea", "Robotically assisted surgery", "Chelation therapy or similar treatment as defined by us", "Circumcision, except where medically necessary", "Additional surgery performed during any operation that is not directly related to any medical condition or treatment covered under the terms of this policy", "A treatment or procedure that is provided by a registered medical practitioner practising outside his or her scope of practice", "New medical treatments, procedures, and technologies that have not been approved by us", "General practitioners' fees, prescription drugs, or medication (except where this policy specifies otherwise)", "Any expense recoverable from a third party or insurance or any statutory scheme or any government-funded scheme or agent (for example, ACC)", "Any medical costs declined by ACC if injury is caused by an accident outside New Zealand", "Any medical costs incurred outside New Zealand", "Medical mishap or misadventure", "Any personal incidental expenses incurred whilst in hospital - for example, use of phone, family meals, soft drinks, or alcoholic beverages", "Any costs not specifically provided for under a benefit section outlined in the plan", "Personal health-related appliances; for example, hearing aids, personal alarms, orthotic shoes, crutches, wheelchairs, toilet seats, mouthguards, and artificial limbs", "Medical devices; for example, cardiac pacemakers, nerve appliances, cochlear implants, or penile implants", "Surgical or medical appliances; for example, glucometers, oxygen machines, respiratory machines, diabetic monitoring equipment, or blood pressure monitoring equipment", "Any costs not specifically related to the consultation or treatment such as administration costs or statement fees", "Disability or illness arising from misuse of alcohol, drugs, participation in a criminal act, or intentional self-injury", "Attempted suicide or suicide within 13 months from the start date of the plan" ], "sublimits_nzd": { "oral_surgery": 300000, "mental_health": 1000, "general_surgery": 500000, "overseas_treatment": 30000, "home_nursing_annual": 6000, "home_nursing_per_day": 150, "public_hospital_annual": 3000, "diagnostic_tests_annual": 5000, "minor_surgery_per_claim": 3000, "spinal_surgery_lifetime": 200000, "ambulance_transfer_annual": 200, "public_hospital_per_night": 300, "tongue_or_lip_tie_lifetime": 400, "cancer_personal_accessories": 2000, "melanoma_per_3_policy_years": 200, "screening_per_3_policy_years": 250, "day_to_day_health_plan_annual": 600, "guardian_accommodation_annual": 3000, "specialist_consultation_annual": 5000, "speech_language_therapy_annual": 150, "guardian_accommodation_per_night": 300, "post_operative_therapy_per_event": 1500, "private_hospital_medical_admission": 300000, "transport_and_accommodation_annual": 3000, "exercise_activity_contribution_annual": 150, "support_person_accommodation_per_night": 200, "support_person_accommodation_max_nights": 10, "orthodontic_treatment_per_year_max_3_years": 200 }, "gap_payment_rules": "We will pay up to the Reasonable charges for any covered procedure or treatment, up to the specified benefit limit (whichever is less). If a provider charges above our Reasonable charges, the policyholder must pay the difference directly to the healthcare provider, regardless of the benefit's maximum limit. We will not pay or reimburse any costs exceeding 100% of actual costs incurred. Any refunds, subsidies or entitlements from other sources (ACC, another health insurer, government-funded agency, Work and Income, or employer) must be claimed first, and we deduct those amounts before assessing the remainder. We do not cover any excess applicable under another insurance plan.", "pre_existing_rules": "A pre-existing condition is any health or medical condition that you or any child was aware of, or were experiencing signs or symptoms of, before the start of the policy, or a medical event that occurred before the start of the policy. All pre-existing conditions must be disclosed at application. Personal exclusions may be placed on the policy certificate for pre-existing conditions; these last for varying periods (from 1 year to life). Children added under 6 months of age may be added with no personal exclusions placed due to their medical history. A Medical report is required within the first 5 years of the Hospital & Surgical base plan or Specialist module if the child was added after 6 months of age and their complete medical history was not supplied at application. We may decline a claim or add a backdated exclusion for any non-disclosed pre-existing condition.", "waiting_periods_days": { "surgical": 365 }, "acc_interaction_rules": "KidSmart is designed to complement ACC and will not cover claims related to accidents that ACC covers. If ACC does not cover the full amount, the policy may pay the difference (up to Reasonable charges and the benefit limit) if the treatment is covered under the policy. The guardian/child must first pursue the ACC full payment option. Under the ACC partial payment option, the policy covers the cost difference up to Reasonable charges or the benefit limit, whichever is less. If ACC declines cover, the insurer may ask for a review or appeal and requires the ACC decline letter within 3 months of issue. If ACC reverses its decision, the insurer may seek reimbursement for claims already paid. If ACC refuses or stops cover because of non-compliance with ACC requirements, no claim can be made under the policy. Any expense recoverable from ACC is excluded. ACC top-up benefit covers any shortfall between ACC's payment and actual private hospital costs; the applicable benefit's maximum limit applies.", "mental_health_sublimit_nzd": 1000, "mental_health_admission_rules": "The mental health benefit provides $1,000 per child per policy year for consultations with a psychiatrist, psychologist, psychotherapist or counsellor; no excess applies. Providers must be registered with the Medical Council of New Zealand (psychiatry scope), New Zealand Psychologists Board, Psychotherapists Board of Aotearoa New Zealand, or New Zealand Association of Counsellors or other relevant association. Treatment or counselling for psychiatric, psychological and neurodevelopmental disorders (including ADHD, autism spectrum disorder, dyslexia, intellectual disability, motor disorders, dementia, and specific learning disorders) is explicitly excluded under the general exclusions. There is no specific inpatient mental health admission benefit described.", "oncology_high_cost_drugs_cover": "Chemotherapy drugs administered orally at home, prescribed by a registered medical specialist and used during an approved cycle of chemotherapy treatment, are covered under the private hospital medical admission benefit (up to $300,000 per child per policy year). Non-Pharmac subsidised drugs (including cancer drugs registered by Medsafe but not Pharmac-funded) are covered under the non-Pharmac subsidised drugs benefit, with costs included within the maximum limit of the applicable surgical or non-surgical benefit. Up to $2,000 per child per policy year is provided for personal accessories needed during or within 6 months after cancer treatment (e.g. wig, hat, scarf).", "pharmac_vs_non_pharmac_drug_rules": "Prescription drugs covered under modules (other than the non-Pharmac drugs benefit) must be listed under section A to I of the Pharmac Schedule (section H only applicable if used during a procedure in a private facility), Pharmac-approved, medically necessary, and prescribed by a registered medical practitioner; the child must meet Pharmac's funding criteria. Separately, the non-Pharmac subsidised drugs benefit under the Hospital and Surgical base plan covers all Medsafe-registered drugs regardless of Pharmac funding status, where treatment is prescribed by a registered medical specialist as appropriate, the condition is not otherwise excluded, and the drug is prescribed within Medsafe guidelines. If the drug qualifies for a government or other subsidy, only the remaining cost is reimbursed. All costs under the non-Pharmac drugs benefit are included within the maximum limit of the applicable surgical or non-surgical benefit; this benefit cannot be used with any benefit on an additional module." }, "endpoints": { "summary": "/api/product/accuro/kidsmart/summary.md", "wording": "/api/product/accuro/kidsmart/wording.md", "history": "/api/product/accuro/kidsmart/history.json" }, "canonical_url": "https://healthinsurancecomparison.co.nz/api/product/accuro/kidsmart/facts.json", "generated_at": "2026-05-16T12:53:05.644Z", "license": "CC BY 4.0 — attribute https://healthinsurancecomparison.co.nz" }