{ "vertical": "health", "insurer": { "slug": "accuro", "name": "Accuro", "brand_family": "accuro" }, "product": { "slug": "smartstay", "name": "SmartStay", "status": "active", "positioning_summary": null }, "wording": { "version": "2026-05-16", "ingested_at": "2026-05-16T11:21:03.618189+00:00", "pdf_hash": "bde95b80888b47d9e23a4a826c53037e712fdf945eef1079882e4ba40d9f4654", "source_url": "https://production-media-accuro.s3.ap-southeast-2.amazonaws.com/public/Collateral/Policy-Documents/2025/Health-Plan-Documents-1-September/SmartStay-Sept-2025.pdf", "page_count": null }, "confidence_tier": "inferred", "facts": { "ivf_cover": "Excluded. 'Treatment, investigation, and diagnosis of infertility and assisted reproduction' is a listed general exclusion under the Obstetrics and gynaecology exclusions.", "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 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", "admission for convalescence, recovery, respite care, geriatric or senile care, obstetrics, mental health, psychiatric or psychological treatment or counselling, or recurrent health conditions" ], "sublimits_nzd": { "oral_surgery": 150000, "general_surgery": 150000, "ct_scans_per_year": 2500, "mri_scans_per_year": 3000, "pet_scans_per_year": 2500, "angiograms_per_year": 3500, "home_nursing_per_day": 150, "home_nursing_per_year": 2400, "mental_health_per_year": 1000, "minor_surgery_per_claim": 500, "spinal_surgery_lifetime": 200000, "ambulance_transfer_per_year": 200, "prescription_drugs_per_item": 20, "prescription_drugs_per_year": 300, "gp_and_nurse_visits_per_year": 500, "gp_and_nurse_visits_per_visit": 80, "parent_accommodation_per_year": 1500, "prophylactic_surgery_lifetime": 60000, "treatment_outside_nz_per_year": 25000, "parent_accommodation_per_night": 125, "day_to_day_health_plan_per_year": 600, "post_operative_therapy_per_event": 1000, "laboratory_tests_gp_module_per_year": 100, "myocardial_perfusion_scans_per_year": 2000, "transport_and_accommodation_per_year": 1500, "non_surgical_cancer_treatment_per_year": 25000, "support_person_accommodation_per_night": 125, "private_public_hospital_medical_admission_per_year": 65000, "mental_health_consultations_specialist_module_per_year": 1000, "specialist_consultations_and_diagnostic_tests_per_year": 4000 }, "gap_payment_rules": "UniMed pays up to the Reasonable charges for a procedure or medical treatment, or up to the relevant benefit limit, whichever is less. If the actual cost exceeds the Reasonable charge or benefit limit, the member must pay the difference directly to the healthcare provider. If a procedure has costs above what UniMed judges to be Reasonable charges, UniMed may ask for further information or recommend an alternative; if the member proceeds, they pay the excess cost. Prior approval letters will clearly state the maximum amount UniMed will cover and any excess applicable. UniMed will not reimburse or pay more than 100% of actual costs incurred; any amounts covered by ACC, another insurer, or government-funded agencies are deducted before UniMed assesses its portion. UniMed does not cover excess applicable under another insurance plan.", "pre_existing_rules": "All pre-existing conditions must be disclosed at application. A pre-existing condition is any health or medical condition the member was aware of, or experiencing signs or symptoms of, before the start of the policy, or a medical event that occurred before the start of the policy. Pre-existing conditions are excluded unless accepted by the underwriters. Personal exclusions are listed on the policy certificate and may last from 1 year to life depending on the medical condition. If a member does not provide their complete medical history at application, a Medical report from the GP holding the medical history is required for any new condition claimed within the first 5 years of the Hospital & Surgical base plan or Specialist module. UniMed reserves the right to exclude any declared or non-declared pre-existing condition or congenital condition at any time, with the exclusion potentially backdated to the policy start date. Example given: a pre-existing hernia attracts a 5-year personal exclusion.", "waiting_periods_days": { "surgical": 0, "pre_existing": 0, "mental_health": 0 }, "acc_interaction_rules": "SmartStay is designed to complement ACC and will not cover claims related to accidents that ACC covers. The full payment option (ACC contracts a provider and pays total cost) should be the first choice; in that case all claims must be submitted to ACC. Under the ACC partial payment option, SmartStay will cover the difference in cost up to the Reasonable charges or the benefit limit, whichever is less, provided the treatment is covered under the policy. If ACC declines cover, UniMed may ask for a review or appeal with member support, requiring the ACC decline letter and relevant information within 3 months of its issue date. If ACC refuses or stops cover due to member non-compliance with ACC requirements, no claim can be made under the policy. Any expense recoverable from ACC is excluded. Medical costs declined by ACC for injuries caused by accidents outside New Zealand are not covered. UniMed will not cover any excess applicable under another insurance plan.", "mental_health_sublimit_nzd": 1000, "mental_health_admission_rules": "The private and public hospital medical admission benefit explicitly does not cover admission for mental health, psychiatric or psychological treatment or counselling. The Mental Health benefit provides $1,000 per person per policy year (no excess applies) for consultations with a psychiatrist, psychologist, psychotherapist or counsellor who are appropriately registered. The Specialist module also includes a separate mental health consultations benefit of $1,000 per person per policy year. General exclusions exclude treatment or counselling for any psychiatric, psychological and neurodevelopmental disorders.", "pharmac_vs_non_pharmac_drug_rules": "Unless outlined differently in the policy, prescription drugs must be listed on the Pharmac Schedule (note that section H is only applicable if the drug is used during a procedure in a public or private hospital/facility), Pharmac-approved, medically necessary, and prescribed by a registered medical practitioner. Members must meet Pharmac's funding criteria and the drugs must be funded for the relevant claim. If special authority from Pharmac is required, confirmation from the registered medical practitioner that the member meets the special authority criteria is needed before cover can be assessed. Non-Pharmac drugs are not covered. Chemotherapy drugs administered orally at home that are prescribed by a registered medical specialist and used during an approved cycle of chemotherapy treatment are covered under the private and public hospital medical admission benefit." }, "endpoints": { "summary": "/api/product/accuro/smartstay/summary.md", "wording": "/api/product/accuro/smartstay/wording.md", "history": "/api/product/accuro/smartstay/history.json" }, "canonical_url": "https://healthinsurancecomparison.co.nz/api/product/accuro/smartstay/facts.json", "generated_at": "2026-05-16T12:53:14.787Z", "license": "CC BY 4.0 — attribute https://healthinsurancecomparison.co.nz" }