> _Markdown transcription of Accuro StaffCare policy wording, effective 2026-05-16. Source: https://production-media-accuro.s3.ap-southeast-2.amazonaws.com/public/Collateral/Policy-Documents/2025/Health-Plan-Documents-1-September/StaffCare-Sept-2025.pdf_ --- # StaffCare Health Plan Document # Welcome to StaffCare Thank you for choosing StaffCare. We want you to understand your policy and be confident in your health insurance cover, so please read this document carefully. You must provide true, correct, and complete information about yourself and any additional Member when setting up this policy and when making any changes. This Health Plan was previously issued under the Accuro brand. Accuro is becoming UniMed. You will still see reference to Accuro as we transition. Please note that the terms and conditions for this Health Plan are included within this document. The general UniMed terms and conditions do not apply to this Health Plan. ## Contents - StaffCare at a glance - 3 - The StaffCare cover and benefits - 5 - Hospital and Surgical base plan - 6 - Additional modules - 13 - What's not covered (exclusions) - 16 - How to submit a claim - 19 - How to apply for prior approval - 20 - How to make a claim after treatment - 21 - What we will pay - 23 - General conditions of your policy - 25 - What you need to do - 27 - Making changes to your policy - 29 - Other important information - 32 - How to contact us - 34 - Glossary - 35 ## Tell us about changes Please make sure that we have your most up-to-date contact details. Contact us if your circumstances change. --- # StaffCare at a glance This Health Plan document explains what's covered for all StaffCare policy holders (benefits) and what's not covered (general exclusions). Check your policy certificate for details that are specific to your policy, including personal exclusions, excesses and the modules you have cover under. This document and your policy certificate make up your policy. Please make sure you read these documents and keep them in a safe place. Your StaffCare policy starts from the date on your policy certificate, or the date specified for each additional Member. You'll be covered until your policy ends because it's been cancelled or terminated. ## Who StaffCare is for This StaffCare policy is only for New Zealand citizens, residents, or people who are entitled to funding under New Zealand's public healthcare system. We've designed this policy to complement the services that are provided by the public health system and the Accident Compensation Corporation (ACC). ## Extra care and support Some customers are more vulnerable to the risk of unfair outcomes or disadvantages due to their personal circumstances. This could be due to, for example, health or disability reasons, life events, financial or personal resilience, knowledge or confidence in managing financial matters. To help us recognise and act with the appropriate level of care please chat to one of our team about your needs so we can take extra care and provide support that fits your needs. ## The New Zealand healthcare system has three main components: **Accident Compensation Corporation (ACC)** provides comprehensive, no-fault personal injury cover for anyone in New Zealand. **The public health system** is subsidised by the government and provides cover for all New Zealand residents. It covers acute treatment (when surgery or treatment needs to happen immediately because of a medical emergency) and some elective treatments, which can take years to occur in the public health system. **The private health system** gives you control over when and where you're treated, including being able to choose the doctor, specialist or hospital that you prefer. Often people will decide to have elective treatment in the private health system as it's quicker. Treatment is 'elective' when it's scheduled in advance to happen at a later date because it isn't a medical emergency. ## Main benefits of StaffCare ### Hospital and Surgical base plan benefits: cover for each person in a policy year | Benefit | Amount | |---------|--------| | General surgery | $200,000 | | Major diagnostic procedures such as CT and MRI scans | refer to benefit for limits | | Oral surgery | $100,000 | | Private hospital medical admission | $65,000 | | Non-surgical cancer treatment (chemotherapy and radiation treatment) | $60,000 | | Treatment outside of New Zealand | $10,000 | ## Start with the base plan and add additional modules When your policy starts, you begin with the base plan that everyone on the policy must have: the Hospital and Surgical base plan. You can choose to add any of our other modules for yourself or any of the additional Members on the policy. They don't need to be the same modules for all additional Members. Check your policy certificate to see the additional modules and additional Members on your policy. ### Specialist module Cover for specialist consultations and diagnostic tests. ### GP module Cover for GP and nurse consultations, along with prescription drug costs. ### Day to Day Health Plan Cover for everyday costs such as going to the doctor, natural therapist, dentist or optician. ## Terms used in this document We've explained some common health insurance terms. Words printed in italics are key terms as defined in the glossary on pages 35 to 37. Key terms only appear in italics the first time they are used. 'We' and 'us' means UniMed. 'You' means the Primary Member (the policy holder), and may include all other individuals attached to your policy as additional Members. For explanations of medical terms, please ask your GP or other healthcare provider, or consult the Health Navigator website at www.healthnavigator.org.nz --- # The StaffCare cover and benefits This Health Plan document lists what's covered for all StaffCare policy holders (benefits) and what's not covered (general exclusions). A general exclusion could be a medical condition or service that we've decided we won't cover for anyone who has this type of policy. Your policy certificate contains the details that are specific to your policy, such as what modules each person in your family is covered for, as well as any personal exclusions. A personal exclusion is where we've reviewed the medical information you've provided for us when you applied for cover, and have decided that a certain condition may pose too great a risk to insure against. Personal exclusions last for different lengths of time (from 1 year to life), depending on the medical condition. Personal exclusions may not apply to you as you have joined a Group insurance scheme. However, if they do, all personal exclusions will be listed on your policy certificate. You'll automatically have the Hospital and Surgical base plan. Please check your policy certificate to see whether you have cover under any of the additional modules. Your policy certificate will list any excess applicable under your Health Plan. An excess applies to the base plan or additional modules once for each person for each year they have the policy. To find out what type of prescription drugs are covered under your policy, refer to the 'Conditions of cover for prescription drugs' section on page 26. --- # Hospital and Surgical base plan The following benefits apply to the Hospital and Surgical base plan. Please take the time to read over these and ensure you understand them. Contact us if you have any queries about any of our benefits. ## Standard benefits: ### General surgery **$200,000 for each person in a policy year** **An excess applies to this benefit** If you're wanting to claim under this benefit, we strongly recommend you seek prior approval before your treatment. This benefit covers the costs of Reasonable charges associated with surgical treatment. The benefit covers the procedure(s) and all subsequent treatment or expenses listed below. - Private hospital or public hospital costs - Physiotherapy while in hospital - Surgeons' fees - Anaesthetists' fees - Costs of essential prostheses listed in the Accuro schedule - Pre-operative and post-operative diagnostics, consultations, or tests, if they occur within 1 year before or after the approved surgery All costs must be associated with the original diagnosis, including any complications of the initial surgery. This benefit also includes diagnostic surgeries such as a hysteroscopy, cystoscopy, laparoscopy and arthroscopy. We may consider that an alternative, less invasive procedure or medical treatment is the most suitable method of treatment instead of the proposed surgery. If so, we'll cover the costs associated with this rather than paying the surgical claim. Oncology consultations and treatment following surgery are covered under the private and public hospital medical admission benefit. #### This includes: ##### Spinal Surgery This benefit covers the costs of spinal surgeries. You can claim this benefit as needed but it only provides cover up to $200,000 for each person over their lifetime. A list of all spinal surgeries which fall under this benefit can be found under the Resources page on the Accuro website. ##### Breast reconstruction This benefit covers the costs of a breast reconstruction of the affected breast only after a mastectomy for the treatment of breast cancer. The reconstruction of the affected breast must occur within 24 months after a mastectomy that we've approved under this policy. ##### Breast symmetry This benefit covers the costs of unilateral breast reduction surgery on the unaffected breast in order to achieve breast symmetry after a mastectomy for the treatment of breast cancer. The reduction of the unaffected breast must occur within 24 months after a mastectomy that we've approved under this policy. ### Oral surgery **$100,000 for each person in a policy year** **An excess applies to this benefit** This benefit covers the costs of Reasonable charges associated with oral or maxillofacial surgery listed below. - Surgical removal of impacted or unerupted teeth - Surgical removal of cysts or soft tissue swellings - Surgical drainage of oral abscesses - Pre-operative and post-operative diagnostics, consultations or tests if they occur within 1 year before or after the approved surgery This benefit doesn't cover the insertion or removal of dental implants, or the exposure of a tooth. You must be treated by a New Zealand-registered oral or maxillofacial specialist, in an accredited private hospital or clinic. A New Zealand-registered medical practitioner, dental surgeon, or dentist must refer you or the additional Member on your policy. A registered oral surgeon or registered dentist must perform the surgical removal of unerupted and impacted teeth. They must write to us to confirm the status of the impacted or unerupted teeth. ### Major diagnostic procedures **An excess applies to this benefit** This benefit covers the costs of Reasonable charges for the following diagnostic procedures. - Angiograms — up to a maximum of $3,500 for each person in a policy year - Computerised axial tomography (CAT or CT) scans — up to a maximum of $2,500 for each person in a policy year - Positron emission tomography (PET) scans – up to a maximum of $2,500 for each person in a policy year - Magnetic resonance imaging (MRI) scans — up to a maximum of $3,000 for each person in a policy year - Myocardial perfusion (MP) scans — up to a maximum of $2,000 for each person in a policy year Cover applies whether or not you're admitted to a hospital. ### Prophylactic surgery **$60,000 for each person** **An excess applies to this benefit** This benefit covers the costs of prophylactic (preventative) surgery if you have an increased risk of developing cancer because of a high-risk status or gene mutation. You can claim this benefit as many times as you need to but it only provides cover up to $60,000 for each person over their lifetime. To claim under this benefit, you must meet the requirements listed in the eligibility criteria for Prophylactic surgery. ### Non-surgical cancer treatment **$60,000 for each person in a policy year** **An excess applies to this benefit** This benefit covers the costs of Reasonable charges for admission to a private hospital or facility for non-surgical cancer treatment. The non-surgical hospital treatment must be recommended by an appropriate registered medical practitioner as being necessary to improve the health of the Member. This benefit covers the following costs that occur for non-surgical cancer treatment. - Private hospital or facility fees - Other hospital or facility costs, including intravenous fluids, dressings, and prescription drugs used during the non-surgical cancer treatment - Chemotherapy drugs administered orally at home that are prescribed by a registered medical specialist and to be used during an approved cycle of chemotherapy treatment under this policy - Registered medical specialist fees, including fees directly related to the non-surgical cancer treatment and that have occurred within 6 months of the date of treatment - Diagnostic procedures, including diagnostic procedures directly relating to the non-surgical cancer treatment that occurred within 6 months of the date of treatment ### Private hospital medical admission **$65,000 for each person in a policy year** **An excess applies to this benefit** This benefit covers the costs of Reasonable charges for admission to a private hospital for reasons other than surgery. The non-surgical hospital treatment must be recommended by an appropriate registered medical practitioner as being necessary to improve the health of the Member. This benefit covers the following costs that occur during the period of hospitalisation. - Private hospital accommodation fees - Other hospital costs, including intravenous fluids, dressings, and prescription drugs throughout hospital admission - Registered medical specialist fees, including fees directly related to the hospital admission and that have occurred within 6 months of the date of admission - Diagnostic procedures, including diagnostic procedures directly relating to the hospital admission that occurred within 6 months of the date of admission This benefit doesn't cover admission for convalescence, recovery, respite care, geriatric or senile care, obstetrics, mental health, psychiatric or psychological treatment or counselling, or recurrent health conditions. ### Treatment outside of New Zealand **$10,000 for each person in a policy year** **An excess applies to this benefit** This benefit covers reimbursement of Reasonable charges for a surgical procedure or medical treatment performed at an overseas hospital, where the procedure or treatment isn't available in New Zealand. To qualify for this benefit, the Member must: - be in New Zealand when they are diagnosed and must not have started an appropriate medical process in New Zealand - request a surgical procedure that is medically necessary and is not experimental or being trialled - get the procedure or treatment pre-approved by us - make sure the procedure meets all policy criteria including being subject to all excess, Reasonable charges, maximums, and exclusions described elsewhere in this policy. We don't cover travel and accommodation costs. ## Other benefits ### Post-operative therapy **$1,000 per event** **No excess applies to this benefit** This benefit covers the costs of Reasonable charges associated with post-operative therapy provided within 12 months following a related surgery, cycle of chemotherapy or radiation treatment that we've approved under this policy. This includes: - Occupational therapy - Physiotherapy - Speech and language therapy - Osteopathy - Chiropractic treatment - Dietician/Nutritionist consultations - Lymphedema physiotherapy You must be treated by a New Zealand-registered health or medical practitioner with a current practising certificate who is registered with their professional association. The treatment must occur and be completed within 12 months after the event date of your surgery or treatment. This doesn't include costs for personal items such as food/food substitutes, materials or garments. ### Home nursing **$2,500 for each person in a policy year** **No excess applies to this benefit** **$100 a day.** This benefit covers the costs of post-operative home nursing care by a New Zealand-registered nurse. You need a referral for home nursing by a New Zealand-registered medical specialist. Post-operative nursing care must begin within 6 months after related surgery, or after a cycle of chemotherapy or radiation treatment that has been approved under this policy. ### Other benefits Other benefits that we offer are summarised below. ### Minor surgery **$500 for each claim** **An excess applies to this benefit** This benefit covers the costs of Reasonable charges for minor surgery performed by a New Zealand-registered medical practitioner in private practice. This includes the removal of moles, cysts, and toenails. The procedure must be medically necessary — without it, the physical wellbeing of the Member would be affected. ### Mental health **$1,000 for each person in a policy year** **No excess applies to this benefit** This benefit covers the costs of Reasonable charges for consultations with a psychiatrist, psychologist, psychotherapist or counsellor. They must be registered either under the psychiatry scope with the Medical Council of New Zealand, as a psychologist with the New Zealand Psychologists Board, as a psychotherapist with the Psychotherapists Board of Aotearoa New Zealand, or as a counsellor with the New Zealand Association of Counsellors or other relevant association. ### Post-operative therapy **$1,000 per event** **No excess applies to this benefit** This benefit covers the costs of Reasonable charges associated with post-operative therapy provided within 12 months following a related surgery, cycle of chemotherapy or radiation treatment that we've approved under this policy. This includes: - Occupational therapy - Physiotherapy - Speech and language therapy - Osteopathy - Chiropractic treatment - Dietician/Nutritionist consultations - Lymphedema physiotherapy You must be treated by a New Zealand-registered health or medical practitioner with a current practising certificate who is registered with their professional association. The treatment must occur and be completed within 12 months after the event date of your surgery or treatment. This doesn't include costs for personal items such as food/food substitutes, materials or garments. ### Home nursing **$2,500 for each person in a policy year** **No excess applies to this benefit** **$100 a day.** This benefit covers the costs of post-operative home nursing care by a New Zealand-registered nurse. You need a referral for home nursing by a New Zealand-registered medical specialist. Post-operative nursing care must begin within 6 months after related surgery, or after a cycle of chemotherapy or radiation treatment that has been approved under this policy. ### Transport and accommodation **$2,000 for each person in a policy year** **No excess applies to this benefit** A registered medical specialist must confirm in writing that the condition of the Member cannot be treated at a local private facility. The specialist must tell you to travel to an alternative private hospital in New Zealand. We'll reimburse one of the costs below for the Member. - **Air transport** Return economy airfares and return taxi fare from the airport to the private hospital - **Rail transport** Return train fares and return taxi fare from the station to the private hospital - **Road transport** - Return bus fares and return taxi fare from the station to the private hospital - Return private car journey, calculated on the mileage travelled at $0.30 a kilometre These costs must directly relate to an overnight admission in a private hospital under your policy. You must send receipts for reimbursement with your claim. Pre-operative and post-operative consultations or treatments do not qualify. #### This includes: ##### Support person benefits This benefit includes cover for the costs of a support person. A registered medical specialist must confirm in writing that you need a support person to accompany the Member to the alternative private hospital in New Zealand. We'll reimburse one of the transport costs and accommodation below for the support person. - **Air transport** Return economy airfares and return taxi fare from the airport to the private hospital - **Rail transport** Return train fares and return taxi fare from the station to the private hospital - **Road transport** - Return bus fares and return taxi fare from the station to the private hospital - Return private car journey (if not travelling with the patient), calculated on the mileage travelled at $0.30 per km - **Accommodation expenses** incurred up to $200 per night, for a maximum of 10 nights These costs must directly relate to an overnight admission in a private hospital of the Member under this policy. You must send receipts for reimbursement with your claim. Pre-operative and post-operative consultations or treatments do not qualify. ### Parent accommodation **$500 for each person in a policy year** **No excess applies to this benefit** **$125 a night for accommodation.** This benefit covers reimbursement of accommodation expenses paid by a parent accompanying a Child aged under 18 years, who is listed on the policy certificate. The Child must be undergoing medical treatment with overnight admission in a New Zealand private hospital that we've approved under this policy. This benefit is for one adult only. You must send receipts for reimbursement with your claim. ### Public hospital **$3,000 for each person in a policy year** **No excess applies to this benefit** **$300 a night.** This benefit is paid only if you're admitted to a public hospital for four or more nights in a row. ### ACC top-up **An excess applies to this benefit** We cover any shortfall between what ACC pays and the actual costs of the surgical procedure or medical treatment in an approved private hospital or facility. We deduct the excess, which you must pay. You must send us a copy of ACC's decision before getting treatment. These other terms apply. - The Member must receive ACC's acceptance of their claim before treatment. They must also give us evidence of ACC's acceptance and the amount that ACC will pay for the treatment. - We may ask the Member to apply for a review of ACC's decision. We may ask for your permission to seek legal advice at our cost. You must reimburse us for any cost ACC subsequently covers from the review. - We only provide cover if a claim has been paid under a benefit of the Hospital and Surgical base plan or another additional module that the Member holds. The benefit's maximum limit will apply to all costs paid. ### Varicose veins **2 procedures per leg per lifetime** **An excess applies to this benefit** This benefit covers the costs of Reasonable charges associated with this procedure. In order to receive cover, the treatment must be medically necessary, and without it, the Member's physical wellbeing would be affected. This is inclusive of all consultations, treatment and/or follow-up assessment or treatment that may be required. ## Loyalty benefits Loyalty benefits allow you to use your insurance not just for treatment but to maintain good health after you've held your StaffCare policy for more than 2 years. No personal exclusions or excess applies to these benefits: however, some benefits have conditions about when they can be claimed, so please read conditions carefully. For further information and other Member offers, please visit Accuro's website accuro.co.nz/memberbenefits ### Sterilisation **$3,000 for each policy** This is a one-off contribution up to $3,000 toward the total cost of the procedure. After 2 years of continuous cover, this benefit covers the costs of Reasonable charges of sterilisation including vasectomies and female sterilisation procedures. It doesn't include reversals. ### GP health check **$150 for each person every 3 policy years** After 3 years of continuous cover, this benefit covers the costs of a health check performed by a New Zealand-registered medical practitioner (GP). Children aged 25 years or younger don't qualify for this benefit. ### Bowel screening **one kit for each person every 3 policy years** After 3 years of continuous cover, this benefit provides you with a bowel-screening kit. Please contact us if you wish to redeem this benefit and we'll arrange for the kit to be sent to you. Children aged 25 years or younger don't qualify for this benefit. --- # Additional modules You can choose to add any of our additional modules for yourself or any additional Member on your policy. These modules include: - Specialist module - GP module. Check your policy certificate to see if you're covered under any of these modules. You won't have these modules unless you've asked us to add them to your policy. We recommend that you read over the benefits carefully and make sure you understand them. Please contact us if you have any queries about the following modules, or would like to add a additional module to your policy. ## You can also add our Day to Day Health Plan Our Day to Day Health Plan provides a mixture of the benefits from our additional modules, up to a maximum of $600 for each person in a policy year. This Health Plan is designed to help you cover the everyday costs of staying healthy, such as going to the doctor, dentist or optician. It covers the costs of prescription drugs and the annual flu vaccine. You can also enjoy natural therapy treatments to help improve your health and wellbeing. Contact us if you'd like to add Day to Day Health Plan to your policy. ## Specialist module The Specialist module is our most popular additional module. It provides access to private tests and specialist consultations to speed up the time to reach your diagnosis. This is an additional module, so please check your policy certificate to see if you're covered and if there is an excess. ### Specialist consultations and diagnostic tests **$5,000 for each person in a policy year** **An excess applies to this benefit** #### Specialist consultations This benefit covers the costs of Reasonable charges for consultations with a registered medical specialist when referred by a registered medical practitioner, even when you don't require hospitalisation. This includes: - Cardiac surgeons - Cardiologists - Ear, nose and throat specialists - Gastroenterologists - General surgeons - Gynaecologists - Neurosurgeons - Oncologists - Ophthalmologists - Orthopaedic surgeons - Paediatricians - Urologists Cover is not applicable to obstetricians unless specifically provided for. #### Diagnostic tests and treatment This benefit covers the costs of Reasonable charges of diagnostic procedures that directly relate to a medical condition when referred by a registered medical specialist. This includes: - Allergy test - Ambulatory blood pressure monitoring - Audiology - Audiometric test - Bone density scan - Cardiovascular ultrasound - Cardioversion - Colposcopy - Dobutamine transoesophageal echocardiography - Electroencephalography (EEG) - Electromyography (EMG) - Endoscopy - Exercise electrocardiogram (ECG) - Holter monitoring - Laboratory test - Mammography - Nerve conduction test - Nuclear scanning - Stress echocardiogram - Ultrasound - Urodynamic assessment - X-ray Please note that some diagnostic tests are covered under the Hospital & Surgical base plan. These are specifically listed under the Major diagnostic procedures benefit. ### Mental health consultations **$1,000 for each person in a policy year** This benefit covers the costs of Reasonable charges for consultations with a psychiatrist, psychologist, psychotherapist or counsellor. They must be registered either under the psychiatry scope with the Medical Council of New Zealand, as a psychologist with the New Zealand Psychologists Board, as a psychotherapist with the Psychotherapists Board of Aotearoa New Zealand, or as a counsellor with the New Zealand Association of Counsellors or other relevant association. ### Loyalty benefits We give you this extra benefit after you've held the Specialist module for more than 3 years. #### Melanoma **$200 for each person every 3 policy years** After 3 years of continuous cover, this benefit covers melanoma investigations. ## GP module The GP module provides cover for visits to your doctor, including cover for prescription drugs. This is an additional module, so please check your policy certificate to see if you have cover under this modules. No excess applies to this module. This module has an initial No-claiming period of 90 days, which means that you can't make a claim for any benefit on the module, such as GP visits, in the first 90 days. ### General practitioner (GP) This benefit covers the costs of GP visits, including home and after-hours visits. Up to $55 for each visit, to a maximum of $500 for each person in a policy year. ### Registered nurse This benefit covers the costs of practice nurse visits. Up to $35 for each visit, to a maximum of $200 for each person in a policy year. ### Prescription drugs This benefit covers the costs of prescription drugs ordered by a New Zealand-registered medical practitioner or registered medical specialist. Up to $20 for each item, to a maximum of $300 for each person in a policy year. --- # What's not covered (exclusions) We can't cover every kind of medical condition and treatment, so we have to exclude some things. We've listed these general exclusions below. Please contact us if you have any questions. Your personal exclusions will be listed on your policy certificate. We aim to fully explain what is not covered in your policy. Unless specifically provided for in the plans you select, StaffCare doesn't cover any claims as described below. ## Health conditions we don't cover It's important to know which conditions we don't cover. We've listed these below but please ask if you want to know about cover for a different condition that is not listed. ### Psychiatric, psychological and neurodevelopmental disorders We don't cover treatment or counselling for any psychiatric, psychological and neurodevelopmental disorders. This includes but isn't limited to: - 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 ### Certain types of care We don't cover these types of care. - Any acute care - Any long-term care - Palliative care as defined by us (except where this policy specifies otherwise) ### Some conditions We don't cover these conditions. - 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 ### Obstetrics and gynaecology We don't cover any expenses arising from these obstetric or gynaecological conditions. - 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 Acute care is covered by the public health system and ACC. ## Tests, diagnostic procedures and treatments that we don't cover Below we list the various tests, procedures and treatments we don't cover. ### Treatment for preventative reasons We don't cover any expenses when no symptoms or evidence exist for a condition detrimental to your health; for example: - 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 or eye treatment or surgery We don't cover these procedures including any treatment, investigations or consultations related to a procedure or any complications that may occur from one. - **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 ### Organ failure or donation We don't cover these procedures including any treatment, investigations or consultations related to a procedure or any complications that may occur from one. - 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 ### Other treatment or surgery We don't cover these procedures including any treatment, investigations or consultations related to a procedure or any complications that may occur from one. - 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 ### Other costs We don't cover these costs. - 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 ## Other expenses and costs we don't cover Below we list other expenses and costs that we don't cover. ### Appliances and devices We don't cover the following. - 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 ### Expenses arising from drugs, criminal activity, or self-harm We don't cover the following. - 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 --- # How to submit a claim Choose one of two ways to submit a claim for your procedure or medical treatment. You can: 1. Get prior approval for your claim by submitting the details of your procedure or medical treatment before it takes place in order to confirm that it is covered under your policy. 2. Submit a claim after the procedure or medical treatment has already taken place. Use the flow chart below to help you decide whether you need to get prior approval or if you can make a claim afterwards. ## Flowchart: How to submit a claim **Have you already had the treatment?** **No** → Is your treatment likely to cost more than $1,000 or require hospitalisation? Or would you just like to make sure it's covered? - **Yes** → Apply for prior approval (Go to page 20) - **No** → Submit a claim (Go to page 21) **Yes** → Submit a claim (Go to page 21) --- # How to apply for prior approval Prior approval is when we confirm cover under your policy before your procedure or medical treatment (such as a surgery) happens. We'll also tell you of any conditions or excess that may apply. We need 2 working days to process prior approvals. Prior approval is required: - for any procedure or medical treatment that is likely to cost $1,000 or more - if your procedure or medical treatment requires hospitalisation, day-stay, or in-patient care. If in doubt, get prior approval. If you don't get prior approval, we may not be able to approve your claim. ## Collect a prior approval form You'll need to complete a prior approval form. On Accuro's website you can find the prior approval form or submit a prior approval request through the Member portal, or we can post or email a copy to you. The Primary Member must sign this form, and so must the patient if they are over 16 years of age. ## Get an estimate of the cost Ask your healthcare providers and the hospital for an estimate of the cost for the procedure or medical treatment. Please try to get an estimate of the cost for all parts of your procedure and treatment. Include the number of nights in hospital, theatre fees, and any additional costs such as equipment and physiotherapy. This information allows us to make sure the full cost will be covered. We understand that the information you get will be an estimate and the actual costs may vary. If the cost is above what we judge to be a reasonable cost for the type of procedure or medical treatment (our Reasonable charges), we may ask for further information or we may recommend an alternative treatment or health service provider. If you choose to continue at the previous cost, you'll need to pay the difference between the amount we approve and the actual cost of the procedure or medical treatment, regardless of the benefit's maximum limit. You'll need to let us know if another insurer, including ACC, has a responsibility to pay for all or part of the procedure or medical treatment. ## Provide medical evidence You and all additional Members on your policy must give us all the information we reasonably need to assess your prior approval or claim. We're entitled to ask for information from the prior approval process, up to and following a claim being made. You'll need to provide some medical evidence for why the procedure or medical treatment is required, so that we can make sure it's covered under your policy. This medical evidence could be either a copy of the GP referral letter or a letter from the specialist that confirms why the treatment is needed. You may also need to ask the GP who holds the patient's medical history to complete Accuro's Medical report. Please see the 'When do we need a Medical report?' section on page 22 for further information on whether a Medical report will be needed. You'll need to pay for any costs associated with getting medical evidence. ## Submit your prior approval You can submit your prior approval by post or email, or through the online Member portal on Accuro's website. In some cases, we may need to contact you or the healthcare providers to request additional details to make sure we assess your prior approval correctly. We'll contact you if this is the case. Please call or email us if you're unsure about how to apply for prior approval, including whether or not you need to supply a Medical report. --- # How to make a claim after treatment When you're submitting a claim, you're asking for payment of a procedure or medical treatment that has already occurred. We'll pay up to the Reasonable charges for any necessary medical procedure or treatment that's covered by a benefit as outlined in your policy, up to the specified benefit limit. You can only claim for events that occur after the relevant health insurance cover has started. ## Collect a claim form If you haven't got prior approval, you'll need to complete a claim form. On Accuro's website you can find the claim form or submit a claim through the Member portal, or we can post or email a copy to you. The Primary Member must sign this form, and so must the patient if they are over 16 years of age. ## Collect invoices or receipts Include all invoices or receipts with your claim as well as any receipts if you've already paid for the procedure or medical treatment. ## Provide medical evidence You and all additional Members on your policy must give us all the information we reasonably need to assess your prior approval or claim. We're entitled to request information from the prior approval process, up to and following a claim being made. You'll need to provide some medical evidence for why you need the procedure or medical treatment so that we can make sure that it is covered under your policy. This medical evidence could be either a copy of the GP referral letter or a letter from the specialist that confirms why the treatment is required. You may also need to ask the GP who holds the patient's medical history to complete Accuro's Medical report. Please see the 'Why do you need to provide medical evidence' section on page 22 for further information. We recommend that you read your policy certificate, including any exclusions listed on it, as well as the 'What's not covered' section on pages 16 to 18 to make sure that the procedure or medical treatment is covered under your policy. If you're unsure, you can apply for prior approval beforehand, which confirms whether the procedure or medical treatment will be covered. ## Submit your claim You can submit your claim by post or email, or through the online Member portal on Accuro's website. Your Member portal on Accuro's website also allows you to start a claim and save it, so you can add invoices as you receive them and submit it all together when you have all the information. We may need to contact you or your healthcare providers to request additional details so that we assess your claim correctly. We'll contact you if this is the case. ## What if you already have prior approval? If you have already been approved to have the procedure or medical treatment, you'll just need to send us copies of the invoices and receipts if you've already paid the provider. Please include your membership number and claim number with the invoices. We'll then assess these and pay the providers directly. If you've already paid the invoices, we'll reimburse you. --- # Why do you need to provide medical evidence? We need medical evidence to confirm that the service you are claiming for is covered under your policy. We need medical evidence to assess a claim or prior approval. Medical evidence could either be a copy of the referral letter, or consultation notes from the GP, dentist or optometrist. We would also accept a copy of the specialist's letter or notes confirming the outcome of your consultation or treatment. The medical evidence must be from the medical professional who saw the patient for the condition. It must state why the consultation, procedure or treatment is, or was, required. ## When do we need a Medical report? We will need our Medical report form to be completed if the person claiming had to give us their medical history when they applied for this policy or any modules. We need this for: - any claim within the first 3 years of your Hospital & Surgical base plan or Specialist module, and - for a medical condition that you've not claimed for before. The Medical report form needs to be completed by the GP (or dentist or optometrist) who holds your medical history. We need this form to give us the history of the condition, its symptoms, and when it first became apparent. Often the GP referral or specialist letter will not give us a comprehensive history of the condition, which is why we ask for the Medical report form to be completed. ## Things to remember We can only accept and provide cover for costs: - for a person who is covered under your policy - for events that occur after your policy begins - under a policy that has premiums paid up to date - for benefits listed in the base plans or modules you have cover for - charged at a reasonable and fair cost (within our Reasonable charges) - for services only in the private sector (unless listed otherwise in your Health Plan document). We recommend that you read the next section ('What we will pay'), as things listed here may affect your claim or the amount we're able to pay out for a particular procedure or medical treatment. Please call or email us if you're unsure about anything, including whether you need to send a Medical report with your claim. You must pay any costs involved in getting any of the information above. --- # What we will pay Excesses and limits on your policy will affect the amount we can pay. ## How an excess under your cover affects your claim Excesses apply to some benefits. An excess is the amount you have to pay when you have a claim, before we pay the rest up to the limit for that benefit. Different excesses may apply to your base plan and the Specialist module. The excess applies to each person covered by the base plan or additional modules for each policy year. If your employer has selected an excess option under the Hospital and Surgical base plan, or Specialist module, you can: - choose to leave this as it is — you will have to pay the full excess - take up an excess buy-out option if it is offered — you will pay a smaller excess. With the excess buy-out option, you reduce the excess by paying a small premium. To take up an excess buy-out option, please contact us or your financial adviser. All relevant excesses are listed on your policy certificate. If you make a claim for a benefit that has an excess, we take the excess off any payment we make for your claim — off either a reimbursement to you or a payment made to your health service provider. You're responsible for paying the excess amount directly to the health service provider. If your claim is less than your excess amount, we won't make a payment until further claims are received, meaning the full excess amount has been reached. This excess applies for each person and for each policy year. When we send you a prior approval, your excess will be clearly shown on the approval letter. You'll need to settle this amount directly with your health service provider. ### Example For example, you have a $1,000 excess under the Hospital and Surgical base plan and claim for a $950 MRI scan. You need to pay the $1,000 excess before we can reimburse you for anything. The $950 you've already paid would go toward your excess, so we wouldn't reimburse you for this claim. However, if you needed another $950 MRI scan in the same policy year, you'd only have $50 of the $1,000 excess left to pay and we'd reimburse the remaining $900. ## How policy benefit limits affect your claim Unless specifically stated in this Health Plan document, all benefit limits are for each person in each policy year. The benefit limits reset back to their maximum levels at the start of each policy year. You can't carry over your benefits from one policy year to the next, or transfer them to other Members covered by the policy. The minimum or maximum amount for each benefit that you can claim for an event is set out in the 'The StaffCare cover and benefits' section of this Health Plan document. We won't pay or reimburse any costs that amount to more than 100% of the actual costs incurred. As such you must claim any other refunds, subsidies, or entitlements available to you from another source first. This includes ACC, another health insurer, a government-funded agency, Work and Income, or your employer. We'll take any reimbursement from them off the total amount before we assess the amount against the benefit under your policy. Please note that we do not cover excess that is applicable for another insurance plan, whether it be another UniMed Health Plan, or one from another insurer. Unless specifically stated in your policy or accepted in writing before the event, we do not cover any healthcare you receive in the public health system. This means a procedure or treatment in a public hospital or facility that is controlled directly or indirectly by Health New Zealand | Te Whatu Ora. ### Example For example, if you had an x-ray that cost $110 and ACC agreed to cover $60 of it, we would only be able to assess reimbursement of the remaining $50 under your Specialist module. ## We will cover Reasonable charges 'Reasonable charges' is the cost for a procedure or medical treatment that we judge to be reasonable and within a range of cost charged for the same procedure under similar circumstances. Our Reasonable charges make sure that healthcare providers are fair with the amount charged, and within a reasonable range, for similar medical treatment or procedures. For procedures that have a Reasonable charge applied to them, we look at the average cost as well as the range of charges for the same, or similar, procedure throughout New Zealand. The Reasonable charge that is set represents the cost that is within what we consider to be a reasonable range for that, or a similar, procedure. We understand that some healthcare providers charge more than others, which is why we set an upper limit, while maintaining costs within a reasonable range. If the cost for your procedure or medical treatment is above what we judge a Reasonable charge, we may ask for further information or you may want to consider an alternative treatment or healthcare provider. If you choose to proceed, then you will need to pay the difference between the amount we approve and the actual cost for the procedure or medical treatment, regardless of the benefit's maximum limit. You will need to pay this extra amount directly to your healthcare provider. If you apply for prior approval, our approval letter will advise you of this and the maximum amount we can cover. ## Maximum cost we will pay We'll pay the cost for a procedure or medical treatment that falls under your policy, up to the relevant benefit limit or the Reasonable charges for this procedure, whichever is less. If the cost for your procedure exceeds the maximum limit or the Reasonable charge, we can't pay the exceeded amount. The extra cost will be your responsibility. ### Example For example, if a procedure has an average cost of $27,500 throughout New Zealand. We may determine that the Reasonable charge of $33,000 applies for this procedure. This means that if you were to have a procedure of this type, we'd provide cover up to $33,000 as it's unlikely that the procedure would cost above that. However, if it did cost over $33,000, you'd need to pay any costs over this. If it costs less than that, we only pay the actual amount charged. ### Example For example, if you had surgery done by your GP under the Minor Surgery benefit and it came to $1,200, we would only be able to provide reimbursement of $500. The remaining $700 would be your responsibility. This is because the benefit limit for Minor Surgery is $500 for each claim, so we are unable to provide cover for costs above this amount. --- # General conditions of your policy In the next section we explain other circumstances that may affect your cover. ## We don't cover claims covered by ACC ACC is New Zealand's accident compensation scheme, which provides cover if you're injured. Your StaffCare Health Plan has been set up to complement this and won't cover claims related to accidents that ACC covers. If ACC doesn't cover the full amount for your treatment, we may be able to pay the difference if you have cover for this treatment under your policy. Special conditions apply to surgery or treatment covered by ACC. Under the ACC legislation, you can choose between: - **Full payment option** — ACC contracts a provider to carry out the procedure or medical treatment and pays the total cost. - **Partial payment option** — ACC contracts a provider to carry out the treatment, but only funds a portion of it. The full payment option should be your first choice, so you don't have to make any contribution towards the cost of surgery or treatment. In this case, you must submit all claims to ACC. ### If ACC agrees to partially pay Under the ACC partial payment option, you'll have to contribute to the cost of the healthcare services. We'll cover the difference in cost up to the Reasonable charges for this procedure or treatment, or up to the benefit limit in your policy, whichever is less. The treatment or procedure must be covered under your policy. ### If ACC declines cover If ACC declines cover for treatment that is covered under your policy, we might ask them to review the decision, or submit an appeal. We'd need your support in this — you'd need to give us the ACC decline letter and any other relevant information within 3 months of its issue date. When you give us the decline letter and relevant information, you're giving our legal representative authority to review the case. In cases where ACC reverses its decision to decline the claim, we may seek reimbursement from ACC or you for any related claims that we've already paid. ### If ACC refuses cover or cover stops You need to make a reasonable effort to secure and maintain cover. If ACC refuses to cover a claim, or stops claim cover because you're not complying with ACC's requirements, you won't be able to claim under your policy. ### Example For example, you have an accident and need an x-ray. If ACC agreed to cover 80% of the cost, and you have the Specialist module, we'd pay the remaining 20%. ## We don't cover events during a No-claiming period The GP module has a 90-day No-claiming period that applies to all Members on the module. You're not covered for any events that happen during this No-claiming period. --- # What you need to do Your responsibilities are explained in the next section. ## You must disclose pre-existing conditions Our Health Plans are set up to cover treatment of signs, symptoms and conditions that arise after your policy has started. However, with group insurance schemes we offer cover for pre-existing conditions in certain circumstances. This means you can apply for treatment for health conditions that existed before the start of your policy. The exclusions listed on pages 16 to 18 still apply. If you're not offered cover for pre-existing conditions when you apply, and you or any additional Member complete a full application to join, you must disclose all pre-existing conditions for all additional Members, including congenital conditions. A pre-existing condition is: - any health or medical condition that you're aware of, or were experiencing signs or symptoms of, before the start of your policy - a medical event that occurred before the start of your policy. Our underwriters need to know about all previous and current signs, symptoms and conditions so they can fully assess your application. We'll list any excluded conditions on your policy certificate. Personal exclusions may be placed on your policy because of pre-existing conditions or any other additional Member's pre-existing conditions. We don't place personal exclusions on policies for all pre-existing conditions. Make sure you check how long each exclusion applies for. After the time period listed with the exclusion has passed, you can then claim for that condition. We may decline your claim if you need a procedure or medical treatment for, or related to, a pre-existing condition that you didn't include on your application form, and that you or the additional Member knew about or should have known about. We reserve the right to exclude any declared or non-declared pre-existing condition or congenital condition from your policy at any time. The exclusion may be backdated to apply from the start of your policy. ### Example For example, if you had eczema at the start of your policy, we'd place a personal exclusion for this condition for a period of 2 years. You'd be unable to claim for anything relating to eczema within the first 2 years of your policy. However, once you'd had the policy for 2 years, the exclusion would drop off and you could then claim for services relating to it. ## Your duty of disclosure Everyone seeking insurance under this policy has a legal duty to disclose everything they knew (or ought to have known) that would have influenced our decision to provide cover. All information given to us must be true, correct and complete. If the information given is untrue, incorrect or incomplete, we don't have to pay a claim. We may also treat all or any part of your policy as if it did not exist, cancel it, or amend the terms applying to you or an additional Member. We can take any of these actions immediately if: - any information given to us is untrue, incorrect or incomplete - you or any additional Member has not told us about something else that is relevant to our decision to accept a claim, and any reasonable person in the circumstance would have known that information. If we've already paid the claim, we will recover the amounts paid from you. If, at any time, we become aware of any pre-existing condition that you haven't disclosed, we'll add this to your policy certificate, and it will be recorded as an excluded condition. In some circumstances, where we identify fraudulent behaviour, we may take legal action against you or the additional Member involved. --- # You must pay your policy's premium You must continue to pay your premium to make sure you're a Member and are eligible for benefits. If your employer has chosen to pay these premiums for you, you do not need to do anything. You can choose to add additional Members or modules that are not covered by your employer. Then it's your responsibility to make sure that these additional parts of the policy are paid up to date. We'll do our best to notify you of any updates to your policy and premiums. You must pay us the premiums in advance at one of the frequencies we offer. ## You're only covered when you've paid your premium We won't pay any claims if premiums are owed on your policy. We don't have to pay until your premiums are up to date. If payments of your premiums are missed, or if your membership has ceased for any reason, we can't provide cover for any services outside the period for which you've paid premiums for. We can only assess cover for a claim when the premium for your policy is up to date for the period when the healthcare services took place. ## We'll cancel your policy if you haven't paid your premium for 90 days If you don't pay your premium on your policy, we'll send you letters to tell you that your policy has fallen into arrears. We'll cancel your policy if premiums have not been paid for 90 days or longer. Cancellation takes effect from the last date you have paid premiums up to. ## You can continue your cover if you leave employment If you leave your employer, they will tell us within 30 days. We will contact you to offer you options for continuing your health cover. If you choose to take up this offer, you are responsible for paying any premiums for your new individual policy. ## We may increase your premium at any time We may apply a general premium increase and other changes to premiums at any time. The premiums and discounts for your StaffCare policy are not guaranteed. We reserve the right to review and adjust premiums and discounts at our discretion to make sure our policies and Health Plans are viable. We'll give you a minimum of 21 days' notice of such a change. ## We'll continue to make deductions if your contact details change We want to make sure you are covered. If our letters are returned and marked 'no address', we'll continue to make deductions until you tell us otherwise. When you accept this policy, you're authorising us to make deductions. --- # Making changes to your policy This section explains what you can do with your policy — from start to finish. ## 14-day free-look period We provide a 14-day free-look period that begins from the start date on your policy certificate, or 5 working days after you receive your policy documents (whichever is later). This free-look period allows you to review your policy and make sure it is right for you. You can make changes to your policy within this 14-day period. If you change your mind and wish to cancel within this 14-day period, we'll refund any premiums paid, as long as you haven't made a claim under the policy. To cancel within the 14-day free-look period, you must write to us and ask to cancel the policy. The Primary Member must sign the request. ## Adding Children and additional Members to the policy You can add your spouse or partner and Children or whāngai under the age of 25 years, onto your policy at any time. Ask us or your advisor for the correct application form. We'll assess each application and decide whether the additional Member can be added on the basis of the health information we receive. Cover for an additional Member begins from the start date listed on the policy certificate that has the additional Member listed as covered. Once an additional Member has been added to your policy, they will remain on it until the Primary Member tells us otherwise. The Primary Member is responsible for keeping additional Members updated about all matters related to the policy, and any changes to the policy or the additional Member's cover. Premiums for added Members will be charged from the start date for the additional Member, as shown on your policy premium notice as part of the normal billing cycle. If you have three or more Children on your policy, you only pay premiums for the first two Children as long as the Health Plan and modules selected are the same for each Child. All Children will remain on Child rates up to 25 years old. ## Adding a Child who is under 6 months old You can add a Child who is under 6 months of age to your policy by completing a Group short application form with no personal exclusions placed due to their medical history. The exclusions listed on pages 16 to 18 will still apply, including congenital conditions. A Child who is under 6 months of age is eligible to receive cover free of premiums for the first 6 months after birth. We will charge the relevant premium once the Child has reached 6 months of age. ## How long can Children or whāngai stay on my policy? Any Children who have been added to your policy before they reach 25 years of age will be classified as a Child and charged at a Child rate. Once they reach 25 years of age, they'll remain on your policy but will be charged an age-related premium, unless you ask us to remove them from your policy. Any additional Member aged 25 years and over who has been included on your policy, may apply to have their own policy. If they do so within 30 days of leaving your policy, they will not need to go through the full application and approval process. ## How do I remove additional Members from my policy? You can remove an additional Member from your policy at any time by writing to us and signing the request. The Primary Member is responsible for removing additional Members from the policy if circumstances change — for example, following a marital separation. When a family arrangement changes, a separated partner may apply to become a Member in his or her own right and continue on a separate policy. If you remove an additional Member from your policy and wish to add them again in the future, they'll need to complete a new application form and go through the full application process. ## Maternity leave If you're going to take maternity leave, ask your employer whether they will continue to cover your policy. If they won't, you can either choose to pay the premiums yourself, or to suspend your policy for up to 12 months. If you do neither, and your premiums stop, we will cancel your policy. (Refer to the 'You must pay your policy's premium' section on page 28.) ## Leaving employment After you leave your current job, you may qualify to transfer to your own individual policy without further underwriting (such as additional medical questions). This depends on how long you have participated in your current employer's Group insurance scheme. If you do qualify, we will send you an offer to continue your cover once we've had confirmation you have left your job. You will have 30 days to take up this offer. After that, you will need to complete a full application and be medically underwritten. Contact us or your adviser for more about continuing your cover. ## Death of the Primary Member If the Primary Member of the policy dies, the partner who has been included on the policy may retain the policy and continue paying the appropriate premium. The partner is then considered the Primary Member. The 'We waive the premium on death or terminal illness' section on page 26 has more information about whether the waiver of premium applies. ## How can a policy end? Cover for your StaffCare policy ends when any one of these things happen: - you ask us to cancel your policy — the request must be from the Primary Member or designated financial adviser (if applicable) - you leave employment with the employer who has an agreement with us to provide cover under this policy; you may qualify to transfer to your own individual policy without completing a full application form — contact us or your adviser to confirm - your employer writes asking us to remove you from the Group insurance scheme, or the Group insurance scheme comes to an end - you or your employer fail to pay your premium or part of your premium for 90 days or longer - you or any additional Member breach the terms of this policy - the last Member covered by this policy dies. ## Suspending your policy You may ask us to suspend your cover for a period of time, ranging from 2 to 24 calendar months. You must write to us when applying to suspend cover. We'll consider an application to suspend cover for the following reasons. - Travelling overseas for a period longer than 2 months (maximum length of suspension is 24 months) - Taking maternity leave (maximum length of suspension is 12 months) - Being registered as unemployed for a period longer than 2 months (maximum length of suspension is 12 months) - Being made redundant or suffering financial hardship (maximum length of suspension is 12 months) Please contact us if you wish to apply to suspend your policy for any of the reasons above. We'll tell you if we need any further documentation or evidence. Please remember that we won't pay any benefits under the policy to you or any additional Member on your policy who is suspended at the time an event occurs. The Primary Member or additional Member must have continuous cover under this policy for a 12-month period before they can apply for suspension. There must be a 12-month period between the previous suspension and the start date of the next suspension. Please note that if you suspend your policy, the period your policy is suspended for won't be deducted from the timeframe for any personal exclusions you or any additional Members have on the policy. ### Example For example, you have a 2-year personal exclusion for eczema, and you suspend your policy for 12 months after 1 year of cover. You won't be able to claim for treatment relating to the eczema for the first year of cover, while suspended, or for the year following suspension. ## Cancelling your policy If you cancel your StaffCare policy within your 14-day free-look period, we'll refund all premiums paid, as long as no claims have been made by a person covered by your policy. You can cancel your policy at any time. After the 14-day free-look period, we can keep any premiums we've received, irrespective of the date you cancelled the policy. You must pay all premiums due up to the date of the cancellation. In all cases, cancellation must be requested by the Primary Member or designated financial adviser (if applicable). We'll acknowledge your request to cancel your policy when we receive it. We won't reinstate membership after your policy is cancelled, unless you have taken up the offer to transfer to an individual policy within the set 30 day timeframe. If you don't take up the offer to continue, this doesn't stop you from applying to rejoin later. But you must make a new application. When you cancel the policy or cover for an additional Member, the date of cancellation depends on the frequency of your premium payments. - If you pay premiums at a frequency of monthly or less, the date of cancellation is the next due date for premium payments after we have acknowledged receiving the cancellation request - If you pay premiums at a frequency greater than monthly, the date of cancellation is the expiry of the month in which we receive the cancellation request. We may refund a pro-rata amount of the premiums paid, depending on the circumstances --- # Other important information This section outlines other important information about your policy. ## Your Health Plan document This Health Plan document may change from time to time according to prevailing conditions and policies, and at the discretion of UniMed. This is to make sure that the cover provided reflects current trends and is commercially sustainable. We'll do our best to give reasonable notice (at least 21 days) before any changes. You may cancel the policy at any time (see 'How can a policy end?' on page 30). For more information about discounts and eligibility, visit accuro.co.nz/about/discounts This document provides information of a factual nature only, and is not an opinion or recommendation in relation to StaffCare. This policy has no surrender value. We are not liable for the standard or effectiveness of the procedures and medical treatment that this policy covers. ## Privacy statement — we're committed to respecting your privacy Personal and health information is collected and held by UniMed in accordance with the Privacy Act 2020 and Health Information Privacy Code 2020. We value the trust you place in us to protect, use and disclose this information appropriately. Please see unimed.co.nz/privacy-statement for our Privacy Statement which sets out how we collect, store and share your information, as well as how you can access and correct your personal information. ## Financial Services Council UniMed is a member of the Financial Services Council (FSC). UniMed is authorised to collect, use and disclose personal information and health information about you and other individuals covered by your policy to help detect and prevent fraud and other serious probity concerns. You authorise disclosure of personal and health information to FSC or its agents and FSC members for the above purpose. ## Code of practice This policy complies with the Financial Services Council Code of Conduct. You can get a copy of our financial statements for the last reported year by writing to us at: UniMed PO Box 10075 Wellington 6140 Or you can download a copy of UniMed's annual report from UniMed's website www.unimed.co.nz. --- # Membership of the Society This Health Plan is insured and underwritten by Union Medical Benefits Society (UniMed). UniMed is the trading name for Union Medical Benefits Society Limited, which is incorporated under the Industrial and Provident Societies Act 1908. This legislation governs the way the Society is run and the health benefit plans it administers. Like all legislation, it can change from time to time. Membership is available to anyone who UniMed accepts for membership and is permitted to become a Member under the rules of the Society. Your employer has applied for membership with UniMed. As their employee