{ "vertical": "health", "insurer": { "slug": "southern-cross", "name": "Southern Cross", "brand_family": "southern-cross" }, "product": { "slug": "regularcare", "name": "RegularCare", "status": "active", "positioning_summary": null }, "wording": { "version": "2026-04-01", "ingested_at": "2026-05-16T08:14:09.653791+00:00", "pdf_hash": "369d048b250ce08c2a9b11aaffa903072df8902c1a92c0c3d9c9cbbcc0010e77", "source_url": "https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_RegularCare_plan.pdf", "page_count": null }, "confidence_tier": "verified", "facts": { "ivf_cover": "Infertility or assisted reproduction is explicitly excluded: 'We don't cover any costs related to infertility or assisted reproduction.'", "exclusions": [ "Pre-existing conditions unless clearly stated otherwise on your membership certificate (this exclusion doesn't apply to cover provided under the 'Day-to-day treatment' benefit if you have the RegularCare plan)", "Cystic fibrosis", "Dementia", "Kyphosis", "Loeys-Dietz syndrome", "Marfan syndrome", "Pectus carinatum", "Pectus excavatum", "Polycystic kidney disease", "Scoliosis", "Spina bifida", "Any congenital conditions except for umbilical hernia, inguinal hernia, undescended testes, hydrocele, tongue tie, phimosis, and squint", "Gynaecomastia", "Illnesses, injuries, conditions or disabilities that are caused or contributed to by the abuse of substances such as alcohol or drugs", "Self-inflicted illnesses or injuries", "Injuries or disabilities from war, or any act of war (whether declared or not)", "Injuries or disabilities from active duty in the military of any country or international authority", "Injuries or disabilities from terrorism", "Specific drugs, devices, techniques, tests, and other healthcare services that haven't been approved by us before you receive the treatment", "Healthcare services related to, or incurred as a consequence of, any accident, treatment injury, or work-related gradual process injury, except for what you're entitled to under the 'Accident and treatment injury top-up' benefit", "Any surgery, procedure or treatment that changes, improves, or enhances appearance, regardless of whether it was done for medical, physical, functional, psychological, or emotional reasons", "Pregnancy and childbirth, except for what we cover under the 'Day-to-day treatment' benefit for prescriptions and physiotherapy if you have the RegularCare plan", "Termination of a pregnancy", "Infertility or assisted reproduction", "Contraception, including the insertion or removal of intrauterine devices, except when used for medical reasons", "Sterilisation or its reversal, for example, vasectomy", "Treatment of obesity (including weight loss surgery), except for what we cover under the 'Gastric banding or bypass allowance'", "Breast reduction, except for what we cover under the 'Breast reduction allowance'", "Subsequent breast reconstruction surgery (including replacing prostheses) or breast symmetry surgery, except for what we cover under the 'Surgical procedures' benefit for breast reconstruction and the 'Breast symmetry allowance'", "Healthcare services directly related to, or incurred as a consequence of, gender affirmation (confirmation) surgery", "Correction of refractive visual errors or astigmatism by surgery, or by surgically implanted intraocular lenses, or by laser treatment", "Healthcare services performed by a dentist, periodontist, endodontist, or orthodontist", "Implantation of teeth, including titanium dental implants", "Extraction of teeth, which includes the complete extraction or partial removal of any part of a tooth, tooth root or tooth remnant", "Surgery that's designed to assist or allow for orthodontic healthcare services", "Health screening, except for mammography and breast screening ultrasounds, and colonoscopy", "Maintenance examinations or medical check-ups", "Any examination required by a third party (including preparing reports) such as physical examinations for life insurance, travel insurance and driver licence", "Vaccinations", "Prophylactic healthcare services, except for what we cover under the 'Prophylactic treatment allowance'", "Treatment for any medical condition that's not causing significant problems to your physical health", "Healthcare services that are not approved treatment", "Healthcare services provided at a public facility that is directly or indirectly controlled by Health NZ Te Whatu Ora, except where we've approved it in writing before you receive the treatment", "Healthcare services provided outside of New Zealand, except for what we cover under the 'Overseas treatment allowance'", "Healthcare services provided by a person who is not a health services provider", "Healthcare services using technology (such as digital computer images) to help monitor and diagnose skin cancers and other skin lesions – for example, mole mapping", "Pathology and laboratory tests, except for what we cover under the 'Laboratory tests' benefit", "Organ transplants", "Transfusion or injection of autologous blood or blood products, except when used as part of eligible chemotherapy treatment, or where cell saver is used as part of eligible surgical treatment", "Autologous chondrocyte implants", "Stem cell transplants", "Healthcare services provided for the diagnosis, management, or treatment of developmental or congenital abnormalities of the facial skeleton and associated structures", "Healthcare services for mental health, except for what we cover under the 'Psychiatrist consultation' benefit, the 'Psychiatric hospitalisation' benefit, and the 'Day-to-day treatment' benefit if you have the RegularCare plan", "Healthcare services provided to manage or treat snoring, or upper airways resistance, or both", "Treatment of HIV", "Appliances or equipment (surgical, medical, or dental), for example, CPAP machines, hearing aids, orthotics, crutches, surgically implanted lenses (except monofocal lenses), except when specifically included in the list of prostheses and specialised equipment as part of eligible surgical treatment", "Acute care", "Administrative charges such as statement fees, cancellation fees, or non-attendance fees", "Hospital charges incurred for your personal convenience related to a stay in hospital, such as newspapers, meals for your family, alcohol, and TV rental", "Long-term care where hospitalisation lasts, or is expected to last, more than 90 days, including geriatric in-patient care and disability support services", "Respite and convalescent care", "Drugs that are not Pharmac approved (except as specifically permitted under chemotherapy benefits and the IV infusions non-cancer benefit for Medsafe-indicated drugs)", "Ultrasound when related to obstetrics and varicose veins (legs)", "X-ray when performed by a dentist or chiropractor", "Family history of cancer (specific cancer excluded) under Cancer Cover Plus upgrade, where two or more biological siblings or parents diagnosed with colorectal, breast, ovarian, or prostate cancer before age 55" ], "sublimits_nzd": { "cardiac_tests": 3000, "allergy_services": 600, "diagnostic_tests": 2000, "gp_minor_surgery": 800, "laboratory_tests": 56, "chemotherapy_base": 48000, "diagnostic_imaging": 8000, "overseas_treatment": 5000, "ambulance_allowance": 144, "surgical_procedures": 100000, "skin_lesion_services": 5000, "day_to_day_orthoptist": 128, "dietitian_consultation": 400, "day_to_day_gp_per_visit": 45, "iv_infusions_non_cancer": 600, "specialist_consultation": 4000, "breast_symmetry_lifetime": 10000, "chemotherapy_100_upgrade": 100000, "chemotherapy_300_upgrade": 300000, "day_to_day_hearing_tests": 128, "day_to_day_physiotherapy": 180, "day_to_day_prescriptions": 400, "breast_reduction_lifetime": 15000, "psychiatrist_consultation": 600, "day_to_day_nurse_per_visit": 20, "post_operative_home_nursing": 900, "psychiatric_hospitalisation": 2250, "post_operative_physiotherapy": 180, "day_to_day_audiology_per_visit": 40, "prophylactic_treatment_lifetime": 30000, "day_to_day_audiology_consultations": 128, "day_to_day_physiotherapy_per_visit": 30, "gastric_banding_or_bypass_lifetime": 5000, "travel_and_accommodation_allowance": 400, "post_operative_home_nursing_per_day": 150, "intravitreal_injection_drug_component": 100, "psychiatric_hospitalisation_ancillary": 160, "post_operative_physiotherapy_per_visit": 30, "post_operative_speech_language_therapy": 280, "skin_lesion_services_gp_non_affiliated": 800, "skin_lesion_cryotherapy_gp_or_affiliated": 150, "chemotherapy_base_non_pharmac_medsafe_indicated": 8000, "post_operative_speech_language_therapy_per_visit": 56, "psychiatric_hospitalisation_per_night_or_day_stay": 450 }, "gap_payment_rules": "Southern Cross covers 80% of actual charges incurred for eligible healthcare services up to policy limits, unless the insurer or Affiliated Provider specifies otherwise. The member is responsible for paying the remaining 20% co-payment (the gap) plus any excess directly to the health services provider. When using an Affiliated Provider contracted for a service, Southern Cross covers 80% of charges up to relevant policy limits unless otherwise advised. Members must also pay any amount exceeding policy limits directly to the provider. If another insurer or person is liable to contribute, the amount covered by Southern Cross is reduced by any such payment.", "excess_amounts_nzd": [ 500 ], "pre_existing_rules": "The policy does not cover any costs related to, or incurred as a consequence of, any pre-existing conditions unless clearly stated otherwise on the membership certificate. This exclusion does not apply to cover provided under the 'Day-to-day treatment' benefit for RegularCare plan holders. The policyholder must disclose any health conditions, signs, symptoms on application. Pre-existing conditions may be noted on the membership certificate.", "acc_interaction_rules": "The plans do not provide cover for healthcare services related to acute care or to an accident, treatment injury, or work-related gradual process injury that ACC is legally responsible for. However, if ACC does not pay the full amount charged, the member may claim the shortfall under the 'Accident and treatment injury top-up' benefit — the policy covers up to 80% of the remaining eligible cost after the ACC contribution has been deducted, up to the policy limits for the relevant benefit. Members must do everything reasonably possible to obtain ACC approval before claiming the top-up, including signing all documents to enable Southern Cross to protect any entitlement from ACC.", "mental_health_sublimit_nzd": 2250, "mental_health_admission_rules": "Cover for psychiatric hospitalisation is $2,250 each claims year. This covers admission and care by a specialist who is vocationally registered in psychiatry in an approved facility. Sub-limits apply: up to $450 for each night or day-stay in hospital accommodation, and up to $160 each claims year for ancillary hospital charges. No excess applies to this benefit. Mental health healthcare services are otherwise excluded except for psychiatrist consultations ($600 each claims year) and, for RegularCare plan holders, the Day-to-day treatment benefit.", "oncology_high_cost_drugs_cover": "Under the 'Chemotherapy for cancer (base)' benefit, up to $8,000 each claims year is included within the overall $48,000 annual limit for chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the diagnosed cancer. Under the Cancer Cover Plus Chemotherapy 100 upgrade ($100,000 per claims year) and Chemotherapy 300 upgrade ($300,000 per claims year), non-Pharmac-approved but Medsafe-indicated chemotherapy drugs are covered without a separate sub-limit, subject to the overall annual cap. No specific Keytruda example is mentioned in the policy text.", "pharmac_vs_non_pharmac_drug_rules": "Generally, drugs must be Pharmac approved to be covered. Under the 'Chemotherapy for cancer (base)' benefit, up to $8,000 each claims year is available for chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the diagnosed cancer; the Cancer Cover Plus upgrades (Chemotherapy 100 and Chemotherapy 300) cover non-Pharmac-approved but Medsafe-indicated chemotherapy drugs without a stated sub-limit (subject to the overall annual cap). The 'IV infusions (non-cancer)' benefit covers IV infusions of Medsafe-indicated drugs but does not cover the cost of drugs that are not Pharmac approved. The 'Day-to-day treatment' prescriptions benefit excludes cover for drugs that are not Pharmac approved. If drugs would require special authority from Pharmac in a public facility, they are only covered if the same special authority criteria are met." }, "endpoints": { "summary": "/api/product/southern-cross/regularcare/summary.md", "wording": "/api/product/southern-cross/regularcare/wording.md", "history": "/api/product/southern-cross/regularcare/history.json" }, "canonical_url": "https://healthinsurancecomparison.co.nz/api/product/southern-cross/regularcare/facts.json", "generated_at": "2026-05-16T12:53:11.197Z", "license": "CC BY 4.0 — attribute https://healthinsurancecomparison.co.nz" }