{ "vertical": "health", "insurer": { "slug": "southern-cross", "name": "Southern Cross", "brand_family": "southern-cross" }, "product": { "slug": "ultracare", "name": "UltraCare", "status": "active", "positioning_summary": null }, "wording": { "version": "2026-04-01", "ingested_at": "2026-05-16T07:49:05.352165+00:00", "pdf_hash": "a6254b23187c493f11edf45e598b142054fd01667c5b90f26ad2c11a1204dc5d", "source_url": "https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_UltraCare_plan.pdf", "page_count": null }, "confidence_tier": "inferred", "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 membership certificate, and does not apply after 3 years of continuous cover on this plan, or to Day-to-day treatment or Vision and Dental benefits)", "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 (exclusion does not apply after 3 years of continuous cover on this plan)", "Gynaecomastia", "Illnesses or injuries 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", "Unapproved healthcare services (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 any accident, treatment injury, or work-related gradual process injury that ACC is legally responsible for (except for Accident and treatment injury top-up benefit)", "Cosmetic treatments and procedures (any surgery, procedure or treatment that changes, improves, or enhances appearance)", "Pregnancy and childbirth (except Obstetrics allowance and Day-to-day treatment for prescriptions or physiotherapy)", "Termination of pregnancy", "Infertility or assisted reproduction", "Contraception, including the insertion or removal of intrauterine devices (except when used for medical reasons)", "Sterilisation (except as covered under Surgical procedures benefit) and reversal of sterilisation", "Treatment of obesity including weight loss surgery (except Gastric banding or bypass allowance)", "Breast reduction (except Breast reduction allowance)", "Subsequent breast reconstruction surgery (including replacing prostheses) or breast symmetry surgery (except as covered under Surgical procedures benefit or Breast symmetry allowance)", "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 (except Vision and dental benefit for UltraCare 400 plan)", "Dental implants including titanium dental implants (except Vision and dental benefit for UltraCare 400 plan)", "Extraction of teeth (except as covered under Surgical procedures benefit or Vision and dental benefit for UltraCare 400 plan)", "Surgery designed to assist or allow for orthodontic healthcare services (except Vision and dental benefit for UltraCare 400 plan)", "Health screening (except mammography and breast screening ultrasounds, colonoscopy, and annual health checks)", "Maintenance examinations or medical check-ups (except annual health checks)", "Any examination required by a third party such as physical examinations for life insurance, travel insurance, and driver licence", "Vaccinations (except flu vaccination under Day-to-day treatment)", "Prophylactic healthcare services (except 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 approved in writing before treatment)", "Healthcare services provided outside of New Zealand (except 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 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 for the diagnosis, management, or treatment of developmental or congenital abnormalities of the facial skeleton and associated structures", "Healthcare services for mental health (except Mental health consultations, Psychiatric hospitalisation, and Day-to-day treatment benefits)", "Healthcare services to manage or treat snoring or upper airways resistance", "Treatment of HIV", "Treatment of cleft palate", "Appliances or equipment (surgical, medical, or dental) such as CPAP machines, hearing aids, orthotics, crutches, surgically implanted lenses (except monofocal lenses) (except when included in 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", "Personal costs 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", "Respite and convalescent care", "Family history of cancer (as defined) excluded under Cancer Cover Plus upgrade only, for the specific cancer type; does not apply to Chemotherapy for cancer (base) benefit" ], "sublimits_nzd": { "radiotherapy": "Unlimited", "cardiac_tests": 5000, "hearing_tests": 210, "palliative_care": 2400, "allergy_services": 1000, "diagnostic_tests": 3000, "gp_minor_surgery": 1000, "laboratory_tests": 70, "optometry_annual": 350, "chemotherapy_base": 60000, "osteopathy_annual": 300, "podiatry_services": 400, "audiology_services": 200, "diagnostic_imaging": 100000, "overseas_treatment": 30000, "ambulance_allowance": 180, "annual_health_check": 100, "chiropractic_annual": 300, "optometry_per_visit": 70, "surgical_procedures": "Unlimited", "obstetrics_allowance": 1000, "orthoptist_treatment": 200, "osteopathy_per_visit": 60, "physiotherapy_annual": 300, "prescriptions_annual": 600, "skin_lesion_services": 10000, "gp_services_per_visit": 100, "chiropractic_per_visit": 60, "iv_infusions_non_cancer": 1000, "physiotherapy_per_visit": 60, "skin_lesion_cryotherapy": 200, "specialist_consultation": 10000, "breast_symmetry_lifetime": 10000, "chemotherapy_100_upgrade": 100000, "chemotherapy_300_upgrade": 300000, "nurse_services_per_visit": 30, "travel_and_accommodation": 500, "breast_reduction_lifetime": 15000, "mental_health_consultation": 1500, "psychiatric_hospitalisation": 3500, "dental_services_ultracare400": 750, "dietitian_consultation_annual": 625, "skin_lesion_gp_not_affiliated": 1000, "prophylactic_treatment_lifetime": 50000, "dietitian_consultation_per_visit": 125, "gastric_banding_or_bypass_lifetime": 7500, "post_operative_home_nursing_annual": 2800, "post_operative_home_nursing_per_day": 175, "post_operative_physiotherapy_annual": 300, "post_operative_speech_language_annual": 400, "psychiatric_hospitalisation_ancillary": 200, "psychiatric_hospitalisation_per_night": 700, "dietitian_nutritionist_combined_annual": 440, "post_operative_physiotherapy_per_visit": 60, "post_operative_speech_language_per_visit": 80, "chemotherapy_base_non_pharmac_medsafe_indicated": 10000, "prescription_glasses_contact_lenses_ultracare400": 500 }, "gap_payment_rules": "When using an Affiliated Provider contracted for a healthcare service, Southern Cross covers 100% of the actual charges incurred for eligible healthcare services up to relevant policy limits, unless Southern Cross or the Affiliated Provider advise otherwise — no gap payment applies in this case. For non-Affiliated Providers, cover is limited to reasonable charges as determined by Southern Cross; the policyholder is responsible for paying any amount exceeding reasonable charges directly to the health services provider. The policyholder is also responsible for any amount exceeding policy limits. If a healthcare service is assessed under actual charges (rather than reasonable charges), the policyholder pays any amount above the policy limit.", "pre_existing_rules": "Pre-existing conditions are excluded unless clearly stated otherwise on the membership certificate. This exclusion does not apply after 3 years of continuous cover on this plan, and does not apply to cover under the 'Day-to-day treatment' benefit or the 'Vision and Dental' benefit (UltraCare 400 plan). Pre-existing conditions disclosed by the policyholder are listed on the membership certificate. If information on the membership certificate contradicts this policy document, the membership certificate takes precedence.", "waiting_periods_days": { "surgical": 0, "maternity": 365, "pre_existing": 1095 }, "acc_interaction_rules": "The UltraCare plans do not cover 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 for treatment, the policyholder can claim the shortfall under the relevant benefit via the 'Accident and treatment injury top-up' benefit, subject to that benefit's policy limits and terms. The insured must do everything reasonably possible to obtain ACC approval for payment, including signing all necessary documents, and must co-operate to enable Southern Cross to protect any ACC entitlement.", "mental_health_sublimit_nzd": 1500, "mental_health_admission_rules": "Psychiatric hospitalisation is covered up to $3,500 each claims year. This requires admission and care by a specialist who is vocationally registered in psychiatry in an approved facility. Sub-limits apply: up to $700 for each night or day-stay in hospital accommodation; up to $200 each claims year for ancillary hospital charges. Reasonable charges apply. Mental health consultations (with a psychiatrist vocationally registered in psychiatry, or a psychologist registered with the New Zealand Psychologists Board) are covered up to $1,500 each claims year. General mental health costs are otherwise excluded except as covered under the Mental health consultations benefit, Psychiatric hospitalisation benefit, and Day-to-day treatment benefit.", "oncology_high_cost_drugs_cover": "Under the Chemotherapy for cancer (base) benefit, chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the diagnosed cancer are covered up to $10,000 each claims year (included within the overall $60,000 annual chemotherapy limit). Under Cancer Cover Plus upgrade options, non-Pharmac approved but Medsafe-indicated chemotherapy drugs are covered without a separate sub-limit, up to $100,000 each claims year (Chemotherapy 100) or $300,000 each claims year (Chemotherapy 300). Cancer Cover Plus excludes the specific cancer type for which a covered person has a defined family history of cancer (two or more biological siblings or parents diagnosed with colorectal, breast, ovarian, or prostate cancer before age 55, where the covered person was aware or should reasonably have been aware before applying); this exclusion does not apply to the base chemotherapy benefit.", "pharmac_vs_non_pharmac_drug_rules": "Under the Chemotherapy for cancer (base) benefit: Pharmac approved chemotherapy drugs are covered within the $60,000 annual limit; chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the diagnosed cancer are covered up to $10,000 each claims year (included within the $60,000 limit). Under Cancer Cover Plus upgrades (Chemotherapy 100 and Chemotherapy 300): both Pharmac approved and non-Pharmac approved but Medsafe-indicated chemotherapy drugs are covered without a separate sub-limit, up to $100,000 or $300,000 each claims year respectively. Under the IV infusions (non-cancer) benefit: drugs that are not Pharmac approved are not covered. Under the Day-to-day treatment prescriptions benefit: drugs that are not Pharmac approved are excluded. Under Allergy services: drugs that are not Pharmac approved are not covered." }, "endpoints": { "summary": "/api/product/southern-cross/ultracare/summary.md", "wording": "/api/product/southern-cross/ultracare/wording.md", "history": "/api/product/southern-cross/ultracare/history.json" }, "canonical_url": "https://healthinsurancecomparison.co.nz/api/product/southern-cross/ultracare/facts.json", "generated_at": "2026-05-16T12:53:20.781Z", "license": "CC BY 4.0 — attribute https://healthinsurancecomparison.co.nz" }