{ "vertical": "health", "insurer": { "slug": "southern-cross", "name": "Southern Cross", "brand_family": "southern-cross" }, "product": { "slug": "wellbeing-one", "name": "Wellbeing One", "status": "active", "positioning_summary": null }, "wording": { "version": "2026-04-01", "ingested_at": "2026-05-16T07:41:35.319513+00:00", "pdf_hash": "d49433a23467e8c47889a58bfbb82e201b3882ca0585609560de4baa54e03f87", "source_url": "https://www.southerncross.co.nz/-/media/Southern-Cross-Health-Society/Health-insurance/Member-collateral/Plan-documents/Current-plan-documents/PD_Wellbeing_plan.pdf", "page_count": null }, "confidence_tier": "inferred", "facts": { "ivf_cover": "We don't cover any costs related to infertility or assisted reproduction.", "exclusions": [ "We don't cover any costs related to, or incurred as a consequence of, any pre-existing conditions unless we've clearly stated otherwise on your membership certificate.", "We don't cover any costs related to, or incurred as a consequence of, the following chronic conditions: Cystic fibrosis, Dementia, Kyphosis, Loeys-Dietz syndrome, Marfan syndrome, Pectus carinatum, Pectus excavatum, Polycystic kidney disease, Scoliosis, Spina bifida.", "We don't cover any costs related to, or incurred as a consequence of, any congenital conditions except for umbilical hernia, inguinal hernia, undescended testes, hydrocele, tongue tie, phimosis, and squint.", "We don't cover any costs related to, or incurred as a consequence of, gynaecomastia.", "We don't cover any costs related to, or incurred as a consequence of: 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.", "We don't cover any costs related to, or incurred as a consequence of, injuries or disabilities from: war, or any act of war (whether declared or not); active duty in the military of any country or international authority; terrorism.", "We don't cover any costs related to, or incurred as a consequence of, specific drugs, devices, techniques, tests, and other healthcare services that haven't been approved by us before you receive the treatment.", "We don't cover any costs for healthcare services that are 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.", "We don't cover any costs related to, or incurred as a consequence of, 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.", "We don't cover any costs related to, or incurred as a consequence of, pregnancy and childbirth, except for what we cover under the 'Obstetrics allowance' if you have the Wellbeing Two plan, the 'Keeping Well Module' for prescriptions, or the 'Day-to-day Module' for prescriptions or physiotherapy.", "We don't cover any costs related to, or incurred as a consequence of, termination of a pregnancy.", "We don't cover any costs related to infertility or assisted reproduction.", "We don't cover any costs related to, or incurred as a consequence of: contraception, including the insertion or removal of intrauterine devices, except when used for medical reasons; sterilisation or its reversal, for example, vasectomy.", "We don't cover any costs related to, or incurred as a consequence of, treatment of obesity (including weight loss surgery), except for what we cover under the 'Gastric banding or bypass allowance'.", "We don't cover any costs related to, or incurred as a consequence of, breast reduction, except for what we cover under the 'Breast reduction allowance'.", "We don't cover any costs related to, or incurred as a consequence of, subsequent breast reconstruction surgery (including replacing prostheses) or breast symmetry surgery, except for what we cover under the 'Surgical procedures' benefit for breast reconstruction or the 'Breast symmetry allowance'.", "We don't cover any costs for healthcare services directly related to, or incurred as a consequence of, gender affirmation (confirmation) surgery.", "We don't cover any costs related to, or incurred as a consequence of, correction of refractive visual errors or astigmatism by surgery, or by surgically implanted intraocular lenses, or by laser treatment.", "We don't cover any costs related to healthcare services performed by a dentist, periodontist, endodontist, or orthodontist, except for what we cover under the 'Keeping Well Module' or the 'Vision and Dental Module' for dental services.", "We don't cover any costs related to, or incurred as a consequence of, implantation of teeth, including titanium dental implants, except for what we cover under the 'Keeping Well Module' or the 'Vision and Dental Module' for dental services.", "We don't cover any costs related to, or incurred as a consequence of, extraction of teeth, which includes the complete extraction or partial removal of any part of a tooth, tooth root or tooth remnant, except for what we cover under the 'Surgical procedures' benefit for tooth extraction or the 'Keeping Well Module' or the 'Vision and Dental Module'.", "We don't cover any costs related to, or incurred as a consequence of, surgery that's designed to assist or allow for orthodontic healthcare services, except for what we cover under the 'Keeping Well Module' or the 'Vision and Dental Module'.", "We don't cover any costs related to: health screening (with specified exceptions); maintenance examinations or medical check-ups (except annual health checks under the 'Day-to-day Module'); any examination required by a third party.", "We don't cover any costs related to vaccinations, except for what we cover under the 'Keeping Well Module' or the 'Day-to-day Module' for flu vaccinations.", "We don't cover any costs related to, or incurred as a consequence of, prophylactic healthcare services, except for what we cover under the 'Prophylactic treatment allowance'.", "We don't cover any costs related to, or incurred as a consequence of, treatment for any medical condition that's not causing significant problems to your physical health, except for what we cover under the 'Keeping Well Module' or the 'Day-to-day Module'.", "We don't cover any costs related to, or incurred as a consequence of, healthcare services that are not approved treatment.", "We don't cover any costs for 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.", "We don't cover any costs related to, or incurred as a consequence of, healthcare services provided outside of New Zealand, except for what we cover under the 'Overseas treatment allowance'.", "We don't cover any costs related to healthcare services provided by a person who is not a health services provider.", "We don't cover any costs related to healthcare services using technology (such as digital computer images) to help monitor and diagnose skin cancers and other skin lesions – for example, mole mapping.", "We don't cover any costs for pathology and laboratory tests (subject to exceptions stated in the policy)." ], "sublimits_nzd": { "cardiac_tests": 5000, "palliative_care": 2400, "allergy_services": 750, "diagnostic_tests": 3000, "gp_minor_surgery": 1000, "chemotherapy_base": 60000, "diagnostic_imaging": 60000, "overseas_treatment": 30000, "ambulance_allowance": 180, "surgical_procedures": "Unlimited (individual prostheses limits apply)", "skin_lesion_services": 5000, "iv_infusions_non_cancer": 750, "skin_lesion_cryotherapy": 150, "specialist_consultation": 5000, "breast_symmetry_lifetime": 10000, "chemotherapy_100_upgrade": 100000, "chemotherapy_300_upgrade": 300000, "travel_and_accommodation": 500, "breast_reduction_lifetime": 15000, "psychiatrist_consultation": 750, "psychiatric_hospitalisation": 3500, "dietitian_consultation_annual": 500, "skin_lesion_gp_not_affiliated": 1000, "gastric_banding_bypass_lifetime": 7500, "prophylactic_treatment_lifetime": 40000, "dietitian_consultation_per_visit": 100, "post_operative_home_nursing_annual": 2800, "laboratory_tests_wellbeing_two_only": 70, "post_operative_home_nursing_per_day": 175, "post_operative_physiotherapy_annual": 300, "intravitreal_injection_drug_component": 100, "psychiatric_hospitalisation_ancillary": 200, "post_operative_physiotherapy_per_visit": 60, "obstetrics_allowance_wellbeing_two_only": 750, "psychiatric_hospitalisation_per_night_or_day": 700, "post_operative_speech_language_therapy_annual": 350, "chemotherapy_base_non_pharmac_medsafe_indicated": 10000, "post_operative_speech_language_therapy_per_visit": 70 }, "gap_payment_rules": "Where Southern Cross covers 100% of actual charges (typically when an Affiliated Provider is used and unless otherwise advised), no gap applies to the insured. Where reasonable charges apply (typically for non-Affiliated Providers), the insured is responsible for paying any amount exceeding the reasonable charges directly to the health services provider. The insured is also responsible for paying any amount exceeding the policy limits and for paying any applicable excess directly to the health services provider.", "pre_existing_rules": "Pre-existing conditions are excluded unless clearly stated otherwise on the membership certificate. This exclusion does not apply to cover provided under the optional modules. The prophylactic treatment allowance is not available if the person was confirmed as having a high risk of developing the disease the prophylactic treatment is designed to prevent before their original date of joining, unless the membership certificate specifically states otherwise.", "acc_interaction_rules": "The Wellbeing plans do not provide cover for healthcare services related to an accident, treatment injury, or work-related gradual process injury that ACC is legally responsible for. Where ACC does not pay the full amount charged, the insured may claim the shortfall under the 'Accident and treatment injury top-up' benefit, subject to the policy limits and conditions of the relevant benefit. The insured must do everything reasonably possible to obtain ACC approval for payment, including signing all necessary documents to enable Southern Cross to protect any ACC entitlement.", "mental_health_sublimit_nzd": 3500, "mental_health_admission_rules": "Psychiatric hospitalisation is covered up to $3,500 each claims year for 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, and up to $200 each claims year for ancillary hospital charges. Reasonable charges are covered. No excess applies to this benefit. Psychiatrist consultations are covered separately up to $750 each claims year (reasonable charges, no excess).", "oncology_high_cost_drugs_cover": "Under the Chemotherapy for cancer (base) benefit, up to $10,000 each claims year is available for chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the cancer diagnosed, within the overall $60,000 annual limit. Under the Cancer Cover Plus upgrades (Chemotherapy 100: $100,000 per claims year; Chemotherapy 300: $300,000 per claims year), chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated are covered without a separate sub-limit up to the respective annual cap. The Cancer Cover Plus upgrade excludes cover for the specific cancer where a family history of cancer exclusion applies (two or more biological siblings or parents diagnosed with colorectal, breast, ovarian, or prostate cancer before age 55, where the insured was or should have been aware of the diagnosis before joining).", "pharmac_vs_non_pharmac_drug_rules": "Chemotherapy for cancer (base) covers Pharmac approved chemotherapy drugs and up to $10,000 each claims year for chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated for treatment of the cancer diagnosed. Under the Cancer Cover Plus upgrades (Chemotherapy 100 or Chemotherapy 300), chemotherapy drugs that are not Pharmac approved but are Medsafe-indicated are covered without a separate sub-limit, subject to the overall annual cap ($100,000 or $300,000). The IV infusions (non-cancer) benefit does not cover the cost of drugs that are not Pharmac approved. The Allergy services benefit does not cover the cost of drugs that are not Pharmac approved. The Keeping Well Module and Day-to-day Module prescription benefits exclude cover for drugs that are not Pharmac approved." }, "endpoints": { "summary": "/api/product/southern-cross/wellbeing-one/summary.md", "wording": "/api/product/southern-cross/wellbeing-one/wording.md", "history": "/api/product/southern-cross/wellbeing-one/history.json" }, "canonical_url": "https://healthinsurancecomparison.co.nz/api/product/southern-cross/wellbeing-one/facts.json", "generated_at": "2026-05-16T12:53:23.912Z", "license": "CC BY 4.0 — attribute https://healthinsurancecomparison.co.nz" }