> _Markdown transcription of UniMed Hospital Select policy wording, effective 2025-08-01. Source: https://www.unimed.co.nz/assets/PlansAndDocs/Health-Plans/Hospital_Select_Plus_Modules_Plan.pdf_ --- # COREBUS HS + OPTS 01.08.25 1 ## PLEASE NOTE All benefits in all sections apply to each person on the Health Plan unless otherwise stated. All benefits included in this Health Plan document are inclusive of GST charged by healthcare providers. **Voluntary Excess Option:** Any voluntary excess option selected applies per claim. All benefits where an Excess applies are indicated within this Health Plan document. # HOSPITAL SELECT BASE PLAN and/or MODULE D, MODULE G, MODULE S, MODULE N ## Step 1: Compulsory Base Plan ## Step 2: Combination Of Modules ## Step 3: Add Dental/Vision Module Hospital Select is the base plan to which the additional modules may be added, individually or together, with the exception of Module D which cannot be added to Hospital Select Base Plan on its own. --- # UNION MEDICAL BENEFITS SOCIETY LIMITED Effective 1 August 2025 It's the security of knowing we're there ## PLEASE NOTE All benefits in all sections apply to each person on the Health Plan unless otherwise stated. All benefits included in this Health Plan document are inclusive of GST charged by healthcare providers. **Voluntary Excess Option:** Any voluntary excess option selected applies per claim. All benefits where an Excess applies are indicated within this Health Plan document. ## Hospital Select is the base plan to which the additional modules may be added, individually or together, with the exception of Module D which cannot be added to Hospital Select Base Plan on its own. --- # Hospital Select Base Plan ## Private hospitalisation surgical benefits THE FOLLOWING SECTION REFUNDS 100% OF THE REASONABLE CHARGES LIMITED TO THE BENEFIT MAXIMUMS FOR ANY ADMISSION. ### Surgery (Excess applies) An admission for Non Acute Qualifying "Surgical Procedure(s)", together with that procedure's associated recovery time, performed by a Registered Medical Specialist in a Licensed Private Surgical Hospital. - Surgeon's fee - Anaesthetist's fee - Hospital fees, in a Licensed Private Hospital or Private Facility approved by UniMed for: - Accommodation - Theatre fees and Anaesthetic Supplies - Perfusionist - Intensive Care and special In-Hospital Nursing - Recovery Nurse - X-Ray examination, ECG - Intravenous Fluids, Irrigating Solutions, Dressings, Prescriptions and Antibiotics - Devices and Appliances (crutches, toilet seat, shower stool, walking frame, darco shoe, moonboot, non-motorised wheelchair hire, mastectomy bra when recovering from surgery, and the initial pacemaker insertion) - Emergency Ambulance for hospital admission - Surgically Implanted Prostheses - Laparoscopic Disposable | Per Admission | No Maximum | ### Post-operative Therapy Post-operative Therapy up to six months following surgery, cycle of chemotherapy and/or radiation oncology: - Occupational therapy - Physiotherapy - Speech and language therapy - Osteopath - Chiropractor - Dietitian/Nutritionist consultations - Lymphedema physiotherapy Costs for personal items such as food/food substitutes, materials or garments are excluded. | Per surgical event, cycle of chemotherapy and/or radiation oncology | 1,500 combined | ### Surgical Tests & Investigations #### Gastroscopy and/or Colonoscopy | Per Policy Year | No Maximum | #### Surveillance Colonoscopy or Gastroscopy Where no signs or symptoms are present, reimbursement of 50% of actual costs up to limit. Limit of one procedure every 24 months. | Per 24 Months | 2,500 | #### Gastroscopy and/or Colonoscopy Please note: if the procedure extends to a polypectomy, the claim will be considered under the Private Hospitalisation Surgical Admission benefit and if applicable, the Health Plan excess applies. --- ### In-Patient Non-Pharmac Subsidised Pharmaceuticals Pharmaceuticals prescribed by a Registered Medical Practitioner which have been approved by Medsafe and are not fully or partly subsidised by Pharmac through the New Zealand Pharmaceutical Schedule. | Per Policy Year | 2,000 | ### Oral Surgery (Excess applies) All Oral Surgery performed by a Registered Oral Surgeon, including the removal of impacted and unerupted teeth. Not included in cover is tooth exposure, implantation of teeth or costs of dental implants. | Per Policy Year | No Maximum | ### Spinal Surgery (Excess applies) This benefit covers the costs of spinal surgeries. A list of all spinal surgeries which fall under this benefit can be found on the Approved Surgical Procedure list under Important Documents on our website. | Per Lifetime | 200,000 | ### Breast Reconstruction (Excess applies) Breast reconstruction performed by a Registered Medical Practitioner in Private Practice. Breast reconstruction required as a result of a prophylactic mastectomy is not included. | Per Policy Year | No Maximum | ### Breast Symmetry, Post Mastectomy The costs of unilateral breast reduction surgery in order to achieve breast symmetry after a mastectomy for the treatment of breast cancer. This procedure must occur within 24 months after a mastectomy approved by UniMed under this Health Plan. | Per Lifetime | 6,500 | ### Angiography (Excess applies) Angiograms and Angioplasty including hospitalisation, specialist and ancillary fees. | Per Policy Year | No Maximum | ### Lithotripsy (Excess applies) Performed by a Registered Medical Specialist. Special conditions apply, refer to UniMed Terms and Conditions. | Per Policy Year | No Maximum | ### Accident Surgery (Excess applies) Before Qualifying "Surgical Procedures" are undertaken UniMed must receive written confirmation from the "ACC" regarding their decision to either accept or decline your claim for surgery. Qualifying Injury Claim(s) that the "ACC" agree to accept will also be accepted by UniMed for "top-up" coverage to the benefit levels applicable to the "Private Hospitalisation Surgical Benefits" section. If "ACC" decline your claim UniMed will, at its sole discretion either assist with the total cost of surgery or pay the difference between the actual cost of surgery and what the "ACC" would have contributed had your claim been accepted by them to the levels applicable to the "Private Hospitalisation Surgical Benefits" section. ### Home Nursing Home Nursing by a Registered Nurse for a six month period following surgery and/or a cycle of chemotherapy/radiation treatment in a Licensed Private Hospital on referral from a Registered Medical Practitioner. | Per Day | 150 | | Per Policy Year | 6,000 | ### Ambulance Emergency ambulance call out, excluding injuries. | Per Policy Year | 200 | ### Parent Support Accommodation In the event of a Member's insured child having surgery in a Licensed Private Hospital for which cover is available, a benefit for parent accommodation in the hospital is payable of: | Per Night | 150 | | Per Policy Year | 600 | ### Hospital Cash Allowance – Medical/surgical admissions When admitted to Public Hospital for a full 24 hours or more. Child Benefit - 50% of benefit limit. (All injury admissions excluded) | Per 24 Hours | 150 | | Per Policy Year | 1,800 | ## IMAGING - CT Scan - MRI Scan - PET Scan - Cardioversion - Myocardial Perfusion Scan - Scintigraphy | Per Policy Year Combined Maximum | 300,000 | ## SURGERY - PRIOR/POST ADMISSION BENEFITS (SIX MONTHS BEFORE AND SIX MONTHS AFTER SURGERY) ### Imaging - X-rays - Mammography - Ultrasounds - Nuclear Scanning | Per Policy Year Combined Maximum | 300,000 | ### Specialists Consultations following referral from a Registered Medical Practitioner. | Per Policy Year | 300,000 | ## PRIVATE HOSPITALISATION ### Radiation Oncology Limited to Planning, Shielding and Accessories, Field Setup and XRT Simulation and performed in an approved Private Hospital facility. | Per Policy Year | 65,000 | ### Chemotherapy Benefit payable for treatment by a Registered Oncologist in Private Practice. Benefit applies to the cost of materials, chemotherapy drugs which are Pharmac approved, plus hospital accommodation together with approved ancillary hospital costs. Included in this benefit is cover for Non-Pharmac chemotherapy drugs that are Medsafe approved for the treatment of cancer, up to a maximum of $10,000 per annum. Included in cover is genetic/genomic testing. Testing is payable following a cancer diagnosis and referral by a Registered Oncologist. | Per Policy Year | 65,000 | ### Surveillance Following Cancer Treatment Following surgery or treatment for cancer, associated with an eligible claim under your Health Plan, cover exists for Registered Specialist consultations and investigations related to the cancer diagnosis. This is not available for skin cancers/lesions removed by a minor surgery procedure performed by a specialist in their specialist room or a general practitioner in their practice room. The benefit applies from the end date of treatment, for a period of five consecutive years, up to a limit of $3,000 per policy year. ### Medical Hospitalisation Cover is for Non Acute Medical Hospitalisation (excludes Psychiatric/Geriatric) in a Licensed Private Hospital, on admission and under the care of a Registered Medical Practitioner. Ancillary hospital charges. | Per Policy Year | 65,000 | | | 500 | ### Acute Private Hospitalisation Medical/Surgical Grant An admission for an "Acute" Qualifying Medical Condition or "Surgical Procedure" under the care of a Registered Medical Practitioner in a Licensed Private Hospital. | Per Policy Year | 5,000 | ### Psychiatric/Geriatric Hospitalisation In a Licensed Private Hospital, on admission and under the care of a Specialist Psychiatrist/Geriatrician. Refund of Hospital Accommodation fees, and ancillary hospital charges. | Per Policy Year | 5,000 | ## MINOR SURGERY ### Registered Medical Specialist Not requiring general anaesthetic, including preceding consultation and performed in specialist rooms. | Per Policy Year | No Maximum | ### Registered Medical Practitioner or Registered Nurse/Nurse Practitioner Not requiring general anaesthetic, including preceding consultation and performed in practice rooms. | Per Visit | 500 | | Per Policy Year | No Maximum | ### Minor Skin Lesions Removed by a GP, Registered Nurse/Nurse Practitioner Performed by a Registered Medical Practitioner, Registered Nurse/Nurse Practitioner in practice rooms, including preceding consultation. | Per Policy Year | 2,000 | ## OVERSEAS TRANSPLANT In the event of Heart, Lung, or Liver transplant surgery being required outside New Zealand, UniMed will assist with a once only grant. | Per Lifetime | 20,000 | ## MENTAL HEALTH BENEFITS ### Mental Health 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. | Per Policy Year | 1,000 | ## WAIVER OF PREMIUM Upon the death by natural or accidental causes prior to age 65 of any Member paying the adult contribution rate the surviving spouse and/or qualifying dependants named on the Health Plan will receive two years free coverage at the benefit levels applying at the date of death. ## BEREAVEMENT GRANT Upon death by natural or accidental causes prior to age 65 of any person on the Health Plan. | Per Life | 2,400 | ## "ACC" TOP UP BENEFIT The 'shortfall' between actual costs and ACC refunds for out of hospital expenses incurred as a result of qualifying personal injury or employment related conditions are covered to the limits as shown. **NB: For a claim to qualify, ACC must have provided financial assistance towards treatment costs.** ## LOYALTY BENEFITS ### Obesity Surgery or Breast Reduction Surgery Benefits apply after five years' continuous membership in the Hospital Select base plan. A one time grant is payable of 50% of actual costs up to the benefit limit. For Breast Reduction Surgery, an underlying medical condition must apply. Excluding removal of implants or cosmetic reduction. | Per Lifetime | 8,000 | ### Overseas Treatment (Excess applies) Benefits apply after five years' continuous membership in the Hospital Select base plan. A grant is payable of 100% of the Reasonable charge for the identical procedure in New Zealand. The procedure must be available in New Zealand and eligible under the terms of your Health Plan but the Member prefers to be treated overseas. The procedure must be performed by a medical practitioner who is registered to carry out the procedure in the country where the procedure is taking place. A referral for the procedure from a New Zealand Registered Medical Practitioner will be required. Reimbursement of travel or accommodation costs is excluded. Benefit payable as reimbursement on production of invoices and prior approval is required for the treatment to be eligible. | Per Policy Year | 30,000 | ### Sterilisation Sterilisation procedures are covered after three years' continuous membership in the Hospital Select base plan. | Per Policy Year | 5,000 | ### Prophylactic Surgery Benefits apply after five years' continuous membership in the Hospital Select base plan. A one time grant is payable for a prophylactic mastectomy and/or bilateral salpingo-oophorectomy due to an increased risk of cancer due to a genetic mutation or family history. Eligibility criteria applies to claim for this benefit, which can be found in the Claims Documents section under Important Documents on our website. Breast reconstruction is not included under this benefit. | Per Lifetime | 40,000 | ### Bowel Screening Kits After three years of continuous membership in the Hospital Select base plan, this benefit provides you with access to an at-home bowel-screening kit. Visit the Members section of our website for terms of the benefit and information on how to access these. Children do not qualify for this benefit. | Per Policy Year | One kit for each person every three policy years | ## Additional modules You can choose to add any of our modules to your policy. These modules include: - Module "S" Specialists - Module "G" Day to Day - Module "N" Natural Health - Module "D" Dental/Vision Please note the Dental/Vision module can only be added with either the Day to Day, Specialist or Natural Health module. Check your membership 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 module to your policy. --- # Specialists - Module "S" THE FOLLOWING BENEFIT SECTIONS REFUND 100% OF ACTUAL MEDICAL COSTS TO THE SPECIFIED MAXIMUMS. ## Imaging - Bone density scan - X-rays - Mammography, including surveillance - Ultrasounds - Nuclear scanning - Holter monitoring - Exercise ECG - Blood pressure monitoring - Stress echocardiography - Cardiovascular ultrasound - Echocardiography - Transoesophageal echocardiography - Urodynamic assessment - Audiology | Per Policy Year Combined Maximum | 7,500 | ## SPECIALISTS ### Specialists Consultations following referral from a Registered Medical Practitioner. | Per Policy Year | 5,000 | ### Obstetrics Treatment by a Registered Medical Practitioner for obstetric conditions. | Per Policy Year | 1,000 | ## LOYALTY BENEFIT ### Hearing Aid Grant Benefit applies for the purchase of a hearing aid after three years' continuous membership in the Hospital Select base plan with Specialists module. This benefit does not apply to the rental or lease of hearing aids. | Per Policy Year | 1,000 | ## "ACC" TOP UP BENEFIT The 'shortfall' between actual costs and ACC refunds for out of hospital expenses incurred as a result of qualifying personal injury or employment related conditions are covered to the limits as shown within this option. **NB: For a claim to qualify, ACC must have provided financial assistance towards treatment costs.** --- # Day to Day - Module "G" THE FOLLOWING BENEFIT SECTIONS REFUND 100% OF ACTUAL MEDICAL COSTS TO THE SPECIFIED MAXIMUMS. ## General Practitioners Treatment and consultation by a Registered Medical Practitioner. | Per Visit | 65 | | Per Policy Year | No Maximum | ## After Hours Home Visits or consultations with a Registered Medical Practitioner at an after-hours facility | Per Visit | 70 | | Per Policy Year | No Maximum | ## Registered Practice Nurse/Registered Nurse Practitioner Treatment and consultation by a Registered Practice Nurse or Registered Nurse Practitioner. | Per Visit | 65 | | Per Policy Year | No Maximum | ## Prescriptions User part charges for Prescription items on the New Zealand Pharmaceutical schedule and prescribed by a Registered Medical Practitioner. Includes Psychiatric medications prescribed by a Registered Medical Practitioner. | Per Policy Year | 400 | ## Non-Pharmac subsidised pharmaceuticals Pharmaceuticals prescribed by a Registered Medical Practitioner which have been approved by Medsafe and are not fully or partly subsidised by Pharmac through the New Zealand Pharmaceutical Schedule. | Per Policy Year | 1,000 | ## Laboratory Tests The cost of laboratory charges for occult blood or glucose tests, requested by a Registered Medical Practitioner. | Per Visit | 100 | | Per Policy Year | No Maximum | ## "ACC" TOP UP BENEFIT The 'shortfall' between actual costs and ACC refunds for out of hospital expenses incurred as a result of qualifying personal injury or employment related conditions are covered to the limits as shown within this option. **NB: For a claim to qualify, ACC must have provided financial assistance towards treatment costs.** ## LOYALTY BENEFIT ### Psychiatric Consultations Benefits apply after five years' continuous membership in the Hospital Select base plan with Day to Day Module. Consultation with a psychiatrist who is vocationally registered in New Zealand. | Per Visit | 150 | | Per Policy Year | Three Visits | --- # Natural Health - Module "N" THE FOLLOWING BENEFIT SECTIONS REFUND 100% OF ACTUAL MEDICAL COSTS TO THE SPECIFIED MAXIMUMS. ## Osteopath Consultation and treatment provided by an Osteopath with New Zealand Registration. ## Chiropractor Services from a Registered Chiropractor including X-rays. | Per Policy Year Combined maximum | 200 | ## Treatment provided by the following Registered Practitioners - Chiropodist - Physiotherapist - Dietitian - Podiatrist - Acupuncture - Homeopathy - Naturopathy - Nutritionist - Medical Herbalist - Remedial Massage Therapy - Rongoa Māori Practitioner, as per Ministry of Health list of Practitioners - Traditional Chinese Medicine Practitioner registered with the Chinese Medical Council of New Zealand Costs for personal items such as food/food substitutes, materials or garments are excluded. | Per Policy Year Combined maximum | 800 | ## Wellness benefit A health check by a Registered Medical Practitioner. | Every 3 Years | 100 | ## "ACC" TOP UP BENEFIT The 'shortfall' between actual costs and ACC refunds for out of hospital expenses incurred as a result of qualifying personal injury or employment related conditions are covered to the limits as shown within this option. **NB: For a claim to qualify, ACC must have provided financial assistance towards treatment costs.** --- # Dental & Vision - Module "D" THE FOLLOWING BENEFIT SECTIONS REFUND 100% OF ACTUAL MEDICAL COSTS TO THE SPECIFIED MAXIMUMS. ## Orthoptist Treatment by a Registered Orthoptist. | Per Policy Year | 300 | ## Optometrist Consultation by a Registered Optometrist. **NB: Vision testing only, for spectacles/lenses see below.** | Per Visit | 75 | | Per Policy Year | 300 | ## Spectacles and Lenses Reimbursement of costs (excluding replacement for loss or breakage) of spectacles or contact lenses. | Per Policy Year | 500 | ## Dental Dental treatment by a Registered Dental Practitioner including routine maintenance, fillings, extraction of teeth, dentures, periodontic and orthodontic treatment. A dental hygienist is a dental practitioner and is covered under this benefit. | Per Policy Year | 600 | --- # Head Office Union Medical Benefits Society Limited 165 Gloucester Street, Christchurch PO Box 1721, Christchurch 8140 unimed.co.nz ## Need to know more before making your choice? Phone UniMed's friendly, helpful staff now and secure your future. If calling from Christchurch please phone 03 365 4048. **Freephone: 0800 600 666**